“If you really want to change practice then you have to adopt a new language”Sam Newman, Partners4Change (1)
Our Conversations Count approach is based on The Three Conversations®. Partners4Change have a list of words that are banned in their approach. Many of these words describe what we currently do, including ‘assessment’, ‘review’, ‘allocation’, ‘hand-off’, ‘referral’, ‘pathway’, ‘journey’ and ‘waiting list’. Others describe who we currently do these things to: ‘customer’; ‘client’; ‘service user’; ‘case’. All the banned words are words that we use all the time.
We weren’t sure about banning words. It felt a bit extreme. So, we described the list as ‘words that make you go hmmm…’ and added to it with our own frequently used phrases including ‘case transfer’, ‘screen’, ‘care management’, ‘active case’ and ‘passive case’, along with acronyms including AQ, RQ, ADMM, SAF, PRF and 5Q.
This article doesn’t provide a quick-fix list of alternative words. But it does aim to challenge the language of our current approach, and illustrate why these words should make us go hmmm…
A language of processes and systems
“In many areas the system is dictating practice and tying up hard pressed practitioners to spend significantly more time inputting a person’s notes on the system and processing the next steps than they spent talking with the person in question”.Jenny Pitts, National Development Team for Inclusion (NDTi) (2)
“We’ve got a form and a process for every relationship… Love becomes relationships. Relationships become processes. Processes get processed. Health and social care box ticked”.Rob Mitchell, Bradford Council (3)
Our current approach, like that of many other authorities, can be compared to a production line or, as Partners4Change describe it, a social care sorting office. It’s a one-size fits all process, with endless bureaucracy, hand-offs and delays. We focus on what’s wrong, what people can’t do or struggle with, and the services we can put in place to meet needs. Assessments and reviews have become forms designed to open (or close) doors to services, with boxes to be ticked, and set questions regardless of who we’re ‘assessing’, what their lives look like and what really matters to them. We talk about pathways and journeys and we allocate and refer, because we keep passing people around, continually putting them on waiting lists, screening them and handing them over for someone else to deal with somewhere else in the system.
Conversations Count isn’t about processes and systems. It’s about people. We won’t need to talk about assessments or reviews, because we’ll be having conversations and taking stock with people about their lives. Handoffs, referrals and waiting lists won’t be part of our vocabulary because they won’t be happening. We’ll be working with people and sticking with them until we’re sure that they are safe, that any crises are over and that their plan for a good life is working for them.
Can we really stop talking about ‘needs’?
The concept of meeting needs is a core part of the Care Act, but ‘eligible needs’ and ‘care and support needs’ are on the list of words that make us go hmmm… We currently assess care and support needs, consider fluctuating needs and complex needs, determine eligible needs and put services in place to meet needs. Can we really stop talking about ‘needs’?
Possibly not, but we can certainly stop beginning conversations by talking about needs. Instead, we can listen to what people want to tell us, what they want us to know. We can ask people about their lives, and what matters to them.
We’ll consider needs in terms of what needs to change to keep the person safe, or what needs to happen next for the person’s life to be better. We’ll prevent and reduce needs by supporting people to remain as independent as possible for as long as possible.
People will still have needs, but we’ll stop defining them by their needs, and instead see their assets, strengths, and what a good life looks like to them.
And where is the person?
“People want support to have a life not a service”Clenton Farquarson, Think Local Act Personal (TLAP) (4)
“look for the person, not the condition; fit support around a good life instead of asking people to fit their lives around a good service”Alex Fox, Shared Lives Plus (5)
Behind all the endless forms, referrals and bureaucracy of our current system are people. But we’re good at hiding them. We talk about ‘customers’; ‘clients’; ‘service users’ and ‘cases’. These terms suggest distance, them and us. They describe an (unequal) power relationship. They imply choice when often there is none. They dehumanise.
The Conversations Count approach is all about people – their life, their strengths, their networks, their community. We won’t need to refer to people as customers, clients, service users or cases, because they’ll no longer just be names on a list waiting to be screened, or CareFirst numbers on a desktop. We’ll be having conversations with people about what’s good, what they want and what will work for them.
Adopting a new language
We can’t continue to distance ourselves from people and what really matters to them. We can’t continue to hide behind forms and processes, and behind jargon or acronyms. We need to step off the social care conveyor belt and start talking about people. About listening, strengths, assets, connections, relationships, communities, happiness, love.
If we’re serious about changing practice, we do need to adopt a new language. And maybe we do need to ban some words after all.
I wrote this blog in the early days of the development of Conversations Count in Adult Social Care in Sheffield. I’ve included it here to explain the background to the phrase ‘Words that make you (and me) go hmmm…’
Conversations Count is based on The Three Conversations® approach developed by Partners4Change. It’s about listening to people, and understanding what matters to them and what a good life looks like to them and their family. Instead of focusing on what people struggle with, assessing their needs and putting in formal packages of support, the aim is to look at people’s strengths, what they want to achieve, and what they, their family and community can, or could, do with the right support.
The approach is also about releasing workers from the endless forms, referrals and bureaucracy of the current system.
(1) Conversations Count innovators session presentation, Sam Newman, Partners4Change, 30 January 2018
(2) Release social workers to do what they do best, Jenny Pitts, National Development Team for Inclusion (NDTi), Social Care Future blog, 1 March 2018
(3) For the Valentines I never knew, Rob Mitchell, Last Quango in Halifax blog, 10 February 2018
(4) Round Table Discussion: Care Act (2014) – Assessments and Effective Conversations, National Development Team for Inclusion (NDTI), 1 August 2017
(5) Shared Lives: a new health and care system, Alex Fox, Chief Executive Officer, Shared Lives Plus, Policy Press Blog, 28 February 2018