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

How migrant workers built the NHS

Celebrating our diversity and multi-ethnic contribution. The NHS at 60 years. (18m35s)

These days we hear increasingly regular (and baseless) assertions that migrant workers are in some way to blame for a range of problems, including the performance of the NHS. The truth is very different. This film was made by my former colleagues at NHS North West, as part of a resource documenting the history and contribution of migrant workers (especially Black and Minority Ethnic people) to the establishment and running of the NHS. The complete resource includes a mobile exhibition, a booklet documenting the history and this film. The whole package was launched to mark the 60th Anniversary of the NHS in 2008.

As the Chair of the Royal College of GPs, Professor Clare Gerada summed it up, you are far more likely to encounter a migrant worker treating you in the NHS than contributing to any queues to take advantage of it.

Dangerous Consequences

Last week the Coroner examining the death of transgender school teacher Lucy Meadows issued a pretty exceptional reprimand to Britain's press.

Michael Singleton, coroner for Blackburn, Hyndburn and Rossendale, singled out the Daily Mail as he accused the paper of "ridicule and humiliation" and a "character assassination" of Lucy Meadows, who took her own life in March.

He urged the government to implement the recommendations of the Leveson report on press intrusion as he criticised the "sensational and salacious" press coverage.

Delivering a verdict of suicide, he told the inquest into her death he was appalled at media reports about Meadows.

As he closed the inquest, he turned to the reporters present and said: "And to you the press, I say shame, shame on all of you."

Debate

The Coroner's sharp words have been reported widely in the press during the past week.

Paris Lees, writing for the Guardian's Comment is Free blog suggested that, instead of more regulations (on top of existing ones that are not enforced), press bullies should be made to meet the people who accuse them of bullying (in much the same way that criminals are sometimes required to meet their victims).

The Daily Mail continued to defend their position.

Former Guardian editor Peter Preston, used his Observer column about the Media to suggest that such cases presented "tricky demands for sense and sensitivity" … thereby contributing to a misrepresentation of the actual issues.

Top marks for making sense ought to go to RAF Search and Rescue pilot Ayla Holdom, writing for the Observer's Society section, who provided a clear personal account illustrating that Lucy Meadows' experience was far from unusual.

Holdom's account also echoes the many case examples presented to the Leveson enquiry last year by Trans Media Watch.

Denial

There is a feeling that the press, in some quarters, continues to be in denial about its behaviour.

Some commentators have sought to diminish or refute the coroner's critical words by arguing that Lucy Meadows had not specifically mentioned Richard Littlejohn's monstering in her suicide note (although she had complained, unsuccessfully, to the Press Complaints Commission).

Others, such as Peter Preston (above) have written as though the Meadows case was a single, atypical (albeit regrettable) event. Treating the Littlejohn article as a one-off avoids discussion of a genuinely systemic problem.

The Daily Mail eventually removed the offending article by Richard Littlejohn from its web site, but denies any culpability and has never reported on the vigil organised outside its offices.

There is a feeling, too, that elements of the press are behaving as though they fear what unforeseeable consequences might ensue if they were to address their behaviour and go about reporting trans peoples' lives (if at all) in a different, informed, and more respectful fashion.

Change, they think, is best avoided … especially when the status quo suits them well.

Just imagine...

This raises the question of just what might happen if the press were to abandon their present habitual approach and report and debate trans peoples' issues in an honest, informed, and reasoned way.

Here are some possible outcomes. You are invited to add more in the comments...

1. Imagine what would happen if the press were to investigate and report upon the concerns raised earlier this year by the #transdocfail affair? Policy debates concerning all aspects of trans peoples' contact with health professionals have always been conducted until now without the pressures of external press scrutiny … or with the press only offering the kind of reporting that reinforces the status quo. If trans people thought they were receiving backward, unfair or abusive treatment in the system (whether by doctors or commissioners) they had little chance of having that unfairness opened up to public scrutiny by the press. This is unhealthy and could possibly explain why reform in this field has ground on so slowly for decades compared with other areas of health. Put simply, the system has no real incentive to change if the press is not capable of calling out entrenched practice. The consequence of enlightened reporting could be far better health care.
2. Imagine what might have happened if the press had been capable and minded to report upon the passage of the Gender Recognition Bill. Could a provision requiring the dissolution of healthy marriages (in return for legal recognition) have had such an easy passage if any newspaper had been prepared to examine how exceptional such a proposal was? For trans people on their own to try and oppose this was a truly David and Goliath match, with no stones for David to throw. As a result, a truly exceptional provision … the only time the Government has ever required citizens to end their marriage for any reason … was passed without comment. Press scrutiny of this move at the time may have changed the debate significantly … even if only to provide a hearing for the non-trans partners harmed by the provision. Press scrutiny in the future may look back upon the incident as a shameful episode in Labour's history, meriting apologies and compensation.
3. Imagine what might happen now if the press similarly dissected the Government's attitude towards trans rights in the passage of the Same Sex Marriage Bill … which proposes to charge trans people who divorced for legal recognition to convert their civil partnerships back into the marriages that were stolen from them, and which will allow spouses a veto in future over applications for legal recognition. (The latter is arguably contestable in the European Court of Human Rights). Informed press scrutiny might again change the balance of the debate, so the government didn't have a completely free ride.
4. Imagine what might have happened if the press had been around to report on the lengths which the Department for Work and Pensions had been prepared to go to in order to deprive a tiny number of trans women over sixty of a state pension at the appropriate age (or to make back-payments when their right to this had been established). Imagine how a diligent press might have presented the case of a trans man who had to choose between losing his pension (because he was aged under 65) or applying for legal recognition. Press attention might have pressured MPs and senior civil servants to think twice about the inequities of their actions.
5. Imagine what might result if the press provided readers with positive role models of trans people living happy and successful lives post transition and reported hate incidents against trans people where they occur. In fairness, this same 'what if' scenario could be applied more widely to the reporting of hate crimes on the basis of race, disability and sexual orientation. Instead, trans people often don't report hate crimes because of the feeling that they will not be taken seriously and, if anything, the press might be likely to make things even worse.

Pie in the sky?

Chances are that some will look cynically at such suggestions and dismiss them as foolish idealism.

Some may argue that similar things could be said about the press reporting of other minorities … as though that somehow makes it OK.

Others might argue that it isn't perhaps the role of the press to be our social conscience or policeman. Fine, but the status quo is hardly neutral, with the press both actively (and by omission) contributing to inequality for many groups.

The above examples illustrate that bad things don't just occur when the press presents a negative portrayal of a minority like trans people. Bad things also occur when the press fails to comment at all.

Bad things happen when people get the idea that they can act with impunity. And this is the message that the press give to people in connection with groups such as trans people. "Do what you want, we won't be looking" is the impression. And the rest is down to human nature.

Please add your own "Imagine if…" suggestions in the comments below.

Stonewall's Equal Marriage Bingo Card

Having successfully completed its passage of the House of Commons, the Government's Same Sex Marriage bill enters debate in the House of Lords today.

Observers expect this part of the passage to be every bit as excruciating as it was in the Commons, where MPs competed to see how hysterically offensive they could be.

And the Lords have plenty of "previous". The Hansard accounts of their debates on issues such as equalising the age of consent, introducing same sex partnerships, and the Gender Recognition Bill are not for the faint hearted. The new debate kicks off with consideration of a wrecking motion by one peer to not even debate the legislation at all.

If you are planning to listen to the Lords debates, you might as well settle back with some popcorn, and fill out this handy bingo card produced by campaign group Stonewall. See how many specious arguments you can spot.