Adult Social Care Glossary, v 0.6

The frontline.

It’s a place where opposing armies face each other in war and where fighting happens.

It’s the military line or part of an army that is closest to the enemy, formed by the most advanced tactical combat units.

It’s an area of potential or actual conflict or struggle. [1]

It’s the term we attribute to the people who work at the core of health and social care.

In this blog I’ll explore why the term ‘frontline’ and the associated language of war in the social care narrative makes me go hmmm… and why it has no place in our better, brighter social care future.

A place where fighting happens
Ironic, isn’t it, that we use the term frontline – so imbued with aggression and conflict – to describe people dedicated to sustaining and enhancing life?

Or maybe not, when so much of our current social care world does resemble a battleground.

Where often it feels we spend more time defending our budgets and processes than people’s human rights, and more time fighting with, than for, individuals and families.

More time ‘on duty’ than meeting all our statutory duties.

More time creating barriers and boundaries than crossing them.

The term frontline suggests invasion. Assault. Attack. It’s an all too accurate reflection of the power dynamics at play. The judgement involved in our assessment and eligibility determination. The threat of the review. The fear of budgets being cut, and support being removed.

Authority and control sit with the ‘professionals’ on the frontline, while ‘service users’ are the passive recipients of decisions made about them, and services delivered to them.

Often of course the power is even further from people seeking or drawing on support, as in reality it doesn’t sit with ‘frontline’ workers, who are caught in the crossfire, defending their decisions to panels and the decisions of panels to the people seeking support. Who are the passive recipients of ‘innovation’ and ‘transformation’, battered by an onslaught of change imposed by above. Who are constrained by perpetual process and bureaucracy, and defeated by impenetrable IT systems.

Opposing sides
As well as reflecting the battlegrounds and barriers in our current system, the use of the term ‘frontline’ perpetuates and reinforces the idea – and reality – of ‘them and us’, of opposing sides. The people on the frontline are professionals. Key workers. Carers. Heroes. On the other side: ‘service users’, ‘the vulnerable’, ‘the cared for’, ‘those’.

“…we will continue to express our gratitude and admiration for all adult social care professionals, wider local authority teams and unpaid carers who do so much important work, each and every day, to care for the most vulnerable in our society.”

Department of Health and Social Care [2]
Even definitions of coproduction refer to “professionals and people who use services” [3] or just “professionals and users” [4] – alongside references to sharing power as equal partners.

The ‘professional’ label offers people working in social care an identity, while people drawing on support remain an anonymous, objectified, dehumanised group.

This distinction also reinforces stereotypes and stigma by implying that people who draw on social care support aren’t professionals, and that professionals aren’t people who draw on social care support.

Frontline heroes
“I want to thank carers for all they do to look after our loved ones. Throughout this pandemic, they have gone above and beyond to protect our parents and grandparents… This exceptional career choice is tough but rewarding, and I would urge anyone who is thinking of a career in care to come forward and join this heroic workforce.”

Boris Johnson [5]
“Any new settlement must recognise the extraordinary sacrifices made by the social care workforce throughout the pandemic to care for elderly and vulnerable people with utmost professionalism and often at great personal risk.”

House of Commons Health and Social Care Committee [6]
Like soldiers on the frontline of war, during the pandemic people working on the social care ‘frontline’ have been identified by the government and the media as heroes.

As with ‘professional’, this label gives care workers an identity, but at the expense of the people they support, whose identity is in turn diminished, and whose contribution and sacrifice is seldom acknowledged.

Like the ‘vulnerable’ label frames (and blames) the person as the problem and deflects attention from the politics and policies and prejudice and power dynamics that cause and perpetuate vulnerability, the hero label shifts the focus from long term failures to properly support and reward people who fulfil these roles, and more recent failures to provide the protective equipment and workplace environments and working conditions to keep workers safe.

“Where language tells us health care workers were frontline soldiers, reality tells us individuals were scapegoated and thrust into battles with little help or support from the ones handing out proverbial medals.”

Hiba Ansar [7]
The military metaphors also extend to unpaid carers, who are often collectively referred to as an ‘army’. As with the hero label, there’s the implication of bravery and sacrifice – that battling is part of the role, not the result of decades of failures to adequately fund and reform social care.

Invisible heroes, a hidden army and the forgotten frontline
“Care workers have been the invisible heroes throughout the pandemic. They’ve been on the frontline giving their all while looking after older and disabled people.”

Caroline Abrahams [8]
‘Invisible heroes’. A ‘hidden army’ of carers. Campaigns to gain recognition and reward for people working in paid and unpaid roles in social care frequently suggest care workers are invisible or hidden. But an estimated 1.25 million people in England are employed in ‘direct care’ roles, and 1 in 8 adults are unpaid carers [9][10]. Not hidden or invisible, more like overlooked and forgotten.

“So, please stop referring to us as hidden carers. We are seen and heard every day. We’re not hidden, just conveniently ignored”.

Mina Akhtar [11]
However, most attempts to raise the profile of the ‘forgotten frontline’ bring us back once again to the ‘them and us’ narrative. From Jo Brand’s reference to the “hugely demanding, arduous, sometimes repetitive, often boring, thankless nature of the work that care workers do” [12], to Unison’s description of “the day-to-day challenges of caring for vulnerable people” [13], the TUC’s reference to “emotionally and physically draining” work [14] and multiple references to the “burden” of caring, all too often this narrative involves blaming and dehumanising people drawing on social care, further eroding their identity.

“The truth of the matter is that the low status accorded to care workers derives from the low status accorded to people who draw on care and support and in turn to supporting people to live their lives. Reinforcing such thinking helps no one”.

Neil Crowther [15]
A better, brighter future
‘Frontline’ is a term that doesn’t belong in our better, brighter social care future. It suggests and reflects division and conflict. It perpetuates a power dynamic we need to move beyond. It divides us into the protectors and the protected. Saviours and the saved. Carers and the cared for.

We need to be on the same side. Our battles should be for better lives, for human rights and social justice and against process and bureaucracy – not with each other.

We need to let down our defenses. Be open about our vulnerabilities. Recognise each other’s value, and our collective strength.

We need to stop fighting each other. Start looking out for one another. Be curious, not furious. Build trust, not walls.

In our better, brighter future, caring is a relationship, not a task or a service.

In our better, brighter future, people working in social care have the status and support they deserve, because people drawing on social care have the status and support they deserve.

We are all human. We are all equals. We need to drop the labels and cross the barriers they reflect and perpetuate.

We’re better together, and we can make our social care future better, together.

[For references/footnotes please see original article]