Social exclusion and social justice: a rural perspective ...

© The Policy Press, 2009 • ISSN 0305 5736

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Social exclusion and social justice: a rural perspective on resource allocation Sheena Asthana, Joyce Halliday and Alex Gibson The process by which the UK government allocates resources for public sector services has rarely been scrutinised from the perspective of social exclusion or social justice. Yet, not only is a significant proportion of public expenditure targeted at just these issues but also the resulting per capita and areal allocations vary significantly with important implications for distributional equity. One product is an apparent urban/rural divide. This article draws on examples of both discretionary and mainstream funding mechanisms to explore the consequences for social exclusion and social justice in rural areas, finding concern for both vulnerable groups and universal welfare.

Introduction Any journal article that includes three disputed and chaotic concepts in its title is destined to grapple with some difficult conceptual issues before addressing its substantive claim: that rural communities do not get a ‘fair’ share of funding for statutory services. Theoretical accounts of social exclusion and social justice rarely engage with the largely technical issue of resource allocation.The aim of this article is to demonstrate that they should. Public expenditure (total managed expenditure) by central government, local authorities and public corporations is currently around 42% of Gross Domestic Product in the UK. In England, the National Health Service (NHS) alone accounts for £90 billion of spending, while local government receives an annual £67 billion by way of formula funding and specific and area-based grants. How these resources are allocated has fundamental implications for equity, however defined. A significant proportion of current public expenditure is targeted at redressing social exclusion. Social security is the largest single component of public spending. Providing a range of financial benefits to economically vulnerable groups such as the unemployed, retired people, low-income families and disabled people, it plays a key role in offering protection against the economic exclusion of individuals and families. Considerable amounts of public expenditure are also directed at tackling social exclusion on an area basis, where a spatial concentration of deprivation is associated with a range of linked problems, such as unemployment, poor skills, poor housing, high crime and ill-health. Indeed, public sector expenditure can be considered as a component of economic regeneration in its own right. Public sector services are major employers. Around 30% of all employees work in the three sectors of public administration, health and education. In addition to providing direct employment opportunities, this has major multiplier effects on local economies. In recent years, there has been an increasing tendency to use the terms ‘social inclusion’ (the converse of social exclusion) and ‘social justice’ interchangeably, Key words: resource allocation • rural • social exclusion • social justice Final submission December 2008 • Acceptance December 2008 Policy & Politics vol 37 no 2 • 201-14 (2009) • 10.1332/030557309X411264

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a practice that has led to a lack of conceptual clarity. While social exclusion initiatives focus on inequality and tend to involve selective or discretionary policy measures, the concept of social justice has traditionally been associated with notions of equality, social rights and universalism (Marshall, 1950; Titmuss, 1968). This reflects an understanding that access to key services such as health, education and transport are a normal part of life – a ‘right’ within the ‘just society’. Although the principle of universalism has come under attack in recent years (Ellison, 1999), a significant proportion of public expenditure is still directed at services that benefit the population as a whole. This suggests that access to institutional welfare remains a key right of citizenship. The denial of the social rights of citizenship through inadequate welfare funding threatens social justice and, we argue, should also be considered as a key process of social exclusion. As noted above, however, few accounts of either social exclusion or social justice focus on the role of public sector resource allocation. In the first part of this article, which briefly explores concepts of social exclusion and social justice, we suggest that this neglect of resource allocation reflects a tendency, within the British literature in particular, to place greater emphasis on economic than administrative aspects of exclusion. Within the rural context, the lack of attention that has been given to systematic administrative exclusion can also be linked to a discourse that portrays rural dwellers as un-needy (indeed, one could go so far as to say ‘undeserving’) on the basis of both their ‘choice’ of residence and their ‘culture’ of self-sufficiency. In the second part of the article, we substantiate our proposal that people living in rural areas are subject to systematic exclusion and a failure of social justice because of inequities in resource allocation. We begin by considering the current approach to reducing social exclusion through the use of discretionary funding. Because such funding tends to respond to area-based deprivation indicators and/or be channelled through area-based initiatives (ABIs), it fails to recognise the plight of disadvantaged people who are not living in disadvantaged areas. This includes the rural poor. We then consider mainstream service provision and find that, because resource allocation systems are highly sensitive to the spatial distribution of deprivation, provision across a range of sectors is becoming increasingly differentiated. One consequence is an evident rural/urban divide. This suggests that the core principle of universalism is being abandoned in favour of a residual welfare state, a shift that has significant implications for social justice in rural communities.

Social exclusion and social justice: what do these concepts mean in a rural context? Social exclusion has become a mainstream issue on the British political agenda. In England, the aim of the Social Exclusion Task Force (now based in the Cabinet Office) is to coordinate the government’s drive against social exclusion across departments.The Scottish Executive has also set out a range of social inclusion and equality strategies and, in 2008, launched a major consultation on tackling poverty, inequality and deprivation. In addition, common objectives are set at European level and translated into national policy via the National Action Plan for Social Inclusion

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(DWP, 2006). This advocates action across the lifecycle, from the alleviation of childhood poverty and disadvantage to a minimum income for pensioners. The inclusion agenda places a strong emphasis on the importance of place, reflected in a diversity of ABIs such as the National Strategy for Neighbourhood Renewal in England and the Fairer Scotland Fund. This concern to ensure that no one is ‘seriously disadvantaged by where they live’ (SEU, 2001: 5) ostensibly extends to rural populations. The Commission for Rural Communities carries the strap line ‘tackling rural disadvantage’, while social justice for all is one of three priorities for English rural policy laid out in the Department for the Environment, Food and Rural Affairs’ Rural Strategy (DEFRA, 2004). Rural proofing, introduced by the English rural White Paper in 2000 (DETR/MAFF, 2000), represents a purported commitment by government ‘to ensure that rural needs and circumstances are taken into account in policy development and delivery’ (CRC, 2007a: 4). Despite this political prominence, concepts of social exclusion are contested. Within academic literature, definitions tend to be broad, stressing the complex, multidimensional nature of social exclusion. Thus, according to Levitas et al (2007: 9), social exclusion involves ‘the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas’. Such definitions give rise to the possibility of not one but many ‘social exclusions’ and suggest that the term ‘socially excluded’ can apply to those who experience stigma and marginalisation (such as people with alternative sexualities) but who are not otherwise economically deprived. By contrast, the government tends to focus on economic hardship (and its associated social outcomes).Thus, the Social Exclusion Unit (the predecessor of the current Task Force) offered the following definition of social exclusion: ‘when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime, bad health and family breakdown’ (SEU, 2004: 4). Turning to the processes that give rise to social exclusion, accounts again range from those that focus on the socioeconomically deprived to broader multidimensional frameworks. For example, Levitas’ well-known tripartite analysis identifies a redistributionist discourse (RED) (in which social exclusion is entwined with poverty and inequality and where the solution lies in the redistribution of power and wealth), a moral underclass discourse (MUD) (centring on moral and behavioural delinquency) and a social integrationist discourse (SID) (which, while recognising the importance of access to social services and social participation, sees exclusion primarily in terms of labour market attachment and pursues social inclusion more narrowly through paid work) (Levitas, 2005). Other approaches suggest that inclusion is a function of overlapping spheres of integration, reflecting not just economic policy but the social and legal system as a whole (Philip and Shucksmith, 2003; Levitas et al, 2007). For instance, Shucksmith et al (2006) highlight three important conceptualisations of social exclusion. The first is again an underclass hypothesis, which like the MUD (see also, for example, Murray, 1990) holds the poor to be effectively excluding themselves by virtue of their deviant behaviour. In contrast, the second, termed ‘European’ or systemic explanations, focuses on the role of institutions and systems and the part played by powerful individuals and groups in society (Shucksmith et al, 2006: 680). This Policy & Politics vol 37 no 2 • 201-14 (2009) • 10.1332/030557309X411264

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approach highlights the importance of administrative exclusion by the state, together with labour market exclusion as a result of capitalist restructuring and globalisation. It departs from SID in not placing the primary emphasis on access to the labour market. A third important strand places the emphasis on issues of discrimination and a lack of enforced rights. It is the second ‘systemic’ concept of exclusion, resulting from bureaucratic relations or state administrative systems (Reimer, 2004), that is of critical importance to this article. It encompasses the idea that people can be excluded because of, for example, reduced access to political and legal systems, or as in our particular focus, an inequitable distribution of resources that encompasses access both to universal services such as health and education and to discretionary funds designed to reduce inequalities. Also key is the idea that lower-quality services and/or reduced choice (exclusion as a result of discrimination and a lack of enforced rights) are acceptable in rural areas. This view is reinforced by conceptions of rurality that stress the rural idyll (Cloke et al, 1995;Woodward, 1996; Matthews et al, 2000; Meek, 2008).Thus, being poor and excluded would appear to be less of a problem in the countryside than in the city because it is such a nice place to live.The idyllic representation of rural life, revolving around close-knit communities that have a strong culture of self-sufficiency, also shapes the view that rural dwellers have less service needs.Where statutory services are limited or non-existent, voluntary sector activity can be relied on to plug the gaps (see, for example, Sherwood and Lewis, 2000). Finally, service deprivation may be legitimised by the argument that people have ‘chosen’ to live in rural areas. In a curious variant of the moral underclass perspective, rural poverty and deprivation are depicted in individualistic rather than structural terms. Within this discourse, rural dwellers are in danger of being reduced to the level of the ‘undeserving’ on the basis of both their ‘deviant’ choice of residence and their ‘deviant’ social values. For example, attention has been drawn to the elitism of rural cultures (Agyeman and Spooner, 1997); the intolerance of rural communities to people who are defined as ‘different’; and the resulting exclusion of people with mental health problems (Parr et al, 2004), alternative sexualities (Little, 2001;Watkins and Jacoby, 2007) and black and minority ethnic backgrounds (Chakrabarti and Garland, 2004; Knowles, 2008). While such literature plays an important role in challenging the myth of the rural idyll and highlighting the needs of those who experience stigma and exclusion, it also runs the risk of introducing new clichés about rural life – if rural dwellers are such a bunch of overprivileged, racist homophobes then, like a moral underclass, they are so divorced from mainstream values that they perhaps deserve to be excluded from policy attention! The idea that rural people are somehow different has also shaped the way in which social justice issues have been perceived and acted on in urban and rural areas. As noted above, social justice is generally understood to refer to the entitlement of individuals and groups to fair and equal rights and participation in the full range of economic, social, political and legal opportunities. In the British countryside, however, a more limited definition of social justice has prevailed. In the past, this stemmed from an overly narrow focus on agriculture and conservation, the interests of resource capital, most particularly agrarian capital, being given priority over wider social policy issues (Woods, 2006).This was a product of the centrality of agriculture Policy & Politics vol 37 no 2 • 201-14 (2009) • 10.1332/030557309X411264


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to the governance of rural regions at both the national and the local level and the fragmented institutional structure of the state, with little integration or coordination of rural policy across government (see, for example, Winter, 1996; Woods, 2005). From the 1970s onwards, the declining economic significance of agriculture, counter-urbanisation (and the concomitant rise of the vocal service class), neoliberal reforms (including the retreat of state services) and calls for more integrated approaches to rural policy suggested an increased profile for social justice in rural areas. However, a socially progressive agenda has failed to materialise (Ward and Lowe, 2007). At the national level, rural policy continues to be dominated by the land management agenda. At the grassroots, a ‘politics of the rural’ (Woods, 2006) has emerged, whereby issues as diverse as reductions to public services in rural areas and the 2002 Liberty and Livelihood March are presented as threats to ‘a rural way of life’ and discrimination against ‘rural people’ (Anderson, 2007). As with the rural idyll, such presentations serve to distance rural dwellers from the mainstream social justice agenda. They also draw attention away from key issues such as systematic administrative exclusion. Finally, before addressing the core issue of equitable funding it is necessary briefly to clarify our definition of rural. However, its significance as a cultural construction and its practical and political implications are undeniable. Since July 2004, an official definition of rural areas has been in place for England and Wales. This is based on population density and settlement type and is used across government to inform the development of policies to meet the needs of rural communities (CRC, 2007b). Under this definition, one fifth of England’s population live in rural areas, that is, in settlements of 10,000 or less. This population is disproportionately old and far from immune from poverty, most particularly in remote rural areas (Harrop and Palmer, 2002).Thus, in 2008, the proportion of households living in relative poverty (below 60% of median income) was higher in sparse rural areas than the English average (CRC, 2008: 21).

Resource allocation: on the need for more conceptual clarification Across most statutory service sectors, rural communities get significantly less funding per head than their urban counterparts. Most people who are committed to social justice would probably agree that, provided that it promotes equity, this distribution of resources is likely to be appropriate. However, while it is generally assumed that robust mechanisms are in place to ensure that public spending reflects levels of public need, government formulae have become so statistically complex (many would say incomprehensible to all but specialists) that systems of resource allocation have been subjected to surprisingly little public scrutiny. In England, the allocation of resources has long been influenced by the understanding that deprivation is synonymous with service need. Given the obvious problems facing deprived inner-city areas and problem estates, this may appear to be reasonable. However, the relationship between deprivation and service need is not straightforward. If the goal of public services is to promote equity in outcomes (or to reduce the gap between the most and least socially advantaged), then deprivation is a legitimate indicator of need (provided that the service in question has an impact on Policy & Politics vol 37 no 2 • 201-14 (2009) • 10.1332/030557309X411264

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desired outcomes such as a reduction in health inequalities or income differentials). Initiatives that directly address such problems associated with poverty and social exclusion are normally supported through discretionary funding streams. ABIs have emerged as a key feature of this response (Joshi, 2001; Lawless, 2004). While the use of area-based deprivation indicators to direct funding for social inclusion-type programmes may be a rational response to the spatial concentration of disadvantage, the growing tendency to treat deprivation as synonymous with need for mainstream (ie not targeted) public services is less rational. For most mainstream services, particularly those that have been established and maintained as universal services, the main equity criterion is equity of access (or equal opportunity of access for equal needs). Service ‘need’ in this case is not measured in terms of the relative difference between the most and least socially disadvantaged but in crude or absolute terms. A range of factors tends to influence the crude distribution of service needs of which deprivation is only one. It is important, therefore, to ensure that an undue emphasis on deprivation does not obscure the needs associated with other legitimate influences such as demography. As we explore below, a lack of clarity about the relationships between equity, deprivation and service need has impacted on resource allocation and service provision in rural areas.This has had significant implications for both social inclusion and social justice in rural communities.

Discretionary funding and rural communities In recent years, there has been growing awareness of the persistence of poverty and social inequality and the parallel development of a wide-ranging policy response designed to ameliorate disadvantage (Hills and Stewart, 2005). In some cases, additional discretionary funds are used to support mainstream programmes and service delivery in areas where problems of deprivation are perceived to put such services under pressure. In others, targeted initiatives aim to address the geographical concentration of social and economic deprivation. ABIs have a long history in English welfare policy (Crawshaw et al, 2004) but have been particularly favoured by New Labour. In addition to measures such as health, education, employment and sport ‘Action Zones’, key initiatives include the New Deal for Communities, the Neighbourhood Renewal Fund and Sure Start. ABIs are typically targeted at inner-city and declining industrial areas (eg only eight of the 86 English Neighbourhood Renewal areas are part rural). In so far as they provide a mechanism for targeting resources at relatively large numbers of deprived people and the potential (arguably not realised) to tackle problems of multiple deprivation in a joined-up way, they are a rational response to the fact that some areas suffer disproportionately from problems (Smith, 1999). Against this, ABIs exclude large numbers of the disadvantaged. This is because most deprived people live outside deprived areas.The example of Sure Start, a highprofile ABI that operated on a phased basis between 1999 and 2006, illustrates this well. Described as ‘a cornerstone of the Government’s drive to tackle child poverty and social exclusion’ (Tunstill et al, 2002: 1), Sure Start supported a range of initiatives designed to improve health, strengthen families and communities, improve children’s social and emotional development and increase their ability to Policy & Politics vol 37 no 2 • 201-14 (2009) • 10.1332/030557309X411264


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learn.While evaluation evidence of the impact of Sure Start remains mixed (in part because of the time taken for effects to become obvious) (NESS, 2005), an extensive body of research has shown that Sure Start type initiatives such as parenting support, high-quality out-of-home care and preschool education can significantly improve social, behavioural, educational and health outcomes, especially for children from disadvantaged backgrounds (Melhuish, 2004; Asthana and Halliday, 2006). Yet, although the programme operated in the most deprived 20% of wards in England, which encompass up to 400,000 children, this still means that two thirds of under four-year-olds living in poverty received no support. Sure Start provision has been particularly sparse in the countryside. Of the 524 Sure Start local programmes, only 15 were based in identifiably rural areas (Williams, 2006) although a further 43 mini programmes were developed in part to address this gap in provision (Glennie, et al, 2005). Flagship initiatives such as Neighbourhood Nurseries and Early Excellence Centres have similarly been concentrated in deprived urban neighbourhoods and Children’s Centres, despite the aim of universal coverage by 2010, seem set to preserve this distinction. In the most disadvantaged (primarily urban) areas, they already act as an integrated provider (with direct capital support), but later (Phase 3) centres to be introduced in the more advantaged (often rural) areas are likely to concentrate largely on providing advice and information about services located elsewhere. The infrastructure in rural areas thus seems unlikely to receive either the resources or the restructuring that has occurred as a result of sustained intervention in the most disadvantaged localities. Yet, levels of child poverty are not insignificant in the countryside. There are 900,000 children, one quarter of all those living in low-income households, living in rural areas. In accessible rural districts (which have the lowest rates), one in five children live in low-income households. In remote rural districts it rises to one in four (as opposed to one in three in urban areas) (www.poverty.org.uk/R08/index. shtml). Significantly, more direct indicators of ‘need’ for early years services suggest that living in the countryside does not protect an individual if they are poor. According to figures from the Millennium Cohort, reported levels of maternal depression are fairly constant across all locations. Indeed, the highest levels (although not significantly higher) are found in market towns. Rural women also appear to be at greater risk of lacking social support. Poor psychosocial health and lack of access to support is strongly related to the development of problem behaviours and indeed subsequent risk for mental health problems in children and families (OakleyBrowne et al, 1995; Ghate and Hazel, 2002;Wilkinson, 2005, Asthana and Halliday, 2006). It is these very families that Sure Start was designed to reach. It needs to be asked whether rural children, particularly those living in the most remote areas, are ‘being “included” on the same terms and on comparable conditions to those in more populated areas’ (Shucksmith et al, 2006: 684). It is important to acknowledge that area-based deprivation indicators and ABIs are not good at identifying and addressing rural disadvantage. Because the rural poor live among the more affluent, their poverty is hidden by meaningless statistical averages (Asthana et al, 2002). Even at the small spatial scale of the census Output Area (OA), rural neighbourhoods tend to be far more socioeconomically heterogeneous than urban neighbourhoods. Moreover, data at OA level are normally aggregated for policy purposes. As a result, the effects of pockets of severe deprivation in rural areas Policy & Politics vol 37 no 2 • 201-14 (2009) • 10.1332/030557309X411264

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are diluted. Against this background, it is hardly surprising that the government’s social inclusion programmes have tended to overlook legitimate problems such as low rural incomes and lack of access to affordable rural housing. The scale of resources that is now channelled through discretionary grants is also becoming an equity issue. In 2006/07, Hackney, Newham and Tower Hamlets received more from the Neighbourhood Renewal Fund alone than the entire budget allocated to any shire district council (whose responsibilities include the provision and maintenance of subsidised housing). The growing use of targeted initiatives thus represents a significant – and not entirely transparent – way of directing public expenditure at urban England.This is an issue that merits more attention in debates about rural service deprivation and critical consideration from the standpoint of social justice and inclusion where it is suggestive of administrative exclusion by the state with ramifications for the individual and the community that may extend (as with differential support for the early years) across the lifecourse.

Mainstream funding and rural communities: the case of NHS resource allocation Despite their limitations, area-based deprivation indicators provide an efficient way of directing funding for targeted initiatives that directly address social exclusion.The endemic use of such indicators to direct funding for core mainstream services is less rational.The distribution of NHS funding illustrates some of the contradictions that can arise from a well-meaning desire to redress poverty and inequality. An underlying concern with deprivation has guided the ways in which NHS resources have been allocated for a number of years.Thus, the Allocation of Resources to English Areas (AREA) formula (which allocated NHS funding from 2003/04 to 2008/09) took account of the age structure of populations and incorporated a range of ‘additional needs indices’ which were designed to capture healthcare needs over and above those accounted for by age (for a full description of the derivation and composition of the AREA-weighted capitation formula see Asthana and Gibson, 2008; Galbraith, 2008). Like standardised measures that control for age, additional needs indicators reveal the impact of non-demographic factors on health and are particularly responsive to the pattern of social deprivation. With per capita costs in the age index for Hospital and Community Services component of the AREA formula ranging from £269 for a child aged 5-15 to £2,799 for over 85-year-olds, it is often assumed that areas with the oldest populations have received the greatest NHS funding allocations. However, this was very often not the case. The most deprived, urban populations tend to be younger while populations in rural affluent areas tend to be demographically older. As a result, the influence of additional needs indices tends to oppose that of the age index. When the age-related and additional needs indices were incorporated into the AREA resource allocation model, the additional needs indices usually ‘won the battle’ (Stone, 2006). Thus, in many rural areas, the positive effect on funding of a relatively old population was cancelled out by the negative effect of affluence. The AREA formula resulted in profound differences in funding levels. In 200506, the average per capita funding allocation was £1,280 in the 20% most deprived Primary Care Trusts (PCTs) compared with £927 in the 20% least deprived PCTs. Policy & Politics vol 37 no 2 • 201-14 (2009) • 10.1332/030557309X411264


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When geography is taken into account, the positive targeting of NHS funds is even more apparent. PCTs serving populations in both the most deprived and most urban quintiles received the highest average per capita funding allocations (£1,323) while PCTs serving the most rural and least deprived populations received the lowest (£922) (Asthana and Gibson, 2008). This raises important questions about equity. There is no doubt that the formula directed funding at areas that suffer the worst health – in relative terms. Thus, standardised mortality and illness ratios are highest, and average life expectancy lowest, in the urban and declining industrial areas that received the highest allocations. However, it does not necessarily follow that areas suffering from the worst health inequalities also have the highest crude rates of illness.The practice of standardising measures of disease prevalence by age has become so common that it is easy to overlook the fact that, for most conditions, demography is a far more significant determinant of illness than deprivation. As people get older, they are more likely to develop long-term chronic and degenerative conditions such as heart disease, cancer, arthritis and dementia. Older people are also far more likely to die than younger people and to require the expensive, high-intensity care associated with proximity to death. As a result, although rural affluent communities are better off using standardised measures, they can have higher crude or absolute burdens of disease than their deprived urban counterparts. This issue is made the more significant by the ‘ageing’ of the rural population, which is proceeding faster than the national average and is most pronounced in the most rural areas (Champion and Shepherd, 2006). There are several indications that the NHS funding formula has underestimated the healthcare needs of rural communities. While only 6% of PCTs serving the most deprived and most urban populations ended 2005-06 in deficit, no less than 71% of PCTs serving the most affluent and most rural populations failed to break even (Asthana and Gibson, 2006). Average waiting times also varied significantly according to deprivation, indicating differences in levels of service stress. In 200405, for example, patients in the 60 most affluent PCTs had to wait, on average, 90 days for an inpatient appointment compared with 74 days in the 60 most deprived PCTs. There was, moreover, an enormous range with respect to waiting times. In Caradon, a district within Cornwall, patients had an average waiting time of 145 days. In Hackney, by contrast, patients waited on average for 54 days for an inpatient appointment. The strain produced by the chronic underfunding of rural health services (together with a drive towards large specialist centres) has been reflected in a wave of proposed closures and service reconfigurations in deficit areas. While media attention has focused on plans to target accident and emergency, paediatrics and maternity services in areas that are struggling with significantly less funding than the national average, it is the Cinderella services – elderly care, rehabilitation and support for carers – that have arguably been more silently squeezed. These services provide support for the most vulnerable in our society. They are no less deserving because they are not conveniently located in pockets of social deprivation. One could contend that progressively shifting funding towards deprived areas is an acceptable price to pay if we are to reduce the health gap between the most and least advantaged.Yet, while the goal of reducing health inequalities is manifestly about Policy & Politics vol 37 no 2 • 201-14 (2009) • 10.1332/030557309X411264

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prevention, the vast proportion of NHS resources has been spent on curative and particularly hospital services. It is generally agreed that the NHS (and particularly national hospital services) has relatively little to contribute towards the reduction of health inequalities compared with other sources of variation such as income distribution, education, housing and lifestyle.Thus, the targeting of curative services to urban deprived populations over and above levels of underlying illness is unlikely to have promoted greater equity in outcomes. At the same time, it has exacerbated inequity in access to healthcare by underestimating the needs of older but less deprived populations (Asthana et al, 2004).

Rural provision in other service sectors It is not only within the health sector that deprived populations receive significantly more funding per head for statutory services. The distribution of English local government funding (covering social services, the police, fire and environmental services) is also strongly weighted for deprivation. With shire areas receiving, on average, £382 per capita by way of Formula Funding, compared to £514 per capita in unitary authority areas, £607 per capita in metropolitan areas and £819 per capita in the London area, there is a genuine concern that funding differentials are excessive (Gibson and Asthana, 2008). Add to these figures the billions targeted in discretionary grants and it is clear that public expenditure is strongly targeted at urban England. It is difficult to assess the degree to which this focus accords with the fair access to services and opportunities demanded by the social justice agenda. The government places considerable faith in its ability to develop scientific objective resource allocation formulae that distribute funding in relation to population need. Perhaps because of this, less effort has been made in collecting data that can show whether or not people living in similar circumstances with similar needs have access to similar services.There are, however, worrying signs of a postcode lottery in core service provision. With respect to adult social services, the proportion of over 65-year-olds who are helped to live at home is 40% higher in London boroughs than in rural counties and twice the rate of London pensioners receive intensive home care (Audit Commission, 2006). At the other end of the age spectrum, early education and childcare settings in urban areas are significantly more likely to employ qualified staff than county settings (Taggart et al, 2000). Large variations have also been found in provision for pupils with special educational needs (SEN). Little is known about geographical inequities in SEN provision. However, pupils with low incidence needs such as autism and multisensory impairment appear to be particularly disadvantaged (House of Commons Education and Skills Committee, 2006: 30–1). These are vulnerable children. Rather than using complex geographical formulae that use dubious proxy indicators to identify need, national eligibility and assessment criteria should be used to ensure that the needy and the disadvantaged are protected irrespective of where they live.



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Conclusion There has been an unfortunate tendency to assume that because rural communities are, on average, more affluent than urban communities, they have significantly lower needs for public services. This article has sought to challenge this perspective from the perspective of both reducing social exclusion and promoting social justice. If social inclusion is to remain a core aim of public policy, then the focus of concern must go beyond the needs of highly deprived urban neighbourhoods to admit the vast majority of the poor who live outside these areas. Services that support the most vulnerable in society are in danger of becoming so constrained in areas suffering shortfalls in public sector funding that the vulnerable poor living in more affluent places may well receive less support than the moderately well off living in poor places. This is not compatible with ‘fair’ funding formulae. We have also sought to argue that the pursuit of social justice and the challenge to systemic exclusion means that concern should not be restricted just to the poor and disadvantaged.The distribution of mainstream statutory spending seems to imply that those who enjoy better circumstances should not expect the same level of service as the deprived. Yet, key services such as hospitals, schools, roads and community amenities have been established and maintained as universal services, not just residual services for the poor. Universalism has been a core principle of those committed to social justice. By supporting the practice of narrowly targeting public services, the government is at risk of abandoning that principle. In the health sector, at least, there is a real danger that, if funding formula continue to shift resources progressively in favour of deprived areas, two national health services will emerge. One, predominately urban, northern or metropolitan, will be increasingly well resourced and offer a comprehensive range of service options on a timely basis. The other, operating largely in rural, suburban and relatively affluent England, will be an ever more hard-pressed service adjusting to progressively lower levels of relative per capita funding, with those who can afford to do so turning increasingly to the private sector.The implications for social justice and equity and for any definition of social exclusion that includes a commitment to distributional equality (Levitas, 2005) are profound. Acknowledgements We would like to thanks the referees of this article for their very helpful comments. References Agyeman, J. and Spooner, R. (1997) ‘Ethnicity and the rural environment’, in P. Cloke and J. Little (eds) Contested countryside cultures: Otherness, marginalisation and rurality, London: Routledge, pp 197–217. Anderson,A. (2007) ‘Spinning the rural agenda’, in G. Giarchi (ed) Challenging welfare issues in the global countryside, Oxford: Blackwells, pp 140–56. Asthana, S. and Gibson,A. (2006) ‘The relationship between the funding formula, the allocation of funds to trusts and the size of their deficits or surpluses’, in House of Commons Health Committee (ed) NHS deficits: Volume II: Written evidence, London: The Stationery Office, pp 152–59. Policy & Politics vol 37 no 2 • 201-14 (2009) • 10.1332/030557309X411264

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Sheena Asthana, School of Law and Social Science, University of Plymouth, UK, [email protected] Joyce Halliday, University of Plymouth, UK, [email protected] Alex Gibson, University of Plymouth, UK, [email protected]
