This paper examines the proposition that the welfare policies enacted and legitimised in the name of ‘choice’ have the effect of increasing the effective choice of service by consumers of welfare. The example of residential care of the elderly is used to illustrate the ways in which privatisation has influenced choices of care for elderly people in Devon. The paper reviews empirical material from two surveys of private homes in Devon in order to throw light on the ‘myths’ and realities of choice in residential accommodation and in other welfare provision available to the elderly in Devon. The paper identifies as the key debate the question of priorities: whether resources should be concentrated on providing suitable residential places for the increasing number of the very disabled elderly or used to increase the alternatives for the larger, more able groups. The latter option can perhaps be reasonably achieved through market mechanisms, whilst the former is more likely to require the specialised skills of social workers and other caring professionals. Although it is possible to argue that the growth in numbers of private old people's homes represents an increase in choice for the elderly, on closer examination this appears too simple an assertion. The expansion of the private sector has not necessarily expanded the range of alternative forms of care. In particular, there seems a major flaw in current policies by which the operation of the DHSS subsidy increases the availability of residential rather than domiciliary care.

Recent changes in the law have made it possible to pay adopters in certain circumstances for the upkeep of their children. This is a policy change which has been controversial since it challenges values concerning not only the nature of adoption but also the boundaries between State and parental responsibility. It also represents a significant extension of local authority powers with regard to income maintenance. This raises issues of equity in relation to central government benefits for the maintenance of children and other forms of help available to disadvantaged families.

Following its recent reorganisation of the management of the hospital sector of the NHS, the Government is currently engaged in a review of the primary health care sector. Certain of its proposals may be interpreted as suggesting movement towards a system modelled on American-style Health Maintenance Organisations (HMOs). This article seeks to explore the context in which HMOs have developed, to assess their current performance and to evaluate their potential impact on the health delivery system. It suggests that they must be understood primarily in the context of initiatives aimed at reducing health expenditure, and finds that the cost advantages claimed for them are achieved through reduced utilisation rather than through greater efficiency. It also argues that this reduced utilisation is likely to increase inequalities in health care.

There has been an ongoing dispute about inequalities in health ever since the suppressed publication of the Black Report in 1980. It has recently been given a new edge by three publications: the proceedings of an SSRC Workshop held in November 1983 and the Registrar General's Decennial Supplement for 1979–1983, and another half-suppressed report, this time from Health Education Council. The first and third broadly claim that inequalities in health are widening; the second that they are irrelevant. This paper reviews the debate since 1980 around the issues of measurement (how to assess differences between social groups and how to compare across time) and the four kinds of explanation examined by the Black Report. The concluding discussion emphasises the essentially political nature of the debate over the ‘trends’ but concludes that, whilst most agree on the importance of materialist/structuralist variables, there are differences in the policy implications of the different explanatory positions. However, on the whole these will not be resolved by ‘further research’: the time is long overdue for a redistribution of resources to eradicate poverty.