Andy Cowper ponders on the language used by NHS managers and policy makers and how it can frustrate outsiders and even clinicians and make matters worse
“Language most shows a man; speak that I may see thee; it springs out of the most retired and inmost parts of us, and is the image of the parent of it, the mind. No glass renders a man’s form or likeness so true as his speech.”
- Ben Jonson, Timber, Or Discoveries Made Upon Men And Matter
All professions have a professional language, and it tends to serve the same purpose slang language does – to confuse outsiders.
Medicine’s mixture of Latin, Greek and the aphasically anatomical is particularly impenetrable. That has long been complemented by the wonderful world of medical acronyms, which used to pepper patient notes as an arcane shorthand (FLK for “funny looking kid”; NFN “normal for Norwich”; TFBUNDY for “totally fucked but unfortunately not dead yet”).
The language of NHS management has a weakness for martial, military, technical and sporting metaphors. It can be no coincidence that these have historically tended to be perceived as male domains.
Latterly, it has also succumbed to the “coolspeak” of the management consulting and tech industries. If I hear about one more “deep dive” in NHS management, I swear I’ll get the bends.
Where much of modern management, done properly, is likely to be desk bound data analysis and interpretation, it is surprising that we get such physically robust analogies as “surfing the internet”, “crunching the data”, “log-rolling”.
There is something about insecurity and rhetorical inflation at work here, I think. As I suggested last week, I think a fair number of senior leaders in the NHS spend a great deal of their professional lives terrified because they are expected to manage things over which they do not have meaningful control, while operating in a safety critical industry that is by no means there yet on tasking safety properly safely (human factors and design and all).
In Simon Lancaster’s new book You Are Not Human - How Words Kill, he observes that while politicians talk about the NHS as a person (“our baby”, “to be set free to stand on its own two feet”, managers often describe the NHS as a machine (because they are trying to control it. So, we get toolkits galore, and drives for this and that.
Lancaster proposes that this language, which implies that managers are “in the driving seat” makes clinicians frustrated as they feel that should that be true, they are just nuts and bolts. This can drive a range of martial metaphors about clinical staff at the front line, and lead towards unhelpful metaphors like “battling disease”.
Getting lawyered up
One of the more depressing tendencies in NHS management over recent years has been the drive to “get lawyered up” in the event of complaints or errors. In the worst trusts, it has bred the defensive culture that is quick to the non-apology apology (“we are sorry if you feel you have been wronged”).
When you speak to lawyers in the context of a personal friendship, it is staggering how often they tell you that the worst thing to do in any dispute of any kind is to get lawyers involved.
The law is rarely about determining the truth: it is generally about escalating competing arguments as far as possible. At some point, a judge may have to make a decision, but there are lots of lovely, lovely billable hours to be had out of even the flimsiest of attacks and defences.
(Phrased like that, the law and bad politics resemble one another to a disturbing extent.)
How might NHS leaders, managers, politicians, policymakers and colleagues go about changing the language to reduce rhetorical inflation and increase transparency and accountability? That is another column for another time, but I welcome your thoughts in the comments below.