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'We must evolve our terminology to reflect our approach to care. Let's start with 'service user''


I think it’s fair to say that learning disability nurses are all too familiar with a variety of often puzzling terms used to identify the individuals we support. But there is one term in particular that, put simply, has to go.

When I was little my mother, when getting ready for work, would speak of how many ‘clients’ she was due to meet with on that day, whilst at the same protesting to the use of the word to describe individuals. It has always stayed with me and I think it is why I have such an objection to some of the terminology we use to identify those we support.

You could certainly make a case that we have improved our terminology since I was a child, yes, but there is much more room for evolution. And nowehere more so than with the most common term I hear used to brand individuals we support: ’service user’.

Firstly, I find this such a generic term. Anyone can be a service user - it’s certainly not a term exclusive to learning disability. You could say that I am a service user because I meet with a dietician to discuss my needs but I don’t particularly want to be branded as such. I am first and foremost me - a person, an individual - and I am certainly different to all of the other people my dietician supports.

“My entire class has somewhat of a grudge against it and we aren’t afraid to pull each other up if we use terms others don’t agree with.”

Second of all, I just despise the term itself. Service user. It is undervaluing. And I am not the only student nurse who has an objection to it; my entire class has somewhat of a grudge against it and we aren’t afraid to pull each other up if we use terms others don’t agree with.

And thirdly, in practice I’ve heard professionals say that ‘individuals who use our services or people we support’ sounds clumsy and unprofessional. Yes, this may be true, but service user sounds cold, clinical and it isn’t very person-centred, an approach to care which is core to learning disability nursing.

”We are very good at practising in a person-centred way, so why are we not equally good at using person-centred terminology?”

We are very good at practising in a person-centred way, so why are we not equally good at using person-centred terminology? The way we speak as professionals reflects upon the individuals we support and many adopt the phrases we use to brand them into their word bases. I often hear those that I support refer to themselves as service users, and I always cringe.

”No, you are not a service user”, I want to say; “you are an individual”.

”What is respectful about disregarding the individualism of a person you support?”

The NMC code (2015) give specific guidance to treat people with kindness and respect. What is respectful about disregarding the individualism of a person you support?

I must emphasise that we are improving as a profession (learning disability nurses being the best at this of course!) And yes, service user isn’t half as bad as some of the shocking terms we used to be using. Yet what we say still needs a little bit of tweaking. I encourage you to use more personalised terms: ’an individual who uses our services’, ’an individual that I support’, or ’the people we support’.’ Recognise them as people - as individuals.

Nursing is a profession full of strong individuals, and with said strength comes the ability to be your own person and practice in the way you want. We shouldn’t be conforming to the cultures of the specific teams we work in. We should be exploring our own cultures and ethics and questioning our word bases, and doing so as an individual.


Readers' comments (9)

  • Hazel Nash

    I couldn't agree more. It's an argument we have had time and again in mental health nursing. Great blog, Becky!

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  • Interesting piece Rebecca,...I think the term in my 1st year on this issue and most student nurses in my year (Adult & Mental ) felt 'service user' or 'client' was a better alternative to terms like 'individual' or 'patient'.

    However, I do agree with your point that

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  • ....nurses should be encouraged to use a person-centred term when referring to someone they are caring for.

    Fisayo (final year MH nursing student)

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  • I agree completely. I hate the term 'service user' and prefer 'patient' myself, speaking from my own experience as someone who has 'used MH services'in the past. The term 'service user' has connotations of someone 'choosing' to be unwell, or of the way public services more generally are being privatised and turned into consumer industries (another example is how rail passengers are now 'customers'). Also, surely it would be more in keeping with the 'parity of esteem' between mental health and physical healthcare, to use the generic term 'patient' for both...rather than using divisive terminology.

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  • I also totally dislike the term "service user" and cannot bring myself to use it. I prefer "patient" for both physical and mental health care, most people don't understand what service user means...but everyone understands what and who a patient is.

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  • I still use the term patient myself, I work in mental health. Over the years various terms have been used from patient, client, service user, service participant, expert by experience, consumer and customer. Which one is best? What others could be used? We talk of the therapeutic alliance or nurse:patient relationship, do we have a nurse:service user relationship or nurse:client relationship or even a nurse:customer relationship?

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  • it is someone who doesn't actually work at grass roots who decides the title in a desperate attempt to be PC-

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  • I agree with the previous two comments. I really do think service user sounds
    very impersonal and as if you are getting on a bus or train or telephone etc. Patient is a medical term. Service user is generic.. we need to differentiate between service users!!! For instance a carer is a service user, a relative is a service user, a GP is a service user, the ambulance service is a service user as well. The NHS is not a business like a bank, supermarket or factory.

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  • Well said, Rebecca. I hate the term. A 'service user', to me, is somebody who has chosen to be in the position he is in and decided which is the service he is going to choose. It works fine if you're deciding who is going to come and repair your roof. And I am not a 'service provider', which sounds more like somebody from the leisure and hospitality industry. I am a nurse, not a hotelier.
    People who need care from nurses and doctors are patients. Why do we have such a problem with that? Are we so scared of patronising or offending our patients that we have to give them a title that makes them seem less in need of our help? That does not 'empower' them (another buzzword I hate)? Patients actually prefer the term patients. They are not all over-sensitive, anxious individuals who feel devalued by having to have help at some point in their lives.
    I could go on but I fear the readers will become bored.........

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