The emergence of the disability movement in the UK (and elsewhere, such as the United States) demonstrated a tremendous shift in the way that disabled people and their needs were viewed, leading to the politicization of disability, placing it firmly on the policy agenda. The concept of power is crucial in this context since those who possess the power, set the agenda. When looking at the issue of who governs, Dahl focused on the power at play during the decision making stage of the policy process, where equally allocated voting rights were not matched by the allocation of power resources such as status, influence, wealth and where success and thus power was demonstrated by having a policy proposal accepted. Using disability politics as an example, the power clearly lay in the hands of medical professionals and also charities who defined disability as a medical problem requiring rehabilitation or treatment and segregating and marginalising disabled people in the process.
Critics of Dahl such as Bachrach and Baratz (1962) argued that power is exercised before this stage in determining what is allowed onto the agenda for discussion in the first place. The fact that disability was not a political issue and was not on the public policy agenda showed that power did not lie with disabled people themselves. Lukes (1974) highlighted a third dimension, based on latent power of dominant values or norms in society and the way that thinking is conditioned along lines of what is acceptable or not and what is possible or not i.e. what is thinkable and doable.
During the 1980s the disability rights movement used direct action both to challenge the structural exclusion of disabled people and to create a positive image of disability, shifting the view of disabled people as tragic, passive victims and showing that disabled people did possess some form of power to influence the policy agenda on their terms. Key to the success of the disability movement was the redefinition of disability, controlling language, ideas and discourse and creating a shift in political thinking on disability. The emergence of the social model of disability to replace the medical model set out disability as a clear social problem rather than an individual medical problem, and highlighted disabled people as a "marginalised and disadvantaged constituency". Therefore what was once viewed as a personal, medical problem was moved into the public arena as a political issue with policy consequences.
The disability movement also provided new evidence highlighting the disadvantage and exclusion of disabled people. The academic credibility of the evidence supported the distinction between definitions of impairment and disability under the social model, locating disability in social structures. The evidence was needed to provide a shift to the values and ideas that came to the fore during discussions on disability. Evidence offered can be viewed in light of dominant values and explanations are offered within the constraints of social norms, attitudes and symbols.
The disability movement contested the dominant values and symbols associated with disability and created a shift towards a new normative and political label of disability and thus influenced the type of policy measures to be taken to deal with this new policy agenda. In the context of discussing the thinkable and the doable, it would not have been thinkable or publicly acceptable at one time for 'disability' to be viewed as a social problem, nor would it be doable to create anti-discrimination legislation with the aim of integrating disabled people into society. Indeed in the mid 1990s it wasn't quite acceptable to provide disabled people with their own citizenship based civil rights legislation. It was thinkable but ultimately not doable in the form of Roger Berry's Civil Rights (Disabled Person's) Bill in 1994. The dominant values and discourse on disability at the time did not empower disabled people but still viewed them as needing to be cared for, and considered the expense of integrating disabled people to outweigh the benefits of providing full access to education, the labour market and so on.
Ultimately the passage of the legislation was blocked and the following year saw the introduction of the Disability Discrimination Act, a piece of anti-discrimination legislation based on the medical model, that allowed a level of justification and various exemptions when it came to (not) making provision for disabled people. The emergence of the social model had not been accepted by policy makers in this instance and at that time, although that is not to say that great progress wasn't made in altering public attitudes and the terms of debate on disability.
It does highlight the difference between the thinkable and the doable in terms of policy making and how different actors interpreted and portrayed evidence, reaching different conclusions by utilising different models of disability. Comparative politics can be used to draw out some conclusions from the case study of disability, when the UK is compared with the US. The Disability Rights movement of the US had different roots to that which emerged in the UK, with different types of disability organisations acting to influence change to policy, and with precedent already set by the early black civil rights movement for civil rights based approaches to tackling oppression of marginalised groups. The resulting policy agenda in the US was consequently different to the one the UK arrived at. It is also worth noting that disabled people as a group are non-homogenous and may have other more important identities apart from their impairment. As such, identity politics, interest groups and organisations for and organisations of disabled people are all thrown into the mix in the debate on disability, meaning that this set of political issues and potential solutions is unique and not necessarily representative of other policy areas. Nonetheless, useful generalisations can be extracted from this case study when looking at the influences of what is thinkable and doable throughout the policy making processes.
The health system is a good example of a policy area that demonstrates different levels of governance and different models of participation, thus looking at dispersal of power both in policy making (determining what is thinkable) and implementation (determined by what is doable).
In the example of the reform and restructuring of the UK National Health Service, we have seen a move from centre-periphery relations (functional, spatial and through identities) and concentration of power, to a form of multi-level governance which aspires to an increased participation in policy making and greater dispersal of power. Since the birth of the NHS in post war Britain, Doctors have been the dominant power in health policy making, which created an imbalance in representation within and between policy making groups. Ideas and models to provide an alternative to this approach arose partly through the need for reform and greater efficiency but also in response to ideology and values around the role of the public sector, and the relationship of the state to the citizen. A conservative approach to reform would be likely to minimise state intervention, and have top down control of the system. A social democratic approach promotes active citizenship and greater participation in decision making processes, allowing for greater consultation and a wider range of interests to be represented through issue networks and partnerships.
These different perspectives in themselves are political and result from ideological differences and the source of values used to influence policy making. This has seen a shift to the rights and responsibilities agenda, taking a more holistic approach to promoting good health and recognising health inequalities, along with a change to governance and management of the NHS to implement this new policy agenda.
Where the NHS is concerned, the role of public opinion is not to be underestimated in determining what is acceptable or thinkable as a policy measure regarding the highly symbolic NHS. Reform in this area is an emotive issue that often mobilises the public and this constrains the options available to policymakers e.g. it would be unthinkable to do away with the NHS. Different venues for policy making will have different perspectives eg localised solutions within a context of national targets allowing the degree of influence of different actors to shift over time. Further constraints on what is doable arise from cost implications of different options, the practical capacity to implement certain courses of action, and whether or not the electorate or interest groups would find various options to be palatable.
There are various constraints that exist in both policy and practical terms that will influence what is doable, and constraints around social norms, language and ideas that will determine what is thinkable in different contexts, places and times. The conflict and tension that exists between the thinkable and the doable has influenced both the values that underpin policies and the models of participation, venues and actors through the various stages of policy making, including who has the power to set the agenda and push certain ideas forward.
