Adult Social Care Glossary, v 0.6

In the statutory social care world, we talk about cases all the time. We screen, allocate, assess, manage, transfer and close cases. We carry caseloads. We have active cases and passive cases. We deal with complex/challenging/difficult cases. We record case notes and maintain case records in our case management systems. We hold case conferences and carry out serious case reviews. We learn from case studies and case examples and case file audits and case law.

In the real world, beyond the jargon of social care, if you talk about a case, you’re probably packing for a holiday. Maybe you’re reading a crime novel where there’s a case to be investigated or a mystery to be solved. Or watching the news where there are prime suspects in a case. You might even be defending your case in an argument or a courtroom.

The term case has multiple meanings, but many of them relate either to baggage, or to something we investigate, judge or learn from. When we talk about cases in social care, we’re usually either talking about people with cases (problems to be dealt with) or people as cases (i.e. baggage). In this blog I want to explore the similarities between the social care uses of the term case and its real-world definitions, and look towards a better, brighter future where instead of ‘dealing with cases’, we listen to and work with people.

(Before I get started with ‘case’, the phrase ‘dealing with’ also really makes me go hmmm! A deal suggests an agreement – that two parties agree to something with mutual benefit. We are all in awe of the Wigan Deal[1], perhaps for that very reason – it’s a simple articulation of a win: win scenario. The gesture of shaking hands seals the deal, and indeed the Wigan Deal logo includes a hand shake. But to me the phrase ‘dealing with’ has negative connotations far removed from a shared understanding and mutual benefit. Instead of hands shaking, I think it suggests the hands of power brushing together, having dealt with a person or a problem, and swiftly moving on. It indicates process, through-put and the completion of a task. It symbolises a paternalistic, controlling, transactional approach far removed from the collaborative, relationships-based philosophy so impressively demonstrated in Wigan.[2]

Problems to be dealt with: people with cases
In social care, people have cases, not lives. In our world of referrals and handoffs, we have become detectives investigating these cases. Case records and cases notes are our clues. We piece together scraps of information from our case management systems about the cases we’ve been allocated, to find out who said and did what to who, and when (and maybe – though not always – why). Decisions about futures are taken by managers who judge and authorise based on words on their screens about the past: standard phrases, common terms, boxes ticked, job done.

And all too often we label people’s cases as ‘complex’, or ‘challenging’ or ‘difficult’ i.e. they don’t fit neatly into our standard pathways or services so we’re not sure how to respond.

We like our case studies too. The Care Act statutory guidance contains over thirty scenarios faced by individuals including Deirdre, Brian, Jacinta, Kate, Mr A, Miss Y, Mrs D, Ms P, ‘an older man’, ‘two brothers’ and ‘a resident’. Most of these case studies start with a diagnosis or a ‘condition’ or a label: ‘Beryl was diagnosed with stomach cancer’; ‘Sally is 40 and has a physical disability’; ‘Lynette who has learning disabilities’; ‘Mrs Pascal, who is frail and elderly’; ‘Adbul is a deafblind man’; ‘Isabelle is 15 years old with complex needs’. These two ‘cases’ particularly stand out: ‘Lucille develops a need for a care home placement…’ (a ‘need’ for a care home ‘placement’??) and ‘At the age of 72 years, Ms W, although registered disabled, was an active member in her community…’ (hideous).

Case studies tell us real and imaginary stories to illustrate a principle or explain an approach: evidence to inform our practice. But the irony is that while the professional literature overflows with case studies, all too often we’re failing to listen and respond to the genuine stories of the real people we’re working with every day.

Suitcases, labels, conveyor belts and journeys: people as cases
Local authority social care departments have much in common with airports. Both have queues and gates and labels. There is screening and scanning. Interactions are fleeting and increasingly automated. The clock is always ticking. There is always a ‘journey’.

We have become the baggage handlers. People are our cases.

Our equivalent to the check-in desk is our ‘front-door’, where we ask formulaic questions about cases. If the cases clear this initial stage, we apply numbers and labels to describe them and where they’re going next. The next stage usually involves further screening where, like the staff checking hand luggage at the departure gate, we line cases up and assess them when we’re ready – inducing anxiety in families and friends as we decide whether they meet our entry criteria. Then – if we let them in – we swallow them up into our system. As with the numerous carousels and conveyor belts in airports, there are multiple pathways and processes for us to choose and, as with suitcases, the destination is usually assigned from the start (like Lucille’s ‘need’ for a care home ‘placement’). And like suitcases, social care cases may be mishandled or damaged as they pass through our hands, or sent to the wrong place, or lost completely in our system.

Much of the language we use in relation to cases reflects this processing of people. We ‘screen’ cases (often multiple times). We ‘prioritise’ and ‘allocate’ cases from desktops or work trays or spreadsheets. We ‘handle’ cases and ‘carry’ caseloads. We talk of ‘active’ or ‘live’ cases to indicate people we’re currently working with, and ‘passive’ cases to describe those acquiescent people at the bottom of our review lists. We ‘refer’ and ‘place’ and ‘transfer’ cases and have ‘case transfer protocols’ to describe when we can shift responsibility to other teams or organisations. We ‘manage’ cases – helped (and often hindered) by our ‘case management systems’, with their embedded workflows and process maps to illustrate how far our cases have progressed on their ‘journey’.

And we are actively recruiting social workers as baggage handlers to process people through our system. A quick scan of current job adverts reveals we’re looking for social workers to:

“carry a caseload”
“manage a caseload”
“assess, monitor, evaluate and review cases”
“investigate referred cases”
“carry out effective work in the most complex and challenging cases”
“manage and monitor a workload of complex, specialist and generic cases”.
This, from a recent recruitment campaign for children’s social workers, sums it up:

“Are you a social worker looking to move into screening and referring cases?”

Are you?

So why do we do it?
Of all the words that make me go hmmm (and there are lots!), case is up there at the top of the list. Describing people’s lives as cases is bad enough – but people as cases? In no way would I ever defend the use of the terms client, customer or service user in social care – but at least they imply a human (just about). A case is an inanimate object. Talk of ‘my case’, ‘our cases’, ‘your case’ and not only are you assuming ownership, but the person you’re possessing has become not quite human in your eyes. Something to do things to, rather than someone who just needs a bit, or a lot, of help and support to get on with living their life. And the danger of this dehumanising, othering attitude – conscious or unconscious as it may be – is that objects don’t have wishes and feelings and hopes and rights.

So why do we do it? Why do we describe people and their lives as cases? Maybe it’s to do with professional status: doctors and lawyers have cases so why shouldn’t we? Maybe it makes it easier to manage our ‘workload’ if we label people’s lives as cases that we can solve and write about and learn from and close? Maybe it makes it easier to justify ‘screening’ and ‘handling’ and ‘carrying’ and ‘placing’ people if we call them cases and distance ourselves sufficiently to pretend that it’s ok to pick them up and move them like baggage around our system?

A better, brighter social care future
Despite what the job adverts say, those of us who work in social care don’t join the workforce to process cases through a system. We do so because we believe in human rights, social justice, families, friendships, love. We believe in people. We want to make a difference. We care.

Instead of embracing our values and our passion and our initiative, our current system sucks us in to its structures and processes and hierarchies and rules, and spits out robots reliant on forms and procedures to complete tasks and achieve targets. Our bureaucracies have dehumanised us, and in turn we have dehumanised the individuals and their families we’re here to support.

There is a better way. In our brighter social care future we talk about, and work with, people, not cases. We’re no longer detectives piecing together clues from notes and records on our system, investigating and solving complex cases. We’ve rejected our role as baggage handlers attaching labels and carrying cases through our gates and on and off our conveyor belts. Our practice is no longer prescribed in manuals and procedures or informed by fictional case studies.

Our new world revolves around building and maintaining connections and relationships and communities, with people rather than processes at its core. Instead of dealing with cases, we work with people. We’ve dropped our jargon and our labels, and regained our humanity and our humility. We listen hard, understand what matters and focus on finding ways to be useful. We’re kind. We’re people, with our own experience and skills and values and ambitions, helping other people with their own experience and skills and values and ambitions to get on with living the life they choose.

Forget those anonymous case studies. We’re telling a different story, and it’s a story we’re proud to tell.

[For references/footnotes please see the original article]