Needs that fall on deaf ears: 'It means I have a normal relationship with my wife': Marianne Macdonald looks at a pioneering scheme in south London

WENDY DIBDIN was left crippled when a drunken driver crashed into her car 19 years ago. Suddenly her husband, John, became a part-time carer and her son, Steven, and daughter, Caroline, then six and two, had a wheelchair- bound mother. Mrs Dibdin, then 34, had to stop teaching physics, stay home and learn the humiliating realities of local authority care.

'The home help came to me one day when my bed was wet and I asked her to change the sheets,' she recalls. 'She refused. She said: 'Today is not the day we change the bed linen'. I asked if she expected me to go to sleep in a wet bed. She said: 'Well, I'm not changing it'.'

That small, but deeply upsetting, incident is one many disabled people endure every day. They have to wait for strangers to bathe them, shave them, feed them, even put in a Tampax. Often these intimate tasks are performed by strangers doing their chunk of care - home help, meals on wheels, nursing.

This structure has its own problems. Aside from the embarrassment of having a stranger wipe your bottom, any tensions that arise are left hanging. Disabled people can request their local or health authority to change their carer, but it is unlikely to happen.

'If you've just had a massive row with your assistant, the last thing you want is them taking you to the toilet,' says Linda Loft, director of the Greenwich Association of Disabled People, a charity set up in 1974 to serve the disabled, six of whom are on its payroll.

Since 1989 the association has been addressing the problems faced by Mrs Dibdin and thousands of other disabled people living at home. Its solution has been to empower disabled clients by letting them hire their own help. Using money from the Government's Independent Living Fund and joint finance, members circumvent local authority care. They can recruit a personal assistant to carry out all their needs to their own timetable.

Mrs Dibdin now employs Mandy at pounds 4.50 an hour, setting her hours and duties to suit her needs and according to her budget. 'Now I have control over my own staff, the bedwetting problems don't arise,' she says. 'I can tell Mandy to change my sheets if I want her to. But the problem doesn't come up, because she's there to take me to the loo.

'Having a personal assistant has enabled me to become a mum again instead of asking my children to do things for me. My husband used to work for BT until he took voluntary retirement. It has made a tremendous difference to our relationship.'

The same transformation has happened to Phil Wardale, 42, the Greenwich group's chairman. Until 18 months ago he lived with his parents. Now he is married. 'It means I can have a normal relationship with my wife,' he says. 'It means I can go out all day without worrying about someone taking me to the toilet. I don't have to rely on my parents - they're parents again instead of carers - and it puts me on an equal footing with my brothers.'

Mr Wardale does sound a note of caution, however, carefully describing his personal assistant, Simon Betts, 34, as 'more than an employee, but less than a friend'. He adds: 'It's like any relationship. You have to work at it.'

The Personal Assistance Schemes were set up in Greenwich with money from the King's Fund charity. They have been so successful that councils across the country have requested a copy of an independent evaluation of them. This found that, when directly employed by the disabled, personal assistants provide far better value for money. Because the scheme has few overheads, the disabled can buy themselves far more man-hours than a local authority.

The report suggests that for its pounds 5m-plus home help budget in 1991- 91, Greenwich council could have purchased 665,912 man-hours. With the same amount, the Personal Assistance Scheme could have bought 1,045,569. A pounds 347,000 sum for care attendants in the same period could have bought Greenwich 36,400 man- hours. The equivalent PAS hours would have been 71,843.

There are some drawbacks. Many disabled people are elderly and unable to cope with the requirements of employing staff. Duties include paying their national insurance contributions, filling out tax returns and, where necessary, firing those who are unsatisfactory. For this group the association provides an 'agency' which, in return for roughly pounds 1 per personal assistant hour, helps in recruitment and takes responsibility for financial details.

It is lobbying Greenwich health authority to transfer some of its care responsibilities to the local charity. It also wants the Government to change the law which makes it illegal for a local authority to make direct payments to disabled people to buy their own care packages.

But there are vested interests to overcome. 'Disabled people are segregated in special schools, special homes, from the age of three or four,' says Mrs Loft. 'They have special transport and special help. A whole bureaucracy has grown up around that system imposed on them by the able-bodied. That means there are jobs at stake. People are protective of their positions.'