1. Introducing diversity and difference

This course focuses on issues of difference and diversity in a specific sense. Rather than analysing diversity in terms of kinds of communication and relationships, the focus here shifts to diversity in terms the people involved in interactions in care settings. Again, it is simple common sense to state that ‘good’ communication in health and social care services involves acknowledging and responding to the diverse needs and backgrounds of everyone involved, whether service users or staff. In the context of care services, it is not unusual for people to say, for example, that ‘everyone is different’ and ‘we aim to treat all our patients/clients/workers as unique individuals’. However, while agreeing that, at one level, ‘everyone is different’, and that each person brings a unique combination of needs, experiences and attributes to every interaction, in this course we shall claim that some ‘differences’ matter – or more accurately are made to matter – more than others, in people's everyday experience of using and working in care services.

The kinds of ‘difference’ explored in this course are related to what are sometimes called people’s social identities: that is, their membership of particular groups that are said to share common experiences and needs. These include differences on the basis of ‘race’ and ethnicity, gender, disability, age and sexuality. What marks out these apparent differences from other kinds of diversity is both their importance in structuring people’s everyday experience, including their experience of health and social care services, and the ways in which they are used to define certain people as ‘other’, or as different from a supposed ‘norm’.

Issues of diversity and difference have been an important focus of discussion and debate, and a significant strand in the development of policy and practice in the care sector since the 1970s. Starting with feminist and anti-racist campaigns in the 1970s and 1980s, there have been a range of initiatives, both at the level of government legislation (NHS Executive, 2000) and in terms of specific policy and practice guidelines, designed to combat prejudice and discrimination, and develop equality of access and participation. Issues of communication have played a large part in these debates and initiatives, arising from concerns about apparent ‘communication problems’ affecting particular groups of service users or staff. Many initiatives in the area of diversity have been designed to address and overcome such ‘problems’, whether this involves providing interpreters for people who do not speak English, producing literature in community languages, or installing hearing loops and Braille signs for people with hearing and visual impairments.

However, in what ways do issues of diversity and difference impact on interpersonal communication in the context of health and social care? Is diversity a ‘problem’ and if so, what exactly is the nature of the problem, and whose problem is it? How is the way people think about these practical issues influenced by different ways of thinking about the nature of ‘difference’, and how is it produced and perpetuated? Most importantly, perhaps, how should those involved in care services respond to issues of difference and diversity, and how can they ensure that all service users are able to participate fully in the range of interactions that take place in services on a day-to-day basis?

These are the kinds of questions explored in this course. Firstly the course looks at general issues of difference and communication, and the ways in which these impact on service users and staff. The next three sections each apply these ideas to a specific dimension of ‘difference’: Section 5 discusses issues of ethnicity, Section 6 gender and Section 7 disability. Since ethnicity is arguably the focus of most debate in issues of diversity and communication, this is the longest section, and here many of the key issues of this course are developed. Our choice, as authors, of these three dimensions should not be taken as an indication that they are in any way more important than others that are not discussed in as much detail, such as issues of age, sexuality and class. The decision to focus on three dimensions of difference was made mainly on the grounds of limited space. However, we would argue that issues of ethnicity, gender and disability are sufficiently important, and that there is sufficient diversity between them, to help illuminate other areas that are not covered so extensively. Finally, although we discuss these dimensions separately for reasons of clarity, it is important not to forget the ways they intersect and overlap in people’s actual experience.

To summarise, this course explores the following core questions.