Friday, February 24, 2012

Archive it now or lose it forever


The month of February is LGBT History Month in Britain.

As a Patron to the annual event, I try to find helpful ways of contributing.

Last year I was delighted to be a part of a big project to create a high quality educational resource, charting the historical relationship between LGB & T people and medicine, and their contributions towards it.

This year I've similarly been part of a project to launch a new scheme to help improve the quality of care provided in GP Practices; I'll also be giving a talk myself about the twentieth anniversary of the foundation of Press for Change.


Some of these projects highlight the difficulties of obtaining historical information.

The historical timeline, for instance, relied heavily on previous attempts to create the same kind of resource and refine it. The main research was undertaken by staff from the Lesbian and Gay Foundation (LGF)  and the Trans Resource and Empowerment Centre (TREC).

As I advised on the content, I was conscious of how we were all often relying on memories of things we had read elsewhere to fill gaps. There are few libraries of museum collections which do more than document fractions of the story. Newspaper records have often erased or distorted lives and events.

I have no doubt that future efforts to piece together more of our histories will build on our efforts in the same way. Finding additional information feels a lot like foraging.

Erasure of a different kind

Tracking down historical information from tens or hundreds of years ago is understandably difficult for any long-marginalised community. Isolated people don't keep systematic records. Anything that does get recorded is likely to be through the eyes of others, reflecting the dominant ideas of the time. We can talk a lot about various kinds of erasure and their consequences.

However, as I pointed out a couple of weeks ago, we can't afford to be smug and think that erasure is something that other people do to us. If we are careless we can end up doing it to ourselves. My explanation of how Press for Change lost an online resource that had taken 13 years to assemble, should be a warning we never have to repeat again.

Good news

Before I continue, there is some good news.

The remarkable power of the Internet (and Twitter especially) meant that, shortly after I publicised my blog about history "hanging by a thread" I started getting contacted by concerned professional archivists. Before long I was in correspondence with a very helpful lady from the British Library.

It turned out that, unbeknown to ourselves, Britain's premier repository of literary treasures … books, manuscripts and periodicals … had been quietly harvesting copies of Press for Change's web site since 2006, as part of a massive project to preserve key parts of the UK's internet resources.

So, if you want to look up what we were doing back then, find accounts of what went on, or (more importantly) provide a reference to that material in a modern day work, you can once again do this.

I'll not give the address here, as the archive is for research rather than a substitute for present day communities running their own services. However, if anyone wants access for their own work then I'll certainly point you in the right direction.

Archive nominations welcomed

It turns out that the British Library is quite keen to receive suggestions of other sites that it could archive for posterity in this way.

So, if you run a British web site whose contemporary content would be valuable to researchers of social history in the future, and if the site is capable of being electronically crawled to copy the content, then do let the library's web archive team have your nominations.

The address to write is: They will write to the owners of any sites you nominate to obtain permission to copy and store the content.

Do note that the BL Web Archive's interest is only in UK sites. Readers with resources in other countries will need to find out how the web is archived by their own national institutions.

Let's learn from our fortune

Let's not forget, however, that the fact this information was archived for us to use now, was about luck rather than planning.

Let's also remember that capturing history for future study is about a lot more than simply saving web sites, or ensuring that the backups of your electronic documents are readable in the future. The latter is a whole subject in its own right, and I don't want to attempt to go into that in depth here.

In summary, it's not just about whether backup media can be read in 5, 10 or 50 years time. It's not just about whether future word processor or email programs will be able to open and display the files.

Future historians will need a lot more than to simply be able to read our electronic materials.

Making sense of the information

For myself, as a former activist, I know that the history of what we did and achieved is a complex amalgam of many separate components.

There were the exchanges (spoken, written and electronic) that I and my colleagues had about the big decisions, as well as the small. Some of that is in paper form. Some of it is in email archives. Some of it was verbal and exists only in our heads.

Already it can be difficult to recall the order of some events. Which came first? Did our decision to do 'A' influence 'B'? Or was it the other way around?

How did we reach the conclusion to prioritise one thing over another? How did we formulate the line we were going to take? Who was there? How do we understand the events … as we saw them at the time, and as we have rationalised them further looking back?

Understand too, as you contemplate these questions, that four people could have experienced the same discussion or events and have different recollections about it. Therefore, this can never be just about one person's view. This is why, where I've been able, I've been keen to examine or record different viewpoints myself.

If there was one thing that I personally wish I had done, looking back, it would be to have kept a proper diary … not just to record events in the right sequence, but to record what I thought about them too. Inferring the same information from 85,000 emails in 4Gb of electronic archives is a much harder job.

New technologies, new challenges

If it's difficult enough to look at how we may capture the right detail for historians from just 15-20 years ago, I think the current era poses even bigger challenges for the future.

As I watch contemporary campaigners working, I can see the attractions that everyone sees in today's free social media. Savvy campaigners can do so much more with these tools than we could ever dream about just a decade ago.

Today's campaigners don't just put information out to their followers; they have continuous conversations. They link to other information in the moment … stories on news sites and videos on YouTube, for instance.

Yet it is all far more ephemeral than the web site and email services we painstakingly built by hand (and which professional archivists fortuitously copied for posterity).

Today's campaign site could disappear overnight on the whim of the provider. We see it happen. And most campaigns have no contingency for that, let alone the prospect of easily recovering current documents stored in such services. Think how much harder that will be retrospectively.

That doesn't mean I don't think people should use these services. Quite the reverse. However, if campaigners plan to change the world then (modesty aside) they need to have thought for whether historians will be able to trace what they did and why. Not just in a hundred years, but in ten.

Three things you can do

Attempts to plan for the future can be doomed to failure. None of us has any idea what it may hold. However, we can do a few basic things that seem to have held good, regardless of the technologies that they use in their own age.

  1. Start a diary. Write it up reasonably close to the events, so that your honest contemporaneous thoughts and impressions are kept. Include the names of people, the reasoning for decisions made, and the things ruled out or deprioritised. In this modern age summarise the essence of online conversations too. What was the mood? Whose views stood out?
  2. Take photographs of people and events.
  3. Have a system of filing systems - paper documents, electronic documents, emails, photos
  4. Start filing the papers before it is too late to contemplate trying to do it retrospectively.
  5. Use storage that can expand. And please don't do what I did and throw away stuff that you later realise it would have been valuable to keep.
  6. Keep emails in some sort of correspondingly structured form. Print the most important ones, as an insurance in case the electronic ones ever become unreadable. Remember this can happen both because the media may become unreadable or because the software may no longer be available.
  7. Devise a similarly structured way of saving electronic documents. If you have the space then, once again, keep paper copies of the most important documents. The same readability precautions apply.
  8. Make regular backups of the computer files. When you upgrade computers or software think about how you are going to preserve the content.

I doubt that's a complete list. Maybe readers can add to it, or chip in their own retrospective experiences.

Above all, however, I think we all owe it to future generations to help them make sense of the history being made today. Without that, there's the risk of someone else telling it differently.

And in the meantime, I and some of my former colleagues are discussing how to pull together and professionally preserve our own records and recollections whilst we still have the chance.

Sunday, February 19, 2012

20 Years On - Why Pressing Mattered

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As I retired from being an activist back in 2007, I tend to carefully ration talks about trans rights and activism these days. I prefer to leave the stage clear for what I call the "new generation".

I love supporting them, opening doors and (if they can bear it) offering any words of wisdom I might have to offer.

The end of this month sees a very special anniversary, however….

It's the twentieth anniversary of when the campaign Press for Change was founded.


I've written about Press for Change before.

I've written about how it came to be founded in a Westminster tea shop on 27th February 1992.

I've written about what it achieved and how that achievement was rendered virtually invisible by the mainstream media.

And I've written about how all trace of the remarkable achievements have been almost lost.

The common thread of all these pieces is my interest in making sure we don't lose the history of such an incredible set of achievements, and those who brought them about in such a short space of time, against such immense odds.

I am, after all, a Patron of LGBT History Month, so you'd expect me to proselytise about such things.


Last summer I was approached by the Manchester trans men's social and support group MORF to ask if I would do a talk for them for LGBT History Month.

Initially I was reluctant, for the reasons I've mentioned above. My head was full of the people I could recommend in my place.

Then they mentioned the date … 27th February … coincidentally the 20th anniversary of the founding of Press for Change. How could I resist?

Why Pressing Mattered

I've therefore agreed to do a talk on that evening.

It will be at the LGBT Centre, 49-51 Sidney Street, Manchester

(Just behind "On the Eighth Day" on Oxford Road).

It starts at 7pm.

And my talk will be peppered with archive photos and my first hand recollections and analysis of why it all mattered.

I hope you'll join me there.

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Wednesday, February 15, 2012

GP Leader Dr Clare Gerada welcomes 'Pride in Practice'

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Yesterday saw the culmination of several months of collaboration between NHS North West and the Lesbian and Gay Foundation on a brand new initiative.

'Pride in Practice' is a new standard of excellence in healthcare for lesbian, gay and bisexual (LGB) people, designed to help GP Practices improve the quality of the care and services they provide.

Personally I was delighted at having been able to arrange for Dr Clare Gerada, the Chair of the Royal College of GPs, to be a big part of the launch.

And Dr Gerada, taking time out from the Health and Social Care Bill, showed she really understood and supported an initiative like this. Addressing the Manchester audience via a Skype video link from her offices in London, she committed to promoting the initiative to her colleagues later this week.

Picture gallery

Supporting Quality

Pride in practice is a support tool for GPs. It helps them to critically self-assess how their services appear to LGB patients and are experienced by them. It also provides helpful information about health needs that Doctors may not have been taught to think about, and ideas for how to innovate in their care.

The process is administered by Manchester-based charity the Lesbian and Gay Foundation, who designed the resources and road tested them with local volunteer practices. NHS North West, the Strategic Health Authority, provided the funding to complete the design project and print the workbooks and award plaques.


The launch event, held at LGF's resource centre in the centre of Manchester's gay village, was packed out with almost 70 people having booked to attend. It was standing room only for LGF's own staff at the back.

Delegates included several GP practices and health centres, representatives from 17 Primary Care Trusts and Clinical Commissioning Groups, and a small number of hospital and provider trusts interested in what they could learn too.

Already there have been enquiries about whether the scheme could be used by Dental Practices and Pharmacies as well as GPs. The aim, of course, is better healthcare in all its forms.


The proceedings were kicked off by LGF Chief Executive Paul Martin OBE, who explained how the organisation had come to the conclusion that a tool like this was needed and had put together a strategic proposal which they had then asked NHS North West to support.

LGF are also strategic partners of the Department of Health, so although the implementation begins in North West England, I'm sure they will be carefully examining how the principles can be applied elsewhere, while having respect to local stakeholders and initiatives.

Paul was followed by Dennis Baldwin, LGF's project manager for this development, who explained how Pride in Practice operates.

Shahnaz Ali, Director of Equality, Inclusion and Human Rights at NHS North West, explained the SHA's long history of engaging in strategic partnership with stakeholder organisations such as LGF, and how that operated in both directions as an equal partnership. She said,

'Despite the huge changes going on in the NHS, GPs will remain the first point of contact for the vast majority of people who need health care – that’s why a project like this is so important. Lesbian, gay and bisexual people have a right to feel safe and welcome in the NHS and have equality of access to services.'


Shahnaz went on to introduce Dr Clare Gerada, who appeared on screen via a video link from the headquarters of the Royal College of GPs in London.

Personally I was delighted at having been able to persuade such an important figure to appear.

Dr Gerada and I had only become acquaintances via Twitter because of our mutual interests in the twists and turns of the health bill. When I had explained to her what 'Pride in Practice' was about, however, she made the time to contribute to the launch, even though her diary meant she had to be in London.

I was even more personally flattered when she began her contribution by asking to see where I was over the video link.

Although she has an important position as the Chair of the Royal College of General Practitioners, Clare maintains a very active interest in hands on practice. She often tweets about the pleasure in running her surgery, and explained that her own experience in dealing with LGBT patients arose from the fact that her practice is in London's Vauxhall district, which has a large gay and trans population.

Clare praised the quality of the content in the 'Pride in Practice' workbook and the positive aims of the scheme as a whole. She said she would be promoting it to her GP colleagues across the country and thought it should be discussed at the Academy of Royal Colleges and promoted throughout all heatlh professions.

Building on experience

The initiative builds on the experience gained from a previous pilot project in GP surgeries.

Two years ago, NHS North West provided backing for an LGF campaign which encouraged surgeries to display LGF Helpline posters in their waiting rooms as a visible sign that the surgery was a welcoming environment to LGB people. Although well received in some practices, the resistance and hostility which the project encountered from others led to the proposal for Pride in Practice (PiP).

The original poster project continues, expanded now to the whole North West region via the support of the five PCT Clusters: Cheshire and Wirral; Cumbria; Greater Manchester; Lancashire; and Merseyside. As LGF doesn't operate directly in those areas, the scheme has been adapted to signpost local voluntary services providing the same kinds of support and advice.

Signed up

Meanwhile, 'Pride in Practice' has already become a success just via word of mouth. Before the launch 17 practices had already signed up. Others who are interested in doing so can complete a form here.

The initial aim is to sign up sixty practices before the end of March. After that, the scheme will grow according to the resources available, and according to which parts of the NHS want to support promoting it in their area. The scheme fits in very much, of course, with the ideas about GPs having a bigger part in innovating better services.

The surgeries that sign up to PiP will be expected to create a welcoming environment – including using inclusive language and imagery, monitor sexual orientation, consulting with LGB patients, getting involved with health promotion and outreach, and training staff on specific LGB issues.

Help on how to undertake sexual orientation monitoring (and ask sensitive questions well) is available through this online resource.

During the launch, the two surgeries who had acted as guinea pigs, testing the approach by completing the exercise themselves, received the first GOLD recognition plaques, to display on the wall in their premises. Patients using services will be able to tell from these plaques how well advanced their surgery is.

To register for the Pride in Practice launch visit: or for more information contact

Sunday, February 12, 2012

The men with baby bellies - reloaded


It's almost four years since the story of Thomas Beatie, the 'Pregnant Man' first hit the International headlines.

News first broke on this story in the Advocate in March 2008 and then had a replay in July of that year when the baby arrived.

Since then the issue has had further replays around the world as Thomas and his partner announced first a second and then third baby.

Not the first, just the most prolific

Contrary to the usually lazy reports, Thomas Beatie was not the first trans man to carry a baby to term … just the most prolific to date.

And, if some trans men were a bit uneasy about the apparent contradictions in deciding to perform that most quintessiantially female of roles once, the controversy has grown with each successive pregnancy.

Juliet Jacques wrote about the topic in 3SIXTY in March 2008, after the Beatie story was first broken by the Advocate. Her account is reproduced here on her blog.

Now the whole issue has wings again, as Pink News carries a story today claiming the first case of a trans man in Britain.

Again the claim about the British case being the 'first' is wrong. Unfortunately journalists make these assertions rather too often. Really it means they've not personally heard of another case before and can't be bothered to research.

A deeper analysis

Anyway, it provides a reason to dust off an essay which I first wrote and released only as a Podcast back in March 2008, when the first big story broke. Here it is if you'd like to listen again:

However, I'm well aware that some people can't hear the Podcasts for whatever reason … perhaps because they use a computer at work or they lack the time or even the equipment on their PC. That's a shame in this case because I went to some lengths to get behind the hype and take a philosophical view of the issues. So now, at last, I've dug out the script for people to read instead.

The Men with Baby Bellies - March 2008

A couple of weeks ago an article appeared in the Advocate, a US gay and lesbian magazine. It was a first person account written by an Oregon man, Thomas Beatie.

To look at him Beatie looks like just about any other American man, I guess. He’s got a beard; muscular limbs; deep voice – you know, all that “man” stuff.

The difference is that his bulging belly isn’t an all-american beer gut, but the outward sign of what’s been growing now for five months in his uterus (yes uterus).

For, as Thomas explained, he is pregnant. And he’s pregnant for the simple reason that his legally married wife, can’t have children herself.

(Hmmm.. just think. How many wives have jokingly told their husbands that they’d have a family if he could be the one who did the hard bit?)

Deadly serious

In Thomas and Nancy’s case, of course, it was no joke. They had been married for ten years. To neighbours in the quiet Oregon logging community where they live, they are just an ordinary heterosexual couple.

There was no need for anyone to know that Thomas had a transsexual background. And, in the normal run of things, the two would have planned for Nancy to do the childbearing – using donor sperm by one means or another. Other couples do this all the time – whether officially through fertility clinics, or unofficially, with an ovulation calendar and a turkey baster.

But twenty years ago Nancy had needed to have a hysterectomy, as a result of severe endometriosis, so she couldn’t conceive herself.

A couple in Tom and Nancy’s position would be very unlikely to succeed in adopting a child. The false, negative, beliefs about transsexual people make that a very difficult proposition even in Britain. In redneck Oregon the prospects would be zero.


So caught between the strong human desire to have a family – and the absence of any other viable options – Thomas made the decision to offer the womb he still possessed to bring a dearly wanted child into the world.

In the normal run of events that kind of generosity would be readily applauded. We’ve all read cases of mothers, sisters and even total strangers donating eggs – or even the use of their womb for nine months – to overcome another woman’s inability to conceive or carry a child herself. Most of us don’t need it to be explained why people do these things. The desire to bring children into the world and bring them up in a loving relationship is accepted as an axiom of humanity.

The assumption we all share this instinctive urge is so strong, in fact, that (even today) women and couples report feeling pressure from society if they don’t have children. Questions are asked. Fingers are pointed. Relatives express profound disappointment.

Thomas and Nancy’s desire to have a family therefore ought not to require more explanation than that.  ... Except that I’ll add, of course, that it’s also an enshrined human right too:

Human Rights

Article 16 of the Universal Declaration of Human Rights, made by the UN in 1948, says that “Men and Women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family”.

For us Europeans the same spirit was expressed in Article 12 of the European Convention for the Protection of Human Rights and Fundamental Freedoms, signed in Rome in 1950. It says, Men and Women of marriageable age have the right to marry and to found a family, according to the national laws governing the exercise of this right.

And just before you speculate whether these expressions are meant to include families in which one partner is transsexual then two decisions of the European Court of Human Rights are worth noting:

The first, in 1997, confirmed that the relationship between a transsexual man, his female partner and their children by donor insemination was a family in the eyes of the court.

The second, in 2002, unanimously affirmed the right of transsexual people to marry and to found a family. In Britain, of course, these convention rights are underwritten by the Human Rights Act. The right of transsexual people to marry and to be recognised in law for all purposes in their acquired gender is also underpinned by the Gender Recognition Act. So the law on these matters is just about as unequivocal as it gets.

Biology 101

Before we go on, of course, many of you will be wondering how a transsexual man can be a man and yet still have the apparatus to produce eggs and nourish them to full term. Perhaps this underlines, however, how little is known about trans men as a whole.

You see, whilst male to female surgery is relatively straightforward and has come to be very sophisticated and successful these days, genital surgery for people going from female to male is a very different kettle of fish.

Instead of one stage, it takes four or five. That makes it correspondingly more expensive too. In the US, where Thomas lives (remember), the $100,000 required isn’t covered by most health insurance schemes either. So if you’re not rich enough to afford the equivalent price of a substantial house, you’re never going to be able to remove your female apparatus, let alone afford a penis.

Female to male surgery is also nothing like as sophisticated (yet) as the reverse. Modern surgery to fashion a vagina and the bits that go with it can require very close scrutiny by a gynaecologist to tell it’s been constructed.

By contrast, manufactured penises still tend to look a bit odd, they may not be able to work properly just to pee; sexual function is even more hit and miss. It’s no surprise, therefore, that most trans men have learned that being a successful man in our society has surprisingly little to do with having a penis.

So it’s not at all unusual or remarkable, therefore, that a man like Thomas would still have the innards and genitals he was born with – in spite of looking, sounding and feeling like a man in every other respect.

For that reason it’s also not surprising to learn that Thomas is not the first trans man to have conceived and carried a child in his belly.

Not the first

In June 2000 the US magazine, Village Voice, carried the story of Patrick Califia and Matt Rice – two men living together; both of whom had been born as girls; and cradling the eight month old son which Matt had carried.

And in the week that I’m writing and recording this piece the papers in Britain have unearthed the similar case of a 39 year old businessman, Sam More, who conceived and gave birth in the UK.

According to the same newspaper it’s believed that, worldwide, there have been at least a dozen other cases overall.


One thing that these men tend to have in common is the reports they give about the hostility or indifference of medical personnel they encounter.

More describes, for instance, NHS ante-natal staff refusing to talk or even look at him. Thomas Beattie similarly describes going through nine separate doctors to try and get pregnant with clinical assistance before resorting to DIY means.

None of this is surprising, given the kinds of reception which trans men often report from other clinical encounters. The film Southern Comfort documents the death of Robert Eads, a trans man who died from cervical cancer that doctors in the southern US refused to treat. A trans man in the UK recently reported the horrifically disrespectful way he was treated when he had to go into an NHS hospital for a hysterectomy.

You see, doctors aren’t even keen to remove these organs from trans men when there are strong health reasons. As a society we can’t therefore be too precious about what trans men do as a result of having them.


Watching debate about these cases in the last week or so – in the US and in the UK – has certainly been interesting. In the US the Blogs and noticeboards have lit up with posts from people who, regardless of politics or ideology, share a woeful ignorance about the facts we’ve discussed here. In the UK we’ve been blessed initially that the journalists who’ve approached folks like me for research have been astonishingly sophisticated and intelligent in their approach. Whether that will last among their peers is another question.

But it’s certainly interesting to see how people have difficulty being clear about what it is they feel most uneasy about. Is it the question of a man having a baby? Or is it the question of a transsexual person being fertile either way, or having a family and bringing up children?

A Philosophical Question

The irony in the first case is that writers and philosophers, feminists and theologians, have long enjoyed speculating about men having babies.

Throughout the past century in fact, people have been writing about pregnant men. The people in Ursula Le Guin's novel “Left Hand of Darkness” are all one gender and therefore "men" can get pregnant. In Marge Piercy's novel “Woman on the Edge of Time”, everybody grows babies in artificial wombs but both men and women can nurse the infants when they're born. And in the film “Junior”, male scientist - Arnold Schwarzenegger - carries a pregnancy in his own body as part of a fertility research project.

A Legal Question

When it comes to the question of transsexual people being fertile then, in any other contexts, the ideas put forward would send shivers down the spine.
In Germany, one of the very first countries to legislate to recognise gender changes, applicants were required to be permanently sterile. Note – not just unable to take their former reproductive role, but to be sterile full stop. In any other context people would have been alarmed. Yet it seemed a wholly reasonable proposition to require this for trans people.

Fortunately Germany’s model wasn’t followed by any of the dozens of other states that now legally recognise a change of gender. Yet, when the Gender Recognition Act was debated in Parliament in 2004, there were still people prepared to stand up and call for such a requirement – or to insist that rights could only be claimed in return for mandatory surgery.

Those voices didn’t win, fortunately. Parliament realised the unacceptable nature of stipulations of those kinds. We therefore have an Act in Britain which recognises that someone can be a man or a woman without genital surgery, if there’s a good reason why. And there’s no talk of denying people the right to passing on their genes, having babies or bringing up children by any means possible.

What about the children?

And what about those children? Well, for decades trans people used to be advised that the cure for the way they felt was to go and marry and have children. So we have lots and lots of examples of children with one (and sometimes two) parents who are trans – and all the evidence points to them being happy and well adjusted.

Some might argue that such children might be the butt of teasing or bullying at school. Well, that happens. Children get bullied when they have a single parent, or parents of different colours. They survive family break-ups and acquiring step fathers or mothers. They survive having parents in prison. They survive abuse. Children are resilient and the thing that matters most is not what your parents are, but the fact that they are there – and the knowledge that they love and care for you. As for the school situation, bullying is wrong – whatever the reason. The solution isn’t to prevent children having trans parents, but to deal with the bullying. Full stop.

Summing up

Trans parentage inevitably raises lots of questions, but I hope you’ll see from this discussion that the best way to deal with those is to start from the basis of facts rather than supposition and hysteria. And if all else fails? Well, as always, those handy Human Rights principles are a good basis to start from.

The last word on this comes from one of those US bulletin boards that I mentioned at the outset though. One of the correspondents there asked what kind of maternity clothes a guy like Thomas Beatie should wear over his bump. The answer, from another correspondent, was disarmingly simple: The same kind of shirt all men wear when they’ve got a pot belly.

Difference is, Thomas’s belly will get small again.

Friday, February 10, 2012

Pearls among swine


This has been an exciting week for trans people concerned with the way the media represents them.

Watching some of the events from afar, I can imagine that some of those involved in the big news items will have experienced the same kind of mix of adrenaline and hope as my colleagues and I felt when our campaigning milestones came along, years ago.

In our day, it was watershed moments where we achieved legal rights advances … employment protection, the right to NHS treatment, legal recognition of our identities. (I would link to the historical record of those moments but, as I explained recently, the internet no longer has much of a live record of those events.)

Nowadays, the issues at the forefront tend to be the media (for the way it represents trans people), and medicine (for the way it handles patients who come looking for help).

Today's Stars

This week it's been the turn of the wonderful campaigners in Trans Media Watch to feel that their lottery numbers were coming up. (If I had a crown to pass on, I would certainly pass it to them).

It's not even a year since I went to report on the historic signing of a Memorandum of Agreement between the cheeky young campaign and national broadcasters Channel 4, and the BBC. March 2011 was full of hope and optimism, as I tried to capture in my blog about the event.

Of course, there was criticism at the time from some people, perhaps so used to disappointment and oppression, that they were convinced of negative motives. They just could not believe that strangers could ever want to help trans people achieve better, more respectful, representation.

I can't blame people for those low expectations. I remember that people used to tell us the same about the ambitious goals we pursued for legal recognition and rights. It's the job of campaigners to prove their critics wrong.

The critics could have been forgiven a measure of "I told you so" shortly after last year's partying too...

First there was criticism to be levelled at Channel Four's own first effort to show willing. And I dished it here and here.

Later, in June, the BBC was in line for lambasting too.

It's the BBC that I want to talk about in a moment. First, however, I want to reflect on more recent events.

Change takes time

When I criticised Channel Four and the BBC last year, it was in the knowledge that real change takes time.

Policy commitments come easily. Anyone can put on an event, sign papers and make speeches. The actual work takes longer. And it is the outcomes from that work that the people on the receiving end want to see. Regular readers will know my obsession with measuring outcomes.

Sure enough, we've begun to see the outcomes.

For Channel Four the first obvious product was the reality show, My Transsexual Summer, reviewed here by trans writers Juliet Jacques and Paris Lees.

Juliet has also worked the opportunity further by opening up mainstream consideration of questions such as whether trans roles in drama should be played by trans actors. (I interviewed Juliet at length on her thoughts about trans people and the media back in 2010).

Having said that real change takes time, it's a credit to everyone concerned that serious discussions like these can now already happen in publications like The Guardian and New Statesman … I would have sold my granny for those kinds of platforms in my day.

Channel Four, in particular, have also clearly not sat about.

The pipeline from idea to screen for television series is long and complex. Yet here we were, seeing a lengthy fly on the wall documentary on our screens barely eight months after the Memorandum of Understanding was signed.

Subsequently, we've also heard about the behind-the-scenes success of the Transcamp project, bringing programme makers and trans people together to come up with new and innovative ideas.

It's all still early days; however the indications are of many things coming together.

Political advance

It's one thing, of course, to get a few television projects off the ground to represent trans peoples' lives more accurately. It's a rather bigger challenge to ensure trans people have a political voice that can be taken seriously. This week saw that come together spectacularly as well though.

First off was some great coverage of the discrimination faced by a ten year old trans child and her family, featured on the BBC's flagship "Big Breakfast" TV show, along with TMW's Paris Lees in the studio to interpret the wider issues raised.

The show discussed how ten year old Livvy James had started a petition to urge newspapers to stop using the kinds of pejorative reporting which she linked to the name calling and bullying she experienced. By yesterday, Livvy's local paper was able to report on the support she'd received.

This human interest story was merely the curtain-raiser to the appearance later the same day of Helen Belcher, a Trans Media Watch campaigner, giving an hour-long testimony to the Leveson judicial inquiry. The inquiry is examining the culture, practice and ethics of the British press.

The transcript of Helen's cross-examined testimony is available online here (page 37 onwards), or you can view the video here (approximately one hour in).


Trans observers have been understandably excited about the significance of being able to document the experiences they've faced for years before this kind of formal inquiry. The contribution from Trans Media Watch (written evidence here) is not only significant in itself, but because it joins other evidence which contradicts the statements made already on oath by journalists, editors and representatives of the Press Complaints Commission.

Trans writer Jane Fae described Wednesday February 8th as "T-Day. Transition Day. The Day it All Changes". As someone who once wrote of watershed legislative and legal events in similar terms, I have immense sympathy in hoping she's right. Time will tell.

One noticeable difference already, however, is that when Trans Media Watch call foul against performers who make tasteless jokes at the expense of trans people, the time from offence to apology is very much faster.

It took several months for campaigners to achieve an outcome in response to complaints about Russell Howard's Good News show. By comparison, the response to criticism of a joke in poor taste by chat show host Jonathan Ross was almost immediate.

Meanwhile back at the BBC

The faster, more public, and more effective the criticism, the more likely you could come away with the impression that broadcasters are only now finding their way to reporting respectfully on trans issues.

The impression might be that everything that went before must have been so much worse. Surprisingly, that's not the case.

This week, following up my article on lost historical material, I decided to try and do what I could to resurrect some of the many recordings which I have in my archives, and which had ceased to be available publicly when the Press for Change web site was lost. (I've also been helping a volunteer retrieve some of the written content of the site, but that's another story).

I wrote earlier this week about "Dusting off the 'lost' PFC tapes" and, since then, I've uploaded more than a dozen recordings that I thought would interest people. Among those recordings were BBC Radio programmes from as long ago as 2005 … programmes which discussed trans issues seriously and in depth, even if sometimes controversial opposing views were aired as well. The fact is that these programmes were produced well.

I therefore wanted to pick out a handful of these recordings, just to underline that not everything that has gone before has been awful. Some of it was actually rather good. Which just goes to show that the Corporation's producers already have it in them to make good material. The challenge for campaigners is to teach from these examples in an encouraging and supportive way.

Unreliable Evidence - BBC Radio 4

This edition of the BBC Radio 4 legal series "Unreliable Evidence" was first broadcast in August 2005, just over a year after the Gender Recognition Act was passed by Parliament, and a few months after it had come into force in April 2005. The programme features trans activist and lawyer Professor Stephen Whittle OBE, alongside other lawyers, talking about the reasons the law was necessary.

Unreliable Evidence - BBC Radio 4 (mp3)

Woman's Hour - BBC Radio 4

This item was first broadcast on BBC Four's Woman's Hour on 28th Feb 2008. It features Lee Gale of TransBareAll and Polly Carmichael of the Tavistock and Portman Child and Adolescent Gender Identity Development Unit.

Woman"s Hour Discusses Trans Children (mp3)

Stephen Whittle and Julie Bindel debate Gender Reassignment - BBC Radio Five Live

This item was broadcast on BBC's Radio 5 Live in January 2008. It features law Professor Stephen Whittle and journalist Julie Bindel, two people whose knowledge and views on the issue of gender reassignment could not be more different.

Stephen Whittle and Julie Bindel debate Gender Reassignment (mp3)

Wednesday, February 08, 2012

Dusting off the 'lost' PFC Tapes


In a recent blog I explained how the original (1995-2009) Press for Change web site had been essentially lost, apart from an incomplete series of snapshots taken at intervals by the Internet Archive in the United States.

I explained also how the latter archive did not copy the many Podcasts that were made and published between 2005 and 2007, and that they were (in effect) lost from public access.


As a contribution to LGBT History Month 2012 I've decided to try and remedy that in part by retrieving the original files from my own computer archives and uploading them to a modern day podcasting platform, AudioBoo.

The number of recordings that I post up in this way will depend on the apparent interest. Locating, uploading and tagging the recordings takes time and there's no point if people aren't downloading them.

You'll be able to find them by visiting my profile on the AudioBoo service, where you can also subscribe for notifications if you wish … or you can subscribe directly to this RSS feed

To kick this off, I've already uploaded two short interviews with well-known US activists Kate Bornstein and Jamison Green, which I recorded at the School of Speech and Drama in Bethnal Green London on 15th June 2007, where we were all attending and speaking at the first ever Trans with Pride conference, "Transfabulous".

Kate Bornstein

Kate Bornstein is an author, playwright, performance artist and activist. Her books are taught in over 120 colleges and universities around the world and she has performed her work live on college campuses, in cinemas and theatres across the USA, Canada and parts of Britain, Germany and Austria. At the time we me,t Kate was touring colleges, youth conferences and high schools, leading workshops on sex, gender and alternatives to teen suicide.

Kate's keynote address has already been featured on the Just Plain Sense Podcast. In our one to one interview, however, I wanted to talk more about her and the ways she thought the UK and US compared for trans activism.

In Conversation with Kate Bornstein (mp3)


Jamison Green

Jamison - James - Green is an internationally respected leader within the US Transgender movement. A powerful speaker and compelling writer, he is an acknowledged inspiration to many - trans and non-trans alike.

At the time I spoke to him here he was chairman of the board of Gender Education and Advocacy Inc. (GEA), and a board member of both the Transgender Law and Policy Institute and the World Professional Association for Transgender Heath (formerly the Harry Benjamin society). He has many other board memberships and affiliations too. These are listed on his own page.

This wasn't the first time Jamison and I had met and talked. I had seen him often because he had spent some time working in Manchester. However, this was a good opportunity to talk about the differences in trans campaigning approaches in the context of a live event.

In Conversation with Jamison Green (mp3)



Tuesday, February 07, 2012

NHS Mosque Radio Pilot doubles take-up of vital screening


The BBC Asian Network recently broadcast a report about a novel and effective social marketing campaign pioneered by NHS Bury.

The PCT has collaborated with the town's local Mosque Radio service to target important health messages to the South Asian community, with spectacular results.


Primary care staff can often find it difficult to reach specific communities with messages that apply especially to them.

South Asian people have particular genetic health risks, such as a higher than average incidence of diabetes. Asian women also often develop breast tumours at an earlier age than the average population and are less likely to be detected in time for early intervention. Unmanaged diabetes can have serious complications, including permanent blindness.

These are difficult health messages to get across by conventional techniques, aimed at the whole population. It's especially problematic where communities aren't traditionally used to seeking help until symptoms are already evident, or there are language or cultural barriers.


In circumstances like this, using a community's own channels can be both cheap and effective. Staff from Bury Primary Care Trust describe how they organised a screening campaign for over 50's in the muslim community, checking for the signs of visual damage connected with untreated diabetes.

The approach resulted in a 70% takeup of screening, compared with just 30% when letters are sent out in the normal way. This is attributed to offering the screening within the familiar environment of local muslim community centres, along with peer encouragement.


This is just one example of the creative, beneficial and cost saving initiatives that can arise when NHS commissioners and public health managers engage with diverse communities and work with them to address specific health inequalities.

The amazing thing is that these approaches quite often cost nothing and yet are so much more effective than firing messages indiscriminately at the whole population as though they will all react in the same way.

They're not hard; however, they do require managers to understand the diversity of their local population, have evidence of what the health inequalities are in their area, and to develop strong stakeholder relationships where ideas like this can be brainstormed.

Best practice

This is the kind of best practice which I often bang on about, as the dividend that comes from applying cultural competence in areas like commissioning. As the NHS looks for ways to achieve more with less it is to be hoped that this kind of innovation will catch on. The report mentions how nearby NHS Blackburn with Darwen are aiming to copy the success of this example.

You can hear the rest of the story in this short BBC recording...

Bury PCT Mosque Radio Project (mp3)

Sunday, February 05, 2012

Our history hangs by a thread


It's the curse of the modern age.

And it's perhaps far more insidious than censorship.

Historians of the future will curse us.

And it's already depriving modern day campaigners of their own resources.

It's the tendency for web sites full of important information to be lost.

Our modern history relies on just one university-based project.


The odd thing about this phenomenon is that most people think the reverse. We are all told to be careful about what we post on the Internet as it will be there forever and will be hard to remove.

Well, maybe that's so if we are talking of drunken indiscretions posted by your 'friends' to Facebook. The launch of the new timeline feature there has brought home just how much the social networking giant has stored over the years on its servers. When editing my own timeline I was surprised to realise that everything I had written there in the last five years was all faithfully preserved.

Fragile history

In 1995 I created my own first web site, using the facilities provided then by the US service CompuServe. From January 1996 I developed that space further to provide the growing trans rights campaign Press for Change with its first proper web presence. You can't see any of that now though, because CompuServe took down the whole "our world" service on 30th June 2009.

The only pages of mine that survive from that era are those captured by a little known service known as the Internet Archive … aka the Way Back Machine.

Here's my original personal site, as captured in December 1998. Aw, didn't I look young?

Knowing where to look

By the time that first snapshot of my CompuServe web site had been taken we had already moved the Press for Change pages to a commercial server and a dedicated domain. The site was then managed by my very talented campaign colleague Claire McNab, and we worked closely together with me writing much of the content and her putting it up.

If you know how to look for it, that original Press for Change site was also first snapped in December 1998 (by which time it had already evolved considerably, over 18 months of development.

In 2006 the Press for Change web site had a complete technical and content facelift, with vice-president Tracy Dean implementing a content management system and me once again writing the content for new sections that reflected the campaign's new post-legislative emphasis. Here it is just before the change in January and afterwards, in December.

The PFC web site continued to grow whilst Tracy and I remained in charge. However, I left Press for Change in November 2007 and Tracy left shortly afterwards. This was how it was looking in mid 2008.

After that the site fell into disrepair. This was how it looked, broken, in October 2009.

Another volunteer then stepped in and gave the site another revamp. This is what it looked like in August 2010. Then it crashed out completely and I gather that the contents were lost. It is only recently that Press for Change has gone back on air, with a new site built from scratch … and most of the original content, documenting one of the most effective campaigns of its kind, lost to casual visitors.

Not the only case

I can provide you with this history tour through the Press for Change web site because, of course, I know the original site intimately and remember roughly where to look.

None of the content you can find by trawling the Internet Archive is indexed by search engines like Google though. So if you're one of a new generation of campaigners, the valuable material (particularly on two decades of legal work and the first hand reports on historical milestones) is not immediately apparent. It relies on the memories of my generation.

And the Internet Archive is not infallible.

Much of Press for Change's history was documented in the web archives of over 4,500 posts to the campaign's list server, PFC-News. The archive captured the indexes to this, which include some fascinating snapshots of the paper newsletters that we sent out in the early days; however the bulk of the news archive was never saved by the Internet Archive because those pages were actually coded to deter automated web crawlers. The index records that I sent the very first message through PFC-News on 18th July 1997, but you can't drill any deeper to find out what it said.

The Internet archive also doesn't preserve active content or media such as MP3 files. Therefore, all the Podcasts that I produced on the Press for Change site from 2005 are now completely unavailable. You can find the pages that describe them, but not the recordings (except in my own personal offline archives).

Government sites too

A similar issue occurs with the web sites of Government departments. When the Coalition took power in May 2010 one of the first things they did was to shove parts of the previous administration's content onto the National Archive.

This is where, for instance, the whole of the Department of Health's pages on Equality and Diversity ended up. This is also where you'd have to look to find the products of years of my work on transgender equality, for instance. Again, I know personally how to find these pages because I was intimately involved in getting the Department to set them up. It's not so easy for others who may be looking for this information though.

Annoyance or Tragedy?

Personally I find the short-lived transitory nature of internet content mostly just an annoyance. I have a much better index between my ears from 20 years of work, and my office is full of archived material that I can reach for. Nevertheless, it slows me down and makes it sometimes difficult to refer to sources in my writing.

For a new generation, however, I think it is nothing less than a tragedy … especially as I lurk in modern activist fora (which are even more vulnerable to sudden loss) and see people reinventing wheels to solve problems my generation solved only 10-15 years ago.

For trans people, whose work and views have been virtually ignored by the mainstream media until very recently, the loss of historical references online is even more aggravated, because there is practically nothing in public archives that documents our history and work. This makes trans people vulnerable to people who would rewrite that history.

Hanging by a thread

You may think that the Internet Archive is at least a way of mitigating these risks. It was started as a project in 1996 precisely for the reasons I've stated. However, the project is reliant on donations and was only able to complete a sweep of the entire web in 2007because of a generous grant. Dig deeper into their pages and you'll see how the system relies on a collection of second hand computers to operate. It too could disappear one day.

These days I look at my own paper and disc archives with renewed gratefulness that I kept them. Ironically, I feel as though I've got a better historical record of the early days of my work, in the pre-web days of the early 1990s, than I have for work undertaken at the Department of Health just three years ago. It's a reminder to treat those archives with care and I hope one day I will find a reliable home to look after them.

All I can say to a current generation is to keep this volatility of information in mind, and to ensure what you're doing today is still there for the people who follow you.


Saturday, February 04, 2012

The level of harmful practice is shocking

Anjum Mouj of Imkaan

It is estimated by the World Health Organisation (WHO) that over 100 million women in the world have been subjected to the barbaric practice politely referred to as Female Genital Mutilation (FGM). In Britain it is reported that over one million women each year experience at least one incident of Domestic Abuse (DV). In 2011 the Foreign Office's Forced Marriage Unit was called upon to give advice or support in 1468 cases where Forced Marriage (not to be confused with Arranged Marriage) was suspected.


These are horrifying statistics by any measure you choose. The collective term is "harmful practices", taking in other kinds of violence too, such as so-called "honour" killings, acid attacks and so forth.

Each act of violence involves the NHS, Police and other agencies. The incidents can have long term consequences in terms of difficulty in child birth (in the case of FGM), or in terms of chronic mental health issues for both the victim or their family, especially children.

Incidents involve others beside women. Forced Marriage (FM) is used as a means by some families to deal with gay, lesbian or transgender sons and daughters, or to transfer care responsibility for disabled children. Domestic violence is experienced by men as well as women, and in both heterosexual and same sex relationships. FGM involves family elders in complicity with practices that their communities carry on regardless of illegality.

Just as child abuse is said to progress from generation to generation, so too do practices such as FGM.


These are not issues which GPs, hospital doctors, police, teachers and social workers can turn a blind eye to. Quite apart from the statutory and human rights violations that are involved, there are safeguarding issues for others in the same family.

If a pregnant woman displays signs of violence or FGM at ante-natal appointments, there is a risk her unborn baby girl may suffer the same outcome. If teachers suspect a teenage schoolgirl is being sent abroad for forced marriage, they have a responsibility for her rights as well as those of her younger sisters. A woman appearing in A&E with suspicious injuries is likely to appear again if nobody does anything. Her children are possibly traumatised witnesses to the violence, or could be subject to sexual or physical abuse themselves.

Where possible within health care we acknowledge that it is better to prevent illness or injury than to simply patch it up. In these hard times, there are not just social and personal consequences to such occurrences, but financial ones too. Put bluntly, unaddressed harmful practices come with a long string of costs if we do nothing.

Yet some public sector workers may be confused about whether to act. There can be false assumptions about moral relativism … the idea that we should 'respect' what are assumed to be the cultural practices of immigrant populations … that in some way multiculturalism means being permissive of abuses of women, children, lesbians, gays and disabled people.

That assumption is wrong. Human Rights campaigner Peter Tatchell dealt with the question brilliantly in a lecture that I filmed a couple of years ago. The title of his speech, "Multiculturalism and the subversion of human rights" captures the issue perfectly.


Action to address these issues is not helped at present by cuts in funding for third sector organisations providing support. The Guardian reported only last week that charities providing refuges to women escaping domestic violence have had their funding cut by 31% since 2010.

On an average day last year 230 women were turned away by the charity Women's Aid, around 9% of those seeking refuge, because of a lack of space.

Southall Black Sisters, a charity which provides support for Black and Minority Ethnic victims of domestic violence, and which has repeatedly battled to avoid cuts to funding, says that it is in danger of losing up to half its staff next year.

The SBS case made clear, incidentally, why Equality Impact Assessments are such a crucial part of ensuring cuts are applied in a rational way, if they have to be applied at all … and that post-hoc action (completing assessments after a decision has already been made, in the hope of ticking the equality box) was unlawful.

A problem the public sector can't ignore

Quite apart from the impacts of failing to address harmful practices, the squeeze on charities in this field means that the problems will increasingly come to fall back in the lap of public sector organisations, especially the NHS. And, in order to address this, NHS staff need to learn a lot more about the issues, and managers of services need to make strategic policy decisions about how their services respond.

Any action needs to start with basic awareness, of course. It's no good the NHS simply patching people up and sending them home, only for them to return shortly with more injuries, or pregnancies made complex by the consequences of genital mutilation.

To tackle this, NHS North West's Equality and Diversity team held a full day event for the whole region's Equality and Diversity leaders, with specialist presenters, so that they could then take this knowledge back to their organisations and decide how to address the issues. The team holds regular quarterly development meetings with the system's E&D leads; however, this was the first time the whole day's schedule had been devoted to a single topic in this way.

Full house

Packed sessions were led by Anjum Mouj (pictured above) and her team from the London-based charity Imkaan, including two of the authors of a major report published in September 2011 for the Greater London Authority. Sumanta Roy and Dr Patricia Ng discussed the forms that harmful practices can take, their impacts on the people involved, the scale of incidents and the risks of failing to address this.

Full photo coverage of the event can be seen here.

LGBT and Disabled People too

Although people generally picture these issues as affecting women, the Imkaan team also covered the less-acknowledged incidence of FM and DV directed at men, and especially the way in which FM can be used by families to suppress and erase same sex orientation and transgender identities in families and communities.

Audience discussion of these wider topics was assisted by representatives from NHS North West’s strategic equality stakeholder partner organisations, covering lesbian and gay people, transgender people, disabled people, plus BME communities, men and women.

First hand experience

Other speakers included Faye MacRory, from Central Manchester Foundation Trust, who described a very successful pilot project detecting and acting on the signs of DV and FGM in hospital settings such as A&E and Maternity. Faye described the practical steps involved in setting up the project, which led to 697 actions being initiated on behalf of women patients, and emphasised the financial as well as social and individual benefits of taking such an initiative in conjunction with other Manchester agencies.

Workshops in the afternoon expanded in practical ways on the themes of the morning, and included a workshop led jointly by Afrah Qassim (a Merseyside based Community Development Worker) and Dorcas Akeju OBE, chair of the national Genital Mutilation Group.


The meeting was attended by almost 40 delegates, who were really positive about the day. One of the attendees commented “This has been a genuinely eye opening event with really excellent well informed speakers”, while another attendee pressed that it is very important that within health, networks and staff should become more aware of these issues.

E&D leads who attended are being asked to identify how they are going to follow-up within their own organisations. Shahnaz Ali, Director of Equality Inclusion and Human Rights at NHS North West said, “It is essential that people see this day as the start of a process, we will be looking in due course for the outcomes that people achieve as a result of what they’ve learned today.”

Friday, February 03, 2012

What did you do when they were taking the NHS apart Granny?


Those who've followed my work will know that I've been involved in consulting for and advising various parts of the NHS system in England at a strategic level for many years, both for the Department of Health and (at the last count) 16 different parts of the existing Strategic Health Authority, Primary Care Trust and acute / specialist / mental health landscape.

Through some of those direct client contacts, I've also met and advised managers in over seventy additional NHS organisations. That's not counting the ones who've heard me speak or chair events over the years.


Readers will also know that I've been first cautiously analytical about the health white paper and then downright critical of some of the changes contained in the Health and Social Care Bill. The bill is currently working its way through the House of Lords under a hail of criticism from more and more professional bodies.

More recently, as more and more highly placed commentators go on record to spell out what they think the health bill's consequences will be, my own critique from just four months ago actually starts to look tame by comparison.


As it looks more and more right to publicly voice concerns, and as the government of the day looks more and more determined to push through change regardless of the democratic process, I begin to find myself reflecting on the question that generations of young people have probably asked their grandparents in the past about other watershed moments in history: "How could you have let it happen?".

My grandson Harvey (pictured) is just 19 months old at the time of writing. If the doomsday scenarios which many of the commentators describe for the NHS were to come about in the next few years, I wonder how I could answer him, on his 18th birthday, with any pride?

More to the point, it leads me to wonder how managers inside the NHS, who really would have the power to put the brakes on the present changes, rationalise that question for themselves.


Personally I'm fortunate in the sense that, as an independent consultant to managers, rather than a direct employee of the NHS, I have a degree of freedom to speak out in my own capacity.

Consultants are employed for their expertise and their ability to step back, analyse and tell clients what they need to hear, even if it may be unpopular.

As a business consultant in the information technology field for many years before I began my present speciality, and having worked in the equality field for around 20 years, I'm used to giving that news direct to the people who are paying the invoices.

I also learned how to express a professional view that is separate to the activities of individual clients. This is something that any consultant worth their salt must do as a matter of routine. It's marketing.


The architecture of the NHS system is very germane to the business of advising people how to achieve equal outcomes.

I've often lectured equality stakeholders on the need to understand the structure of the organisation you want to influence … to use "the lines of accountability and control" as I refer to them. Therefore, it is entirely proper that, as a independent consultant, I express a view on how structural change in a large organisation like the NHS may affect equality.

Some structures lend themselves to stakeholders being able to find the right people to speak to, and for that person to be able to influence outcomes in the necessary way.

Other systems (in spite of what the NHS White Paper may have initially promised) make it a great deal harder, if not downright impossible for smaller groups.

It's impossible to be an expert in equality strategy without having a view on the effectiveness of organisational and leadership structures. This time last year I described how I thought that the direction of change in the NHS impacts the levers of change for stakeholders.

Hands Tied

Managers who actually work in the NHS are in a rather different position to myself, however. Any view they express is likely to be construed in the context of their job title. Therefore what they can say or do is potentially constrained by the amount of flexibility they have at their pay grade.

A junior administrator voicing criticism externally is likely to (a) be disregarded (as too junior) and (b) disciplined (for breach of their contract). Most staff in an NHS organisation don't have the authority to speak to the press.

The junior staff member who voices their criticism internally is also likely to be hamstrung. Again they'll be cautioned for speaking out of turn on matters that don't concern them, and they will also know that voicing dissent in that way is probably a career limiting move. Recent cases have shown over and over that NHS hierarchies don't apparently react well to people speaking up.

What's more, even where they are senior enough to speak, then their communications team will be very concerned with the effect their words have on the organisation's reputation. They also have to consider their professional code of conduct, both within the service and within any professional bodies they belong to.

This isn't unique to the NHS of course. It applies to many organisations. However, the principle of Whistleblowing is equally well established in many other organisations too. History doesn't treat those who sit on their hands and allow bad things to happen very well.

A dilemma

I therefore want to focus on the leadership dilemma for senior NHS managers when faced with the implication of the big changes happening in the NHS (even before the legislation has been passed).

A stakeholder recently said to me, “Surely, if all NHS managers refused to implement the changes they couldn’t happen?

What should a manager do? Should they set out to defend all the changes taking place on the basis that they are being told by their superiors that they are the best way forward? Or should they decide to rebel in ways that would certainly put them into very hot water?

Would it be a sensible gamble? In reality nobody knows what the actual outcomes will be in the end. Cultures have a way of surviving organisational change, rather like cockroaches in nuclear war. The change, though dramatic, may be overcome (as previous NHS reorganisations have been mitigated in the past), simply by managers finding the ways to carry on the culture regardless of the structure.

And if Parliament has decided to undertake these enormous and far reaching changes (the largest ever in the 64 year history of the NHS) then is it at all democratic for anybody in the system (from the post room clerks to the NHS Chief Executive) to stand in the way, or do anything less than their utmost to try and ensure the change works as well as possible?

You may argue that managers can't be allowed the indulgence of picking and choosing which parts of government policy they should implement.


This dilemma is inevitably bound to invite some soul searching and presents a challenge to any manager's personal and professional integrity. I'm not sure there's any simple answer.

On a practical level individuals must certainly consider first the professional code of conduct and ethical principles for managers.

Ultimately people must also keep in mind the importance of having a job, especially in a climate where opportunities don't grow on trees, and where the welfare safety net is acquiring ever more frightening holes.

Even so, I'm still left wondering how the grand children of some of the most senior enablers of the present changes will view decisions made today, in the event that Britain's most valuable social asset ceases to resemble the NHS we know.