Disability and the Welfare State in Britain

In Disability and the Welfare State in Britain. Changes in Perception and Policy 1948–1979, Jameel Hampton provides a scholarly account of the development of disability policy after the Second World War. The book reflects upon the continuities and changes in attitudes towards disability, and considers how the state responded to its increased responsibility in ensuring the welfare of some of its most vulnerable citizens. Through an analysis of the policy decisions taken, Hampton considers how the government was influenced by other non-statutory agencies like the Trades Union Congress (TUC), the media and the Disablement Income Group (DIG). Hampton establishes early in his introduction that by 1981 'it was recognised that the supposedly cradle-to-grave welfare state had actually failed millions of disabled people, not least in respect and acceptance from exclusion', and states that it is his intention to address these developments (p. 1). Under the wartime coalition many of the personal social services which supported disabled people had become firmly embedded within local government and non-statutory organisations. The state preoccupation was with universal welfare concerns, such as the NHS, and Hampton argues that this is reflected in the work of other welfare historians, in which personal social services (PSS) remain 'the least studied area' (p. 6). Disability, however, has in recent years emerged as a major area of scholarly research, and Hampton highlights Anne Borsay's valuable contribution to the field, Disability and Social Policy, 1750–2000. Borsay argues that the implementation of the Beveridge Plan created a 'model system of social citizenship'; however, for 'disabled people marginal to the workforce, benefit levels were low and take-up stigmatising'.(1) Building upon Borsay's contention that the welfare state failed to guarantee against the 'poverty and financial exclusion' of disabled people, Hampton's book provides a closer examination of the factors which contributed to this system.(2) His work, therefore, is a welcome addition to the current historiography on disability in the 20th century, and will be of particular interest to scholars and students hoping to gain a more comprehensive understanding of the development of services and provisions for disabled people during the period 1948–1979.

A significant part of Hampton's analysis centres upon the activities of the Disablement Income Group (DIG), and he makes a valid claim in asserting their significance to the emergence of disability onto the policy stage in the mid-1960s (p. 8). Hampton observes that:

'While central government is key to creation of social policy, it is essential to study other influential actors and groups to illuminate the complex and often conflicting motives that generate government action and the dynamic nature of policy creation' (p. 9).

Within his extensive discussion of the organisation and activities of DIG, it is evident that Hampton has considered the contributions of other actors in the policy-making process, though there are some limitations with regard to his use of sources. His research prioritises government records and parliamentary papers, a wide range of local and national newspapers, and other archival material, noting that the oral testimony of disabled people was beyond the scope of the book. Although he acknowledges that this may result in them and their families appearing as 'passive objects of policy', the omission of experiential evidence from disabled people themselves appears a missed opportunity to present a more compelling and complex account of the implications of welfare policy development (p. 11). Nonetheless, Hampton has laid the foundations for other historians to adopt alternative approaches, grounded within the scholarly research he has undertaken. Sonali Shah and Mark Priestley have broadly demonstrated how the examination of 'historical change through the connections between private lives and public policies allows for a discussion of agency and choice, as well as structure and environment', adopting a biographical approach which considers the lived experience of disabled individuals.(3) Hampton's contribution to our understanding of personal social security will, one hopes, encourage further research in this area.

An overview of statutory welfare from the 17th century to the Second World War is provided by chapter two, in which Hampton identifies three distinct phases. Starting with the Poor Law Act of 1601, Hampton discusses how the Act made it the responsibility of local parishes to provide relief to the impotent poor. Within a mixed economy of welfare, Hampton establishes the central role of the family within a system where the amount of relief available was determined by the ‘amount of care they could receive’ from family members which, he states, was rarely sufficient. The chapter then discusses the significance of the Industrial Revolution which, arguing that it transformed society to create a ‘previously unimagined class of poor people’ (p. 27). According to Hampton, the state’s response to growing financial pressure was to limit the availability of outdoor relief under the New Poor Law of 1834, and the workhouse became the preferred method of statutory provision. (pp. 26–7) Although disabled people were more readily able to access outdoor relief, Hampton argues that this was stigmatising and required increasingly ‘supplicant behaviours’ from those who received it (p. 28). Hence, within a brief overview of the period, Hampton historically situates charitable giving with notions of stigma, providing valuable context to how and why this became a point of resistance for disabled people in the latter half of the 20th century. Hampton argues that by the end of the 19th century, the expansion of institutions brought attention to the need for greater specialisation which saw specific welfare provisions be made for certain groups of disabled people in the early 20th century, including children and disabled ex-servicemen. For the majority of disabled people, however, relief remained limited, and Hampton concludes his contextual chapter rather ominously by stating: ‘surely, future provision would correct the exclusion of those currently excluded’ (p. 41).

However, in his consideration of the period 1948–63, Hampton argues that disabled people were defined by their ‘comparative exclusion from the welfare state settlement' (p. 53). National Assistance remained the only statutory payment available to the general classes of disabled people, who had ‘no political profile … no meaningful public and emotional sentiment’, and lacked representation outside government to lobby for better provision, particularly when compared to groups like the blind and ex-servicemen (pp. 53–4). Accordingly, disabled people remained heavily reliant upon non-statutory provision, and a general allowance for disabled people was rejected by the Labour government on the basis that it undermined the contributory principle of National Insurance. Building upon David Gladstone's discussion of PSS, and the ideological debate over the responsibility for the supply of welfare, Hampton demonstrates how the issue of contributions continued to influence policy-makers throughout the period under study, and presented a challenge to the introduction of more comprehensive benefits for disabled people.(4) In the 1950s and early 1960s, local councils assumed greater responsibility for personal social services (PSS), which Hampton argues reflected a move from ‘residential and medical considerations of disability to those of community and social integration’ (p. 59). However, whilst the period certainly indicated a shift in public perceptions and concern for disabled people, community care was also prioritised because it was considered to be a financially expedient measure. Reflecting upon the impact of research by the Piercy Committee and Peter Townsend in the 1950s, Hampton states that ‘disabled people were not discovered at some indeterminate point in the mid-1960s’, but that there was a growing concern throughout the 1950s for the needs of disabled people which were not met by the welfare settlement (p. 73). Julie Anderson, equally, observes this development in the proliferation of charities for disabled people, the work undertaken by the Central Council for the Care of Cripples, and the march on Downing Street in 1951 by 800 members of the British Limbless Ex-Servicemen's Association (BLESMA) which helped to create a precedent for more direct action by disabled people.(5) In establishing a trajectory through which the public became increasingly aware of issues relating to disability, these examples further qualify Hampton’s assessment of the more gradualist development of disability as a public policy issue.

Hampton analyses the period 1964–9 in chapter four, focussing particularly upon the emergence of DIG, which led to a heightened awareness for the needs of disabled people within society. According to Hampton, factors such as:

‘the American Civil Rights Movement; the waning of confidence in bureaucrats and professionals in the 1950s; the permissiveness of the 1960s and increased willingness to offer help to those whose misfortune was partly self-inflicted, such as drug abusers; a reduction in seeing traditionally marginalised groups as moral failures'

provided fertile ground for the development of disability as a major issue of public concern (p. 85). Hampton quite rightly identifies Megan du Boisson as central to the success of DIG, noting the effectiveness of a more moderate approach which engaged the public by appealing to circumstances which they could relate to, for example the potential long-term separation from family members  (p. 92). Hampton provides a thorough overview of the role of the media throughout this period, noting the regularity with which DIG featured in the press which, he argues, ‘compelled both major parties, the House of Commons, and the Trade Union Congress to engage with the welfare of disabled people as an unjust oversight of the settlement of the 1940s’ (p. 13).

According to Hampton, DIG's influence was evident in proposals made by the Minister for Social Security for the introduction of an Attendance Allowance for the severely disabled which, he argues, 'was significant as the first divergence from the contributory principle' (p. 98). Discussions, however, did not address the needs of 'those chronically unable to earn, such as disabled housewives', and Hampton maintains that the prevailing attitude of the Labour Party was to consider disability a problem which could be ‘dealt with after more pressing issues’ (p. 98). The Conservative position is presented as one of political expediency, accepting the need for some future cash provisions on the understanding that there 'were now political consequences for not engaging with disabled people' (p. 99). Despite their potential influence, Hampton argues that trade union support was tempered by the perception of disabled people as a minor workforce who did 'not fit the steely self-image of the industrial worker' (p. 102). Hence, whilst the TUC applied a degree of pressure on Labour to improve incomes for those not covered by National Insurance, disability remained a marginal concern for trade unions, particularly in the face of rising unemployment in the 1970s. Despite criticism from Labour backbenchers dissatisfied with Wilson’s gradualist approach to social welfare, the chapter argues that many within government continued to differentiate between the war and industrially injured and the general disabled either ‘philosophically or because of concern about the great costs and complications of an unbiased national disability income' (p. 104). Despite reservations, cash benefits 'emerged as a topic of serious enquiry' during this period with changing conceptions of relative, rather than absolute poverty, and the chapter provides evidence for this in its discussion of the various ministries, official committees, and working parties investigating the issue (pp. 105–11). Hampton's analysis of the findings of the Seebohm Committee indicate that disability remained a secondary concern to other PSS groups; however, he argues that this was because the 'Committee's priorities were established before disabled people became a political and policy issue' (p. 111). The chapter ultimately concludes that 'despite the important psychological gains of recognition and representation, disabled people did not receive new cash provisions; however, the period was significant in achieving a general consensus that this was desirable and would be 'dealt with after the major reorganisations of the 1960s' (p. 120).

The years 1970–2 are addressed within chapter five, which gives particular attention to the passage of the Chronically Sick and Disabled Persons Act (CSDPA) in 1970. Hampton argues that despite considerable psychological gains, the full implementation of the Act was 'curtailed by the fear of 100 per cent identification and great expenditure' (p. 169). Instead, the Conservative government advocated selective cash payments over the expansion of services proposed by the CSDPA, and Hampton argues that new social conceptions of disability gave greater impetus towards the move for cash provisions which were considered to enable independent living to a far greater degree than services. The work of DIG is discussed in relation to British entry to the European Economic Community, and by bringing a European focus to their research, DIG were able to make 'unfavourable comparisons between British and European schemes' (p. 142). This demonstrated their ability to be responsive to the concerns of government, and allowed them to continue to exact considerable pressure during this period. The chapter concludes with a discussion of the Thalidomide scandal, which saw the government come under significant pressure to provide those effected with cash benefits for life, thus legitimating the idea of 'a non-contributory lifetime income for those with chronic conditions' (p. 164). Hampton argues that DIG's failure to agitate on the issue of Thalidomide meant they 'missed an opportunity to further their goals' (p. 167). However, DIG chose not to jeopardise its relations with the government, and with the establishment of the privately funded Lady Hoare Thalidomide Fund, the 'government were able to evade calls for involvement or new statutory provision for thalidomide victims or other disabled people with a £3 million pound donation' (p. 167).

Chapter six examines the period from January 1973 to the introduction of Housewives Non-Contributory Invalidity Pension (HNCIP) in 1975. Despite economic recession and the abandoned commitment to full employment, Hampton states that the 'political situation in 1974 was favourable to increased social expenditure' (p. 182). The radicalisation of the media, Labour and non-statutory groups saw a commitment to new cash benefits, and with the introduction of HNCIP 'DIG largely began to disband, having seemingly achieved its objective' (p. 182). In his appraisal of the group's impact, Hampton discusses their success in making disabled people, 'perhaps the most neglected disadvantaged group in the 1960s', an issue for public concern; he concludes, however, that they were unable to make their 'proposals for a national disability income financially agreeable' to either the Wilson or Heath governments' (pp. 190–1). The chapter then offers an analysis of cash benefits introduced in the period 1973–9, stating that the principles underpinning them acknowledged income as a 'right regardless of National Insurance contributions' (p. 202). However, Hampton tempers this assessment with examples of how issues of stigma, the complexity of assessments, variable qualifying criteria, and the challenges individuals faced in physically applying meant cash benefits often remained symbolic gestures which were 'largely impotent, and reached only a small portion of disabled people' (p. 204). In his condemnation of the implementation of CSDPA and the ineffectiveness of cash benefits, Hampton argues that economic rationality has been the pervasive argument within disability histories when critiquing statutory provisions for disabled people post-1945. He counters this by suggesting that:

'Economic rationality was never applied to the Act's treatment of severely and appreciably disabled people: hospitalisation and/or residential care cost far more than allowing people to remain in their homes with adequate support' (p. 214).

Whilst certainly an interesting observation, it is one which requires further examination, particularly given the variety of needs that individuals presented with and it would have been useful to have examples to qualify this statement. Hampton concludes that the CSDPA 'ensured that the general classes did not escape the Poor Law tradition of localism and stigma', and by the late 1970s the limitations placed upon increased social spending made plans for the expansion of services and cash benefits unrealistic (p. 215). However, as Hampton observes in his epilogue, the failures of CSPDA were significant to the emergence of new initiatives led by disabled people in which ‘welfare for disabled people came to be viewed as a human right’ (p. 232). With the rolling back of the state, Hampton maintains that the increasingly radicalised disablement lobby had unrealistic expectations of what could be achieved; however, the influence of the social model of disability saw disabled activists take up increasingly diverse issues which were influential to the passage of the Disability Discrimination Act in 1995.

Hampton argues that during the period under study ‘both major parties, the Ministry of Health, the media, academics and the House of Commons’ acknowledged disabled people as a coherent group who had been an ‘oversight of the post-war settlement’ (p.237). However, ‘perception always raced ahead of policy’, and Hampton discusses the history of PSS for disabled people as a mixed record of successes and failures (p. 237). Non-statutory efforts continued to perform a vital role within a mixed economy of welfare, and Hampton presents organisations like DIG as instrumental in raising the profile of disabled people, and guiding the direction taken by government in planning new provisions in the 1970s. However, despite significant psychological and representational gains, Hampton concludes that the myth of universal welfare failed to secure disabled people ‘equality in incomes, outcomes or wealth’ (p. 244). In his assessment of the period, Hampton has made a valuable contribution both to the historiography of the welfare state, and disabled people more generally. In addressing the development of PSS for disabled people, Hampton’s work is a welcome addition which negotiates the complex relations and actors involved in the policy process.

Notes

1. Anne Borsay, Disability and Social Policy in Britain since 1750, (Basingstoke, 2005), p. 168.Back to (1)
2. Ibid.Back to (2)
3. Sonali Shah and Mark Priestley Disability and Social Change Private Lives and Public Policies, (Bristol, 2011), p. 2.Back to (3)
4. David Gladstone, 'Renegotiating the boundaries: risk and responsibility in personal welfare since 1945', in Welfare Policy in Britain. The road from 1945, ed. Helen Fawcett and Rodney Lowe (Basingstoke, 1999), p. 35.Back to (4)
5. Julie Anderson, War, Disability and Rehabilitation in Britain, (Manchester, 2011), pp. 186–9.Back to (5)