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?


  1. I think the difficulty with finding a satisfactory descriptor is partly analagous to the awkward position social care finds itself in. Working in mental health services, 'patient' is often the preferred term as there is often not a great deal of choice involved. I read some poll that I can't find reference to that it is the preferred term for users of services, however, in general social care teams, 'patient' is a misrepresentative term. I tend towards 'service user' in that context but it sounds unnatural in some circumstances. The question itself though is a perfect illustration of the importance of language in shaping attitudes and thought processing.

  2. I think it will be interesting to see how, with increased joint working with Health across the sector, the use of language and the whole overall corporate culture will evolve. Hopefully the social model will have a positive impact on the medical model, or perhaps there will emerge a new pardigm.