Michael Oliver’s research while affiliated with University of Central Lancashire and other places

This final chapter will attempt to bring together some of the issues thrown up by attempting to apply the social model of disability to social work as an organised professional activity. It will begin by looking at some of the conclusions and recommendations that were made in the first edition of this book 15 years ago, in 1983, and will then consider what progress if any has been made and what now needs to be done.

The distinction between individual and social dimensions of disability already referred to are also important in discussing the causes of both impairment (individual limitation) and disability (socially imposed restriction). From an individual/ medical view the main causes of impairment can be seen in Table 3.1.

A major theme of this book is that social work, as an organised professional activity, has given little thought to the problems of disability, and where it has it has merely reproduced traditional thinking in its application to social work practice. A second theme is that much of this traditional thinking about disability is inaccurate and incorrect at least in that it is incongruent with the personal experiences of many disabled people. A third theme will be to develop more appropriate thinking about disability and to draw out some of its implications for the practice of social work.

Living within a family or in residential accommodation can be disabling for impaired people, and in the wider context all impaired people are disabled to a greater or lesser degree by the society in which they live. The social model of disability suggests that impaired people in Britain may face educational disability, employment disability and economic disability, and it is perhaps somewhat ironic that some of the legal measures taken to combat such disadvantages actually further contribute to the disabling process. This chapter will focus upon some aspects of this relationship between disabled people and society and consider some of the possible intervention strategies for social workers. To begin with the discussion needs to be placed in the context of legislation relating to disability.

Prior to 1970 help for disabled people and their families was really only available through the health service (medical social workers) or voluntary organisations such as the Invalid Children’s Aid Association and the Spastics Society. A few local authority health departments set up professional social work services in the 1950s, staffed mainly by medical social workers and in some cases occupational therapists as well. Welfare departments in the pre-Seebohm days also offered services to disabled people, but as most did not employ trained social workers little was done beyond material help and information-giving, while some provision was made for residential care. However, the Seebohm Report, local government reorganisation and the Chronically Sick and Disabled Persons Act 1970 was supposed to change all that and usher in a new era. Following this a number of other developments and reorganisations of social welfare, in particular the community care ‘reforms’ of the 1990s through the National Health Service and Community Care Act 1990 but also the Disabled Persons (Services, Consultation and Representation) Act 1986, the Children Act 1989 and the more recent Community Care (Direct Payments) Act 1996 have transformed the organisation of the statutory social services. Just what this has meant as far as social work with disabled people is concerned will thus be a major theme of this book.

In the previous chapter, one of the main difficulties that disabled people faced at all ages was how to maintain relationships with their families while also achieving a level of independence and autonomy within them. Leat (1988) suggests that the pressures of dependency within families is the most significant cause of disabled people having to enter residential care, though this analysis was part of the Wagner report into residential care which was concerned to promote its positive use but failed to consider the impact of poor community services on these relationships. This impact may also account for the fact that disabled adults are far more likely than non-disabled people to be living alone. In 1986, 30 per cent of disabled adults were living alone (Martin et al., 1989) which compares with just 11 per cent of the whole population at the time of the 1991 census. As would be expected, the proportion rises with age but even if only those under 65 years are considered, some 16 per cent of disabled adults are still living alone. This has significant implications for the provision of both housing and personal assistance which would enable these individuals to live independently, but also for the provision of support to those within families.

The social model of disability can be a useful and sensitising perspective in considering the implications of disability for family life. There are three ways in which the ‘disability relationship’ discussed in the previous chapter is important here. To begin with, the disablement of an impaired individual may be exacerbated by the way he or she is treated by the family, as with the way some disabled children are overprotected by their anxious parents. In addition, family structure and stability may be adversely affected by one of its members becoming disabled, though it is important to note that such an occurrence may strengthen rather than weaken familial ties in some situations. Finally, there is the question of the way society treats families, through social policy provision, where there is a disabled member.