White Privilege

We know. We’ve known for years that the health and social injustices experienced by Black, Asian and Minority Ethnic (BAME) people is worse than for white people.

In 2010 The Marmot Review “Fair Society, Health Lives” identified that health inequalities are a matter of social justice. Those who live in the most deprived neighbourhoods, those who experience social injustice have poorer health.

Ten years later the Marmot review team published “Health Equity in England” in March 2020, just as COVID-19 was arriving in the UK. Shockingly this showed that in ten years health inequalities in England had got worse. The more deprived the area the shorter the life expectancy. For women in the most deprived 10% of areas life expectancy fell.  It also identifies, although not in the headlines, that the life expectancy of Black, Asian and Minority Ethnic people continued to be worse than white people.

We know. We’ve known for years that BAME people are at comparatively higher risk of mental ill health, and are disproportionately impacted by social detriments associated with mental ill health. Race Equality Foundation published a shocking report in 2019 but I bet you never heard about it.

We know. We’ve known for years that black people are more likely to be stopped and searched by the police. Between April 2018 and March 2019, there were 4 stop and searches for every 1,000 White people, compared with 38 for every 1,000 Black people. The data is published here by the Government.

We know. We’ve known for years that Black men are over-represented in the prison population. Black men are 26% more likely than white men to be remanded in custody. They are also nearly 60% more likely to plead not guilty. Analysis conducted for the Lammy Review (2017) found a clear direct association between ethnic group and the likelihood of receiving a custodial sentence. The Prison Reform Trust have been tracking this for years.

We know. We’ve known for years that Black students achievement levels at school are lower than their White peers. The data is published regularly by the Government.

I could go on as there is research and evidence from every aspect of public policy that shows the disparities and inequities that we know exist.

So why haven’t we changed things. What have we been doing? I think we’ve been tinkering around the edges without facing the more fundamental and challenging things that would really make a difference.

There’s loads of training out there but does it actually change anything? The majority of people who rock up to equality and diversity training appear to be those who already ‘get it’. What about those in positions of power and authority?

A few years ago I undertook the NHS Leadership Academy’s Nye Bevan programme. It’s a programme for people working at a senior level in health and care who want to progress to executive leadership roles. One of the most controversial sessions was led by the fabulous Eden Charles. It focussed on race and ethnicity in leadership. There was an outcry from many white participants of “but what about sexism … what about ableism … what about homophobia … what about …”

Why were we only focussing on race?

Eden showed us The Doll test. Originally done in the 1940’s this psychological experiment was repeated in the 2000’s. Watch it. Please. This is why we need to talk about race and racism. I’m not sure the session was challenging enough and I’m pretty sure that lots of people switched off as someone else in their organisation ‘does’ equality and diversity so they don’t really need to worry about it.

If we look at the positions of power across our society, in politics, in the public sector, the NHS, the voluntary sector, religious institutions … the common theme is well educated, middle class, white men. The NHS probably has the best data on diversity thanks to tireless work over many years by people like Yvonne Coghill and the introduction of the Workforce Race Equality Standard (WRES). The WRES, introduced in 2014, was a wakeup call that shone a light on the lack of BME staff in leadership positions. But progress is slow. In the period 2016 – 2019 the number of BME people in the most senior (Very Senior Manager (VSM) being the most senior leadership banding in the NHS) only increased by 1%. That’s an additional 33 people in 3 years. There’s a total of 2,212 VSM positions with only 143 BAME people in these VSM positions in the NHS. The disparity between the number of BAME staff in more junior positions and those in leadership positions is stark.  

In 2019 a small group of People of Colour (POC) formed Charity So White. Set up to challenge the racism in the Voluntary, Community and Social Enterprise sectors they initially faced a backlash from white people who failed to see or listen to what they were advocating for. There is institutional racism in the Charity sector. That’s a fact and the sector needs to take systemic action to address it rather than continue to put their heads in the sand and deny it exists.  

We do need to talk about all the other forms of discrimination and oppression but we also need to learn to talk openly and honestly about why we as white people really struggle to talk about racism.  There are two books I’d really encourage you to read: White Fragility: Why it’s so hard for white people to talk about racism, Robin Diangelo and Why I’m No Longer Talking to White People About Race – Reni Eddo-Lodge. Once you’ve read them find some time to talk with your peers, your teams, your friends about how you feel and what you’ve learned. As white people we have to take responsibility to listen, learn and understand without expecting our BAME colleagues and friends to answer all our questions. White privilege is real. If you’re white you didn’t choose it, but you have to accept it. You are born with privilege even if you live in a very deprived area, even if you didn’t have a good education. Your whiteness affords you privilege because of the way society has been constructed and the history of generations before you.

There’s a term more commonly used now – intersectionality[1] – it basically means that we need to look at and understand the complex identities people have which lead to multi-layered discrimination and oppression. Imagine being a Black Lesbian or a South Asian Gay Muslim. Maybe rejected by your family and rejected by the LGBT community and ostracised by your religious community. You live in the grey space between every community.

It’s essential that we start to redesign our public policy to recognise the systemic racism that is inbuilt. Of course, it’s not just about race, it’s about intersectionality and a society that perpetuates discrimination. But race is an essential starting place. Funding formulas that allocate public funding for services are biased – the Carr-Hill formula used to allocate funding to General Practice is weighted in favour of areas with older populations. This means that very deprived communities get less funding as the life expectancy if you live in the most deprived areas is significantly lower so you die before your GP benefits from the funding formula. Before you all rage at me – I know this is incredibly complex but we have to do better. All of the evidence is there from the Deepend work that started in Scotland and is being developed in many areas of England. It’s the inverse care law – those that need the most get the least.

COVID-19 has highlighted the disproportionate impact it has had on three groups: –

  • BAME communities (including Gypsy, Roma and Traveller people*)
  • Socio-economically deprived communities
  • Inclusion Health groups (e.g. people who are homeless / living in temporary and multi-occupancy accommodation, Gypsy, Roma, Traveller communities, people in contact with the justice system)

If you go back to the beginning of this blog … we knew this before COVID-19. Of course, it’s had a disproportionate impact on these communities. They already experience greater health inequalities, reduced access to services etc.. etc.. Of course, some of us knew it and have been banging on about it for years but maybe now those in positions of power can really hear and see it so we can start to do more than an equality impact assessment that sits on a shelf alongside the policy that perpetuates these inequalities.

So, what should we be doing?

  1. Educate yourself. Talk about it.
  2. Look at your organisation – is there bias and blindness in decision making borne from who’s making the decisions?
  3. Make time in your teams to talk about it, honestly and with kindness. It’s OK to not know and to seek to find out. It’s not OK to stay silent and leave it to others.
  4. Involve people from diverse backgrounds and communities. We have to stop ‘doing to’ and start ‘working with’ (read Hilary Cottam’s Radical Help) people who have first hand lived experience.
  5. Speak up and act – it’s everyone’s responsibility, especially if you’re White.

[1] Intersectionality is a theoretical framework for understanding how aspects of a person’s social and political identities might combine to create unique modes of discrimination

*Gypsies and some Traveller ethnicities are recognised in law as being ethnic groups protected against discrimination by the Equality Act 2010

Privilege of working for the NHS

So it seems I wrote a very controversial and divisive facebook post last week. I was commenting on what I’ve been reading from NHS staff who were expressing that they don’t usually have any ‘perks’ in their jobs so getting discounts offered, freebies sent to work and being able to queue jump was OK. It is OK. NHS staff are doing a remarkably hard job, it’s hard in ‘normal’ times let alone at the moment. But I do think we should also be thinking about other colleagues who don’t get the limelight or recognition, much less the offer of freebies. Staff who work in the voluntary sector, who’s funding has dried up due to fundraising being impossible. Staff who work with the most vulnerable in society who don’t have access to services in the same way the rest of us do. Staff who work on much less favourable terms and conditions than those of us in the NHS. They are also on the front line, putting themselves at risk, working long hours often in more challenging environments than NHS settings. My post is below.

“I’ve seen quite a few posts on here referring to NHS staff not having any perks to justify taking up the discounts and offers from retailers.
I know NHS staff work incredibly hard. But we also have pretty generous holiday allowances, carers leave, permanent contracts (mostly), access to car lease schemes, many get 5 days volunteering allowance etc.. etc… No NHS staff have been furloughed or lost their jobs due to this.
Charity and voluntary sector staff tend to earn significantly less, have insecure contacts as they are always subject to funding being identified, less holiday, less access to training and development (as funders don’t like to cover those costs), often have to fundraise to keep their services open and so on. These organisations tend to work with the most vulnerable, stigmatised and marginalised people in society – people who are homeless, people with addictions, people living in poverty, people who are sexually abused – without these organisations our society would have even worse health inequalities and the pressure on the NHS would be even greater. We don’t hear anything about these people. No one is offering them discounts and no one is clapping for them.

I think we have to remember the privilege and security we do have as NHS employees. Public and corporate donations to charities have reduced significantly whilst public and corporate donations to the NHS have gone through the roof. I recently asked a corporate that is donating food to NHS staff if they would consider a similar donation for people who are homeless. Their response was a flat out no as it’s the NHS they want to be seen to be supporting.”

What a small number of responses highlighted was how misunderstood the voluntary sector is. So many assumptions or mis-perceptions – everyone is a volunteer, that they didn’t have to train for years, that they don’t do clinical work etc.. etc.. It highlighted the hierarchy that whether we like it or not exists. NHS staff are at the top of that hierarchy and they deserve the applause, the accolades, the ‘perks’. Within the NHS there’s also a hierarchy – mental health and learning disability services come somewhere close the the bottom of it. Social Care (for that read care homes looking after the elderly) probably comes next. Care for people outside ‘elderly care homes’ possibly comes next, followed by ‘other emergency services’ and ‘other local government staff’, bus and train drivers, supermarket staff, delivery drivers. Then, if you really think hard, you might remember ‘others’ – usually volunteers. There’s almost never a mention of voluntary sector staff. People who work for not-for-profit organisations, charities, social enterprises.

Who are these organisations of which I speak? Refuges, domestic violence services, hospices, substance use services, homeless services, refugee and asylum seeker services … I could carry on. Ah, but they don’t provide ‘clinical care’ I’m told. Interestingly they do. Hospices care for people at the end of their lives. Doctors of the World and Medicines Sans Frontiere provide primary care services for those who can’t get registered with a GP practice, even though they are entitled to be registered and receive the same access to care as the rest of us. Sexual Health services including those providing HIV care and treatment. These organisations care for people at their most vulnerable, who are the most stigmatised by society, who often can’t get access to the same services you or I can.

There’s an issue here that the people who are most marginalised, stigmatised and invisible to the rest of society are cared for by the most marginalised and hidden sector – the voluntary sector. They have to fund raise and fight for public service contracts through expensive procurement processes that often cost more than the value of the contract being tendered. Contracts that are then micromanaged to make sure that none of the funding is used for management, admin or other such frivolous things that public sector organisations have included as their core costs automatically paid for my the tax payer.

There is a huge inequity that simply has to be addressed. There are glimmers of hope in pockets around the country. Glimmers that we need to learn from, especially at the moment as we start to think about what the future looks like. There has been radical and rapid change, driven by a public health pandemic, that we need to keep. Areas where the boundaries between organisations have become more fluid, partnerships focused on action and delivery, leadership that’s explicitly given permission to act. I hope that the positives stay but with some reflection and honesty about how it’s been resourced and what the impact on the voluntary sector has been. Our recovery phase needs to understand the precarious position these vital social sector organisations are in and find ways to allow them to flourish in a brave new world that is prepared to continue action to support those most vulnerable and enable action through their trusted organisations who truly understand what needs to be done for lasting change.

We can’t change the different terms and conditions that each sector has applied to them. But we can stand together. Recognise and name the inequities and change practice to equalise funding relationships and the power dynamic that drives them. So take the freebies and discounts but ask about others, share these where possible and, if nothing else, open your eyes to how other sectors and organisations work and value them as much as we value the NHS.

p.s If you want to find out about voluntary sector activity in your area NAVCA (National Association of Voluntary and Community Action) have a searchable database so you can connect with those working in your area – https://navca.org.uk/find-a-member-1

Privilege and life

As lockdown continues, life carries on. Today my son submitted his last assignment for his degree. Fingers crossed he’ll be rewarded with a Bronze Swimming certificate (BSc) for his efforts. Fortunately he’d managed to complete all of his fieldwork and submit his dissertation before lockdown happened. It doesn’t seem like two minutes since he started at Uni. Come to think of it, it doesn’t seem like two minutes since he started at school!

I didn’t go to Uni. I didn’t stay on at school for A-levels. I didn’t have the most enjoyable of childhoods. I left school on the 21st June 1989 and I left home on the same day. I remember the date vividly. My friends were celebrating the end of exams and a long summer ahead before they started back in 6th form whilst I was trying to work out how to get my stuff out of the family house without attracting the unwanted attention of my father. I didn’t have any choice about leaving. I wasn’t welcome to stay, that much had been made very clear. I left without incident and started out on my ‘adult’ journey through life.

There’s a lot of assumptions made about ‘people like me’. On the face of it I appear privileged and middle class. Indeed I am. Now. I spent many of the years, after being told to leave my family home, sofa surfing, not knowing where I might get any money from, borrowing money and on occasions stealing it so I could eat and pay the rent. Thankfully those years are a long way behind me but they remain vivid in my memories. Those years, and the years I was ‘parented’, contributed hugely to how I parented my children. I think it’s called reverse psychology! I wanted them to have all the things that I didn’t have. Hugs, love, opportunity and unconditional support.

I recognise the privilege I hold now. That drives me every day to try and improve the system, the services that are meant to be there to safety net us, the support that helps us to live our lives in the ways that we determine. All to often I encounter people (now known as the Dementors) who seem to thrive on bureaucracy and process. They do what they’re told and no more. If the computer says no then it’s no. I’ve adopted a new strategy. I ignore those people and, like a moth to the light, go where the energy is. I am surrounded by amazing people. Those who see the potential, who are creative at working around bureaucracy, the passionate, committed folk who want / need to make change happen.

I have no evidence base for this, no research to refer you to but I do have a theory. Livi’s theory if you will. The people who see the potential for change, who want to create different futures and address the inequalities are those who have faced adversity in their own lives, regardless of the background they come from. The people who light fires are those who have faced injustice, lived in an uncaring world, they are intolerant of passivity and maintaining the status quo. These people usually have their own stories …. if you care to ask them and you have the time to listen.

In other news. My fab daughter delivered me a bag of self raising flour this week. This weekend I’ve been baking. I don’t need self raising flour. It only encourages me to bake, baking = lots of lovely food that I really don’t need to eat! But it does make me happy!

Lockdown … cos that’s what everyone’s writing about right?

Well this is all so weird I’ve decided to write a blog. Trying to work out how wordpress works is actually even weirder than lockdown!

For a while I’ve been meaning to start a blog. Largely because I want to share my thoughts and ask others (you) to contribute to my thinking about a number of things. What better time to do it than now. We’re all in ‘lockdown’ but some are more ‘locked down’ than others. I fit in that second box which is partly what the rest of this post is going to be about. Back in March, yes only about 4 1/2 weeks ago, our world changed. At least if you’re a UK resident, other parts of the world were already there. It seems like months ago. I have very vivid memories of how this all started for me, I’ll share them with you.

I was at the PathwaysUK conference (look them up, they are amazing) and the final session of the final day was turned over to talking about the impact coronavirus might have on the homeless population. What was coming? It was the end of two very long days, but Dr Al Story and Prof. Andrew Hayward took the stage and blummin terrified me. They spoke the truth that was really hard to hear.

It was pretty obvious that life was going to change dramatically but I was harboring hope that the festival my daughter and I were due to go to that weekend would just slip under the deadline. I met her at Victoria Station on the Thursday evening (12 March), as I emerged from the tube (Al and Andrew’s words still in my head) my phone pinged with the cancellation of Country to Country. Pretty tearfully I found and hugged my daughter but it would be alright, we’d have a great weekend in London anyway.

Friday morning and I woke feeling a bit rough. I was tired, I’d been working a lot, travelling a lot, I just needed a rest. We set off for a mooch around London. Got the river ferry in and had a mooch around Covent Garden. Didn’t last long as I felt really rubbish. So we went back to our lovely apartment, very conveniently located for the O2, for me to get some rest. In my head I worked through my symptoms …. cough a bit worse than normal (I’m a dirty smoker), feverish, massively tired and achey …. shit. If I had coronavirus then what on earth was I going to do? I live in Yorkshire. My daughters at Uni in Bristol. We’re both in London. If I do have it then she can’t go back to Bristol because she might have it from me. What to do?!?! Many conversations later and we decide that the only course of action is to hire a car and drive home to Yorkshire, together.

So we did! I won’t go in to detail about how we organised it but suffice to say we tried to make sure I didn’t come in to contact with anyone, I spent a lot of money to insure my daughter on my car so we could rescue it from the station I’d left it at earlier in the week, it was all very complicated! Many hours later we arrive home. I felt even worse. Bed. Sleep. Sofa. Sleep. Bed. Sleep. Sofa. Sleep. By the Monday morning I felt alright. Probably not the C word then (didn’t the C word mean something else in our previous world?).

Sunday evening I had a text exchange with work. Things were clearly going to change … incident level 4 and we were being asked to act. Monday was the start of the redeployment of staff. Tuesday I managed to win the lead on a whole new area of work – the NHS response for people who are homeless …. Al and Andrew’s words still ringing in my ears.

What I realised quite early on was that I would be in a vulnerable group no matter what. I’d had breast cancer in 2018 and now have ongoing drugs to reduce the chances of it returning. One of the drugs is basically very low dose chemo every day. This means I am immunosuppressed so any virus is going to hit me worse, let alone what this one might do to me. As the days passed, lockdown commenced and then they announced ‘shielding’ measures. Bugger that would be me. I didn’t get a letter straight away but I did get phone calls from the Hospital and the GP practice that confirmed what I already knew. Having it confirmed made me wobble a bit but I have a lot of work to do so focus and carry on.

This brings me to my current thoughts. I’m being well looked after. My son and his girlfriend are home with me (my daughter is now with her Dad after possibly being exposed to the C word) and they are amazing. Limited trips to the supermarket after which they clean down all the shopping before I’m allowed near. Parcels are wiped thoroughly before I can open them. My son has made me spend a lot of money making sure my home office is fit for purpose. I miss my daughter a lot but video calling is brilliant. I miss having hugs. Even though I have my boy at home we can’t get too close or have a hug. I’m finding that hard. Friday 17 April and the government announce a further three weeks of lock down. That’s fine, sensible. But. Wait. If that’s a further three weeks for everyone then … the penny drops … lockdown won’t just end, there will be a gradual lifting of the restrictions. Slowly different groups of people will be allowed out. Coffee shops, bars, pubs will start to re-open. But I’ll be in that group of people who still have to stay home. So, as everyone else rejoices at the return to social contact and ‘normal’ life, I’ll still be at home with no hugs. That’s pants.

But I will be alive so that’s all good.