Friday, 21 July 2017

TfL Tube Announcement Changes: Why all the fuss over positive Gender Neutral Language and Greetings?

This month Transport for London (TfL) took the "brave" (I call it common sensical) decision to change the outdated greeting on the Tube for passengers. No longer will they hear "Hello Ladies & Gentleman" (which erases the existence of young travellers let alone non-binary ones such as myself); instead they will hear a much more cheerful, modern "Good Morning/Hello Everyone" and then carry on walking out to get on with the much more important business of the day- like going to work to put food on the table and roof over their heads. Stonewall praised the decision and Mark Evers, director of customer strategy for TfL wanted to make sure that announcements were "fully inclusive, reflecting the great diversity of London". Yet the uber rigid gender binary loving brigade of soppy traditionalists were outraged at the suggestion of a gender-neutral greeting becoming commonplace on Britain's streets. If you look at some of the comments sections that are provided under articles in the main newspaper articles announcing the changes, you realise not everyone was pleased. On the Daily Telegraph comments page, John  moans that those who advocate for gender-neutral language would be campaigning for "language control legislation" (shock horror klaxon) and Graham snaps that it is "insulting to the rest of us" (interesting that most comments seem to be from men: http://www.telegraph.co.uk/news/2017/07/13/london-tube-scraps-ladies-gentlemen-make-announcements-gender/).

I hate to break it to John and Graham et al but gender-neutral language has been commonplace for a while and not just in "politically correct" spaces. Whenever I give a speech, I always start with a "Hello Everyone, I hope you are all well today" in a cheerful, positive tone of voice. I never think that when I am specifically choosing to do this I am being particularly subversive; nearly all of my university professors and school teachers used this gender-neutral greeting and shock-horror, didn't get stoned for it. It seems that gender-neutral language in general is receiving a bit of a pounding at the moment and I'm rather bemused by it.

Never forget that gender-neutral language has been championed by the feminist movement for decades. Let's not forget that in 1980, Casey Miller and Kate Swift created a manual dedicated to gender neutral writing, entitled The Handbook of Nonsexist Writing:For writers, editors and speaks in an attempt to try and reform the English Language so that sexist language that dehumanizes women became less common over time and eventually defunct. Swift and Miller offer numerous substitutes for common words (e.g. sales person instead of salesman) and suggested that "they" be used instead of a gendered pronoun (or at the very least use he or she and his or hers), something I have adopted in my own academic essays in the past. Now if those on the anti gender-neutral language disapprove of removing the jingle "Ladies and Gentleman" but are still abhorred by the use of "man" or "mankind" to refer to everyone, I'd be just a tiny bit flabbergasted. Same if they approved of using "businessperson instead of businessman and businesswoman but expressed dismay at the "erosion of traditional greetings." Facepalm for all those folks.

When looking at modern pronoun use, especially for people who define themselves as non-binary, gender-fluid or genderqueer  the debate seems to become ever so slightly more intense. I'm proud that my grandmother's country, Sweden brought in a specific gender-neutral pronoun "hen" (alt-right conservatives hate Swedish progressiveness; I think it's brilliant there are pre-schools in Sweden that have banished any reference to gender, referring children to their first names or as "buddies"; why should they be taught to adhere to outdated gender stereotype roles?). "Hen" first appeared in linguistic circles in the early 1960's and by 1994, Hans Karlgren had added "hen" as a new personal pronoun; arguing that the Swedish language would be vastly improved by the addition of a new pronoun. "Hen" was used in Sweden's first ever gender-neutral children's book, Kivi och Monsterdog (Kivi and Monsterdog) where Kivi is referred to in a gender-neutral way. When I read the book (in the original Swedish) I was happy to find out that it had been written by a male author, Jesper Lundqvist. They'd written a book that worked well, that introduced children (and parents) to gender-neutral language in a clear, concise and age-appropriate way. However, even in Sweden there were conservative critics who bemoaned the extension of the Swedish language (e.g Jan Guillou blaming feminists again). I just think that encouraging children from an early age to take a more gender-neutral and inclusive approach is a good idea and yet they can still celebrate calling themselves a boy or girl if they want to.

There are now a great variety of pronouns that are used by non-binary, gender-fluid and genderqueer people in the English Language; a few are listed below:

Thanks to Greta Bjornson of US College Today for the table! 

Conservatives always seem to be out in force with their ridiculous objections to linguistic changes designed to make the English Language more inclusive: "Oh you don't like what's been in existence so you have to stir the linguistic pot just to be politically correct". For goodness sake, just because I identify as neither male nor female doesn't mean I want to force everyone to adopt a non-binary pronoun or a title. That's my personal choice, my decision and the fact that others are doing the same indicates there is a legitimate demand for separate representation. It's only polite to try and learn the pronoun/title/gender marker that the non-binary, gender-fluid or genderqueer person you are going to meet (or correspond with) prefers and even if you get it wrong the first time, they can correct you without prejudice and you can learn quickly from that mistake. Besides, even if conservatives don't like it, non-binary, gender-fluid and genderqueer people are going to push for gender-neutral pronouns to be accepted on legal documentation and Stonewall are currently trying to get gender markers removed from official documentation such as passports anyways.

Language changes over time and adapts to social change. The historical denotation of the adjective "Gay" and how its meaning semantically has shifted should indicate that fact. In the 1970's it was seen as unacceptable for a woman to have "Ms" as her title; conservatives would say that it was pandering to feminists but today "Ms" is very commonly used by those who believe that their marital status does not define who they are as a person.  "Mx" (used by some non-binary, gender-fluid, genderqueer and intersex people) is now at least accepted as a viable title in its own right; MPs who are elected to Parliament have been able to use it since May 2015 and it is recognised by government departments including the Department for Work and Pensions. So if you still object to the use of Mx, you're a bit behind the times and if your only issue is that you don't know how to pronounce it, then you can be taught how to pronounce it by those in-the-know (see Spacious Perspicacious' wonderful Tumblr post on pronunciation here: http://cassolotl.tumblr.com/post/103744029100).

Of course some critics still want to get themselves into a tizz over gender neutral language and use every public opportunity they can to denounce it. A recent debate has been over whether university professors should mandate their students to use "gender sensitive" language in their essays. In April 2017, there was a report in The Guardian (https://www.theguardian.com/world/2017/apr/02/use-gender-sensitive-language-lose-marks-hull-university-students-told) that Hull University undergraduates would lose marks if they didn't employ "gender sensitive" language in their essays. Now it must be noted that the guidance only referred to a religious activism course and it's not clear whether it was a policy being used across the university but I wouldn't have a problem with adhering to those guidelines. Cardiff Metropolitan University gave students a "gender neutral checklist" to help them come up with alternatives to commonly used gender-binary language. For example, is it really necessary to use the word "workmanlike" when "efficient" sounds more professional (let alone gender-neutral)? I was told when I was in Year 7 that the word "workmanlike" was bad standard English anyways and would never be used in a business document and I didn't use it in any of my work afterwards. You might say that was "political correctness gone mad" but I don't particularly care! As Professor Judith Baxter, emeritus professor at Aston University points out in the article: "The principle of gender-neutral language has been around for 30 years. Businesses, schools, publishing, academic and educational texts use gender-neutral language now. So there is a total expectation"; i.e. gender-neutral language is here to stay, get over it. I may think that deduction of marks is harsh but you get marks deducted for spelling and grammar mistakes and for incorrect essay length. If you know what is expected of you, you must ensure you do not submit substandard work. Simples.

However, as I have studied English Language at A-Level and at the University of York, I am aware that research has been carried out looking into how men and women use language currently and I wonder how such research would be conducted amongst speakers who define as non-binary, gender-fluid or genderqueer.  For example, research conducted by Jenny Cheshire in Reading in 1983 in an adolescent playground found that standard speech patterns used by teenagers were similar to those of adults and suggested that differences in male and female use exist during childhood. An amusing finding that I've often found to be true in my own experience is that men tend to use "ain't" and women tend to use "isn't" in spoken speech; my Mum often corrected my Dad when he was on the phone to clients because he'd drop in "ain't" unconsciously and she thought it sounded inappropriate. American linguist Robin Lakoff  in 1975 argued that women's speech patterns are created by their subordinate role in society, indicated by their increased use of hedgers and fillers ("sort of", "you know"-I use them pretty often too) and indirect request questions. Now it'll be interesting to see whether speech forms may have shifted since these two pieces of research were conducted and I'd certainly challenge A-Level students interested in gender-neutral speech-forms to question the findings. I loved carrying out my A2 English Language investigation project (I looked at dialect use amongst Lincolnshire farmers) and thoroughly recommend A2 English Language to any student who has an interest in examining social language use.

I don't think there will ever be complete consensus on the acceptability of gender-neutral language. But I feel that if most of us are using it in our everyday lives without judgement, then life for non-binary, gender-fluid and genderqueer will feel more equal as they will feel more represented within society. All non-binary, gender-fluid and genderqueer (and agender) folks are asking for is respect and tolerance. In a public service respect and tolerance should be given in accordance with the Public Sector Duty under the Equality Act 2010 anyways!

Moving beyond the micro-debate over gender-neutral language, I am glad to see further breaking down of gender stereotypes generally in British society; the fact that the Advertising Standards Authority is going to crack down on ads that peddle outdated stereotypes with new standards brought out in 2018 so that there aren't more adverts like the Aptamil baby milk formula advert that suggested only boys could be engineers and girls could be ballerinas or the Yorkie "it's NOT for girls advert" is welcome. Yet it'll be amazing to see more adverts with openly non-binary, gender-fluid, genderqueer and agender actors and characters in them. I am heartened to see more schools adopting a gender-neutral uniform option (isn't it great there are already 120 schools that have a specific policy in place?) and I was cheering on the boys at Isca Academy in Exeter who decided to take a stand and protest for their right to wear shorts (and skirts) by wearing skirts (because the academy mandated them to wear trousers all year round even in a heatwave). There's an increasing presence of gender-neutral toilets at arts venues and other public sector spaces (I don't mind whether they have the gender-neutral toilet as a fourth option after male, female and disabled or whether there is a gender-neutral toilet alongside a disabled one). The funny thing is, nobody that I know has told me directly that they feel threatened by these changes or gender-neutral language announcements. Not my Mum, Dad, Brother, Uncle or close friends. In fact, when my Dad turned on the BBC News and heard about the Tube announcement change, he said "Well, what's all this fuss about?" My thoughts exactly. Maybe some people, especially self-styled "defenders of tradition" need to take a step back and think whether the changes being proposed are really that controversial. And if they still want to be called "lady" or "gentleman", they have plenty of opportunities, to hear those words, just not so much in public anymore. And if that still really bothers them, more fool them I say! 

Thursday, 13 July 2017

Lincoln Walk-In Centre Consultation: My Thoughts

I'm concerned by the proposal put forward by Lincolnshire West Clinical Commissioning Group (CCG) to close Lincoln's only Walk-In Centre located on Monks Road. Not only is the centre used by central Lincoln residents and Lincoln College, Bishop Grosseteste University and University of Lincoln students, there are a number of patients who have travelled to the Walk-In Centre from villages such as Skellingthorpe, Waddington and towns such as Gainsborough because they are seeking immediate medical advice and treatment which they are currently unable to access through their local GP surgery. Lincoln's Walk-In Centre, which is part of the Lincolnshire Community Health Services NHS Trust (LCHS) opened in April 2009 and has a dedicated team of 15 which is nurse-led. The Centre is open from 8am to 8pm 7 days a week (except on Christmas Day and Easter Sunday) and aims to see patients within 30 minutes of being booked in at the reception. The team provides a range of minor treatments, including treating minor scalds and burns, insect bites and stings, minor skin infections and offering health screening advice. They can't deal with drug overdoses or severe allergic reactions so those patients are encouraged to make a GP appointment or attend A&E if they need emergency treatment. The Walk-In Centre staff can't issue doctors certificates or repeat prescriptions and patients are usually advised to contact their GP surgery to arrange these but there's no doubt that the Walk-In Centre is providing vital frontline treatment to patients; the team treated a total of 34,470 patients during the last financial year, with the centre costing just over £1m to operate. Lincs West CCG currently have a budget of £380m, so the centre's operating costs are an extremely small proportion of the budget.  The Walk-In Centre was built in order to help reduce Lincoln County Hospital A&E admissions and to allow patients to access medical advice and treatment regardless of whether they are registered with a local GP surgery or not. Lincs West CCG now argue that because of service improvements (the introduction of NHS 111 service for example), patients no longer need to access the Walk-In Centre to receive primary care. They say they need to close the Walk-In Centre to reduce "duplication of services" and improve efficiency. It seems to me that there is such a drive towards efficiency in the NHS and all of our public services these days but it must not come at the expense of patient care and safety.

Reading the Consultation document: 


To help inform the decision making process of patients, healthcare professionals and representatives from local organisations who have decided to respond to the proposal put forward by Lincs West CCG (through filling in surveys, attending drop-in centre meetings and conversing and emailing our newly elected Labour MP, Karen Lee (500 people talked to her about the proposals in Lincoln on Sat 1st July 2017 alone), a consultation document has been provided to give basic information: (http://www.lincolnshirewestccg.nhs.uk/wp-content/uploads/2017/06/Lincoln-Walk-in-Centre-Consultation-Document.pdf). 

The document gives 4 reasons as to why the Walk-In Centre needs to close, which are: 
  1. the centre is not being appropriately used
  2. the type of care that needs to be provided can be provided outside of the Walk-In Centre
  3. the Walk-In Centre is a waste of budgetary resources
  4. the Walk-In Centre has contributed to health inequity in Lincolnshire.
Let me address the fourth reason because I believe it's the most ludicrous. Lincs West CCG claims that maintaining the Walk-In Centre has led to "an inequity in service" provision in the area because the majority of patients who use the centre are registered with a GP and are resident in Central Lincoln wards but they provide no empirical data in the consultation document to back this claim up. It also begs the question whether GP provision in Lincoln wards such as Abbey are appropriate to meet the needs of residents. It's rather rude to suggest that patients who are registered with GPs are somehow enjoying a more privileged service when all they want is to be able to see a health professional to discuss their health condition and get some reassurance face-to-face. Blaming patients for using the Walk-In Centre service that was established because there was (and still seems to be) a need in Lincoln is not good enough and besides, as I've already mentioned above, the operating costs of the Walk-In Centre are miniscule compared to the overall budget and the Lincs West CCG have not provided evidence to show how they are going to improve equity of service across the Lincs West CCG area. 

With regards to "wasting budgetary resources", I fail to see how a service that has been regularly described as "fantastic" and has a 95% approval rating on the NHS website could be seen as "wasteful"; if patients are being provided with the advice, guidance and treatment needed to help them recover, especially if they have sustained a minor injury, then I believe the service cannot be categorised as wasteful. Lincs West CCG say they need to reduce "overlapping of services" in order to increase efficiency but does the plan that they have proposed do that without reducing the accessibility (and perhaps quality) of patient care?

The key component of the plan put forward by Lincs West CCG to accommodate the needs of those patients whose access to medical advice and treatment may become restricted due to the closure of the Walk-In Centre (because of their shift patterns or they feel they need to see a health professional for advice and reassurance) is to rely on GP surgeries around Lincoln extending their opening hours and ensuring the Lincs West CCG area has some form of accessible service for medical advice, guidance and minor treatment available 7 days a week, through a hub of several GP practices who will offer such a service. There would also be an increase in Skype consultations available for students who'd be happy to receive medical advice and guidance online and convenient access to GP services in surgeries near the University of Lincoln and Lincoln College. That's positive news for students but what about other service users?

Increasing "capacity" in GP surgeries so that patients can access appointments, including ensuring that children under 12 have access to an appointment on a same-day basis is a great idea in theory but of course I am naturally sceptical. My family's experience of obtaining appointments with our local GP surgery, Birchwood Medical Practice has generally been positive; in the past I've been able to ring the reception up when I've had ear complaints and I've been seen on a same-day or next-day basis (I've never been left more than a week to have an appointment with a GP). When I wanted to see my GP to take the baseline tests needed to start the application process for the Gender Identity Clinic in Nottingham, I was able to get an appointment slot that was available the week after I phoned reception. My Dad has been slightly less lucky but still he has been seen by his GP within the 2 week waiting period, even for flu advice. However, I've read of patients who have regularly waited over 2 weeks to see a GP to discuss issues related to stress and/or anxiety and some patients have even been advised by their GP surgery to attend the Walk-In Centre so they can be seen quicker. Same-day appointments are avaliable at my local GP surgery but you have to phone up at around 8am and ensure you have time during the day to go to the surgery and those appointments often are during office working hours. That's not always possible if you have an employer who is not flexible and won't give you time off to attend the appointment; very few people want to take a day off unpaid at short-notice to attend if they can help it. Attending the Walk-In Centre before the start of the working day is convenient for parents who want to get some urgent reassurance about their child's earache or women who need emergency contraceptive advice. The suggestion in the report to have walk-in centres in GP surgeries and extended opening hours would go some way towards providing an element of convenience provided that GP surgeries across the Lincs West CCG area are prepared to provide those services. If they do not, then there really will be an inequity in service provision.

Another aspect of the Lincs West CCG plan outlined in the consultation document is to try and get more patients to self-care through accessing information online and asking pharmacists for basic advice and guidance. Pharmacists are trained to give advice on a number of medical conditions including hay fever, athlete's foot and indigestion (see more here: http://www.nhs.uk/Livewell/Pharmacy/Pages/Commonconditions.aspx). Now a stat has been
bandied about by Lincs West CCG in the consultation document which states that "95% of patients who attend the Lincoln Walk-In-Centre do not require treatment".  50% of those 95% of patients "received advice and guidance only" and the consultation document suggests that those patients "would benefit from access to self-care support initiatives". I'm all for public health initiatives wherever appropriate but the consultation document does not specifically suggest whether such initiatives are being planned currently for the Lincs West CCG area, which areas those initiatives would focus on addressing and how much it would cost to create and then roll-out those initiatives. The survey document does talk about the various ways that Lincs West CCG may disseminate information; I believe that all of the methods suggested are appropriate, especially use of social media, newspaper articles and bus adverts.

I personally think it would be an excellent idea for LCHS and Lincs West CCG to look at creating an initiative that raises awareness of the role in pharmacies in helping to offer basic medical advice and guidance to help patients with their self-care treatment but I've never seen any initiatives at a national level either in newspapers, on the TV or on social media that have encouraged patients to ask them for advice and guidance. Also, it's relevant to mention that there have been plans to cut to pharmacist funding (through the Drug Tariff) of 6% - that's been worked out as approximately £14,500 per pharmacy. This could mean community pharmacists having to make cuts to overheads and that may include reducing staff. If there are less staff in pharmacies across our area, it means there are less staff who have the time available to properly advise patients; sometimes a 2 minute slot isn't enough to allay the concerns of a patient and given that the NHS should be a patient-driven service, it may be unrealistic to expect pharmacists to entirely take over the advisory role from community health nurses and GPs. I'd feel uncomfortable as a dyspraxic patient with only being given basic information if I had a recurrence of my recent kidney stone within a 2 minute time slot; it took a 15 minute slot with a GP at the Out-Of-Hours Service at Lincoln County Hospital A&E earlier this year to allay my fears and allow me to ask the questions and take-in the information I needed to help fight the pain and pass the stone naturally. Patients with complex learning differences and/or complex health needs may require longer. Capacity must remain in place within our local NHS trusts, including LCHS to facilitate appropriate time-slots with nurses and GPs to provide an advice and guidance service to patients with complex health needs.

The consultation document also highlights the importance of the NHS 111 service to providing advice and guidance to patients and argues that increasing the capacity within the 111 service (i.e. more call handlers) will help to bridge any potential gap that would be left with the closure of the Walk-In Centre.  I've read numerous comments about the 111 service online from Lincoln residents and I have to say that not many of them are particularly complimentary. It appears that there is a problem with consistency; the quality of advice and guidance given by call handlers on the general 111 service can be quite patchy. I've been fortunate to benefit from the 111 service when I was suffering from severe kidney pain that I later found out in hospital was the result of a kidney stone (I've had them twice since 2013). The nurse that I spoke to was extremely polite, encouraged me to keep calm and eventually suggested I attend Lincoln County A&E directly to get access to specialist pain relief (I needed morphine because the level of pain was so bad ibuprofen and paracetamol combined couldn't touch it). However, I realise that the nurse on the phone may have been able to help me specifically because I was able to describe my symptoms in some detail (despite being in agony) and I had told him about my visit to the GP surgery a few days before, complaining with pain on my right hand side. Yet a patient who's not able or is uncomfortable with describing symptoms to a stranger over the phone will not have been able to access the specific advice and guidance that I received. The 111 service call handlers haven't always been able to gage the seriousness of a medical condition over the phone and that means that patients are having to resort to going to the A&E or the Walk-In Centre in order to ease symptoms and get the reassurance they need.Equally homeless patients and patients who are being subjected to sustained domestic violence and abuse by a controlling partner may be unable to have access to a mobile phone to ring the NHS 111 service and thus rely on being able to walk-in anonymously to receive medical advice and treatment.

What's important to note is that in Lincs, the NHS 111 service call handlers can now pass patients onto a Clinical Assessment Service (CAS) staffed by healthcare professionals who have specialist knowledge of Lincs and have access to patient records. The CAS was established in 2016 to provide patients with appropriate advice and guidance and signpost them to other NHS services wherever appropriate. Or that's how the service is meant to work in theory. My friend who had severe pain in his neck for more than a week was told by a CAS professional that he should just take some paracetamol and rest until the pain went away; the paracetamol did not touch the pain and he eventually collapsed in the evening and was taken to A&E in an ambulance. Deeply worrying given that the NHS website suggests that someone with a stiff neck for more than a week should see their GP or be given advice to see their GP. An example of patchy guidance that needs to be ironed out in the future.

Another problem with Lincs West CCG's plan that immediately springs to mind is that it doesn't reflect the fact that the types of patients who visit the Walk-In Centre aren't necessarily ones who are registered with Lincoln based GPs in the first place (despite the fact that Lincs West CCG claim that the majority of patients are registered with GPs (no percentage given) and from central Lincoln). We need to know what would happen to those patients when the Walk-In Centre closes. How can we deliver quality healthcare to homeless patients, who may need urgent access to treatment, especially if they develop symptoms of flu or fever overnight when the temperatures dip below 0C during the winter months? How do we deliver healthcare to those patients who travel in from surrounding villages and towns who are unable to get into a GP surgery because they have no spaces available? What about tourists coming into Lincoln for events such as Lincoln Pride and the Christmas Market? Will they be able to access a GP appointment at short notice or will they be forced to attend an an already incredibly busy A&E department at Lincoln County Hospital where a 5 hour wait is currently the norm? I'd like to see specific figures published by Lincs West CCG detailing the number of non GP registered patients who attended the Lincoln Walk-In Centre who were homeless or tourists and I'd like to see evidence in their plans that definitively prove that the closure of the Walk-In Centre will not detrimentally impact on the health care of our homeless population and tourists (from the EU and outside the EU).

Further Questions: The Lincolnite Interview: 

Representatives from the Lincs West CCG Governing Body, Dr Sunil Hindocha, Chief Clinical Officer and Chief Operating Officer Sarah-Jane Mills  had a recent interview with The Lincolnite (http://thelincolnite.co.uk/2017/06/closing-lincolns-walk-in-centre-is-the-right-thing-to-do-say-ccg-bosses/) which discussed the reasons why they felt that they needed to close the Walk-In Centre. A number of claims were made during the interview which made me think further about the proposal:
  • Dr Hindocha claims that 2/3 of patients who attend the Walk-In Centre do not receive any treatment at all; that directly contradicts the stats given in the consultation document. Confusing? 
  • Dr Hindocha says that a number of patients who used the walk-in-centre then had an appointment with him on the same day; was that because they'd manage to get a very rare same-day appointment after being advised by a walk-in-centre professional to see their GP or were advised by the Walk-In Centre to contact their GP to gain access to repeat prescriptions or doctor's notes, which cannot be provided by the Centre? 
  • According to Sarah-Jane Mills, over 20% of the patients attending the Walk-In Centre are University students (not sure whether they are from the University of Lincoln only or also from Bishop Grosseteste University...he doesn't provide that level of detail); does that mean GP surgeries located near the University of Lincoln need to have extended opening hours or offer more walk-in services or does there need to be another GP surgery established in the area? 
  • Dr Hindocha argues that numbers of Lincoln Walk-In Centre attendees are falling because of online services....where's the objective empirical evidence to back that claim up? It's not in the consultation document! 
  • A number of GP surgeries have a walk-in service but: 
    • where are these GP surgeries located (are there some outside of the City of Lincoln boundaries)? 
    • which of those GP surgeries have a walk-in service that doesn't require prior booking (i.e. do not need to telephone the receptionist in advance)? 
    • is the walk-in-service only available at certain times of the day (usually in the morning)? 
    • why aren't GP walk-in services being properly advertised so that patients in the local area are AWARE that those services exist?
  • Reference is made by Sarah-Jane Morris to "different types of GP surgery appointments" being made available to patients; how many extra on average will be made available to patients needing to see a GP, how many extra on average will be made available to patients who only need to seen a Nurse Practitioner? 
  • Dr Hindocha says there is "no evidence" in the dataset he has seen to show that more patients would attend A&E if the Walk-In Centre is closed because they'd go to pharmacists to receive "limited self-care information" - where's the empirical evidence from objective studies carried out in other areas of the UK where Walk-In Centres have been closed to back this claim up?
  • Dr Hindocha states the obvious that the Walk-In Centre was not designed with A&E patients primarily in mind but there may be patients who will attend A&E if they cannot get a GP appointment when the Walk-In Centre is no longer in Lincoln. 
  • There will be same-day appointments available (including for non registered patients) but only if patients "clinically require it" (only guaranteed to children under 12).  Where will patients be signposted to if they are deemed "fit enough" to receive advice and guidance elsewhere? Pharmacists or online services? Will there be differentiation in signposting according to individual patient needs? 
  • Currently a shortage of GPs in Lincolnshire but Sarah-Jane Morris states that Lincs West CCG are the "leading recruiter of international GPs" in England and have managed to get 27 to join; this is excellent news but will this number be sufficient to fulfill demand for extended GP surgery opening hours and a GP surgery walk-in service?
  • Dr Hindocha claims that in the 4-5 busiest GP practices in Lincoln, 2-3 additional appointments will be necessary to fulfill demand; is this on a daily basis? 
  • What specific improvements need to be made to the NHS 111 service so that more patients that require specific advice and guidance get the specific support they need? 
  • Conversations about service provision have been ongoing and all NHS trusts based in the Lincs West CCG area have had a chance to have their say on the proposal to close the Walk-In Centre including the risks involved with primary patient care; I wonder what they have said about facilitating the health care provision required for homeless patients and tourists?
    • One of the risks identified concerns the flow of information to patients about alternative NHS services; how are Lincs West CCG going to help local NHS trusts to disseminate that information if the Walk-In Centre is closed (we'll hopefully find out after the Consultation process has been concluded!) 
  • What would happen if there was a major incident in Lincoln and there was no Walk-In-Centre to take the overspill of patients who have minor ailments who were not involved in the incident?
  • There is also the question of where the money (£1m a year) saved from axing the Walk-In Centre will be directed to within the Lincs West CCG budget:
    • Would it be used towards the recruitment of GPs to alleviate pressure on surgeries and fill remaining vacancies?
    • Would it be used to recruit more GP surgery nurses or community health nurses?
    • Would it be used to improve the quality of the 111 service?
    • Would it be used to put in place specialist health services for the homeless in Lincoln?
    • Or has the money already been reallocated to the GP streaming service planned for outside the A&E department in the car park area at Lincoln County Hospital as has been alleged by a NHS Whistleblower (read The Lincolnite article here and judge for yourself: http://thelincolnite.co.uk/2017/06/lincoln-walk-centre-closure-consultation-lie-says-whistleblower/).
  • Dr Hindocha states that closing the Walk-In Centre is not about saving money but streamlining services to "move to a new model of care" with an emphasis on utilising new technology to deliver service and relying on self-care initiatives. Not every patient is going to want to have a Skype consultation though, as I've highlighted earlier.
  • Sarah-Jane Morris seemed to suggest that even a large number of responses against the closure of the Walk-In Centre may not change the mind of Lincs West CCG because they believe they are acting in the best interests of patients. Hmm! Hopefully the consultation process does help Lincs West CCG understand the needs of the local population but also those who may be visiting the area too! 
From hearing the interview and reading the consultation document, it seems apparent that there is an expectation from Lincs West CCG that walk-in services  may become the norm at most, if not all GP surgeries across the Lincs West CCG area. Of course GP surgeries will be mandated to offer a 7 day routine service for patients but it appears that it may not be established straight away (it has to happen within 3 years though) and that the service may be delivered through hubs as opposed to at every GP surgery. I think patients would on the whole welcome a move towards a more convenient and accessible local service, especially if they are based in towns such as Gainsborough or registered at 1 of the 4 or 5 busy GPs referred to be Dr Hindocha but I don't believe the Walk-In Centre should be closed until the provision is in place and the quality of service provision has been tested to see whether patient satisfaction levels match that recorded on the NHS website for the Walk-In Centre.  

Overall Thoughts: 


I believe that Lincs West CCG, working in conjunction with other Lincs based NHS trusts including LCHS must ensure that NHS services are available and accessible to all patients that happen to be in Lincoln at the time they have a medical complaint. There's nothing wrong in theory about extending GP surgery hours (I think they should be extended to 7 days a week for ALL GP surgeries in the Lincs West CCG area and not just be delegated to hubs) but there must be also be some form of walk-in service available in GP surgeries that allows non-registered patients access to medical advice and guidance and minor treatment without them having to resort to using the A&E department at Lincs County Hospital; that includes treating homeless patients and tourists. I agree that the Out-Of Hours GP service (currently based at Lincs County Hospital) should be maintained as it helps to ease A&E pressures overnight. There needs to be more public awareness campaigns at a local and national level that encourage patients to have the confidence to call the NHS 111 service because of the CAS tie-in we now have in Lincs and a national campaign aimed at promoting pharmacy services (I only hope funding will be restored to community pharmacies in the near future). Self-Care awareness can only be increased through national and local campaigning and I'd like to see Lincs West CCG work with local NHS trusts to come up with more innovative social media campaigns so that patients are aware of what they can do to alleviate symptoms of conditions and when they should seek advice in as clear and concise a way as possible.I also understand that Skype consultations may be appropriate for some University of Lincoln, Bishop Grosseteste University and Lincoln College students who are tech savvy but ease of access to services must remain in place for students who'd rather get reassurance face-to-face.

I still feel that closing a NHS service that has received a number of excellent reviews on the NHS Choices website (95% of patients have recommended the service) and is described as ""an asset to Lincoln" that ""provides vital and essential care for the local community" is a great shame. I don't believe the Walk-In Centre should close until at least ALL GP surgeries have extended opening hours and a walk-in service in the majority of those GP surgeries is guaranteed. I also want to have some indication as to where the money that has been saved from closing the Walk-In Centre will be redirected to. I've also heard no specific plans that would be put in place to ensure tourists gain access to minor treatment and prescriptions without having to attend A&E and to offer healthcare directly to homeless patients on the streets of Central Lincoln. With all this in mind, I cannot personally support the Lincs West CCG plans in their current form. I have already signed the petition to keep the Walk-In Centre open (like 4,547 others; patients based in the Lincs West CCG area can sign it here:   https://www.change.org/p/save-lincoln-s-only-gp-walk-in-centre-from-closure?utm_source=embedded_petition_view) and I support the right of Lincolnshire residents and patients to continue to protest against Lincs West CCG for their plan; there's already been a protest that was organised by UNISON outside Lincoln County Hospital on Wednesday 5th July and another was held on the 12th July at 10am outside the Lincs County Council offices. Labour's group on Lincs County Council have also made it crystal clear that they do not support the plans and brought a motion to try and oppose the proposed closure of the Walk-In Centre but I hope that the health scrutiny committee at Lincs County Council will properly look at the plans when they meet on July 19th.

I urge anyone interested in the future of healthcare provision in Lincoln to respond to the consultation and fill in the survey; you can do so here: https://www.surveymonkey.co.uk/r/wic-consultation. You now have until August 18th to respond. 

Wednesday, 28 June 2017

Stonewall School Report 2017: What Needs To Be Done To Make Our Schools Truly LGBT+ Inclusive

This morning there was the release of Stonewall's 2017 School Report, research that had been conducted by the Centre for Family Research at the University of Cambridge. The report provides a vital snapshot into the experiences of LGBT students, with 3,713 participants having responded to
an online questionnaire covering areas such as language, wellbeing and mental health and Internet and Social Media use. The School Report indicates that there has been improvement in schools tackling homophobic, biphobic and transphobic (HBT) bullying: the percentage of HB bullying has decreased from 55% in 2012 to 45% in 2017 and 50% of students hear homophobic slurs "frequently" in the classroom environment, which is down from 70% in 2012. However, the percentage of students who have experience transphobic bullying remains worryingly high, with 64% of respondents stating that they had been bullied on the basis of them being openly trans. 57% of non-binary pupils have also stated they were being bullied for being open about their identity. The question is, how do schools help to create an environment that is truly inclusive, where teachers, support staff and students feel comfortable enough to be open about their gender identity and sexual orientation and whether students have the awareness needed to act as responsible global citizens who are tolerant and respectful of differences?

HBT Bullying and Language:

It's pleasing to see that some progress has been made towards address HB bullying; 70% of LGBT+ students have said that their school has openly stated that HB bullying is wrong, a massive increase from 25% in 2007. However, only 41% of students reported that their school had openly stated that transphobic bullying is wrong. This is unacceptable and there needs to be a change in attitudes in schools that makes it clear that transphobic bullying under any circumstances is wrong. In order to explore why I believe it is wrong, I feel it's necessary to reflect on my own experiences whilst at secondary school in the early and mid 2000s.

I was extremely lucky to attend the Priory LSST (now The Priory LSST Academy) that had an inclusive culture in place which included a zero-tolerance attitude towards bullying of any kind. I did experience name-calling  (the usual gay being used as a slur, camp hand gestures because the pitch of my voice was higher than others in the year, being called he-she/fag/tranny etc) on a systematic, weekly basis from a group of specific individuals but because I wasn't openly calling myself trans non-binary at the time, I didn't feel I experienced any specific name-calling and bullying that directly targeted my gender identity at the time. I now realise that they were bullying me because of aspects of my identity and I didn't deserve to be subjected to it. You are who you are. I was personally afraid to be open about my feelings because I thought I'd been perceived as "mad" by my friends but the signs that I didn't perceive myself as being male were there: I'd never take my vest off in the changing rooms for fear of being stared at by my peers and I always felt uncomfortable being referred to in the third person or as a "boy", insisting they use my name instead. I always insisted on playing a female role in Drama lessons and whenever I created my own characters, they were always female. I have met friends who are non-binary who carried out similar actions at school without explicitly coming out as non-binary. It may have been because the words "trans" or "non-binary" were never used at school and my parents never used them at home either. Instead my Mum always referred to me as "different" and just loved me for who I am.  Again, that's me being fortunate and lucky but it's still sad to see that 40% of respondents to the survey say they can't speak to a parent about LGBT+ issues.

The name-calling I've described above was on top of the name-calling I received due to my short stature and the way I moved due to my dyspraxia (a disability affecting hand-eye coordination). For example, I was regularly called "Colleywobbles" because of the way I walk (my feet are misshapen and face outwards as result of how my feet developed whilst I was at primary school). The School Report figures have revealed that disabled LGBT+ young people are more likely to experience HBT bullying than non-disabled LGBT+ ones (60% as compared to 43%). This is not acceptable and teachers need to support disabled students who are bullied for both being LGBT+ and for their disability. That means reiterating that they are available to have confidential conversations and take action against the bullies as soon as possible, making good on the commitment they have made openly. You see most of the teachers at the school reminded us that we could confide in them privately if we had been name-called on a systemic basis but I never felt I could talk to them fully about my gender identity or sexual orientation because no action was ever taken to rebuke HBT bullies. That in addition to there being no teachers and support staff who openly discussed their gender identity or sexuality in the classroom made me feel as if I'd never be understood and helped in any other way than academically. I was always speaking to my teachers before and after class but this was almost exclusively on academic issues- whether I could make a good teacher when I finished my education, whether Henry VIII really loved Anne Boleyn, whether 2+2 =4 etc etc. I never spoke to them directly about the bullying I experienced as a result of my disability because I don't think many of them knew what the definition of dyspraxia really was and adding my feelings of gender dysphoria into the mix, it made me a very shy but supposedly "gifted and talented" child. The School Report shows that students still feel wary about talking about the HBT bullying they experience: 45% of students say they've never told anyone about the bullying, with 63% stating that "it's not easy to talk to anyone". With teachers not talking about LGBT+ issues, I'm not surprised at these figures.

What was effective at the Priory LSST was the  "anti-bullying champions" Prefect system, created to help foster a zero-tolerance culture against bullying in all its various forms. Such champions (drawn from Year 9 through to Year 13) would befriend and hang around with Year 7-9  students who may have been perceived as "different" by others and be open to homophobic, biphobic and transphobic bullying. I remember an instance of homophobic bullying that occurred in an English lesson where I walked in on a group of three (rather nasty) Year 10 boys picking on my fellow Year 8 friend, calling him a "pansy", a "nancy-boy" and a "groper", falsely accusing him of having touched one of them on the bottom. It turned out that aforementioned Year 8 friend had tried to get past the boy in question and his schoolbag happened to brush past him, making contact. A Year 11 anti-bullying champion happened to be in the vicinity of the classroom and stopped the boys from gesturing and name-calling, managed to get some initial witness statements from those in the classroom and informed the teacher promptly when he arrived. Luckily the Year 10 boys were the only ones to end up facing punishment (I later heard they'd been given detention for a week) and they were made to apologise to my friend for their behaviour. So you see, anti-bullying champions can really make a difference to the school environment and the more of them that are trained in having the confidence to help LGBT+ students, the better; the School Report reveals that only 41% of LGBT+ students had seen their peers intervene to stop HBT bullying which is still more than the 22% of students who had seen teachers intervene.

I realise my school's attitude towards HBT bullying in the early 2000s seems rather proactive in hindsight. I've spoken to LGBT+ friends whose school experiences involved sustained stalking, systematic abuse and harassment and in one case, sexual assault. The School Report states that 7% of LGBT+ students have been the victim of physical bullying, with trans students twice as likely to be a victim than LGB students who do not identify as trans (13% compared to 6%). Any physical act of violence shown towards a LGBT student should be recorded, with the perpetrators removed immediately from the classroom and reported to the police if the act has resulted in the LGBT student sustaining injuries (i.e. a crime). Perpetrators should also be appropriately disciplined, whether that involves detention, temporary suspension or exclusion. Schools must be a safe environment for all pupils, including those who openly identify as LGBT+. The School Report shows this is not yet the case: 19% of LGBT+ students stated that they do not feel safe at school, 9% of trans students stated that they have received death threats whilst at school, 3% have experienced sexual assault and 4% have been threatened with a weapon. That shocks me to my core. Why is it the case that students feel emboldened to threaten their trans peers (open and not) with knives or sexually assault them?

Attitudes need to change amongst the teaching establishment as a whole. Teaching unions are leading the way in encouraging teachers to support their trans students and headteachers need to make it crystal clear that teachers have a duty to tell their students openly that transphobic bullying and language is wrong in any context. Not addressing transphobic language, attitudes and bullying when students are at secondary school does lead to those students entering the working world still believing such attitudes are acceptable when they are not. Transphobic discrimination in the workplace is illegal under the terms of the Equality Act 2010 (protected characteristic of "gender reassignment surgery" applies to employees who are intending, are perceived as intending or going through such surgery) and if a transphobe has committed a criminal offence, they may be prosecuted and convicted of carrying out a hate crime (Parliament has passed legislation in the Legal Aid, Sentencing and Punishment of Offenders Act 2012 that means that offenders can receive tougher sentences if prosecutors can provide evidence of that offender having hostility towards trans people). We want to reduce instances of transphobia in society in general and teachers and support staff need to play their part in this.

I'm concerned to read in the School Report that teachers and support staff are not routinely challenging HBT language when they hear it in the classroom; 68% of respondents say they've very rarely or never heard their teacher "sometimes" challenge those students who are using HBT language. Teachers and support staff must have the confidence to explicitly state the language is wrong and if they do not believe themselves that the words being used ("tranny", "fag/faggot", "he-she", "shim" etc are are wrong, they desperately need to go on a diversity training course as part of their Continuing Professional Development (CPD) to learn why those words cannot be condoned in any form and if they can't get to grips with that, they genuinely need to question whether the teaching profession is right for them when they feel they cannot protect all students within their classroom. Enough of bigotry and enough of silent acceptance. Stand up and support your LGBT+ students.

A zero-tolerance approach across the school environment to HBT bullying is essential and headteachers should review their bullying policies to ensure that they are fit-for purpose. Headteachers could discuss their policies with organisations such as Stonewall and take on-board suggestions made. They must also ensure that all teachers and support staff at the school sign up to the policy and promise to implement measures when they observe HBT bullying in the school environment. If teachers fail to take necessary action and refuse to take part in attending training courses, disciplinary procedures must followed and if teachers are found to participate in HBT bullying in any way, disciplinary procedures must be enacted as soon as the report has been received. Headteachers must explicitly state that transphobic bullying and language use is wrong. The School Report reveals that in schools where this has happened, trans students are less likely to worry about bullying and more likely to report it and are twice as likely to "rarely" or "never hear" transphobic language at school.
Most importantly, headteachers should openly support LGBT+ equality; only 19% of students said they'd heard their headteacher talk about it. Part of supporting LGBT Equality is to encourage the setting up of LGBT+ group for students that meets once a week to allow students to socialise and to discuss the issues that affect them. A representative from the group should be on the school board to discuss the concerns raised with the headteacher. The benefits of the group are that LGBT+ students are more likely to feel part of the school community and are having their concerns addressed. There's no extortionate expense to setting up the group and it can actually lead to real change in the culture of the school environment. That can only be a good thing.

Accommodating Trans and Non-Binary Students: 
I think it's essential that schools take a positive approach to helping students who have disclosed to them that they are trans and non-binary:

  • student confidentiality must be respected; I'm happy to read that when trans students disclose their status to teachers, 75% of them ask about how best to support them but it's not acceptable that 19% of trans students have stated that their teachers did not respect their wish for anonymity. No teacher should disclose a student's gender identity without permission because such disclosure could lead to them becoming subject to bullying. The choice to publically disclose is the trans student's alone. 
  • teachers should have a basic idea of when to signpost trans and non-binary students for further advice and support: 60% haven't been provided with any advice and guidance, such as which organisations they can speak to (Mermaids is one dedicated organisation that all trans and non-binary students can be referred to). 
  •  trans and non-binary students should be allowed to use the bathroom or changing room they feel comfortable using; if a student has openly disclosed their status and have indicated which bathroom and changing room they wish to use, they should be accommodated wherever necessary and dispel any stereotypes being perpetuated by students (e.g. a pre-op trans female student isn't going to flash their penis).
  • trans and non-binary students should be referred to by their preferred name and pronouns, with registers being updated to reflect this; 33% of trans students report that their school keeps using their dead name rather than their preferred name.
  • trans and non-binary students should be able to wear the uniform they feel comfortable in; 20% of students are still being told they cannot wear the uniform that reflects their gender identity. 
These 5 actions need to be taken if schools are to be truly trans and non-binary inclusive.


LGBT Teacher Recruitment: 

There is far more that educational establishments can do to try and reduce instances of trans bullying; for example, incentivising the recruitment and retention of trans and non-binary teachers in state-maintained schools would help provide a number of positive role-models for students to identify with, regardless of their own gender identity or sexual orientation. The report states that there are no figures for students who knew trans members of staff in school; it's bad enough that only 4% of respondents to the School Report knew they had an openly bi member of staff in their school! Bi and trans visibility in the teaching professions remains stubbornly low, with graduates being put off pursuing a worthwhile career because they feel they may be openly discriminated against on the basis of their gender identity and/or sexual orientation. Universities who run PGCE courses and schools participating in teacher training programmes should proactively counter and challenge the narrative that schools are not trans and non-binary inclusive and reach out to LGBT+ societies on campuses to encourage students to consider volunteering in schools to explore teaching as a viable career option. I would have dearly loved to have become an English and Philosophy teacher but I found it very difficult to find a volunteering opportunity after I graduated in 2010 to gain the necessary experience needed to have a chance of having my teacher training application approved and I don't want other trans and non-binary graduates who have achieved the necessary qualifications to go through the same experience.

Sex and Relationships Education:

The School Report findings back up recommendations made by organisations such as the Terrence Higgins Trust that Sex and Relationships Education (SRE) is needed in schools that is at least LGBT inclusive (I'd like it to be non-binary, queer, intersex and asexually inclusive too): 40% of respondents revealed they are not being taught anything about LGBT issues at school, 76% haven't learnt anything about bisexuality in school and 77% have not been taught about gender identity and so have no idea what being "trans" means. Only 20% of LGBT students overall and 10% of faith school students had been given any advice and guidance on same-sex relationships. 13% of LGBT students have been taught about healthy same-sex relationships and only 20% of students have learnt about consent in same-sex relationships. 17% have learnt about violence or abuse in relation to same-sex relationships. Given that the primary duty of an educational establishment is to impart vital information to students so they can appreciate the diverse world in which we live, the fact that students are still leaving school without any understanding of gender identity, healthy same-sex relationships, consent and domestic abuse and violence is quite frankly shocking.

It is important that SRE guidance provided to schools is appropriate, written by SRE experts with input from LGBT people to inform lesson planning. Whether SRE would be delivered by the same teacher who has responsibility for Personal, Social, Health and Economics Education (PSHE) or whether it will be a teacher with a background in social sciences or the Arts is not yet clear. I would love for there to be a specific PGCE pathway to be created that allows for applicants to train in PSHE and SRE as their main specialism but embedding SRE into existing PGCE and teacher training programmes could be a way of ensuring teachers are equipped to teach the subjects when required to do so. I'd rather foster a passion for SRE and PSHE; if teachers are engaged with the subject material, they can impart that information in a lively and enthusiastic way and students may be more likely to retain the information years afterwards.

Current PSHE must include the basic information on LGBT+ issues; it's embarrassing that some students are leaving school with no idea that gay, lesbian and bi people can get married (58% of respondents said they've never been taught about same-sex marriage or civil partnerships).

Another aspect of the School Report that concerns me about the current curriculum is that only 20% of LGBT pupils are being taught about safe sex in same-sex relationships. There is an argument put forward that teachers do not have the time or the resources available to them to be able to teach their students about all forms of safe-sex. At my secondary school we received no direct sex education that was LGBT inclusive (hence why I had no idea that trans people existed) and the only sex education we did receive was delivered in a half-an-hour Biology video in Year 9, a series of worksheet based lessons that followed on from that video and a Year 11 hour lecture delivered to the whole year group with the instructor talking about how to put a condom on the banana. Not very instructional or reassuring (good job I haven't shown much inclination for sexual activity anyways!) I believe that sex education in schools must include helpful information on same-sexual intercourse free from judgement. It's embarrassing that young people are being left to learn about same-sexual intercourse online and are being taught that it shouldn't be talked about; silence is sending out a signal that same-sexual intercourse is still "wrong" when in-fact it is far from being wrong.

However, having strong SRE and PSHE provision isn't really enough. The National Curriculum as a whole should have a focus on LGBT+ acceptance and encourage students to take an interest in LGBT+ issues and admire LGBT+ role models. Only 25 of LGBT students reported that they had discussed LGBT+ issues in English or Geography. Embedding LGBT+ awareness into PGCE courses beyond the Equality and Diversity requirement is key. Why not talk about Lord Byron as a bisexual in English Literature lessons? Why not celebrate Alan Turing as a gay role-model in Science lessons? Students in GCSE Religious Studies lessons already learn about marriage and divorce and various religious and ethical views on sex, so why not devote a lesson to discussions of gender identity, with reference to a range of religious views (OK some of those views are far from accepting but they have been openly stated-e.g. Pope Francis talking about the "ideological colonisation" which is nonsense btw)? Discussions about gender identity should take place but in a respectful manner. The individual responses quoted in the report which talk about positive experiences of embedding LGBT+ issues into the curriculum speak for themselves; Sadie mentions that she discussed work by Oscar Wilde and Audre Lorde whilst studying A-Level English Literature; how amazing it would be if engagement with LGBT+ authors, poets and playwrights happened at Key Stages 3 and 4?

Wellbeing and Mental Health: 

We need a comprehensive approach to help deal with the mental health crisis affecting our LGBT+ students in schools. The name-calling that I received systematically from my bullies in the early years of secondary school (it fizzled out by Year 10) made me feel anxious and worried about being truly myself. I remember numerous school days which ended with me coming home, running to the toilet, locking the door and crying for an hour or two wondering what I'd done to deserve such bullying. There were days when I didn't want to go to school to face my bullies and I'd be happy whenever I happened to have the flu or vomiting bug because it meant I didn't need to attend and listen to their vitriol. Yet anxiety is unfortunately not the only mental health condition experienced by LGBT+ students. It's not right that 84% of trans young people who responded to the School Report have self harmed and 45% of them have attempted to commit suicide. The figure for LGB students self-harming is at an unacceptable 61% with 22% attempting suicide. It breaks my heart as an equal opportunities activist to read these figures. No young person should ever have to feel ashamed of their feelings or their identity to the point where they are cutting themselves with razor blades and planning to end their own lives. Labour have a specific plan to help these students, which involves ensuring that every school in England has access to a counselling service, the number of mental health professionals including specialist nurses increasing and the number of school nurses increasing too. The Conservative Minority Government, propped up by an openly homophobic, biphobic and transphobic Democratic Unionist Party have shown very little inclination to make the counselling service immediately available to schools, which I think is a great opportunity missed. PM May promised to protect LGBT+ people in the UK if she were to retain her premiership during the last General Election campaign Pink News interview; she now needs to prove that her words are worth more than the computer they were written on. That means providing investment in school counselling and pushing forward with plans to make mental health services more accessible to young people who are self-harming. Organisations such as Mind and the LGBT Foundation have specific programmes in place to help LGBT young people; for example Mind has their online Elefriends community which has currently 50,000 members who help each other talk about their condition free from judgement and if a similar scheme were to be brought in specifically aimed at 12-18 year olds and curated and monitored by trained professionals, it may help them discuss their mental health in an open way. All teachers should be trained in mental health first aid by headteachers signing their schools up for the "Mental Health First Aid" programme and school nurses should be aware of how to help LGBT+ students with specific health concerns. Schools should liaise closely with Childhood and Adolescent Mental Health Services so that students have access to the specialist support they need as quickly as possible.

Social Media: 

65% of LGBT+ students believe that social media companies would not tackle abuse or remove HBT content when it had been reported by them to those organisations. Young people are spending increasing hours accessing social media content and I believe that Facebook, Instagram and Twitter have a responsibility to carefully filter and curate the content with offensive posts being removed as quickly as possible after being flagged. Whilst I accept that it is inevitable that young people may come across HBT abusive content whilst online (97% of respondents have seen such content), taking robust and quick action when the content is reported might increase confidence and trust in online platforms which would be a positive outcome.

There is a problem with Social Media trolling at the moment and I believe that it needs to be addressed in a robust, comprehensive and rigorous manner. 40% of respondents to the survey indicated that they had been a direct victim of HBT abuse carried out by trolls, including 58% of trans respondents. With digitalisation has come new forms of abuse and it's worrying to read that 6% of LGBT+ students have been photographed or filmed without their consent and 3% of students have had social media accounts created by abusers pretending to them to get them into trouble. 75% of students who have been bullied online did not reported the abuse to the platform. That demonstrates a lack of trust in online platforms to tackle HBT abuse.  I also believe trolls need to be blocked from accessing the platform entirely if evidence has been found to indicate sustained stalking and trolling of young people's social media accounts, with them being reported to the police for appropriate action to be taken.  Stonewall has recommended that social media platforms consult with organisations to improve their reporting procedures but I also believe that clearer signposting needs to be made available online to victims of HBT abuse and bullying so they access the help and support they need emotionally to deal with the after-effects of that abuse; you'd think in 2017 that Facebook would be able to send a message to victims that had details of organisations such as Stonewall or the NSPCC given that they already have online websites, Facebook pages and Twitter accounts with contact information on.

We must also beef up Internet Safety lessons in primary and secondary schools at all key stages within the National Curriculum further so that students gain the confidence needed to report content and trolls because they understand it is part of keeping themselves safe whilst online. Such lessons would also protect LGBT+ students from becoming victims of abuse online perpetrated by padeophiles. The Dare2Care campaign, established by Sarah Champion, MP for Rotherham and Shadow Secretary of State for Women and Equalities has a recommendation within their National Action Plan that calls on teachers and support staff to be given training on a regular basis so they have up-to-date knowledge and awareness of new online platforms, apps and trends. If we are to help LGBT+ students, the training provided as part of a teacher's Continuing Professional Development must be fully LGBT+ inclusive. That may mean the Department for Education commissioning organisations such as Stonewall and Mermaids to design specific courses to help deliver content directly to teachers and other educational professionals; LGBT+ people should be involved in the creation of content to ensure it is truly fit-for-purpose and can give teachers some ideas that they can implement in their own classrooms.

Conclusion: 

The School Report 2017 findings have shown that there is an urgent need for schools and educational establishments to look at their plans, processes and systems to ensure that they are truly LGBT+ inclusive, especially for trans, and non-binary students. Teachers and support staff must continue to have access to training opportunities so they can increase their awareness of LGBT+ issues and develop strategies to help students in their classrooms on an individual basis. Headteachers need to openly talk about LGBT+ equality, take a firm stance against HBT bullying and encourage the setting up of LGBT+ inclusive groups. Schools should work with local Child and Adolescent Mental Health Services to allow LGBT+ students access to counselling. Signposting should be available to students so they can access advice and guidance from organisations such as Mermaids and Stonewall. There should be a drive towards encouraging more trans, non-binary, gender-fluid, genderqueer and agender graduates into the teaching profession. The National Curriculum should be embedded with opportunities to discuss LGBT+ issues and role-models.Most importantly of all, SRE needs to be introduced that is truly LGBT+ inclusive. If I was the Secretary of State for Education, I'd be asking for the creation of a SRE curriculum that can be delivered in all schools and mandating that it will be delivered in faith schools, with lessons already built in addressing LGBT+ issues. Perhaps that may one day be the case. For now we have to make do with the rather wishy washy promise to provide guidance to state-maintained schools and hope that individual schools openly choose to have discussions around safe same-sexual intercourse and gender identity. I only hope the School Report shocks schools into action so they can truly be an inclusive and nurturing environment for ALL students, where they can be open about their gender identity and/or sexual orientation and respected for their openness.