Project objectives

This is a qualitative study using individual and group interviews with a purposive sample of older citizens. The key deliverable will be a model of how benefits are understood by older citizens, and the role of benefits in mitigating loneliness, considered through the lens of a distinction between universal and conditional entitlement.

The key aims are to: identify how older citizens value the material and symbolic effects of a range of universal and conditional benefits; explore how their understanding of entitlement to universal and conditional benefits is related to the uptake and effects of benefits; and to identify the role of conditional and universal benefits in fostering social capital and preventing or mitigating loneliness. The project thus seeks to generate knowledge that can inform efforts to foster social capital and address loneliness and isolation in older age.

This will feed into a conceptual model of ways in which welfare benefits impact on wellbeing in older age, with particular focus on social relations. Specifically, the project is expected to inform the contemporary debate about the introduction of means-testing for what are currently universal benefits for older people, as it is generating findings that show how nature of entitlement to benefits can shape health and wellbeing. Policy briefings will be produced that are envisaged to inform the work of local government and voluntary organisations as changes to benefits for older people are discussed and potentially planned and implemented.

Brief summary

Methods

We interviewed 29 older citizens in three contrasting areas of England: London, Sheffield and Cambridge.  We purposively sampled adults aged 60 or over to include a range of ages, ethnic identities, urban or rural residence and income levels.  Although not intended to be statistically representative of the population of England, the sample included older people with diverse experiences and backgrounds.  Invitations to take part in the study were made through contacts such as church, community and charity groups.

There are a number of methodological challenges in asking about entitlements to welfare benefits. First, financial circumstances and needs-based entitlements can be sensitive issues to discuss.  Second, asking directly about views of various benefits risks generating rationalisations, or routine ‘public’ statements about entitlement, rather than providing access to those forms of tacit knowledge which allow what is sayable and thinkable, or the more normative assumptions that might underpin how entitlement, conditionality, and universality are related to health and wellbeing.  We therefore used in-depth interviews which were loosely structured and allowed participants to talk at length about their biographies, families, circumstances, lives, and how they managed, before asking directly about benefits.

Interviews were transcribed in full, and analysed using both inductive and deductive methods.  This entailed the research team coming together to work on early data and develop an initial coding frame which was informed by the literature on the impact of conditionality, and by open coding the initial data to generate insights into ‘what was going on’.  A descriptive coding frame was then agreed between the research team, and applied to data within each geographical site.  The team then met to discuss the site specific analyses, map relationships between framings of conditionality and wellbeing outcomes, using comparisons made within and between the sites and deviant cases to test emerging hypotheses.  For instance, an early hypothesis that ‘conditionality’ always lead to disrespectful relationships between claimants and providers was challenged by the positive impacts reported from using a (means tested) community centre, leading us to identify ‘contribution’ as a key framing.  The final analysis therefore focused on different framings of conditionality for wellbeing, and this paper reports the pathways that link these to wellbeing and public health outcomes.

Results (including findings in relation to the objectives)

We identified two distinct framings of conditionality, and how these have different implications for wellbeing. Entitlement that is understood collectively, as arising from financial or other contributions to a social body, were framed largely as taken for granted expectations of being part of a welfare state. Uptake of these had positive impacts on the self, beyond the material gains, including the social recognition implied by standing in a reciprocal relation to the state: entitlement therefore (for those who qualified) as a positive mark of belonging, and contributing to wellbeing through pathways fostering social integration.  Other forms of conditionality, based on individualised concepts of need or vulnerability, fostered debate about legitimacy, fracturing feelings of solidarity. These framings not only had implications for reduced uptake (and thus direct impacts on health and wellbeing) but also broader implications for structural determinants of public health, such as erosion of social capital. At an individual level, increasing conditionality is likely to lead to higher barriers to benefit uptake, with imperfect systems, complex eligibility requirements and stigma reducing uptake. This will have implications for wellbeing at the individual level, both in terms of reduced access to material resources for those in need, but also through psycho-social pathways of increased anxiety and diminished recognition. At the social level, increasing conditionality risks fracturing commitment to collective notions of welfare. There are also more complex pathways, through which universal benefits impact on the public health by, for instance, fostering ‘public goods’ such as increased use of public transport or increased social interaction.

When considering the wellbeing impacts of introducing further conditionality to welfare entitlement, it is important, then, to consider not only the impact on individuals, but those effects that are mediated by relational meanings linking the individual, the social body and the state.

A conceptual model of how welfare benefits impact on wellbeing has pathways that link implications at individual, social and structural levels. Conditionality mediates these pathways.

Conclusions

Current erosion of the foundations of the welfare state in the UK and other countries has been ideologically driven, in an economic context where ‘targeting’ has a plausible, even seductive, appeal.  However, the implicit logic model by which such targeting (increasing individually understood conditionality) impacts on health is untested. Given the complex pathways through which entitlement affects wellbeing and the public health, policy makers cannot assume that restricting access to welfare benefits to those in most need will necessarily have the intended effects. However, we also need to avoid romanticism, and a nostalgic argument for simply reviving post-war understandings of the welfare state. In increasingly globalised societies, conditionalities reliant on national citizenship, for instance, may no longer be appropriate. Similarly, as our data suggest, understandings of welfare (and the bases of entitlement) are contingent, and they are malleable: following Williams, the meaning of ‘welfare’ are likely to change further.  Paying attention to the pathways through which the framing of entitlement impacts on health might better enable policy makers and practitioners to better assess potential impacts, and to identify points for mitigating negative consequences for public as well as individual health.

Calls for introducing further conditionality to benefits for older adults are often based on claims that this will increase fairness and equality. Our analysis suggest, in contrast, that introducing conditionality has the potential to promote inequality and foster differentiation and division.

Plain English summary

What was the research about?

Welfare benefits for older people in the UK include some universal benefits. These are ones that everyone over a certain age can get, such as winter fuel allowance and free travel passes. There are also some conditional benefits, only available for those in greatest need, such as pension credits. This research was about how these kinds of entitlement matter for health and wellbeing for older adults.

Why was the research needed?

Targeting benefits to those in greatest need is appealing in times of austerity. However, it may have unintended consequences. We need to understand more about the potential impact of increases in welfare conditionality on wellbeing and inequality.

What did we do?

We interviewed 29 people aged over 60 from three different areas of England: Sheffield, London and Cambridge. We included people from different backgrounds and ages. They talked to us about their work and social histories, their current day-to-day activities and financial and social priorities as well as their views and experiences of welfare benefits.

What did we find?

There were clear differences in attitudes towards and experiences of universal and conditional benefits. Respondents anticipated changed behaviours and negative impacts on their own and others’ wellbeing if currently universal entitlements (such as free travel passes) were to be removed.

Universal benefits:

• supported a sense of social recognition and pride among older people;
• were often unquestioned, and viewed as a reward for a lifetime of hard work and financial responsibility;
• facilitated a sense of self-worth by enabling social activity and contributions to family and society e.g. volunteering or caring for grandchildren.

Conditional benefits:

• raised questions about who deserved the benefit, fraudulent claims and whether people used the benefit responsibly;
• were stigmatised so that applying for them brought feelings of shame and anxiety;
• were difficult to access, deterring needy individuals from making claims.

Implications for policy and practice

Findings support earlier work that shows that tougher conditions on eligibility for benefits results in needy individuals missing out, with negative impacts on health and wellbeing. This happens because assessment processes are imperfect, or because claiming involves hassle or stigma. These findings also suggest that introducing conditions may threaten the sense of self-worth that universal benefits foster and encourage social divisions. Action is needed to: reduce benefit stigma; to ease access to benefits and to increase understanding and debate around the pros and cons of universal benefits.

Dissemination

Academic dissemination

Peer reviewed article

1. Milton S, Buckner S,Salway S, Powell K,Moffatt S and Green J (2015) Understanding welfare conditionality in the context of a generational habitus: a qualitative study of older citizens in England Journal of Aging Studies 34: 113-122
   http://www.sciencedirect.com/science/article/pii/S0890406515000614

Report

1. S Buckner and J Green. Entitlement and universality: the need for research on the impact of introducing conditionality in welfare benefits on health andwellbeing in older age. Discussion paper, August 2013.
   http://sphr.lshtm.ac.uk/files/2013/08/Welfare-benefits-discussion-paper_08082013.pdf

Conference presentations

1. Milton, S and Buckner S. Ageing, welfare and wellbeing: an exploration of the meaning of universal benefits amongst older people in the UK  BSA Conference, Leeds, April 2014 [presentation].
2. Buckner S et al The role of universal benefits in shaping health and wellbeing in older age: a focus on social isolation, loneliness and connectedness Public Health England Annual Conference, Warwick Sept 2014 [presentation].
3. Powell, K et al The role of universal benefits in shaping health and wellbeing in older age: a focus on social isolation, loneliness and connectedness SPHR Annual Scientific Meeting, Sheffield, Oct 2014 [presentation].
4. Buckner, S et al Ageing, Welfare Benefits and Wellbeing: The role of welfare benefits in shaping wellbeing in older age Aging & Society 4th Interdisciplinary Conference, Manchester, Nov 2014.
5. Powell K et al. Older people’s wellbeing in the UK: what role do universal welfare benefits play? European Public Health Association, Glasgow, Nov 2014 [presentation].
6. Buckner, S et al Welfare benefits, nature of entitlement and health and wellbeing in older age: a focus on social isolation and connectedness as part of Symposium: Entitlement and Access to Resources for Older People in Relation to Health and Wellbeing BSG Annual Conference, Newcastle upon Tyne, Jul 2015.
7. Buckner, S. Ageing, welfare benefits and wellbeing: The role of welfare benefits in shaping wellbeing in older age Public Health@Cambridge Showcase Event. May 2014 [poster].
8. Buckner, S. Ageing, welfare benefits and wellbeing: The role of welfare benefits in shaping wellbeing in older age Anglia and Essex Public Health Conference June 2014 [poster].

Non-academic dissemination

1. SPHR@Cam Stakeholder Engagement Event Feb 2015.
   Buckner, S et al. Welfare benefits and wellbeing in older age [presentation].
   Buckner, S et al. Welfare benefits, wellbeing and loneliness at older age: towards an evaluation of the impact of withdrawal of universal benefits [poster].
2. SPHR Stakeholder Event, Cambridge Nov 2013. Welfare benefits, wellbeing and loneliness at older age: towards an evaluation of the impact of withdrawal of universal benefits.
3. Preliminary findings shared face to face with local stakeholders in Sheffield via the Sheffield Palliative Care Studies group (Katie Powell) and the ScHARR SPHR management group, which includes public health practitioners and public representatives (Katie Powell and Sarah Salway).
4. ScHARR team members have fed study findings into a Sheffield City Council consultation process.
5. ScHARR team members are sharing project findings with representatives from public, practice and policy in February 2015.

Public involvement

PPI: The project was discussed at a PPI workshop run by the West Anglia Comprehensive Local Research Network, which involved several older patients and members of the public. Participants considered the project important and relevant to older people. They provided input on specific project components, which particularly shaped sampling (e.g. efforts to include participants from more rural areas) and data collection (e.g. the interview questions and their wording).

Sheffield 50+ and Sheffield Palliative Care Studies Advisory Group have been engaged via two structured workshops. Older people gave feedback on: research questions and focus; recruitment; data collection methods; data analysis (emerging themes) and potential research outputs.

Sheffield SoPHR PPI Advisor Roy Darlinson has given ongoing support to the work in Sheffield. He has participated in the PPI events and also an early analysis of themes workshop. He continues to be involved in the study.

Feb 15: The project was presented at the SPHR@Cam annual stakeholder engagement event. Nick Roberts, a PPI rep who had been a participant at the WACLRN workshop in November 2013 in which initial PPI input into the project was sought, acted as discussant and provided comments on the findings from the project from the perspective of an older member of the public.

Sep 15: The project was presented at a PPI workshop for the Ageing Well Programme run by SPHR@cam. Opportunities for further research that builds on the findings and translation into practice were discussed with local PPI representatives.

This project was funded by the National Institute for Health Research School for Public Health Research (project number SPHR-SWP-AGP-PR5).

Department of Health Disclaimer

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School for Public Health Research, NIHR, NHS or the Department of Health.