A Taxonomy of Social Need*
One of the most crucial problems facing the social services is
how to identify social need. This article attempts to provide a
framework for clearer thinking about need.
The concept of social need is inherent in the idea of social service.
The history of the social services is the story of the recognition of
needs and the organization of society to meet them. The Seebohm
Report (1) was deeply concerned with the concept of need, though
it never succeeded in defining it. It saw that ‘The Personal Social
Services are large scale experiments in ways of helping those in
need’.
Despite this interest it is often not clear in a particular situation
what is meant by social need. When a statement is made to the
effect that a person or group of persons are in need of a given
service, what is the quality that differentiates them – what definition
of social need is being used?
*
Bradshaw, J.R. (1972) ‘The taxonomy of social need’, in McLachlan, G.
(ed),
Problems and Progress in Medical Care
, Oxford University Press:
Oxford.
The concept of social need is of particular interest to economists.
They have a clearcut measure of ‘effective demand’: demand
is ‘effective’ when people are prepared to back it by pecuniary
allocation and ineffective or non-existent when they are not.
This measure will not do for the social services, because there
is normally no link between service and payment (though some
economists think there ought to be). If the social services are trying
to cope with need without limiting it by the ability to pay, how is
it actually assessed?
In practice, four separate definitions are used by administrators
and research workers.
1. Normative Need
Normative need is that which the expert or professional,
administrator or social scientist defines as need in any given
situation. A ‘desirable’ standard is laid down and is compared with
the standard that actually exists – if an individual or group falls short
of the desirable standard then they are identified as being in need.
Thus the BMA’s nutritional standard is used as a normative measure
of the adequacy of a diet (2). The Incapacity Scale developed by
Townsend (3) and the measure of social isolation used by Tunstall
(4) are also examples of normative standards used as a basis of
need. A normative definition of need is in no sense absolute. It may
not correspond with need established by other definitions. It may
be tainted with a charge of paternalism-i.e. the use of middle-class
norms to assess need in a working-class context – though where the
aspirations are to middle-class standards this may be reasonable. A
further difficulty with the normative definition of need is that there
may well be different and possibly conflicting standards laid down
by different experts. The decision about what is desirable is not
made in a vacuum. As Walton (5) has pointed out, the statement ‘X
is in need’ is often taken as an empirical fact. This is not so. It is a
value-judgement entailing the following propositions: X is in a state
Y, Y is incompatible with the values held in society Z. Therefore Y
state should be changed. So the normative definition of need may
be different according to the value orientation of the expert – on his
judgements about the amount of resources that should be devoted
to meeting the need or whether or not the available skills can solve
the problem. Normative standards change in time both as a result
of developments in knowledge, and the changing values of society.
2. Feel Need
Here need is equated with want. When assessing need for a
service, the population is asked whether they feel they need it. In a
democracy it could be imagined that felt need would be an important
component of any definition of need, but a felt need measure seems
to only be used regularly in studies of the elderly and in community
development. Felt need is, by itself, an inadequate measure of ‘real
need’. It is limited by the perceptions of the individual – whether
he/she they know there is a service available, as well as a reluctance
in many situations to confess a loss of independence. On the other
hand, it is thought to be inflated by those who ask for help without
‘really needing it’.
3. Expressed Need
Expresse need or demand is felt need turned into action. Under
this definition total need is defined as the need of those people who
demand a service. One does not demand a service unless one feels
a need, but on the other hand, it is common for felt need not to
be expressed by demand. Expressed need is commonly used in the
health services where waiting-lists are taken as a measure of unmet
need. Waiting-lists are generally accepted as a p