Ruth Crowder, Policy Officer Wales/Swyddog Polisi Cymru at the College of Occupational Therapists, discusses an ode to the passing of the Chronically Sick and Disabled Persons Act. Follow Ruth
45 years ago a private members bill became the Chronically Sick and Disabled Persons Act (1970). It may not have a title that we all feel comfortable with nowadays, nonetheless it was ground-breaking in securing the beginnings of rights for disabled people to be able to access their communities and participate in the vital occupations, activities and participation in family and society life that we all take for granted.
One of the key elements of the Act was a duty on local authorities to provide practical assistance in the home. This includes the assistive equipment and adaptations that serve to help overcome the barriers to independent living caused by our mostly inaccessible housing design.
Many occupational therapy roles in local authorities became so defined by that duty that this would be the only element of occupational therapy interventions delivered by local authority employed occupational therapy staff. That has caused many problems, gaps and duplication between therapists employed in different agencies and can be said to have prevented occupation focussed practice. In its favour though, it was a clear duty which was inescapable by the local authority.
In April 2016 that Act will disappear, replaced by the Social Services and Wellbeing Wales (2014) Act (as it has already disappeared in England, replaced by the Care Act). The new legislation does not replicate the duty and some have concerns that this could mean greater difficulty by disabled people in accessing the support needed to enable essential equipment and adaptations. This is of particular concern given the continued lack of accessible and inclusively designed housing across the UK.
So what difference will the new legislation make? There is now no duty to provide specific services. The local authority does not have to provide an adaptation, instead the duty is for a more co-produced and person- centred care and support service. This allows occupational therapists to deliver much more person-directed and occupationally focussed holistic services: it should stop the schism between what a ‘health’ or a ‘social care’ occupational therapist is allowed by their employers to do. It allows much more flexibility to be creative and innovative. However, occupational therapists will need to be very vigilant that the change does not mean there is no system for when equipment or adaptation is required.
Occupational therapists will only be able to secure access to services for individuals if they can make a robust case to senior managers and budget holders that the decisions they agreed in conversation with their service users is the right, prudent and most effective intervention to enable that person to achieve their well-being needs. If managers and budget holders respect the conversation between a frontline practitioner and citizen, and fund what has been agreed then the new legislation offers considerable opportunity for improvement. The danger comes if either the practitioner cannot hold their case together in those discussions, or if the managers and budget holders seek to amend agreed decisions from the perspective of cost-minimisation.
I still can’t help feeling sad that Alf Morris, the MP who drove the Chronically Sick and Disabled Persons Act through Parliament, because of his experience of living with family members with disabilities, saw his work dismantled just before he died in 2012. What did he think? Did he regret that passing of his flagship legislation or did he expect a brave new world where the person is given voice and control over the services provided to help them, with the exciting new opportunities for change, different rights for people with disabilities and a wider choice of options to enable them to participate in life? I hope it was the latter.
It surely has to be a moral imperative that each and every one of us makes sure that as we implement the new legislation and transform the way we work that we never forget the purpose of what we do is to improve people’s lives and enable them to do the things that matter to them by minimising the barriers society puts in their way to live life the way they wish.
The Social Services and Wellbeing Wales Act
Resources for implementing the Act
More resources for implementing the Act
COT Position Statement: Occupational Therapy and Implementing the Social Services and Wellbeing (Wales) Act (2014)
(Fersiwn Cymraeg) Occupational Therapy and Implementing the Social Services and Wellbeing (Wales) Act (2014)