Social citizenship rights have never been fully extended to disabled people and, as a result of this, disabled people are over-represented among the unemployed and experience higher rates of poverty and in general do not enjoy a standard of living that is comparable with current social expectations. Over time there has been an uneasy relationship between healthcare professionals and disabled people. Professional social work has operated from a framework that encourages paternalism and dependency as part of an individualised understanding of disability. Social work services concerned with disabled people developed in the health sector of the welfare state as well as some services in the voluntary sector. Prior to the 1970 Chronically Sick and Disabled Persons Act, services were frequently provided in a haphazard way. This legislative framework established responsibility for disability services within local authorities. However, the development of services varied across local authorities and tended to be given lower priority than other services.
Social work continues to be dominated by an individual approach or a medical model of disability that has been heavily criticised by disability organisations. Much of the criticism levelled against social work has been the exercise of professional dominance and control over the lives of disabled people that seemed to serve the interests of welfare professionals rather than meet the needs or aspirations of service users. This way of dealing with disabled people created dependency with little opportunity for service users to have a voice in the planning, design or delivery of services.
However, beginning with legislation such as the 1990 NHS and Community Care Act, there have been moves to reduce professional dominance and dependency through managerialism, the introduction of market principles and social care.
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