Andrew Russell says social services must get involved if they
want to change disabled people’s lives.
I can see a problem looming for disabled people. It is to do
with health professionals, social services professionals and
disabled people themselves. The perspectives of these three groups
do not match up very well, but may unwittingly combine to form a
very undesirable recipe for the future delivery of services.
Disabled people have long campaigned for inclusion. They do not
want to be seen as a health problem, a bundle of symptoms to be
solved, researched or alleviated. Yes, they need health care like
everyone else, but they also need other help. Because this other
help is complicated, long-term and hard to formulate, it only comes
to the lucky (or persistent) few.
In claiming autonomy from a medically colonised past, disabled
adults have not yet achieved the sort of personal social service
many really need. Not to be controlled, but supported, encouraged
Social services have, by and large, forgotten about disabled
people in terms of assisting them develop and understand and take
control of their own situation. There is little worry of scandals,
compulsory treatments and crises in work with disabled people. The
pressures of strands of social work where these dangers do lurk
means that physical disability cases do not get allocated. They
certainly do not receive long term support.
Health professionals have a lot to offer. But whatever some may
say, it isn’t the province of paediatricians, orthopaedic surgeons
or even GPs to lead the complex support for a person with a severe
impairment living in modern society.
Enter reorganisation: a lot of jockeying is about to go on among
health and social services purchasers and providers, in which the
social needs of low profile groups such as those with physical
disabilities are likely to be an afterthought.
The perennial tendency to define physical disability in terms of
a medical diagnosis, a missing limb or a loss of function, will
play into the hands of health specialists who want to “solve”
problems with a pill or an operation. It is the social implications
of daily living that feature most strongly in the minds of disabled
people most of the time. Actually, social services staff understand
this very well, and it is time to stake a claim.
What is needed – and what I contend is a social services lead
role – is a key worker system. This should offer strong support,
particularly through transitions, by effectively linking with other
services such as further education, housing, training of various
kinds, employment and voluntary sector organisations.
While cost will be involved for social services, much of the
total expenditure will come from these other bodies. Good practice
does exist in this field, and is being promoted by a care
co-ordination network for disabled children.
Let health professionals address health problems. But if social
services professionals don’t want to be officially declared
irrelevant, the time is coming for them to stand up and be
Andrew Russell is executive director of the Association
for Spina Bifida & Hydrocephalus.