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The purpose of this paper is to offer a working de®nition of social exclusion and to operationalize it in such a way that an initial empirical analysis of social exclusion in Britain today can be undertaken. After a brief review of conceptions of social exclusion and some of the key controversies, we operationalize one de®nition based on the notion of participation in ®ve types of activityÐconsumption, savings, production, political and social. Using the British Household Panel Survey, indicators for participation on these dimensions are developed and analysed both cross-sectionally and longitudinally for the period 1991±5. We ®nd strong associations between an individual's participation (or lack of it) on the ®ve different dimensions, and on each dimension over time. However, there is no distinct group of socially excluded individuals: few are excluded on all dimensions in any one year and even fewer experience multiple exclusion for the whole period. The results support the view that treating different dimensions of exclusion separately is preferable to thinking about social exclusion in terms of one homogeneous group.

Can we rely on the public service ethos to deliver high quality public services? Are professionals such as doctors and teachers really public‐spirited altruists—knights—or self‐interested egoists—knaves? And how should the recipients of those services, patients, parents, and pupils, be treated? As passive recipients—pawns—or as active consumers—queens? This book offers answers to these questions. It argues that the original welfare state was designed on the assumptions that those who worked within it were basically altruists or knights and that the beneficiaries were passive recipients or pawns. In consequence, services were often of low quality, delivered in a patronising fashion and inequitable in outcome. However, services designed on an opposite set of assumptions—that public service professionals are knaves and that users should be queens—also face problems: exploitation by unscrupulous professionals, and overuse by demanding consumers, especially middle class ones. The book draws on evidence from Britain and abroad to show that, in fact, public policies designed on the basis that professionals are a mixture of knight and knave and recipients a mixture of pawn and queen deliver better quality and greater equity than policies based on more simplistic assumptions about motivation and agency. In particular, contrary to popular mythology, the book shows that policies that offer choice and competition within public services such as education and health care can deliver both excellence and equity. And policies aimed at building up individual assets and wealth ownership can empower the poor and powerless more effectively than those aimed simply at bolstering their current income.

There are two fundamental changes currently under way in the welfare state. These are the development of quasi-markets in welfare provision, and the supplementation of 'fiscal' welfare by 'legal' welfare: policies that rely on redistributing income through regulation and other legal devices, instead of through the tax and social security system. This article argues that these changes are in part the result of a fundamental shift in policy-makers' beliefs concerning human motivation and behaviour. People who finance, operate and use the welfare state are no longer assumed to be either public spirited altruists (knights) or passive recipients of state largesse (pawns); instead they are all considered to be in one way or another self-interested (knaves). However, since neither the 'new' nor the 'old' set of assumptions are based on evidence, policies based on the new set are as likely to fail as those based on the old. What is needed are 'robust' policies that are not dependent on any simple view of human behaviour. 'In contriving any system of government, and fixing the several checks and controls of the constitution, every man ought to be supposed a knave and to have no other end, in all his actions, than private interest. By this interest, we must govern him and, by means of it, notwithstanding his insatiable avarice and ambition, co-operate to the public good. ' (David Hume, 1875, pp. 117-18) 'If it is accepted that man has a sociological and biological need to help, then to deny him opportunities to express this need is to deny him the freedom to enter into gift relationships. ' (Richard Titmuss, 1971, p. 243) There are two fundamental changes currently under way in the welfare states of Britain and other developed countries, each rather different from the other. One -the replacement of the state provision of

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This article outlines a theory of government failure that parallels the more well-established theory of market failure. It builds on the work of the public choice school concerning the behaviour of governments under the assumption that all relevant agents pursue their selfinterest. It examines the theoretical consequences for efficiency and equity of three kinds of government activity: provision, subsidy and regulation. The conclusion is reached that all three may create inefficiency and inequity, but that the form and magnitude of the failure will differ with the type of activity; hence it is important that the three are distinguished. It is also emphasised that the extent of government failure in each case (and whether it is greater or smaller than the corresponding areas of market failure) is ultimately an empirical question, not a theoretical one.

Objective To determine whether observable changes in waiting times occurred for certain key elective procedures between 1997 and 2007 in the English National Health Service and to analyse the distribution of those changes between socioeconomic groups as an indicator of equity. Design Retrospective study of population-wide, patient level data using ordinary least squares regression to investigate the statistical relation between waiting times and patients' socioeconomic status. Setting English NHS from 1997 to 2007. Participants 427 277 patients who had elective knee replacement, 406 253 who had elective hip replacement, and 2 568 318 who had elective cataract repair. Main outcome measures Days waited from referral for surgery to surgery itself; socioeconomic status based on Carstairs index of deprivation. Results Mean and median waiting times rose initially and then fell steadily over time. By 2007 variation in waiting times across the population tended to be lower. In 1997 waiting times and deprivation tended to be positively related. By 2007 the relation between deprivation and waiting time was less pronounced, and, in some cases, patients from the most deprived fifth were waiting less time than patients from the most advantaged fifth. Conclusions Between 1997 and 2007 waiting times for patients having elective hip replacement, knee replacement, and cataract repair in England went down and the variation in waiting times for those procedures across socioeconomic groups was reduced. Many people feared that the government's NHS reforms would lead to inequity, but inequity with respect to waiting times did not increase; if anything, it decreased. Although proving that the later stages of those reforms, which included patient choice, provider competition, and expanded capacity, was a catalyst for improvements in equity is impossible, the data show that these reforms, at a minimum, did not harm equity.