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Public Values and Public Trust: Responses to Welfare State Reform in the UK


The welfare state faces a number of challenges. Recent reforms in the UK appear broadly successful in attaining targets and improving cost-efficiency, but are nonetheless confronted by public disquiet and unease. This article argues that one difficulty with the new directions in policy is that they rest on a particular and limited understanding of agency. Reformers tend to operate within a theoretical framework that understands behaviour as driven by individual and predominantly rational incentives and pays little attention to the expressive and normative aspects of social action. The problems that arise in these areas when a competitive market logic is applied in social provision tend not to be recognised. Such a logic may contradict established values of social care and commitment to user interests. A qualitative survey of 48 members of the general public is used to examine perceptions of and responses to the NHS reforms, and to show how public discourse in this area is at variance with the instrumental and individual assumptions of policy-makers. The result is that the reform programme damages the legitimacy of the service and that those responsible for the new policies fail to recognise that the individual instrumental agenda is eroding public trust.

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Appleby J. and Alvarez-Rosette A. (2005), ‘Public responses to NHS reform’, in Park A., Curtice J., Thomson K., Jarvis L. and Bromley C. (eds.), British Social Attitudes, London: Sage.
Atman C., Bostrom A., Fischoff B. and Morgan M. (1994), ‘Designing risk communications and correcting mental models of hazardous processes’, Risk Analysis, 14: 5, 779–87.
Axelrod R. (1981), ‘The evolution of cooperation’, Science, 211: 4489, 1390–6.
Baggott R. (2007), Understanding Health Care, Bristol: Policy Press.
Bevan G. and Hood C. (2006a), ‘Have targets improved performance in the English NHS?’, British Medical Journal, 332: 419–22.
Bevan G. and Hood C. (2006b), ‘What's measured is what matters’, Public Administration, 84: 3, 517–38.
Bourdieu P. (1990), The Logic of Practice, Cambridge: Polity Press.
Calnan M. and Rowe R. (2005), ‘Trust relations in the NHS’, SCARR Trust Conference, London, 12 December.
Cook K. and Levi M. (1990), The Limits of Rationality, Chicago: University of Chicago Press.
Cvetkovich G. and Earle T. (1997), ‘Culture, cosmopolitanism and risk management’, Risk Analysis, 17: 1, 55.
Dasgupta P. (1988), ‘Trust as a commodity’, in Gambetta D. (ed.), Trust, Oxford: Oxford University Press.
Denney D. (2005), Risk and Society, London: Sage.
Dixit A. (2002), ‘Incentives and organisations in the public sector’, Journal of Human Resources, 37: 696727.
Eldridge J., Kitzinger J. and Williams K. (1997), The Mass Media and Power in Modern Britain, Oxford: Oxford University Press.
Ellison N. and Castles F. (2006), The Welfare State Reader, Cambridge: Polity Press.
Enthoven A. (2002), Introducing Market Forces into Health Care, London: Nuffield Trust.
Fehr E. and Gächter S. (2000), ‘Fairness and retaliation: the economics of reciprocity’, Journal of Economic Perspectives, 14: 3, 159–81.
Finlayson B. (2002), Counting the Smiles, London: King's Fund.
Flynn N. (2007), Public Sector Management, London: Sage.
Frey B. (2000), ‘Motivation and human behaviour’, in Taylor-Gooby P. (ed.), Risk, Trust and Welfare, Basingstoke: Macmillan.
Gambetta D. (1988), Trust, Oxford: Oxford University Press.
Giddens A. (1993), New Rules of Sociological Method, Cambridge: Polity Press.
Habermas J. (1987), The Theory of Communicative Action, translated by McCarthy T., Cambridge: Polity Press.
Hardin R. (2002), Trust and Trustworthiness, New York: Russell Sage.
Hargreaves-Heap S., Hollis M., Lyons B., Sugden R. and Weale A. (1992), Choice, Oxford: Blackwell.
Hart H. (1961), The Concept of Law, Oxford: Oxford University Press.
Hills J. and Stewart K. (eds.) (2005), A More Equal Society? New Labour, Poverty, Inequality and Exclusion, Bristol: Policy Press.
Hoggett P. (2001), ‘Agency, rationality and social policy’, Journal of Social Policy, 30: 1, 3756.
Hoggett P., Mayo M. and Miller C. (2006), ‘Private passions, the public good and public service reform’, Social Policy and Administration, 40: 7, 758–73.
Holmwood J. (2005), ‘Functionalism and its critics’, in Harrington A. (ed.), Modern Social Theory, Oxford: Oxford University Press.
House of Commons Health Committee (2006), press release 24 July.
Hovland C., Janis I. and Kelley H. (1953), Communication and Persuasion, New Haven: Yale University Press.
Huber E. and Stephens J. (2001), Development and Crisis of the Welfare State, Chicago: Chicago University Press.
Ipsos Mori (2007), Government Delivery Index,, accessed 9 November 2007
Jaeger C., Renn O., Rosa E. and Webler T. (2001), Risk, Uncertainty and Rational Action, London: Earthscan.
Kahneman D., Slovic P. and Tversky A. (eds.) (1982), Judgement under Uncertainty: Heuristics and Biases, Cambridge: Cambridge University Press.
King's Fund (2005, modified 2007), ‘Independent Audit of the NHS under New Labour 1997–2005’, Briefing Paper 23.
Le Grand J. (2003), Motivation, Choice and Public Policy, Oxford: Oxford University Press.
Le Grand J. (2007), The Other Invisible Hand, Princeton, NJ: Princeton University Press.
Lee P. (2006), ‘Public service productivity: health’, ONS, February,, accessed 19 November 2007.
Luhmann N. (1995), Social Systems, Stanford: Stanford University Press.
Mau S. and Veghte B. (2007), Social Justice, Legitimacy and the Welfare State, Aldershot: Ashgate.
Metlay D. (1999), ‘Institutional trust and confidence’, in Cvetkovich G. T. and Löfstedt R.. (eds.), Social Trust and the Management of Risk, London: Earthscan.
Moellering G. (2006), Trust, Elsevier.
Norris P. (ed.) (1999), Critical Citizens, Oxford: Oxford University Press.
Offer J. (2006), ‘Social theory and agency in social policy since 1830’, Journal of Social Policy, 35: 2, 283302.
Ostrom E. and Walker J. (eds.) (2002), Trust and Reciprocity, London: Russell Sage Foundation.
Parsons T. (1951), The Social System, London: Routledge & Kegan Paul.
Petts J., Horlick-Jones T. and Murdock G. (2001), Social Amplification of Risk, Sudbury: HSE Books.
Picker (2007), Is the NHS Becoming More Patient-Centred?, London: Picker Institute.
Pierson P. (2001), The New Politics of the Welfare State, Oxford: Oxford University Press.
Plant R. (1991), Modern Political Thought, Oxford: Blackwell.
Polanyi K. (1944), The Great Transformation, Boston: Beacon Press.
Preker A. and Harding A. (2002), Innovations in Health Service Delivery, Washington, DC: World Bank.
Prime Minister's Strategy Unit (PMSU) (2006), The UK Government's Approach to Public Sector Reform, London: PMSU.
Propper C., Wilson D. and Burgess S. (2006), ‘Extending choice in English health care’, Journal of Social Policy, 35: 4, 537–58.
Rothstein B. (2005), Social Traps and the Problem of Trust, Cambridge: Cambridge University Press.
Seligman H. (2000), The Problem of Trust, Princeton, NJ: Princeton University Press.
Simon H. (1978), ‘Rationality as process and as product of thought’, American Economic Review, 68: 116.
Sun (2006a), ‘Wasted decade’, 12 October.
Sun (2006b), ‘Our NHS and the truth which dare not speak its name’, 14 April.
Sun (2006c), ‘MRSA’, 24 February.
Sztompka P. (1998), Trust, Cambridge: Cambridge University Press.
Taylor J. (2007), ‘The impact of the specialist schools programme on exam results’, Lancaster University Management School Working Paper.
Titmuss R. (1970), The Gift Relationship: From Human Blood to Social Policy, London: Allen & Unwin.
Todd P. and Gigerenzer G. (2003), ‘Bounding rationality to the world’, Journal of Economic Psychology, 24: 143–65.
Toynbee P. and Walker D. (2005), For Better or Worse?, London: Bloomsbury Press.
Treasury (2007), Comprehensive Spending Review: Meeting the Aspirations of the British People, Cm 7227, London: HMSO.
Weber M. (1978), Economy and Society, Berkeley, CA: University of California Press.
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Journal of Social Policy
  • ISSN: 0047-2794
  • EISSN: 1469-7823
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