Friday, April 26, 2013

The best of the Podcast - Now on SoundCloud

The 'best bits' from the Just Plain Sense Podcast, which complements this blog, are now available on SoundCloud.

That means you can listen to them here, or using the iOS or Android apps which Soundcloud provides.

Sunday, April 14, 2013

What became of the EHRC?

 EHRCbannerBold vision, as articulated before the 2010 General Election

Whatever became of the Equality and Human Rights Commission?

You may well ask.

When was the last time you heard about them?

This is an important question, as the Commons will debate on Tuesday this week whether to strip away an important part of their statutory authority.

You'll probably not hear about this in the media, consumed as they are with the Thatcher controversy.

And you'd have to look hard anyway, as the provisions are buried inside an arcane-sounding debate on the Enterprise and Regulatory Reform Bill.

The Lords have already voted against this move.

However, readers will know by now what generally happens when the Government is determined to get its way. Tuesday's debate sees the amendment return to the Commons, where the repeal clause will probably be reinstated.

I shall therefore explain why this is important … starting with some background.

The Equality and Human Rights Commission

The Equality and Human Rights Commission (EHRC) was originally created by the Equality Act 2006. The new commission, which replaced three separate historical regulators for gender, race and disabled peoples' equality, came into being on 1st October 2007.

There were mixed feelings about the EHRC from the beginning.

On the downside, supporters of the former Equal Opportunities Commission (for gender), Commission for Racial Equality, and Disability Rights Commission were concerned about the lack of focus which a single regulatory body would lead to. The EOC, CRE and DRC had all been very successful advocates for rights in their own respective corners and feared dilution of their efforts. The concern was increased by the numbers of specialists in these areas who were shed through redundancy in the three bodies, as the new body recruited from scratch.

On the plus side the new commission promised a unified approach to dealing strategically with a much wider range of equalities, including sexual orientation, gender identity, religion or belief and age. As the name suggests, the EHRC was also to be the UK's home for strategic thinking and education about Human Rights.

The EHRC operated four clear strands of work:

  1. It created a single national helpline for anyone with concerns about their personal rights, or for employers and policymakers seeking advice about complying with equalities legislation. This was going to be especially relevant when the UK's confusing historical baggage of rights legislation was replaced by a single Equality Act in 2010. The help line operated separately in England, Scotland and Wales (where the laws are different) but was available to anyone for the cost of a local call via an 0845 number.
  2. The new commission also had the power to pursue strategic legal cases where it thought that the judgement of those cases would advance an important aspect of equalities law. This was not new. The three commissions which the EHRC replaced had varying amounts of statutory power to support important legal cases. What was new was that the EHRC brought some of the best legal minds together in one place, with the ability to bring cases to the courts which might otherwise not have been possible. The textbook example of this was the Sharon Coleman case, which the EHRC inherited from the Disability Rights Commission. The successful outcome of this case led to the incorporation of protections on grounds of association in the Equality Act 2010.
  3. The EHRC also had a budget to support the strategic funding of voluntary sector organisations, in order to carry out operations which were compatible with the commission's aims. In 2011, for instance, the commission granted £10 million to a total of 61 organisations. The priorities were voluntary or charitable schemes which were: (a) Providing advice and advocacy services; (b) Promoting good relations; and (c) Providing legal advice.
  4. The other principal mission of the commission was to act as the regulator for Equalities and Human Rights. This meant ensuring, in particular, that Public Sector bodies complied with the Public Sector Equality Duty. In 2010, for instance, the EHRC carried out national research to determine for itself how effectively NHS organisations were implementing the duty. This followed earlier action where the Commission issued warnings pending legal action to NHS Trusts failing to comply with the Race Relations Act (which was still in force at that time).
At its peak the EHRC employed around 600 people in England, Wales and Scotland (Northern Ireland already had a separate equality and human rights commission).
The organisation was quite regularly in the news, especially as a result of the successes it had in strategic equality cases and as a result of promoting its various campaigns and publications. In 2009 the Commission famously began proceedings against the British National Party, explaining:
"The legal advice we have received indicates that the British National party's constitution and membership criteria, employment practices and provision of services to constituents and the public may breach discrimination laws which all political parties are legally obliged to uphold"
In 2009 the commission also achieved UN 'A' Status, as an accredited National Human Rights Institution (NHRI).

Death by a Thousand Cuts

In May 2010 the Conservative and Liberal Democrat Coalition Government took power.

Although both parties had cooperated in passing the Equality Act 2010 in the last week of the previous administration, it was readily apparent from the rhetoric of the Conservative side of the partnership that equalities (and in particular the Human Rights Act) were seen as incumbrences or "red tape" getting in the way of business and weighing down the public sector.

I wrote about the threats at the time and I explained how the Government's strategy worked from several directions at once in a pincer action.

Since then, much of this has come to pass.

  • The Government has 'reformed' legal aid provisions, making it harder for individuals to get professional support to obtain redress on their own through tribunals and the courts. Without this, the role of the EHRC's helpline and its support for third sector advice services would be even more important.
  • The Government has also 'reformed' the EHRC, cutting the workforce in the process and obliging it to abandon certain activities, such as running a helpline or running big independent campaigns.
  • The Government has also talked of 'reforming' the way that Judicial Review actions can be brought to the Courts. Judicial Reviews are often used to challenge the legality or rationality of actions by public bodies.

The EHRC's strategic plan for 2012-15 shows how it has scaled back its ambitions.

The moves taking place in Parliament tomorrow need to be understood within this context.

The attack on Section 3

Parliament will this week be debating Clause 57 of the Enterprise and Regulatory Reform Bill, which proposes to repeal Section 3 of the Equality Act 2006.

The debate is part of a process called "Ping-Pong", where the Commons debates amendments which the Lords have made to their legislation at an earlier stage in Parliamentary process.

The Lords had been persuaded to throw out this particular provision during their debates on what the Commons had previously passed.

The Enterprise and Regulatory Reform Bill is an arcane sounding piece of portmanteau legislation, which is probably why few have really concentrated on what it contains. You wouldn't learn much from the official description either:

A Bill to make provision about the UK Green Investment Bank; to make provision about employment law; to establish and make provision about the Competition and Markets Authority and to abolish the Competition Commission and the Office of Fair Trading; to amend the Competition Act 1998 and the Enterprise Act 2002; to make provision for the reduction of legislative burdens; to make provision about copyright and rights in performances; to make provision about payments to company directors; and for connected purposes

Clause 57 proposes to repeal Section 3 of the legislation which created the EHRC: The Equality Act 2006.

Section 3 of that legislation is quite important as it sets out the actual purpose of the organisation:

Gen Duty

The Government has argued in the past that this so-called purposive clause isn't necessary as it doesn't itself DO anything.

Purposive clauses are quite rare in UK legislation. Where they exist, however, they assist the courts in determining how to interpret the legislation they preface, by spelling out the overall purpose of everything else in the Act. If anything is unclear or appears ambiguous the courts can refer back to such a statement to clarify what was probably in the minds of the lawmakers when they passed the legislation.

Lawyers might be too polite to say so but such clauses also act like a burglar alarm for the rest of the legislation. It is difficult to stealthily change the effect of the detailed clauses in the legislation if the effect of removing or amending clauses creates a conflict with the purpose of the whole. The only way around that would be to amend the purpose clause … and that is a dead give-away.

Removing the General Duty clause may not have immediate effect, therefore. However, the danger is in what the removal facilitates by stealth at a later date.

What Parliament had said before

The advice given to the Lords when they reviewed and rejected the change was phrased in a prettier way, of course.

Their Lordships had been reminded of the original purpose of the clause, as explained by the Bill Minister in 2006, Lord Falconer:

"The Bill aims to move us towards a society which reaches out towards its diverse members and communities. It places the emphasis on the positives. The new commission will use its powers to tackle inequality, diversity. the fair treatment of disabled people and human rights, reaching out to a wide audience. It will improve compliance with the law through it enforcement powers. It will benefit public services by embedding human rights at their core. By promoting understanding between communities, it will help to advance a stronger, more cohesive Britain. The new commission will bring a new ethos and style, built on partnership working, responsiveness to stakeholders and to expertise."

Parliament's Joint Committee on Human Rights in its 16th Report unanimously welcomed what is now section 3  saying that it would "serve in practice as a unifying factor in the performance of the commission’s duties."

The original wording of the clause was debated and amended in the House of Lords in 2006, following objections by the (then) Conservative Opposition that it was too broad.

There was no opposition to the amended section 3 in the House of Commons at the time. Eleanor Laing MP (Conservative), who withdrew proposals for minor changes in the wording, said: "the important thing about [section] 3 is that we all admire the aspirational nature of the general duty within it."

What this Government now says

The Government’s Consultation Paper, Building a Fairer Britain: reform of the Equality and Human Rights Commission, GEO March 2011, para 1.8 stated that section 3 "has no specific legal function" and "creates unrealistic expectations…about what the EHRC can achieve."

The Government claims that the repeal of s3 is simply "legislative tidying up" and the "removal of gold-plating".

In its parliamentary briefings (July and September 2012) the EHRC (which knows how to watch its language in public) said that the repeal of s3 is "unlikely to have a significant adverse impact on its work."

However, if the clause does so little (as the Government claims) you would have to ask why they are so determined to remove it.

Another view

Professor Sir Bob Hepple, Emeritus Master and Emeritus Professor of Law at Clare College Cambridge argues:

"First, section 3 EA 2006 does have a legal function. In the absence of a ‘purposes’ clause in the EA 2010, the courts and others enforcing the EA 2010, are able to use section 3 EA 2006, as a helpful guide to the interpretation of the single Equality Act., enabling them to fill gaps and to resolve ambiguities. The Labour Government declined to insert a purposes clause in the 2010 Act believing (mistakenly in my view) that this might conflict with specific provisions of that Act , and could involve the ratification of Optional Protocol 12 of the European Convention on Human Rights, a step which successive governments have resisted. However, the absence of a purposes clause in the single Equality Act was less important than it might otherwise have been, because of the general duty of the EHRC set out in section 3 of the earlier 2006 Act.  The repeal of section 3 will deprive those applying the law of interpretative principles and will leave equality law rudderless. It increases the likelihood of inconsistencies in the way in which the single Act is applied."

He continues:

"Secondly, and perhaps even more significantly, repeal will remove the unifying principle to which both the Lord Chancellor and Lord Lester referred when promoting the EA 2006. It will remove the link between equality and other fundamental human rights. "At the core of the EHRC’s general duty , and implicitly underlying the specific rights against discrimination, harassment and victimisation and the positive duty to advance equality as set out in the EA 2010, is respect for and protection of each person’s human rights." Section 3 embodies the same approach as Art 2 of the Universal Declaration of Human Rights, which provides that all "the right and freedoms" embodied in the Declaration are to be enjoyed without any kind of discrimination.  The EA 2006 and 2010 seek to overcome the fragmented approach to different strands of discrimination, which has characterized British legislation in the past. Section 3 of the EA 2006 adopts a unitary human rights perspective. That does not raise "unrealistic expectations", as the Government claims, but sets out the nature of the society which the new legal framework seeks to achieve. Repealing that provision will undermine the historic reunification of equality and human rights law which was achieved in the Acts of 2006 and 2010.  Section 3 does not imply that the EHRC alone can achieve the kind of society described. Its obligation is simply to "encourage and support" those working for such a society."


"No evidence has been produced that s3 has produced ‘unrealistic expectations’ of what the EHRC can achieve. On the contrary, the importance of the link between equality and human rights was demonstrated in the EHRC’s broad-ranging inquiry into the ill-treatment of old people receiving care in their own homes, which is both an equality and human rights issue.8 The link between the issues is based on s3’s aim of encouraging and supporting a society ‘in which there is respect for and protection of the dignity and worth of each individual.’ Another example is the investigation by the Commission for Racial Equality (CRE), a predecessor of the EHRC, into ill-treatment of black prisoners.9 The Prisons Service’s perfectly valid legal defence to the allegation of discrimination was that white prisoners were treated equally badly. There was, at the time, no equivalent to s3 EA 2006. Conversely, when the EHRC intervened in a case arising in respect of the Public Sector Equality Duty (PSED) of alleged race disproportionality in the application of the use-of-force policy against young detainees, it became apparent that the general duty under s3 was crucial. Had the case only involved the PSED, the Home Secretary could have reconsidered the policy and made the same decision. But the link with s3 ensured that the new use-of-force policy had to be abandoned to the benefit of all detainees. Without s3 this result would not have been possible."

The Professor continues:

"Thirdly, the removal of the duties in s3 will limit the EHRC’s ability to encourage and support voluntary self-regulation. As Baroness Campbell of Surbiton said, s3 ‘reinforces the notion hat the EHRC is doing more than enforcing the law.’10  The Government wants to restrict the EHRC to core law enforcement functions.  ‘Bizarrely’ remarked Baroness Campbell, ‘this will stem from a Bill to promote enterprise and growth by reducing the regulatory burden. We risk creating a body increasingly reliant on costly and intensive legal action to have a meaningful impact.’11 Lord Lloyd of Berwick, the distinguished former Law Lord, has challenged the Government’s claim that s3 should be repealed on the grounds that it is ‘purely aspirational’. He points out that the wording of ss 8 and 9 is also ‘aspirational’ but these sections are not being repealed. How can the Government claim that s3 is ‘too broad’ and at the same time say that it contains nothing that is not already in ss 8 and 9?"

 He argues that the intended repeal of Section 3 weakens the EHRC itself:

"Taken in the context of severe cuts in the funding of the EHRC and other changes, the proposed repeals are likely to further weaken the EHRC’s case for  accreditation by the International Co-ordinating Committee of National Institutions for the Promotion and Protection of Human Rights (ICC) as a status A body in full compliance with the ‘Paris Principles .’ The International Council on Human Rights has emphasized that ‘ the most effective national institutions generally have a broad and non-restrictive mandate’ and an ‘all-encompassing jurisdiction’ as well as ‘adequate budgetary resources’( Assessing the Effectiveness of National Human Rights Institutions, ICC, 2005, p 8). The ECHR’s A status is already being questioned (see the correspondence between the Rt Hon Theresa May MP and the ICC and UN High Commissioner for Human Rights, appended to the ECHR’s briefing, September 2012).  The Government should be using this Bill to implement the ICC’s recommendations, and to increase the ECHR’s accountability to Parliament, rather than seeking to restrict its mandate."

A polite translation would be that international bodies are not impressed by the EHRC being reduced to the status of decorative Poodle.

Hepple also stresses why voluntary sector bodies cannot fully replace the functions of the EHRC that have been curtailed:

"Severe cuts are being made in the resources provided to the EHRC, and nearly all the EHRC’s frontline activities are being withdrawn or contracted out to less experienced bodies. It is unrealistic to expect voluntary organizations to take over the promotional work that the EHRC has done in the past, or to work towards the kind of society envisaged in s3 without the encouragement and support of an independent equality and human rights commission. Not only are the resources of those organizations limited, but they lack the experience and authority of an independent statutory agency. It is vital that these duties be retained by the EHRC. The argument that financial mismanagement by the EHRC in its first years makes it necessary to cut back its powers now, cannot be sustained because in the past two years no such difficulties have risen and the Commission is under ‘new management’.  In order to retain its independence and to ensure the most effective delivery of its services, the Commission should have the broad aims set out in s3 and the discretion to decide which of its services it can best provide itself and which should be contracted out to other providers."

In summary

You could be forgiven for feeling that Bob Hepple's arguments and plea sound rather like the summing up of the Defence before the court decides whether to send the accused down for life.

As I said in my introduction, however, this is possibly a plea that is already too late, as the true objectives of the Government are all too clear.

Looking back, you could be forgiven for wondering whether both the idea of a single equality body and a single equality act may have been a strategic blunder by the previous government, creating a system of regulation that is far more easy to tear down than what preceded them.

One regulator is easier to emasculate than three, as we are now witnessing. And nine Acts of Parliament plus over 100 sets of regulations were probably rather more difficult to demolish than one single Equality Act.

Still, it was good while it lasted.

Monday, April 08, 2013

NHS England Business Plan puts health inequalities to the fore

NHS England Business Plan Goal 8

NHS England (the new name for the NHS Commissioning Board) has published its three year business plan (2013-16) today.

The plan, "Putting Patients First", which you can download here, claims to put patients at the heart of the board's mission, and rests on an 11-point 'scorecard', which will be used to measure progress made.

As you will see, the promotion of equality and reduction of health inequalities figures clearly in the measures.

Priority 8, is an explicit commitment about promoting equality and inclusion.

Many of the other scorecard priorities (e.g. 1, 2 , 6, 7, 9 and 10) refer to areas in which the achievement of equal outcomes would need to be a significant factor if the goals are to be meaningfully achieved.

1 = Satisfied patients

2 = Motivated, positive NHS staff

6 = Ensuring that people have a positive experience of care

7 = Treating and caring for people in a safe environment and protecting them from avoidable harm

9 = NHS Constitution rights and pledges

10 = Ensuring the staff of NHS England understand their roles, are properly supported, and are well motivated

On the face of it, this will all be very welcome if outcomes measure up to promises.

Not all things, Not everyone

Anyone who works in this field will know that inequalities are difficult to address.

The larger the landscape, the more complex and embedded the issues.

If there was an easy way to address inequalities then everyone would have done it by now.

The best any organisation can hope to achieve in any one period of time is to pick your strategic goals on the basis of the evidence and focus on them.

Sadly, unless you have a lot of resources, that means you can't be all things to all people.

However, it is important to be clear about what priorities are being applied.

Tackling health inequalities

As I predicted recently, the emphasis in this plan appears to be much more about health inequalities (Steve Field's obvious area of interest) compared with other aspects of equality.

Now that, in itself, is not a bad thing.

Health inequalities predicated on peoples' characteristics (gender, race, disability, sexual orientation, gender identity, religion/belief or age) have tended to suffer in the past, with most of the emphasis in public health strategy being focussed on factors such as where people live and their economic status or class.

Thinking about health in a more nuanced kind of way is what PCT commissioners were supposed to be there to do. I.e. They were employed to design and manage a health service based on local needs.

If they weren't factoring those local needs then it somewhat begs the question why we needed 151 PCTs to essentially commission the same thing.

Garbage in, garbage out

My experience is that that is exactly one of the ways in which PCTs were too often failing in their responsibilities though.

And they failed often because their major partners in local planning, the Local Authorities, were pretty awful at this function too.

Take a look at any Joint Strategic Needs Assessment (JSNA) and the chances are that it will present a limited picture of the population, based on the information most readily to hand … age, sex and place. (The place where people live is then used rather crudely to infer racial demographics too).

Groups who don't all obligingly live in one electoral ward (such as disabled and LGBT people) tend not to figure in JSNAs, since nobody is sure how to count them.

So, if NHS England plans to use its immense muscle to influence how local health strategy is designed through CCGs to identify and tackle health inequalities then that is no bad thing.

However, it will need to recognise that it is dealing with essentially the same commissioning personnel as before … who failed to gather the data and analyse it under the previous management.

That previous management often showed us, through generally poor outcomes in goals 2 and 3 of our EPIT framework, that they were often clueless about where to begin.

It will be interesting to see their strategy to overcome that weakness.


There are therefore (in my opinion) limits to what NHS England can promise to do.

The staff in the equality and health inequalities team will need to realise that they cannot produce the outcomes themselves; they need to influence a system of 212 CCGs to produce the outcomes for them.

And to measure whether progress has in fact been achieved in three years, the first challenge will be to have some kind of baseline measure which you can then eventually compare with.

However, if the mechanisms to collect that baseline data don't already exist (as they generally don't) then that problem is, in itself, an essential precursor to address.

This is why I have then picked up on the precise wording of priority 8 above. Read it carefully.

The priority refers to "progress in reducing identified health inequalities on all indicators for which data are available".


This is a constraint that worries me, as I know from experience that the amount of actual peer reviewed evidence available for some very real health inequalities is practically non-existent.

And it is peer-reviewed evidence that clinicians tend to want to see.

There is plenty of the other kind. We call it "grey research".

This is the kind of largely qualitative, experiential, data that is collected by equality stakeholder organisations in order to make the case for policy interventions. It is often collected using methodologies (such as convenience and snowball sampling) which are easy to criticise and dismiss.

Such organisations carry out this kind of field research precisely because the other kind has not been prioritised or funded.

In 2009 an academic study carried out by the Department of Public Health and Epidemiology West Midlands Health Technology Assessment Group researched just how much peer reviewed research there was on LGBT health needs, for instance. They found very little, and their conclusions as to why this should be the case are very instructive.

With the possible exceptions of gender and race, a similar picture is likely to be found for other protected characteristics too.

This raises the concern, therefore, whether NHS England's health inequalities team will simply apply the definition of their performance indicator to exclude the protected characteristics where data isn't easily available (in the interests of scoring well in NHS England's performance culture) or whether, in pursuing a policy objective with grey research, they will hit a familiar wall with CCGs regarding such evidence as "just political propaganda, not REAL evidence".

I know where my bets would be.

The assessment, therefore: Great objective, but keep an eye on whether the implementation is as equitable as we all hope.

And the rest

As I pointed out in a previous article, inequality is not just restricted to health outcomes … important as they are.

I've also written before about the concerns for equality in the NHS workforce … underlined, particularly, by the failures admitted by NHS England Management in their own recruitment drive. Some very senior clinicians also voiced these kinds of concerns.

Furthermore, the experiential evidence from many protected groups of patients also points to the barriers experienced in actually trying to access services across the board … whether that is in GP surgeries, community services, in hospitals, ambulance or mental health services.

An example of these kinds of barriers is illustrated by the cases collated recently by trans community campaigners, which the GMC are considering investigating further.

Disability groups have also argued for years about the various kinds of barriers they encounter.

We also know that lack of cultural competence can get in the way of engaging with patient groups in some Black and Minority ethnic communities.

As I said at the outset, one management cannot tackle everything that is wrong across the board.

Inequalities have had generations to work their way into the fabric of a massive and complex system like the NHS, and it would be unfair to expect NHS England to fire off wildly at everything that moves.

For one thing, there are limits to the scope of NHS England's own influence. I addressed this in a previous article where I argued that fragmentation threatens the ability to pursue some inequalities.

However, if areas are not being addressed because decisions have been made to prioritise efforts in places where the data will look good then it is as well that patient and workforce communities become aware of that.

Where, then, will NHS England trim its cloth?

What isn't measured...

The clues are in the priorities and measures chosen by NHS England … the measures on which it will hold itself accountable.

What isn't measured doesn't get done.

Therefore, although the organisation has managers who are nominally working in other areas as well as those on the dashboard, stakeholders will need to scrutinise carefully whether the things that matter to them are subject to being counted in three years time.

You can be pretty sure that the focus will be on those things.

And my assessment is that the one which will suffer in particular will be the NHS workforce, as this is the area where the executive have already demonstrated they don't really grasp how to solve the problems. This is reflected in the paucity of hard specific scorecard measures to show that they ever will.


Monday, April 01, 2013

The Health and Social Care Act: the tale in a timeline

Use the right arrow control to advance step by step

Reblogged from the King's Fund website

This interactive timeline is a visual guide through the events that led to the Health and Social Care Act being implemented.

It sets current NHS reforms within a historical context - from the creation of the internal market in 1989, to the establishment of the first Foundation Trust in 2004, to the passing and implementation of the most recent controversial legislation.

The timeline was initially published alongside Never Again? The story of the Health and Social Care Act 2012 by Nicholas Timmins for The King’s Fund and the Institute for Government.

It has now been updated to include the main milestones taking us up to the main elements of the Act coming into force on 1 April.

Get Just Plain Sense Podcasts on your smartphone

IMG 0133

'Just Plain Sense' is not just a blog.

It is a Podcast channel too.

Begun in March 2008, the channel deals with topics around the themes of Equality, Diversity and Human Rights … just as this blog does … but with an emphasis on in-depth interviews with people and documentary-style coverage of events.

At the last count there were more than 80 episodes to listen to.

How to listen at home

There are many ways to hear the Podcasts.

The easiest way on a desktop or laptop computer is via the web site:

You don't need any special software at all to listen in this way. The web site works like another blog, except that under the description for each episode you'll find a player that you can just click on.

If you want to browse other web pages whilst listening to a show, simply open another browser window / tab or click on the Play in Popup option, which appears at the bottom of each item.

Listening this way is a bit like sitting in front of your radio.

Listening on the move

Podcasts really come into their own when you're out and about though.

Just as portable transistor and built-in car radios changed the way we access wireless programmes, smart phone and tablet technologies open up a whole different way of listening to Podcasts too.

In fact that's why they are called Podcasts. The name came about because people began wanting to listen to independent material, at a time and place of their own convenience, on their iPods.

Mobile listening isn't restricted to Apple-made devices though.

Using the mobile pages

The simplest way of all to hear a show is to load the mobile version of the Just Plain Sense site on your phone's web browser.

The address for this is

Press any of the show icons to stream the corresponding show. If you let the whole show download before leaving the house then you'll be able to listen to it later.

If you do this on an iPhone, iPod Touch or iPad then, in addition, you'll see an option at the bottom of the screen, as illustrated above. Selecting this will put an icon on your device's 'Home' screen, so you can come back to this display any time you want. You're not adding an app, and there is no charge. You're simply storing a short cut to this mobile-friendly web page.

The only limitation with this kind of access is that you won't get any notification when new shows appear, and you can't download lots of shows in advance before going on a trip.

Remember that if you download shows using 3G internet connections from your phone then this will consume your mobile allowance. The average Just Plain Sense show is about 30Mb in size.


Using a Podcast app

A more organised way to access Podcasts is to use a mobile phone app.

There are several of these available.

The photo shows Apple's own version (which works on the iPhones and iPads).

The advantage of a Podcast app is that you can organise all the shows you want to listen to regularly, and the app shows you how many news ones you have yet to listen to.

In this illustration you'll see that I listen to a lot of BBC drama and comedy.

Apps like this also mean you can choose between 'streaming' a show or downloading it.

Streaming means you listen to a show whilst it downloads, and the show isn't stored on your device afterwards. If you're familiar with the BBC iPlayer then that works in a similar way in most cases.


Downloading means what it says. You store a complete version of the recording on your mobile device. Then you can listen to it as and when you choose.

Downloading means you don't incur big 3G downloads and you can listen when there's no mobile signal. However, if you hang on to lots of shows you'll use up your device's storage.

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Subscribing to shows

You can just pick and choose what shows you want to listen to via podcasting. A Podcast app like the one above will contain a listing of very popular shows that you can just select by touching the appropriate icon.

If you listen in an ad-hoc way like that then there's nothing to tell you when the next show in that series comes along. You'll need to remember to go back (in, say, a week) and look again.

The idea of 'subscribing' to a show makes it a lot easier. In this case the podcast app will go and check each Podcast site periodically, and notify you when there are new shows to listen to.

The subscription doesn't cost anything. In fact, the shows producers don't even have any record of the fact that you've chosen to subscribe to their shows. It's not like a magazine or newspaper subscription. It's just the term used for storing details of the podcasts you're interested in on your device.

The benefit of subscribing to a podcast is that it takes all the work out of listening to shows you're interested in. If you want to then the app can download the new shows automatically for you … so they're there when you want to listen on the move. Alternatively you can just settle for being informed, and 'stream' the show online when you want to listen. The choice is yours. Cancelling a subscription is as easy as setting it up.

Using iTunes to subscribe

If you use iTunes or an app like the one above then you can just search for the shows you're interested in, by name.

For instance, you can find 'Just Plain Sense' that way just by searching for the name in the online store.

The other way to access or subscribe to a show is to look for the instructions on a show's web site. For instance, the Just Plain Sense web site has a purple 'Add to iTunes' button on the right hand side of the screen.

If all else fails, you can also just use the show's 'feed' address. For Just Plain Sense that is

Other shows

If you like my material then there are two other feeds where you'll also find more.

For short items, which are not formatted like radio programmes, I use a service called Audio Boo.

The feed URL for this is

And if you'd like to hear readings of my poetry, then there's a separate podcast channel for this, called Fishing for Birds.

The feed URL for this is


Happy listening!


Equality and Health Inequalities at NHS England

NHS England E+HI

Organisation chart for the NHS England E&HI team as at 1st April 2013
NHS England is in full operation from today.
That makes it important to know how the Equality and Health Inequalities (E&HI) function is organised.
I haven't been able to put names to all of the functions yet. However, here is your cut out and keep guide to the organisation as it appears so far.
It is expected that the post of Head of Equality and Health Inequalities will be decided in the next 7-10 days. All indications are that the directors want a clinician in this post … possibly someone already earmarked from Public Health.
For the rest, I have some names but I can't reliably match them to posts yet, so I've left them off for now.
The lines in the diagram show the line management structure.
The seven senior managers are, so far as I can tell, all accountable to the two Directors.