Can ‘Compromises’ in an Integrated Care System Perpetuate Ableism?

Systemic ableism it’s a fairly big concept. For those of us who don’t eat, sleep and breathe disability activism like myself the idea of ableism being perpetuated can be hard to understand. But to act as anti-ableist allies, we must understand this concept to be able to recognise and act upon this.

But, how do we recognise this? Let’s break this down, using the example of the integrated care system.

What is an integrated care system?

“Integrated care systems (ICSs) are partnerships that bring together NHS organisations, local authorities and others to take collective responsibility for planning services, improving health and reducing inequalities across geographical areas.” (Charles, 2022). 

The integrated care system is a very vital co-productive system that has a significant impact meaning no one part can work in isolation and for this to work successfully all parties must be working as a collaborative team. I have had integrated care systems growing up between school, and the services I was under, occupational therapy, physiotherapy, speech and language you name it. There was often a fair few people around the table when it came to my annual reviews. Successful co-production doesn’t happen overnight and many discussions have to be made and solutions have to be found together. Different systems work differently and of course, this is going to take some deliberation and compromises. Yet, depending on where the compromises are, are the differences between ableism being perpetuated or not and this plays a big role in systemic ableism because there are so many layers to address.

Going back to my example, you have two fairly big organisations, working together the children’s services I was under and my school both of which run very differently. Meaning that sometimes a change that the children’s services want to make may not be possible within the school environment which is when compromises have to be made. But actually, if that compromise is still disadvantaging me then that’s when ableism gets perpetuated. For example, in primary school, I had a specialist chair that I sat in, in class, so when I went up to secondary school I logistically couldn’t take it from one class to another because of the ableist structure within the social and physical environment.

Look, I’m not saying that something should have been done about this because it was physically near enough impossible. But, it’s still due to ableist structures. Another example, in school I always had energy drinks and energy tablets, to get me through the day that was named in my Educational Healthcare Plan. Yeah, it wasn’t a problem, it was mine to control. Yet, I was never given a pass so when I had a supply teacher I always used to get called for, for having an energy drink as a pass stating that I needed this was never made.

I survived. Yet, both of these issues stem from collaborations between the integrated care system and an example of how ableism is perpetuated. In some respects, the schools environment was ableist which then perpetuated into the wider integrated care system because compromises had to be made which didn’t truly meet my access needs.

Do you see what we mean by systemic ableism now this is only half of the concept without considering historical factors. These are only small examples and I am not complaining but, this is how it starts and eventually, these small compromises turn into bigger compromises. Resulting in real disadvantages and discrimination. For example, a particular children’s service could have been on their anti-ableist training and perhaps be a bit more aware of ableism. But the school’s ableist systems impact the integrated care system perpetuating onto the children’s services and if that service doesn’t act as anti-ableist allies then wider changes can’t be made.

Ableism is everyones problem, you can’t dodge it and as an ally you should be constantly re-evaluating this because thats what allyship is. I’m not saying, it’s easy and will happen overnight because it won’t we all have work to do as a collective to do this because it can’t be done any other way.

It’s hard and there’s a lot to be done, but it’s time to stop deciding who’s ableist and who’s not and whose responsibility it is because challenging ableism is everyone’s responsibility even if it doesn’t directly impact you. Just because you work in a different office, department, building or organisation as someone does not mean you have no right in calling out ableist practices as that’s the only way we can move forward.

Now, challenging ableism is a different concept altogether and is hard and I will talk about this in a separate post. But we need to stop placing blame and acting as individual bodies as the only way to address ableism is by doing so together.

Thank you for reading, 

Georgia x 

References (APA):
Charles, A. (2022). Integrated care systems explained: making sense of systems, places and neighbourhoods. The Kings Fund. Retrieved from https://www.kingsfund.org.uk/publications/integrated-care-systems-explained#what-are-ICSs