Why we need to rethink our language in social care
Sam Newman, former social worker and advocate of relationship based care work at Partners4Change, explores the idea that current problems within social care haven’t happened because of the system itself, rather as a result of how we talk about it.
We’re all familiar with calls to ‘fix’, ‘reform’ or ‘transform’ social care, and the endless debate about how this can be achieved. Discussions nationally focus on recruitment and retention, digital solutions, improving ‘patient flow’… Local plans focus on ‘managing demand’, ‘efficiencies’ and ‘strengthening the front door’. These all commit the identical mistake of thinking we just need to get the current system working better. I don’t believe this. I don’t believe any of those things represent a solution. What we need is a revolution. We have to re-think what we mean by care and support, and we need to re-think the words and phrases we choose to use.
Our language reveals, whether we like it or not, our state of mind, our values and principles, what we believe we are about when we go to work. Reducing people to ‘cases’ or ‘IDs’ or ‘service users’, describing ‘throughput’ and ‘diversion’ as our success measures, talking about ‘pathways’ and ‘customer journeys’ as the way we do our work – these all tell a story of how far we have slipped into a world of a sorting office, a production line, where people (if they are lucky enough to be allowed in) are processed and labelled, get passed around, wait, ring us up multiple times asking what’s happening when, and with whom, and why.
Any of us could require some assistance to live the life we want to live, and many of us do. But the labels we apply to people seeking and drawing on support suggest ‘them’, not us. Our language dehumanises and divides. We forget that ‘our cases’ are people with back stories, skills, talents, hopes, fears, successes, failures. People with so much to give, so much to say if we would only listen. People described only by what they ‘need’, what they ‘take’, and where they fit (or rather where we try and make them fit) into our categories and service solutions.
People become ‘cases’ and ‘referrals’ – and worse still we blame them for how busy and overstretched we are by referring to them as ‘demand’. They become one dimensional items on a list – which we are continually screening and triaging – wasting time and energy.
I believe at the heart of this language problem is the concept of assessment. This establishes the power dynamic of the assessor as the expert, with the power and decision making ability, and the ‘assessed’ as the passive, needy, vulnerable person – waiting to be told if they have passed or failed the test. Assessment has been reduced to a form – a very long and complex form, and social work has been reduced to the act of completing the form – including all its multitude of questions – half of which are irrelevant to everyone subject to it, and 20% of which are just downright rude and intrusive.
Defenders of the holy grail of ‘assessment’ say that it is the unique skill set of social work, and furthermore is enshrined in the Care Act. I say if social work is all about completing an often ridiculously long form, let’s get AI to do it cheaper and better. And there is nothing in the Care Act to suggest assessment is what it has become – a form. My reading of the Care Act tells me that what it requires is proof that we have ‘really understood’ someone – what really matters to them as a unique individual. And to do that we have to let go of our identity as experts, and turn up – with humility, to really listen, understand and act on what we hear and see.
I’d happily ban every one of our labels. Each word that illustrates our transactional approach. But talk of banning certain terms often leads to the search for alternative words – not an alternative approach. We don’t need some shiny new words to replace the old ones and to bolt on to our outdated system. We have to walk away from the sorting office approach to social care and rediscover our own humanity and kindness – but do this we need to radically change our practice. We must get to a place where these words don’t feature in our vocabulary because they no longer reflect and shape what we believe, what we think, and how we act at work. A place where we don’t talk about screening and triaging, because we’re no longer processing people like parcels, our task is not to manage lists or workflows. Where we don’t need to talk about ‘assessments’ because we’re having conversations about what people want to talk to us about, not what is on our form – and where we are primarily the listener – in order to understand. Through this activity we work out what matters most – and what counts as support (real co-production). We aim to get people better connected to things that make their lives better, and when they are in trouble, we step forward and really take action to help – rather than referring them somewhere else.
At Partners for Change we’ve worked for more than 10 years with our partners in over 50 local authorities, to develop this very different approach, based on conversations and good relationships. We know, through data and stories, that it is better for people and families, and better for workers whose productivity increases as well as their morale, and when we get those two things right we make much better use of our scarce resources of time and money – wasting much less of both precious commodities.
We have learnt that to work in this very different way we have to discover a new radical language – where we call people ‘people’ and families ‘families’. When we meet as colleagues we don’t talk about referrals, or cases. We don’t describe people according to their category (LD, MH,OPMH) or diagnosis (personality disorder, dementia). We talk about the people we’ve met, spent time with, listened to – and together we try and work out what the right thing to do is – for them, for their families and for us.
Image: ‘The Three Conversations approach’
People tell us that we haven’t got time to work like this. If only we had time to be kind, to stop for a cup of tea, to listen properly. I say – walk away from your sorting office where social workers spend 4 days out of 5 (BASW statistics) completing forms, and where just about all of our energy and attention is on the processes not the people, and you will find an amazing truth. We get to people quicker. We get to the point quicker We reduce dependency on ‘services’. We get more work done. And people and families appreciate the simplest of things – that we really listened, that we did what we said we would do, that we didn’t hand them on to the next person, that they were able to contact us directly if they needed.
And if we drop our dehumanising and blaming labels, and just treat people as people, as us, not ‘them’, we also become the people we really want to be.
Sam has led the development of The Three Conversations – a well-established and transformative approach in social care which listens, works with kindness and supports people to build a good life. It’s about having open and interested conversations with people and families who need support.
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