As part of the Gloriously Ordinary Language programme I run with Tricia Nicoll, we spend a full day focusing on the language we use to communicate with and about people. We begin these sessions by asking participants to think about the words that other people have said or written about them that have stuck – and to share examples if they’re comfortable doing so. We talk about how this language, these labels, are often attached in childhood by parents, teachers or other kids, and how they shape the way we feel about ourselves and the way that other people perceive and respond to us too.

Then we talk about framing, and how groups of people have been described in certain ways through history. The 1913 Mental Deficiency Act with its “definition of defectives”. Disabled people viewed by Eugenicists as “feeble minded” and “social rubbish”, and as “useless eaters” and “lives unworthy of life” by the Nazi regime. “Children in Need”. People coming to this country seeking a better life described as ‘illegal’, ‘marauders’, “an invasion on our southern coast” (in contrast to the ‘ex-pats’ label given to people leaving this country seeking a better life). People entitled to welfare benefits labelled as ‘scroungers’, ‘shirkers’ and ‘skivers’.

A deliberate narrative to serve a purpose. To influence the way we think and feel. To provoke a reaction and justify actions.

We spend the rest of the day focusing on the language we use within the world of social care. The blaming words and phrases like ‘hard to reach’, ‘refuses to engage’, ‘non-compliant’ and ‘challenging’ that write off people as problems and ignore the influence and impact of our attitudes and expectations. The silly words and phrases like ‘accessing the community’ and ‘activities of daily living’ that imply difference. Other. And the ‘them and us’ words and phrases like ‘service user’, ‘client’ and ‘customer’. 

As I wrote in this post about labels, there have been numerous surveys and much speculation and debate about the “preferred terms for labelling individuals” in health and social care. 

“What do we call ‘them’?” 

This reflects thinking that suggests if we require additional support to live our lives, we are a different type of human. Lesser. Not even human at all. 

The point of the day is to expose these ‘them’ and ‘us’ divisions and how they influence the way we behave, and to consider how we move beyond this categorisation and separation so instead of thinking ‘other’ we think ‘each other’. Instead of ‘them’, we think people, we, us. Because we believe that unless we move beyond ‘them and us’, we’ll never achieve the better, brighter social care future so many of us seek. 

However, attempts to move away from terms like ‘service users’, ‘customers’ or ‘clients’ reveal how ingrained this thinking is. Let me explain what I mean by focusing on a couple of terms that are rapidly becoming alternative labels for ‘them’.

‘People we support’

One phrase that’s increasingly used by people working in services to describe people drawing on support (more on that phrase in a bit!) is ‘people we support’. Surely that’s ok, isn’t it? Better than ‘service user’ or ‘client’? An improvement on ‘my case’ or ‘our customers’?

Potentially. But when we pay attention to how the phrase is used, it’s clear that often we still mean ‘them’. Instead of a phrase to describe a relationship, it’s become a label to describe a group of people.

We’ve capitalised the phrase, turned it in to an acronym, and we even refer to ‘our’.

“Our People We Support (PWS) are at the centre of all decisions.”

“You’ll team lead the service of around 5 People we Support (PwS).”

“Helping the PWS to improve their all-round skills.”

“Ensuring that all staff uphold the dignity of PwS.”

“What a pleasure it was to accompany 2 PWS to their pub lunch.”

I’m not making this up. I don’t think I could!

I just spotted the following comment on a discussion forum:

“actually, latest buzz word here, for those that need it – there are no clients any more – our loved ones are now to be referred to as PWS – ‘People we Support’ – pronounced ‘Poos’ – which is fairly appropriate as they are treated like S***, I guess!”

Hmmm…

Even when the phrase is less explicitly used as a label, it still often feels unnecessary. Take this sentence:

“Our aim is for the people we support to be happy, healthy and at home, living the life they choose as active members of their communities…”

Like ‘the vulnerable’ or ‘the disabled, the use of ‘the’ suggests ‘those people’ – them, not ‘people’ – us. ‘The PWS’. Remember, “Othering can be as simple as speaking of a group of people as “them” in relation to another’s “us”, or even putting the definite article the in front of a label.” [1]

How about we remove ‘the’… and even remove ‘we support’?

“Our aim is for people to be happy, healthy and at home…”

Why is it so hard for us just to talk about people? We? Us?

Don’t we all want to live in the place we call home, with the people and things we love, in communities where we look out for each other, doing the things that matter to us? [2]

‘People who draw on care and support’

The concept that we ‘draw on’ care and support emerged from the Social Care Future narrative: 

“When organised well, social care helps to weave the web of relationships and support in our local communities that we can draw on to live our lives in the way that we want to, with meaning, purpose and connection, whatever our age or stage of life.” Neil Crowther and Kathryn Quinton [3] [emphasis added]

This represents a conscious and explicit shift away from the dominant framing of social care as for ‘the vulnerable’ / those / them and offers a different story – about all of us, not them and us. About each of us living the lives we choose to lead, and all of us benefitting from and contributing to great social care. It deliberately shifts away from the framing of people as passive recipients or users of care to articulate instead the idea of people having agency and being in control. “If you draw on or draw upon something… you make use of it in order to do something” [4], so we draw on support to live the lives we choose to lead. This also helps us to shift from the concept of care as a destination and think instead of support as a vehicle – a means of achieving the things that matter most to us. And it helps us to shift away from the tricky term ‘independence’ and its association with self-sufficiency and living without support.

It’s amazing to see how ‘drawing on’ has infiltrated our vocabulary over the past few years. However, while it was intended to introduce a new way to describe people’s relationship with care and support, it’s rapidly become a new way to refer to people. This isn’t necessarily a problem. There’s not much wrong with sentences like, “Yet, too often, the voices of people who draw on care and support are missing from events and debates.” 

But it’s clear that the phrase is also becoming another label to suggest ‘them’, distinct from professionals, citizens, us.

“The term ‘co-production’ describes working in partnership by sharing power between people who draw on care and support, carers, families and citizens.”

“If you’re a person who draws on care and support or someone who works in social care…”

Frequently ‘people’ is substituted for ‘those’. Them.

“Co-production sets out a way of working where professionals and those who draw on services…”

We still imply ownership.

“…consider creative solutions to ensure we match our people who draw on care and support with available resources.”

Still suggest people are looked after. Cared for.

“The Committee is particularly keen to receive submissions from experts by experience – those who draw on care and support, and those who care for them.”

“People who draw on care and support and their carers…’

And again, so often it’s a layer of categorisation that’s just not needed. 

“To enable people who draw on care and support to receive outstanding quality care…” could just as easily read, “To enable people to receive outstanding quality care…”

“If a person who draws on care and support receives more than one charged-for service…” could just as easily say “If a person receives more than one charged-for service…” (or “If you receive more than one charged-for service…”)

Again, why is it so hard for us just to talk about people? We? Us?

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Any of us could have cause to draw on care and support in the future, and many of us do right now. But too often the language we use and the way we communicate implies that some people are different, lesser, other.

Them, not us.

Often when I talk about language and labels, people ask ‘what should we use instead’? And I say ‘people’, ‘we’, ‘us’.

Try it.

And if you feel you require more context or description, ask yourself what that need or desire to categorise tells you about yourself, your practice and the system you’re working in.

Labels are for jars.

Social care is for people. 

We. 

Us.

References

[1] Can ‘other’ be used as a verb? Merriam-Webster

[2] Social Care Future

[3] How to build public support to transform social care: a practical guide for communicating about social care, Neil Crowther and Kathryn Quinton, Social Care Future, April 2021, K. (2021, April). Retrieved August 16, 2023, from Social Care Future: 

[4] Draw on, Collins Dictionary