Monday, 14 August 2017

Thoughts on Charlottesville: Keep Standing Up To White Supremacists and Alt-Right Commentators

The horrific events that have occurred in Charlottesville on Saturday seem to have shocked people not just in the US but around the world. Such events should shock every person who believes that compassion towards others should never be rationed. Heather Heyer, a civil rights activist who was exercising her democratic right to peaceful protest lost her life and 19 people were injured as a result of a driver seemingly choosing to deliberately run over protesters just because they were counter-protesting an organised hate driven rally organised under the vague label of "Unite The Right". If an ISIS terrorist had done this on a Saturday afternoon in an American city, they'd have been immediately labelled as a terrorist; yet President Trump could only condemn the "egregious display of hatred, bigotry and violence on many sides"  in his first statement rather than call out the actions perpetrated by the driver straight away.
Alt-righters have already tried to excuse or condone the driver's actions, stating that the driver had been "scared" by the number of protestors in the road and swerved off. We shall find out in the next days, weeks and months what primarily motivated the driver (the young man from Ohio currently charged with second degree murder is the main suspect) to commit such a heinous act but nobody should be surprised if police find out he had accessed materials that had been created and disseminated by alt-right commentators. The suspect seems to have adopted a poisonous, nationalist, white supremacist Neo Nazi based ideology that should be condemned at every opportunity. The act was deliberate and if found guilty, people have every right to label him a domestic terrorist because his act was designed to terrorise innocent people inspired by his political ideology. That makes the driver no better than ISIS suicide bombers.

The "Unite The Right" rally at Emancipation Park was organised by the former Daily Caller writer Jason Kessler, with speakers such as Richard Spencer, President of the National Policy Institute (a white supremacist think-tank) who has openly called for "peaceful ethnic cleansing" of the US or a "white homeland" for "a dispossessed white race" as The Southern Poverty Law Center have highlighted (https://www.splcenter.org/fighting-hate/extremist-files/individual/richard-bertrand-spencer). Such views are ridiculous to a liberal like me but then Spencer idolises nihilistic Nietzsche:
(see more about Spencer here: http://www.dailywire.com/news/11089/5-things-know-about-alt-right-leader-richard-aaron-bandler). Alt-righters like Spencer love being allowed to vent
 their views full of hatred, bigotry and inspiring xenophobia, racism as well as not being ashamed of celebrating white supremacism. Urgh.

The event was planned after it was revealed in February that Charlottesville City Council had voted remove and sell a statue of General Robert E Lee, after a campaign run by a local high school student. There have been a number of campaigns across the American South dedicated towards removing monuments that celebrate the slave-owning Confederacy. I don't entirely understand why the divisive legacy of the Confederacy needs to be celebrated (after all the Union side won) and it's strange to see the level of negative emotion shown by white people who are upset that the confederate flags aren't being waved with pride on a daily basis anymore because they say that flag represents freedom and liberty. I thought the modern United States flag was meant to represent those values? Yet there are others who believe the confederate flag should still be celebrated because it honours the sacrifice of confederate soldiers (the flag itself is a battle flag and not a national flag so there is some sympathy with the honour element: http://www.bbc.co.uk/news/magazine-23705803). Anyways the Charlottesville rally was basically planned for months and was designed to be the largest gathering in decades of white supremacists (5,000-10,000 was the estimate given for attendance pre the event). There was an altercation on Friday night between white nationalists/supremacists/alt-right and counter-protestors on the University of Virginia campus, where counter-protestors were sprayed with pepper spray and lighter-fluid (you can read more about the build-up here: https://www.theguardian.com/us-news/2017/aug/12/nazi-white-nationalist-rallies-virginia-protests).

Alt-right white supremacist nationalist speakers (that's what the majority of the alt-right are really....white supremacists; Spencer admitted the alt-right was a movement "for white identity" and he coined the term so it's easy to see it as modern code for white supremacy even though he rejects the term white supremacy) stir up hatred, bigotry and fear in a provocative manner. It's what they specialise in. Division is their end goal. Most of them hate diversity and cannot abide the idea of coexistence. That's why it's important for those of us who believe in the values of tolerance, compassion and respect to speak up and actively condemn speakers like Richard Spenser and also continue to condemn traditional white supremacist group speakers, including the ex KKK grand wizard, shameful David Duke. Duke's brass neck is visible for all to see. He can't hide his delight in the fact that Trump's election has meant he's now empowered to speak out about his white supremacist agenda: "We are determined to take our country back....We are going to fulfill the promises of Donald Trump". Duke interprets the "take back our country" slogan as being one that follows white supremacist lines but Duke was more than a bit upset at Trump's (vague) rebuking tweet, stating openly that Trump's win was down to "White Americans....not radical leftists". Duke's tweet is racist and false; "radical leftists" include white Americans and there were also Americans from ethnic minority groups who did vote for Trump (wonder if some of them regret this now given his actions during the Presidency...). Still a shame that Duke's been allowed a Twitter account when alt-right commentators such as Milo Yiannopolous have been banned from the social media site; what makes Duke more acceptable than Yiannopolous?!

It's important to mention the fact that most of the white supremacists and alt-right protesters were men. As a trans non-binary person, I find it very difficult to accept that white guys are the "most oppressed" people in America (and equally in the UK). A Vox article "The Charlottesville protesters are white fragility in action" (https://www.vox.com/identities/2017/8/12/16138558/charlottesville-va-white-fragility) points out that men at the march were changing slogans such as  "you will not replace us"; given that the 2016 census data indicates that 76.9% of the US population are white as opposed to 13.3% of the US population who are black or African American (https://www.census.gov/quickfacts/fact/table/US/PST045216) demonstrates quite clearly that these white men have no reason to chant such a slogan and besides, racial diversity is certainly nothing to fear. Yet these men are evidently afraid of change; there's no doubt a large number were angry at President Barack Obama and want to dismantle his legacy and also at the Black Lives Matter protests that have been gaining momentum in the US and beyond.

In America, white supremacists have the right to protest (under the 1st Amendment). An article in Vox explains how even the American Civil Liberties Union defended the right of Kessler et al to protest in Emancipation Park (https://www.vox.com/policy-and-politics/2017/8/12/16138326/aclu-charlottesville-protests-racism).  I can and will never understand how someone can be so insecure about their own life that they end up blaming immigrants, African Americans, Asian Americans or Latin Americans for their own misfortune. There's no evidence to prove white people are being oppressed on the basis of their skin colour. It is worrying to see predominately young men turning to Neo-Nazi, white supremacist ideology for comfort. There's something quite frankly chilling about seeing young men marching with tiki torches, chanting Nazi-era slogans and threatening innocent students and protestors standing up for their fellow Americans with violence.  It seems we have to defend a person's right to protest, even if their views are abhorrent to us; that's the supposed hallmark of a democracy. But nobody should condone the right of protesters to resort to verbal abuse or physical violence, regardless of who those protestors happen to be. Violence is never the answer.White nationalists are far from the paragons of American virtues that they purport themselves to be. No gentility of character evident whatsoever.

A tepid false equivalence statement such as the one issued by Trump as his first response to Charlottesville was not acceptable. There was NOT blame "on many sides"; the blame firmly lies with the white supremacists. This group of individuals have oppressed African Americans, Asian Americans and Latin Americans for generations. They protest because they want to continue having a foothold in American politics, aided and abetted by alt-right commentators who have now spruced up the white supremacist ideology to suit the millennial (and younger) social media watching audience. They have used YouTube, Twitter, Facebook and even Instagram to their own advantage to push an odious ideology which has no place in a liberal, tolerant and open world. Most political commentators (and most Americans) wish Trump had openly condemned white supremacist and, alt-right groups on Saturday. Republican politicians lined up to criticise Trump's choice of words: Senator Cory Gardner urged Trump to "call evil by its name", stating that the act was committed by "white supremacists and this was domestic terrorism". Utah Senator Orrin Hatch tweeted that white supremacist protesters' "tiki torches may be fuelled by citronella but their ideas are fuelled by hate & have no place in civil society". Instead, Trump couldn't help but lay part of the blame for the events at the door of those who bravely protested these groups, including Black Lives Matter activists. I'm not ashamed to say that if I'd lived in Charlottesville and I had heard that an alt-right and white supremacist rally was going to take place in my town or city, I'd have tried to get involved in peacefully protesting them. Any person who abhors white supremacist ideology would have done the same.The White House has issued a "clarification statement" where they state that Trump was referring to white supremacist groups in his statement; it's just sad that he couldn't condemn them by name in the first place. Trump has also spoken out and mentioned the KKK by name but why did it really take him so long? If I was President of the US or Prime Minister of the UK, I'd have called them out straight away. A dithering attitude doesn't inspire much confidence leadership wise.

The events in Charlottesville demonstrate the need for real cultural change in America, including conservative attitudes towards peaceful protestors from the Left. Protestors are not paid shills for George Soros, no matter how hard the alt-right wants to push that false stereotype. People on the left care about freedom but they also care about (on the whole) equality and diversity and celebrating living in a multicultural society. It's important to mention that there are Republican lawmakers who want to make it legal for protesters to be hit by cars. In the UK this would be entirely unthinkable and contravenes Article 8 of the UK's Human Rights Act 1998. So to a British person like me, such a change in laws regarding protest in America are repulsive. So the lawmakers of North Carolina (who passed a bill with 67 people voting for it...https://www.usnews.com/news/articles/2017-04-28/north-carolina-house-votes-to-protect-drivers-who-hit-protesters) Texas, Florida, Tennessee and North Dakota really need to take a look in the mirror and question their prejudices; would they try and change the law if an alt-right or conservative protester was mowed down by a car? Hmm.

Education is going to be key if America is to deal with the issue of persistent white supremacist ideology being pushed by elements of the alt-right movement. From an early age, whether at church (community centre or any other religious building), in elementary schools or at youth camps, children should be taught that hating a person based on the colour of their skin is fundamentally wrong and at odds with any notion of freedom, liberty or equality. However, testimony from the driver's history teacher proves how much of a challenge it is to try and get some young men to steer away from being seduced by Neo-Nazi and white supremacist ideology; his comment about Dachau concentration camp is so chilling that I will not mention it here (read it for yourself: http://abcnews.go.com/US/charlottesville-murder-suspects-teacher-thought-nazis-pretty-cool/story?id=49193213).

More generally, frank conversations do need to be had over white privilege. This may be more difficult with those who have conservative  political views who may not wish to be told that their comments or actions have a negative impact on people from ethnic minority backgrounds and could be interpreted as casually racist; an interesting case is pointed out in the first Vox article where a young woman at an anti-racism training session couldn't accept that her views could be challenged so overtly by participants who were from ethnic minority backgrounds  to the point where she declared she "might be having a heart attack" to her white colleagues which then re focussed attention and sympathy on her and away from the comments she had made. Some white-supremacists and casual racists react in such a sensitive way so as to escape their responsibility for their hate speech. Others are blatantly proud to hold such views and they should be condemned openly for those views. I don't think there is any free-speech issue concerning  no-platforming of racists, white-supremacists who may define as alt-righters; social media sites should be diligent in policing their platforms and quick to remove videos, tweets and Facebook posts that contain white-supremacist or racist ideology whenever they are alerted to such content.

There are certainly white nationalist supremacists out there who appropriate Christianity for their own ends without seemingly recognising some vital basic facts about Christianity (Spencer describes himself as an atheist and a "cultural Christian", which is confusing enough!) Firstly, Jesus was from the Middle East (born in Judea which is now part of the Palestinian West Bank) and was a Jew; he was not white or evangelical. Secondly, Jesus believed that demonstrating acts of compassion were a vital part of leading a fulfilled and happy life. Thirdly, Jesus believed that those acts of compassion should be demonstrated to all, regardless of religion, nationality or race. Fourthly, Jesus taught us about the importance of loving your neighbour; alt-righters and white supremacists may love their immediate neighbour but show little respect or compassion towards those who lead different lives. James Martin, a New York based Jesuit Priest, points out in a Twitter post (https://twitter.com/JamesMartinSJ/status/896528129971281920) that "supremacy is absurd to Jesus": Mark 10 42:43 makes it clear that Jesus expects us not to "lord power over others" and be "each other's servants". The Parable of the Good Samaritan is one of the best examples of Jesus's acts of compassion to use to counter alt-right narratives but Father Martin also points to the example of the Roman centurion, whose servant he healed without passing judgement on either of them. Racism, Marks says, "goes against all that Jesus taught: It promotes hatred, not love, anger, not compassion, vengeance, not mercy. It is a sin". Religion can be a force of good in the world and it is a Christian duty to stand up to white nationalist supremacists. After all, we are all made equal in the image of God the Father, Son and Holy Spirit: (Galatians 3:28: "There is neither Jew nor Greek, there is neither slave nor free, there is no male or female, for you are all one in Christ Jesus). God does not show favouritism (Deuteronomy 10:17 declares that God "is not partial and takes no bribe").  Christians should also be prepared to forgive those who truly repent of their racism/ white supremacism: Ephesians 4:32 states: "Be kind and compassionate to one another, forgiving one another, just as in Christ God forgave you". That being said, Christians respect the legal system and the law must be allowed to take its course when racists have taken action designed to terrorise others.

It has to be pointed out clearly that problems faced by communities in rural America (also faced by deindustrialised communities in the North of England) are NOT the result of "diversity genocide" or completely the fault of "mass globalisation". White supremacists only look to the past and glorify every action taken by the ancestors. That's not going to help solve the issues faced by "angry white young men" today.  Instead, there needs to be policies enacted that help to address those issues. The Alt-right and traditional white supremacist groups like the KKK cannot offer solutions; they just contribute articles to their own groupthink websites like AltRight.com where they try and read fascism into the work of David Bowie: (http://forward.com/fast-forward/360401/richard-spencer-and-white-supremacists-aim-for-bigger-platform-with-altrigh/).

As I've said earlier, education is key. More young white American men from working class backgrounds should be encouraged to apply for higher education programmes (including night school) because they need to realise that they will probably not be able to walk into a job without a good standard of education -i.e. college degrees (see more here: https://www.fastcompany.com/3062321/why-are-there-so-many-white-young-american-men-without-college-degrees). Trump's more bothered about reviewing federal education policies (mainly K-12 education) than increasing access to college education and the fact that his administration has rolled back the protection for individuals who may default on their college loans signals a disregard for college students. In fact, Trump wants to reduce state grants for career and technical education (for those who do not want to go through traditional college, akin to the UK apprenticeship programmes) and cut the funding for the US federal work-study (for those who do attend college but might have ended up working to fund it) programme by 50% (https://www.theatlantic.com/education/archive/2017/05/trumps-education-budget-takes-aim-at-the-working-class/527718/).

Young people should also be empowered to look for a sense of self-worth that is not contingent on "membership" of a hate political movement. Getting them involved in community work, arts projects, the church can help in this respect.

Those who elected Trump who do not consider themselves in any way a part of or allied to the KKK or the Alt-right movement (including some independents) apparently did so in part because they believed that he could bring economic prosperity to the American rust belt. As of yet, Americans have heard very little about policies that would directly help working class Americans, including those who may have alt-right sympathies. Instead, there's an emphasis on tax reform that seems to predominantly benefit business owners, cutting the corporation tax from 35% to 15% (although Trump says he'll eliminate income tax for single people earning under $25,000 a year) with the "hope" that those business owners then expand and create jobs for young people including those involved in the alt-right movement. Will such trickle-down capitalist economics work? Doubt it.

Recently, Trump's administration have focussed on isolationist and protectionist policies, including trying to bring an immigration reduction bill (named the RAISE Act) to Congress; such an act would, according to a Penn Wharton study, lead to the US's Gross Domestic Product being 0.7% lower by 2027 and 2% by 2040. Whilst it may raise per capita GDP in the short term, the economy on a person-by-person basis would be smaller by 0.3% (https://www.vox.com/2017/8/11/16125578/raise-act-economic-impact) by 2040. The Penn Wharton study also found that such a policy may end up reducing the number of jobs in the US by 4.6 million. Trump's approach has been criticised by the Dean of Harvard Business School, Nitin Nohria who stated that the US needs to focus on the "ambitions and aspirations linked to globalisation" because they are part of "the American dream". The US must remain attractive to highly skilled migrants because they help drive economic growth: "more than 50% of Silicon Valley start-ups have an immigrant co-founder" and they help to employ US born citizens in well paid roles:  (http://www.independent.co.uk/news/world/americas/us-politics/donald-trump-economic-policy-us-risk-president-harvard-business-school-dean-name-a7870866.html). A more positive and progressive approach to immigration would be much better and there needs to be economic reforms that help young people get into work. But that doesn't seem to be coming any time soon.

My thoughts and prayers are with the family of the Ms Heyer and with the injured and their families who are in a critical or serious condition in hospital; having lost my Uncle on Sunday due to liver cancer I can only hope that they are all being well supported during the grieving process. Nobody should lose their life when exercising their right to protest peacefully. Nobody.

Thoughts are also with the two police officers who died when their helicopter crashed into a wooded area outside of Charlottesville. They died whilst carrying out their duty to "protect and serve".

Yet we must continue to protest white supremacists through countering the ideology that feeds their hatred, including through social media and engaging in a positive, practical way with those who would be susceptible to turning to the alt-right for advice and guidance. A pro-active approach is essential.  The words of Edmund Burke are more important now than ever:



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.