When Inclusion Becomes a Script

  

Organisation X: A Case Study —  What Accountability Really Means

I want to talk about Organisation X. Not to name and shame, and not to rehearse a complaint, but to explore what disability equality looks like in practice when things quietly go wrong.

I come to this as someone who has spent over thirty years working in disability equality, and as a researcher whose PhD focused on accountability from a disability equality perspective. I also come to it as a disabled person. Those positions are not in conflict. In fact, disability equality work depends on holding them together.

What follows is a case study, drawn from lived experience and analysed through a disability equality lens. Lived experience is not an anecdote here; it is data. It tells us how systems actually behave when policies are no longer words on paper but interactions between people.

The Welcome That Wasn’t

One of the quiet truths of disability equality is this: welcome matters more than we think.

Around 40% of people will experience an impairment at some point in their lives. That doesn’t mean everyone is disabled, but it does mean organisations should assume difference, not sameness. This is what the anticipatory duty is about.

In Organisation X, that assumption wasn’t there. No one looked for me. No one paused to wonder whether the patient might be delayed, disoriented, tired, or simply in the loo. It wasn’t hostility. It was something more ordinary: the expectation that the “normal” patient would cope.

This is where exclusion often begins — not with intent, but with inattention.

When Inclusion Becomes a Script

Organisation X, like many organisations, uses inclusion phrases. “Hello, my name is…” “Who is with you today?” These are meant to signal respect.

But scripts don’t guarantee inclusion. When I was asked who was with me, the conversation immediately shifted away from me. The accompanying person became the focus. I had to ask, more than once, to be included in my own consultation.

This isn’t unusual. Disability equality research has documented it for decades. Disabled people are frequently spoken around rather than spoken to. We are present, but slightly off-centre. Visible, but not quite addressed.

Being Told to “Just Go to X-Ray”

Large organisations are complicated places. Hospitals especially so. That’s precisely why clarity matters.

Being told simply to “go to X-ray” — without clear directions, without checking understanding — may seem trivial. But for someone in pain, tired, or cognitively overloaded, it’s not. Accessibility failures often hide in vagueness. Clear instructions are not a special adjustment; they’re good practice for everyone.

Eye Contact, or the Lack of It

What unsettled me most was how often people didn’t quite speak to me.

Questions were directed at the air behind my head. Conversations happened beside me. Even when someone stood directly in front of me, eye contact was avoided. This isn’t about politeness or social awkwardness. From a disability equality perspective, direct communication is about recognition.

To avoid dialogue is, in a very real sense, to avoid the person.

Power at the Front Desk

Reception desks don’t look powerful, but they are. They control access.

In Organisation X, that power was exercised in a way that felt parental, disciplinary, and demeaning. I was spoken to like a child being told off. I complied because I had to. The alternative was no care.

This is why disability equality work talks so much about power. When people don’t recognise the power they hold, they can cause harm without ever meaning to.

The Weight of Accumulation

None of these moments, taken alone, would make headlines. That’s the problem.

It took five interactions like this before I met someone who treated me as fully human, who made eye contact, who spoke to me as a person. By then, I had already withdrawn. I was cautious, quiet, and afraid of being seen as “difficult”.

Disability equality research calls this cumulative harm. It doesn’t shout. It erodes.

The Accountability Gap

Organisation X, like many organisations, has values. It talks about dignity, respect, inclusion. I don’t doubt the sincerity behind those words.

But values only matter if they are applied evenly. When some people are treated as fully human and others are not, an accountability gap opens up. The organisation’s legitimacy — its claim to fairness — starts to wobble.

This isn’t about individual bad actors. It’s about systems that rely on goodwill rather than responsibility, on training rather than accountability, on intention rather than outcome.

Why This Matters

I didn’t write this because I enjoy revisiting a difficult experience. I wrote it because disability equality is my field, and this is my bread and butter. If we want organisations to do better, we have to be honest about how failure actually shows up: quietly, cumulatively, and often without malice.

Disability equality isn’t about being nice. It’s about recognising power, anticipating difference, and taking responsibility for how systems treat people.

That’s what accountability from a disability equality perspective really means.