Wednesday, August 28, 2013

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.

Monday, August 19, 2013

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..


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.


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!

4CR Header

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 na├»viety 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.

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Tuesday, August 06, 2013

A New Blog: Fanfare For The Uncommon Gran

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.