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Autonomy And Independence In Social Care

This report will critically explore how far social care legislation and policies have contributed to the autonomy and independence of people with learning disability problems.

The report is divided in four main questions that will lead to an advanced understanding of the topic. It begins by defining the word learning disability in social care, followed by an explanation of what the care needs of people with disability problems are. A discussion on why it is necessary to promote the autonomy and independence of disabled people will be followed by a description of related legislations such as disability discrimination act. In analysing the legislation, it will be shown how far it has contributed to the autonomy and independence of people with disability.

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A definition of learning disability is included in the “Valuing People” and states that learning disability includes the presence of: “A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with a reduced ability to cope independently (impaired social functioning); which started before adulthood, with a lasting effect on development” (DoH 2001).

The impact of disability movement on businesses and service provision are major, as adapting to the disabled needs by physical changes, such as ramps, lowered light switches and lowered reception desks and payphones. The impact of the Social Policy of Britain has been impacted very deeply, and has been able to make significant improvement not just to the individuals who have disability but to the general public. (Borsay, 2005)

The area of health access is becoming a major concern. This is due to a number of other factors, which include. The increased longevity for people with learning disabilities with the manifestation of different health concerns linked to age. The survival of children with multiple disabilities into adults with complex needs. The recognition of certain conditions linked to specific disabilities such as Alzheimer’s and Down’s syndrome. The progress of deinstitutionalisation is nearly complete and the remaining large institutions/hospitals are closing and the developments of services in the community are faced with challenges. (Swain et al, 2003)

Some of these factors were previously identified within the document “Signpost for Success” DoH (1998) and are again mentioned partly in “Valuing People” DoH (2001). Also within the White Paper “Valuing People” is the recognition that people with learning disabilities having higher health needs than the general population (DoH 2001 p6). These health needs are as a result of increased incidence of epilepsy; cerebral palsy prevalence for both of these conditions is thought to be three times higher than the general population (Drake,2002), visual problems, hearing difficulties and increased dental needs.

It is recognised that individuals with learning disabilities are sometimes deprived of the best standard of health care service expected by people who do not have learning disabilities (Drake, 2002). In fact despite their higher health needs people with learning disabilities access primary health care less than the general population (Shakespeare, 2003). It is essential that this inequality of care be addressed and unless this is done with the support of the specialist services, and community learning disability nurses in particular, the health-related needs of people with learning disabilities will continue to be overlooked (Oliver et al ,1996).


Autonomy refers to the acknowledgement that a patient is an individual who is also allowed to be given basic rights like the right to information, the right to receive care and treatment and the right to confidentiality (Dalley, 1991). When a patient understands clearly the consequences of complying or refusing his treatment which is called the principle of informed consent, should be the main idea in the cares mind when proposing any form of treatment (Dalley, 1991).

The fundamental dilemma is that of balancing the individual’s autonomy and civil liberty with the need to protect both the individual and the public from perceived risk. In addition, how far should learning disability go in maintaining a function of social control? Swain (2003) believes that when a nurse does not acknowledge their role as an agent of social control, that fuel the public’s misconceptions that surround learning disability.

The word ‘care’ is equally misleading its application of caring for; (protect ion/supervision) and caring for; (worry or show concern). From the perspective of people with disabilities, protected or supervised can sound patronising and disempowering. The need for supervisory care undermines the publics’ ability to see people with impairment as autonomous people. To most people the term ‘care’ highlights a dependency as do most of the charities set up to support the needs of people with disabilities.(Borsay,2005)

Medical services alone are unable to empower a person with a disability to live independently in the community. The provision of the correct equipment and amenities would empower the person to exercise more control over their life. This can only be achieved by the person with the impairment deciding on the level of care that is provided and the equipment required for them to achieve self fulfilment. The Care Standards Act 2000 gives independence but not autonomy and again restricted by financial constraints. We often see fund raising schemes to raise money to purchase wheelchairs for children with multiple sclerosis and spasticity as the specialist equipment gives them the freedom of mobility with out high dependency. This equipment is not available through the welfare system; however we do pay £3,800+ per week for people to attend drug rehabilitation units to help them regain control of their lives. Swain and Cameron define autonomy as the ability to make knowledgeable preferences regarding care plan and implementation, (Swain et al, 2003).


People with disabilities face discrimination from a flaw or loophole in the very legislation that is set up to protect them from discrimination; by permitting the rights of proprietors and businesses to make only ‘reasonable adjustments’ to tackle disabling barriers. Due to the ground of finances, conservation and practicality, disabled people are not treated fairly due to impairment (Disability Discrimination Act, 1995). These barriers can be reflecting in the statistics published by the Disability Rights Commission in 2005, suggesting only half of disabled adults at working age are in employment, compared with four out of five non-disabled people in employment. The DDA 1995 was introduced to prevent people with disabilities from being discriminated on their rights to employment, housing and access to facilities or services. The stipulates adjustments required by employers but only for employers who employ 15 people or more and reasonable adjustments made by housing associations to provide access to housing. The word reasonable can be understood or explained in various ways which lives an open door to some private landlords whom can discriminate on the grounds that they can afford to make the adjustments required. Structures of the buildings do not need to be changed and an alternative access can be made. This is already treating disabled people differently on grounds of impairment and putting a price tag on their equality and disempowering people with impairments. (Barnes, 2002)


Only in 1995 it became illegal in Britain to discriminate against disabled people ‘in connection with employment, the provisions of goods, facilities and services and education’. The ‘weak and toothless’ law of 1995, was amended after the Special Educational Needs and Disability Act was implemented in 2001, which made it unlawful for education providers to discriminate against disabled pupils, students and adult learners . The disability Rights commission in addition to other disability agencies are pressing the government to adhere to new plans to address the low expected institutes and systems to be able to provide premium, service for all special needs people. (Oliver, 1996)

Before the Disability Discrimination Act, disabled people could legally be refused employment by employers. The disabled people will unreasonably correspond to jobs of lower status and lower salary jobs, as a result of poor foundation schooling and the lack of opportunities that was made available for the disabled, as mentioned earlier. The stigmatism occurred when the disabled were deemed as ‘unemployable’ and those who were in employment were openly discriminated against, due to the majority opinion. Employers had a stereotypical outlook to the ability and level of productivity of disabled people.

The empowerment of the disabled people is an area of mention. The rise of the disability movement has been based on empowerment of themselves, as it has been mainly led by the disabled themselves. This encourages the disabled users of service to denote unity, and to provide the people of the society a view of ‘ability’ as opposed to ‘disability’.

The Community Care Act 1996 is a clear example of attempts of increasing the employment for disabled people. This has had many benefits as the government allows local authorities to release funds directly to service users, who purchase their own services and allocate the services to which they assess as being eligible. It empowers the users to assess their own needs and decide which services cater for their specific needs.

The amendments to the law suggest that the society as well as the government were failing in providing disabled people with what they required as humans. British society by making necessary adaptations to laws and services automatically give in to the argument that disabled people were not treated equally, were not provided for equally and were not perceived as equal to those without disability.

The significance of the acceptance of the disabled people may be more satisfying to them as opposed to the legislations that were amended to provide for needs, although I do not belittle the benefit that came out of the amendments. The way in which they were addressed has also been impacted as they were called “crippled” which may have been offensive, to the more accepted “people with disability”. With regards to the social model the government has failed to accomplish their full purpose of providing for all, hence has impacted them by pressuring them into making changes. (Cameron, 2003)

The impact of disability movement on businesses and service provision are also major, as adapting to the disabled needs by physical changes, such as ramps, lowered light switches and lowered reception desks and payphones. The impact of the Social Policy of Britain has been impacted very deeply, and has been able to make significant improvement not just to the individuals who have disability but to the general public.

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Nevertheless, Borsay (2005) argues that there are many areas in the act(DDA) that have loop holes such as education and transport, and this makes it far from comprehensive. The Act talks about the transport requirements but yet it only talks about how the new transport have to meet minimum access standards for disabled people, but it only applies to land base transport. Even areas such as employment are limited, for example, the act does not apply to the armed services and before 2004, and it only covered employers who employ 15 or more people. The act is very weak for example the definition of disability stated in the act is defined narrowly In terms of impairment and is guided by the severity of the impairment rather than by the experience of discrimination. Some impairments and medical conditions have not been covered such as HIV and Aids, despite the fact that they are another source of discrimination. (Drake, 2002)

Although there are many strategies to remove or reduce prejudice in society, for disabled people discrimination remains a significant problem at all levels, as discrimination will always occur because of the people’s attitudes and views against a person with a disability in our society. Thus no matter how many acts legislations are in force, discrimination is an ongoing problem in society, as we can not legislate for peoples attitudes in society. The society should work on educating people about a person with a disability and make them more aware that a disabled person is no inferior to any other person hence no discrimination should be made due to a person’s disability. Therefore the social model of disability should be in practise, although it is easier said than done to educate all ignorant attitudes in society surrounding disability. It may be argued that only a disabled person is able to comprehend what it is like to be discriminated on the grounds of employment, education and transport.



Borsay, A. (2005) Disability and Social Policy in Britain since 1750. Hampshire: Palgrave Macmillan.

Dalley, G. (1991) Disability & Social Policy. London: Policy Studies Institute.

Oliver, M. (1996) Understanding disability – from theory to practice. Hampshire: Macmillan Press Ltd.

Pierson, J., Thomas, M. (2002) Dictionary of Social Work. Glasgow: Harper Collins

Shakespeare, T. (2003) The Disability Reader – Social Science Perspectives. London: Contiuum.

Swain, J., Finkelstein, V, Oliver, M. (1993) Disabling Barriers – Enabling Environments. London: Sage Publications.

Swain, J., French, S., Cameron, C. (2003) Controversial Issues in a Disabling Society. Buckingham: Open University Press.


Barnes, C. (2002) Disability, Politics and Policy in Policy and Politics. Vol 30 No 3.

Drake, R.F. (2002) Disabled people, Voluntary Organisations and participation in Policy Making in Policy and Politics. Vol 30 No 3


General Social Care Council. [Online], Available: http://www.gscc.org.uk/Home/ [10th Nov 2006]






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