The COVID-19 pandemic and the measures introduced to control the spread of the virus have challenged our identities.
We’ve gained labels that change the way we are seen, and the way we see ourselves.
Vulnerable. Shielding. Furloughed. Key worker. Carer. Hero. Isolating. Isolated.
We’ve lost loved ones. Livelihoods. Connections to the people and places that form – or formed – vital elements of who we are.
We’ve lost opportunities, choice, hope. Vital elements of who we could become.
For many of us, this is a temporary state. A lockdown with an end in sight.
But for too many people who draw on social care, the lack – or loss – of identity, and in turn the lack or loss of connections, of hope, of choice, is permanent.
If we work in social care, we often meet people during periods of huge change. Chaotic, scary, bewildering times. These dramatic life events change how people see themselves and change how they are seen. They attach new labels, add a new layer of identity or strip several layers away. But in our fleeting encounters we barely scratch the surface – focusing on a problem to be solved, a risk to be managed, a personal care need to be met, rather than seeing and hearing and understanding the whole person – who they are, who they’ve been, who they want to become.
In this blog post I consider some of the ways in which our current practice ignores, and indeed erodes, people’s identity, and suggest that in order to genuinely rewrite social care we need to pay far more attention to identity.
Lenses and layers of identity
Often by the time we meet you, you’ve been screened. Triaged. Discharged to assess.
We’ve identified you as vulnerable. At risk. In need.
You’ve ticked the right boxes.
You’ve become a referral. An allocation. A concern. A case.
We’ve read details about your problems and your conditions and your needs from forms. Our records reflect your life through the lens of (usually multiple) ‘professionals’. We’re already forming an impression of you, possibly already determining your (our) outcome.
“The majority will be your four calls a day stuff”.
Our assessments and reviews allow us a snapshot of you, a glimpse in an intense, pressurised situation. You – or people close to you – answer pre-determined questions about what’s wrong and what you can’t do. You’re under pressure to say the right thing, without being totally sure what the right thing is. To score enough points to proceed.
If we identify you as ‘eligible’, we plan and provide services to maintain your existence, to keep you alive, then close your case and move on.
If we decide you’re ‘not eligible’, we signpost you elsewhere, then close your case and move on.
Labels as the enemy of identity
Our labels strip people of their unique identity. Individual hopes, desires, fears and potential are obscured by the labels and associated assumptions and judgements we attach.
We talk of being strengths-based, but our language shrieks deficits.
We talk of being person-centred. Of putting the person first. But the person is nowhere to be seen.
Service user. Case. Vulnerable. At risk. Inappropriate referral. Not eligible. Non-compliant. Challenging. Complex. Hard to reach. Difficult to engage.
Our labels strip away the unique identity of the people close by too – family members and friends identified as carers, representatives, appropriate individuals. Not human beings with desires, fears, needs and potential of their own.
These labels make our social care world of screening and signposting and assessments and eligibility determinations and services go round. Our sorting office approach relies on them. It depends on categorisation and standardisation and lists and forms and one-size fits all solutions.
Blurred identities suit our system.
This distancing protects us too. It shields us from feeling too distressed or helpless ourselves, as we process people along our workflows and down our pathways.
And in turn we become ‘other’ to the people we’re here to support. Dehumanised. Robotic.
Social worker. Assessment officer. Care manager. Case worker. Our own identities hidden behind our own labels, and all the stereotypes and assumptions and judgements and rules and boundaries they bring.
Ubuntu: I am because we are
Of course, our identity isn’t just about who we are as individuals. It’s intrinsically linked to how we’re connected to people and to places. We’re daughters, sons, sisters, brothers, mums, dads, partners, friends, neighbours, colleagues. We live in homes, on streets, in communities, in cities, in countries, in virtual worlds.
Our relationships make us stronger. Help us feel we belong. Feel known. Feel we have a place in the world.
If we don’t have these connections, or we lose them, we’re missing part of ourselves too. Yet still too often the essential role of friendships and relationships and love and belonging is overlooked in social care, as we commission and plan and provide services to keep people alive but overlook the connections, meaning and purpose vital for people to thrive.
Our most vulnerable
Our othering extends to the collective identity of people who draw on social care. The dominant narrative is one of helpless people who need to be looked after. This narrative has been reinforced throughout the pandemic by the government and the media, and perpetuated by many of the policy makers and think tanks and charities calling for reform.
The vulnerable. The most vulnerable. Those who are vulnerable. Our most vulnerable. Society’s most vulnerable.
This dehumanising language often sits alongside equally dehumanising stock images of disembodied body parts. Hands. Legs. Backs. Bodies without heads. Anonymous. Invisible.
Why does it matter?
This lack of identity matters because it impacts on pretty much every decision that’s made at every level within and about social care.
It matters because it means people are left out of conversations, and decisions are made about them, not with or by them.
It matters because it means people are expected to be passive recipients of services, losing choice and control as assumptions are made and pathways are followed and solutions are prescribed based on labels and classifications rather than individual personalities and preferences and aspirations.
It matters because it means people are not valued. Not respected. Ignored. Neglected. Rights are not upheld, and barriers are not removed. Histories are denied, and futures are destroyed.
It matters because it means people who currently draw on social care are rarely visible in strategic decision making about local policies and support and services that affect their lives, and largely absent from panels and discussions at national conferences and seminars and webinars about the future of social care.
It’s mattered during the pandemic, at horrific cost, as the Care Act easements and blanket do not attempt resuscitation notices and hospital discharge policies and PPE distribution prioritised protecting the NHS over the lives of people who draw on and work in social care.
And it matters for the future of social care, because when the people who draw on and work in social care are barely visible, where’s the public pressure and the political will to invest, to reform, to change?
Acknowledging and affirming identity
As we tentatively start to look ahead, we have an opportunity to build back better and create a brighter, kinder, more human social care future where we acknowledge and affirm identity.
Where we have the time and space to really listen. To learn. To understand who and what matters to people to maintain, or reclaim, or renew their identity.
Where we are all seen and heard and valued and loved for who we are, and who we can become.