Disabled people are regularly denied their human rights, since policies and laws are hard to translate literally into practice. This article aims to make connections between social practice theories and Disability Studies, in order to understand the problems faced by disabled people, using different methods to look in detail at how practices are shaped and how disabled people get excluded. Disabled people are active agents in making change, both informally on an everyday basis and through formal actions. Thus we also suggest that the insights of disabled people could bring a fresh perspective to social practice theories, by troubling the taken-for-granted in our everyday lives.

BackgroundThe UK Equality Act 2010 requires providers of health services to make changes or ‘reasonable adjustments’ to their practices in order to protect disabled people from discrimination or disadvantage when accessing care. Existing evidence suggests that despite this legislation, health services are not always providing reasonably adjusted care for disabled people. This paper presents the perspectives of disabled people themselves in relation to their experiences of accessing reasonable adjustments in hospitals in England.MethodsTwenty-one semi-structured interviews were held with disabled people who had a recent experience of hospital care in England. Participants were asked about the extent to which the hospital provided reasonably adjusted care, and if necessary, how they thought the provision of reasonable adjustments could be improved. Each interview was anonymised and transcribed, and the data analysed using thematic analysis.ResultsParticipants reported mixed experiences about whether and how reasonable adjustments were provided: some shared positive examples of good practice; others spoke about difficult encounters and limited provision. Recommendations made include a need for culture change in how reasonable adjustments are perceived and enacted; improvements in identifying the needs of disabled people; improvements to the hospital environment and the provision of information; and the need to involve disabled people themselves in the process of change.ConclusionsGaps remain in how reasonable adjustments are provided for disabled people accessing hospital care. It is important for hospital staff to listen to the perspectives of disabled people about the provision of reasonable adjustments, and make improvements as necessary. Hospital staff could also do more to share good practice in relation to the provision of reasonable adjustments to effectively inspire and embed positive change.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3757-7) contains supplementary material, which is available to authorized users.

Accessing hospital care and being a patient is a highly individualised process, but it is also dependent on the culture and practices of the hospital and the staff who run it. Each hospital usually has a standard way of ‘doing things’, and a lack of flexibility in this may mean that there are challenges in effectively responding to the needs of disabled people who require ‘reasonably adjusted’ care. Based on qualitative stories told by disabled people accessing hospital services in England, this article describes how hospital practices have the potential to shape a person’s health care experiences. This article uses insights from social practice theories to argue that in order to address the potential problems of ‘misfitting’ that disabled people can experience, we first need to understand and challenge the embedded hospital practices that can continue to disadvantage disabled people.

This paper applies social practice theories, which focus on the pattern of everyday activities, such as studying at university or playing music. Some theorists analyse practices by looking at the different elements from which they are formed, and that has helped us to gain insights into how disabled people can get included and excluded from ordinary activities. We focus firstly on common strategies for adjusting practices, namely providing another social actor and allowing more time. Secondly, we turn to ways in which social practices can be re-designed for everyone. Thirdly, we explore practices in a more restricted and 'specialised' setting, such as a centre for disabled people. We conclude that social practice theory has not given a full account of the effect of exclusions. Disabled people's inclusion can change the shape of a practice, but it is important to recognise and embrace such changes in the mainstream of social life. Points of interest• Social practices are things we all do, like shopping or cooking or playing music. • Some social practices are hard for some disabled people to take part in. We call that 'exclusion' . • But things can change. Disabled people can be part of that change, by showing others how things can be done differently. • The UK has a law called the 'Equality Act' (2010) which means public services like hospitals should include disabled people. They have to adjust the way they do things. • Social practices should not just be tweaked for a disabled person.They should be changed so everyone is included.