Feature

New party, old agenda?

Labour has underestimated the political significance of the disability movement, argues David Pilgrim

The government has outraged disabled people by exploring ways of reducing their welfare rights. It has focused on potential fiscal savings to ensure its election tax pledges. Perversely this has led it in turn to consider a change to tax plans for disabled people. Disabled people are also angered by the lack of consultation between government and disability groups. Despite ministerial statements about ‘fully consulting at all stages’, few disability groups interviewed by the BBC had been consulted over the changes.

This recent skirmish reflects a deeper problem. The previous Conservative administrations had a consumerist ideological stance which, at some level, resonated with the individual needs of disabled people. Tories also had their own solution to the economic cost of unemployed groups who created a ‘burden of care’ — charity. What we await is Labour’s own ideological position. Will it be more of the same — a red rose with a red nose?

The last few years have seen important debates on both the Right and Left which are shaping what is possible in social policy. Apart from celebrating charitable acts as a triumph over state paternalism, the consumerism the Tories enforced in the public sector also created political space for collective new social movements of the Left. There was a formal encouragement of user involvement in mental health services and the continued expansion of the disability movement in its various forms. Groups such as People First, Survivors Speak Out and the Disability Alliance increased, and their direct action symbolised as much a challenge to the vested interests of ‘the caring professions’ and Labourism as to Conservative governments.

The state was criticised by both ends of the political spectrum: Conservatives seeking fiscal savings and diverse Leftist projects tired of state paternalism created the citizenship debate of the late 1980s. At that time, demands from the libertarian Right for a minimalist state were tempered by the realpolitik of government. Thatcher had to concede the contradiction that capitalism could neither live with the welfare state nor without it.¹ She had to make do instead with stimulating a ‘mixed economy of welfare’.

For disabled people, reforms in health and welfare created contradictory structures. For example, the purchaser-provider split, managerial-ism and privatisation were three key, and quite contradictory, policy trends. The first could only create quasi-markets not genuine markets. The NHS and social services did not become a market of goods that individual consumers could pick and choose, instead health authorities made proxy decisions on behalf of local populations. The second, managerialism, was a bureaucratic measure, whereas privatisation was anti-bureaucratic. Far from the state being ‘rolled back’, there was more and more centralisation of power. The traditional counterbalancing power of local authorities was stripped and their elected officers and employees were regulated. The most relevant example of this was endorsement of the 1988 Griffiths Report on community care, which framed much of the 1990 legislation. It gave local authorities a ‘poisoned chalice’ of responsibility without adequate resources. Also the government of the time sought to create contradictory ‘enabling authorities’ (‘enabling’ individuals, community development and market development).² Within this scheme the notion of ‘empowerment’ was co-opted by Right and Left.

Research into users’ views of health services in the early 1990s revealed that people with mental health problems and physically disabled people had a different agenda from that of either service commissioners or clinical professionals.^{3 4} The following contrasts can be made from this research:

Disabled people sought direct users power but commissioners sought proxy power;

Disabled people emphasised the complexities of their experience and their identity as (attempted) citizens. Commissioners wanted to consider service users’ views as ‘customer feedback’ — one of many inputs to purchasing decisions which ‘took on board’ a variety of ‘stakeholder’ opinions;

Disabled people sought social rights but commissioners sought to achieve cost-effective services;

Disabled people emphasised citizenship but commissioners emphasised ‘health gain’;

Disabled people emphasised collective participation but commissioners emphasised ‘individual needs assessment’;

Disabled people demanded more resources which they directly controlled while commissioners were obliged to contain and minimise costs.

The picture is not much different now than it was, say, five years ago. If the Labour government has no substantial ideological vision to replace the Conservative guiding principles of charity, marketisation, managerialism and privatisation in health and social services, then the policies will continue to affect service users by default. In its own interests, New Labour needs to recognise the enduring political force of new social movements. If the government both cuts material support for disabled people and fails to ally itself with the disability movement, quality of life for disabled people will deteriorate rather than improve during Labour’s administration.