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SPICKER, P., 1993. Needs as claims. Available from

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SPICKER, P., 1993. Needs as claims. Social Policy and

Administration, 27 (1), pp. 7-17.

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Needs as claims

Paul Spicker

Social Policy and Administration 1993 vol 27 no 1, pp 7-17.

Abstract. People 'need' things if they will suffer negative effects without them. Needs are
based in problems, but they are not only problems; they have to be understood in terms of
a relationship between functional problems and resources. Needs are a form of claim
made against services.
The concept of 'need' is not decisive in the allocation of resources, and this paper
argues that the concept has to be understood as a form of claim-language. Once needs
are understood in terms of claims, many of the apparent difficulties in conceptualising the
issues dissolve; the main conflicts are between different types of claims, rather than
contested definitions of need. Similarly, the establishment of priorities between greater
and lesser needs depends on the strength of the claim which the needs present, and the
context in which services operate, rather than on intrinsic comparisons between different
levels of need.
It follows that need is often not the sole, or even the primary, determinant of the
legitimacy of a claim. Greater needs only have priority over lesser ones if they also
constitute a claim of a different, and stronger, kind.

'Needs' commonly refer to the kinds of problem which people experience: for example,
people who suffer from mental or physical impairments are deemed to have 'needs' on
that basis. 'In a general sense', Feinberg writes,
'to say that S needs X is to say simply that if he doesn't have X he will be harmed.'
(Feinberg, 1973, p.111)
The statement makes the central point that 'needs' primarily relate to negative effects.
The idea of 'harm' is not a very clear one; people's interests can be harmed if they lose
opportunities or privileges, for example; but for practical purposes it helps to focus on
the most important welfare interests. People need, for example, shelter, food, and
clothing; a person without these things will suffer negative effects, whatever the reason.
Doyal and Gough interpret harm primarily in terms of an impaired ability to participate in
society - a form of social disability. (Doyal, Gough, 1991, pp 2, 50-51)

It can sometimes be difficult to distinguish negative effects from the absence of positive
ones: if a child 'needs' education, this may be seen as much as a comment on the positive
benefits of education as on the negative effects of the lack of it. But a positive benefit
whose absence has no obvious negative effects - like, say, the lack of a birthday party or a
hobby - should not be considered a 'need'. Items of this sort are sometimes referred to
as 'luxuries' - though there is often some contention as to just which items should be
seen as luxuries (there is survey evidence to dispute the definition of both the examples I
have given: Frayman, 1991), and whether negative effects are incurred by their absence.

Feinberg's other main point is that a need must be a need for something. A person may
suffer harm, for example, as a result of an accident, but it is difficult to identify this as a
ground for 'need' in itself; the only 'needs' would be measures either to avoid the harm
initially or to alleviate it subsequently. A specific item is only needed if there is no
alternative. It is possible to say that people need food, but not that they need beef and
not lamb (unless there is a special reason why one item cannot be substituted for
another). The regulations for Supplementary Benefit single payments used to embody a
principle that a person should not be considered to be in need if they had 'failed to avail
themselves of a suitable alternative item'; I think this is right in principle even if it was not
always applied appropriately in practice.
Page 2

Doyal and Gough (1991) argue that needs can be seen as 'objective' interests. But they
also link this lack, explicitly, to a concept of social justice. People who are in need are not
simply people who have a problem; they lack something which will remedy that problem
(Feinberg, 1973). There are circumstances in which people with a degree of impairment
have no identifiable 'needs' as a consequence: for example, people who are intellectually
handicapped, even if they are disadvantaged by their handicap, may well live a fulfilled
life, manage their self and household care satisfactorily, maintain an occupational role,
and have full personal and social relationships. They are usually thought of as having
'needs' when they have needs for particular kinds of provision of services - a need for
housing, for medical care, for domestic support. This implies that problems have to be
interpreted, or operationalised, as requiring a particular kind of response; and properly
speaking, the definition of a 'need' is determined by the relationship between functional
problems and possible responses.

If the issue is not so much that people have problems, as that they do not have the
resources to resolve them, discussions of needs are liable to become discussions about
resource allocation. One implication is that the process of interpretation is liable to
depend greatly on the kinds of responses which are available (Spicker, 1987). Another is
that whether people are considered to have a need depends greatly on the resources
which are available to them. People with mobility difficulties might be considered to
need adaptations to their home, because provision of for such items is widely made; but
people with respiratory problems are unlikely to be thought of as 'needing' air
conditioning, not because such provision is necessarily inappropriate but because, in the
UK, it is simply not available.

Some commentators have argued that the idea of 'need' is an empty one; it is more
appropriate, they argue, to consider the issue of demand (Williams, 1974; Nevitt, 1977).
A person who has a problem, and whose problem might be appropriately responded to
by a particular service, does not necessarily present a demand to that service.
Conversely, there may be those who do demand services effectively - the demand for
residential care for elderly people is a case in point - even though they do not experience
the problems or their problems are not best met by the responses available. It is clear,
whatever their basis, that needs are the substance of a wide variety of competing and
conflicting claims for service, and some choice between them is necessary when seeking
to resolve these claims or to decide on an appropriate method of distribution.
The identification of 'need' constitutes a claim to service; the differentiation of various
'needs' distinguishes between people who are demanding services according to the
strength of their claim. The language of 'claims' has been used elsewhere in a slightly
different context; Rein proposes it as a substitute for the language of 'rights' (1983, ch 2).
But 'rights' and 'claims' are not directly equivalent: there are rights, like privileges and
immunities, which are not claim rights (Weale, 1983, ch 7), and a claim of right is a claim
of a special kind, which appeals to a set of moral values. Needs are not the only basis on
which claims can be made; people can equally base claims for service on other kinds of
concept, like rights, waiting time, desert or contribution to society. However, if needs
entail responses, there are no needs which are not in some sense claims.

Definitions of need

The many ambiguities in the definition of need have been the source of much of the
academic discussion of the concept to date. Bradshaw's 'taxonomy' of need (1972)
distinguishes normative need (established by experts) from comparative need. The
contrast of these ideas with 'felt' and 'expressed' need serves to draw attention to the
question of who defines need as constituting a claim for service. Both normative and
Page 3

comparative need rest on some external arbiter. There are cases in which expert
assessment outweighs individual judgment. The most important are those where people
are considered unable to exercise a responsible choice - children are required to attend
school, and mentally ill people may be committed to institutions for medical treatment -
but there are other examples without this qualification, like the fluoridization of water
supply in order to reduce dental caries.

If 'need' depends on the degree of suffering, it may be difficult to assess from the
outside, and there is an argument to say that felt need should be taken into account in
attributing priority between competing claims. An example of the kind of conflict which
may arise can be found in applications for rehousing. Should a person who suffers
depression or stress as a result of insecurity or poor housing conditions be given priority
over someone else who does not? This would usually be considered inequitable in
housing allocations, because it would penalise those who attempt to cope with equally
unsatisfactory conditions, and few if any allocations schemes would take account of it
(Spicker, 1987). The main cause of homelessness is the breakdown of relationships in
the previous accommodation; the failure to take stress into account may arguably have
found an outlet in applications for rehousing by homeless people.

The argument that individuals are the best judges of their own needs may be extended
to the view that need has to be 'expressed' by the person who has it. 'Expressed' need is
a direct claim for priority. This is not directly equivalent to 'felt' need; a person may feel
a need without expressing it. Bradshaw suggests that 'one does not demand a service
unless one feels a need', but this is debatable; people might also demand services on the
basis of entitlements (like Child Benefit, and perhaps some of the services to younger
pensioners), and they might even be required to represent felt entitlements in terms of
need (like students claiming benefits on the basis of low income). A reliance on
'expressed' need puts the onus on the individual to claim a service, which is the normal
pattern in British social services. Social security benefits have to be claimed (and,
notoriously, people are not in general informed of what they might claim); people have
to apply for council housing; sick people have to present themselves in order to receive
medical care. This can be defended from the point of view of individual freedom - people
should not be forced to have services that they do not want. But there are arguments
against this method of establishing need. The expression of need assumes that people
know the service is available to them; the evidence from social security benefits is that
they may not. People may be deterred by the cost or inconvenience of applying for
services. And many people are reluctant to claim. For whatever reasons, many people
do not receive means-tested benefits they are entitled to receive; and in the health
service - a model of universal care accessible to all - those in the lower social classes
receive less service despite a greater incidence of serious illness (DHSS, 1980).

The potential for conflict between the needs of individuals is evident, because they are in
competition for resources. But conflicts between individuals are not the only kind. Rae
(1981) points out that arguments for redistribution have increasingly become concerned
with blocs in society. One example of this trend is the idea of territorial, 'area-based'
policies, which attempt to alleviate disadvantage by providing resources to everyone
within a particular geographical area. The problem with this approach is that need is not
confined to particular locations (Holtermann, 1975); research undertaken on Educational
Priority Areas found that the majority of children living in them were not deprived and,
more important, that the majority of deprived children did not live there (Barnes, Lucas,
1975). A policy which seeks to redistribute resources between areas may exacerbate the
problems of people who are badly served in areas which otherwise are well provided for.
The Resource Allocation Working Party in the NHS has redistributed money from London,
which has been a centre of high-cost medical expertise, to other regions; but it has also
led to complaints in poorer districts (like Southwark) where the level of service continues
Page 4

to be inadequate. Equally, policies which have concentrated on the disadvantages of

groups of people - like women and ethnic minorities - may conflict with problems of
other kinds. A policy which is concerned to correct the educational disadvantage of some
ethnic groups may effectively take place at the expense of others who are disadvantaged,
whether as individuals or as groups. The demand for equal opportunities for women to
occupy important positions may, at the individual level, favour a socially advantaged
woman over a socially disadvantaged man.

Societies can also be said to have 'needs', in the sense that there are measures which
help to avoid negative or harmful effects to people as a community (Spicker, 1988, ch 1).
If the justification for the satisfaction of need is that negative effects are to be avoided,
there is equally a case for avoiding negative effects for a whole society. Social services
have a number of possible functions which might be seen to meet social needs, rather
than individual needs. There is a 'handmaiden' function, complementing the industrial
process: education benefits industry by training workers, the health service keeps them
fit for work. Social services may exercise social control, as they do in the probation
service or in deterring people from voluntary unemployment. (And there are cases - like
the treatment of mental illness - where the function of social services is ambiguous,
uncertainly poised between the needs of individuals and society.) Once again, then, the
greater need of one individual may not be decisive; it has to be set against not only the
needs of others, but against needs of different types. Society's needs encompass such
issues as maintenance and reproduction. Arguably the same criteria may help to explain
the relative priority given to the geriatric patients in the health service; because their
contribution to society is considered to be less than others of working age, and because
they are less likely to benefit from the available treatments, they may receive a lower
level of service.

What may seem at first to be competing conceptions of need can be interpreted in a

much weaker sense; they are simply competing claims of need. The strength of such
claims depends, not on the intrinsic validity of the concept of 'need' to which they are
referred, but on other factors entirely, like political support, perceived legitimacy and the
normative framework in which the claims are made.

Priorities between needs

Given competing claims, it may seem difficult in theory to allocate priority directly
between alternative types or definitions of need. Susan Clayton (1983) criticises
Bradshaw's 'taxonomy' because it is not geared to deal with operational issues. There is
no obvious way, for example, to determine which is greater, an expressed need or a
normatively defined one, or to weigh the claims of an individual against an area. She
identifies the difficulty, I feel, but not its source. Because needs depend on a relationship
between functional problems and responses, they can only be understood in the light of
practical constraints; but this relationship does not feature in Bradshaw's classification.

The idea of need depends strongly on the context in which it is applied. Rein (1983)
argues that services are not always formed by reference to principles; it also happens
that principles are defined in terms of the way that services respond to them. In council
housing, the emphasis in service delivery on openness, consistency and administrative
simplicity has led to a definition of need strongly dependent on the use of precise and
measurable indicators of need, like overcrowding and lack of amenities (Spicker, 1987).
The definition of disability in the industrial injuries scheme is clearly influenced by the
intention to establish relatively unambiguous criteria for compensation - a system which
leads, in practice, to a person who loses three toes receiving greater compensation than
someone else who has only lost two. By contrast, the vagueness in many authorities of
the criteria for admission to day nurseries reflects not so much the complexities of
Page 5

underlying needs (disability and housing need are also complex) as the desire in personal
social services for a flexible response, coupled with the determination of social workers
to retain a high degree of professional discretion.

Where claims do compete, priorities are often represented in terms of 'greater' or 'lesser'
needs, and it is assumed that priority should be given to people with greater needs. In
the health service, other things being equal, a broken leg generally commands greater
priority than an ingrowing toenail. In housing, it is consistently argued that 'councils
should let their houses to the people in greatest need' (for example, the Director of
Shelter (Scotland) in Inside Housing, 1986). (In social security, by contrast, there is great
suspicion of any concentration on 'need'; this principally reflects concerns about the
defects in the methods used and the limited adequacy of selective benefits.)

'Greater' and 'lesser' need are not terms which can be established solely by reference to
the size of the problem; they also have to take into account what is needed. If all needs
are needs for something, the strength of a claim based in need must derive from either
the quantity or quality of what is needed, or the suffering which is caused by its absence.
The first of these alternatives - that a person who needs more has a greater need - is
superficially attractive; a person whose income falls substantially below a poverty line has
a greater need than someone who is only marginally below it. But this case could also be
seen as establishing a degree of suffering, and there are other examples which cannot be
interpreted in the same way. I do not think one would say that a person who lives in an
unfit house has the same need for rehousing as someone else whose house has just
burned to the ground - although the quality and quantity of what they both need may be
identical. It is, then, the degree of suffering or damage which defines a person as being in
'greater' or 'lesser' need.

Bradshaw's distinction of 'normative' and 'comparative' standards of need is important

here, because it implies different approaches to the issue of prioritisation. A normative
concept of need is one which depends on the definition of a norm, or a specific level at
which negative effects begin. The idea of 'absolute poverty', to take a well known
example, describes a minimum standard needed to live, or 'subsistence'. There are few
examples of this position in practice - the absolute concept is something of a straw man -
but there are examples, at least, of the establishment of minimum standards: Seebohm
Rowntree defined a concept of primary poverty, where people have less than is necessary
for subsistence (Rowntree, 1922).
If needs are normatively defined, then on the face of it a person either is or is not in
need. But not all needs are equally important, and the claims which they represent are
not necessarily of the same strength. People are not simply said to be 'poor' or 'not
poor'; they may be destitute (almost totally without resources), poor, deprived, or
disadvantaged. Within these categories, there are further gradations - like 'very poor',
'poor', 'fairly' poor. These are not precise terms with a universally agreed meaning, and
they may overlap with the other categories; there is no clear distinction, for example,
between 'fairly poor' and 'deprived'. In the case of other 'needs', there are gradations
made between those things which are needed more and those which are needed less.
This may mean either that both things are necessary, but one is more important than the
other; or that a condition has only been partially satisfied. People in general need food
to live, and to be healthy; the food might be enough to preserve life but not health. A
person without any food at all is more 'in need' than someone who does not have food
which is adequately nutritious, but it makes perfectly good sense to talk about both
people as being 'in need'. The 'greater' need, though, is the one which implies a lower
standard of existence, or a greater degree of suffering.
Page 6

The basis of priority in allocation, on this model, is that certain strata of need have to be
addressed before others. The effect of clearance and modernisation policies in Britain
has been substantially to improve the basic level of housing, so that although people are
still in need through problems of dampness and disrepair, the old problems of houses
without water supplies or sanitary facilities have largely been eliminated. But it is not
necessarily the case that greater needs must be addressed first: a utilitarian calculus,
which aimed to promote the 'greatest happiness of the greatest number', or a cost-
benefit analysis, might imply a different outcome.. There are circumstances in which one
may deal with many lesser needs for the cost of one large need - for example, in the
choice between saving a life with one expensive operation, or performing several minor
operations which relieve severe discomfort. The QALY, or 'quality adjusted life year', is a
means of comparing the cost-effectiveness of different treatments. Properly speaking,
QALYs provide a means of evaluating different patterns of expenditure rather than an
assessment of the strengths of different claims, but it seems clear that QALYs can also be
the basis for the relative assessment of different priorities (Richardson, 1992). If a hip
replacement buys a QALY for £700, and heart transplantation for £5000 (Ham, 1992,
p.253), it seems to follow that hip replacements are a more efficient way of meeting
need, and so that there should be more hip replacements - even though the comparison
is hardly between similar conditions. The point here is not that people with a broken hip
have a greater need than those with serious heart problems - if anything, the reverse is
the case; but they may have a stronger claim once resource issues are considered.

Comparative needs, by contrast, are defined wholly by comparison with others. A person
who would be considered 'poor' in Britain might be 'well off' in the terms of the Third
World. Different standards are being applied, based on comparisons within societies
rather than between them. Perhaps the best known example of this is the concept of
'relative' poverty, though as it is commonly used - for example by Townsend (1979) - the
idea of relative poverty conflates two distinct propositions. The first is that poverty is
socially defined. This is unarguable, but it is not inconsistent with the absolute view:
'food' or 'shelter' mean different things in different societies. The second, which is more
contentious, is that poverty is necessarily understood in terms of inequality. On this
basis, words describing degrees or levels of need - like 'deprivation', 'poverty' and
'destitution' - cease to have any intrinsic meaning; their sense can only be determined by
comparison with the circumstances of others. At the same time, there is little difficulty in
understanding the idea of 'greater' and 'lesser' needs. A concept of need based in
inequality is transitive, which means that if A is judged to be in need compared to B, and
B is in need when compared to C on the same criteria, then A has the greatest need and C
the least. A comparative concept of need implies, then, a relative judgment about the
claims which are presented. In practice, this is much of what 'needs assessment' is about:
an example is the measurement of area deprivation in terms of the relative prevalence of
problems in different areas (e.g. Jarman, 1983; Townsend, 1987). The procedure is
problematic; there is a risk in the assessment of needs of drawing distinctions between
cases where there is no real difference; so, area-base policies give preferential treatment
to areas where there is 50% unemployment over those where there is only 35%, and
housing points schemes might give priority to people with no hot water, bath or
washbasin to those who have no hot water or bath but who do have a basin.

If need is understood in a comparative sense, then the reduction of need is primarily a

matter of reducing inequality, and one means of doing so is by giving priority to greater
needs. But it is also possible to reduce inequality in other ways. Rae outlines four basic
strategies for the reduction of inequality: 'maximin', which is raising the floor, 'minimax',
which is levelling down, changing the ratio between lower and higher brackets, and 'least
difference', narrowing the gap between top and bottom (Rae, 1981). Maximin and least
differences imply that priority should be given to the greatest need; but minimax and
ratio strategies do not, because they do not necessarily focus on those who are most
Page 7

disadvantaged. It might, for example, be argued that the way to create greater equality
for women and racial minorities is initially to open opportunities and access to positions
of power and status (the kinds of arguments which have informed 'affirmative action' in
the US: see Dworkin, 1978).

The determination of priorities probably depends more on the context in which services
operate than on any specific conception of need. Needs can be understood only in
relation to resources, and in the allocation of scarce resources the main difficulty is to
decide between competing claims which may all have a high degree of legitimacy. In the
allocation of finance, like discretionary payments in social security, it could be argued
that the most effective use of resources in relieving need might be to offer limited,
marginal benefits to many people. The position can be justified in both normative and
comparative terms. If 'need' is understood normatively, then depending on the structure
of those needs, small improvements could shift many people to lesser levels of need. If it
is understood in the comparative sense, marginal improvements can reduce inequality; in
Rae's terms, the effect is egalitarian not through 'maximin' but rather through the 'ratio'
of inequality. But it is difficult to apply these arguments more generally; there are some
resources which cannot be divided. When a council house is let, it can only be to one
household in need. There is a strong case here to concentrate on the greatest need,
because the effect of diverting to a lesser need will diminish the effectiveness of the
response in reducing need. It is necessary to consider, not only the problems which give
rise to the claim, but the means through which that claim might be met.

The legitimacy of the claim

The strength of a claim depends on other factors besides need, including the pattern of
responses which is available; it follows that claims based in needs (and even serious
needs) are not necessarily sufficient to determine the provision of service in themselves.
At the same time, some claims are recognised for certain needs which seem almost
marginal, in terms of the degree of suffering involved - examples are the system of
compensation for industrial or war disablement, or the extra money given to pensioners
on Income Support who pass the age of 80 - nearly four pounds per week more than
those aged 75-79. The explanation is simple enough: the need itself is not the sole, or
even the primary, determinant of the legitimacy of a claim.

The legitimacy of a claim - its moral strength - depends in the main on social values.
There are moral duties which require all of us to reduce the suffering of others -
'humanitarian' principles, and the duty of charity. These are sometimes subject to certain
conditions, like the 'desert' of the recipient. This sometimes may mean that a person
who has behaved immorally has forfeited any right to be helped as a member of society,
but more usually it implies that someone who has failed to avail his or herself of an
alternative (like unemployed people who 'refuse' to work) is not considered to be
genuinely 'in need'.

Equally, there are rights which reside in the recipient. Up to this point, I have referred to
needs as if they constituted a ground for claiming in themselves, which implies that a
person who has a greater need than another person also has a stronger claim when other
things (like resources) are equal. But it can also be argued that the claim is based, not
direclty in the need itself, but indirectly in the rights which legitimise a claim for service.
This is, I think, the principle behind the National Health Service. The NHS is sometimes
referred to as 'universal', a term which emphasises that even though people are in fact
selected and treated according to their need, all people are treated on the same basis,
through an 'institutional' concept of welfare. The NHS treats all normatively recognised
needs, not only those which are most serious. The institutional model rests in the view
that everyone is likely to experience need at certain times during their lives, and then
Page 8

when these needs occur they have a right to services. This is very much the pattern of
the 'Welfare State'. A welfare state is one which offers optimal services to all its citizens
as a matter of right. This implies that there will be a portfolio of services which add to
the quality of life of all the citizens. It is arguable whether there is any case for a
hierarchically or rationally ordered set of services weighted according to the priority of
the need, because this would reduce the comprehensiveness of the coverage.

This suggests a different approach to considering claims based on 'need'. A person who is
in greater need may have a claim to more service than someone in lesser need, but this is
not the same as saying that this person has a stronger claim - someone who has broken
two legs does not, on the face of it, have a stronger claim to medical care than another
person who has only broken one. In the case of the QALY, because no-one has a greater
right to a QALY than anyone else, the financial assessment is likely to become the
deciding factor in the determination of priorities. The claims for service depend on
rights, and the rights are of equal weight. If some needs do present higher priorities than
others, it is because they are associated with different rights. The right to continue living
is generally speaking greater than the right to avoid discomfort, because the second can
be negated by the first; this should also mean that a person who needs food to avoid
starving, or a person who needs medical attention to survive, has a greater right than
someone with a lesser need. On this model, priority to those in greater need depends
on the rights which the needs represent, not on the degree of suffering in itself. At the
same time, rights to different services can be based on factors which are related to need,
but which go well beyond the issue of suffering - like citizenship, age, desert, or
contribution - and it is far from clear that the primacy of the need will determine the
outcome.

This might suggest that there are contexts in which the language of rights, rather than
the attribution of problems, would be an appropriate way to refer to certain needs. Even
so, rights determine priorities only when 'other things are equal', and it may be legitimate
to meet needs on the basis of considerations other than the rights of the recipients. The
legitimacy of provision (and so, the moral strength of a claim) depends on a wide range of
values and norms, not only on the strength of particular rights; the case for concentration
on the greatest need seems, in general, to grow weaker as the focus shifts from the
individual to the wider society. The issue of priority between needs is made complex, not
only because it is necessary to qualify initial propositions about need to take into account
complex and varied circumstances, but because it represents a debate about principles.
The initial strength of a claim on the grounds of need may be dependent on its ability to
establish a right. Rights, however, are only recognised within the context of a framework
of values, and the strength of a claim of 'need' is necessarily diminished if it conflicts with
these values.
Page 9

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