Thursday, 26 November 2009

Language games

What is the correct term for a person who has involvement with the social care sector? In my experience there was in practice no real concrete guidance, individuals largely left to make their own decisions, though like a swarm of bees almost everyone settled on ‘client’, or ‘service user’. In the case of joint working teams the medical professionals stuck resolutely to their classic label of ‘patient’.

The lack of guidance is surprising as the terms we use to describe people are often highly loaded, crystallising the whole histories of professions and influencing the way practitioners relate to the people they work with. Patient, the dominant term in medicine, is regarded by suspicion by social care carrying as it does connotations of passivity in the face of the all conquering medical paradigm. I also find service user difficult as many people I came into contact with were not, or did not wish to be, in receipt of any services.

It is client however, which I have enormous difficulty with. On one hand it does distribute power more evenly between an individual and the organisation, but its origins are rooted in the consumerist conception of the welfare state which I regard with some suspicion. When we speak of clients we imagine somebody who is purchasing a service and entering into a contract. Fine. Perhaps. This view has delivered some improvements through increasing choice and accountability, but at the cost of increasing means-testing. ‘Clients’ increasingly do - literally purchase their care with the Local Authourity acting as broker. Services such as care are no longer a right more an option; if you wish to pay for it. It’s often struck me as an unfair that if you require medical treatment, the state will, quite rightly, cover the cost of this. However, if you happen to need a carer to enable you to go about your daily life, this can be at the cost of a large portion, or in other cases all, of your savings and income. The term client is less innocent than it appears, but is it possible to have a world without such labels?

Thursday, 12 November 2009

The downside to professionalisation

I've been in an essay mode recently, a condition a friend once referred to as 'nesting', I'm surrounded by paper; handwritten lecture notes, books, photocopied chapters, and memos scrawled in a desperate attempt to capture inspiration like a delicate butterfly in a net. I plan to enjoy a weekend of relaxation before clearing the floor ready for my next essay due in two weeks time. No doubt this scene is being replicated in rooms across the country. From Newcastle to Exeter invitations shunned, partners asked for understanding and sacrifices being made in the hope that a good grade means a better future.

From 2012 a three or four year university degree will be the only route of entry to the nursing profession. I have mixed feelings about this. I wrote an essay on the nursing profession as an undergraduate in the early noughties about the politics of the profession. It didn't get me a good grade, but it introduced me to the debate in nursing between on one hand the Florence Nightingale School of nursing which emphasised the pastoral, caring side of nursing and the Mrs Bedford Fenwick school which argued for minimum training standards, registration and increased professionalism. These polar positions have endured through the creation of a universal NHS and can be clearly seen the views put forward today by the RCN and the Patients Association.

For me I feel that both elements have a point. I recognise that the health service has moved on and requires increased specialist skills, but I cannot help agreeing with some of the views expressed on the BBC 6 o'clock news that a 3 or 4 year degree format may put many potentially good nurses off entering the profession. In many ways the story of Nursing and Social Work are similar, both can trace their early development to Victorian amateur pioneers, both have struggled with gender discourses and both have seen groups fighting for increased professional recognition.

One issue in social care has been the creation of a two-tier workforce with unqualified workers experiencing reduced status - as humorously documented in Clare in the Community (October 10th 2007) , fewer development opportunities, and career ceilings. All of which leads to workers with years of experience leaving the field rather than opting to take a three or four year degree. The importance of unqualified workers is often ignored, even in papers such as the Guardian; they rarely appear in accounts which talk of 'the profession'. I was shocked when I first walked into my office to discover that in a team of around 12 there were only two qualified Social Workers, one being the team manager, so in terms of front line workers there was only one qualified Social Worker. It is not my intention here to critique the Social Work degree. My point is that raising barriers to a profession can be problematic. I have had the pleasure of working with many dedicated and competent unqualified workers, who would be regarded as social workers in other parts of the world, many who could have so much more to offer.