Author: Jessie Krish

Adam Shepherd is a third year medical student at King’s College London. For Trans Day of Visibility he shares his reflections as a trans man researching transgender people’s experiences in healthcare settings.

A ‘Select Gender’ box with two options: ‘Male’ or ‘Female’

When I was born, a doctor assigned me to be “female”. During my childhood I felt increasingly at odds with the ways that I was being socialised as a girl by the world at large, but it was only in my early twenties that I learned a word to make sense of my growing unease: Transgender.

As a Latin prefix ‘trans’ simply means “on the other side of”. Nowadays ‘trans’ epitomises much more than that – it is an umbrella term for diverse identities and experiences of people whose gender does not align with the one they were designated at birth. To me, ‘transgender’ encapsulates that feeling of comfort, pleasure, and relief of arriving after a long and tiring journey: home sweet home.

However these definitions are a far cry from how we were understood even 70 years ago. From labelling trans people as mentally ill and promoting the use of psychotherapy to cure us, to realising the benefits of letting us transition to our identified gender, the relationship between medicine and the trans community has historically been strained.

The impacts of this is still felt today. A 2016 report found that transgender people in the UK, on average, experience higher health inequalities than cisgender lesbian, gay, and bisexual people. In 2018, Stonewall and the National LGBT Survey showed how trans individuals are more likely to face discrimination in medical settings, and more likely to avoid seeking healthcare when they need it.

As an aspiring doctor I was appalled at the anecdotes I heard in my own support groups – stories of being met with ignorance and insensitivity when seeking medical care as a trans person. My first opportunity to do something about this came when I undertook my Masters of Public Health dissertation in which I explored trans people’s experiences of primary care.

In my research, communication emerged as a key factor shaping the relationships transgender people had with their General Practitioners. Yet even before entering the consultation room, participants had to mediate inflexible medical records which failed to recognise their identities and bodies. Fixed ways of thinking about gender are embedded in healthcare practices through these processes and documents, making communication only part of the problem.

To make sense of this, sociologist Ruth Pearce proposed two conceptual models to think about the experience of being trans. “Trans as condition” depicts the traditional understanding that ‘trans’ can be clearly defined, often by a healthcare professional, and that transitioning resolves a person’s transness. “Trans as movement”, in contrast, posits that ‘trans’ is variable and versatile, similar to how we subjectively experience the world around us. From this viewpoint, ‘trans’ stops being a defect that needs correcting, and becomes a social identity.

Working with Dr Benjamin Hanckel, I sought to better understand how the changing conceptualisations of trans experiences were reflected in healthcare guidance, and whether it aligned with lived experiences of transitioning. Looking at healthcare guidance documents by NHS England illuminated these discrepancies. Changes over time in the language used illustrate how institutional shifts towards the idea of “trans as movement” has enabled greater numbers of gender diverse people to emerge from the shadows through being officially recognised in these documents. However, rigid medical forms often do not account for diverse experiences of gender. Consequently people who are transitioning continue not to be accounted for in health structures built around the expectation of cisgender bodies.

What is evident is that for healthcare to become inclusive of all trans people, we need to tackle the very design of healthcare organisations, which is often based on outdated ideas of gender. But gender is a complex topic.

In another project Dr Benjamin Hanckel and I asked young people who visited the Science Gallery London exhibition GENDERS: Shaping and Breaking the Binary to explore what gender meant to them. Whilst traditional ideas of gender surfaced, early findings point to how many young people are increasingly open about gender, recognising it as being fluid, even if at times it feels restrictive, reminiscent of a “trans as movement” framework. Nonetheless, the question remains as to how these new and shifting models of gender, that recognise everyone’s myriad and diverse experiences, will enter into healthcare provision.

As I look towards the future of becoming a medical professional, I realise there is a way to go until transgender people are not just accepted, but have their needs acknowledged in healthcare settings. With the recent court case concerning the provision of puberty blockers to trans youth and continued lack of knowledge among healthcare providers, the future might seem bleak, but change is on its way. From Brighton and Sussex NHS Trust expanding vocabulary for midwives to include gender neutral terms, to the emergence of new grassroot organisations to advocate for the health needs of the trans community, the tide is slowly beginning to turn.

Further Reading:

• I am your trans patient
• Trans health and the risks of inappropriate curiosity
• The dangers of trans broken arm syndrome
• Understanding Trans Health
• Transgender Health: A Practitioner’s Guide to Binary and Non-Binary Trans Patient Care
• The A-Z of Gender and Sexuality: From Ace to Ze

Following Sarah Everard’s murder, and public discussion about why male violence against women continues to be commonplace in our society, we hear from two members of the King’s community.

Joy Whyte is Strategic Director for Education and Students, and chair of the newly convened King’s oversight committee on “Preventing and Addressing harassment and sexual misconduct”

Joy Whyte

Data released by UN Women on 10 March 2021 showed that over 70% of women in the UK have experienced sexual harassment in public. For women aged 18-24 the figures were even higher – just 3% of respondents said they had not experienced such harassment.

Around the same time the UN report was released, we saw the news of Sarah Everard’s disappearance, a police investigation, and – tragically – the discovery and identification of her body. Six months earlier, in September 2020, Blessing Olusegun had gone missing after a walk and, heartbreakingly, her body was found the next day on a beach in Bexhill. Whilst Blessing’s unexplained death drew much less media coverage at the time, an online petition is urging the reopening of the police investigation.   

Writing last week, Mandu Reid, the leader of the Women’s Equality Party, notes that “True, most women will not be kidnapped or killed. But the more important point is that male violence against women is absolutely not rare.” 

Yet the narratives around assault tend to highlight women’s vulnerability, rather than the actions of the perpetrator or the culture in which those arise. The Scotland-based organisation Zero Tolerance, which has published best practice tips for reporting on violence against women, observes that “headlines like, ‘Woman raped’ can make it seem like violence is something that ‘just happens’ to women when in fact these crimes always have both a victim-survivor and a perpetrator”.

With these recent events on my mind, I’ve been reflecting on two contrasting incidents that happened to me on the tube in the same fortnight, about 18 months ago.

In the first, I randomly fainted on a rush hour tube, which was very unnerving and thankfully extremely unusual. But someone helped me to get back up, someone put my book in my bag, another person gave me some water, someone called the TFL station staff, and someone even offered to walk me home. People were kind, considerate and involved. I felt cared for and supported.

A week or so later, I was harassed on a morning rush hour tube. A man put his hands round my waist to move me out of the way – it was intrusive, inappropriate and unwelcome. I said all the things I’ve previously thought of only after the event, quite loudly, starting with: “why are you touching me?”, then “you’d say excuse me to a man, you wouldn’t touch them”. And finally, when he told me I was angry, “yes I am angry, because you touched me inappropriately”.

The man who harassed me was clearly embarrassed by my reaction. And the people around me on that busy rush hour tube were also embarrassed, and completely silent. Even though I was vocal, no-one spoke up alongside me. I got off the tube, and got on with my day. If I mention either story, it’s normally the one in which people were kind, rather than the one in which I was ignored. Not because the latter doesn’t matter, but because it seemed so routine – a part of living in the world as a woman.

Yet, as this interview with Laura Bates (the founder of the Everyday Sexism project) notes, “from the #MeToo movement to Black Lives Matter, the inflection point for resisting injustice is not when one crusader saves the day, but when everybody is emboldened to speak out at once.”

However, the solution to sexist interactions and gender-based violence affecting women is not to be found in changes to their everyday behaviours (and I use the term ‘women’ inclusively, encompassing non-binary and trans identities). Rather, we need to focus on education;  resourcing for the courts – in which successful prosecutions are shockingly rare; training for the police and all parts of the criminal justice system; meaningful engagements around consent and respect; the introduction of the long-awaited Online Harms bill, which will better protect children and young people from being exposed to online pornography; and robust interventions – societal, legislative, and corrective – that expose the problem of violence, not as something that women should have to endure, but rather as an issue that we can prevent and address through complex, holistic, societal solutions.

Here are some suggestions for practical actions that you can take (please add other suggestions in the comments below):

• Sign up to the UN Women UK’s campaign on Safe Spaces: 
• Respond to the (recently reopened) government consultation on Violence Against Women and Girls
• Use the Zero Tolerance guidance to challenge organisations/headlines that employ language that sensationalises or draws attention away from the crime itself
• Think about how to be an active bystander. Solace Women’s Aid outline three key options you can explore, if it’s safe to do so:

1. Create a distraction – You can let both parties know you are present by interrupting the situation. You could ask for the time or some information, and stand in the line of sight whilst assessing the situation.
2. Directly confront – Talk to the assumed victim – ask if they are ok, if they need help. Talk to the assumed perpetrator – remain non-judgemental and calm.
3. Delegate the intervention – If you think someone else is better placed to take care of the situation, call a service such as the police or talk to someone senior, a friend of the perpetrator/victim, or an impartial source.”

Finally, I’m reminded of Professor Stan Cohen, who I was lucky to work with at LSE, and who was fond of quoting Saul Alinsky’s parable: “A fisherman sees a body floating down stream and jumps in to rescue it. The same happens a few minutes later, and then again, and again. When a tenth body floats down, the fisherman leaves it and runs upstream, to find out how to stop these people getting into the water in the first place.”

We’ve been spending way too much time downriver. Let’s do all we can to change that.

If you’ve been personally affected by sexual violence or harassment, please reach out and access support.

• Our Chaplains are available to all in our community (of all faiths and no faith) by contacting the Chaplaincy and Dean’s Office on 020 7848 2373 and 020 7848 2333 or at chaplaincy@kcl.ac.uk and dean@kcl.ac.uk.  

• For students, you can also contact our counselling service on 020 7848 7017 or email counselling@kcl.ac.uk. Your personal tutor is also able to offer support. 

• For staff, you may want to talk to a trusted colleague or manager. And our independent and confidential Employee Assistance Programme (EAP) is also available by phone or email.   

Following Sarah Everard’s murder, and public discussion about why male violence against women continues to be commonplace in our society, we hear from two members of the King’s community.

Roscoe Hastings is the School Manager, and equality, diversity and inclusion lead, of the School of Population Health & Environmental Sciences in the Faculty of Life Sciences and Medicine at King’s. 

Roscoe Hastings

The week beginning on the 8th of March was bookended by International Women’s Day and Mothering Sunday. It should have been a week of celebrating women, shining a light on the injustices they face and reflecting on where we have come and where we still need to go in the fight for equality – particularly on how far we must go in addressing the systemic issues for trans women and women of colour. However, it was not the week that any of us anticipated.

It saw us mourning the death of Sarah Everard, another woman murdered after not being able to walk home safely at night; we watched a peaceful vigil (and some would say protest) against that murder being broken up by heavy-handed policing, and yet another woman’s experience of mental health and racism being vilified and questioned on national TV – this time Meghan Markle’s. As ever, sitting behind all these events has been yet more hatred, harassment and gaslighting on social media.

As I watched on horrified and ashamed of what I was witnessing, I was struck by two clear self-reflections. One was how easily I fell into the “I’m not part of the problem” mantra, seeing the problem as “other men”. Secondly, that my silence in not wanting to appear tokenistic in tweeting or speaking out about what I was seeing, or thinking that I should let women speak for themselves, is the problem. I, like many, have been saddened by the sheer scale of the stories that women have told in the last few weeks, of their lived experiences.

It is all too easy to think that our sector is liberal thinking, inclusive and a ‘bastion of progress’. We have seen a shift in the last two decades. We have seen a (slow) increase in the representation of women in the sector – more women vice-chancellors, more women professors; the establishment and success of Athena SWAN; the creation of Women’s networks on many of our campuses; and progress in addressing many antiquated policies and practices in relation to flexible working, probation, promotion and more. I do not want to make out that the job was by any means ‘done’, but there had been at least some progress. I was proud to work in a sector that held these issues as important and non-negotiable and was on a journey trying to deliver change. However, what we have seen over the past weeks has made me question where we are, and how we are challenging ourselves as a sector. 

I currently have the privilege of leading the diversity and inclusion agenda in my School, one in the Faculty of Life Sciences and Medicine at King’s, which has been an eye-opening experience. I fell into the role partly because no one else in the School stepped forward to take it on – leading me to ask questions about why this was the case. I have been struck by how many of the colleagues who are leading this work in the university are women and/or are people of colour. While this may seem like a great thing – the people who have for years been underrepresented and marginalised in higher education are leading the charge for change – I have come to realise that this is double-edged. The responsibility for initiating and delivering change in culture, practices, and a system that has been built over centuries on the dominance of white, cis men, is a further burden on those who have been oppressed by it. How can we think that this is ok?

The absence of men, as allies, in these spaces and conversations, is part of the problem. By not being present in the committee meetings, delivering the training, or speaking out when needed, we are complicit in the very problems that we think we are tackling. In leaving women, people of colour and the marginalised to lead equality and diversity work in the sector, we are reinforcing a silence that permits continued harassment, microaggressions, misogyny, and outright racism and sexism that should have been long banished from our universities and sector.

So, what can we do?

• Educate yourself. Take time to reflect on your own (in)action. Listen to women when they are sharing their experiences in a way that inspires trust and respect. This requires empathy, attention, a refusal to interrupt and valuing the experiences being shared. 
• Be comfortable in being uncomfortable, the discussions and sharing of these experiences by your colleagues, students and friends may produce self-blame, shame and anxiety. The solution is to learn and engage more, not to retreat and make yourself feel better or absolved.
• Engage in support for women by asking —not assuming — how you can best support, advocate, and act. Remember, it is not about you. Ask women how you can amplify, not replace, and take over.
• Change your mind set about the role of men in equality and diversity spaces.  If we continue to leave the heavy lifting to others, progress will continue at its current glacial pace. We need active, vocal, and strong allies.
• Step forward and step up. The easy part of being an ally is saying you will be better or respond. The hard part is in taking the action you have committed to. Hold yourself to your promises and commitments. If you see something, say something, and commit to action when you witness inequality, harassment or bullying in all its forms.

I have reflected a lot over the past fortnight on my role in these conversations, how I have been complicit, and how I need to change. I would encourage all men to do the same. 

Equality, Diversity & Inclusion Project Assistant, Jessie Krish, writes about the UK Census: what it is, why participation matters and how this aspect of our democratic framework stands to have real impacts on equality and inclusion in research, local governance and our daily lives.

The UK census, which happens every 10 years and gathers information that gives the UK government a picture of all the people and households in England and Wales. The data that is collected is used to plan services such as transport, education and healthcare.  

It is really important that we all fill the census out on Sunday 21st March or as soon as possible thereafter: ‘who’ participates impacts the data we have and our view of ‘who’ our country is.  

The overall response to the last census in 2011 was 94% but amongst some black and minority ethnic households it was up to 10 percentage points lower. This can lead to decision-makers operating without awareness of the needs of particular communities. Entering the recovery phase of the pandemic, which has brought stark disadvantages such as health-inequalities between different ethnic groups to light, this is more important than ever. 

We are excited that this year the census will ask voluntary questions on sexual orientation and trans status for the first time since the census first ran in 1801. Iain Bell, Deputy National Statistician at The Office for National Statistics commented in The Guardian that, ‘without robust data on the size of the LGBT population at a national and local level, decision-makers are operating in a vacuum.’ In the same article, Nancy Kelley, chief executive of Stonewall, said: ‘Historically, lesbian, gay, bi and trans people have been a hidden population in the UK, and this lack of visibility has damaged our ability to secure the rights and the support our communities need.’ 

Image from the 2021 national census campaign.

Sophie Rust recently joined Equality, Diversity & Inclusion as a Project Officer, working two days a week in the Faculty of Arts & Humanities. She previously worked in King’s Careers & Employability.  

Nine months after the murder of George Floyd sparked a resurgence of the global Black Lives Matter movement, I have been reflecting on my own journey towards practising anti-racism. Layla Saad in her book Me and White Supremacy explains that commitment to anti-racism is a lifelong practice. It is one that I have only recently started to understand.  

Last June we saw organisations scrambling to articulate positions on racism. Many were sceptical about the depth of convictions behind their public statements and black squares. Whilst structural and individual racism must be addressed, it was my own inaction that left me most uncomfortable. Asking myself ‘am I really doing enough?’, the answer was a resounding no. Like many other white people, I considered myself liberal, progressive, and ‘not racist’, but through engaging with anti-racist scholars and activists such as Ibram X. Kendi, Reni Eddo-Lodge and Akala, I understood that ‘not-racist’ is not enough. This seemingly neutral position actually upholds the status quo in order to retain white privilege.  

Educating myself has helped me deepen my understanding of racism, the legacy of colonialism and empire, and how I can show up as an ally to People of Colour. One of the texts that has been most helpful is Layla F Saad’s Me and White Supremacy: How to Recognise your Privilege, Combat Racism and Change the World.  Originally a 28–day Instagram challenge, Me and White Supremacy is now in book form with journaling questions to complete at the end of each day. I got a small group of friends together to read and discuss it over a few months, which provided accountability and support as we confronted this uncomfortable subject matter together.  

The book begins with an introduction to Saad’s own story, an overview of white supremacy as a topic and instructions on how to use the book. The rest of the book is split into four themed sections: Week 1 – The Basics which grounds you in key concepts; Week 2 – Anti-blackness, Racial Stereotypes and Cultural appropriation; Week 3 – Allyship; and Week 4 – Power, Relationships, and Commitments.  Saad has given me vocabulary to discuss racism and white supremacy, which has transformed my confidence to speak about race. Journaling has enabled me to go deeper into the content and relate knowledge that might otherwise remain abstract and theoretical to my daily life. 

Instagram post and graphic by illustrator and activist Danielle Coke presenting steps you can take in the short-term to combat racism and contribute to change. Follow Danielle on Instagram @ohhappydani.

Responding to the section on commitments at the end of the book, I explored my sphere of influence to see where I could practice anti-racism. This led me to examine where I was shopping and to discover Black-owned alternatives via marketplaces such as Jamii or Janet’s List. I became a member of gal-dem which is an independent media organisation committed to telling the stories of people of colour from marginalised genders. I decided to join the trade union UNISON in order to organise and campaign for better working conditions for all staff. I joined my local Labour Party to understand more about local issues where I live in Tottenham which has a large Black and Minority Ethnic population. In my previous role in King’s Careers & Employability I participated in our local Race Equality Group and worked with Gya Niyazi to ringfence 20% of the Student Opportunity Fund grants for Black students. I’ve also started having conversations about race with my family. This has been one of the most challenging commitments, especially with the added barrier of virtual communications during the pandemic. These are just a few examples related to my personal sphere of influence so I’m not sharing them as a blueprint. I know this is just the beginning and I still have a lot to do. Each day presents new opportunities.  

Saad writes: ‘it is your responsibility within yourself, your communities, your educational institutions, your corporations, and your government institutions to do the work that you can do every day to create the change the world needs by creating change within yourself.’ There are fantastic ways to get involved in anti-racism work at King’s such as the Race Equality Network, Global Day of Service, Conversations about Race and anti-racism resources. Learn more about anti-racism at King’s here.  

Please do reach out to me by email or LinkedIn (sophie.rust@kcl.ac.uk) if you have feedback on this blog post or want to connect – I would love to hear from you! 

This blog is part of a series from Director of Equality, Diversity and Inclusion, Sarah Guerra, where she will be addressing the ‘whole picture’ of EDI, why it is important, and how we go about making effective, systemic change.

There are a variety of ways to diversify your workforce and enable those from underrepresented groups to get the experience they need to get on the career ladder and progress successfully. These include graduate recruitment schemes, apprenticeships and internships. 

Recruiting graduates differs from overall employee recruitment, as candidates are less likely to have previous employment experience under their belt. It is ironic, in my view, that as a University we don’t have a consolidated or consistent approach to graduate recruitment! We have a great 2-year rotational scheme in our IT department that aims to develop graduates’ IT and business skills and experience and has proved very successful. I really find it hard to understand why we don’t have more of this across the university and will devote some time to exploring this over the coming months. 

In general, new graduates are highly ambitious, eager to impress in their first career role, and have high expectations of their managers to support and actively sponsor their career. Targeted graduate recruitment as part of a recruitment strategy can enable a focus on creating greater diversity in areas where there are the greatest gaps. This can positively increase the number of BME graduates entering employment through graduate recruitment, which subsequently impacts the talent pipeline. 

A targeted approach could include using higher education ethnicity data, looking at universities with better BME representation. With our 17,900 undergraduates making up just over 60% of the student population, King’s is in an excellent position here, and, with our Careers and Employability Department, we should be thinking about how to maximise this competitive advantage. 

In addition, the implementation of  cross-organisation schemes, in which BME graduates spend a few months in each department, provides greater exposure across an organisation’s activity and can help those who are joining the workforce to evaluate where their strongest skills lie. The Civil Service is very good at this and has several schemes for graduates under the umbrella of the Civil Service Fast Stream (this is how I started my career). This lays the groundwork to help new entrants succeed in their future careers, providing opportunities at an early career stage for valuable leadership insights across a range of environments. 

All recruitment, and particularly graduate recruitment, requires care and attention. Employers should already have good quality data on their workforce and collect data on  new graduate employees so that they can track them as they progress. (See my blog ‘The Drive for Data’). This helps organisations to understand the rewards for their investment and provides insight into what other future targeted interventions are needed. 

Historically, many graduate schemes have suffered from the built-in biases we are all aware of. Any future schemes need to be designed and operated carefully, seeking to identify and minimise bias at each stage of the recruitment process and ensuring that, once in an organisation, all individuals are treated fairly and given equal opportunities to succeed and thrive. 

Apprenticeships were historically a method for developing a new generation of practitioners in a trade or profession, through training that is done on the job, accompanied by formal study. They are increasingly attractive as individuals prefer to get hands-on work experience and not build mountains of student debt.

There is significant under-representation of BME apprentices in some industry sectors with higher earnings potential, such as engineering and science. Therefore, organisations have a crucial role to play in redressing this imbalance and ensuring that women, disabled, or queer people, BME and other marginalised groups are not discouraged from taking up apprenticeship opportunities.

Employers can do this by encouraging applications for apprenticeships from under-represented groups and scrutinising the reach of their recruitment strategies – asking themselves, how might these reach a wider audience? They can and should review recruitment and selection criteria to ensure they don’t exclude or discourage under-represented groups. They can go further and consider giving all atypical applicants who meet the minimum selection criteria an interview, and using positive action to address under-representation (see my blog on ‘Targets, Quotas and Money’). Organisations have also seen success by targeting information at parents of young people from disadvantaged groups to help address their under-representation.

Targeted Internships or Work Experience Internships are career-based learning experiences that involve “real world” work environments and expectations. Taking a targeted Internship approach can help address underrepresentation or experience gaps. To make this meaningful and effective, an organisation would need to consider how to structure these programmes and also provide experiences that enable interns to learn about the tasks of their work but also learn to navigate environments and build networks. It is important that Interns are recruited in an open and fair process. Internships should not be nepotistic; they should be a serious part of an organisation’s hiring pipeline. The Civil Service’s award-winning diversity internship programmes, including the Early Diversity Internship Programme and the Summer Diversity Internship Programme, are good examples.

It is important to treat people as individuals and place a positive value on diversity – not to be seen to be ticking a box or tokenising. Equality is about fairness in society, where everyone can participate, and have the opportunity to fulfil their potential. So whether it is interns, apprentices or graduate recruits, there is a need to ensure equal access to opportunities to fully participate in the learning process, to treat everyone fairly, and equip both managers and learners with the skills to challenge inequality and discrimination in their work/study environment.

The coronavirus crisis has illustrated how embedded and ingrained Vision 2029 is at King’s, prompting an extraordinary short-term realignment across our five strategic priorities of Education, Research, Service, London and Internationalisation. The institution’s immediate response demonstrated our immersion in the concept of service, and the strength of our partnerships in our local London boroughs– and with Cornwall, through the extended community of King’s Service Centre. Our academic strategies for education and research have been adapted swiftly and imaginatively so that our students can continue to receive a world-class education under dramatically changed circumstances, and our research continues to thrive and make a major national and international impact. King’s people have responded creatively and pragmatically, adapting to challenging circumstances while continuing to deliver at the highest level. Our increased reliance on technology is just one example of how our professional services capabilities, and the expertise of our professional services staff, are fundamental to success. Overall, as we have shaped our route to recovery, the effect has been to accelerate, rather than defer, our commitment to Vision 2029.

As someone who has benefited from a graduate recruitment scheme, starting my career in the Civil Service Fast Stream, I have a real enthusiasm for them. Without a doubt this scheme gave me a start and professional grounding that has stood me in good stead throughout my career. Equally, as the only brown girl of that group, and the last to get promoted, eventually finding myself leaving to get the recognition I deserved, I fully recognise their limitations in a world in which structural inequalities persist.

Kendall Robbins is a first-year student nurse at King’s who has Ehlers-Danlos Syndrome (Hypermobility Type). Reflecting on 10 years working in the Arts, she considers how Disability Arts and the Social Model of Disability can contribute to future healthcare practice and the building of an inclusive world.

An illustration of the Beighton Scoring System, a screening system commonly used to assess joint hypermobility. Illustration by Aleksandra Lacheta

Ehlers-Danlos Syndromes (EDS) are a family of 13 inherited conditions causing weakened connective tissue. Connective tissues are the building blocks of your body, supporting your skin, blood vessels, organs, muscles, tendons, ligaments and bones.  If those building blocks are faulty or weak, they can cause widespread issues. In EDS this manifests as a range of symptoms and comorbidities – additional conditions that frequently co-occur with EDS – ‘double-jointed’ or hypermobile joints, stretchy skin and poor wound healing, disabling and chronic musculoskeletal pain, frequent dislocations, dysautonomia, cardiovascular problems, gastrointestinal disorders, anxiety disorders, swallowing and throat dysfunction, mast cell activation syndrome and urological dysfunction and prolapse – just to name a few.  

The average diagnosis period for EDS is 12 years from the onset of symptoms. I remember it starting when I was 5. My mom took me by the hand, and my arm just dislocated. It was at the age of 28 that more limiting symptoms began to appear, sometimes so badly that I would need to lay down under my desk at work. My friends and family thought I was a hypochondriac.  One doctor told me it was stress and I needed a life coach. Eventually a diagnosis of ‘Ehlers-Danlos Syndrome – Hypermobility Type’ from a renowned specialist gave my pain and discomfort credibility. I was told I was considered disabled under the Equality Act, a 2010 UK parliamentary act that names 9 ‘protected characteristics,’ including disability, sexuality and race, to legally protect people from discrimination in the workplace and in wider society.

At the time that I received my diagnosis I was working at the British Council, managing global cultural projects in architecture, design and fashion. I was a design expert and had led projects which looked at the problem-solving power of design. Through my job, I started to work with the Unlimited disability arts commissioning platform, who first introduced me to the Social Model of Disability. Before, I had understood disability through the Medical Model, which suggests a person is disabled by their impairments or differences, and it is the role of healthcare professionals to ‘fix’ this. According to the Social Model, someone is disabled by barriers created by society rather than by their impairment or difference. This changed the relationship I had with my condition. 

I left my job at the end of 2019 when I became physically unable to continue working in an office.  I wanted a new career in which I could explore concepts of care with others experiencing barriers. This is how I came to join King’s as an Adult Nursing student. Sometimes I feel like a spy listening in on lectures describing conditions and hearing future healthcare professionals being taught to interact with individuals experiencing illness. It can feel very othering to sit through a lecture describing orthostatic hypotension, while in my head I am screaming ‘I know what that feels like!’

Since starting my Nursing training in September last year, we haven’t talked about disability in depth or explored concepts like the Social Model. Perhaps this isn’t surprising given that 2.9% of non-medical/dental clinical staff, 1.2% of non-consultants, and 0.8% of consultants in the NHS have declared a disability.  If these self-declarations are accurate, then there’s actually very little lived experience of disability within the NHS workforce. Alexandra Adams, who will be the NHS’s first deaf-blind doctor, has spoken out about the discrimination she has faced whilst training to become a medic. 

Indeed, the Social Model was developed by disabled people who suggested that healthcare was trying to fix them, unhelpfully framing disabled bodies as the problem, and not accounting for the agency of disabled people. I strongly believe that the Social Model of Disability should be explored in healthcare education; healthcare practitioners need a toolbox that helps them to understand the experience of illness and connect with disabled people in a collaborative way to identify barriers.  

Raquel Meseguer / Unchartered Collective – A Crash Course in Cloudspotting (the subversive act of horizontality)

Alongside the activism out of which the Social Model developed, Disability Arts emerged, encompassing art practices in wide-ranging media that focused on telling human stories about disability. Disabled artists continue to offer up their experiences of healthcare and illness, giving visibility to some of the perspectives of the 18.4 million people across England with a long-standing disability or illness.

Dolly Sen’s Mental Health Signposting work takes viewers on the journey of being signposted to mental health services. Raquel Meseguer and Unchartered Collective’s A Crash Course in Cloudspotting challenges the social conventions around rest in public space by inviting audiences to partake in public rest and experience the stories of those who need to do it. Christopher Samuel’s Welcome Inn invites visitors to sleep in at the Art B+B Blackpool and experience inaccessibility firsthand.

Welcome Inn, a sleep-in installation that is difficult to stay in by artist Christopher Samuel. Photograph by Claire Griffiths.

Projects like Visability93 challenge stereotypes of disability, while Sport England’s Mapping Disability: the Facts gives a clear picture of the spectrum of barriers people are facing.  

A typeface created for the Visbility93 campaign designed to represent the 93% of disabled people who do not use a wheelchair.

I think many people still imagine disability through the narrow perspective I previously did. The Social Model of Disability opens discussions about how we care for each other as a society, and how we might do this better. It makes space to unpack individual experiences, whether already diagnosed or not, and to consider the pains and pleasures of disabled life in three-dimensional social reality, going far beyond  the medical mitigation of symptoms. Alongside a critical understanding of disability models, disabled artists can offer future healthcare workers a different understanding of the meanings of disability and care. Embedding this approach early on in medical education could help to ensure that care and interventions start from the point of recognising barriers and collaborating to build a world that includes everyone. In my opinion, this would transform the experience of disability.

Further reading: 

• EDS ECHO: For healthcare professionals who want to improve their ability to care for people with EDS and HSD
• Ehlers-Danlos Syndromes Toolkit for GPs
• NHS Employers: Understanding Disability
• NHS Employers Disability History Month campaign
• A history of disability from a Disability Arts perspective
• NDACA (National Disability Arts Collection & Archive) 
• The Social Model of Disability explained by Shape Arts
• Unlimited Disability Arts commissioning programme
• Disability Arts Online
• The Centre for Disability Studies
• Disability Visibility: Politics, Culture, Media podcast
• Rare Disease Day: 28 February 

This blog is part of a series from Director of Equality, Diversity and Inclusion, Sarah Guerra, where she will be addressing the ‘whole picture’ of EDI, why it is important, and how we go about making effective, systemic change.

Discussing EDI reward, targets and quotas are some of my least favourite topics, second only to terminology. It is like quicksand. Setting EDI targets is always controversial. Should goals or targets be set? Which behaviours do they lead to? What kind of backlash might be set in motion? How do you set the target? How do you account for all the nuance within each protected characteristic?    

On the other hand, what gets measured gets done. Organisations have measures for all sorts of things they care about – why not EDI?  And since the law has given us the ability to take Positive Action recognising imbalances in ‘the system,’ why wouldn’t we use all the tools and levers available? 

Section 159 of The Equality Act defines Positive Action, and it can be summarised as follows: positive action in recruitment and promotion can be used where an employer reasonably thinks that people with a protected characteristic are under-represented in the workforce, or suffer a disadvantage connected to that protected characteristic.  

The critical thing about a good EDI strategy is that it demonstrates that everyone in an organisation is valued. It expresses that, to be truly successful and reap the benefits of a diverse workforce, it is vital to develop and sustain an inclusive environment in which  everyone feels able to participate and achieve their potential. Targets and Quotas only work when it is clear how they relate to that overall aspiration. (See my recent blog ‘The Drive for Data’).  

It is important to understand the baseline and find ways of measuring progress and effectiveness. This necessarily requires setting targets and goals against key processes and behaviours. These can be identified through employee data and feedback and should align to the organisation’s culture and employee engagement approach. They can then be embedded in recruitment, induction, talent management and career advancement.   

Targets can be set for the whole organisation, for constituent parts of it, or for individuals, be that via everyone’s PDR (Personal Development Review), or by being included in the personal objectives of members of the Executive and Leadership team. 

There can be a lot of confusion in these discussions. In some places targets are just not part of the culture of an organisation and so setting them for EDI can be very jarring. Positive action is often misunderstood and felt to be positive discrimination. There is a fear that by setting targets you are creating unfair advantage – essentially choosing someone for their characteristics rather than their fit for the role.  For many there is real concern and fear of setting targets due to uncertainty as to how they will be met. Any measurement can result in perverse behaviours, outcomes, or a ‘tick box’ mentality that undertakes the letter of the target, but doesn’t understand the spirit, purpose and ethos.   

In deciding whether to set targets it is important that your EDI strategy clearly articulates what you are trying to achieve. Then you can define the purpose of a target. Is it trying to change behaviour, and fundamentally develop a different culture? Is it trying to show the efficiency of a process? These are very different things!   

At King’s we have a number of key performance indicators – they can be found here – and we also seek to measure our success via external charter marks and benchmarks, including the Athena Swan and Race Equality Chartermarks, The Stonewall Workplace Equality Index, and the Business Disability Forum’s Disability Standard.   

Falling into a similarly, easily misunderstood and controversial category are quota shortlists. This is a positive action measure; a mechanism and a proactive practice that is intended to increase diversity across an organisation.   

Positive Action effectively means that for any recruitment process you identify a minimum threshold for whatever area you are targeting, e.g % of women on the shortlist for leadership roles if your data shows an underrepresentation in this area. It is sometimes referred to as The Rooney Rule, borrowing this name from a high-profile use of Positive Action in the USA. 

The Rooney Rule is an American National Football League policy that requires league teams to interview ethnic-minority candidates for head coaching and senior football operation jobs. It is an example of affirmative action, even though there is no hiring quota or hiring preference given to minorities, only an interviewing quota.  

Positive action measures, like quota shortlists that are based on good evidence, like employee data analysis, and are supported with the right training and guidance as part of an overall strategic approach, can support the recruitment process. They can help in identifying and developing diverse talent. These shortlists can be used to track progress in improving underrepresentation. Quotas can demonstrate real insight and commitment from an organisation and a determination to address their diversity representation.    

Equally all processes are still operated by people, so the organisation and its people need to fully understand why this is being done and how to implement it effectively.  Without enough understanding of how disadvantage and underrepresentation occur it is easy for others to assume that candidates coming through on quota shortlists do not meet the standard and are not succeeding on merit. The bad feeling that can result is one of the biggest dangers with targets and quotas. The reciprocal pitfall for those who are talented and from underrepresented groups, is the feeling that they have somehow been tokenised, or the internalisation of the belief that they are less than worthy.  

Turning to money, organisations need to provide adequate financial reward to their people (I also discussed pay gaps and pay transparency in ‘The Drive for Data’). Ideally this is based on a clear reward strategy involving policies and practices that support organisational objectives. It should aim to enable a motivated, valued and effective workforce. Depending on the type of organisation, reward policies might implement benchmarked benefits, bonuses and pay incentives. These can encourage loyalty, and, by offering competitive terms, conditions and benefits, attract new, diverse talent.  

At King’s a fundamental part of our reward approach is ensuring everyone is paid a living wage. The living wage is a UK wage rate that is voluntarily paid by 7,000 UK businesses, set by the Living Wage Foundation to reflect and meet everyday needs – like the weekly shop, or an unplanned trip to the dentist. The London Living Wage is currently £10.85 per hour. 

The Living Wage Foundation logo.

One of the things we talk about in HR circles is the psychological contract.   

The psychological contract refers to the unwritten set of expectations of the employment relationship, as distinct from the formal, codified employment contract. Taken together, the psychological contract and the employment contract define the employer-employee relationship.  

Included in this is trust which I discussed in an early blog in this series, ‘The Trust About Trust’. In essence it sets out the expectations around the organisational culture, what will be required from an employee and what they will get in return.  

Ensuring there is a positive psychological contract allows individuals to appreciate the total reward package. It also allows for all positive action, targets and quotas to be understood and bought into. Where the psychological contract is weak there is a tendency for employees to easily believe the worst of their organisation and to fall into distrust and cynicism.  

Organisations that ensure everyone understands expectations, and what it will take to be a successful employee who is rewarded, are the ones that see the most success. To do it well, this information should be documented and shared as part of employees’ inductions.   

So, these are all tools available to us. It is critical that EDI practitioners work with leadership and communications colleagues across the organisation to continuously demonstrate and explain how and why these measures increase fairness and make the organisation a better place to be.   

For LGBTQ+ History Month, KCLSU LGBTQ+ Officer Martina Chen writes about intersectional identities, this year’s LGBTQ+ History Month theme, and the importance of amplifying QTIPOC voices and addressing discrimination in queer spaces. 

As a queer, second–generation Chinese Italian, my life has always been shaped by a complex web of clashing cultures, values and communities.  And because of my multilayered identity I have experienced interlinked forms of discrimination and marginalisation;  not just from wider society but also the communities that I am part of, whether that is the Italian community, the Chinese community or the LGBTQ+ community.   

When I first came to King’s, I felt a strong sense of acceptance for being queer and found my new environment to be generally more welcoming, multicultural and inclusive than Italy. However, I noticed that intersectional issues and identities were not so visible. As someone whose experience is not informed by solely BAME / POC challenges or queer challenges or gender challenges, but by an interaction and mixture of all of them, I found that the tendency to look at these issues in an isolated manner erased the experience of those, like me, whose identity is more complex and subject to the challenges implied by all of these positions. 

In my role as KCLSU LGBTQ+ Officer, my priority has been to uplift and amplify intersectional queer identities and experiences  which are frequently neglected and overlooked. From the moment I started organising this year’s LGBTQ+ History Month, my priority was to centre queer, trans+ and intersex people of colour (QTIPOC) and their experiences, as they are the most marginalised group and experience oppression at the intersection of  queerphobia, transphobia, interphobia and racism. 

Other central focuses have been amplifying non–Western queer voices and experiences; exploring the relationship between colonialism, gender and sexuality, and fostering dialogue about decolonising queer history and our understanding of queerness and gender identity. National LGBTQ+ History Month celebrations and queer movements continue to be Eurocentric, white–centric and cis–centric.  

With the rising racism, transphobia, hate crimes and far-right narratives around the world, it is more crucial than ever to create visibility for those who have been historically erased. We need to acknowledge and address the different forms of discrimination happening not only in wider society but within the queer community as well. 

It’s time to ask: who is benefitting from LGBTQ+ laws? Who is being excluded? Who is included in the calls for LGBTQ+ equality? Whose stories are being told? There might not be a simple answer, but what is certain is that queer, trans+ and intersex people of colour have been left behind.  

We have made huge progress, but queer spaces continue to be white, cis and male dominated, and queer culture is still frequently  understood to be a cis, white, gay male culture. Although we might all be part of the same community, cis white queer folks can still be complicit in sustaining white supremacy and transphobia, and the harms that POCs and trans+ folks are subject to. Cis, white, gay privilege is real. 

It is striking that, whilst trans, non-binary, black and POC queer folks and their experiences have been excluded, marginalised and erased, queer liberation movements were historically led by QTIPOCs. Trans+ black women led the Stonewall Riots and paved the way for our rights today, yet they were subject to hatred, discrimination, erasure and violence from some cis white queer folks. This persists today through organisations such as the LGB alliance, trans-exclusionary feminists and elitist white, gay groups, who continue to perpetuate hatred and violence against trans women and queer people of colour, especially Black trans women.  

I hope that this year’s LGBTQ+ History Month, together with the global conversations  about racism and transphobia, encourages us to break down the mirage that there is a united queer community. It’s time to start addressing the division, hatred and violence that is still perpetuated by our own members, so that we can build a truly intersectional, inclusive and united queer community and call for the liberation of all queer folks, not just white, cis, gay men.  

White, cis, queer-presenting men dance on the tip of an iceberg. Feminine-presenting and gender non-conforming queer people of all skin colours hold onto the much larger portion of the iceberg, submerged under water.

This blog is part of a series from Director of Equality, Diversity and Inclusion, Sarah Guerra, where she will be addressing the ‘whole picture’ of EDI, why it is important, and how we go about making effective, systemic change.

An Inclusion or Diversity audit helps an organisation to understand both the culture and demographics of their employees. It enables you to see the breadth of diversity, and which factors and activities are needed to help increase inclusion across the business.  

An audit can include a variety of diagnostic tools and activities, such as gender pay gap analysis, supplier diversity audits, or equality impact assessments or as we call them at King’s, since the 2010 Equality Act – Equality Analysis. King’s uses  Equality Analysis (EA) to systematically analyse the potential impacts that new policies, practices, projects, or services might have on different groups within the King’s community. 

Diversity audits should be seen as, and feel like, positive activities towards building an inclusive culture. They can be powerful in bringing together data and analysis through consultation with employees. They should provide a holistic view of the organisation in terms of diversity, equality, and inclusion, enabling the creation of focused, clearly evidenced strategies to achieve improvements.  

As well as generating valuable data, one of the key benefits of carrying out these audits is to show staff that their views and opinions on how we become a more inclusive employer matter. Depending on the number of employees involved, this can generate many ideas, sometimes too many for the organisation to cope with. So, when starting out, the parameters or ambitions of the audit need to be clear, and everyone needs to be ready for the volume of information and action it might bring. This being so it is important to have a clear way of feeding back how community input and ideas have been reviewed, actioned, or not taken forwards – and why. Every step of this process should be part of building that overall trust I talked about in my blog-post The Truth about Trust.  

In higher education (HE) there are two clear and familiar audit frameworks: Athena Swan and the Race Equality Chartermark. (Though perhaps many people haven’t thought about them like that.) 

The Athena Swan and Race Equality Charter logos

The Athena Swan Charter framework supports and transforms gender equality within higher education (HE) and research. It was established in 2005 to encourage and recognise commitment to advancing the careers of women in science, technology, engineering, maths and medicine (STEMM). King’s has been a member since its inception and was awarded  Bronze status in 2016. 9 of Kings’ 18 academic departments have achieved Silver awards, and in December 2020 we submitted an application for a whole university Silver award – you can read more about this here.

Advance HE’s Race Equality Charter (REC) is a framework through which institutions work to identify and self-reflect on institutional and cultural barriers standing in the way of Black, Asian and Minority Ethnic staff and students. King’s was an early adopter and joined the scheme at its inception. We recently renewed our Bronze award – you can read more about our plan and findings here.    

As well as the two well-known HE frameworks recognising our determination to be intersectional in our approach, we also take part in the The Stonewall Workplace Equality Index, and the Business Disability Forum’s Disability Standard. 

The Stonewall Workplace Equality Index and Business Disability Forum’s Disability Standard logos

The Stonewall Workplace Equality Index is a way of measuring progress on LGBTQ+ equality. King’s first submission to Stonewall’s WEI was in 2019. The scheme was in its fifteenth year, and 445 organisations from diverse sectors – spanning banking to healthcare, education to law and retail to government – participated.

The Disability Standard is a tool developed by the Business Disability Forum (BDF) to monitor the accessibility of an organisation across all aspects of its business, including products and services, recruitment and facility. We undertook this standard in 2017 and scored less than 50%. Hence disability inclusion became one of the areas specifically identified in our EDI strategy for improvement. 

In 2020 we also took part in the Working Families benchmark. This  is the only tool available that measures all aspects of flexible working and work-life policies and practice. It evaluates how well these are integrated into your organisation’s values and culture, and looks specifically at how well you support and engage with parents and carers. 

So, wow that is a lot of audit. They have all been so valuable but also SOOOOO much work – and I thank all of those who  helped us to undertake them. I really look forward to the day we have a combined intersectional benchmark. 

It is easy to see these charter marks and measures as a bureaucratic exercise. Indeed, recently the government characterised much of this in just this way. However, it is essential that we recognise that for organisations to thrive; to attract and retain the best people, and forge conditions in which those people can be successful and healthy, we need to undertake these kinds of detailed investigation. To understand the range of our communities’ experiences, we need to see through the eyes of individuals, as well as the big picture that data reveals. This enables us to identify overall themes that we can address to help everybody, as well as issues which may seem smaller because they only impact a few people but can make such a critical difference.

I urge you to browse all our ‘audits’ and reports – you can get a summary in our Annual report and then dig deeper.