The barriers faced by disabled people globally in accessing paid work are a profound social challenge. Many reasons are provided as to why these barriers exist and new policy visions offered up. Any analysis that does not include issues of impairment type and severity, social barriers, welfare regimes, cultural expectations and wider social and economic systems underestimates the complexity of the factors involved. There are a number of conundrums that lie at the heart of our understanding of disability, work and employment. First, how is it that, given the major efforts being invested in trying to get disabled people into paid employment in the ‘developed’ world, progress is so slow – encouraging one key writer to state that there are no easy or enduring fixes for disabled people and paid work, and that many programmes are doomed to fail or under-shoot their target (Marin inMarin et al. 2004)? The second key conundrum is why, given the historically low expectations and assumptions that disabled people cannot work, have some disabled people actually gone on to obtain and retain paid work (Burchardt 2005; Roulstone and Barnes 2005)? However, whilst disabled people are increasing their presence in the contractual labour market there is much evidence of continued labour market disadvantage.