Making Equality Work

"A huge 'little' book" … "Brilliantly researched" … "A must read" … "Refreshing" say reviewers.

Our new book, is now on sale from today on the Kindle store in all territories.

£7.99 in the UK. Purchase here.

MAKING EQUALITY WORK combines background facts and theory about the history and nature of equality and diversity in Britain with the detailed description of how we set out successfully to raise the measurable levels of equality outcomes for the National Health Service in North West England.

The first half of the book is a theoretical primer. It explains how Britain changed over the last 50-60 years with the progressive emergence of all the diverse groups which we see today, and how society and the law responded to the demands from each group for social equality and protections. We explain why equality matters and why attempts to change public institutions to achieve it often fail. This is backed by an extensive literature review.

In the second half of the book we describe our own practical, evidence-led and strategy-driven approach within a public sector system of over 60 autonomous NHS trusts, and how that can be applied elsewhere. The book explains not only WHAT we did, but WHY we did it that way, and the benefits and pitfalls in hindsight.

The text is written in an accessible style for a wide range of readers and contains many references to contemporary published work from both academics and public sector sources.

"This is a huge 'little' book. A text book that reads more like an engaging novel. Full of facts, statistics and testimony. A brilliantly researched book with a strong narrative outlining the context for equality in the NHS and why, despite considerable progress, equality matters more today than ever before. What you get is written by people with a passion and an expertise, who have got their hands dirty, detailing a candid, system wide case study highlighting approaches and successes but realistic about progress and lessons learnt."

— Dean Royles, Chief Executive of NHS Employers and Acting Chief Executive of the NHS Confederation.

"...a must read for all those who work not just in healthcare but in other sectors too"

— Dr Kailash Chand OBE, Deputy Chair of the British Medical Association.

"It is refreshing to see a book which gives the important background and context of equality laws. This book is important in making equality laws understandable in Plain English."

— Linda Bellos OBE, Chair of the Institute of Equality and Diversity Practitioners.

"This book provides a solid local, regional and national context to equalities and human rights in the UK and how and why they should be embedded into the work of public authorities. It is a refreshing reflection on real life experiences of equality work in the last 7 years of the NHS. Any due diligence in building new health and social care systems should pay regard to the lessons of the past. This book offers many of them."

— Jackie Driver, Programme Head, Public Policy at the Equality and Human Rights Commission and Chair of Breakthrough UK.

"MAKING EQUALITY WORK is essential reading for equality practitioners as well as senior management in the health sector and beyond. In a refreshingly jargon-free way, the book shows how it is possible to work strategically to achieve positive change, against formidable obstacles, in a very large organisation where promoting equality was not always a priority."

— Peter Baker, Men’s Health Consultant.

"...provides a model that has been shown to work on a large scale and presents it in a way that makes understanding it manageable. This is an essential textbook for those want to bring about real change in their organisations, and provides a roadmap to enable this."

— Sîan Payne, Director of Organisational Development at the Lesbian and Gay Foundation.

"...an important and welcome publication, not just for the NHS but in any organisation or venture: it is not only a 'how to' book but also a 'why to' book. The 'why' is often the biggest barrier, and it is well tackled here."

— Lorraine Gradwell MBE, former Chief Executive of Breakthrough UK.

Fishing for Birds

OUR NEW BOOK, Making Equality Work, will be coming out later this month.

It's all written and copies are currently with a select number of reviewers.

To find out more, click on the tab above.

In the meantime, to ensure everything is ready to release the eBook when we are ready, I have released a collection of poems that I've been meaning to formally publish for many years.

Baiting a line with a kite flying high

The title Fishing for Birds was inspired by a man who uses a wheelchair, whom I met once on Boston Common in the US. His hobby was to fly a kite from his chair (no easy feat) with the aid of a fishing rod.

Richard Troise referred to his hobby as 'Kite Fishing'.

The metaphor of using a kite to fish for birds, even when you can't walk,  struck me as an immensely strong one at the time. So strong that I decided to name my anthology after the poem of the same name, which I penned to describe that encounter.

A mix of emotions

I don't promise that every poem in this book has a diversity theme. Some are just plain absurd. Some capture painful or reflective moments in my life.

I tackle the big existential questions. Do Doughnuts have a soul? Is there a use for Bastards? Are Teddy Bears a single woman's best friend?

The poems have been performed by me occasionally over the years. But I always vowed I would release them as a book one day.

That day has come.

Kindle edition

Fishing for Birds is available in Kindle format on Amazon for £3.99. You can buy it here.

If you don't have an actual Kindle, that's not a problem as there are free Kindle apps for Windows and Apple PCs, and for iPad and Android tablet devices.

A full list of the free Kindle apps and how to download them is here.

Happy reading.

Steve Field Moves To CQC

STEVE FIELD, Deputy Medical Director of NHS England and the main force behind the commission's Equality and Health Inequalities team is moving to become the Chief Inspector of General Practice at the Care Quality Commission.

The move, announced today, is a logical one for Field, given his background as a former chair of the Royal College of GPs, who also developed GP training. He is also still a practicing GP.

However, the move also raises questions now over the leadership and direction of the Equality and Health Inequalities function at NHS England.

Personal stamp

Field had previously put a very strong (some would say idiosyncratic) personal stamp on the shape of the team and the type of appointments to it.

He surprised many by completely passing over established senior figures in the NHS equality area, pushing for an emphasis on health inequalities.

Job share

In theory the director-level championship role for E&HI was shared one-day-a-week with Paula Vasco-Knight, a practicing nurse whose main role is as Chief Executive of South Devon Healthcare NHS Foundation Trust.

On that one day each week Field returned to general practice in Birmingham so that, effectively, the championship of E&HI was a job share.

Now four fifths of that 1 FTE job share has departed.

Operational Head

Nominally the lead for the E&HI function is Ruth Passman, who was appointed in June.

Ruth Passman is certainly not in the same league as Professor Field. Having known her, I think she would admit that.

In fact this blog was probably the only place you would have heard of her appointment.

So this move creates a space and lots of questions.

We'll be interested to see what happens.

Fourth Column Revolutionary

GERMANY is to introduce the option for parents of Intersex babies to record the child's gender as a blank in the nation's birth registry.

This is an entirely sensible and pragmatic approach to dealing with an issue where, very belatedly, doctors and officials are realising that their need for binary certainty ("it must be one or the other") is not in the interests of the child.

Intersex campaigners have been presenting their own lived evidence for decades, arguing how the non-consensual assignment of their bodies after birth had consequences which the parents and doctors didn't have to live with.

Although this is arguably a first for birth registrations, the idea of not specifying gender is not unique to Germany.

Norrie May-Welby, a South Australian citizen, has fought an on-off-on campaign in that country to have an 'X' on their passport, enabling them to travel abroad.

The designator 'X' is already accepted as an alternative to 'M' or 'F' by the International Convention which governs the standards for Passports, meaning that any country could utilise it if desired.

And many countries nowadays have processes for citizens to apply to correct the gender given in their birth registration, to accurately reflect the social gender role acquired by an adult … although only from Boy to Girl or Girl to Boy..

Restricted

The new German provision is not open for parents to use voluntarily for their children.

It is only to be applied where doctors say that the newborn's physical sex is ambiguous.

Opponents of such restriction will argue that it reinforces a longstanding medicalisation of sex and gender.

The process can't just be used to limit the influences of official gender in their child's life and options.

Problems

The Independent, presenting the story, chooses to emphasise the questions raised by a blank space, positing how this might be a problem in later years with other official documents, when getting married, or if the grown up child was to be sent to prison for committing a crime.

Arguments like that miss the point that people of mixed, indeterminate or self-altered gender encounter these issues anyway. Prisons need to have intelligent guidelines for dealing with such cases; filling in the blank on their birth certificate arguably exacerbates the issue rather than requiring consideration of what is most appropriate and humane in each case.

Discussions like that remind me of how a topic like this is considered in terms of how it rocks the status quo, rather than whether the status quo is actually a good thing or not.

Fifteen years ago I wrote an essay about what might happen if we did away with the gender registration altogether. For everyone.

Today seems like a good time to reprise that.

Please forgive the wandering style at the beginning. We writers evolve. Oh, and I left the Conservatives too. All change!

I don’t know if you’ve noticed, but some revolutionary ideas only need to be aired once and they take off like a balloon that’s not been fastened well-enough to a toddler’s pushchair.

Other ideas, no less dramatic when viewed in hindsight, seem to need to E-volve for a while, before the world starts RE-volving in their wake.

Take the fax machine … Little more than a dozen years ago, facsimile machines were something of a rarity, even in business.

Do you remember how we all practiced that neat trick of folding our correspondence in three, inserting it into an envelope (self-seal for the business-stylish, of course) and sticking a stamp on the front … to await the vagaries of the post office?

A message bound for overseas inevitably meant that someone would need to pay a visit to the post office, to grapple with how many pennies it cost to send sixty grams of glorified tracing paper to Timbuktu by air. And DON’T talk to me about Telex machines !

Yet try getting a timely letter to "The Times" these days without a fax. Try getting a request played on the radio…

Yes, it’s fairly obvious why the fax machine struck such an obvious and immediate chord in people’s minds that, today, parents give them to far-away daughters for Christmas, as a way of hinting that a letter or two wouldn’t go amiss now and then.

A revolutionary idea, if its’ benefits have a universally obvious appeal, does not need to sit on the shelf for long. … Or does it ?

In the late 1940s, a distinguished government scientist in the UK looked at the electronic calculating machines being developed at that time on both sides of the Atlantic and concluded that Britain’s national requirements for the new "computers" would most probably be met by having two or perhaps three of the things. Over in the United States, a committee at the International Business Machines Corparation, arrived at a very similar conclusion for the office machinery giant. Computers were perhaps useful, but a bit esoteric.

Going back further still, there is the little-remembered case of the US Senator who, after a demonstration of Mr Bell’s new Voice Telephone, pronounced confidently that he could see a day when every town hall in the United States would have one of those useful pieces of apparatus.

There is a tendency for people to very often assess a new idea in familiar terms. They ask themselves, "would the telephone be more convenient for telegraph operators than morse code", rather than "do we need telegraph operators any more ?".

I’ve left out the Internet in this set of examples, of course. Yet, on a scale calibrated by the speed with which an idea can achieve mass adoption, the Internet … and more particularly its’ two stars "e-mail" and the "World Wide Web" … already makes the meteoric successes of the fax machine, mobile phone and Microwave Oven look decidedly less dramatic than they were for their time.

The long term revolution of the Internet will not stem from what it does quicker or more conveniently, mind you, but from what it previously impossible and undreamt-of things it will make into commonplace reality tomorrow.

The lesson however, is that, for technology, it’s not just enough for something to be useful, or affordable … but that the timing has to be right too. A world that already understands the advantage of cheap rapid communication is a world that’s ready to accept the simple proposition that electronic mail is just the same, but even cheaper and faster.

But does a similar principle hold true sociologically ?

It seems amazing to me now that when I was taking my Eleven-Plus examinations as a child in mid-sixties Britain, single young mothers were still being despatched off to nursing homes in shame to have "illegitimate" children delivered and then taken away for immediate adoption … in scenes which would now provoke an immediate outcry.

When I graduated in mid-seventies Britain, it was still not entirely the "done thing" for couples to "live in sin", as it was then called … and it took until 1975 before we had a "Sex Discrimination Act".

As recently as 1967, adult male homosexuality was a criminal offence and it took until the mid-NINEties before a first attempt to harmonise the homosexual and heterosexual ages of consent ended in what is still a half-way house … a fudge.

In some quarters, of course, unmarried mothers still have pariah status over thirty years on. Women continue to earn less than men. And homosexual people are still only really "tolerated" or "accepted", in the right sort of places .. largely thanks to a perception that "straight" society gets something out of them. Take away the perception that so-and-so’s "OK" because he or she is a good singer, tennis player, or whatever … and the reason for many quarters of society to suppress their continuing distrust of people with different sexual lifestyles would still be there, 31 years on.

So, there is a parallel … based on perceived benefit … but it’s a muted one, compared with the simple "see it - want it" psychology that applies to society with technology-driven revolution.

Of course, by now you’re probably wondering where on earth I’m headed in this line of argument, but patience children, please …

The STARTING point that I wanted to get to was that there doesn’t appear to be any sociological equivalent of, say, the Microwave Oven … a new way of thinking about or doing something which is so instantly attractive that people lust after the means to embrace its’ benefits. That is why social change is, perhaps, so often slow and E-volutionary, rather than RE-volutionary … except, of course, where it’s driven by changes in lifestyle brought about by rapid adoption of a new technology.

The other point I wanted to underline however was that, even then, the acceptance of a change depends upon the extent to which people have already had the ground laid by what’s gone before. This is why, of course, society is ready and able to digest ideas about trans-people that it wasn’t ready to digest a mere decade ago.

So, when you meet with a "revolutionary" social idea, don’t be disappointed if you find that you have to keep repeating it over and over … for years if necessary … before anyone actually stops, puts their drink down and says, "Run that past me again dear …"

And the "idea" that this is all leading up to certainly isn’t new … or mine…

I first heard it mentioned, almost as a throwaway line, by Dr Michael Will of the Faculty of Law at the University of Geneva. He was speaking at the Amsterdam Colloquy : Transsexualism, Medicine and Law in April 1993 … and when he casually tossed the line into his presentation, he admitted that it wasn’t his either … It had already been put forward by Judge F.A. van der REIJT, the Chairman of the Dutch Gender Foundation at the very start of the Colloquy.

It’s a really simple question, too …

"Why not eliminate sex altogether … the UK birth certificate’s FOURTH COLUMN … from public records for the whole of Europe ?"

Now … watch your reaction for a moment …

You smile … you nod … you acknowledge the simple elegance of the idea .. then you shrug … "Impossible" says the little voice from the oldest recesses of your brain’s social reasoning department … and then you smile indulgently at Christine’s naïviety and change the subject … let’s talk about the ACHIEVEable !

See what I mean about revolutionary ideas ? Often so simple … yet outside of our reach.

Well … the idea IS barely five years old … and where’s that elusive MASS benefit ? Oh … well, I’m coming to that !

What set me off again, however, was something I read from the UKPFC-forum a few weeks ago … so often a place where ideas blow in on the breeze like a dandelion seed, and either settle to germinate and flower … or blow out the door again, unnoticed.

It was one of those things that remind me that we are still painfully apologetic, as a community, about asking for what’s rightfully ours ..

Just before Christmas the forum’s debate touched for a day or two on what to do about that fourth column on the UK birth certificate. Somebody wanted to alter the "label" from "Sex" to "Gender" … believing that a (non-existent) means of correction could then be invoked to change it less contentiously .. missing the point that the essence of the case is about acknowledging the CORRECT sex by a better understanding of what defines it, rather than trying to pull a legal "fast one". That line of reason never got time to surface though … as the preoccupation of those taking part in the discussion boiled down to an acceptance, from the word go, that people at large would not countenance changing something like that for such a small minority of people to benefit.

It reminds me of one of those silent Charlie Chaplin films … you know .. where Chaplin battles for ages to open a door by pushing and pulling .. totally oblivious to the fact that it’s a sliding door.

What’s in it for the masses ?

That … in a manner of speaking … is what the government argued ten years ago too, in the Mark Rees case at the European Court of Human Rights, in saying that a change to birth registration procedures would "impose" new responsibilities and obligations on society…

What’s the benefit to 99.99% of the population in enabling the meaning and purpose of the UK birth certificate to be altered from a purely historic record of observation at the time of birth ?

(That’s a rhetorical question, incidentally … I don’t need telling <grin>)

Well, of course, put THAT way it all seems quite reasonable to the 99.99% whom we assume aren’t going to derive any benefit … But then we ought to perhaps break that down and REALLY focus on 51% of that number ..

Let’s go back, in fact, to where your eyes glazed over at the thought of deleting the fourth column altogether.

WHY is it such a REVOLUTIONARY idea ?

You KNOW why, tacitly, of course.

The fourth column of the British birth certificate is the root of the most enduring and entrenched systems of discrimination in modern society. On the basis of that fourth column it is decided whether or not you inherit your deceased parents’ estate in preference to your younger brother. On the basis of that fourth column you will either work until you are sixty or sixty five (at least, if you’re over 40 now). It will decide who you can marry, what laws apply in favour and against you.

It assumes the state’s prerogative to define you … and from that perspective it can be viewed as fundamentally repressive.

Put another way, ask how any of these things are possible WITHOUT that column on the birth certificate to act as the root of all gender-connected reasoning on your behalf.

So, annihilating that fourth column in society really IS a revolutionary idea … which affects not a mere five thousand transpeople, but fifty five million citizens … and especially those twenty six million for whom the entry "Girl" denotes a lifetime’s expectation of taking second place. Moreover, it asserts the right of the state to define every one of us.

So, instead of meekly and apologetically asking if society is prepared to correct the column that discriminates against US, maybe it wouldn’t hurt, now and then, to point out the fact that the road we’re on leads logically to a conclusion that benefits the MAJORITY of society.

In principle, of course, it’s something that governments of all shades have been working towards in a modest fashion for years anyway …

As I said, if you’re under forty years of age, then you ARE going to have the same retirement age irrespective of what it says on your birth certificate. Already, you have the right to be treated equally by the inland revenue, regardless of sex. At work, you can’t be discriminated against (legally) on the basis of your sex. Already, people like Jeffrey Archer are talking of altering the law of succession too … though why he should work on the assumption that it will take fifty years to achieve baffles me.

All around us, changes are already in progress that make the requirement for a legal reference point for sex into an anachronism. But why empty the bath one cup at a time when you can just pull the plug out ? If it’s anachronistic to treat a woman differently in the eyes of the Inland Revenue, why is it appropriate to retain the means to distinguish her legally from a man at some other time ?

Why enact ten acts of Parliament to eliminate society’s gender distinctions when one will do ?

When you find the REAL answers to those questions, of course, then you’re on the road to understanding why the British establishment has been so unwilling to even COUNTENANCE taking the first step … which it thinks it would be taking in any move that might weaken the general belief that the fourth column is planted in stone foundations. We are that first step.

Permit the idea that sex-based social positioning is not as "permanent" as it’s always been taken to be, and you find that before long people will begin to see the social barriers as capable of change too.

Janice Raymond characterised trans-people as some sort of fifth column. She missed the point entirely though … for in truth we are the FOURTH COLUMN REVOLUTIONARIES.

Copyright © 1998,2013. All rights reserved

A New Blog: Fanfare For The Uncommon Gran

Just Plain Sense is the main brand that I use for content mainly related to Equality, Inclusion and Human Rights.

Aside from the written content on this blog there is the Just Plain Sense Podcast, founded at around the same time in 2008, and the Just Plain Sense You Tube channel.

That's almost 200 blog articles and 90 Podcasts in the last five years.

Over that time, however, I have also added other blogs and Podcasts to express ideas that wouldn't really fit the 'Just Plain Sense' brand.

Fishing for Birds is a Podcast set up several years ago just to host readings of my poetry collection of the same name. One day I may publish the text of the poems as an eBook but, for now, they are performed online for your enjoyment.

Then there is this site's alter ego 'Just Plain Daft', which is a bit like The Onion or The Daily Mash, taking a satirical view on contemporary events or thinking. The format of articles under this masthead have evolved a bit since I began. Hopefully, in the process, they've become sharper. However, they are an acquired taste … not for everyone.

Recently I began to realise that that I had other ideas to express which wouldn't fit into any of these. They are the sort of thoughts which have impressed themselves on me as I contemplate the start of my seventh decade next year and wonder when to call myself 'retired'.

Fanfare For The Uncommon Gran is about approaching the enormous watershed of retirement when your life has been anything but ordinary. Like all new blogs I can't entirely predict which way this one will evolve. I write when I catch myself thinking about some aspect of life and have something to say. And that something may well evolve in the next few years as my own life and outlook changes.

I do hope you'll come along for the ride though.

And this isn't the end for Just Plain Sense. Just another fork in the road.

NHS England Launch New Equality and Health Inequalities Newsletter

Observant readers will have noticed that I've said little or nothing about NHS England's Equality and Health Inequalities team since April, when the new structures came into being.

Yes, I was critical of the manner in which the team was recruited during the previous year, and how I still think continuity was compromised in that process.

Yes, I've pointed to the inequalities which were being reinforced in the establishment of NHS England, even as the leaders mouthed the right words.

I was perplexed, too, by the virtual radio silence in the last four months, during which time this blog was probably the only place where you could learn anything about the structure of the national Equality and Health Inequalities Team and appointments to it.

On the whole though, I had already decided to grant the new Equality and Health Inequalities team some space in which to get a grip
on their brief.

Breathing space

Any new team requires a bit of space and time to come together, to learn about each other, to establish their processes and objectives, and to start producing outputs (let alone outcomes).

And NHS England has already begun to deliver in some areas, most notably the kind of stakeholder engagement driven by their Patient Voice team.

It was about now that I was beginning to contemplate asking broader questions though.

So I was pleasantly surprised this morning to see a few answers.

Newsletter

The first edition of "Everyone", the Equality and Health Inequalities team's newsletter, has been published today.

In fact, "newsletter" might not be the right term, as the style is more that of a magazine.

Issue one explains the interim equality objectives, which I reported on back in April. There is confirmation that the Equality Delivery System (EDS) is undergoing a refresh and still has an important part in transformation plans. And there are pictures and profiles of the sixteen-strong Equality and Health Inequalities team … many being entirely new names in the sector.

Timely

Such a publication is very timely. Any longer and the silence from the new team would have prompted questions.

A four month interregnum on national Equality governance is something that has to be accepted following such a massive reorganisation of the NHS system in England.

And maybe it's OK to stress patience whilst a group of relative strangers continue to build from scratch.

For now it's OK to learn about personalities and to hear about plans and processes.

So long as nobody forgets that, in the end, this new team will ultimately be measured on the genuine outcomes.

What really changed. For who. And how permanently.

The team marks its inaugural meeting in April with a cake

Charing Cross Team Echoes View On ICD Revision

Earlier today I posted a short item reporting a statement by the heads of two English Gender Identity Clinics, Professor Kevan Wylie and Dr Walter Bouman, confirming their views about how the International Classification of Disease (ICD) should be updated for gender identity diagnoses.

For background see another recent blog.

The position of these two senior clinicians was not surprising, given their involvement in the global consensus-building process led by the World Professional Association for Transgender Health (WPATH). However, this was the first time that two clinical heads had stated the position so succinctly in writing.

Rapid response

No sooner had this morning's blog gone out than I heard from a senior clinician at the Charing Cross Gender Identity Clinic, England's largest.

Dr Stuart Lorimer lamented that it was a shame the letter had only had two signatories. He felt sure his colleagues would want to have had the opportunity to express the same to ILGA, who were gathering the information. They'd simply not been approached.

Another letter

I suggested that there was no reason they couldn't endorse the principles independently. I provided the contact details for ILGA's policy officer and the Charing Cross team went off to agree a suitable letter, to be signed by the chief clinician, Dr James Barrett.

And this is what James' message, addressed to ILGA, says:

Madam,

Following the joint statement of Drs Bouman and Wylie, we would like to make our own position clear regarding gender related diagnoses in the forthcoming ICD-11. As the oldest and largest of the UK’s gender clinics, we find that dealing with the ongoing needs of our sizeable caseload (currently, around 4000 active attendees) keeps us occupied to the extent that we are often less directly involved than we would like to be in global matters such as the ICD-11 discussions in Geneva. This does not, however, mean that we are ignorant of or indifferent to those discussions.

As specialist clinicians dealing with the day-to-day realities of gender treatment, our own collective view is very similar to that of our professional colleagues. We support the renaming of the current F64.0 diagnosis, Transsexualism, to the less contentious Gender Dysphoria, Gender Incongruence or similar. Also, the diagnosis itself should, ideally, remain within the ICD-11 in a category aligned with gender identity, sexual or reproductive conditions rather than that section specifically designated mental health. This would help safeguard future provision of healthcare to gender variant people.

Again, a very clear endorsement of the direction being taken in the consensus process. And I don't doubt that the heads of the other English Gender Identity Services would agree too.

Two UK Gender Clinic Heads Make Clear Their Policy Position on ICD-11

"We are both of the opinion that the diagnosis of transsexualism (F64.0) should be removed from the mental health chapter of the forthcoming ICD-11 and that the terminology which describes this condition should be changed to gender dypshoria or gender incongruence, or another more neutral term. "

That is the clear policy position being expressed by the clinical heads of two of England's Gender Identity Clinics, Kevan Wylie and Walter Bouman.

Professor Wylie heads the Porterbrook Clinic gender identity clinic in Sheffield and Dr Bouman heads the Nottingham service.

Their words come in a letter to a policy officer at the International Gay and Lesbian Assocation (ILGA), Sophie Aujean, who is gathering views from european clinical leaders on the revision of the International Classification of Diseases.

They add, "In order to ensure access to treatment and appropriate healthcare for trans people we support inclusion of this condition within the ICD-11, preferably in a separate chapter of sexual-related, gender identity-related and reproductive-related conditions."

This statement does not come as a surprise, since both Kevan Wylie and Walter Bouman have been closely involved with the consensus process being conducted by the World Professional Association for Transgender Health. However, it is the first time any clinicians in England have committed their positions to paper quite so unequivocally.

This will add to expectations of a more than cosmetic change to the underlying precepts in the revised clinical protocols to be determined by the Gender Identity Services Clinical Reference Group, which will begin work shortly. If a broadening clinical consensus agrees with stakeholders that transgender experiences don't belong within mental health classification then it becomes really difficult to continue advocating ways of working which impose unusual conditions on patients seeking hormonal and surgical support to realise their identities.

New Reports On The ICD Revision Process for Trans-Related Diagnoses

In February of this year I reported on an important international meeting, hosted by the World Professional Association for Transgender Health (WPATH).

The meeting in San Francisco brought together clinicians and stakeholders from across the globe to seek a consensus on recommendations to the World Health Organisation, which is currently working towards the first revision of the International Classification of Disease (ICD) in 25 years.

Downloads

WPATH have now released their own formal report on the proceedings, which contains far more detail on the discussions.

The report will be available to WPATH members on the members area of their website and an executive summary has been published on the public-facing side.

However, there doesn't appear to be any restriction on sharing the full report openly; therefore I have arranged that you can download it here.

GATE contribution

The group Global Action for Trans Equality (GATE) also set up a working party of their own on the specific issue of diagnostic categories for children exhibiting 'atypical' gender behaviours.

The question as to whether it is necessary or desirable to have a formal diagnostic category in order to help such children (or, rather, the adults caring for them) was something which completely divided the WPATH meeting in February.

The formal WPATH report contains the various papers which were submitted pro and con … mostly con.

And GATE have now published a separate report on their Buenos Aires working group discussions in April, also arguing strongly against such classification.

I have made the GATE working group report available here.

International dimension

Both the WPATH and GATE activity underline that, in the internet age, there is a far stronger voice from outside of the western first world in debating these topics.

I've commented on this previously in the context of the policy position in Cuba.

This should all be contrasted with the debate surrounding categories in the the US Diagnostic and Statistical Manual (DSM). The DSM is is an almost exclusively North American concern, with the result that mental health categories reflect the way United States culture views human behavioural diversity.

Since transgender medicine has been dominated in the past by western first world cultural ideas about diversity, it will continue to be interesting to see how this plays out in the ICD revision process.

Three Good Reasons Why Government Disability Policy Matters To YOU

You might have heard some stuff in the media about disabled people.

You know the stuff. "Disabled people are claiming too many benefits"

"The Work Capability Assessment is a fair process".

"The country can't afford the benefits bill".

"We're all in this together".

Even if you harbour the suspicion that some or all of this is so much spin, it's not top of your own list of concerns though.

There's paying the mortgage.

There's holding on to your job and making ends meet.

You can't be expected to worry about what happens to a few disabled people, right?

I mean … you're sympathetic and so forth (poor dears). Some of them sound like they're not on the make.

But, it's not your battle, huh?

Three scenarios

Here are some thoughts.

Tonight on their way home from work your husband or wife is hit by a car, breaking their back. They are never going to walk again. Tomorrow you are going to grapple with becoming the sole earner whilst learning to become a carer too. You are going to learn about housing benefit to make up the rent. Your house will be regarded as too big for your needs so you won't get enough. You can't afford to adapt the property so your partner can have some independence. Your partner will be unable to get into that favourite restaurant you both love because the wheelchair won't go up the steps and they are regarded as a hazard for other eaters. ATOS say your partner is fit for work but employers consistently tell them they've not been shortlisted for vacancies. From tomorrow you are going to realise that everyone suddenly looks on you both as burdensome and costly. You come to live with peoples' suspicion that any welfare payments you receive are probably fraudulent.

You don't have a partner?

Tonight whilst settling down with a drink in front of the telly you find you suddenly can't move one side of your body. Your mouth contorts. You try to speak and a strange slurred sound comes out. You can't raise your arm or hold the glass. Fortunately a friend is round and recognises the signs that you are having a stroke. They call 999 and your life and some of your future is saved. Tomorrow you wake up and come to terms with the fact that these symptoms might respond partially to speech and physiotherapy but you are now a disabled person. You can't go back to work. The savings you put aside for buying a house are counted as your living benefits are means tested. Add most of what's described above.

Young, fit? Not at risk of chronic illnesses yet?

Your Father died a while ago and your mother has been living independently on her own. Recently you noticed that she was forgetting things you had just told her. Now you learn from the neighbours that she has been wandering around the local streets without warm clothes and doesn't seem to have been eating. The doctor has informed you today that your mother has Alzheimer's disease and will become progressively less capable and aware. The disease will kill her eventually but she can have five years if looked after well. Your siblings won't hear of Mum going into 'a home'. One of you will have to give up their job to look after her … and the consensus is that that will have to be you. You need to give up your job and become a full time carer. You discover the complexity of claiming benefits to enable you and your mother to survive. You do this job 24/7 for every day of the year. The local authority has no funding left to pay for stand-in 'respite' care so you can have a break. The stress means you become ill yourself.

Someone else's problem?

There is a tendency when we are young and healthy to imagine that disability is something that hits other people. Yet it can visit all of us in the space of 24 hours and seldom goes away.

Disability isn't just something that people are born with. It can arrive in your life through accident, or illness, or simply the result of ageing.

So, when the government is pursuing policies which disabled people say are harmful to their lives shouldn't we be just that little bit more concerned?

Before tomorrow?

Play Disability Policy Bingo

 

The House of Commons is debating today whether the Government should carry out a Cumulative Impact Assessment on how its policies, considered together, affect disabled people.

They won't, of course. They don't need to. They know already full well just how their policies are working.

The debate will act as a reminder of the kind of rhetoric which this government has adopted over the last three years, cynically developing a language which paints vulnerable people as a problem.

For that reason we invite you to play Bingo as you spot the dog whistle terms that trip off Conservative tongues.

Alternative Guide To The New NHS In England

 

The King's Fund, an independent charity working to improve health and health care in England, does a nice line in easy-to-understand multimedia explanations of complex detail

Back in April, they marked the largest reorganisation in the NHS's history with a very creative Prezi, whirling through the history of NHS reorganisations and the history of this one.

And this video provides another really helpful contribution, explaining the complicated way in which the components of the new NHS mesh together.

Ironically, of course, the simplified explanation in this short presentation merely serves to underline what a dogs breakfast the whole thing has now become.

… If that's not an insult to the culinary choices made by dogs

Transgender Archive Moves to Canada

Readers of this blog will know that I'm a keen advocate for ensuring that diverse communities understand and preserve their histories and pass that knowledge on to the generations that follow them.

History is not only important for communities to understand their own position in the present; it is also an important source of education for everyone concerned with equality … for ensuring that we learn from
and don't repeat the mistakes or brutality of previous generations.

This is why I've been a keen proponent for educational materials to help educate public sector staff about BME, LGBT and Disabled peoples' history, and for keeping those resources in the public domain in spite of
major reorganisations.

I also keep an eye out for useful resources from elsewhere, such as this excellent series of Podcasts from the BBC on disabled people's history. There are invariably things which all activists can learn from understanding the history of other groups.

Save it or lose it

These are the reasons why I've been keen to promote the capture of archive material from fast-moving civil rights campaigns, such as trans people, in the digital age. My argument is that communities, now more than ever, must act to preserve material from volatile online platforms, such as Facebook groups, blogs, list servers and even web sites, for the benefit of future historians.

The lesson taught by the total loss of the original Press for Change web site is that vital and unique material is very easy to lose. Miraculously in that case the disaster was mitigated by the British Library's excellent UK web archive. That was luck rather than planning, however.

Over the years I've tried in my own way to preserve history of a different kind. Many of the interviews in my Just Plain Sense series of Podcasts have been conceived as a means of capturing oral history from diverse people with first hand recall of events. Now and then I pull those materials together to make them easier to find.

Professional archives

Other individuals have kept their own libraries. Where possible I've encouraged those people to donate their collections to professional archivists for cataloguing and preservation. I've done this with my own files and I was pleased when veteran activist Mark Rees followed me in donating his entire store of correspondence and cuttings to the LGBT Archive at the London School of Economics.

Not only are many valuable contemporaneous records preserved through archiving in that way; we've also been able to ensure vital protections for sections of the archive to preserve the privacy of living persons. This means sections will not be available for several decades but will be preserved in the meantime.

The Transgender Archive

One archive that has been in existence for longer than most is the collection begun in 1986 by Professor Richard Ekins of the University of Ulster at Coleraine in Ireland.

The Ekins Transgender Archive is probably the most complete academic collection of recent transgender history in the world. It has been collected systematically from newspaper and media coverage in the UK for over 27 years.

Now, following his retirement, Professor Ekins has arranged a new home for the archive, to ensure its continued preservation and facilitate new studies.

The new custodian, Professor Aaron Devor, explains:

The Transgender Archives at the University of Victoria is about to get a lot bigger! Our movers have packed up the equivalent of more than 125 bankers’ boxes (158 linear feet) of transgender books, magazines, articles, audio tapes, video tapes, photographs, artifacts, etc. in Northern Ireland, and we expect them to arrive in Victoria sometime around the end of July.

Richard Ekins, Professor Emeritus of Sociology and Cultural Studies at the University of Ulster, Northern Ireland, UK, has most generously entrusted his extensive collection of transgender materials to the University of Victoria Transgender Archives. Originally called the Trans-Gender Archive, the collection was founded by Professor Ekins in January 1986 with the collaboration of the President and the Librarian of the UK-based Self Help Association of Transsexuals (SHAFT). The ground-breaking University of Ulster Trans-Gender Archive collection ceased its connection with the University of Ulster in July 2010, upon the retirement of Professor Ekins, and it is now on its way to the University of Victoria.

The collection is focused on understanding how attitudes and representations of transgender people have developed and changed over time. It looks at three broad aspects of transgender--biology and the body, gender expression, and erotic expression and representation--through the lenses of expert knowledge, as recorded by scientists and social scientists; transgender community member knowledge, as recorded by and for transgender people themselves; and common-sense knowledge, as recorded by and for members of the general public. It is truly a treasure and we are honoured to become its guardians.

Accessible online

The archive will be accessible online in its new home.

'Positive Vibes' at NHS England

Trans delegates at a consultation forum on NHS Gender Identity Services (GIS) were smiling and talking of 'Positive Vibes' at the end of a long day of participative discussions and presentations on service commissioning reform in London yesterday.

The meeting, facilitated by NHS England's Patients and Partnerships team, in conjunction with the Equality team and Specialist Commissioning leaders, involved over fifty stakeholders.

The event was designed to explain both the interim arrangements for commissioning GIS in England, and the process that will follow to develop an all new service specification and protocols for implementation in April 2014.

Listening

A significant part of the time was also spent gathering views … although, unusually for such occasions in the past, the leaders present gave the strong impression that they had already absorbed and understood many of the areas of contention.

The conduct of the event, which took place at the Coin Street Neighbourhood Centre near London's South Bank, appears to confirm the promises of a new kind of approach to stakeholder involvement under the new regime.

As one delegate observed to me, "the atmosphere could not have been more different compared with the event organised last year by the Department of Health under the Government Equality Office's Transgender Action Plan".

One civil servant had described their experience at that meeting last year as "bruising". And you could understand why delegates to yesterday's event may have been anticipated the proceedings with cynicism.

There were no raised or angry voices on this occasion though, as stakeholders and NHS England staff alike threw themselves into the work with gusto.

Leaders

The event was attended for five hours by Professor Steve Field, NHS England's Deputy Chief Medical Officer, who also has a cross-cutting responsibility overseeing work on Health Inequalities and Equality.

Field is a GP (he still practices one day a week in Birmingham). He was the previous chair of the Royal College of General Practitioners (RCGP) and wrote the organisation's curriculum for the training of GPs. He is also a keen advocate of the NHS Constitution and quoted the opening passage when speaking in the afternoon:

The NHS belongs to the people. It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.

Field was joined by NHS England's Head of Specialised Commissioning, Kate Caston; the Portfolio Director for Mental Health, Patrick Neville; and gender clinician Dr John Dean, recently appointed to chair the Clinical Reference Group (CRG) for Gender Identity Services.

Also present was Professor Dinesh Bhugra, who is President of the World Psychiatric Association (WPA) and a former President of the Royal College of Psychiatrists. He is Professor of Mental Health and Cultural Diversity at the Institute of Psychiatry in London. His attendance confirmed the level of engagement now in the processes of reform.

Specialised commissioning

NHS England is responsible for direct national commissioning of over 150 so-called 'Specialist Services'. These are clinical specialities where the relatively small size of the patient population, the cost profile, or the specialised concentration of clinical expertise means that it would not be sensible for local Clinical Commissioning Groups (which replaced Primary Care Trusts) to each contract services.

The purpose of CRG's is to review and improve the delivery of these specialist services, which includes refining the specifications for purchasing such services from provider clinics. NHS England currently has 74 such CRG's, which were initially set up in 'shadow' form in 2012, so that NHS England would have policies in place to take over commissioning these services in April 2013.

One of those 'shadow' CRG teams had engaged with trans stakeholders over the last year to develop an initial national policy for Gender Identity Services. They based their work on the policy used in the East Midlands, thought to be among the best. The product of their work was the draft English Service Specification (ESS) which had been put to full public consultation in January 2013.

Interim specification

It was explained that the reason why that 'ESS' had not been adopted from 1st April was because of the strength of stakeholder feedback received.

Reports say that, of all the 150+ policies consulted upon in January 2013, more than 80% of the feedback had concerned the GIS documents, and had come from trans stakeholders.

Thus, one important purpose of the meeting was to explain the policy which it was proposed to adopt for the interim, based on the service specification recently developed by NHS Scotland, with a few specific changes. It was proposed to introduce this interim policy from 1st July 2013.

It was this and other proposed changes which had already provoked howls of concern from clinicians in some of the English Gender Identity Clinics, which I reported a couple of weeks ago.

The NHS England team will be meeting the clinicians on 21st June to discuss the same proposals. As Steve Field commented, "The process may be rocky at times and clinicians may find the change difficult".

World Class

Steve Field explained that, having bought time by implementing an interim service specification and protocols from 1st July, the main work of the Clinical Reference Group would be to embark upon a detailed review, aiming to present a new set of proposals to stakeholders by January 2014 and implement those new policies from April the same year.

He explained that he had heard some of the concerns voiced during this event around existing services, acknowledging worries about the safety of the location of one clinic, and the present differences in accessibility to services in different parts of the country. He was also familiar with all the feedback from the January consultation.

His ambition, he said, was to achieve uniformly high standards across England, although he acknowledged that it couldn't be guaranteed that everything that people wanted could necessarily be funded by the NHS. "We will consult to learn", he promised.

Field made clear his view that all GIS clients had the right to be treated with dignity, care and compassion … adding, "We need to find a way of detecting early where that's not happening".

He expected lots of patient input to the CRG's design work. "We want to design a service that's the best in the world".

The Scottish connection

John Dean presented a potted version of the proposed interim specification, highlighting the four areas of difference between this and the Scottish Service Specification (SSS) on which it is based.

The details will be covered in a subsequent blog once the meeting with clinicians has concluded on 21st June. They concern details such as how referral takes place; the expected pathways within a service; which kinds of treatments are available to be funded; and the order in which some things can occur.

NHS England have also promised to release all of the presentations and captured workshop comments from the event.

One headline to be going on with is that the new interim policy will permit referral direct from any General Practitioner or other clinical service into any of the GIC services that are commissioned in England.

Although GP referral already happens in some parts of England, it is far from the norm. Accommodating it may be one of the biggest practical changes which existing clinics need to adjust to. However there are clear benefits for patients, who will no longer need to be referred through their Community Mental Health Team in the first instance, and will also have a much wider choice of clinics to attend.

It is concerns about changes like this that have some of the clinicians in uproar, as reported before. And it is hard to tell at present how much of the clinical antipathy stems from hearsay and speculation, and how much that may be dissipated in the course of Friday's event by talking through and understanding the proposals.

Whatever the mood of the clinicians, however, the NHS England team were leaving no doubts of their own determination about reform. The seniority and experience of some of the figures involved means that objections would need to be very well founded. At the end of the day it is NHS England who will be purchasing and contracting services and there were hints of an attitude that if some providers didn't want to offer services in the form the commissioners wanted then then they could be decommissioned.

Open to innovation

John Dean also expressed a willingness to look at ways of innovating to develop better services. He said he was in favour of looking at ways of delivering more elements of the services locally and there will be active discussions about how NHS England might be able to cover facial hair removal for some patients (only available in some areas till now).

The interim proposals had already prompted new questions. One delegate asked whether patients could be referred from private clinicians into NHS services. Another queried whether patients could be referred back at later stages following an initial treatment episode … for instance, where someone might have been deferred a decision about gender reassignment surgeries after transitioning socially but then decided, years later, to pursue that. Others wanted to know whether, if facial hair removal were to be funded now, past patients (who could not afford to purchase such treatment themselves) could return seeking such help.

Questions like these underline how change often raises new questions at the same time as trying to resolve old ones.

 

Update 21st June 2013

The meeting of clinical leaders of the English Gender Identity Services and NHS England's specialist commissioners took place on Friday 21st June 2013, as planned. Multiple sources have confirmed that the meeting was constructive and successful. In discussions, which included the opportunity to learn about the Scottish approach in more detail, the clinicians are understood to have found the necessary changes less of a concern than previously feared, and were able to agree to operate with them as required. This means that the interim protocols will commence from 1st July 2013 as expected. It is understood that the discussion may have also highlighted concerns which the clinic leaders themselves have had concerning the capability, knowledge and professional behaviours of some general practitioners. The capabilities of GPs are an even more important issue in a system where they are responsible for direct referral. It is therefore vital to bear in mind that this is only the very first step in a change process, where both clinicians and patients have a stake in seeing things change for the better. There will be much work for NHS England the specialist commissioners to do in order to address the whole environment in which this kind of care pathway operates. NHS England have committed to providing written up details of both meetings so far.

A Feast of Diverse History

Delegates to a Unison LGBT Conference in Brighton examine the LGBT Timeline Exhibition

Between 2008 and 2013 the NHS North West Strategic Health Authority's Equality, Inclusion and Human Rights Team developed three comprehensive educational resources, explaining the history of diverse groups.

An understanding of peoples' history is an important part of understanding a patient or employee's present. It informs the reasons why they may have different experiences or needs from your own.

Each history was developed as a mobile exhibition, an accompanying booklet (containing more detail) and a video.

Since the reorganisation of the NHS in April 2013 those resources have become harder to access.

The exhibitions are now in the care of the 5 Boroughs NHS Partnership Foundation Trust. To enquire about booking the exhibitions for conferences or other initiatives contact their Head of Equalities Dave Thompson MBE.

I have already recovered the BME, LGBT and Disability videos and made them available through Just Plain Sense.

And now, finally, I have been able to recover the three historical timeline texts and make them available here as PDFs, to view or download.

Simply click on the cover image below to access the corresponding document. Note that these documents are accessed via Google Drive. If your organisation's IT policy blocks access to this service then you will need to access the documents from another computer on a less restricted connection. Alternative Dropbox file download links are provided beneath each image in case of difficulties with Google Drive.

 Alternative Dropbox download for Disability Timeline

 Alternative Dropbox download for LGBT Timeline

Alternative Dropbox download for BME Timeline

Cuban Paper Adds Weight To Wider Swing in Transgender Classification

Far from the stereotype. Cuban medicine reflects a growing narrative in other Latin countries, rejecting the dominant western view that has pathologised departures from narrow gender role expectations.

The modern western explosion in consciousness about the lives, needs and expectations of trans people can be traced back a quarter of a century to the late 1980's and early 1990's … with a massive acceleration driven by access to first personal computers, then email and finally the world wide web during those years.

In the past 6 or 7 years another acceleration has occurred because of social media and the easy access to blogging platforms.

This is not to suggest that there was no debate about trans lives previous to that point.

The Just Plain Sense Podcast channel illustrates several first person accounts of life when trans people networked and discussed the way they were portrayed through social encounters, conferences and letter post. (See here, here and here)

Anglo-centric

Those discussions were limited back then by geography and the ability for people to find one-another. People in Britain saw themselves mainly in the context of only their own culture. There was a similar pattern in the United States, but with people spread even further apart.

A wider consciousness needed to wait for the arrival of electronic communications. And then discussions moved to being limited by language. There was wider comparison of views, but only to a point.

It is not surprising, perhaps, that as British and American activists enthusiastically embraced email and list servers and then the web, the writing was in English and about western anglophone ideas.

As that experience of life was moulded by a transatlantic consensus among a small number of clinicians who brought the same medical viewpoint to both shores, it is also not a surprise that so much of what you will find online … in either activist or clinical narratives … follows the same pattern, critiquing the effects of the same medical viewpoint.

You could be forgiven for imagining that nobody outside of the United States, Britain and Europe has (or had ever had) anything to say about the existence of trans people.

Universal

That notion is incredibly naïve of course.

The most cursory historical and anthropological analyses reveal that trans people are found in all human societies and throughout history.

Colonisation may have tried to suppress the ways that societies embraced trans people, and history has to be recovered from attempts to erase it, but it is all there.

As activism grew and matured, westerners have realised the need to piece together the other parts of the puzzle.

Through networking and overcoming the language barriers, people have developed a wider view … understanding that whilst people and societies in far flung places may have adapted and conceptualised transgender-like lives differently, the underlying human phenomenon was essentially the same.

Landlocked

Ironically, whilst trans activists may have developed that kind of understanding over the last two decades, the dominant medical narratives have been slower to move from a landlocked state.

Clinicians have been through the same horizon-widening experience … only more conservatively.

When the International Classification of Diseases (ICD) was last ratified in 1990 (and published in 1992) the classification of trans experiences had changed very little from the previous version published in 1975. And these were exclusively western classifications, created by North American and Western European clinicians from essentially a single stable, imposed as a viewpoint for the rest of the world to follow.

This is not a phenomenon restricted to trans medical diagnoses. It happens across medicine and has been particularly felt in the areas where western pharmaceutical interests have had a stake in controlling classification.

This is why it is important and refreshing that the World Health Organisation seems to be embarked on a much wider consultancy-based process, based on modern web tools, to involve many more people in agreeing and ratifying the next ICD revision.

And this, in turn, is throwing light on a much more diverse understanding of trans identity, as clinical teams start speaking up to show that they don't embrace the kind of western-led pathologisation of difference which has passed for evidence-based medicine before.

Consensus process

It is now almost six months since WPATH and international advisors such as myself met in San Francisco to discuss a wider consensus for how the ICD revision should look. I reported on that event in February and noted the wide spread of countries involved: Canada, China, Venezuela, Bahrain, Argentina, Cuba, Australia, South Africa, Turkey and plus the Europeans (Belgium, Sweden, the Netherlands, Norway, Spain and the UK).

The formal report on that meeting will be published in a few days from now. It will add layers of detail about the discussions which I didn't cover in my blog report … although the bottom line is the same of course.

The Cuban viewpoint

One appendix to that forthcoming report will be a paper from the Cuban National Commission for Comprehensive Care of Transsexual People. The paper was something which we had discussed during the meetings, with the Cubans joining us by video link.

I haven't been able to share the content before as we were unable to determine whether the Cubans were happy for this at the time. However, as it is now being published as part of the WPATH report, I think I can now safely share the substance.

The authors explained that the National Commission for Comprehensive Care of Transsexual People (Cuban Gender Team) is working on the modification of the protocols of health care for transgender people in Cuba.

Our group believes that progress should be made towards psycho-depathologization of trans-sexuality and other trans identities, as expressed in the Declaration of the Cuban Multidisciplinary Society for the Study of Sexuality (SOCUMES), adopted at its General Assembly in 2010. Therefore, we support the position of the World Professional Association for Transgender Health (WPATH) on the legitimacy of multiple trans-identities and the need for psycho- depathologize them.

They continue:

We do not support to uphold gender dysphoria as a requirement for transgender people, transgender or gender nonconformity to be able to access to hormone treatments and surgical sex reassignment. Not all ailments requiring health care should be interpreted as diseases. Health care is a human right. However, we understand that the current characteristics of most health systems in the world, do not allow for other alternatives. The Cuban health system meets the standards designed by the WHO in relation to universal and free access to all services. Public health in Cuba has a social and preventive approach; it does not only focus on the attention to syndromes or diseases, but also deals with the attention to aches and social demands of quantitatively minority groups. For this reason, we advocate the possibility of including health care of trans-people in a Z Code (health ailments that are not considered diseases and contact with health services).

The insertion of transsexualism in the DSM and CIE was not based on scientific evidence, but on a pathologizing interpretation of all those expressions that deviate gender from the binary standard. Throughout history, many people have suffered from anxiety, depression and   rejection to their body due to their anthropomorphic features, such as skin color, and they are not classified as mentally ill. So, we wish to imply that in the absence of scientific evidence showing that trans-sexuality and other gender identities/roles are mental disorders, we support the removal of trans identities form the section of mental illness.

(CIE is the Cuban acronym for ICD)

At the WPATH consensus meeting on the nomenclatures proposals for health care of trans identities of CIE-11 the inclusion of the term «gender incongruence in adults and adolescents», «body-gender dissonance» and «gender incongruence in childhood» were discussed. Our positions on these issues are: We disagree with the use of the term «gender incongruence» because it reinforces stigma and discrimination against these people. The term incongruence implies anomaly or disorder. We do not consider gender should be deemed «incongruent» in its diverse, fluid and heterogeneous expression. Moreover, the use of the term «body-gender dissonance» means recognizing gender construction exclusively from the sexual difference viewpoint. Many trans-people do not take the appearance of their genitals as a reference for their identity and gender role; nor does it apply to persons with ambiguous genitals who feel they belong to either gender. The term dissonance also has pathologizing implications. For these reasons, we prefer the term «gender nonconformity» as it has no implications of abnormality or disturbance and means that, regardless of the body, the person does not identify with the legally and culturally assigned gender. The above nomenclature, although not quite perfect, can be applied also to persons who are identified as intersex or those who express a gender different from the one assigned. In regard to «gender incongruence in childhood», we believe that it should not be considered a mental disorder and should not be included in any classification of CIE-11. The infants with gender nonconformity do not require hormone treatments until reaching puberty or surgical treatment until they reach adulthood. Health care to this group of people consists in the psychological attention to relieve distress that the mismatch with the gender assigned at birth generates them. Most infants with gender nonconformity do not show a gender transition when they reach adolescence and adulthood. It is also essential to relieve the distress of parents and to work with the rest of the family and the school and community contexts from a more flexible and fairer gender approach. We also reaffirm the need to consider the bioethical aspects in managing gender variant children, concerning respect for their dignity and autonomy, as well as to decide the actions of affirmation of gender identity/role together with the family, considering always the child's best interests.

This contribution is significant because it widens the consensus for moving away from earlier narratives. It ensures that the movement for this is not seen as a parochial one, but a viewpoint which is emerging in widely different health systems and cultures.

For the Cubans this is no sudden overnight change. Early in 2010 the Cuban Multidisciplinary Society for the Study of Sexuality (SOCUMES) proposed a clear declaration on depathologisation and a paper published in April 2012 sets out the reasoning in more detail.

The rest of the world

Some may regard Cuba as separate from the rest of the world ... trapped in a bubble by long isolation. But we see this kind of language emerging more widely among other latin countries, with countries such as Argentina passing laws which put parts of the West to shame.

The proposals from the WPATH/ICD consensus process will now be subjected to much wider international scrutiny, through a process which determines whether clinicians think the new language works in their own practice. This will highlight whether there are parts of the world which cling to past ideas and don't like such moves to depathologisation and more facilitative language.

The language adopted by Cuba's clinicians gives hope that change really is rolling in though.

NHS England Head of Equality and Health Inequalities Revealed

After several months of speculation it appears that the new Head of Equality and Health Inequalities (E&HI) for NHS England will be another health policy specialist, Ruth Passman.

The appointment is very much in line with predictions I previously made about the role.

Public health specialist

Passman, who will be reporting to the NHS England E&HI Directors Professor Steve Field and Paula Vasco-Knight, was a Senior Health Policy Advisor for Government Office North West until the regional Government Offices were disbanded by the coalition government in 2010.

Following the dissolution of GONW, Passman became a Senior Policy Advisor for the North West Public Health Team. Her portfolio included the development and implementation of regional health strategy and the support and co-ordination of health input to regional partnerships.

Carbon reduction

Ruth has also held the regional lead on Sustainable Development across the former North West Strategic Health Authority and the regional office of the Department of Health, where she led the North West Regional response to developing and implementing a Carbon Reduction Action Plan.

Holding the Local Area Agreement health and social care portfolio lead for the North West, Ruth has been closely involved in the development and implementation of the North West region's Local Area Agreements and their health and social care reward targets.

Ruth's career has included working in the voluntary sector, health and academia where she taught social policy, cultural studies and sociology.

In the field of health and regeneration, Ruth has acted at Director and Chief Executive level, establishing and leading organisations and renewal programmes.

Part time

The new appointment is for two days each week … a model already established in the E&HI team, where the national lead for equality, Paula Vasco-Knight, also works just one day a week.

It is believed that these part time appointments are favoured because of a severe lack of budget … a fact revealed by the other national lead, Steve Field, in a recent Guardian interview.

For the other three days each week Ruth will continue to fulfil her existing role in Public Health England.

Disability - A New History

Regular readers of this blog will know about the NHS Disability history timeline which we produced and launched this year.

Just like our previous BME and LGBT history resources, the NHS timeline consists of an exhibition (which we researched in close cooperation with a steering group of disabled people), a booklet (containing even more detail that wouldn't fit on the display panels) and a film (featuring both disabled NHS staff and stakeholders talking about their experiences).

At the time we embarked upon the disability history project last year we were quite surprised at how few resources like this had been published before.

Standing on the shoulders of others

When we produced the other timelines we and our researchers looked at previous attempts that people had made in the relevant fields and then set out to build something more comprehensive, drawing on that preceding work.

We fully expect that in future people will do the same to our work as well. We're not precious about that.

But, for disability, there was nothing quite like what we were setting out to produce … a straightforward account of the various strands of social history pulled together in one place.

Enter the BBC

This is why I'm so delighted to say that, by sheer coincidence, BBC Radio 4 has recently begun broadcasting a new series of programmes which entirely complement what we were setting out to achieve.

Disability - A New History is a series of short themed programmes by Peter White, which the BBC has sensibly decided to make available as a permanent resource.

You can hear the shows as broadcasts, of course. They normally go out at 1.45pm on Radio 4.

You can catch up the previous shows on the iPlayer.

Better still, the shows are available permanently as Podcasts, so you can download and keep them. Buttons are provided to subscribe automatically in a range of Podcast applications such as iTunes. For others there is the RSS feed: feed://downloads.bbc.co.uk/podcasts/radio4/r4disability/rss.xml

There is a gallery of images to accompany the shows, just as we included images in our booklet.

And finally, for the benefit of hearing impaired users, the BBC has also included the transcripts of all the shows. You'll find these at the bottom right hand corner of the show page.

History is important

Readers will know that I'm especially keen about history in connection with equality and diversity. Without history there is no context for understanding the present … or where you think you're going in the future. If you don't understand the past you can't know whether you're at risk of repeating it.

It is immensely difficult to walk in another's shoes, which is why I think E&D practitioners should always have their ears and eyes open and be prepared to look and listen rather than talk.

Learning the history of a group of people saves making avoidable mistakes. It's a question of manners. People who are unaware of their privileges expect, far too often, that people they know little about will have all the time in the world to provide them with personal tuition. I think that's rude. It's far more polite to do some research of your own. That signals that you care enough to have tried to understand the other person's world.

And learning about one group's historical experiences can be immensely educational for activists in other groups too. There is very little originality in marginalization and oppression. The more you study the historical treatment of one group, the more the parallels are apparent. You can then go on and study how that group has advanced … what they did to address their discrimination, which may be applicable to your own position.

NHS Employers Boss Embraces Podcasting

 The Chief Executive of NHS Employers, Dean Royles, is a great advocate of social media.

He's also incidentally a great advocate of Equality and Diversity. I know him well from the days when he was the Director of Workforce and Education for the now-disbanded NHS North West Strategic Health Authority and he really understands why equality strategy is so important to a diverse organisation serving an even more diverse population. However, I digress...

NHS Employers is the voice of the hundreds of NHS organisations which, together, employ 1.4 million staff in the UK (the NHS is the world's third largest employer). They lead debate on issues such as pay and contracts and defining best practice for the workforce. This means they also have a big responsibility for equality issues within the workforce.

Communications is obviously central to the mission of such an organisation.

This is why it is good that Dean is such an enthusiastic advocate for embracing anything that extends the reach of the organisation's messages. He leads by example, as an enthusiastic Twitter user, for instance. Follow @NHSE_Dean. He tweets about his interests as well as about the latest buzz in management topics.

Dean believes strongly that managers and staff in systems like the NHS should use social media and he is keen to slay the myths which he believes get in the way.

Given this mission to reach out and communicate it is not surprising that Dean has steered his organisation to embrace any technologies that work. First came webinars and video. And now the organisation is embracing Podcasts too.

Characteristically Dean leads from the front, showing one of many ways that the medium can be used to get the ear of the thousands of managers in the NHS system. His management team are now following suit, with a growing programme of shows on their own specialist topics.

The advantages of Podcasting for an organisation like the NHS is that it is a medium that can reach people 'hands-free' even when they are doing something else. Managers can listen with headphones on their office PC, of course, but podcasts can also be heard on smartphones too … so people can tune in whilst commuting, taking a jog, or doing the gardening.

There are several ways to obtain the NHS Employers Podcasts.

• You can listen to Dean's own blogs using the widget above. This updates every time he releases a new show.
• If you have iTunes on your computer then search for 'NHS Employers' in the Podcast section of the store or take a short cut via this link.
• If you have the Podcasts app on your iPhone or iPad just search for 'NHS Employers'
• If you have the SoundCloud app on your iPhone or Android device you can search there for 'NHS Employers' too, or visit the web site.

It's early days for the content … the organisation is still only just scratching the surface of what it can potentially do with this medium. However, it's worth watching how they get on … and Dean's a great act to follow.

Why Support For Trans Youth Matters

They say a picture is worth a thousand words. That's why I like this new poster produced by Trans Student Equality Resources (TSER). The message is simple and intuitive: young trans people who receive support do far, far better than those who get none. It applies to adults come to that … although the graphic rightly concentrates on one group, one message. If you want to download the full size image for printing then you'll find it with other infographics at http://transstudent.org/graphics