Adult Social Care Glossary, v 0.6

I suggested at work recently that ‘customers’ wasn’t the right word to use to describe people we support in adult social care. The colleagues I was with had a different view – extolling the virtues of the customer experience, customer service and the benefits of viewing colleagues as internal customers, and the conversation moved on. So, I thought it would be helpful to use this blog to gather my thoughts and be better prepared in future to explain exactly why referring to people as ‘customers’ in this context makes me go hmmm.

A person who buys goods or services from a shop or business
“People do not shop for human services and they certainly don’t shop for a life.”

Simon Duffy [1]
Think ‘customer’ and you automatically think transaction: buying and selling. Indeed, the dictionary definition of a customer is “a person who buys goods or services from a shop or business”[2]. Customers consume. Money changes hands. But fundamentally in social care our business is good lives, and good lives are built – not bought. You can’t purchase friendships, relationships, hobbies, jobs or love. You can’t buy purpose, ambition, happiness or hope.

Choice
The term customer implies choice. As customers we choose whether to buy and how much we’re prepared to pay. We browse a range of products, compare prices, get quotes, read reviews. We make snap decisions or take our time. If we’re not happy we cancel our order, take our purchase back, get a refund.

More often than not ‘customers’ of social care don’t choose to come to us in the first place, but they’ve exhausted all other options, tried everything else and social care is their last resort. Often their lives are falling apart. And once they approach us, we’re the ones who choose, through our assessment and our eligibility criteria, what type of support to offer and indeed whether we can even ‘help’ at all. We present a limited range of services as our solutions to ‘fix’ problems – our choice, imposed on our ‘customers’.

Custom
Customers give shops or business their custom. And custom can also refer to a personalised or individualised approach – custom-made or custom-built – the opportunity to design your own. But customised usually means exclusive and therefore expensive and unattainable. Most of the time as customers, although we have choice, we don’t have a say in design.

And often this is the case in social care too. For all our talk of ‘co-design’ and ‘co-production’, all too often ‘involvement and engagement’ is a tick-box exercise to validate a decision already taken or a plan already approved.

As well as its association with trade, custom also means a traditional way of doing things – “something you usually do”[3] – the way we usually respond to a particular person, or in a particular situation. The larger the organisation, the less responsive it is to individual circumstances and preferences. While the local cafe may be able to respond to requests for no onions or extra sauce, the high-street chain can’t alter the make-up of their pre-packed sandwiches.

So, while we may aspire to a personalised, co-designed approach to social care, the scale and bureaucracy of local authorities means that all too often, as with tailored clothing or made-to-measure furniture, such an approach remains out of reach for the majority.

Power
A customer has buying power. Customers usually have an equal position with the supplier in negotiations, and often a superior one because ultimately they can change their mind and walk away. ‘Customers’ of social care have no such power. All our noble talk of empowering people just reinforces the stark truth that we hold the power and see it as ours to give away.

Journeys and pathways
“Now that we are the customers and the culture is one of business, we have normalised the idea that for every problem there must be a service.”

Hilary Cottam [4]
Much time and effort is spent on understanding and ‘mapping’ the ‘customer journey’, but ultimately the pathway is our design, and the result is often a linear process diagram – from ‘front-door’ to assessment to eligibility determination to plan to approval to service. And despite this one-size-fits-all road map, the reality of our systems is a complex tangle of processes and referrals requiring procedures and factsheets and navigators and advocates to interpret it. And the reality of people’s lives is a complex tangle too. Most people’s lives don’t run in straight lines, and everybody’s life is different. Process maps only work in social care when we focus on problems, label people by need or diagnosis, fit them into the associated box and prescribe the corresponding service. Customers may go on journeys, but people live lives.

Customer service and the customer experience
Those who defend the use of the term customer do so in part because of its association with customer service – the ‘customer experience’. Good customer service is about good relationships. Responding quickly. Being friendly and helpful. Building trust and respect. Listening to feedback and continually learning, developing and improving.

In adult social care we may have some way to go in adopting these principles, but if we continue to believe that by referring to people as customers we’ll somehow magically assume those same values and behaviours, we might as well give up now.

Customer satisfaction: how was it for you?
Businesses use feedback forms and satisfaction surveys to understand customer experience. In adult social care we often do the same, with set questions and boxes to tick. We also determine satisfaction through endless performance measures showing response rates and ‘journey’ times. We hold customer forums, where we invite a token group of ‘service users’ to tell us what matters to them, often with an agenda shaped by what matters to us. We include compliments in newsletters and investigate complaints. But as with our social care assessments, we’re asking the wrong questions and as a result, although we may learn something about our ‘service’, we learn very little about the difference we’ve made to people’s lives. Maybe that’s deliberate? Because if we were having genuine, interested conversations with people, and if we knew we’d really helped, the results would be immediately obvious, and we wouldn’t have to rely on surveys and statistics at all.

Consumer rights
Consumer law protects our rights when we buy goods or services, and we can get help if we’re treated unfairly or if things go wrong. And of course, in social care we respect and protect human rights. In theory anyway. But the reality of our social care sorting office means that decisions are made with one eye on the clock and the other eye on the budget. And as such can we genuinely say that our actions protect people from (and don’t subject people to) inhuman or degrading treatment? That people aren’t detained without good reason? That we uphold people’s rights to family and home life? Rights and social care is a whole other (as yet unwritten) blog, suffice to say that complaints about broken washing machines are in a very different league to complaints about broken lives.

Internal customers
So, what about that last thread of the argument in favour of the term customers – that our colleagues in other teams and departments, not to mention our partners in other organisations and agencies, are also our customers? This idea doesn’t relate to trade, as we have no goods to sell, so once again we mean relationships and the virtues of customer service. However as discussed above, ultimately the term implies buying and selling, and by perpetuating its use we are maintaining a system where our trade is people and our transactions are hand-offs and referrals. By continuing to perceive fellow employees as customers, the inference of transaction and process remains. Whereas talk of colleagues or partners, and immediately you think of collaboration and of a team.

‘Our’ customers
Ultimately the term ‘customer’ is yet another distancing and dehumanising label – just like ‘service user’, ‘client’ and ‘case’. By describing people as customers, we gather them into a homogenous group ‘over there’, not like us. And not just any group, but a group whose identity is defined solely by their relationship to us as consumers of our services: ‘our customers’.

A better, brighter social care future
“Ultimately, we cannot be customers of relationships.”

Alex Fox [5]
In our new social care world, people are not passive recipients of generic services but active participants in shaping their lives.

In this better, brighter social care future, we as social care workers acknowledge we don’t have all the answers, but we do at least start asking the right questions, recognising people as experts in their own lives, and focusing on what needs to happen next for them to achieve what matters most. We reject our part in the business of processing ‘cases’ and walk away from our role as brokers of home care hours or residential care beds. Instead of facilitating transactions between customers and providers, we help people to see themselves and those close to them as a key part of the solution, not the problem.

Instead of ‘dealing with’ a generic group of customers, distinguished only by the service they consume, we are liberated from the constraints and bureaucracies of our current system and have sufficient time to get to know people and work with them and their families and communities. Our ‘customers’ become providers themselves. Employers, providing jobs for others. Employees, providing goods or services to customers of their own. Homeowners, providing space in their houses in return for companionship and support. Volunteers, providing experience and skills – and learning new ones too. People, providing friendship and laughter and wisdom and smiles and love.

And if people do need to purchase support to help them live the life they choose, we work with them and their families not just to explore a range of options, but to design and influence and create the solutions they know will work for them. A genuine, co-designed choice, not just the same old service offerings from the much-thumbed pages of our tired directories.

In this new world we don’t need standardised journey maps and process diagrams to tell us which way to go next, because we listen to people’s views about the direction they’re keen to take and the destination they’re aiming for. We support them to find the route that will work best for them. We help remove the obstacles in the way. We don’t need monthly forums to improve our generic services and maintain our dehumanising institutions, because we have conversations every day about improving individual lives and supporting communities to thrive. And we don’t need surveys and statistics to determine satisfaction because we know people and their families well enough to know when they’ve achieved what’s important to them – and we keep working with them until they have.

In our better, brighter social care future, our focus has shifted from transactions to relationships. We have all moved on, from consumers or providers or brokers of services to citizens and collaborators and colleagues with genuine choice and control. Equals, all bringing our own experience and expertise and responsibility, and working together to build, and maintain, and live good lives.

[For footnotes/references please see original article]