Why language matters: reframing responsibility for accessing services

From the NSPCC's Library and Information Service specialists

In health and social care, it’s common to hear people who have trouble accessing or engaging with services referred to as “hard to reach”, “service resistant” or “non-engaged”.¹ Yet, these are often people who feel unheard and ignored, and are not getting the services they need. The responsibility for ensuring access and engagement with services should be with the agencies themselves, not the users.

Are people really “hard to reach” or is it that services are hard to access?

“Hard to reach” is sometimes used to describe individuals, while at other times it’s applied to whole groups of people, often – but not always - those who are marginalised or economically disadvantaged.²

Case reviews have identified a range of people who experience recurring issues around access to and engagement with service providers:

• teenagers
• first generation immigrants, asylum seekers and refugees
• fathers and male carers
• d/Deaf and disabled children
• people whose first language is not English.

If such large groups of people in all our communities are being described as “hard to reach”, yet there is a lack of agreement around who exactly is “hard to reach”, then this suggests that lack of engagement is more to do with the accessibility of the services, rather than the people who need their help.³

What’s the potential impact of using the term “hard to reach”?

There are lots of reasons why a person or community might find it difficult to access help. Labelling people as “hard to reach” ignores the diverse and complex reasons behind why someone might struggle to take up services being offered.

Using the phrase “hard to reach” can lead practitioners to think that potential service users are “too hard” to work with, stopping them from thinking about what the potential barriers to engagement might be.

It also risks blaming groups or individuals for not taking up offers of services or not speaking out about their needs, when actually people are not being listened to and engaged with in a way that fully involves them. Because of this, some service users prefer to identify themselves as “under served” or “under represented”.

What are some barriers to engagement?

By being aware of the different barriers people and communities face in accessing services, we can start to identify ways to make them more accessible.

Potential barriers include:

• stigma within a community or among friends and family around asking for or seeking help
• historic lack of trust in a service, e.g. if a service is thought to discriminate against specific groups
• lack of familiarity with or awareness of a service
• fear of consequences of asking for help, especially if living in an unstable or dangerous situation such as experiencing domestic abuse
• geographical or environmental barriers, such as an unsuitable location or no disabled access
• issues around availability of services, such as long waiting lists or inconvenient opening hours
• communication differences, such as language barriers.^4,5,4

  What can you do to reduce barriers to engagement?

  Consulting the people that could benefit from a service but who are not using it may widen the possibilities for engagement, identify challenges, and create opportunities for change. Approaches to increasing the accessibility of services include:

  Community outreach

  Making people aware of the service and its resources can be the first step in starting a conversation. Services can increase their visibility by:

  • marketing, advertising and signposting to services
  • being clear about what the service is and how it can help users
  • listening to feedback and providing users with the kinds of services they want.

  Practical support

  Stress associated with remembering and getting to a service can be reduced with:

  • flexible opening and appointment times
  • written and verbal reminders of appointments or events
  • where appropriate, meeting the child, young person or family where they are comfortable, such as a neutral venue.

  Building relationships

  A positive relationship between practitioners and service users is an important aspect of engagement, and can be encouraged by:

  • building knowledge about the community and creating an inclusive space, such as having multilingual staff
  • growing trust and respect by having a rapport and being non-judgemental
  • asking directly and listening to users about any difficulties they have around accessing the service.^5,6,5

    > Listen to our podcast episode about intersectionality in social work practice.