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Winter work


It’s all about what we say, as much as what we do


All_in_what_we_say_George_Coxon


The language used in social care is important, and needs a different approach to that used elsewhere. It’s all about what we say, as much as what we do, says George Coxon

As an ex senior mental health clinical nurse specialist with numerous subsequent NHS management, trainer, policy lead and commissioning roles, I feel I have been heavily indoctrinated with medical model language. But, now as a staunch care home activist, I have become uneasy about a lot of medical jargon, labelling and words that could alienate and disempower people in my care homes.

I have gotten into trouble saying some controversial and mildly critical things of our much beloved and revered NHS world of great power, influence and omnipotence, but I do wish to put the case for how we talk in social care land with a different model of care that needs to be better understood.

There is a growing determination to speak up about what progressive, elevated social care work looks like, and how we don’t get entirely consumed by what the matter is with those we look after, but more so, what matters to them.

In fact, I am now challenging a lot of diagnostic; disease; treatment; illness orientated terminology in my care homes, partly to embed a more ‘relational care’ ethos as much as a ‘person centred one’. Perhaps you may say that this is all just semantics? That may in part be true, but I do believe that we, humble, often much maligned, care home people need to speak up loud and proud about what makes our work attractive – to create a new narrative with a specific glossary of terms that we like that deviates from us being seen as a lesser part of the health care world.

In practice what this means is, for example, outlawing language such as ‘challenging’ behaviour, or ‘doing’ things to people, like feeding, toileting, dressing, and changing them, etc.

As to being ‘aggressive’ – I contend that no older person with dementia is ever aggressive. Aggression requires premeditated malicious intent, and a person living with a dementia, who may be resisting care for example, is simply feeling under threat and not understanding what the helper is trying to do.

Even the use of the word ‘admission’ when someone is moving into a care home is one that I am eager to ban. We are not a hospital: we have ‘arrivals’ not ‘admissions’, and we are promoting homely life, not life in a clinical treatment setting.

So, having got all that provocative stuff out of the way, I want to share some words that do really matter to the work we do in my care homes, and to ask what are the key words that matter to you and your work?

In the year prior to the pandemic, I did a TED style talk at our local South West Academic Health Science Network. It was an event that care providers organised thanks to the amazing support of the then CEO, Professor Jonathon Gray. My 18-minute rehearsed talk was titled It’s bout time’ a play on words that set out to speak about what the most important word in care home life is.

I asked the real and virtual audience for their views what the most important word in a care home is? Is that Kind, Keen, Safe, Curious or Proud, for example?  My conclusion was that the most important word was Time, and how we use that time well.

These days, my word compilation has broadened still further – possibly more since the pandemic and all we have endured in these last two and a half years. I’m now also talking about Atmosphere and how this is shaped by Culture which in turn is very much driven by Language.

Can we take this further?

I’m very eager to hear from others about how we can build more inspiration, insight and mutual respect across our health and care divide. I happen to think this must include a recognition of difference.

I wrote a piece for the British Geriatric Society about Fun-guarding being as important as Safeguarding, and have said (perhaps rather contentiously) that Fun is a word that very much differentiates the values and contrasting themes between NHS and care home life. For example, fun is something we encourage hugely for those we look after as a priority in a care home, but is a lesser priority on a busy emergency department in a hospital!

I also wrote a piece titled ‘It’s only words‘ for the Institute of Health and Social Care Management (IHSCM) publication ‘The Loop’ (issue 4, January 2022). Do have a look: talk to colleagues, and let me know what you think.

I do hope I have not said anything too outrageous here. I’m simply saying that social care and care home work has a lot of great things going on to be confident, strong and positive about, and that we need more action to achieve any level of parity with our NHS colleagues and partners.