What is Ableism in Health and Social Care?

Ableism is discrimination or prejudice against people with disabilities. This can be obvious or subtle. It places disabled people at a disadvantage. Their abilities, needs, or experiences are seen as less important than those of non-disabled people.

Ableist ideas often suggest that there is a “normal” way to be human. Anyone who does not fit this is judged as less able, less valuable, or in need of being “fixed”. These beliefs show up in attitudes, language, policies, and the design of physical spaces.

Ableism damages mental and physical health. It limits opportunities. In health and social care settings, it can lead to poor treatment, inaccessible services and loss of independence for disabled people.

Historical Context

For much of history, society has misunderstood or mistreated disabled people. Mothers were blamed for children born with disabilities. Institutions separated disabled people from their communities. “Charity” models viewed disabled people as objects of pity, not rights-holders.

Since the late twentieth century, the social model of disability became more accepted. This model says that people are disabled by barriers in society, not by their bodies or minds. Attitudes, environments, and systems can disable people.

Yet, ableism still influences health and social care. Some people see disabled lives as less valuable or treat access adjustments as “special treatment” rather than basic rights. Negative stereotypes persist.

Ableism in Attitudes and Beliefs

Ableist attitudes can take many forms:

• People may assume that disability means someone is unable to make decisions.
• Staff might talk to carers instead of the disabled person.
• Some may think all disabled people want to be “cured” or “fixed”.
• A common belief is that disabled lives are less interesting, enjoyable, or fulfilled.

These attitudes can lead to:

• Lowered expectations for disabled people’s well-being and achievements
• Lack of respect for autonomy and personal choices
• Overprotection or complete neglect
• Decision-making without proper involvement of the person affected

Language choices also matter. Using words that suggest pity (“suffers from…”) or inaccuracy (“wheelchair-bound”) is ableist.

Institutional Ableism

Ableism is part of institutional routines and organisational culture. It may not be a deliberate act by one person. Instead, it gets built into how care is organised and delivered. This is called institutional or structural ableism.

Examples include:

• Appointment systems that only work by phone, with no option for emails or texts
• Care homes without step-free entry
• Hospital information only in small print
• No hearing loops or alternative communication options at GP surgeries
• Staff training that ignores issues like sensory overload, pain or energy limits

Institutional ableism is often invisible unless you experience it first-hand.

Physical Barriers

Physical environments can make access to health and social care harder or impossible for disabled people. Barriers include:

• Steps with no ramps or lifts
• Waiting rooms with no space for wheelchairs
• Toilet facilities too small for personal assistants
• Clinical equipment that cannot be adjusted

If facilities ignore access standards, disabled people may miss appointments, receive delayed care, or avoid services out of frustration or worry.

Communication Barriers

Clear communication is vital in health and social care. Ableism shows up when providers ignore different needs. Some people need information in:

• Large print
• Easy Read
• Braille
• British Sign Language (BSL)
• Audio or video formats
• Languages other than English

Without these options, disabled people can miss vital details. Misunderstanding diagnosis, consent, or treatment decisions is common. People with learning disabilities or autism may need more time, less jargon, or visual supports.

Not offering these adjustments breaches legal duties, including the Equality Act 2010.

Medical Ableism

Medical ableism is the belief that the medical view of disability (as a “problem” needing to be fixed) is the only valid perspective. This approach can ignore the rights, priorities, and lived experience of disabled people.

Examples:

• Assuming the main goal for a disabled person should be to “overcome” their disability
• Treating health concerns as “just part of your condition”, rather than taking complaints seriously
• Assuming poor quality of life and failing to offer all treatment choices
• Offering medical interventions without sharing decisions or discussing alternatives

Staff may unconsciously expect less from disabled patients, not refer for other treatments, or give less follow-up care.

Ableism in Policies and Practice

Organisational policies shape how care is delivered. Sometimes, policies built for the “average” patient exclude disabled people. This happens when disability is seen as rare or a “special case”.

Examples:

• No option to book appointments online
• Presuming everyone can fill out forms, understand written instructions, or travel independently
• Routines that expect everyone to wait in noisy, crowded areas

Working practices can ignore fatigue, chronic pain, or mental health conditions. People may get judged for missing appointments or being “difficult” when needs are unmet.

Impact on Mental Health

Ableism causes ongoing stress, anxiety, and low self-esteem. Repeated negative encounters lower trust in services. Disabled people report:

• Feeling unwelcome or judged
• Reluctance to ask for adjustments
• Worry about being a “burden”
• Shame, depression or social isolation

For people with mental health conditions, ableist attitudes can add layers of stigma. They might struggle to get their physical health needs recognised. Their symptoms may be dismissed as “all in your head”.

Intersectionality

Many people experience more than one type of discrimination. Black, Asian, and minority ethnic disabled people, women, and LGBTQ+ disabled people face extra barriers. Intersectionality is the word for overlapping forms of discrimination.

These experiences can deepen the effects of ableism. For example, autistic women may not have their needs understood. Mental health stigma can mean disabled people face double discrimination.

Challenging Ableism

Reducing ableism takes effort at every level. Organisations, staff, and the wider community can all take action. Small changes can make a huge difference.

Actions Health and Social Care Staff Can Take

• Listen to what disabled people say about their needs.
• Always ask before giving help.
• Challenge ableist jokes or attitudes among colleagues.
• Remember that the person is the expert on their condition.
• Offer information in formats people choose.
• Attend training on disability awareness and inclusive communication.
• Value the autonomy and choices of every person.

Service Design and Policies

• Involve disabled people when planning services.
• Conduct access audits of premises, websites, and information materials.
• Update policies to make reasonable adjustments normal, not exceptional.
• Hire diverse staff, including disabled people at all levels.

Language Matters

• Avoid terms that imply pity or passiveness.
• Use positive, accurate language like “disabled person” (the social model) instead of “person with a disability” (the medical model).
• Ask service users what language they prefer.

Complaints and Feedback

• Have clear complaints procedures that are accessible.
• Encourage feedback from disabled service users and use it to improve.
• Treat complaints about access as a chance to learn.

Ableism and the Law

UK law protects disabled people’s rights in health and social care. The Equality Act 2010 says:

• Services must make “reasonable adjustments” to prevent discrimination
• Direct and indirect discrimination are both unlawful
• Auxiliary aids (such as communication supports, interpreters or technology) must be provided if needed

Failing to act is a legal risk and harms trust.

The Care Act 2014 and the Mental Capacity Act 2005 give disabled people the right to be involved in decisions about their care.

Case Studies

Missed Care

A deaf man attends a GP appointment but no interpreter is provided. He cannot understand treatment options. This puts his health at risk.

Feeling Unwelcome

A patient with a wheelchair is left waiting outside a clinic with no accessible entrance. She misses the appointment and loses confidence in the service.

Ignored in Decision-Making

A woman with a learning disability is not asked about her preferences. The doctor talks only to her carer. She feels invisible.

Positive Change

A hospital works with disabled patients to improve signage, install hearing loops, and train staff in basic BSL. Satisfaction rises and missed appointments fall.

Everyday Ableism

Daily life is affected by low expectations and social exclusion. This includes:

• Strangers speaking to the person’s companion, not to them
• Assumptions that disabled people cannot work, learn, have relationships or raise families
• Lack of representation in staff teams, leaflets, and posters

This can seem minor but adds up over time.

The Social Model of Disability

The social model is central to challenging ableism. It says that people are disabled by barriers in society, not just by their bodies or conditions.

Removing these barriers leads to better health outcomes, greater independence, and more trust in services.

Barriers are:

• Physical (steps, narrow doorways)
• Attitudinal (low expectations, stereotypes)
• Institutional (policies about appointments or information)
• Communication (lack of alternatives to speech or print)

The social model helps health and social care workers see what needs to change.

Listening to Disabled Voices

Change is most effective when disabled people are involved in decision-making. Co-production means working together, from policy design to daily practice.

Hearing directly from disabled people brings understanding of real-world barriers and solutions. Listening builds services that meet everyone’s needs.

The Benefits of Inclusion

Accessible and welcoming health and social care services benefit more than just disabled people. Adjustments help:

• Older people
• People with temporary injuries
• Non-English speakers
• Those with mental health conditions
• Parents with prams

Universal design is about making things easier for everyone.

Final Thoughts

Ableism in health and social care disadvantages disabled people. It takes many forms. Attitudes, policies, language, and environments can create barriers.

Disabled people’s voices and choices must be respected. Staff must challenge assumptions. Services meet legal and moral duties only when they value inclusion and remove barriers.

Change is possible with effort, listening, training, and working together. Accessible and respectful health and social care is possible for everyone.