One of the top news stories this week has involved a family who has asked for their daughter, who has severe disabilities, to be taken by social services after they felt unable to care for her without greater support. The case has highlighted an ongoing conversation about the extent of support that the state should offer to people with disabilities and their families, and also about where such support should happen. In recent times, there has been a push to allow people with disabilities to stay in their own homes and often with their own families, rather than in institutions where they were locked away from the rest of society. This move has been welcomed by disability campaigners everywhere as recognition of the humanity of those with disabilities and their right to participate in the family life, as well as work and leisure, that the able-bodied take for granted. Yet, the other side of this story is that the families, friends and loved-ones of people with disabilities often have to provide the care that was previously offered by the state- and they often do it for free or for very little remuneration and with very little respite- perhaps especially in the case of children with disabilities who are not entitled to the same benefits as adults.

While this is a current headline, it is not a new story.  How society cares for those that have different needs or require different types of support than the main body of the population- where such support happens and who pays for it- has been the topic of concern for centuries. There is no straightforward story to tell of the history of social care- the types of provision offered have varied by region and by historical period- but here are some highlights. The family has always played a large role in support networks, and in many periods and places, families were expected to provide financial and physical care for their near relatives (parents, children, occasionally siblings) if they could. If a disabled person or his or her family was particularly wealthy, they might also pay for support- such as nurses or cleaners- either in their home, or in an institution. In much of Western Europe until the nineteenth-century, however, care for the poor- who had limited familial support- was financially supported by the Church and paid for by tithes taken from the rest of the population. In other places, like towns, such provision might be managed by the ‘local council’ or early forms of town governing bodies and guilds. There was also a network of charities- often connected to religious organisations, like monasteries and nunneries- that provided help and care.

Care provision could be distributed in a number of ways. Out-relief was popular before the eighteenth century in Britain, where money was given to the poor themselves or to other members of the community employed to care for those who needed help. This might include payments for nursing, but also cleaning and meal provision. Abandoned or orphaned children were also provided for in similar ways, placed with families who were paid for their support. Evidence from London also suggests that in the sixteenth and seventeenth centuries, there were also semi-formal institutions in larger communities, where community nurses were paid for the care of small groups of people who lived in their homes. This care included providing a home to live in and food as well as medical and physical support. Some nurses specialised in particular types of care- so some ran homes for the dying, while others treated certain types of disease, or only cared for children.

During the eighteenth century and especially in the nineteenth century, community care provision became more formalised and in many areas moved into large institutions, sometimes called workhouses, that could be run by the Church, such as in parts of Ireland, or by local government bodies, such as Poor Boards in many parts of the UK. Rather than giving the poor allowances to live in the community, people who needed support- financial or otherwise- often had to move into large institutions, where they were sometimes segregated by gender, need and even age. This often split families up- putting husbands in different parts of the building from their wives and children, and allowing minimal interaction. In Ireland, concern that the workhouse offered a higher standard of living than the notorious levels of poverty of many parts of Irish society, led the Boards to try and keep condition as poor as possible to discourage people from seeking relief- which led to extremely high mortality levels, especially amongst babies and young children.

Yet, the other side of these institutions was the way that they could be used flexibly by poor families as they tried to seek relief. The widespread growth of orphanages in the eighteenth-century created a place where families could leave children during times of family poverty, or when children were young and could not contribute economically, but also retrieve them when they were older or when the family circumstances improved. Workhouses could be used in similar ways for the disabled and elderly, although there were greater attempts to monitor the use of workhouses for family respite!  Care for those with disabilities has always involved a complex mix of family, state and charitable organisations- today’s news is just the current version of some much older questions.

Further Reading

Jeremy Boulton, ‘Welfare systems and the parish nurse in early modern London, 1650-1725’, Family & Community History, 10(2), (2007), pp. 127-151.

Virginia Crossman, Politics, Pauperism and Power in Late-Nineteenth-Century Ireland (Manchester UP, 2006).

Steve King, Poverty and Welfare in England, 1750-1800: a regional perspective (Manchester UP, 2000).

Katie Barclay wonders how history will remember Big Society welfare policy? She is a historian at Queen’s University, Belfast.