Just Plain Sense

His Lordship Doth Protest Too Much

2012-04-15T14:45:00.001+01:00

This weekend the former Archbishop of Canterbury, Lord Carey, used a prominent article in the Daily Telegraph newspaper to protest that "Britain's Christians are being vilified".

Lord Carey says worshippers are being “vilified” by the state, treated as “bigots” and sacked simply for expressing their beliefs.

He says Christians will face a “religious bar” to employment if rulings against wearing crosses and expressing their beliefs are not reversed.

He writes: “In a country where Christians can be sacked for manifesting their faith, are vilified by State bodies, are in fear of reprisal or even arrest for expressing their views on sexual ethics, something is very wrong."

And he continues:

“It is now Christians who are persecuted; often sought out and framed by homosexual activists [..] Christians are driven underground. There appears to be a clear animus to the Christian faith and to Judaeo-Christian values. Clearly the courts of the United Kingdom require guidance.”

Qualified Right

Carey is over-stating his case, of course. And we've got to assume that he must know that, for the law is clear.

I've written before (here and here for instance) about the way in which the right to have a personal religion or belief, the right to change that belief, and the right to worship in peace is protected as a "qualified" human right. I've also written about the way in which any conflicts raised between this and other rights can be addressed.

It's disarmingly simple really. You have that right to believe or worship what you wish; but this is a world away from having any right to impose that belief on others. Believe that women are second class or that homosexuality is sinful if you feel you must, for instance … but you don't have a right to override the legal protections enjoyed by other people.

Privileged position

And it's clear that Christians have a privileged position … far in excess of what is enjoyed by others under that legislated protection...

The Church of England is not just any old religion. It is established at the heart of the British state, headed by the monarch
Bishops have automatic seats in the House of Lords, with a direct say over every piece of legislation to pass through Parliament
Schools have statutory obligations to stage an act of worship in assembly every day -- and the current government has massively increased the state support for church run teaching establishments
BBC radio has a slot for religious belief in prime time weekday breakfast programming; and both TV and Radio have wall-to-wall programming on Sunday
The primacy of Christianity is still recognised by forcing shops to close on Christmas and Easter Days
And clerics such as Lord Carey have an almost guaranteed platform for their views in most newspapers

Pot meet kettle

The assertion that Christianity is the new underdog in society is therefore risible.

Christians are not singled out for vicious persecution and bullying in the way that many disabled, BME and LGBT people report
You don't hear of Christians suffering from stigma-induced depression in the way that many women, ethnic minorities, disabled people, gays, lesbians and trans folk regularly do
There is no movement asserting that religious belief is a "choice" or targeting Christians or other religious believers for quack "cures" to change them
You don't often hear of Christians being thrown out and disowned by their parents because of their beliefs

By comparison, Christianity seems to have very much defined its brand in terms of targeting others...

Roman Catholicism has set itself against birth control for women since modern methods were invented in the 1960s.
Even as I write, there are moves to roll back provisions which make abortion available to Women in Britain. Women come to Britain from other countries where abortion has been banned through Christian dogma
The Church of England is still torn over whether to allow women to become Bishops, with some followers defecting to the Roman Catholic Church in protest at the idea
Roman Catholics have systematically covered up industrial scale abuse of children around the world
Christians have opposed every move in the last 50 years to emancipate lesbian, gay, bisexual and trans people, included blatant deception and misrepresentation when it has suited

Forbearance

For all this, we still have an attitude of benign tolerance towards Christianity … recognising that the extremists who hijack its power in order to vilify minorities are not representative of the whole. As the law makes clear, we respect the right to worship God in peace and safety, whilst protecting the rights of others from abuses carried out in God's name.

In Christian terms we turn the other cheek and take note of the imperative to "love thy neighbour".

Insult

With all that in mind, Lord Carey's statements must be seen as a profound insult by many women whom his Church has cast as second class citizens; by all the Children who've been abused under the protection of the Church; and by all the LGBT people who may feel that the Church has gone out of its way to vilify them.

Those people know what real vilification and marginalisation mean.

Not for them a prominent article in a national broadsheet paper.

Not for them a guaranteed daily slot on prime time radio.

Not for them blanket coverage on Sunday radio and TV, and an almost automatic seat in any forum where issues of fairness or morality are to be debated.

Not for them the backing of an institution with hundreds of millions of pounds in assets, acquired by taking donations from the poor.

Out of touch

Lord Carey has amply demonstrated how out of touch he is with the genuine experiences of marginalised groups by crying "poor me" when the law seeks to limit the worst excesses of his followers.

And that is the point. His cries of anguish come because the courts have challenged the right of Christians to hold themselves above laws against discrimination which apply to the rest of us.

It is time to say "enough is enough".

It is time for the established Church to wake up and realise that, for whatever reason, it has become synonymous with discrimination rather than love.

At a time when there are immense problems in the world, Carey and his successors have chosen to obsess about women Bishops and opposing complete equality for LGBT people.

Faced with the opportunity to have a real role in the debate over banking excesses, the Church flunked it.

And articles like this weekend's one by Lord Carey continue the decline into irrelevance.

First Do No Harm

2012-04-06T20:46:00.001+01:00

The Coalition Government's Health and Social Care Bill received Royal Assent last week, on the 27th March 2012.

Readers of my Twitter feed, where I've regularly highlighted examples of the debate around this legislation, will know that the passage of the legislation through Parliament has been turbulent.

Last summer I tried to encapsulate widespread concerns as the Bill completed its time in the Commons and headed for further scrutiny (and stronger but futile challenge) in the House of Lords.

Royal Assent

Even now that the legislation has become an Act of Parliament questions are still being raised about the process, and the extent to which democracy might be thought to have failed.

An information tribunal ruling (released 5th April) on the Government's refusal to publish the Department of Health's Transition Risk Register recorded quite a damning indictment on the process as a whole.

In paragraph 85 of its findings it says:

"From the evidence it is clear that the NHS reforms were introduced in an exceptional way. There was no indication prior to the White Paper that such wide-ranging reforms were being considered. The White Paper was published without prior consultation. It was published within a very short period after the Coalition Government came into power. It was unexpected. Consultation took place afterwards over what appears to us a very short period considering the extent of the proposed reforms. The consultation hardly changed policy but dealt largely with implementation. Even more significantly the Government decided to press ahead with some of the policies even before laying a Bill before Parliament. The whole process had to be paused because of the general alarm at what was happening."

And remember, those aren't the words of activists or political dissidents there. That is the judgement of an official tribunal summarising the evidence presented to it, underpinning their conclusion that the long-contested official risk register should be made public.

A new phase

These arguments will no doubt go on. However, a leak of what's alleged to be an early copy of the risk register makes even the argument over this somewhat redundant.

The leak occurred on the eve of Royal Assent … perhaps rather crudely making the point that arguments are now academic. If the document is genuine the contents come as no surprise. The risks are very much as everyone has discussed.

However, the mandate is now officially in place to press ahead with the transformation of the whole structure of the National Health Service … a change which the NHS Chief Executive Sir David Nicholson once described as so big that "you can probably see it from space".

The risk register, even if we get to see the latest version, is not going to change things. It will merely be a device for criticising how reckless the whole transition will have been if things go horribly wrong.

Nobody who cares for the NHS, or for the health of themselves and their loved ones, wants to see that outcome, however. The emphasis now has to be on people working with what they have. Everyone has to make the best of it.

Handing over

Over the coming year existing Primary Care Trusts (now consolidated into fifty supra-local 'Clusters') will progressively hand over the reins of commissioning local health services to around 220 Clinical Commissioning Groups (CCGs), managed by local clinicians.

At the end of March 2013 the original 152 Primary Care Trusts and ten regionally-based Strategic Health Authorities (SHAs) will be disbanded, and the responsibility for overseeing the CCGs will fall to a new byzantine NHS Commissioning Board, headed by Sir David Nicholson (the same man who heads the old NHS).

The NHS Commissioning Board will operate through four national offices and around 50 local outposts with a very similar geography to the PCT and SHA clusters, but under one central management structure.

In April 2013 we will discover how (and if) it all works.

Local battles

The message I'm hearing now is that people accept this change will occur, so their emphasis switches to living under the new regime.

Watching this happen is fascinating … not least because I get an impression of a 'resistance movement' mentality springing up at the local level, where GPs, surviving NHS managers and local politicians are starting to work out how to ensure the NHS spirit lives on, regardless of the new administration.

It is at this local level that the future nature of the NHS will be determined. The Health and Social Care Act potentially enables changes that would be an anathema to the spirit of Bevan's NHS … a universal healthcare service, free (irrespective of personal wealth) at the point of need.

However, the provisions in the new legislation are only toxic if people allow them to be.

Opportunity under pressure

For General Practitioners there is a particular opportunity.

The way GPs conduct themselves in the new Clinical Commissioning Groups will shape the kind of NHS we all experience.

They will certainly be under pressure from the opportunists … the money men who will alternately try to tempt and bully them into opening up the NHS to forces that could change its nature forever.

They will also be under pressure from the NHS Commissioning Board to conform.

Sir David Nicholson has always been a "command and control" kind of man. He talks a lot about "grip", which is management language for micromanaging performance.

In some ways you can't blame him now. His name is on the policy to find £20 Billion in savings from the system over the next five years (the "Nicholson Challenge"). And the NHS Commissioning Board is certainly structured in a way that potentially enables it to breathe warm air down the necks of every local CCG that dares to deviate from the allowed course.

The big unknown is whether it is the mission of the NHS Commissioning Board to unlock all the most feared potential in the new legislation, in a way that has been hotly denied, or whether Nicholson will enable the kind of local autonomy that Andrew Lansley has repeatedly promised. It's hard to see how the two mindsets can be reconciled.

Culture trumps hierarchy

GPs will know of that kind of pressure already. They've all dealt with the sales teams of pharmaceutical companies. Only now the stakes are even higher.

And the way GPs handle that pressure and the accompanying temptations will depend on what kind of individuals they are.

It boils down to the question of what motivates them. Did they go into practice for reasons that reflect all the professed ethics and responsibilities of their profession? Or are they the sort who came to medicine looking for means of personal advancement?

Knowing quite a few GPs, and the subversively caring kind of people they can be, I'm praying that it's the former kind of spirit which will predominate. For, if that's so, the NHS will indeed remain safe.

The rules may change, but culture can work around them any day.

Founding principles

It is with that thought in mind that I was so encouraged to see some Clinical Commissioning Groups putting together founding principles which, if adhered to, will really make a difference. Having such principles embedded into the constitution of an organisation could provide a constant sense check on every decision they make.

As doctors they've inevitably couched these in the terms they are most familiar with... the conservative (small 'c') principle that ensures they ought never to do anything which would harm their patients.

Here's one example. Let's hope it catches on

First do no harm

This CCG will uphold the principle of "first do no harm": we will take no action and adopt no policy that might undermine our patients' continued access to existing local health services that they need, trust and rely upon.
In the spirit of clinically-led commissioning, we reserve entirely the right to decide who we contract with to provide services for our patients. We will take those decisions on the basis of the best interests of our patients and wider local communities.
Among other priorities, and in the interests of offering the best care for our populations, we shall increase the integration of services between different parts of the NHS and between the NHS and social care. We shall not be diverted from this by concerns about anti-competitive behaviour.
In the interests of transparency we will not engage in any contracts or negotiations which impose conditions of commercial confidentiality: will consult local communities before implementing any changes that affect them, and our Board will make all major decisions relating to services in public session.

A good start

That strikes me as a good start. I would feel encouraged if I were a service user in an area covered by a CCG whose first thought was to lay down a set of ethics for themselves like that.

You could improve on a statement like this, of course.

I would particularly like to see something stronger about reflecting the communities that the organisation serves; about engaging collaboratively with stakeholders from all sectors of the community (including all the protected groups); and about using evidence of local needs from those stakeholders to guide the design of innovative and truly inclusive services, in which everyone could expect the same quality of outcomes.

However, it's a start.

Maybe you'd like to suggest improvements too in the comment section below?

Onwards and upwards for Pride in Practice

2012-03-27T18:04:00.001+01:00

The Lesbian & Gay Foundation (LGF) has just announced that they have received funding from the Department of Health to test and develop innovative approaches to improve health and wellbeing.

This funding will enable the further development and preparation for a national rollout of ‘Pride in Practice’, the benchmarking tool that identifies GP surgeries that are fully committed to assuring that their lesbian, gay and bisexual (LGB) patients are treated fairly, and where patients feel able to discuss their issues openly with their GP or healthcare provider.

The development and pilot rollout of Pride in Practice was commissioned by NHS North West and I reported on the joint launch here a few weeks ago.

The process involves surgeries undergoing a simple, self-assessment process, prior to verification by the LGF.

So far, I'm told, almost sixty practices have signed up. This includes an initiative by local NHS commissioners to sign up all of the GP practices in South Manchester.

New Portal

The funds will also provide a new online portal where LGB people can make recommendations of practices or GPs who are LGB-friendly.

Alongside this LGB communities will be supported to make them more aware of their legal rights, and more confident and able to challenge any negative experiences that they may encounter in accessing healthcare.

Care Services Minister Paul Burstow said: “It is crucial that we continue to champion our voluntary organisations, because their expertise allows them to design and develop innovative solutions to the big challenges we face in health, public health and social care.”

If you would like more information on this please contact Dennis Baldwin LGF’s GP Project Manager by calling 0845 3 30 30 30 or emailing dennis.baldwin@lgf.org.uk

Till Political Convenience Do Us Part

2012-03-23T13:20:00.001Z

The coalition government has begun a three month public consultation on equal civil marriage for same sex couples.

Central to this debate is the argument that having two kinds of legal partnership -- civil partnership for same sex couples and marriage for heterosexual ones -- is divisive and discriminatory. Why, if they are meant to be the same thing, should this difference persist? And, if they're not the same thing, does this imply that one is inferior to the other?

The government proposes to make civil marriage (the legal part of what heterosexual couples currently sign up to) available to same sex couples as well. They're not proposing to impose changes on the religious aspects of marriage.

At the same time the coalition proposes to retain civil partnership for same sex partners who don't want the new option, but not to open it to opposite sex couples.

Arguments against all aspects of these proposals will consume the media during the consultation period, and undoubtedly again when a Bill is debated in Parliament.

All this noise threatens to erase the viewpoint of one group whose rights could be the "collateral damage" in whatever accommodation is made. These are the people whose interests I want to discuss.

Crisis meeting

It was the Spring of 2004 and I was attending a crisis meeting at the Department for Constitutional Affairs. The ministry was responsible for the passage of the Labour Government's Gender Recognition Bill, which had already come through the House of Lords. Now it was about to go into Committee stage in the Commons, and the Government was suddenly scared by the chorus of criticism for part of it. We were leading that criticism.

My three colleagues and I sat in a small office around a table with Lord Filkin and David Lammy MP, the Bill Ministers in the Lords and Commons. They were joined by a small team of their officials.

'We' were 'Press for Change', the lobby organisation which had fought for the passage of a Bill to recognise transsexual peoples' privacy and marriage rights. And now we were arguing fiercely against a part of the legislation we had worked long and hard to bring about.

A long fight

The Gender Recognition Bill was the result of 20 years of persistent lobbying by trans people after the famous divorce case of April Ashley in 1970.

The unfortunate consequence of that case, 35 years previously, had been to prevent transsexual people from marrying as members of the gender they presented as. Subsequent decisions had then stripped away further rights in order to be consistent with that decision.

The lobbying had begun in the mid 1980's with a case taken to the European Court of Human Rights by trans man Mark Rees, who subsequently co-founded Press for Change. He lost his challenge.

Two other cases had been lost as well, in 1990 and in 1998, but with progressively smaller margins.

Then, in 2002, the European Court of Human Rights finally got tired of the UK's stance and ruled that the absence of a mechanism to change birth certificates and permit marriage in a transsexual person's acquired gender breached BOTH Article 8 of the Convention (the right to private life) and Article 12 (the right to marriage and family life).

The Gender Recognition Bill was the result of the government's decision to accept defeat and comply. It was debated in Parliament through the first half of 2004; first in the Lords and then the Commons.

The debates took place before Parliament started to consider the Civil Partnership Bill. However, a crucial part of the bargaining for that Bill had already been struck. Civil Partnerships were to be exclusively for same sex couples and Marriages were to be exclusively for opposite sex couples.

Inconvenient exceptions

Trans people had long made a mockery of that concept.

When opposing all those cases in the European Court, the Government had argued many times that transsexual people weren't being denied the right to marry. A trans woman (being male in the eyes of the law) was quite entitled to marry a cis-gender woman, they argued.

The fact that the resulting couple was seen by everyone except the government as a same sex marriage seemed never to trouble the government or its legal counsel. Their existence challenged the whole premise on which the denial of same sex marriage was based.

An increasing number of trans people defied convention another way too: by remaining married when they transitioned. Their gender reassignment transformed an opposite sex marriage into a same sex one in all but name.

Surprisingly, gay and lesbian campaigners never really capitalised on that. We should celebrate those marriages too, for there can be few tougher tests on a relationship than to survive such a dramatic change in one partner.

Above all, I admire the spouses: the heterosexual women who married what they thought was a man and decided, when that turned out not to be the case, that their love and partnership was more important than a gender and sexuality label.

I always wonder at the flexibility of women (and it has mostly been women) who could go through the redefinition of their sexual orientation in other people's eyes with such patience and dignity.

Now, however, those latter couples were a fly in the Government's ointment.

If the transsexual partner in such a marriage was to receive legal recognition then that would create a marriage in which the partners were both legally the same sex. It would break the faustian pact that the government had made with religious leaders to allow the Civil Partnership Bill to pass relatively smoothly.

Something had to give. The something was a ghastly and immoral decision on the part of the Government to throw those inconvenient marriages under the bus.

Disposable marriages

Pause for a moment to take that in. I am still not sure it is possible to find such a precedent anywhere else in legal history, anywhere in the world.

Governments may have prohibited various kinds of marriage. However, NO government had ever legislated before in a way that required a lawfully married couple to end their marriage. It goes against the whole idea.

Marriage is marriage because it is supposed to be for life. "Let no man put asunder" and all that. The vows are supposed to mean something. "In sickness and in health". "For richer for poorer". "Till death us do part".

OK, society has watered that down over the last fifty years. If anyone devalues marriage then it must be the heterosexual couples who marry with fingers crossed, knowing that if it doesn't work out after the passion has passed then they can easily get divorced again.

Compared to that transient attitude to commitment, those transsexual people and their spouses who stayed together through the ultimate challenge are a model to hold up and admire. That's love. That's commitment. That's remembering your vows.

Weasel words

The Government argued, of course, that such couples didn't have to dissolve their marriages really: the transsexual partner could just elect instead not to apply for full legal recognition of their gender.

They even proposed an immensely tortuous middle road, where a trans person could obtain confirmation of their eligibility for legal recognition, use that to dissolve their marriage, complete the recognition process (as a singleton) and then round it all off by entering a civil partnership in their new legal gender.

Lengthy meetings on the logistics of such a tortuous process indicated that if everyone had read the instructions and followed them to the letter, it would be possible to complete the process inside a day. Dissolve your marriage in the morning and be in a Civil Partnership by teatime.

My colleague Professor Stephen Whittle ruefully remarked that we should just pray that neither partner fell under a bus in between. For the point was that in dissolving their marriage for this ridiculous process the couples would be giving up a raft of accumulated legal rights and entitlements that are part of the very point of marriage. All sorts of questions were opened up regarding the continuity of insurance and pension rights.

Human rights

And let's not forget that this law was supposed to be implementing a unanimous decision of the European Court of Human Rights on TWO fundamental principles: the right to privacy AND the right to marriage and family life.

You don't obtain the second with a process which requires the individual to dissolve the marriage they've got. And you don't obtain the first by insisting they can't have it unless they submit to this madness.

This was a nightmare generated entirely by a government which thought it could sacrifice the marriages of an unknown number of transsexual people (and their partners) in return for a deal to secure Civil Partnerships for gays and lesbians.

Collateral damage

I'll repeat that, as it's important to reflect on the political reality...

Married trans people and their partners were thrown under the bus by the Labour government in order that religious opponents could be appeased and gay and lesbian people could have Civil Partnerships.

They call it collateral damage in war.

There were no shortages of people who saw this for what it was.

The Bishops in the House of Lords voted against the provision because, much as some were opposed to trans people's legal recognition, they saw the dissolution of successful marriages as a moral crime. The Parliamentary Joint Committee on Human Rights also expressed their concerns, along with organisations such as Liberty.

Defending the indefensible

Sitting in that office in the Spring of 2004, my colleagues and I hammered the points home. Messrs Filkin and Lammy could not defend the indefensible.

Their officials looked grey. Secretly I think they were on our side and it was clear that the decision wasn't within the gift of the two Bill Ministers present. Their orders came from above. We never did confirm which member of the cabinet was responsible, though we all had our suspicions.

Thus it was that, in spite of winning all the arguments, this monstrously cruel requirement was passed into law with the rest of the Gender Recognition Act (which was otherwise an exemplary piece of legislation).

Four of us eventually collected honours for our part in making the rest of the Act so good, but we never forget what happened that day. Winning the argument but losing the war.

Back to the present

Fast forward now to the present day. Over four thousand people have obtained legal recognition of their acquired gender since the Gender Recognition Act came into force in April 2005.

A handful of those who were already married (maybe fifty or so) decided to go along with the travesty of dissolving their loving marriage to obtain that recognition. Several hundred more decided that it was too high a price.

So there are plenty of transsexual women who are still male in the eyes of the law just so that they can remain married to the partner they love.

The Conservatives have now decided that the time is right to bring forward equal civil marriage for all. This means that your gender ought to be irrelevant in all circumstances.

People who already have Civil Partnerships will (for a fee) be able to convert into Civil Marriages if they wish. Or, as the Government envisages, they can stay in the Civil Partnership if they prefer.

The attention will be on the bizarre anomalies proposed ... where a same sex couple can enter a Civil Partnership on religious premises, but not a Civil Marriage ... and where same sex couples can pick two brands of legal partnership but opposite sex couples can only have the one.

Something for the trans folk

The Liberal Democrats have ensured that the coalition's marriage proposals contain something to address the problem created for transsexual people by the previous administration.

People who are already married will not need to dissolve that marriage in order to qualify for legal recognition. That's because their gender in marriage will no longer matter. Hooray, you say. Isn't that wonderful? But look carefully at the small print...

The government proposes that if a same sex couple are already in a civil partnership and one partner wants to seek legal recognition because of their gender reassignment then they can't. That's because the government isn't proposing to allow opposite sex partners to have civil partnerships. That includes, in their eyes, remaining in one.

Deja Vu?

Deja Vu? You bet. There will, of course, be a mechanism to dissolve the partnership, obtain the recognition, and then get married ... all before supper. But if it was wrong to do this the other way around, and the government thinks that ought to be fixed, why create the same cruel requirement in reverse?

What this boils down to is a fundamental failure of respect for the relationships of transsexual people and those who love them. The government are demonstrating that when a trans person's relationship stands in the way of an otherwise neat policy solution, it is the relationship that has to change, not the rules.

This time we must not allow transsexual people to be thrown under the bus as deals are fixed up for their more fortunate gay and lesbian associates.

It was wrong in 2004 to legislate an obligation to dissolve trans marriages. It is wrong in 2012 to propose the same for trans civil partnerships. Only this time let's not brush it under the carpet.

What about the dispossessed?

And spare a thought too for those trans people and their partners who jumped through all the hoops that the government created. The equal marriage proposals promise that they, too, can convert their Civil Partnerships (the ones they were forced to transfer to) into Marriages ... for a fee.

Think about that...

The government required you to dissolve your happy stable marriage in order to access rights decided for you by the European Court. It charges you for the legal recognition and for the civil partnership you enter instead. And then, seven years later, the government changes the rules and says you can now have a marriage again ... so long as you pay another fee.

If you were one of those couples I imagine you would be annoyed.

Expendable people

And what message does this send? Transsexual people's relationships are expendable. If they're in the way of a policy for a larger majority then they'll just have to lump it.

Over the next few months proponents of equal marriage will be wanting to stress how the core value of marriage is the intended permanence, and the setting which that creates for two people to love and care for each other for life. I support that. And yet the validity of that case is compromised when the proponents demonstrate that they are prepared to flip the rules for one tiny group of people every time they get in the way.

When equal civil marriage comes about I would like those transsexual people and their partners to receive an apology from the state for the unnecessary pain they were caused. I'd like to see the offer to restore the marriages that should never have had to be dissolved. And I don't want those people to have to pay again.

Archive it now or lose it forever

2012-02-24T19:10:00.001Z

The month of February is LGBT History Month in Britain.

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

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

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

Foraging

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

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

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

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

Erasure of a different kind

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

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

Good news

Before I continue, there is some good news.

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

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

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

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

Archive nominations welcomed

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

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

The address to write is: web-archivist@bl.uk. They will write to the owners of any sites you nominate to obtain permission to copy and store the content.

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

Let's learn from our fortune

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

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

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

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

Making sense of the information

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

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

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

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

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

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

New technologies, new challenges

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

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

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

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

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

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

Three things you can do

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

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

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

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

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

20 Years On - Why Pressing Mattered

2012-02-19T19:05:00.001Z

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

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

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

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

Historic

I've written about Press for Change before.

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

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

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

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

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

Invited

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

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

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

Why Pressing Mattered

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

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

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

It starts at 7pm.

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

I hope you'll join me there.

GP Leader Dr Clare Gerada welcomes 'Pride in Practice'

2012-02-15T10:34:00.001Z

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

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

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

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

Picture gallery

Supporting Quality

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

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

Crowded

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

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

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

Partners

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

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

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

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

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

Welcomed

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

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

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

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

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

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

Building on experience

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

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

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

Signed up

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

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

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

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

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

To register for the Pride in Practice launch visit: http://www.lgf.org.uk/prideinpractice or for more information contact dennis.baldwin@lgf.org.uk

The men with baby bellies - reloaded

2012-02-12T14:15:00.001Z

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

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

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

Not the first, just the most prolific

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

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

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

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

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

A deeper analysis

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

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

The Men with Baby Bellies - March 2008

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

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

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

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

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

Deadly serious

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

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

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

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

Pragmatic

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

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

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

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

Human Rights

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

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

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

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

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

Biology 101

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

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

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

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

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

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

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

Not the first

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

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

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

Hostility

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

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

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

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

Ignorance

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

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

A Philosophical Question

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

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

A Legal Question

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

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

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

What about the children?

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

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

Summing up

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

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

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

Pearls among swine

2012-02-10T19:36:00.001Z

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

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

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

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

Today's Stars

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

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

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

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

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

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

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

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

Change takes time

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

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

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

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

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

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

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

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

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

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

Political advance

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

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

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

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

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

Significant

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

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

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

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

Meanwhile back at the BBC

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

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

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

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

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

Unreliable Evidence - BBC Radio 4

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

Unreliable Evidence - BBC Radio 4 (mp3)

Woman's Hour - BBC Radio 4

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

Woman"s Hour Discusses Trans Children (mp3)

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

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

Stephen Whittle and Julie Bindel debate Gender Reassignment (mp3)

Dusting off the 'lost' PFC Tapes

2012-02-08T18:23:00.001Z

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

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

Retrieved

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

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

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

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

Kate Bornstein

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

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

In Conversation with Kate Bornstein (mp3)

Jamison Green

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

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

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

In Conversation with Jamison Green (mp3)

NHS Mosque Radio Pilot doubles take-up of vital screening

2012-02-07T21:30:00.001Z

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

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

Targeted

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

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

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

Effective

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

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

Partnership

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

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

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

Best practice

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

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

Bury PCT Mosque Radio Project (mp3)

Our history hangs by a thread

2012-02-05T13:51:00.001Z

It's the curse of the modern age.

And it's perhaps far more insidious than censorship.

Historians of the future will curse us.

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

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

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

Counter-intuitive

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

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

Fragile history

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

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

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

Knowing where to look

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

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

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

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

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

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

Not the only case

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

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

And the Internet Archive is not infallible.

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

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

Government sites too

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

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

Annoyance or Tragedy?

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

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

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

Hanging by a thread

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

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

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

The level of harmful practice is shocking

2012-02-04T17:09:00.001Z

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

Horrifying

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

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

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

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

Responsibility

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

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

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

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

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

Squeezed

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

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

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

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

A problem the public sector can't ignore

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

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

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

Full house

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

Full photo coverage of the event can be seen here.

LGBT and Disabled People too

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

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

First hand experience

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

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

Follow-up

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

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

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

2012-02-03T18:49:00.001Z

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

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

Analytical

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

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

Questionning

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

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

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

Independent

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

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

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

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

Relevant

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

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

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

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

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

Hands Tied

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

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

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

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

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

A dilemma

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

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

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

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

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

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

Professionalism

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

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

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

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

A Review of the Year - 1996

2011-12-27T15:28:00.001Z

This is the time of year when the media turn out their drawers and rehash their notes to produce reviews of the year just passed.

Rather than recycle 2011, however, I thought it would be much more interesting to dig deep into the archives and see how I viewed things 15 years ago when, as a campaigner for the organisation Press for Change, my colleagues and I were still a full eight years from achieving our primary goal.

The review below appeared on the Press for Change campaign's groundbreaking campaign web site on the evening of December 30th, 1996.

Review of the year

On Friday 27th December 1996 the BBC did something quite extraordinary. Mind you, you'd be forgiven if you missed it ... for it was the very low key nature of the event which made it the more remarkable.

Never an avid television watcher, I must admit that the event wasn't something I'd anticipated either … It was pure chance that I decided to turn on the television in my kitchen to accompany some rather overdue seasonal washing up at 7.30. It was pure coincidence that the set was tuned to BBC2 ... and it was sheer serendipity that meant I caught the name of the presenter of the programme that was just about to begin. Otherwise I suspect I'd have missed the significance of what I was about to see too.

Along with names like April Ashley and Caroline Cossey, Jan Morris is probably one of the best known transsexual names in the world. Her book, Conundrum, first published in 1974, gave the world an intelligently written, even if annoyingly stereotyped, account of what it was like, for her, to be a transsexual woman in the 1960's. An accomplished travel writer and historian, famous first for bringing an on-the-spot account of Edmund Hilary's historic Mount Everest expedition back to the world in 1953, Ms Morris's chintz style of writing isn't everyone's cup of tea. I suspect that it was Jan who gave the world that annoying expression “trapped in the wrong body” too. Mind you, like many who followed in her footsteps, I owe a great deal to her for that book ... the first I read on the subject, and the first opportunity I had, back in 1974, to really begin to understand my own life.

To give credit where it's due though, Jan Morris's most important contribution to transgendered history will be that she has simply got on with her life and treated her condition with a matter-of-factness which invites others to do likewise. As with so many other successful transsexual people, indeed in common with other successfulwomen, the key to her survival has been her very great skill at what she does. And if it's true that a woman has to be far better than a man to get on in this world then it does not take a great deal of imagination to appreciate what it takes for your skills to eclipse the notoriety of being a transsexual woman.

So the remarkable aspect of BBC2's two part personal travelogue, Escaping from Liberty, was not that a transsexual woman was on television ... we've had rather a lot of that this year ... but that it marked, as far as I'm aware, the very first occasion when a transsexual woman was on television to talk about something other than transsexuality.

For Jan Morris's early evening two-part television programme was very firmly in the mainstream. In it she traced the well worn road of so many other travelled writers before her. She was visiting the places that were important and interesting to her ... ticking off the list of places with important associations. And that list did not includeCasablanca!

It was, for me, the cherry on the cake. The summit of a remarkable year. A reflection that transsexuality is coming to rest in the nation's psyche as something that can now be dismissed in a single sentence explaining, out of necessity, how the programme's presenter came to visit Trieste as a 19 year old “Tommy” during the Second World War. It represents the subtle recognition that maybe, at long last, a change of gender is no more of a liability on one's CV than a tonsillectomy.

.. And it set me thinking how far we've come as a campaign in one astonishing year.

A year to remember

When the history comes to be written then I'm sure that 1969 will undoubtedly be recognised as the year when it all started to go horribly wrong for transsexual people in the United Kingdom. Maybe, however, 1996 will go down as the year when, at last, the tide began to turn the other way too.

Many of the foundations were laid before that, of course. Indeed, Press for Change and its' associates had been preparing the ground actively for four years before 1996 even began, and that was on the foundations laid by brave individuals like Mark Rees and Caroline Cossey who had gone before. The flavour for the campaign in 1996 was set, however, by the European Court of Justice hearing of the P vs S and Cornwall County Council case in the autumn of 1995, the proactive appearance of many activists in public at the Conservative and Labour Party conferences that year, and then ... the jewel in the crown ... the opportunity, just before Christmas, for Alex Carlile MP to present a private members bill to parliament in the new year.

It was like a double Christmas present. In the space of one heady week we heard the preliminary recommendation by Advocate Tesauro ... that `P' had been illegally discriminated against under the Treaty of Rome and then the next day, on December 15th, came the announcement that the Liberal Democrat Home Affairs spokesman, Alex Carlile QC MP, was to use his (ninth) place in the ballot for private members' bills to present a piece of legislation to eliminate the problems endured by British transsexuals.

It certainly was an exciting time. In the space of a few months we'd gone from nowhere as a campaign, talking furtively to journalists we barely trusted, to ringing them up and demanding coverage. Chasing ... Cajoling ... Educating. And, less publicly for some of us, sitting down in a corner now and then to cry in sheer relief at the sense that a lifelong burden was at last being shifted ... if only slightly. On December 31st of that year, in fact, I wrote to my colleague, Stephen Whittle :

…But the tide is turning, Stephen, don't you think? Maybe we're in that moment of stillness when the waters have stopped flowing one way, and have not yet begun to rush in the other .. but the boats are ready, and maybe this is our tide. May 1996 bring health, wealth and happiness to you and your family. And may it be OUR year too.

It's hard though, even just twelve months on, to fully take in the sense of excitement that gripped us in January as we started the year. Suddenly we had an enormous task on our hands ... to get our message across to sufficient MPs, in all parties, to put some support behind Alex's bill.

Encouraging people who are accustomed to keeping their heads down to actually go out and see their own MP, or even just write to them, is not an easy task ... and yet in the end hundreds did so. Some even went further… One partner of a transsexual woman personally mailed the entire parliamentary Labour party herself ... signing each letter, and addressing every one of the 300-or-so envelopes by hand. Many others spent late nights on smaller, but no less impressive, personal mailshots too.

It was, in the words of one MP, “the most impressive lobby of its' kind that I've seen in 25 years”. Looking back though, I'm less surprised ... more inclined to visualise the scene when word goes round the prison that there's a crack in the outer wall…

Meanwhile the combined effect of a favourable court recommendation and the kudos of a parliamentary bill (even a bill doomed to failure from the start) was having a long awaited effect on the minds of folk in the media.

Dec 14th 1995	Advocate General Tesauro of the European Court of Justice recommends a favourable outcome in the case of P vs S and Cornwall County Council
Dec 15th 1995	Alex Carlile QC., MP wins ninth place in the ballot for Private Members' Bills and announces that he'll use the opportunity to promote a bill giving full legal rights back to transsexual people.
Jan 1st 1996	A new web site begins, dedicated to supporting the objectives of Press for Change by charting news of the campaign and distributing educational resources to campaigners and journalists alike.
Late Jan	Sonia Carmichael, a pre-operative transsexual woman from Manchester, takes her employers to court on her own for wrongful dismissal ... first evidence that transsexual people across the country are suddenly prepared to stand up and be counted.
Late Jan	The European Commission on Human Rights decides that there is a case to be heard concerning the claim by a transsexual man to be recognised as father to the children of his partner (conceived by donor insemination). A hearing is promised for the autumn. Broader human rights cases by two transsexual women are admitted too.
Late Jan	The Parliamentary Forum on Transsexualism updates and reprints “Transsexualism : The Medical Viewpoint”, incorporating significant new research published in Nature.

With the best will in the world it was hard to get many mainstream journalists to think very far beyond the agenda set by the headline writers little more than a year ago. Brought up on a diet that cast transsexual people as perverts, attention seekers, outlaws of gender discourse (or just plain misguided) it was an uphill struggle to get some writers to think beyond their first stereotyped paragraph, which you could usually write for them in advance…

Strapping worker David stunned colleagues when he sashayed into the office on stilettos and announced: "Don't call me David - call me Jane." The gender bender who deals with [his employer's] most sensitive cases has caused a storm with his sex swop. Six-footer David, who dresses in sharp career woman suits, is already growing breasts, has softened his voice and learned to flutter his eyelashes….
(Sunday People feature, July 1996. Names changed out of respect for the victim)

The idea that there were real people driven to slit real wrists behind this appalling facade was lost on even the more intelligent and thoughtful writers though. And those who did sit still long enough to listen to the catalogue of real issues which we wanted to bring to public attention were just as likely to come back later with their unpublished pride and joy, having been told by their editor or producer that “we did something on transsexuals six months ago ... it's too soon to do another”. Could you imagine that form of self censorship with any other minority issue?

So if the courts and parliamentary legitimisation didn't necessarily achieve direct successes at the start of the year, the one thing they did do was to make transsexual issues a debatable topic all of a sudden.

Jan 31st	A PFC activist appears on Channel 4's “The Slot” in a five minute film explaining the true extent to which she is marginalised and discriminated against.
Early Feb	Regional television covers the run up to the Carlile bill. A first opportunity for PFC activists to say their piece to an early evening audience. Television journalists admit to being stunned by how wrong their own preconceptions had been. PFC activists appear in print too.
Feb 1st	Woman's Hour presents a piece about a teenage transsexual girl and her family.
Feb 2nd	The Alex Carlile bill has its' second reading in the House of Commons. It is pointed out that the bill is being read 26 years to the day after the Ormrod summing-up in the April Ashley case. The bill runs out of time, as expected, but it has served its' purpose well.
Feb 6th	Channel Four shows the first of a two part documentary about young transsexual boys. (The Decision, by Oliver Morse, has been two years in research and production and is widely acclaimed. The media “discover” transsexual men for the first time and gender dysphoria is seen in a non erotic light because the films are about the feelings of children).
Feb 19th	The Kilroy programme revisits transsexual issues.

As the activity began to die down in late February, however, our sights turned once more to applying legal pressure on the establishment and making appointments to speak to groups who had suddenly discovered our existence after all this time.

Mar 6th	A Judicial review examines the cases of two transsexual women (P and G) against the registrar general, for the refusal by the (then) Office of Population, Censuses and Surveys to alter their birth certificates. The case is the first of its kind to be awarded legal aid.
March 31st	A distinguished surgeon, senior enough to have worked on the Queen Mother's hip replacement, goes public when faced with blackmail threats about his treatment for gender dysphoria. William (now Sarah) Muirhead-Allwood gets a relatively good press in some broadsheets and attention is focused on the behaviour of the Sunday tabloid involved in the story.
Early April	Press for Change encourages all transsexual people to apply at once for their birth certificates to be altered in the light of new scientific findings, and reflecting a possible opportunity created by the judgement in the unsuccessful Judicial review. The OPCS ends up dedicating an official, full time, to systematically reject the applications.
April 30th	The event of the year. The European Court of Justice confirms the Advocate General's December recommendation, that `P' was discriminated on the grounds of sex when dismissed by her manager `S' and employers Cornwall County Council. Another brief media flutter ensues, although there is little to report ... for `P' remains `P', an anonymous icon immune from caricature.
Early May	Even less well publicised, another English employment tribunal considers whether the P vs S ruling applies beyond so-called emanations of the state, to private employers too. The court decides in the case of `N' that the ruling does apply, but the employers vow to appeal.

If P vs S had one lasting effect, apart from the obvious, then it was to further reinforce the message to thousands of hidden transsexuals in the community that it was now possible to go for it. To seek compensation for the crude and extraordinary treatment they'd endured at the hands of employers and the people whom you might have expected to know better ... their doctors and health authorities.

We'd always known that the majority of health authorities had a poor record of care in terms of transsexuals. Research conducted for the Parliamentary Forum on Transsexualism confirmed that impression. What was more astonishing, however, was the lengths that authorities were prepared to go to in order to circumvent actions threatened by people who were denied basic therapeutic assessment, let alone hormonal and surgical treatment. Once informed of their legal obligation to treat transsexual people within the NHS, the trusts then seemingly went out of their way to concoct regimes that could only be designed to inflict as much delay and anguish as possible upon the patients ... and this remains an area to be tackled. New rules have thrown out previous treatment and assessment records and put patients in some authorities to the back of the queue at the one grossly overloaded centre which is entrusted with the work ... at Charing Cross Hospital in London. Those actually reaching the end of the assessment process, too, then find an unwillingness to fund their surgery ... or that surgery is scheduled and then, for no reason, cancelled days beforehand.

As one observer commented..

These are people who, through hormone treatment, have long since stopped looking like a member of their natal sex ... and who have taken work leave and endured the effects of coming off that hormone regime in preparation for surgery. They are, literally, in a state of limbo. Neither able to function as one sex or the other. To cancel their surgery just hours beforehand, when the surgeon is free and beds are free, is hard to credit.

Some of the attitudes which inform this type of behaviour became apparent to us, however, as May and June became the time for leaks and reports…

Early May	Press for Change obtains and publishes a health authority report recommending a regime of assessment and treatment. Few transsexuals recognise the creatures which the report describes, but it is progress at least.
-	A fitter in the RAF takes the government to court for wrongful dismissal after being diagnosed as transsexual.
-	The Gender and Sexuality Alliance (G&SA) submits a report to HM Prison Service for a review on the treatment of transsexual prisoners. The report highlights cruel and exceptional treatment, and a system biased against any attempts to rehabilitate transsexual inmates. Tales of sexual abuse emerge ... and a blackmail case involving Harrods illustrates very clearly that transsexual offenders can expect disproportionately punitive treatment in court.
-	The press gets concerned about alleged levels of oestrogen-like chemicals in baby milk formula. The talk is about fertility effects. Nobody wants to discuss the far more serious possibilities on brain development from pre and post natal environmental oestrogens and anti-androgens ... and the world that awaits those we may be poisoning.
-	The Daily Mail reports on a leaked document from the Cabinet Office concerning transsexual rights issues, and passes it to press for Change for comment. The Home Secretary angrily refutes any suggestion that a review should be led by his department.
May 22nd	Rights of another kind hit the press, and the Gay rights movement in the United States shifts into a new gear ... this time with long overdue recognition of the benefits to be had from uniting with transgendered groups out of common interest. The Romer vs Evans ruling is the first shot of many, striking down Colorado state attempts to reverse anti-discrimination laws. People are talking about same sex marriages so loudly that they fail to realise that transgendered Americans have been enjoying them for years.
June	The G & SA reports depressing research that the majority of Rape Crisis Centres have policies excluding transsexual women ... and the attitude of women's groups in general towards transsexuals of both sexes becomes an issue for debate as PFC activists take up invitations to speak at Lesbian, Bisexual and Gay events. The good news is that people prove ready to listen, to learn, and to revise their opinions.
-	Press for Change publishes research into the case of Ewan Forbes-Semphill, a story almost completely erased from the public records in 1967, and which was mysteriously passed-over in the Corbett vs Corbett case that followed two years later. Conspiracy theories abound.

The depressing aspect to July was that even as we finally started to think that we'd actually made headway in eliminating ignorant attitudes from other minorities towards the transgendered, some transsexual people were standing up to prove the depressing fact that small mindedness and fear are universal human traits. In Press for Change we started to get angry and condemnatory letters demanding to know why we were taking part in the Pride 96 march .. and why, indeed, it was now known as the Lesbian, Gay, Bisexual and Transgendered pride! Some, it seems, thought they'd achieved integration and acceptance in their communities by showing that they were just as capable as them at being bigoted. Mercifully, however, the letters pages in journals on all sides were to show that the bigots are well outnumbered ... and London's Pridewas judged a great success all round.

As summer took us nearer and nearer to the silly season though, and as we anticipated another flurry of legal activity, the more important question was whether we were now building on solid journalistic and legal foundations, or not.

July	Radio Four's Today programme displays a sudden penchant for transgendered stories ... first with a feature (completely out of the blue) about Chinese Lesbians and Gays having sex reassignment surgery in desperate attempts to legalise their lifestyles and relationships ... and then with the news that the Japanese government was at last debating whether to legalise surgery. The subtext in the Chinese report is that homosexuality and transsexuality are two very different things and there is some irony in the observation that China regards the latter as a quite legitimate medical necessity and the former as an abhorrence. The conditions aren't exclusively western phenomena ... merely our peculiar regard for them.
July 6th	Press for Change leads a contingent of twenty-or-so rather ordinary looking transgendered people near the head of the Pride 96 procession in London.
July 17th	A transsexual man appeals against the nullification of his marriage after 17 years, in a case which demonstrates that the judges are now treading far more carefully. There appears to be a desire to embrace what is happening elsewhere in the world (New Zealand in particular), and to reflect the implications of the work published in Nature. Lord Justice Ward, announcing a deferral on the decision, says "We are aware of the growing body of medical and international opinion that this court will ignore at its peril".
August	Channel Four screens a series entitled Dark Secrets. Entire half hour programs explore the taboo topics of incomplete or hermaphroditic genital formation and the condition known as Androgen Insensitivity Syndrome ... the condition that produces women who are chromosomally male. The last program in the series, dealing with transsexual men, is a huge disappointment though.
-	Channel Four also screens the film Thanks a Bunch Mr Ormerod by Pamela Jane Hunt, one of a few television producers who happens to be a transsexual woman. The programme, with its' unusual imagery, has mixed reviews from both the press and the transsexual community.
Aug 27th	The XYZ case finally opens in the European Court of Human Rights and provides a new excuse for a round of news pieces and media appearances. The Daily Mail names PFC's Dr Stephen Whittle as the plaintiff, and Stephen shows a lot of style as a personality-in-the-making, with an appearance on Radio Four's Midweek establishing him, above all, as a likeable and essentially rather ordinary Father concerned for the welfare of his children.
Sep 3rd	And, not to be outdone, a new producer in the Kilroy camp, decides that it's time for a third look at transsexuality ... in what turns out to be a far-from-civilised debate.

In a far less glamorous vein, September was a busy time for some PFC activists, preparing to take stall space at University Freshers' week events up and down the country. For, all of a sudden, both the academic world and student lesbian and gay groups had noticed a whole new topic for discussion. Over in the United States things seemed to be hotting up too ... and we hoped to follow through on the XYZ case with a compensation hearing for `P'.

Early Sep

The United States panics when faced with the back-door legalisation of same sex marriages and rushes in the Defence of Marriage Act (DoMA). It is a long awaited opportunity for US transgender activists to claw their way to the centre of the fight back ... pointing out that the new law threatens, uniquely, to unmarry countless Americans who've had legal gender changes but whose partners stuck faithfully to their marriage vows. It's an opportunity, too, to argue for transgender inclusion in the anti-discrimination legislation, ENDA ... for, whilst UK transsexuals have won employment protection and struggle for legal recognition, Americans face the opposite problem.

The final chapter of P vs S and Cornwall County Council should have been her return to the Truro employment tribunal, where she had begun, to seek damages for the unlawful termination of her employment. A five figure sum is expected eventually. In the event, the day came and went, as her former manager and employers sought a deferral of the hearing, “to give them more time.” And it now seems that we'll have to wait till later in 1997 for an outcome.

In some ways we can look back now and see that the Conservative and Labour Party conference fringe events, organised by PFC for the first time in October 1995, were something of a watershed. The previous year, at the Liberal Democrat conference, a similar event had been feasted upon greedily by the press. It was treated as a great laugh. In October 1995 the press turned up at the Labour party event expecting something similar ... and left somewhat disappointed. They didn't get what they wanted, and they weren't ready to print what we wanted. By the next week, at the Conservative Party Conference we were relying on favours from broadcasters we knew to even get a presence. The success of those events lay, in fact, not in the coverage ... and certainly not in the paltry turnout of an audience ... but in the message conveyed by the disinterest. Transsexuals were becoming safe for politicians to associate with. We were therefore rather unsure what to expect out of going back to the conference fringe this year and, in the event, decided at the last moment to give the Conservatives up as a lost cause for the moment, and concentrate our efforts on the Labour fringe instead. It was also a month for broadening the range of issues we are fighting. October, in fact, became a month for consolidation.

Oct 3rd	Press for Change holds a fringe meeting at the Labour Party conference. The press stay away this year, but their places are taken by a much bigger audience of politicians and activists, deeply moved as one of the transsexual speakers dissolves into tears. People confess astonishment : they still weren't aware of the petty and not-so-petty realities endured by transsexual people. Several new speaking invitations are issued ... and delegates go away to tell their colleagues what they missed.
Oct 7th	A transsexual woman takes West Midlands Police to court for wrongful dismissal after they had changed their minds about employing her in the middle of her training. They were worried about conflicts between her legal status and the rules governing the sex of officers carrying out body searches on suspects ... and solved the problem by dismissing her.
-	Back on the less glamorous side of campaign work, another PFC activist has been taking on a life insurance company ... using the weight of medical and legal opinion built up over the year to make the case that there is no reason why they should not treat her as a woman, and so eliminate the breaches of privacy she would otherwise have to endure when dealing with them in the future. That just leaves health insurance, motor cover and pensions to fight over.
-	Other activists reported successes too in getting unions and employers to formulate transgender-inclusive equal opportunities policies ... in an area where it has often been wrongly assumed that a policy covering sexuality is sufficient. (It isn't).
Oct 28th	And just to round off the month we are treated to the rather overdue decision that a transsexual woman can at last, in the eyes of the law, be a rape victim. The ruling by Mr Justice Hooper in Reading Crown court is the more remarkable as it has taken over two years since male rape was recognised, for the law to be extended in this way to transsexual women too. The decision was barely reported, and almost twenty seven years of sexual violence and intimidation mandated by another consequence of the Corbett v Corbett decision are now, presumably, to be swept under the carpet and forgotten. In some respects, at least, rapists have always displayed far better manners than lawyers ... ready to treat transsexual women as women regardless.

It wasn't all positive news as the year drew towards a close. In November, the man appealing against the annulment of his marriage lost ... although as his solicitor said afterwards :

“We lost [the case] but on the facts, rather than on the laws. There was clear indication from the judges that they believe that Corbett needs revisiting, and perhaps an analysis of the law should take into account the concept of gender rather than sex. They said that the New Zealand case and the jurisprudence from the US could not lightly be dismissed and in those cases it was said that once a transsexual has undergone treatment, and the other party is aware of their condition, then there is no legal impediment to marriage.”

We started November with a very tangible piece of recognition though ... as Press for Change found itself shortlisted in the nominations for Campaign of the Year in the British Social Services Media Awards, run by Jewish Care. We didn't win, but the breakfast reception in London's Berkeley Square were an opportunity for networking, and for reflecting that a few years ago we wouldn't have even been considered.

In December too we learned that Channel Four Television are now planning an entire season of programmes about transsexuality for the Spring of 1997 ... an opportunity to rerun programmes made in the past and, perhaps, add something new to gradually developing public sophistication and awareness too.

So, as I witnessed last week, maybe we'll see more transsexual people taking a part in television programmes about something other than their transsexuality. Or ... perhaps more accurately ... those of us in the know will see them and it won't be the tabloids' public duty to warn the rest. A well known Liberal Democrat councillor from Tonbridge may be able to advance his political career further. A talented magician may advance her broadcasting career. A surgeon may go on doing what she has been trained to do ... and airline pilots, solicitors, lawyers and the rest may just get on and do the jobs they're good at. It would be nice to think that 1997 might be the year, too, when 5,000 Britons recover the right to marry and participate in family life like anyone else ... but then perhaps I'm getting ahead of myself. After all, it's taken 27 years to reach this point. It would be a major advance just to enable transsexual people to die with dignity .. with a death certificate which records their death, rather than the death of a person who never was. The idea that we might officially recognise the birth ritual of the real person might take a bit longer.

What cannot be denied, however, is that we approach 1997 in a very different position to the one we were in just one year ago ... and light years from the status we endured just five years before that.

It's not time yet to congratulate ourselves. Being transsexual is still a serious issue. The fear and ignorance cultivated by almost seventy years of institutional misrepresentation cannot be erased from society's programming overnight. That will take decades, although official recognition can accelerate the process. By gradually taking the fear and stigma out of transsexuality, however, we pave the way towards that future and ensure that the eventual establishment of a mechanism to recognise the correction of an individual's status is a courtesy, rather than a concession.

And a world that's capable of respecting an individual's right to accept and accommodate such a fundamental aspect of the way in which they relate to others, might just be a better world for everyone else too.

Happy new year. May it be a liberating one for you too.

Christine Burns
December 30th, 1996

Ten things you'll miss when the NHS has been eviscerated

2011-09-08T17:30:00.001+01:00

Last night the Health and Social Care bill passed its third reading in the House of Commons owing to the natural majority of the coalition government. It passed by a majority of 65 votes (316 to 251) after four Lib Dems voted against it and ten abstained.

The report stage debate, which preceded the final vote, epitomised all that is now worst about our democratic system.

Over 1,000 amendments were added at the eleventh hour, in ways that couldn't possibly be challenged. Ninety minutes of the precious debating time was given over to consideration of an abortion provision tabled by Nadine Dorries. And, if you watched it on TV, you would have seen very few MPs in the chamber, as legislation to radically alter a precious 63 year old institution was waved through in what had become a formality.

Still time

The bill is not law yet ... it still has to pass through the House of Lords ... although many changes had already taken place in the NHS structure before a word of the bill had been scrutinised by the Commons. Such is the contempt which the present administration has for due process.

There is a campaign to persuade members of the Lords to challenge and scrutinise the legislation. This website will give you the name of a Peer to 'adopt', and you're then encouraged to write to them.

Peers don't have constituencies and are not elected, so they don't have to fear the ballot box. This is why people don't often lobby them direct. Conversely, it's hoped that the novelty of a mass campaign appealing to the Peers' sense of independence and traditional constitutional role, will embolden their lordships to give the government a bloody nose.

Any popular campaign relies on people understanding why it is important to act. In this case the cause has not been helped by certain of the mass media (the BBC in particular) failing to challenge the issues effectively.

I have asked people to reach beyond social media networks and talk to their families, friends and coworkers about the issues, and to get them involved in lobbying the Lords. However, people have rightly pointed out that that is difficult to do if people can't readily understand what the changes will mean in personal terms if they go through.

So here are some consequences to discuss with your friends.

Ten things you'll miss

When you go to see your GP and they say you don't need to see a consultant or should take such and such a drug you will no longer be sure whether that decision is because it is best for you or because the GP has their eyes on a new Mercedes. Giving groups of GPs (now called Clinical Commissioning Groups) control of £80,000,000,000 of the NHS budget means just that.
When it takes longer to get an appointment with the GP it is likely to be because they are spending less time doing medicine and more time in meetings with staff from companies like KPMG who are making their commissioning plans for the board to rubber stamp. Commissioning is a complex process. Don't imagine it can be achieved in a few minutes round a desk by a bunch of GPs in their coffee break. The health consulting industry is poised to move in. And how many GPs will know enough to challenge the advice of the experts, with all those impressive charts they'll have?
If you want to challenge those plans then you'll find that the Clinical Commissioning Group that your practice is part of has decided that the meetings about such important things must happen in private. You'll find local politicians hamstrung because of the complexity of the system and the relationships between bodies.Even the experts haven't figured out yet how it will all work.
If your GP does say you need to see a consultant then you'll find that there's an awfully long waiting list because your local hospital will be selling as much as 50% of its capacity to private patients. This is something that existing NHS hospitals will need to do just to balance the books, especially as the government starts rationing public money for the system, year on year.
If your care requires collaboration then you'll find it can't happen because parts of the care path are being run by private companies who use different systems and, besides, planning services in that way could be seen as anti-competitive. The experts are still arguing whether the system known as 'Any Qualified Provider' means decisions about working together can be challenged using European Competition Law. What is certain is that GPs won't know, and that the big money private providers lining up to exploit the uncertainty have pockets deep enough to afford the very best lawyers to challenge every commissioning decision they don't like.
If you have a specialist need then you'll find you can no longer use your local hospital because your doctor's commissioning group has contracted each condition to different private services which, for efficiency, serve large areas and are located 50 miles away. Note that some of the first services to be contracted out in this way will be things like maternity services, because the cost profile of these is very attractive to private providers. Your local NHS hospital will be left with the complex, chronic, expensive cases. It will have to take on private cases itself in order to make ends meet.
In the longer term you'll find a system in which doctors and nurses become increasingly scarce and are not keeping their skills up to date, because the system of teaching hospitals has broken down and the private providers don't want to spend profits on training junior doctors. The Strategic Health Authorities who currently manage the commissioning and provision of training and ongoing development will be abolished in a couple of years and the health bill currently has no plan in it to replace that function. Health Education England (as mentioned by one of those White Papers that came out like confetti last autumn) is still no more than just a name.
The question of which practice you register with will suddenly be a lot more crucial, as this will determine which Clinical Commissioning Group will be paying for any care you need. Health will no longer be planned on the basis of the needs of a locality, but on the basis of the business plan for that collection of practices. Two adjacent surgeries may have very different budgetary priorities and it is quite possible this may actually be used in a deliberate way. For instance, a Clinical Commissioning Group (CCG) whose patients are all young middle class earning professionals without long term illnesses will have a much different cost base than one dealing with patients with chronic illnesses. PCTs currently balance that up by something called 'risk pooling'. Most PCTs serve populations of 150-300,000 people. Within that there will be an average mix of all needs .. so the budget can withstand patients who suddenly need £70,000 on a heart transplant or long term kidney dialysis. If the balance is disturbed then the services with young and fit patients will pocket their profits whilst those serving less well patients will have to ration or go bust. Commissioning Groups WILL be able to go bust, like hospitals. So, if your GP says their list is full but the waiting room looks empty you'll just have to wonder...
We don't know how the system will stand up when there is an epidemic or other health crisis because the whole system of public health is about to be reorganised on new lines and the SHAs and PCTs who formerly planned for and coordinated the system's response to crises are already being taken apart and disbanded.
And when all of this goes wrong, you are also likely to find that the Secretary of State for Health will step back and claim that his hands are tied and that it's all now out of his control, because the traditional accountability vested in him for the last 63 years has been turned into something that armies of lawyers and politicians are still arguing over. Yesterday, in Parliament, the government and opposition had two diametrically opposed legal opinions on this point, which is the first clause in the legislation.

And just a reminder

The NHS wasn't broken in the first place. In fact, various studies indicate that the present system has been on an all time high in terms of public approval, and that Britain's health service delivers top class results for less percentage of national GDP than other systems.

The case for change was not backed by any evidence. Although a system this large and complex (employing 1.4 million staff) could always be improved around the edges, it was fundamentally healthy.

There is now only one chance left to prevent the government's wrecking bill from becoming law, and that is to persuade the House of Lords to show its teeth. The degree to which they do that will depend on how much you can persuade your friends and family to pester them about it.

When the NHS is gone, it's gone. These changes will not be able to be reversed.

The majority of Britons have been born and grew up under a health service that was run for the public good rather than for profit, and which was strategically managed in all our interests. Mostly we take it for granted that it is there when we need it. The rest of the time people probably don't think about it that much.

One day, when you need it, you may discover (too late) that these changes really were as serious as I've said.

In the meantime, have you noticed the sudden glut of advertisements for private health insurance?

In Memoriam: Jodie - Crumpsall's Popular "It" Girl

2011-07-15T15:06:00.001+01:00

This piece was written by me in 2006. Until now I had forgotten about it.

Today I needed to explain Jodie's case to someone and I was suddenly reminded.

I thought it deserved the bigger readership which I can nowadays give it.

And there's always a little thought in the back of my mind about whether I should have been more nosy ... more of an advocate.

Born 20-Aug-72 Died 2006

If you had happened to be around North Manchester's Crumpsall district at any time in the last few years then chances are you might have encountered Jodie.

If you had met her you'd know it. She might very probably have told you to "F" Off. She might have hit you with an (invariably) empty spirit bottle. Or, now and then, she could have given you a cuddle.

When friends gathered at the nearby crematorium to say a last goodbye, the consensus was that Jodie was often given to bursts of anger - and that she was nothing if not unpredictable.

A private matter

Mind you, Jodie could easily be forgiven her violet outbursts and acid tongue; by all accounts she had had a pretty sorrowful past.

In my "day job" I used to be involved in the business management of a company that runs care homes for people with learning disabilities or long term mental health problems.

As I was focussed on the efficient running of the organisation and I wasn't a care worker myself, I always used to take a very strict line over the private and confidential backgrounds of our residents.

Unless I had a need to know then it was simply not my business to ask. And if people gossip, as they unfortunately do, then I generally did my best to tune out.

Nevertheless, there was a kind of inevitability about the fact I would end up learning more than usual about Jodie.

Abused

Details were sketchy, but (reading between the lines) it became apparent that this 34 year old woman who once lived with us had some kind of physical intersex condition when she was born. It was enough of an ambiguity for local Police to have once posed the question, "Is 'IT' a man or a woman".

As I gleaned eventually, on the way to her funeral, this had also been the key to how she came to be in care.

I learned that Jodie had had a horribly abused childhood.

Many of our service users sadly had nobody in the world listed as their next of kin. That's how long term mentally ill people are often treated by their families. But I was surprised to learn that Jodie wasn't born with her paranoid schizophrenia; she acquired it from a childhood filled with alcohol and drug abuse and more.

So it was that, when she turned 18 years of age, she was quickly taken into adult care.

For those of us who've been well versed in the stories of children assigned one sex or the other without consent as babies, Jodie's "medical" treatment might seem a little odd.

Again I learned on the way to her funeral that although she clearly and unequivocally came across to everyone as a young woman, and although the discrimination she found was linked with her physical ambiguity, the psychiatrists treating adult Jodie were reluctant to operate through fears related to her questionnable capacity to give legal consent.

They were afraid she might get better, think differently, and sue them.

From pillar to post

She went through a variety of institutions and care homes in her short life, ending up at one of ours for a few precious years before being taken away from that too in February 2004.

When she left I clearly remember some staff commenting, off the record, that they expected she would probably end up dead before too long. Two years later they were unfortunately proved right.

A problem nobody wanted

For social workers Jodie was a problem.

She had only to have a cuddle with a man for folks to start looking worried and consulting their guidelines on "same sex" intimacies.

Maybe that was also the reason why the system didn't seem able to find another stable residential home for her to go to when she moved on.

Instead she found her way to the hostels for homeless people in the City where, predictably perhaps, they didn't seem to know what to do with her either.

Could that have been connected with a physically ambiguous woman trying to find accommodation in a single sex hostel? I honestly don't know, but speculation of that kind is inevitable.

Homeless, but not friendless

Before too long Jodie was therefore literally living on the streets, or crashing with local friends with alcohol and drug problems of their own. How she died is unclear even now. All we know is that it was seven or eight weeks before her body could finally be released for a state-funded cremation.

I couldn't describe myself as really knowing Jodie .. other than to pass and say hello now and then when she lived in our largest home. When I learned of her funeral I wanted to go though. Part of me was awfully afraid of her leaving this world with nobody there.

I needn't have concerned myself on that front.

To my delight the little Crematorium Chapel was in fact packed. Male friends of hers, clearly with mental disabilities of their own, took instruction on how to carry her coffin into the Chapel before us. Female friends wept for a departed friend.

The speakers played Roy Orbison as we followed her casket :

Pretty woman, walkin' down the street,
Pretty woman The kind I like to meet
Pretty woman I don't believe you, You're not the truth
No one could look as good as you.
Pretty woman, won't you pardon me?
Pretty woman, I couldn't help but see,
Pretty woman, that you look lovely as can be.
Are you lonely just like me?...

Fondly remembered

Her community psychiatric nurse, a caring sort of man, delivered a eulogy that was honest rather than false.

He described their first meeting -- with Jodie unconscious in his doorway, her body for some reason covered in potato crisps. He spoke ruefully of her attacking him with a high heeled shoe -- of her hitting him with an empty spirit bottle.

The minister spoke likewise about being told to "F" Off one day on the street, yet finding her in prayer the next.

There was no point in covering for the reality of Jodie's mental condition and yet it struck me that these people had seen past that and found someone to love, for ALL her shortcomings and flaws.

And nobody was in any doubt as to Jodie's gender. It wasn't even an appropriate question.

As we said goodbye to her and left the chapel it was snowing hard.

"Jodie loved the snow" said our area manager, who had known Jodie for years too.

It seemed in the biting cold that she had a way of still making her presence felt.

30 Years On - The Bradford Twelve

2011-07-12T22:14:00.001+01:00

July 16th 2011 will mark the thirtieth anniversary of a campaign supporting what became known as the 'Bradford Twelve'.

On that day in 1981 a dozen young Asian men from the United Black Youth League were arrested in dawn raids across the city and charged with conspiracy to make explosives and to cause explosions.

The case was set against a backdrop of racist attacks on black and asian communities in Britain, which the Police had done little to address.

The defendants asserted that "Self defence is NO offence" and the hearing of their case lifted the lid on racism in Britain at that time.

Shahnaz Ali (pictured centre) was a teenage girl at the time and was very much involved in the United Black Youth League in Bradford. She was taken for questioning and came close to being charged with conspiracy herself.

Now a senior public sector official, Shahnaz looks back on those events with me in this Podcast interview, and describes what it was like to almost become the thirteenth defendant.

Showing off our wares

2011-07-05T20:34:00.001+01:00

Regular followers of this blog will know that my main work these days is as the E&D Programme Manager at NHS North West.

NHS North West is one of England's ten regional Strategic Health Authorities.

An SHA is a kind of regional extension of the Department of Health, channelling funding from the centre to a network of Primary Care Trusts (PCTs) who, in turn, decide how to spend that money on local services to meet the needs of their populations.

The SHA is then responsible for setting strategic direction and monitoring the performance of the whole 'system'.

It's a huge undertaking. In the North West, the SHA has a budget of £12,000,000,000, oversees a system of 63 organisations employing 220,000 staff, and ultimately addresses the needs of almost 6.9 million people living in a geographically massive region.

A story to tell

Earlier this year I published a series of blogs describing our team's philosophy where Equality and Diversity is concerned. The seventh article in that series provides a handy index into most of these articles.

Since then I've also published a few additional pieces about recent advances, such as the launch of our LGB&T History timeline and a unique practical guide to monitoring sexual orientation.

And if you're wondering why all of this matters then here's a reminder.

Credit where it's due

We are very proud of our achievements as a team.

Our work is led by Shahnaz Ali (pictured right), who is simply one of the most effective innovators I've ever met in this field. I don't think her mind ever stops, and she is a brilliant networker. It is her energy that gets so much out of all of us, as a small but very productive team.

My job, as programme manager, is to catch all the balls she throws and ensure everything gets delivered. Along the way I bring in my various creative and project management talents to flesh things out.

Then there is our communications and engagement lead, Loren Grant, who is simply brilliant at coordinating the talents of our creative contractors, organising the nitty gritty details of events, writing publicity and newsletter materials, running up Powerpoints, and generally producing stuff.

Telling the world

The NHS is a huge place. Overall it employs 1.4 million people. The only larger single organisation is the Chinese Army.

It is never therefore enough to just create good strategies and solutions. You have to work very hard to tell people what you are doing and where to go for expertise. Even in our own region it is a significant task to communicate regularly with 63 NHS organisations.

That's why this week we are off to staff our own exhibition stand at the NHS Confederation Conference in Manchester.

If you happen to be an NHS type and are visiting the conference do drop by to say hello. You'll find us on stand B27.

The Trans Tapes

2011-07-02T17:40:00.001+01:00

I was discussing today with globe trotting blogger Cheryl Morgan the value for young trans people in being able to hear and see older (long settled) trans role models ... a need which mainstream Film, TV and radio are still (as yet) tending to neglect.

Historically, where trans people have been featured on Film, TV or the radio it has tended to be as curiosities, gimmick plot devices, villains or as figures of amusement.

Juliet Jacques discusses the latter in a recent article for the New Statesman. She and I also talked about the broader issues when I interviewed her for my Podcast a few months ago.

Wikipedia provides a long list of films from which you can draw your own conclusions. The topic has also been analysed at length by several other commentators, such as this example from 2007. Others you can find easily via Google.

All this is then reflected in how trans people say they experience the media, as in this report recently published by Trans Media Watch.

A changing landscape

There is no doubt that things are gradually changing. Channel 4, ITV and the BBC have all developed trans characters through their prime time serial dramas, such as Hollyoaks, Coronation Street and Waterloo Road. This is at least a start.

Such stories have been far better researched and characterised than in the past. Nevertheless, the parts are always still played by non-trans performers, and the story lines are almost always around the travails of transition, having surgery, being outed, or otherwise having problems directly related to a trans background.

There is obviously still a long way to go .. though I could entirely sympathise with those trans actors who wouldn't want to become pigeonholed forever by playing trans roles.

Something has to happen before it's possible for trans performers (and they are out there playing non-trans parts) to out themselves and play a mix of roles (in the way that lesbian and gay actors can still get straight parts).

I discussed this dilemma in interviews with both Calpernia Addams and Adele Anderson.

Role Model lives

In my previous blog (and the comments that followed) it was clear that there are many potential role models in real life, happily getting on with valued work, supporting themselves, having fantastic social lives and settled with lovers or long term partners. They're just not being seen outside of their own circle of influence.

These people's lives are far beyond the stories that the media are fixated upon. They have things to say, and except for those few who write for mainstream publications, they are not being heard.

World wide there are even more names to choose from. This site by Lynn Conway, for instance, documents hundreds of examples of trans women ... although it has been criticised for appearing to privilege looks and passability. There is also an equivalent section about trans men.

The Trans Tapes

Although the Just Plain Sense Podcast is about diversity as a whole, I have tried to feature trans people and trans topics as much as I can within reason.

I thought it would therefore be a useful contribution to bring all those programmes together in one place which is easy to bookmark, share and return to.

If you think that's useful why not mention it to your friends. And if you think more voices should be heard this way, why not pick up a microphone or video camera and start featuring more yourself.

The Performers

Calpernia Addams - on the murder of her boyfriend, the aftermath, and making a career in the media

Adele Anderson - on being one third of the group 'Fascinating Aida'

... and on being a trans performer and entertainer

Nadia Almada - on growing up, coming to Britain, transition, winning Big Brother, and her life after

The Activists, Writers and Academics

Professor Stephen Whittle OBE - on growing up, transitioning, and developing into a law professor

Mark Rees - on growing up, transitioning, taking the UK to court, and retirement

Professor Lynn Conway - on transitioning, rebuilding a career, and being a microchip industry pioneer

Professor Joan Roughgarden - on transitioning mid career, support from Condoleezza Rice, and challenging Darwin

Juliet Jacques - on writing her groundbreaking blog in the Guardian and about trans people in the media

Trans Kids and their parents

A mother's tale - on coping when a small child says they have a girl brain in a boy body

The adolescent hormone blocking debate

Mother and trans daughter update the hormone debate

Events and Issues discussed

Adopting children

Hate crime - The International Transgender Day of Remembrance

Charing Cross - Clinician Dr Stuart Lorimer talks about the service

Media Portrayals - The launch of a Memorandum of Understanding

Thank you, but...

2011-06-25T20:10:00.001+01:00

We can all do with a little recognition now and then, can't we?

But when recognition is awarded in a clumsy and cack-handed fashion the result can be the very opposite to what was intended.

I learned this week that I've been placed as number 96 in a 100-strong 'Power List' dreamed up by a London listings magazine - one behind singer George Michael, but one ahead of a "talented pantomime dame".

First I was cautiously bemused. Then I was annoyed. Finally I was embarrassed.

Let me tell you why...

A game everyone can play

Like I say, everyone likes recognition.

Do mothers protest against Mother's Day? Hardly. As children we are all raised to take part in the ritual. We buy into the symbolism so much that it's unlikely you'd find many new Mums to argue against being on the receiving end when their turn comes.

The same goes for the other half of the population. Last Sunday it was Father's Day. Even men whose sole contribution has been no more than a proverbial "cock-up" expect to be recognised by some little token of pampering when the day comes round each year.

If we are to discuss systems of recognition, therefore, we have to enter with our eyes open.

Divisive

We ALL take part, with duties and expectations. If Sandra next door gets chocolates for being a mum, the chances are you may feel aggrieved if you don't get the same.

Recognition is hugely divisive that way.

Being awarded the prestige of an MBE a few years ago I know how destructive that divisiveness can be.

However much my colleagues and I may have deserved national recognition for the voluntary work we put in over decades, the fact remains that our awards left other colleagues, who had also worked hard, feeling overlooked.

It is one thing to all work hard for no return. It becomes something else when some are recognised and some are not.

In our own case national awards worked like ice forming in the cracks between paving stones. Fantastically effective partnerships that were key to our successes in the first place were put under strain and fractured.

In fact I have a theory. If a government really wants to screw up a political movement then all they have to do is lavish favours on some parts of a coalition and ignore the others. A strong overnight frost then does the rest.

So that's my declaration of interest in this matter. However, I digress.

Without warning

I learned about my new 'recognition' quite by accident earlier this week. The Pride Power List had apparently just been published by the London listings magazine Time Out.

An erstwhile colleague challenged one of the compilers, the gay author Paul Burston, on why there didn't seem to be any trans people on a list of the great and good in LGBT society. He tagged me in the facebook thread where Burston replied.

And that is how I was informed that I had been put on this list, tucked away near the end where my friend hadn't first noticed.

Not another list

Time Out's compilation of LGBT glitterati is not the first attempt to list and rank queer people for some kind of recognition.

The Independent on Sunday's annual Pink List is perhaps the most established compilation in the UK.

Each year's selection is bound to attract controversy. In fact I suspect they are designed to. It's both a publicist's and a blogger's wet dream.

(Hey, and what am I doing? Aw shucks, sorry ... I know)

Objective? Well...

It's hard to know where to start picking fault with lists like these. The flaws are so obvious.

Quite apart from the divisiveness which I've already mentioned, what's the basis for picking names for a list of 100 'top' LGBT people?

A list of the top 100 ranked by personal wealth or Body Mass Index I could perhaps understand. These are measures which could be indisputably objective. Maybe even health-promoting.

I could even understand a list based on public votes .. although those are susceptible to distortion. I could ask my 1500 Twitter followers to vote for me and my associates, for instance. (Actually, that would be one measure of "power and influence" of sorts).

But how are these lists compiled?

Well, in the case of the Time Out list, Pride London publisher Linda Riley explains,

'We have tried to make it more public-oriented [than the IoS Pink List] by asking the advice of a wider selection of people and organisations. The original top 300 were sourced by various people, who were given the chance to submit their favourites. This means there are entries who aren’t necessarily known to the wider public and not necessarily famous, such as business professionals. The list celebrates those who have contributed through their work to the LGBT community and/or have influence on the LGBT community by being inspirational role models.’

The magazine continues,

The final list of 100 was decided by judges Ben Summerskill, chief executive of Stonewall; Angela Eagle, MP for Wallasey and one of only two out lesbian MPs; and Linda Riley, managing director of Square Peg Media (publisher of Pride London).

So, you could say that the compilers have tried to cover both bases. They've tried to acknowledge public opinion, and then narrowed that down by committee.

Subjectivities

But this is where all the usual issues of subjectivity arise.

Already this week I've seen some folks say how they feel that the committee's makeup automatically lends a kind of institutional bias to the process.

To quote some of the comments that you can see below the list,

What about the THREE openly-gay Government Ministers? What about the Deputy Mayor of London and the Prime Minister's Political Head of Media, just to mention a few?

And this...

...there are countless numbers of gay men and women across the country doing sterling work in their own community. An example is Paul Martin CEO of the LG Foundation in Manchester who was recently award an OBE in the Queen's Birthday Honours last week. His work in the north west has an impact in London to. Other people to be considered are Derek Bodell and Deborah Jack who steered and continue to steer policy and campaign on HIV and AIDS booth here in the UK and internationally. As does the work of Lance Corporal James Wharton, Household Division who visits schools to combat homophobia in an attempt to serve Queens and Country. Fantastic that Time Out is doing this and to see my old mates Paul Burston and Stella Duffy high up in the list!

And this...

...Lynette Nusbacher, former lecturer at Sandhurst and counter-terrorism advisor to the PM's department. Kate Craig-Wood, Entrepreneur and founder of one of the UK's largest IT groups... But that would be 3 Transsexual women on the list, well above quota.

The names you leave off a list like this assume much more importance than the names you include.

What counts?

Then, of course, there is a well exercised debate about the relative merits of sportspeople and celebrities versus activists, politicians and entrepreneurs.

There are many ways of wielding influence. They're not all obvious. Indeed, some of my own most influential work happens in ways that are not public. You only tease out that kind of influence by engaging genuine peers who understand that in the shortlisting process.

What kind of influence are we counting? People who are role models to the public? Role models for other (especially young) LGBT people? Or people who open doors in business and the corridors of power by leaving an indelible memory that LGBT people can be exceptional contributors, managers and leaders?

Time served?

A vast proportion of the celebrities and politicians on both the Time Out and the Independent on Sunday's lists are people who acquired their power and influence whilst in the closet.

Much of the controversy about last summer's Pink List was about awarding top ten ranking to people who had only recently revealed their sexuality. Last year's Number One was the Rugby Player Gareth Thomas, who had only come out eight months previously.

The IoS explained:

The revelation of Thomas's homosexuality in an interview with the Daily Mail last December confirmed what had been an open secret in rugby union for years after his separation from his wife, but it highlighted the taboo over gay people in professional sport. [..] From living a lie, he has taken on the role of campaigner, working with Childline to reach out to young people facing the dilemma with which he struggled from the age of 17.

Significantly, Thomas tops the Time Out list too.

Unfair advantage?

Trading off the benefits of building a career in the closet is bound to be controversial for some.

For instance, whereas it may be a choice for lesbian, gay and bisexual people it is less of an option for trans people. Given the paucity of trans people on lists like this (I'm the only one so far) this ability to judge when to come out without harming your career is bound to be a bone of contention.

Journalist and Blogger Patrick Strudwick (No. 87 on the Time Out list) has argued in Gay Times that closeted gay people in the media are shirking their responsibilities when they fail to come out. He says,

While pampered public figures indulge their closeted concerns about the effect that being open and honest might have on their career – and, to be fair, on their personal life – thousands of gay kids, every day, face taunts, abuse and violence.

With sentiments and views like this it is inevitable that people might even think it's rather unsportsmanlike to gain advantage from letting others take the public flak and then be whisked to the front of lists like these when they finally deign to announce what people were probably speculating already.

This week, for instance, I've read speculation about the sexuality of a well known TV personality. If they are ultimately forced into coming out would it be right to pour recognition their way for being a powerful or influential gay figure? Should power and influence only be counted when it has been wielded for a few years whilst out? Or is the example set by coping with coming out something to recognise in itself?

Balancing the diversity

Then there are all the issues about balance among the selection. I've already touched on the issue of choosing people for different kinds of influence. But there are other factors too.

Thirty of the top 50 in the Time Out selection are gay or bisexual men. Only twenty are lesbian or bisexual women. Whilst power differences pervade men's and women's lives, you'd expect that the compilers of lists like these could do better, given an overwhelming amount of talented and influential lesbian and trans women to choose from.

I've not done a detailed analysis but my guess is that most of the list would turn out to be white British.

Black african and asian men and women have more obstacles than their sexual orientation or gender identity on the route to power and influence. Yet their presence on lists like this has an immense influence on Black and Minority Ethnic youngsters.

Similar questions need to be asked about the representation of gay and lesbian disabled people. Over 20% of the wider population has some form of disability. Surveys on the LGBT population seem to suggest that this community is no different. Again, depending on what the criterion is for judging power and influence, you might expect a very much more diverse list.

None of this is about being tokenistic. It goes to the heart of questionning the legitimate purpose of such lists.

Who are they for? What is the intended benefit? If Gareth Thomas is a number one on both the Time Out and Pink List because of the inspiration he is supposed to offer, why is it not equally important to ensure that such lists offer inspirational role models to black, ethnic and disabled readers?

Which brings us to the elephant in the room

It is ironic that I only found out about the Time Out list because a gay friend spotted immediately the dearth of trans people. And then he discovered that my name at number 96 had increased the representation by 100 percent.

What does that say? Is there an implication that, among all the gays and lesbians, I am the only trans person with enough power or influence to count?

Flattering that may be, but remember what I said at the outset about divisiveness.

And, frankly, it's a ridiculous assertion. Quite apart from the fact that people can obviously get onto such a list for very different kinds of talents, I'm vividly aware of how many phenomenally talented peers of mine are already in the public eye.

Thrilled and flattered

I'll be clear, of course. Yes, I do deserve to be on such a list as well as some of my peers.

So, thank you Time Out. In critiquing your approach I have no desire to appear churlish.

Trans people haven't generally been popular awards fodder until now. This could be a first. And, apart from the MBE, the Burns trophy cabinet is a bit empty.

But looking at the reasons apparently cited for my being on the list wouldn't really tell a reader why I deserve to be there for something other than pure tokenism.

It says,

Christine Burns - trans activist - MBE and former Tory branch secretary and who helped pass the 2004 Gender Recognition Act

Faint praise

There's no mention of truly influential and groundbreaking work of mine chairing committees that have commissioned and developed work with important impacts for LGBT people in health and elsewhere (I am a true pioneer in that field for trans people).

There's no mention of my major leadership role in Press for Change, creating a new model for online activism that nobody had tried before, handling thousands of contacts, guiding hundreds of people to be effective activists through my prolific writing.

There's not even a mention of being a patron of LGBT History Month, a form of LGBT community recognition that I am very proud about. I could go on...

And then ... I left the Tory party famously over 14 years ago, so that's hardly a reason to be listed. And to say I helped pass the 2004 Gender Recognition Act is to reduce almost two decades of activism to a bit part. It's rather like the distinction that a hen may be involved in making breakfast but the pig is committed.

Indeed, if I only helped pass an Act of Parliament in the teeth of 35 years of establishment opposition, why are my colleagues who played crucial roles not also mentioned? How many such acts of parliament has George Michael (No. 95) forced through?

Reasons to be cynical

This is why I say that initial bemusement gave way to annoyance. An ill-researched biography like this, seen by strangers, would strongly suggest that I didn't really belong on the list for legitimate achievements, but was there purely out of someone's desperation to tick a box.

I am sure this wasn't the intention of the compilers. However a clumsy and cack-handed approach leaves the door open to such speculation. A failure to convince people that the selection committee has really thought objectively about its' selection and rankings reduces what should be an honour to something far more dubious.

I want to be on such list for sure. But I only want to be there with serious and accurately researched reasons for why I deserve to be.

Only then might any of us start to figure out why I'm supposedly more 'powerful' than "talented pantomime dame" Christopher Biggins and only marginally less influential than George Michael. (C'mon now, you're having a larf)

I suppose, in short, that like many people with a string of serious professional qualifications and genuine marks of recognition, I'd like to think that I'm on a list for some kind of objective reason. Otherwise others might construe it as insulting.

And what about the rest?

As I said in my introduction, however, annoyance ultimately gave way to embarrassment.

There are a great many talented trans people. For me to be the only person to make it onto a list like this when I am in such awe of some of those other people leaves me feeling the need to apologise to them all.

I've described the selection process for this list as appearing clumsy and cack-handed because that is the only way to read such poor research.

You don't have to look far to find long lists of influential trans people who would be candidates to give many of the Time Out list a run for their money.

Wikipedia (where I suspect the compilers got my own details) has a long and useful list of notable trans people. A further page even helpfully breaks down lists of transsexual and transgender people in areas such as law, science, entertainment, sports and the armed forces.

It's also not hard to ask around.

Spoiled for Choice

I conducted a short and unscientific survey for just half an hour on Twitter and I was amazed by the number of times the same names kept being mentioned as people whom trans people rated as having power and influence.

Often mentioned were the new breed of trans writers and mainstream journalists. People like Jane Fae (Pink Paper and various), Roz Kaveney (Guardian and others), Juliet Jacques (Guardian and New Statesman and an Orwell Prize nominee) and Jennie Kermode.

These are people who already have a significant reach in terms of mainstream readers, and they are talents that will hopefully be allowed to flourish. Looking further back for influence and inspiration there is the famous writer Jan Morris CBE.

Also mentioned were the leading lights in a new generation of activists who have increasingly come to the fore since I and my generation of campaigners moved aside for them.

These are names like Christina Alley, Louis Bailey, Jason Barker, Sarah Brown (who is also a Lib Dem councillor), veteran activist Roz Kaveney (again), writer / academic Natacha Kennedy, James Morton, and Jay Stewart.

In entertainment there are well-known figures like reality star Nadia Almada and genius singer/songwriter Adele Anderson of Fascinating Aida. There's also comedienne Bethany Black plus (very popular with the Royal Family) the brilliant magician Fay Presto .. not to mention singer and musician CN Lester.

In business there is the computer entrepreneur Kate Craig-Wood, who has been featured many times in the broadsheets as an inspiring example. Then, in public service there are people such as Lynette Nusbacher, a prime ministerial advisor on counter terrorism.

Summing up

Having already written about the dangers of divisiveness it's difficult to edit a list like this. Overall, more than 30 names were suggested to me and I've tried to be fair by picking the ones who came up most often and putting them in alphabetical order of family name.

Any of the others should certainly be on a list of people to watch out for though. That would include people such as a the founders of the influential Trans Media Watch group, including young talent Paris Lees, who I will stake money on being well known and successful before too long.

OK, so a list of 100 LGBT people that includes major media stars, politicians, sportspeople and entrepreneurs might not have room for all the people I've mentioned. Not yet, at least. And some will have to thrash it out competitively, just as the unlisted LGB hopefuls must do too. But if I qualify for a list like this then I'm damned sure there are at least half a dozen in the list above who qualify as well ... in some cases more so.

The fact that we are talking about one trans woman being alone on such a list points to problem in the LGBT community which isn't new. It just highlights it.

I know some wonderful gay, lesbian and bisexual people who would have had no problem correctly describing my own achievements or of naming most of the names above. However, maybe this experience and knowledge doesn't extend to the people who appoint each other to make lists.

Until they remedy that lack of knowledge and experience, however, they are going to continue producing lists which I, for one, feel embarrassed to be seen on.

The freedom to be equally odious

2011-06-17T11:49:00.001+01:00

It's a sad fact. Life's downtrodden aren't perfect.

Whilst they're on the wrong side of society we present the victims of discrimination as universally noble creatures who want for nothing more than to live their lives free of hassle.

If we just got off all their backs then the world would be perfect.

Yet time and again history records that some people's first act, given a sniff of acceptance and equality, is to validate that freedom by putting the boot into someone who they now perceive to be a little further down the heap.

A sign of progress?

My eye was caught today by a cutting from the Halifax Courier, picked up by the eagle eyed staff at Trans Media Watch. "Ban the Drag Acts" screamed the headline.

Oh dear. Not transphobia or homophobia in the heart of Yorkshire, surely?

According to the report Rose White, a Halifax woman, has written to councillors and organisers asking them to either ban Drag performers appearing in Calderdale's Pride celebrations or publish a disclaimer about them. She is quoted as saying:

“Drag queens – homosexuals dressed as women – and drag kings, women dressed as men, performing as stereotypical crossdressers promote, foster and reinforce the belief among the audience that any bloke in a frock must be a homosexual.”

But then there's the rub. Rose, 64, turns out to be a transsexual woman. And how long is it since trans people of any stripe felt accepted enough to be voluntarily quoted with a posed photo of themselves in a newspaper?

Much of my activist career involved helping frightened trans people avoid the press.

When there's someone lower than you

In a peculiar way there's perhaps something to celebrate here. A local newspaper is giving a voice to a transsexual woman doing something other than the usual stereotype reported for generations.

Rose's gender history has no more prominence and discussion than her age or any of the other identifying details which reporters feel obliged to print.

They've got the pronouns right. They're not lingering on salacious personal details. The story is her complaint to officials. These are all marks of mainstream acceptance, right?

Well, yes. Unfortunately, as for every other minority that has clawed its' way from the bottom of life's hierarchy of despair, it's a sad reminder of what people will do the moment they have the chance to take normal freedoms for granted.

Not alone

People like Rose are not unique.

Black and minority people may still have a long way to achieve true equality and freedom from discrimination in Britain. Yet, race and ethnicity are already sufficiently unremarkable to allow parts of minority communities to sometimes voice and practice sexism, racism and homophobia.

Christians and other religious groups teach the history of their own oppression to their children as they grow up. Yet some cannot resist attacking others.

I've met a few deeply racist and homophobic disabled people. And, of course there are some sexist and transphobic lesbian and gay people.

It's a game anyone can play. Unless you are on the very bottom of the pile. And that's where trans people were until recently ... which is why that community's potential for unpleasantness has not been a public commodity until now.

When will they ever learn?

Is this, sadly, the level of equality to which many members of minorities aspire?

Being accepted sufficiently yourself that you have a platform to advocate excluding others? Just like those with the privilege you aspire to?

It seems such a shame that so many people never learn a lasting lesson from the experience of being discriminated themselves.

However, in printing Rose White's views, the Halifax Courier is doing nothing different from when readers from other backgrounds are allowed to express sexist, racist, disablist, homophobic or transphobic views. She is just being accepted into the club.

Welcome to the mainstream, where trans people are free to be as odious as their neighbours.

It's an equality of sorts, but not quite the one that folks like me had in mind.

Launching the new guide to Sexual Orientation monitoring

2011-06-13T19:32:00.001+01:00

About three weeks ago I pre-announced how our team at NHS North West and our partners at the Lesbian and Gay Foundation were working to publish an innovative new 'how to' guide on how to carry out monitoring for sexual orientation among staff and service users in organisations like the NHS.

As I explained on the blog back then, monitoring is an essential way of getting information about who is using a provider's services and the demographics of who they employ. Sensible organisations can use this information to improve and fine tune services to better meet peoples' needs. They can also ensure that their staff profile reflects the diversity of the population, and that particular kinds of staff (eg LGBT people) are not getting a disproportionately bad deal.

Today we launched the completed 48 page colour booklet at a lunchtime event at the Lesbian and Gay Foundation's community resource centre in the heart of Manchester's Gay Village.

Read LGF's release here and NHS North West's release here.

Produced by experts

The new guide has been designed by LGF with the aid of a steering group made up of equality experts. The panel included representatives from

Cheshire Constabulary
Manchester City Council
Pennine Care NHS Foundation Trust
5 Boroughs Partnership NHS Foundation Trust
NHS Trafford
NHS North West and
LGF

Designed to be practical

The guide recognises that many people need help both to build a case for monitoring sexual orientation, and to decide how they are going to go about it. So, the text includes plenty of real life examples of how other organisations like theirs have successfully achieved each of the steps. The guide covers:

An introduction to the terminology
Background on the policy context
A discussion of why we need to monitor
What we are monitoring
Who we are asking
How to prepare the ground in advance
How to actually collect the information
How to analyse it and
How to use it

Accessible

Attendees at today's launch were able to take away copies of the full guide from a proof run of 100. This is so that we can continue obtaining feedback from a wider audience before we go ahead and do a full print run in early July.

We also demonstrated how an online version of the content will appear when it is added to NHS North West's Health Equality Library Portal (HELP). Again, the online version will be released in early July once we've had pilot feedback. I'll blog again, and both NHS North West and LGF will announce when the resource is fully available for everyone.

Welcomed

The feedback today was extremely encouraging though, so we can't wait to be able to get the guide out for the whole world to access.

New resource makes LGBT History interactive

2011-06-13T18:26:00.001+01:00

A few months ago, back in February, I reported on how our team at NHS North West had launched a new travelling exhibition charting the history of Lesbian, Gay, Bisexual and Trans people, especially in England's North West region.

The exhibition, which is well over thirty feet long and occupies 20 display panels, was launched in time to celebrate the beginning of LGBT History Month (of which I'm a patron).

It is now heavily booked to tour NHS and other institutions around the North West.

I promised at the time that we would be following up with an interactive resource that everyone could access. Today it went live.

History you can interact with

Like the touring exhibition, the online version of the timeline has been funded and produced by NHS North West in partnership with the Lesbian and Gay Foundation (LGF) and the Trans Resource and Empowerment Centre (TREC) -- who together carried out most of the research.

The timeline celebrates the history and achievements of LGB&T people, particularly those that have contributed to healthcare over the years, and the development of a vibrant and active community in the North West.

The timeline also documents the way in which the medical view of sexual orientation and gender identity have altered through the ages, showing the landmark decision points where changes occurred.

The interactive resource can be accessed here at http://www.help.northwest.nhs.uk/lgbt_timeline/

Several ways to use it

There are several ways in which you can use the resource:

You can just scroll through the whole timeline from left to right, covering three millennia. This is designed to mimic the experience of walking round the physical exhibition
You can open up a so-called flash book and just turn the pages. This mimics the 34 page booklet which visitors to the exhibition can take away. The booklet contains a lot more material than we could possible get onto the exhibition panels and is therefore a richer experience
You can also download the full booklet in PDF form. This means you can print your own copies to give to people.
Finally, you can also watch the accompanying film, which features many LGBT NHS staff talking about their careers and the experience of working in the health service.

We hope that with the input from specialists at LGF and TREC we have produced the most comprehensive history to date. It's certainly one of the most interactive.

A conflict of loyalties

2011-06-12T14:37:00.001+01:00

Have you ever felt compromised between something that would benefit your community but is bad for everyone else?

Have you struggled with loyalties towards someone who has helped your cause but is now on the 'other side'?

These are moral questions which advocates for equality can find themselves having to ask.

I'm not sure I know the answers. Are you?

Black, white and all the shades between

Politics always used to seem so much easier than this.

In the good old days (before May 2010), we who aim for greater equality and fairness knew where we stood.

Whichever party was in power, Labour or Conservative, our friends might seem to have been mostly on the right side of the fence with us.

Policies were normally, quite obligingly, black or white. Even if the subject was outside of our speciality, we had sufficient confidence in what we thought we knew of the party putting a policy forward to care or not care without too much introspection.

More to the point, in the tribal politics that we have all been reared on in the UK, friends were supposed to be all on one side, and the baddies were on the other.

Sleeping with the enemy

Of course, everyone knows that I have a compromising personal history where tribalism is concerned. I've never made any secret that I was brought up by shopkeeper parents as a Tory. It's only in the last year that I've become a paying (if inactive) member of the Labour Party.

I grew up without really challenging the messages around me. The way that the left branch of UK politics behaved and was portrayed in the 1970's, when I was a young adult, didn't encourage me to ever think of changing my stripes.

In 1992 I formally joined my local Conservative Party in the Cheshire village where I lived. Admittedly, the motive was partly to piss off my vocally socialist boyfriend at the time. Still, being the only young woman's face in the branch for years, I was instantly taken to their bosom.

Within a week of timidly volunteering to go canvassing in my village the branch secretary died from a heart attack. To my disbelief they asked me to step into his shoes. Cautiously, I agreed.

Counterintuitive

The warm embrace of the local establishment went on.

Soon, the formidable ladies of the Cheshire lunching set asked me to chair the constituency's "Younger Women's Supper Group" (ages 40-60). I went on to become both the treasurer and vice chair of the branch, and one of the organisers of a new candidate's election team. I even set up the constituency's first computer.

My popularity within what everyone considered to be the "nasty party" was counterintuitive, given that I now realise how left-of-centre my views had tended to be when we debated policy. That popularity even survived my well-documented coming out to them in the summer of 1995.

I only left the Conservatives in 1997. By that time, as I've famously joked to audiences, I realised it had become more embarrassing to tell people I was a Conservative than to say I was a trans woman. (Cue guaranteed belly laugh from the crowd).

Leaving was easy politically. By that time the discipline of debating policies, and the excruciating sight of the party's public stance on so many matters, made me realise that I was genuinely in the wrong place for my values and beliefs.

I voted Labour in the landslide election. All my campaigner friends let out a collective sigh of relief.

But leaving took a bigger toll on a personal level. Being a party figure wasn't just about beliefs (whose differences could be accepted) but about friendships. I realised that those two were inseparable once you get past the crude advertising of party lines.

Friends where you may not expect them

Those experiences taught me that simplistic political labels are often not helpful, and that the character of a party's grass roots can be much more of an open church than the official dogmatic lines expressed by parties on either side of the House in Westminster.

I began to see how politicians could be intellectually opposed in terms of methods, and yet share the desire to solve a particular problem.

That understanding prepared me to be able to relate to individual Conservative MPs as surprisingly constructive allies when we were building cross party support for the Gender Recognition Bill in 2003/4.

The Conservative opposition leader at the time was Michael Howard. He already knew me well. He sometimes even crossed the road specially to say hello. He quickly signalled that his party supported the legislation in principle, and that MPs could follow their consciences on the matter.

Though he never discussed it with me I suspect that, in spite of his political reputation, his own family background and experience as a barrister informed his understanding of people seeking to establish their identity and be accepted in society.

All this means that you can't always predict from the colour of the rosette who your allies may be.

Like they say of relationships on Facebook, "it's complicated".

Crossing to the dark side

The formation of a coalition government has meant that perhaps more people are now finding themselves dealing with people in a different tribe.

Until now most people would probably have thought of Liberal Democrats in the same mental compartment as Labour.

Indeed, the Social Democrats, who first formed an electoral pact with the Liberal Party between 1981-88, were disaffected former members of the Labour Party anyway. As a merged 'Liberal Democrat' party after 1988, the only difference in many minds seemed to be that LibDem policy was less likely to have to be tested by the realities of government.

It was entirely natural, therefore, the people campaigning for social change would find Liberal Democrat parliamentarians to be useful allies, and acquire debts of gratitude for services rendered.

Discussing one of my recent articles about the Coalition's 'Red Tape Challenge' on the Equality Act, a trans campaigner expressed it thus:

I don't want to implicate Lynne Featherstone in my criticisms ... She has been so supportive of trans equality over the years.

And this is what suddenly struck me about the conflict of loyalties that is now opened up by finding former allies supporting or implicated with the policies of what has generally thought of as "the enemy".

My own reply on this was clear.

There is a danger that if people [Lynne Featherstone] has supported fail to honestly critique her in other areas where she is performing less well then their own integrity starts coming into question. People could point and say that maybe they've been bought off. ... I feel that if I made the defence of everyone's equality a second priority to (say) trans peoples' concerns then that would make us no better than those who turn a blind eye to wrong in exchange for other kinds of favours.

Bluntly, is there a point where maintaining historical loyalties as a result of past favours could be no different to someone who takes a bribe?

Not just loyalties but interests

The more I thought about it, the more it occurred to me that it wasn't just conflicts of loyalties we should worry about but conflicts of interest too.

Many people are concerned about the current proposed changes to the NHS. One area of concern is that the concept of competition embodied in the idea of "any willing provider" can seriously destabilise the whole system by allowing private sector providers to "cherry pick" the low hanging fruit in the system. It is feared this could leave NHS hospitals with complex cases that cannot be profitable on their own.

Yet, if we take another example from the trans community, campaigners have begged for years to be able to access popular private-run gender identity clinics with NHS funding.

Choice, for that community, is very welcome. I suspect it is for many other single issue campaigners too.

The previous government's limited foray into allowing private sector provision in the NHS was sold to the public precisely because it enabled long waiting lists for specific surgeries like hip replacements and hernia repairs to be cleared.

So, if you're a campaigner for a particular group like trans people how are you to resolve the tempting conflict of interest?

Twixt the devil and the deep blue sea

If you're true to your political principles and are concerned about the long term impacts of significant strategic change in the finances of the health economy then the wider good is served by opposing such changes. Besides, people in your community will be hurt just as badly when they or their families want to use NHS services for other needs in the future.

Yet, the opportunist in you might also be tempted by the solution sitting on the plate to fix a problem which your community has been fighting to solve for years.

Which is it to be? Principles or interests?

We live in times that pose devilish questions.