The article for this week’s discussion can be found here as voted for by popular opinion – well, 8 of you! I’m hoping it will be an interesting and wide-ranging discussion which includes views not only of professionals but those who have used/use social work/social care services.
McLaughlin, the author of the paper, tackles an issue that has been controversial and subject to debate, possibly as long as we have had social work. How do members of staff in services that are the providers (or commissioners) of services refer to people who use those services and how do people who use those services, most importantly, want to be referred to.
McLaughlin looks at the way the social work profession has used labels such as ‘patient’, ‘customer’, ‘client’, ‘expert by experience’, ‘consumer’ and ‘service user’ and how these labels may ascribe power to the quality of different relationships. It’s not possible to pretend the power doesn’t exist but it’s also a word that, by labelling and describing someone, automatically infers assumptions.
McLaughlin takes a historical look at the way the language has developed, starting in the 1970s with the favoured ‘client’. The word though, was challenged within social work in the UK (less so overseas) due to the potentially passive nature of the term. It was claimed that ‘client’ makes assumptions of power remaining within the grasp of the professional. Personally, while not necessarily favouring the language, I think we need very clear reminders of where the power lies in the relationship between people who use social work services and the ‘professionals’ and pretending language may change that could be a little disingenuous. But we watched as client faded.
McLaughlin moves on through the 1980s and on to the 1990 NHS and Community Care Act and the (in England) split between adult and children’s services. In adult services social workers became care managers. The purchaser/provider split changed the relationship with commissioning. The social worker was the assessor and the commissioner/purchaser. People became ‘customers’. or ‘consumers’. There was a ‘service’ or ‘package’ to consume – or buy – even if it was commissioned through local authorities.
This switch though, was not evident, says McLaughlin, in children’s services as there was a less choice involved in the provision of some core child protection services. Consumer and customer make assumptions about choice. Personally, having worked through this period in adult services, I think there was – and still is – a fallacy of choice rather than genuine choice and sometimes language is used to mask that – but back to the article.
McLaughlin makes some interesting points about the marketisation of social work and how the language of consumerism was adopted before shuffling us to the end of the 1990s and a different turn.
‘Service user’ he says, developed from the late 1990s/2000s and greater participation and involvement from and by people who used services and the development of the National Service Frameworks. ‘Service users’ became more involved, even, embedded in delivery programmes for social work training and feedback and education in the sector. There could well have been (and be) a tokenistic aspect to this. There has been and continues to be an increase in service user involvement and the language has reflected this but it is by no means ‘done’. Not by a long way.
McLaughlin analyses the use of ‘service user’. It is a generic term used for anyone who may use a social work service, adult or child, mental health, physical disability or learning disability. It picks out one aspect of someone’s life – namely that they are a recipient of social work services, and labels them accordingly without representing or acknowledging the myriad of roles we all have – as parent/child/worker/partner/retiree/friend/supporter.
He raises an important point too when we look at ‘service user’ involvement in education, research and consultation that there is an ‘in’ and an ‘out’. Professional and service user. It’s pretty clear in the language where the power lies there. And it doesn’t acknowledge that people can be both. You are ‘one of us’ or ‘one of them’.
‘Service user’ also neglects those people who are denies services but who might find them useful or need them – or people who refuse services which are offered to them. He also raises the issue of people who are subject to actions where there is no choice or option offered, for example, the removal of a child or a detention under the Mental Health Act. There’s no choice there.
McLaughlin touches on the differences in the relationship when someone uses direct payments and buys and commissions (potentially) their own service. Are they are customer now? I’m not sure but there’s also the different roles that someone has in a multi-disciplinary team. Having worked in a community mental health team, you might have some people referring to a patient, others a service user, others a client. Language needs to (or does it – this is what McLaughlin suggests) find a way to work across disciplines.
McLaughlin moves to the label ‘user’ which often has connotations of the substance misuse so alone doesn’t seem to ‘fit’. He then looks at the way ‘experts by experience’ has developed in its use.
McLaughlin concludes with some thoughts about the way we construct language and he offers some possible alternatives which I’ll leave you to read and evaluate.
So some questions for the discussion on Thursday 18/13 (and please do ask and contribute your own) They may not all come up but some things to think about.
a) Where are we at the moment in terms of language/what do you use at work/in the sector?
b) How do we get away from labelling/stigma/assumption?
c) What do you prefer to be called? (as someone who works in the social care or as someone who uses/may need to use social care services in the future?)
d) Is customer relevant?
e) Do we ask people? Do we respond when we ask?
f) Does language matter?
g) Do we need to find a ‘word’ to describe all people who do and may use social work services?
Those are my initial thoughts but by no means to I ascribe any expertise to them. Do join me on Thursday 8pm BST for about an hour to discuss this paper and issues which arise from it.