The language of the NHS public voice

How language is used to control other people


Language is often used as a tool by people to control others.

People who feel the need to be in control often choose to use words that they think show they are more aware, important, knowledgeable and powerful than the people they are communicating with.

They use ‘jargon’ using a specific form of language that is easily understood by those people they feel are equal to them but that others do not understand.  This gives an unspoken message that they are more important, that they are in control and anyone else’s contribution to the conversation is insignificant and they are right to ignore it.

In the NHS (and in many organisations) managers use management speak which is a type of jargon understood in Board rooms.  They insist that documents for, and records of, meetings use this management speak.  This gives a clear message to the rest of us that running the NHS needs to be by members of the elite ‘Management Speakers Club’ (MSP) only.

This use of language as power, in the MSP even evolves to eventually exclude those not ambitious enough to keep up with the latest words.  For instance, we used to have ‘the future’ now we are all ‘moving forward’,  we used to do things ‘now’ but this became ‘at this moment in time’,  we used to plan for ‘our locality’ but this is now ‘the footprint’ and we used to have ‘health services’ but now we have a ‘health economy’.


An ‘Involvement Industry’ has evolved in the last decade allowed a number of think tanks and consultancies to ‘advise’ the public sector on how to involve people in the services they provide for them.  This new ‘market’ for involvement advisors grew as a response to the new legal duties to involve the public that most public bodies were given over this period and the acceptance of public/private partnerships as the norm in the public sector.

This involvement industry began to take control of the language used in involving people in the services they received, and the NHS readily adopted it themselves.

People started to be regularly considered as ‘customers’ and such words as ‘co-production’, developed in industry in the USA in the 1970s, arrived in the UK and is used now all the time in the NHS and in social care.  The meaning has moved from a true and equal partnership between ‘customers’ and organisations, which was the definition a decade ago, to the current definition of ‘asking some people what their views are and taking some of these views on board, but the organisation makes all decisions’.

NHS England published an Accessible Information Standard in 2015 for health service providers and commissioners which became a legal duty on 31st July 2016.  This requires organisations to identify, record and support people’s individual communication needs, such as sight or hearing loss, autism, learning or speech difficulties or concentration and memory problems.  This new Accessible Information Standard is, of course, written in ‘management speak’ and it includes a number of sentences with 60 or more words in them.

People using health and social care services need to take control of the language used to describe them and in involving them.  

They should be able to choose how professionals address them, as a whole, groups and as individuals.  There are many terms to choose from, such as:

  • people generally using the NHS are often called ‘patients’  ‘customers’  ‘clients’ or ‘service users’
  •  people using social care services are often called ‘clients’ or ‘service users’
  • people with long term conditions are often called’disabled’  ‘chronically ill’  or ‘people with lived experience’

Individuals should always expect a professional to ask how they want to be addressed and not to be automatically called by their first name if they would find that uncomfortable.

We need, as the public and as individuals, to have the confidence to:

  • Challenge the assumption that NHS and social care professionals can ALWAYS choose the language we ALL use
  • Take control of the language that WE use – and not just adopt their chosen words
  • Insist that all documents intended for the public are written in Plain English
  • Insist that any ‘presentation’ material for the public is in Plain English
  • Insist that NHS and social care professionals explain any jargon they use

NHS England repeats in their policies and other documents that:

  • “Patients and the public are at the heart of everything we do”
  •   the NHS is “of the people, by the people and for the people”  

So why can’t the people choose the language used in NHS ‘engagement’?

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