I should begin by declaring certain interests. Richard Titmuss, with Brian Abel-Smith, supervised my PhD. While an undergraduate studying History at Oxford I heard Titmuss speak. As John Stewart mentions in his book, for which he interviewed me, I was inspired to take the postgraduate diploma in Social Administration in Titmuss’ department at the London School of Economics. Titmuss and Abel-Smith were then – the late 1960s – advising Harold Wilson’s Labour government on pensions policy. They felt they needed to understand the history of British state pensions and persuaded me to research a PhD on this subject. This started me on a career of studying the history of British social welfare. Titmuss recommended me for my first job, which was teaching social history to students of social administration in a new department at Goldsmiths’ College London. There, John Stewart was one of my first research students.
I approached this book with considerable interest. It is a comprehensive study of an exceptionally active and influential man with important, original ideas about welfare. Richard Titmuss was born in 1907, the son of a farmer who later ran a not-very-successful haulage business, in a family not rich but not, as has sometimes been represented, poor. They could afford to send him to a private school, though it was undistinguished, and his education was disrupted by persistent ill health, of which we receive no details. He left school at 14 for a commercial college to learn bookkeeping. His father died, and he became the family breadwinner as a clerk in an insurance company. He became interested in politics, as a Liberal, and social questions, ‘reading and studying privately’ and taking evening classes. ‘He had a relentless drive for self-improvement’ in Stewart’s judgement, continuing after what became his long-lasting marriage to Kay in 1937.
His first book, Poverty and Population, was published in 1938. There was great concern in Britain (and elsewhere) from the 1920s about births declining while life-expectancy rose. This aroused among politicians, economists, and others, including Keynes and Beveridge, fears that the workforce was shrinking while the older population, presumed to be dependent and costly, grew, with potentially devastating effects on the economy. The centre of this discussion and of a growing body of research into population change was the Eugenics Society, which moved beyond concern with genetics. Titmuss was an active member. His book was an influential contribution to the debate, stressing how poverty caused ill health and premature mortality, examining its distribution across social groups and regions and the importance of reducing it, in particular helping poorer mothers and children increase the fitness of future generations, issues he pursued for much of his career. Stewart does not quite convey the extent and significance of these concerns before, during, and after World War 2.Footnote 1
Titmuss was convinced of the need to improve the health of all classes. In 1939 he, along with Frederick Le Gros Clark, published another contribution to discussion about the population crisis, Our Food Problem. A Study of National Security. It advocated state-subsidized milk for all pregnant and nursing mothers, young children, schoolchildren, and workers to at least age 24, along with subsidised canteens to ensure healthy food, most of which were introduced during the war. He supported his friend Eleanor Rathbone’s campaign for family allowances and, from 1940, advised the Ministry of Health, while continuing to work in insurance. He published widely in the press, blaming capitalism for declining family size while it grew in less-developed countries like China, arguing that ‘acquisitiveness’ led to perceiving children as barriers to prosperity. Stewart does not discuss whether he recognised that poorer people restricted their family size in order to support the children they had and to protect mothers from the ill effects of pregnancy and childbirth in the absence of good, free health care.
In 1941 he agreed to write one of a series of official histories of the war, on social conditions and social policies, published in 1950 as Problems of Social Policy. He worked on it through the war, studying especially the unprecedented state-directed wartime free medical services, what the evacuation of children revealed about inequalities of health and social conditions and what he argues was its major influence on demands for post-war social reform. In 1942 he resigned from his insurance job and joined the Cabinet Office, advising on health policy among other issues, still active in the Eugenics Society as births continued to decline. Infant mortality also fell but was still too high among the poor, and he remained pessimistic about long-term population trends and prospects for poor children. In 1944 he argued in articles, lectures, and radio broadcasts that the UK population was ‘heading towards extinction’ predicting a fall from c.41m in 1940 to c.37m in 1970 and c.20m in 2000, too pessimistically since births rose in the post-war ‘baby boom’. He does not appear to have commented on this, in a time of growing ‘acquisitiveness’. His only joint publication with his wife, Parents’ Revolt (1942), sub-titled A Study in the Declining Birth-rate in Acquisitive Societies, aimed, quite successfully, at a popular audience, summed up his views. A preface by Beatrice Webb claimed it raised ‘the crucial question of the fall in the birth-rate threatening the survival of the white race’. It argued that the birthrate decline signified the failings of the social and economic order, which must be reformed and equalized, especially raising working-class earnings to enable them to feed and educate their children. The Webbs had no children, the Titmusses just one daughter, but there was no sign that they judged themselves guilty of ‘acquisitive’ failure to advance the race.
Titmuss increasingly focused on the need to eliminate poverty and improve the health of the whole population, reducing preventable disease and improving fitness. After the war he was appointed to the Medical Research Council (MRC) and researched the causes of prevalent illnesses, including TB (from which he suffered recurrently in the 1950s and 60s), infant mortality, and still births. He concluded that these had social as well as clinical origins and argued for many years that medical training should be reformed to educate doctors and nurses in social issues as well as ‘scientific medicine’ and to listen to patients’ accounts of their conditions.
By 1950 he had a strong reputation as social scientist, historian, public commentator on social affairs, and advisor to official bodies. Problems of Social Policy was published and favourably reviewed. He was appointed to LSE’s first chair in Social Administration in the Social Science department, despite having no degree in any subject, the only candidate interviewed. He turned it into a department of Social Administration at a time when the social sciences were marginal in Britain. His inaugural lecture explained his aim to expand Social Administration from social work training to study of the wider social sciences and social services, their historical context, how best to meet social needs, and the relevance of social sciences to policymakers.
He was critical of the inadequacy of post-war social reforms and profoundly hostile to the term ‘Welfare State’ which, he said, evoked ‘the image of paternalism at the summit of its achievement’. Stewart does not mention that the term was equally unpopular with Beveridge and Michael Young (at this point a leading Labour Party official) for similar reasons. Conservatives used it as a term of abuse, and Labour only adopted it favourably in the 1950s. Titmuss argued there had been too little change, the social services must take greater account of the needs of the growing older population and of inequalities of wealth, income, and life chances, and pay more attention to mental ill health. He appears to have been unaware that Labour leaders were conscious that in their six years in office they had failed to fulfil their ambitions for welfare reform, partly because they prioritised achieving economic growth and full employment for the first time in peacetime, which they believed would best improve living standards. They hoped to stay in government and improve welfare services as the economy expanded. Titmuss was exceptional in arguing that economic growth benefitted only the rich, increasing inequality, and full employment could not support everyone in need. He was especially critical of the low level of post-war pensions and the consequent dependence of many poorer pensioners on means-tested supplements from the National Assistance Board (NAB). He was critical of Beveridge for this and other aspects of post-war policy. As Beveridge’s biographer, Jose Harris, points out, Beveridge was equally disturbed because Labour introduced pensions, family allowances, and other benefits at lower rates than the full subsistence he proposed, and he was not consulted about the policies. Labour restricted benefits to prioritise economic growth.
Through the 1950s Titmuss developed his critique of welfare services including changes introduced by the Conservatives. Again exceptionally he stressed that the term ‘state welfare’ was applied to benefits for the dependent poor, but not to the much larger tax allowances, including children’s allowances, and tax reliefs which benefitted the better-off at much greater cost to the state. Tax relief for occupational pensions, benefitting mainly better-paid men, rose under the Conservatives, costing more than state pensions. Social services faced constant criticism as ‘burdens on taxpayers’ while fiscal benefits did not. In an essay he described the trend as ‘The Social Division of Welfare’, creating ‘two nations’ of beneficiaries. He argued that services had improved post-war, but remained imperfect, and social scientists should criticize the shortcomings, seeking necessary improvements. He never believed there was ‘consensus’ between Conservatives and Labour on social and economic policies as some academics argued.
He thought the National Health Service (NHS) had greatly improved health care but, like every service, it needed constant reform, initially on lines discussed above, stressing the importance of a healthy population to the economy. It should be more closely integrated with social services at local level. The desire of the Conservatives, and the Treasury, to cut social spending led to the appointment of a committee headed by a Cambridge economist, Claude Guillebaud, to examine the costs of the NHS, expecting it to recommend cuts and privatisation. Titmuss was appointed consultant, and his then-student Brian Abel-Smith carried out research. Titmuss was suffering from TB and advised the committee from home. He was impressed by his NHS treatment. The report concluded in 1956 that costs had fallen as a proportion of national income, by international standards the NHS was excellent value for money and deserved more, not less, funding. This prevented cuts. Titmuss and Abel-Smith were invited in 1958 to join a Labour committee on the NHS. Titmuss again recommended training of doctors and nurses in social and psychological origins of disease, and local that health and social services should integrated and improved, including for mental health care. This became Labour policy.
He was also invited to join a Conservative committee on pensions policy. Demand rose along with life expectancy while the Conservatives increased subsidies to occupational pensions but not to state pensions. Titmuss favoured older workers staying on past retirement age to boost the workforce and cut pension costs (as Beveridge had recommended, though this is not mentioned), provided it was not enforced by individual economic necessity. He pointed out how little was known about the relationship between ageing, health, and fitness for work. Following strong evidence (especially from the work of his new LSE colleague, Peter Townsend, who had extensively researched the social conditions of old people), he rejected Conservative convictions that families neglected older relatives, while advocating stronger social work support for older people preferring to live in their own homes. Like Townsend and others, he criticised the poor quality of institutional care. The committee reported in 1958 but was ignored.
Meanwhile Titmuss, Abel-Smith, and Townsend advised Labour on pensions. Titmuss criticised the flat-rate pension and contribution system established in 1946 as regressively disadvantaging the lower paid, again blaming Beveridge. The ‘Titmice’, as they were known, supported earnings-related pensions as already publicly funded for public sector workers and commonplace in Europe. They argued that occupational pensions harmed the economy by constraining job mobility and through methods of funding which diverted savings from investment. They presented a fully developed ‘National Superannuation’ scheme, which became Labour policy from 1957. Stewart does not provide full details, but it proposed redistributive income-related pensions, higher earners contributing relatively more than lower, with pension funds to be invested in government-directed economic development. They aimed for a scheme ‘so satisfactory’ that employers would abandon competing private schemes, and old age poverty would terminate.
Titmuss devoted much effort to developing his department. His determination to expand its activities to include broader study of the social sciences to promote understanding of social problems caused conflict in the department. He believed that social workers should not be specialized, e.g. in childcare or elder care, but have broad, generic skills, including listening to service users with respect, to understand their needs. These ideas became increasingly influential in the 1960s, first in Scotland following advice from Titmuss, and then elsewhere in UK following the recommendations of the Seebohm Committee, 1968, which Titmuss also advised. By 1959 he led the largest department of its kind in Europe, in high demand from students, and had established Social Administration as a field in which he was the international leader. His approach was conveyed in his first published collection, Essays on ‘The Welfare State’ (1958). The inverted commas expressed his scepticism about the term. It was widely, favourably reviewed, except by right-wing opponents, including the recently founded Institute of Economic Affairs (IEA) opening a long antagonism. Also, sociologists criticised his lack of theory and focus on empirical research, which he did not regret. He believed theory often obscured clear thinking.
Still suffering from TB, he continued to develop and publicise his ideas in articles in the New Statesman and other journals, radio, and TV programmes, stressing how Britain was becoming more, not less, unequal following Conservative policies, without effective opposition because democracy was weakened by affluence and the increasing power of capital. He argued there had been real improvements in welfare and the quality of life since 1945, especially from the NHS, but more were needed to advance equality and social solidarity. He was part of a wider, growing, range of critics in the 1950s of what was termed the ‘Establishment’, including ‘Angry Young Men’ among writers, and satirists ‘Beyond the Fringe’. In Income Distribution and Social Change (1962) he dismissed the ‘myth’ that the British ‘had never had it so good’, regretting the lack of research into the causes of social and economic inequality, in particular into higher income groups, while there was plenty of research on the poor. He criticized the dominance of public schoolboys, especially from Eton, in positions of power, from schools that were ‘charities’ benefitting from tax relief, while secondary modern schools for poorer children were neglected. He noted growing racial discrimination encouraged by the Conservatives 1962 Commonwealth Immigration Act, the first to limit immigration by, mainly Black, Commonwealth citizens. Society had lost its way since the post-war advances.
Titmuss’ skills were also in demand abroad. In the early 1960s the governments of Mauritius and Tanganyika (later Tanzania) asked his advice on the development of their health and welfare systems. He was concerned about growing inequality between rich and poor countries as well as within rich countries. Abel-Smith did much of the research due to Titmuss’ other commitments and precarious health, leading to improved services and staff training in both countries. Titmuss was also invited to Israel to lecture and advise on research and the development of social services. He advised the government on tax reform, health insurance, and pensions, and made good friends and contacts, while noting that, as Israel became richer, like Britain it became more unequal.
With Abel-Smith and, initially, Townsend, he was closely engaged in advising Harold Wilson’s 1964-70 Labour government on pensions and other policies. The three worked closely together at LSE, until Townsend left in 1963 for the new University of Essex, reluctantly and Titmuss was reluctant to lose him, but he was attracted by opportunities at Essex. They had high hopes for further welfare reform when Labour returned to government. In 1965 Abel-Smith and Townsend published The Poor and the Poorest, revealing the results of their survey of poverty in Britain, which became known as the ‘rediscovery of poverty’: unexpected levels of poverty among children (and unavoidably their families), 2.25m, though it was greater among pensioners, 3m. They presented it to Wilson, and it led to the foundation of the Child Poverty Action Group (CPAG). Townsend and his allies became fiercely critical of Labour for failing to respond with improved child benefits and major welfare reforms, creating a split with Titmuss and Abel-Smith, who continued to advise the government on pensions and other reforms.
Wilson certainly hoped to advance the incomplete post-war reforms, but Stewart fails to mention that he was shocked to discover that Labour had inherited from the Conservatives the largest financial deficit (£800m) since the war. This and later financial crises limited what could be achieved. Labour immediately raised pensions to their highest level since the war, though still not enough to live on, for the largest group in poverty, introduced comprehensive schools and raised family allowances, while reducing child tax allowances so that better-off taxpayers did not gain. It extended free school meals and free milk and some benefits for poorer families, but did not go as far in alleviating child poverty as CPAG wanted until it returned to government in 1974. In 1970 Labour introduced a National Superannuation Bill, implementing the 1957 proposals, but it failed to pass through parliament before it lost the 1970 election.
More successfully, it replaced the NAB, which faced increasing criticism, with the Supplementary Benefits Commission (SBC), intended to be more generous, humane, and less stigmatizing, taking account of personal circumstances. This followed Titmuss’ principles, and he became deputy chair, continuing under the Conservatives. He now advocated a universal, selective system providing benefits ‘as of right’, more responsive to individual need than ‘automatic’ benefits derived from insurance contributions. He argued on the radio and elsewhere that ‘socialist social policies were, or should be, preeminently about equality, freedom, and social integration’, resolving problems of poverty and ethnic integration. Enquiries into ‘means’ alone were inadequate tests of need for there were ‘no standard families with standard or uniform requirements and resources’. The SBC could provide flexible grants adjusted to needs. People should be informed of their rights and helped to use appeal tribunals if unfairly treated. He aimed to reduce claimants, who had doubled from c.1m when NAB was founded in 1948 to 2.5m in 1969, 70% above retirement age. But he discovered that the SBC was understaffed, staff were inadequately trained, working in ‘appalling’ conditions, ’literally slums’, morale was poor, and turnover high. He put much effort into improved training for staff to meet his ideals, but these were far from achieved when Labour lost the 1970 election, then not promoted under the Conservatives.
In 1969 Titmuss was appointed to the Finer Committee on One-Parent Families, established in response to their growing numbers, often poor, overwhelmingly headed by mothers. He made a significant contribution to its comprehensive report, advocating flexible services providing positive, unstigmatising help, financial and otherwise, including helping single mothers find childcare and training for good work opportunities. But he died in 1973 before it was published in 1974,
He was also in demand in the US in the 1950s and 60s, lecturing widely, making contacts, and advising government departments, encouraging development of the study of social policy in American universities and stressing the need to reduce internationally growing inequalities. Critics of the socially divisive privatised health services in the US were especially eager to hear about Britain’s ‘socialised’ NHS. This followed articles in which he criticised the financial ‘disaster’ experienced even by middle-income US families suffering serious illness. Progressive academics were impressed, but the doctors and insurance companies who made substantial incomes from the US system were not about to change. Titmuss had some influence on President Lyndon Johnson’s ‘War on Poverty’ from 1964, including the Medicare and Medicaid Act, 1965, which provided tax-funded health care for older people and the needy poor. He described in The Gift Relationship and in articles and lectures in the US the different outcomes of the US blood donation system, which depended on individuals selling their blood without apparent safeguards, and the UK system of voluntary donation of blood tested for quality by the NHS – demonstrating how ‘altruism triumphed over the market’. The US system tempted poorer donors with poor-quality blood. The effects were serious enough for President Richard Nixon’s administration, after 1969, to introduce some regulation of blood banks.
Also during the busy 1960s Titmuss supported the Anti-Apartheid movement and opposition to the Vietnam war and the Unilateral Declaration of Independence (UDI) by the white minority in Rhodesia. He praised Labour’s opposition to the 1962 Commonwealth Immigration Act, criticised the inadequacy of Labour’s 1965 Race Relations Act. It was extended in 1968 and the Community Relations Commission (CRC) was established to promote good race relations, which Titmuss joined, though it had limited powers. He was ‘aghast’ at Labour’s 1968 Commonwealth Immigrants Act, which further limited immigration rights and attacked Enoch Powell’s racist ‘rivers of blood’ speech in the same year.
In 1969, aged 62, he started to discuss retirement. Colleagues at LSE wanted him to stay on, but his health had always been poor, exacerbated by a life-long smoking habit. In 1973 he died of lung cancer following misdiagnoses, though he praised his ‘marvellous’ NHS treatment. He noted the excellent treatment of his poorer co-patients in the service he regarded as the ‘apex’ of the ‘Welfare State’. He continued to research, teach, and contribute to the Finer Committee and the SBC whenever possible. As Stewart describes, he was widely mourned and praised after his death.
Titmuss was outstanding in his range of activities and contacts, his perceptive criticisms of post-1945 social and economic reforms and their effects, and his evolving proposals for further change and in his international prominence. Stewart comments that he was perhaps over-optimistic about what even a very humane welfare system could achieve, but he did his best to bring it about. He was also very early to recognise the threat to social policy from the neo-liberal new right in the shape of the IEA. Stewart’s account of Titmuss’ life and work is wide ranging and thorough, if sometimes weak on context. As he concludes in his final sentence: ‘Despite his faults and failings we might celebrate him as someone who had a clear vision of a better society, how it might be achieved, and worked tirelessly to that end’.
