Sunday, 9 October 2011

What's a vulnerable person?

The recent Health and Social Care Bill currently debated in the House of Lords prompted some charities to call it an onslaught on the most vulnerable people in society. They argue that the reduction in public services hits the most vulnerable because many of them depend on support that is provided by public services. 
Some commentators even accused the government to jeopardise the support structures for those unable to care for themselves, such as people with physical and learning disabilities. They maintained that there is a direct link between public services and the ability of this group to live a decent life. 
This argument goes to the heart of the issue at stake in the current public service reforms: What does it mean to be vulnerable and are public services effectively reducing vulnerability for those they care for? 
I have some doubts that vulnerable people are always served well by support structures as they currently exist. Let me illustrate this point with an example from my own work. 
People with learning disabilities are shockingly underrepresented in the world of work. Optimistic estimates indicate that only about 12% of all adults with learning disabilities known to social services are actually in some time of employment. Most likely many of those are however in voluntary or part time work which may amount to as little as a couple of hours per week. There are many reasons for this, not least that traditionally the benefits system in the UK has strongly militated against full time work for this population group. 
Inclusive research however shows clearly that many people with learning disabilities want to work, and even young people with disabilities who still live with their families have a strong interest in obtaining a job after school or college. Many of them grow up in families where their non-disabled siblings go to college and then gain employment and they do not understand why they shouldn’t do the same. 
One curious aspect of the benefits and support system in the UK is however that a discourse of ‘vulnerability’ discourages employment for this group. People with learning disabilities are supposed to be either ‘not ready for work yet’ or work is deemed to be an ‘unsuitable’ option for them altogether. Work programmes which are geared to get other long-termed unemployed people into work often do not offer the additional support that is necessary to train, place and maintain a person with a learning disability in a job. 
The biggest hurdle however is the fact that we, as society, are afraid of challenging people with learning disabilities to overcome their own barriers. The current benefit system distinguished between people who are deemed to be ‘fit to work’ from those who are thought to be ‘unfit’. In the case of people with learning disabilities, rarely anyone who wants to work is ever declared ‘fit to work’. Their alleged vulnerability is often the decisive factor that determines their fate to remain on benefits. 
This is significant since without being declared to be ‘fit to work’ you cannot draw on support that is in fact available to get you into work. Even more so, without passing the ‘fitness’ test, the authorities have no obligation to support you to gain employment. So, since employment support programmes for people with learning disabilities are costly, everyone involved (apart from the person with a disability) has an interest in preventing people with learning disabilities to be declared ‘fit for work’. 
Of course, benefit receipts outweigh the costs for employment support in the long run but benefits are being paid out of the treasury coffers while employment support programmes would partially be resourced by local authorities. So a conspiracy of silence is maintained to keep people with learning disabilities out of work. 
The vulnerability argument reinforces this situation. Where people with learning disabilities want to work, they need to overcome the battery of assessments for work fitness AND need to demonstrate that they can cope with the demands of the workplace, something that many charities argue would be cruel and inhumane to ask of them. Is it sheer coincidence that those same services and charities that advance the vulnerability argument to ‘protect’ people with learning disabilities also have a strong self-interest in keeping their clients in semi-dependent positions out of work? 
There is a strange confluence of argument and interest here as the organisations who maintain their services to people with learning disabilities out of work, and hence without proper income that could increase their autonomy and independence, retain their jobs themselves. 
To be clear, there are some excellent organisations in the UK which have tirelessly campaigned for a change in the benefits structure and for extensive funding for employment support programmes for people with learning disabilities. Yet as long as we stress their vulnerability rather than their ability we will always fall back into the instinctive reflex of protecting people rather than confronting the challenges with them. 
The default position for this group should be that people with learning disabilities can and should work. It is then up to us to ensure that we provide the support for their employment ambitions, and stop to cocoon them in a language of vulnerability. 

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