Why language matters
“Language is the most powerful tool we have. Let’s use it well.” – Surviving Safeguarding [1]
This thought-provoking blog was originally posted on Bryony Shannon’s blog; Rewriting Social Care.
Anyone who works with me knows that I care a lot about the words and phrases we use in social care. I firmly believe that our language reflects our values and our feelings, and in turn the way we think and the way we behave. But I also genuinely believe that because the language of the social care world is so deeply entrenched, we don’t think about the true meaning or impact of the words we use, or question why we continue to use them.
In this blog I want to explore how and why language divides those of us who work in social care from the people we support, discuss how our language reflects the failures of our social care ‘system’, and consider how we can use language to rewrite social care.
Jargon, acronyms and power
“Language is a powerful tool for communication but sometimes the way that it is used in social care creates stigma and barriers for understanding. Language is power…” – TACT (The Adolescent and Children’s Trust) [2]
The language of social care creates barriers, and there are enough of those already in the statutory social care world. The terms we use perpetuate the power dynamic between the ‘professional’ and the ‘vulnerable person’, the assessor and the assessed, ‘us and them’.
In our jargon-filled world, people are ‘reabled’ and ‘optimised’. They have ‘episodes’ and ‘outcomes’. We assess whether they can ‘mobilise’, manage ‘activities of daily living’ or ‘access the community’. We purchase ‘packages’ of care.
Our language is just as confusing for those of us who work ‘inside’ the system, as each team or service or organisation develops their own jargon and acronyms. We talk of CCGs, CHC, COPD, the CQC, D2A, DOLS, LD, MCA, MSP and NRPF. We attend DST, MDT, MARAC, MAPPA and VARM meetings. We work in E&A, OOH, SCAS, STIT. We work as or with ASYEs, OTs, ICSOs, IMCAs and PSWs.
The language of logistics
Much of our jargon relates to the way our system is set up to continuously move people around. People ‘transition’ to adult social care from children’s services. We ‘screen’, ‘triage’, ‘signpost’, ‘allocate’ and ‘refer’. We ‘discharge to assess’. We determine ‘pathways’ and ‘journeys’, which often result in a ‘placement’ or a ‘transfer of care’. We map this complexity in logical diagrams, with ‘swim lanes’ to indicate the individual worker or team responsible for processing the person through each particular part of our system.
What our neat process maps don’t show is how readily we block people’s entry because they haven’t knocked on the right door, phoned the right number, filled in the right form, ticked the right boxes, met the right criteria. They don’t show the speed with which we move people through our system, or the number of people waiting in line. They don’t show how readily we pass people back because they’re ‘inappropriate referrals’, or pass them on, once we’ve completed our particular tasks, because we have no idea what to do next.
Our social care departments are not structured to help us work together, with ‘whole people’ and their families and communities, to build good lives. Instead they are designed so we can each play our part in meeting needs: wait here for information and advice; this way for reablement; that way for equipment; over here for continuing healthcare; down there for respite; turn left for home care, or right for a care home. We’re all accountable for our own piece of the jigsaw, but no one gets to see the full picture – and what’s worse, we don’t seem to mind.
Thinking (or not) about what words really mean
“If we think about what words really mean, we can use them more wisely.”
Kate Sibthorpe, Think Local Act Personal (TLAP) [3]
Once we’re subsumed in the social care world, we adopt the ‘corporate’ language without question, and without really stopping to think about the real meaning of the words we use. But to people on the ‘outside’, those words can have a very different meaning. For example, in ‘real life:
- Assessment = test
- Case = baggage
- Frontline = where fighting happens.
Sadly in those examples, the real meanings of the words we use all the time are all too accurate, and reflect much of what is wrong. We battle the very people (and families) we should work with and support. We test whether they’re sick or frail or disabled enough to be allowed in. We move them around our system like suitcases on a conveyor belt until it’s time for the next test and the next battle.
Some words are particularly offensive – like respite, which means ‘a pause or rest from something difficult or unpleasant’ [4]. And some words literally have no meaning at all beyond the walls of social care – reablement anyone?
Labels
“language is the first step to turning people into non human objects”
Mark Neary [5]
We don’t often talk about people in social care. Instead we talk of ‘customers’, ‘service users’, ‘clients’. A lot of the time we don’t even identify people as human at all – they are cases, or referrals, or reference numbers from our case management systems.
Often we’ve already applied a label before we’ve even met the person, attaching all our associated assumptions and judgements too. And when we do meet them, we define and describe them by their ‘condition’, or diagnosis, or problems – their ‘primary support reason’.
And once we’ve applied our labels, we assume ownership. We talk about ‘our’ customers, ‘my’ cases. People become passive recipients as we take responsibility for managing cases, fixing problems, meeting needs, moving on.
Blame
“One of the most insidious ways in which institutions maintain their power to continue to fail is through their tendency to blame individuals for institutional failings. This is woven into public service language.’
Alex Fox [6]
In addition to labelling people, we label behaviours too – particularly when people don’t behave in a way we believe they should. We use phrases like ‘challenging behaviour’, ‘refusal to engage’, ‘non-compliant’, ‘hard to reach’ and ‘difficult families’ all too readily, blaming people instead of acknowledging our own failings. Our failure to listen and understand what really matters to people. Our failure to fully involve people in conversations, particularly when they can’t communicate verbally. Our failure to use language people understand. Maybe it’s us who are refusing to engage. Maybe it’s our behaviour that challenges. Maybe we’re the ones who are the hardest to reach. Maybe that’s deliberate.
Sticks and stones
“Many people would argue that it is just semantics but I really disagree. Language and the effects it has on people should never be underestimated…”
Sally Percival, TLAP Partnership [7]
‘Sticks and stones may break my bones, but words can never hurt me’. So the old saying goes. In reality though, the damage done by careless use of language can last much longer that the time it takes for a broken bone to heal. The words and phrases we use reflect our attitudes towards people. Too often our language shows an absence of kindness, of compassion, and even worse an absence of interest in what really matters, and what will really help.
Wendy Mitchell has written on a number of occasions about the words of the doctor who delivered her diagnosis of dementia at the age of 58: “We’re very sorry, there’s nothing that we can do”, and how the first question her manager asked was “How long have you got?” She is clear that language can make or break someone, and suggests that if her doctor had talked instead of adapting to a new way of living her life, she would at least have left the building with a little bit of hope [8].
Smoke and mirrors
“Changing the language used within organisations and systems can often be a substitute for changing behaviour and beliefs, with the new softer-sounding language adding a coating of irony to unyielding bureaucracies.”
Alex Fox [9]
“I’ve been constantly fascinated by the ability of social care to reinvent it’s language but never its values”.
Mark Neary [10]
Language evolves. The Oxford English Dictionary publishes four updates a year, with more than 1,400 new words, senses, and subentries added in the latest update in June 2019 – including bae, dejunk, meeple, spox and twittersphere. [11] The language of social care evolves too. We talk of independence and choice, personalisation and coproduction, strengths-based approaches and asset-based community development. But all too often, while we’ve introduced different terminology, we haven’t changed our behaviours or our bureaucracies at all. We ask people about their strengths, but still define people by their problems, or indeed view them as problems. We ‘empower’ people through offering them direct payments, then impose strict rules and limitations on their use. We talk of community assets but keep commissioning traditional services and ‘placing’ people in institutions.
A new vocabulary imposed from above without an associated change in structures and processes, and not mirrored by different behaviour and values, can be misinterpreted internally, and greeted with suspicion by people and families – particularly if the new language is seen as a thinly-veiled attempt to divert people from our doors and relinquish our responsibilities. And yet we have to start somewhere, and unless we really start to take our use of language seriously, we’ll never find the words to make a difference, to describe our better future, to rewrite social care.
The language of a failed system
Social care has evolved from the days of community social work to a complex, bureaucratic machine. We’ve industrialised care and automated our processes, and in doing so we’ve mechanised ourselves, labelling and processing people like parcels in a sorting office. We tick boxes, complete tasks, send our parcels off down predetermined routes and move on as quickly as possible to the next in line.
And as such, we’ve removed all traces of humanity to such an extent that we think it’s ok to refer to people as numbers, cases, service users and customers. And indeed, our sorting office approach relies on us maintaining the distance. Real lives are complicated and messy – tangled webs of aspirations and expectations, memories and dreams, hopes and fears, opportunities and barriers. Real lives don’t fit into our neat categories – especially not good lives. If we focus only on problems and attach the corresponding labels, it is so much easier to fit people into the boxes on our forms, channel them down our ‘one-size fits all’, linear conveyor belts and apply our standard solutions.
It’s much quicker to focus on problems and apply quick-fix solutions than to really explore what a good life looks like to someone and how we can work with them to achieve it. Personal care needs are quickly met with the purchase of a standard ‘4 calls a day’, but you can’t buy friendships, hobbies, jobs, love. All those things that enhance our lives rather than just maintain our existence – all those things that make us unique, make us individuals, make us who we are – don’t come in off-the-shelf packages. But, if we don’t recognise people as unique individuals we don’t need to think about their lives as a whole. And if we dehumanise them enough – if we forget that they are mums, dads, daughters, sons, sisters, brothers, friends – we don’t even feel uncomfortable imposing solutions that we’d never want for our own family or our own friends.
“This language protected me from the reality of what I was doing to the people caught in the system… I learnt that dehumanising people through my use of the language of the professional made it easier for me to cope”
Social worker [12]
And ultimately, because we’ve detached ourselves so completely, we’ve lost our identity too. We’ve removed all trace of humanity from ourselves as well as the people we’re working with, and become robots operating the social care machine. We’ve detached ourselves because we have no other option – the conveyor belt is moving too quickly for us to pause for long enough to form any sort of relationship where we can really understand people in the context of their lives, communicate using a method and at a pace that works for them, and explore a range of options together to enable them to get on better with their lives.
Rewriting social care
“And we keep our language simple, making sure that we do not create distance through the use of acronyms and words that prevent us thinking carefully about one another.”
Hilary Cottam [13]
The language we use today is a direct result of the dehumanising, process-driven system we’re operating in. We can continue to produce glossaries and jargon busters, factsheets and guides to demystify our jargon and translate our processes into ‘plain language’. We can employ ‘navigators’ and advocates to help people to understand the complexities of our social care world and negotiate their way through. But in doing so, all we’re doing is perpetuating the system.
If we’re really going to rewrite social care, we need to be radical. We need to dismantle the social care sorting office with its associated barriers, assumptions, battle grounds and quick fix solutions, and return our focus to people, not processes. We need to stop assuming the role of the expert in people’s lives, and reclaim our role as experts in listening, making connections, maintaining human rights and building lasting relationships. We need to welcome people in rather than pushing them away, trust our instincts, our judgement and the people we’re working with, make decisions with people not for them, and focus on capabilities and possibilities rather than problems and risks.
We’ve created and perpetuated the complexities of adult social care. We’ve become the system. And as such, the system won’t change unless we change. We need to change the way we talk with people, and about people. Challenge the dehumanising forms and processes and institutions. Embed our commitment to a strengths-based, personalised approach by reflecting it in the words we choose. Remove the barriers we create through our use of jargon. Close the divide we perpetuate through our use of labels. Listen more. Have more conversations about good lives. Tell more stories of hope. Use a common language we can all understand, with ordinary, honest, compassionate and respectful words that make sense to us all. Be more kind. Be more human.