Would the integration of health and social care promote independent living?
Medical intervention is appropriate for people who are sick, but not normally for people who are well – whether they are disabled or not
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Jane Young
- Guardian Professional,
Norman Lamb has been the care services minister at the Department of Health for just a few weeks, and it seems that the integration of health and social care services is one of his key interests and policy aims.
But there appears to be scant consideration, by Norman Lamb, Dan Poulter or indeed the health secretary, Jeremy Hunt, of whether such integration would actually deliver independent living for working age disabled adults – or, for that matter, for older disabled adults.
The pioneers of independent living, back in the 1970s and 80s, did not consider independent living support to have much in common with health services.
In the early days of the disability movement, doctors were seen almost as the enemy.
Disabled people such as the late Vic Finkelstein and others remember the torture they were put through as doctors and other medical professionals prioritised their ability to walk, for example, over their ability to get around and, generally, the normalisation of anatomical function over their ability to participate.
The fundamental issue for the independent living pioneers, worth remembering today, was that disability is not the same as illness, or sickness.
Medical intervention and the involvement of healthcare professionals is necessary and appropriate for people who are sick, but not normally for people who are well, whether they be disabled or non-disabled.
The government talks a lot about using the social model of disability, by which people with impairments are considered to be disabled by external barriers to participation, such as inaccessible buildings and a society which caters to non-disabled people’s needs.
But ministers conveniently forget that disabled people have long argued that one of the biggest barriers to participation and equality is the lack of personal assistance, by which is usually meant the lack of resources with which to employ sufficient personal assistants, for a sufficient number of hours, to enable independent living.
Since personal assistants do not need to be medically trained, there seems to be no good argument for the assessment of necessary personal assistance to be undertaken under the auspices of a health trust.
In my experience, doctors and other healthcare professionals, especially those based in hospitals, are often some of the least well-informed about disability issues.
This is not altogether surprising, since their training and expertise are driven by the need to treat disease, not to provide independent living support for disabled people.
Rather than medical treatment, disabled people need assistance to perform such varied everyday tasks as driving, bathing, dressing, typing, cooking, parenting activities etc.
None of these functions is normally carried out by medically trained professionals, so on this basis it is illogical for the Department of Health to be wedded to the integration of health and social care services.
Norman Lamb does talk about giving people choice and control, but choice and control on their own don’t add up to independent living.
A person can be given a choice about who comes to help them wash their hair and when, but this doesn’t result in independent living; it merely results in more choice and control over hair washing.
Independent living is much wider than choice and control and depends on the availability of funds and other resources, including peer support from disabled people’s organisations, to enable disabled people to participate in society as equals – contributing their talents, earning money and paying taxes.
This has little to do with health services but much to do with whether the government is prepared to devote the necessary resources to achieve the outcomes it says it wishes to see – disabled people actively engaged in their communities and, wherever possible, undertaking paid work and advancing their careers.
Jane Young is a disability consultant and campaigner.
