Published: 08/12/2005 Volume 115 No. 5985 Page 35

Professor Ellie Scrivens is director of the Health Care Standards Unit at Keele University, which receives funding from the Department of Health. The views expressed here are those of the author and not necessarily those of the DoH.

In his introduction to the Independence, Well-being and Choice green paper in March, then health secretary John Reid expressed a desire to 'provide services with an emphasis on preventing problems and ensure that social care and the NHS work on a shared agenda to help maintain the independence of individuals'.

One of the stumbling blocks to working together is use of language.

Certain words become shorthand for assumptions about relationships between those providing and those receiving services.

Staff in health and social services dislike talk of 'customers' because of the association with commerce. In general, 'consumer' is preferred, but it carries connotations of lack of choice and dependency: if I buy a jar of baby food in a supermarket I am the customer, but the consumer will be the baby.

Similarly, 'patient' is not considered appropriate for a range of people, from those who are pregnant to those receiving social services. The word assumes a medical or clinical dependency and, it is argued, is inappropriate for those with longterm conditions who understand their care and are actively encouraged to take responsibility for it.

The preferred NHS moniker is 'service user'. However, the Better Regulation Task Force in its 2004 Bridging the Gap - Participation in Social Care Regulation report talked about people who used social care preferring 'client', 'resident' or 'consumer', because of the negative connotation of 'service user' - which defines people by a service.

The debate is not new. In 1996, for example, Baroness Masham of Ilton suggested the hybrid 'clipat' to try to bridge the gap between health and social services. Needless to say, it has not gained popularity.

Regardless of what those that use services are called, managers need to recognise the words they use are part of the culture in which they work. It is important to remember the implicit assumptions and to question these continually if those who use services are to be given more control.