nhs jargon We laugh when estate agents describe 'desirable properties'when they mean nice houses - or when when the police talk about 'proceeding in a southerly direction' instead of walking down the road.But what would they make of an NHS briefing docume

Published: 20/12/2001, Volume III, No.5786 Page 26 27

It was the sound of turkeys that originally inspired the word 'gobbledegook'. Alternative terms used over the years include bafflegab, bureaucratese, officialese, doublespeak, stripetrouser (a lovely term invented by George Orwell) and FOG (frequency of gobbledegook).

Symbolised by the Plain English Campaign as a huge dragon, gobbledegook has got itself a very bad name. But what exactly is it? Is it the same thing as jargon? And is jargon always such a bad thing?

Gobbledegook is the long-winded, dense, dry language often seen in NHS and other official writing. It contains many long words and abstract nouns - for example, 'approach', 'decision' and 'process'. It has long sentences, complex structures (for individual sentences and the document as a whole) and an impersonal tone.

It is gobbledegook that makes us 'endeavour to formulate an equitable modus operandi'(rather than try to come up with a fair way of working), and 'determine to scrutinise the documentation vis-à-vis remuneration' (when we could just decide to look at the papers about pay).

Gobbledegook is a feature of spoken communication only where it has been prepared in writing and then read out. In fact, it would be difficult to create such complex language quickly enough to speak it spontaneously - though Sir Humphrey Appleby, of Yes, Minister fame, had a good go.

But gobbledegook is not the only type of jargon. The word 'jargon' comes from an old French word echoing another noise from the bird world: their twittering and chattering.

It is a generic term, covering not only gobbledegook but at least two other types of language that can be unclear.

Technical jargon (or 'shoptalk') is specialist language, written or spoken, that is hard for a lay person to understand.

Technical jargon terms are official names for things - for example, organisations such as the Commission for Health Improvement and primary care trust; staff groups ('professionals allied to medicine' and 'general dental practitioners'); and measures and standards - 'standardised mortality ratio' and 'external financing limit'.Many technical jargon terms are shortened to acronyms.When they become CHI, PCT, PAMs, GDPs, SMR and EFL, lay people are even less likely to understand them.

A third type of jargon - buzz words and phrases - is also rife in the NHS, mainly in spoken language.

'Should you have a window of opportunity, I will bring you up to speed with buying into, bottoming out and generally covering off the key deliverables in this arena by close of play.'

Buzz words are fashionable, and so change quickly.

When they join the everyday language, they are often thought of as clichés, and are used in parodies of stereotypical managers. For example, a trust chief executive on Coronation Street asks a man whose new-born grandchild has just been snatched whether he is 'up to speed on developments'.

Technical jargon can be a valuable shorthand, through which members of a profession can express specialist concepts concisely. In the right company, it improves communication and saves time. But the problems start when we use it in writing or speaking to people who are not familiar with it, without explaining what it means.

Gobbledegook, meanwhile, is a turkey, since it fails in the essential purpose of communication: conveying a message clearly. Its plain English alternatives are always clearer in meaning, and usually shorter.

Buzz words, too, are best avoided. They may be shorter than their plain English equivalents, but are often also obscure in meaning - not just to the public, but to colleagues, too. A survey at ScottishPower showed that 20 per cent of people admitted using buzz words they did not understand, just to fit in at work.

1What other reasons are there for inappropriate jargoning? Manager-bashers might say that we use jargon to show off and to try to sound cleverer than we are, dressing up why we bought something as the 'rationale behind its procurement'. Some might even claim that we use jargon to deceive people, concealing service cuts as 'a diminution of existing core service provision'. But I think most NHS managers have more integrity than that.

One of the more innocent reasons for inappropriate jargoning is the belief that plain English is not 'proper' English. English teachers from our youth may have much to answer for;

traditionally, pupils were rewarded for the use of long and unusual words and complex sentence structures. This style lives on in the language of many esteemed professions, not least academic medicine.

Some managers may feel that they need to use gobbledegook to be taken seriously.However, a law study showed that readers assumed lawyers using plain English came from more prestigious firms.

2Related to the idea that plain language is not 'proper' English is the concern that you cannot express complex ideas in plain language. But you can. Plain language works for any level of complexity - so long as you have thought through and understand the message you are trying to get across.

Perhaps because some people think plain language is simplistic, they worry about sounding condescending to the audience - hence the term 'dumbing down'.Yet there is evidence that people prefer plain English. It is the writer's or speaker's attitude that makes people feel patronised.No language can hide that, jargon-ridden or plain.

But the reason most of us succumb to inappropriate jargoning is pure habit.We spend much of our time with people who understand our technical jargon, and happily spew forth gobbledegook and buzz words. It is no wonder that we sometimes get it wrong and start talking to the public about 'the implementation of clinical governance' or 'having a handle on Our Healthier Nation '.

So, what can you do to tackle NHS jargon? First, try to cut out gobbledegook and buzz words.

Think what you really mean, then say it as plainly as you can. If you are writing, imagine the readers are sitting opposite you and you are talking directly to them.Use short, familiar words, and avoid long sentences.Keep the style lively and direct.do not say: 'The trust recognises the importance of keeping its patients and purchasers fully informed of developments within the organisation and within the NHS nationally.'Try instead: 'We think it is important to keep you up-to-date with what is going on in our organisation and the NHS nationally.'

Next ask yourself - or even better, your audience - whether they will understand technical jargon. If they will, go ahead and use it freely; if not, make sure you explain it, in plain English.There is no need to get rid of technical terms altogether - knowing them empowers lay audiences, so long as they understand what they mean. Explain the jargon briefly as you write or speak, backing this up with a glossary if you think the audience would find it useful.

So, if you use the term 'multi-agency', you might describe this as 'involving several organisations'.A glossary entry could read: 'As well as the NHS, many other organisations are important to improving healthcare, such as social services, housing and education. If something is multi-agency, it involves several organisations working together.'

Last but not least, test your communication.

Ideally, ask your audience what they think.Or try it out on your family and friends, and look at the readability statistics that most grammar-checkers automatically display.Communicating clearly can help the NHS in many ways, not least in encouraging consumer involvement, staff participation and partnership working with other organisations. So why not make using plain language a new year's resolution for 2002?


1Plain English Campaign.

The business of jargon. Plain English 2000 April; 44: 2.

2Kimble J. Answering the critics of plain language. The Scribes J of Legal Writing 1994-5; 5: 1-27.

3Carr S. Tackling NHS Jargon: getting the message across. Radcliffe Medical Press, 2001.