Language and Power

I came across this article on LinkedIn, which discusses ‘new language’ in the NHS. At first, I thought it was a joke piece, making fun of the odd propensity to invent language in the health and social care sector but the author has confirmed that it isn’t a joke, but it is a piece intended to provoke discussion.

Once I get past giggling at the ridiculousness of ‘Leaderlove’ and ‘Leaderlover’ and ‘Carevision’ and I’m not sure I’m quite past the giggling stage to be brutally honest, it did make me reflect on language and how we use it within the sector. The thought that someone could seriously be proposing creating new language to describe what can otherwise be described in language we have is both baffling and worrying.

I have and do often condemn the use of invented language and portmanteau words and phrases which seem to rely a ‘new way of thinking’. Business speak seems to demand that new ideas have new language. A sign of intelligence is the ability to explain complex ideas simply and a sign of ignorance is explaining simple ideas with unnecessary complexity.

Moving right on from the sheer offensiveness of talking about ‘leaders’ who ‘love patients’ (seriously, as a user of services, I don’t want to be loved, I want to be respected and listened to), we move to the NHS propensity to create words. It’s all very cosy when we are sitting in meetings with other NHS leaders and feeling quite proud of ourselves for inventing a new phrase that other people pick up. I’ve sat in a number of ‘NHS’ meetings of late and while I am becoming more fluent in ‘NHS speak’, I recall the first few where, even after 20 years in social care, it felt like a completely different language. Why do people talk about DToCs rather than people who are waiting to be discharged from hospital? When people become DToC figures, we are losing sight of the reality of the work we do. When people become ‘unexpected death figures’, we lose sight of what the impact can be. When people who agree with their managers become ‘leaderlovers’ (nope, still giggling), what does that say about those who don’t conform? Are those who don’t claim to ‘love’ their patients seen as somehow inferior practitioners or managers because the language doesn’t fit?

The key is that those who determine the language are those with power. When I worked in social care, the local authority I worked in did some consultations about some safeguarding documentation with service users and changed the word ‘vulnerable adult’ to ‘adult in circumstances which make them vulnerable’. Yes, it took more ink but the language was important to those who used the service and it made the term more meaningful.

I may not describe myself as a ‘vulnerable adult’ but wholly accept that there have been times in my life where I’ve been in circumstances which have made me vulnerable — not least, every time I seek medical attention for myself or a family member. Talk about ‘bed blockers’ which I’ve considered before, influences thoughts and implies blame in the way that ‘people who are ready to be discharged from hospital’ does not. We can say that some of these terms are shorthand but they do influence the way we think about people and about patients.

Creating new words that need a longer glossary which make them even less accessible to people who use services isn’t a solution that any equality and diversity specialist should advocate. A part of the barrier to power held within organisations is the jargon and language is created. Language creates accessibility and it is a means to involve people.

If ‘supervision’ isn’t working as a word anymore (and I fail to see how it isn’t as it is an understandable concept within health and social care) why not ask people who are supervised about their preferences. The thought that my manager would sit me down and say ‘are you ready for carevision?’, firstly would crack me up but secondly and more seriously would make me seriously question his boundaries. I don’t want love or care from my managers or leaders. I want them to listen, respect and respond to me. Equally if any leader in the organisation I worked in claimed to love staff members or patients, I would question their boundaries.

Language is powerful. Actually, language is power. English has more words than any other language in the world. Let’s use the ones we have to clarify and involve, let’s use them to explain and illuminate. Inventing one word when you can use two is not a skill, especially when it makes the concepts less clear and needs more explaining than a two or three word phrase. If explaining the concept of ‘leaderlover’ takes longer than saying ‘leader who loves people they work with and for’, it’s not worth shortening. There is no glory in obfuscation.

The sheer fact a 150 page book called NHS Jargon Explained exists says a lot about what’s wrong with the health service at the moment. Yes, we need professionally specific acronyms. I don’t want to type out electrocardiogram every time I want to refer to an ECG but actively creating language is another matter, especially if the role is about inclusion.

The other day, I had a brief ‘twitter chat’ with someone behind The Edge — which is some fancy NHS improvement thingie. I queried what a ‘hackathon’ was. The reply was (and I accept that this is in 140 character tweets) that ‘this is something used a lot in health’, thereby implying that I should know what it means because I work in health. It’s a silly example but it displays how assumptions about understanding can dictate a power relationship. I immediately felt stupid as if I had asked something that had exposed me as an outsider.

Every time I have to ask what an acronym or invented word means, the power relationship is established with those who ‘know’ having a power over those who ‘don’t know’. If I walk into a community mental health team and, when I speak with a manager, have to ask what an AMHP (approved mental health professional) is, that immediately sets me up as an ‘outsider’ or someone who doesn’t know as much about ‘the system’.

There is a lot within health and social care where language is complex and jargon is used. Creating more when it is not necessary though, creates more barriers and creates more exclusion.

Let language break down barriers, not create them.

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