The Values of Assessment: It’s easier when you work in partnership

Professor Val Williams, from the Norah Fry Centre for Disability Studies at the School for Policy Studies discusses a recent project to understand people’s personal experiences of the social care assessment process.

Every day we hear about a different crisis in the NHS, some of which, at the least, can be attributed to problems in the funding of social care.

So, what happens to people who need to ‘apply’ for social care? It’s not like phoning up the doctor’s surgery and seeing your GP. To get into the social care system, you first need to have an assessment. And that assessment process will go on to determine how you will be funded, and what support may or may not be considered essential to enable you to live your life. Sounds simple? Not necessarily so. As the findings from our recent research ‘The Values of Assessment: Disabled adults and social care’ show.

The research team, led by Val Williams and Sue Porter at the Norah Fry Centre for Disability Studies, worked in partnership with members of a peer support network at the West of England Centre for Inclusive Living (WECIL), a local disabled people’s organisation, to understand their personal experience of assessments. These stories revealed the sometimes deeply felt emotions and negativity which can be created by an assessment. It can, for example, be very difficult to portray yourself as ‘needy’, to tell someone else about all the things you cannot do, rather than share the positive things you can do.

The 2014 Care Act was being implemented at the time this research was carried out, requiring social care practitioners to focus on disabled people’s own chosen outcomes in their lives, and to carry out assessments in a personalised way, so that disabled people achieve ‘wellbeing’. Everyone is different and real personalisation means recognising that fact.

All this sounds great, but the disabled people who worked with us knew that things can feel very different in practice.

The core part of this project, led by Jon Symonds, included interviews with 30 practitioners, and the messages which came from them were actually very similar to those from disabled people. In fact, the disabled researchers in the WECIL group helped to find meaning in the practitioner interviews, by listening to extracts and discussing them with the team. The theories of social care assessments might sound good, but they are often hard to achieve in practice.

‘Social workers have so many pressures on them that it is sometimes difficult for them to put the principles into practice’ said Symonds. ‘Resource Allocation Systems restricted the amount of funding available to meet a person’s needs and although many would advocate for disabled people with their managers, some would also negotiate with a person which demands were reasonable and more likely to be funded’.

The disabled people interviewed in this project said that what was most needed was ‘trust’. Practitioners also spoke about establishing a personal relationship, listening and taking time for trust to build. However, practitioners described meeting with some potential clients they felt could not be trusted:

‘Sometimes they need help but don’t want it, and sometimes they want help and don’t need it’. (Practitioner interviewed in the ‘Values of Assessment’ research).

So, there is still a need for social workers to exert ‘professional judgment’ to help some people decide what will best enable them to experience wellbeing. These are the more difficult things to discuss, and to reconcile with the views of disabled people themselves, who want control over their own lives. For truly independent living, people need support and may even need help in reaching a decision about that support. However, they also want to be part of the conversation, to speak up for themselves, and to be full partners in that assessment process. Achieving that joint interaction is much more than just ticking a box on an assessment form.

On January 19th 2017 we launched a set of videos, which were created by members of the team led by Jon Symonds, and feature the experiences of the WECIL group. These videos were designed to start the conversation between social work practitioners and disabled people who use social care. The most important thing to learn from the disabled people in these videos is that they could understand, empathise and work with the practitioners who were assessing them.

The videos from this project are now freely available, and the project team would like to hear back from anyone who has used or watched them – for training, for discussion, or just for fun. We would like to know how they’re being used, and how they could make a difference.

The ‘Values of Assessment’ videos are dedicated to Dr Sue Porter, who died suddenly on 11 January 2017, whose inspiration and leadership made this project possible. Her untimely death was a tragic loss to the disability movement, and to disability research.

International Day for the Elimination of Violence against Women

Dr Emma Williamson, Senior Research Fellow in the Centre for Gender and Violence Research, comments on why recognising the subject of violence against women has never been more relevant than it is now.

25 November marks International Day for the Elimination of Violence against Women, followed by 16 days of Activism against Gender-Based Violence.

On this day, communities reflect on the damage caused by violence against women and its impact on women, children, men, and societies around the globe.

As well as acknowledging the harm that violence against women causes, 25 November is also a day to celebrate the achievements of a movement which seeks to eradicate the gendered violence which many face every day. To recognise the men and women who work to support victims and perpetrators, to challenge abusive behaviours within societies across the world, and to stand up to the causes of violence by naming misogyny and oppression in its many forms.

At the Centre for Gender and Violence Research based at the University of Bristol, we know only too well about the experience and impact of gendered abuse. Researchers are currently engaged in projects speaking to victims and perpetrators of a wide range of abuses; collecting official data from the police and other statutory bodies; working with refugee communities to address violence against women during displacement; and working with a range of non- governmental organisation (NGO) partners to ensure that research makes a difference in the world.

So, along with our partners in the UK, Europe, and internationally, we mark 25 November as a day to recognise the achievements of a social movement which still has many uphill struggles to face.

In addition to the consistently high rates of domestic and sexual violence and other forms of gender-based violence which are experienced every year, this year in particular is a poignant year. Women’s rights have been attacked in a number of countries around the world: Poland and its attempts to restrict access to safe abortions; US presidential candidates’ “locker-room banter” about grabbing women whether they want it or not; the re-trial of a footballer on the basis of the introduction of evidence about the victim’s sexual history; and the crowning of Bono as one of Glamour magazines “women of the year”.

Okay, so the last one isn’t quite an obvious offence to women and equality – he does a lot of work about poverty and its impacts on women- but in a world where over half the population is female, it would be nice if an honour for women were given to one!

These examples show the struggles which we face to challenge the oppression which underpins gendered violence and abuse. They also show us the power of solidarity in the many acts of resistance they evoke. Polish women striking and taking to the streets against the attack on their already limited rights. Michelle Obama’s eloquent speech about the everyday reality of sexism and misogyny. Government reaction to the use of sexual history in sexual assault cases. We have yet to see how sisters uncut respond to Bono but you can be assured it will be creative and fitting!

Of course we also face an additional challenge in the UK with the recent Brexit vote to leave the European Union. The Centre for Gender and Violence Research in Bristol has a long tradition of working with European partners and we regularly meet to identify the emerging challenges which threaten the elimination of violence against women.

Whilst the terms of Brexit remain unclear, we continue to appreciate the importance and power of a global network of campaigners, researchers, and activists challenging the status quo and fighting for women’s human rights.

In Spring 2017, the Centre will be launching a new Journal of Gender-Based Violence. This is the first European- based international journal focusing specifically on this type of violence and abuse. We believe that now, more than ever, we need a space where evidence, policy, and ways of tackling gender-based violence across national borders, can be shared. It will provide a critical space in which we can continue to learn from one another and recognise the connectivity between the different challenges we face.

To articulate how far we still have to go, take a moment to look at the predicament of women worldwide below. (Infographic reproduced with kind permission from United Nations Women).

infographic-violence-against-women-en-11x17-no-bleeds

Gender, Violence and Justice: What does justice look like?

Dr Emma Williamson shares her reflections on the recent Thinking Futures event at the University of Bristol, which debated what justice means for victims of gender based violence.

What does justice look like? This was the question asked at last week’s Thinking Futures event run by the Centre for Gender and Violence Research at the University of Bristol. The event was part of the wider Thinking Futures programme which celebrates research from the University’s Faculty of Social Science and Law, and supports the national ESRCs Festival of Social Sciences.thinking-futures-cgvr-event

We chose the topic of Gender, Violence and Justice as it coincides with current research looking at Justice, Inequalities, and Gender Based Violence being conducted in partnership with Women’s Aid, England, and Welsh Women’s Aid.

The event, held at the Church Above The Shops, was introduced by Thangam Debbonaire, MP for Bristol West. Thangam brought to the evening her experience of working with the perpetrators of abuse, whether individuals or collective within processes and systems. She reminded us of the need to challenge and change those behaviours and the ideas from which they come. Thangam also recognised the long and on-going history in Bristol of women fighting gender based violence, from the early Women’s Aid movement, to Rape Crisis, to Integrate – all of whom were represented on the evening.

Geetanjali Gangoli, from the Centre for Gender and Violence Research was first to speak, highlighting findings from a recent study conducted for Her Majesty’s Inspectorate of the Constabulary (HMIC) on so called ‘honour violence’. Geetanjali highlighted the barriers faced by Black and Minority Ethnic Women when trying to challenge abuse which might be categorised as honour based. She recognised that for some of the women in the research other relatives, including male relatives, were sometimes the ones to encourage victims/survivors to seek justice through the police and official systems. Geetanjali also discussed the difficulty of challenging abuse which might be condoned by families and communities, and the importance therefore of thinking about what justice means in wider and community based context.

Layla Ismail was next on the podium, both in her capacity as director of Refugee Women Bristol, and in her role for FORWARD, the national charity concerned, for many years, with the issue of Female Genital Mutilation (FGM) or ‘cutting’. Again, the importance of community justice was raised. – To stop this particular abuse, adult survivors of FGM should be given the space to talk about their experience and the impacts it had had, in the hope that it would be a catalyst for social change. Young women in Bristol, supported by FORWARD, have been at the forefront of work on this issue nationally, and it was a pleasure to hear about their success in changing attitudes. In terms of our initial question, what does justice look like, justice here looks like no more FGM/cutting.

As well as inspiring the audience, Layla also challenged the multiple and sometimes contradictory oppressions which women might face. In this case the abhorrence society directs to FGM whilst condoning within popular media similar plastic surgery procedures. These contradictions do not go unnoticed within those populations where FGM has been an issue.

Following Layla was Rowen Miller from SARSAS – Somerset and Avon, Rape and Sexual Assault Service. Rowen was talking about sexual violence and justice, and what it feels like, from a survivor’s perspective to walk into a court of law, to take steps to seek formal types of justice. For most it feels like walking into the lion’s den. Rowen highlighted the importance of empowering survivors following assault to make they own decisions about how they wish to proceed, and the systems they have put in place to assist with this, including acting as a go-between for survivors who might want to report anonymously and the police. As with all of the speakers, Rowen offered us hope about the growth which is possible for survivors following experiences of gender based violence, and the importance of supporting, standing alongside and behind, survivors to their sources of justice, whatever that is.

The final panel speaker of the evening was Marianne Hester. Marianne focused more on domestic violence as one part of the wider gender based violence continuum. She highlighted the failures of formal justice to offer ‘justice’ in the sense of convictions for crimes, and discussed the alternatives we might then wish to explore. If formal justice on a population level, on the whole, doesn’t work for victims/survivors then what are the alternative available to us?

Following the panel presentations, the chair opened up the discussion to the audience. Initially reluctant, understandably, the audience come forward with a wide range of ideas about what justice might look like: rough justice, social justice – social change, restorative justice – in its true and safe form, empowerment, and resistance. As well as people’s experience of working in the field of gender based violence, people also talked about their experiences of abuse and the formal justice system.

We would like to thank all of the audience members for creating a safe space and atmosphere where survivors felt able to speak, and to those speakers for sharing their experiences with us. Injustice was not being able to face the perpetrator, in court, and tell him what he did. Injustice is over five years fighting a perpetrator who twists the system to drag you, as a victim/survivor, through the courts repeatedly. Injustice is being told by a therapist that if you choose to report an incident to the police then you cannot continue to receive their help.

So, taking the injustices which unfortunately inform our ideas of what justice might look like, for this group justice was about a wider recognition of gender, and other, inequalities. It is recognising misogyny as a form of gendered hate crime, and of finding new ways to challenge it. It is challenging schools to implement relationship and respect education – despite the government not making it mandatory. It is fighting for the support services needed to allow victims/survivors to seek the help they need, and to stand alongside them in their struggles to stop it happening in the future to others. Above all justice was what victims/survivors think it should be.

In a week when the US elected a president who admitted sexually groping women without asking (many would call that sexual assault) – justice is living in a society that says that is not okay and stands together to change it.

For further information about the Centre for Gender and Violence Research: http://www.bristol.ac.uk/sps/research/centres/genderviolence/

Anyone interested in talking to the research team about experiences of abuse, as part of the Justice Project, please contact us via the project page or email: sps-justiceproject@bristol.ac.uk

Undermining needs-based social security

alexmarsh

Professor Alex Marsh, a leading academic in Housing Studies and Professor of Public Policy at the School for Policy Studies examines the impact of the Overall Benefit Cap (OBC) and what it means for the future of affordable housing in the UK.

We are about to see one of the welfare policies of the late, only occasionally lamented Coalition government bear particularly ugly fruit. Next Monday the process of lowering the Overall Benefit Cap (OBC) from £26,000 per year begins. Over the coming months the policy will be rolled out across the country, with the cap being reduced to £20,000 outside London and £23,000 in London.

Likely policy impacts
The change to the level of the cap is likely to have a dramatic effect. The initial cap at £26,000 affected a relatively small number of households, mostly large families and those in particularly high cost properties. However, the Chartered Institute of Housing has estimated
that lowering the cap will affect 116,000 households including over 300,000 children. Other analysts have argued that this is an under-estimate and the change will affect closer to 500,000 children. Lowering the cap means that some households will be left with next to no
assistance from the government with their housing costs. Their weekly entitlement to housing benefit will drop sharply: as a consequence there is a risk of rent arrears accumulating rapidly. Given these are households who are already entitled to social security benefits they will struggle to make up the shortfall in rent from elsewhere. Hence there is a serious concern that arrears will be followed swiftly by eviction and homelessness.

It is likely that many of these households will turn to their local authority for help under the homelessness duties. The net result could therefore be that they end up in temporary accommodation which is both poorer quality and more expensive than the property from which they’ve been evicted. So the public purse will end up paying more for less.

The standard response to these arguments from Government is that households can exempt themselves from the OBC by moving in to employment. Indeed, one of the key characteristics of the policy, from the Government’s perspective, was that it incentivised households to seek employment.

However, there is limited evidence that the initial cap at £26,000 had such an effect. The likelihood that the lower cap will have such an effect is equally questionable, in large part because most of the households affected are not deemed to be unemployed and able to actively seek work.

Challenging the principle
Most informed commentators are expecting the change to the OBC to have some significant negative impacts on the living standards of low income households and the homelessness statistics over the next year. But it also brings a broader point of principle into sharp relief.

The introduction of the Overall Benefit Cap via the 2012 Welfare Reform Act was viewed as one of the Coalition’s more popular reforms. Placing a limit on the maximum amount of benefit a household could receive was claimed to restore ‘fairness’ to the social security system by ensuring that no household reliant on social security received more than the equivalent of median household income. Many social policy commentators argued that this claim to greater ‘fairness’ was highly dubious, for a variety of reasons.

Nonetheless, it was a claim and a policy that seemed to meet with considerable approval among voters, as measured by opinion polls at least. So much so that the Labour opposition shows no inclination to repeal the OBC.

However, the OBC represents a fundamental change in the nature of our social security system. It breaks with the principle that assistance should be based upon need and that the government has obligations to ensure that households secure a minimum standard of living.

Assistance on the basis of needs
Under the social security system as it operated prior to the introduction of the OBC it was true that some households ended up receiving substantial sums of money from the state. But that was not accidental or arbitrary. It was a product of their household characteristics –
most typically the presence in the household of several children – and/or their high housing costs. There is little robust evidence that either of these policy drivers are a function of the social security system itself.

Yet, it is clear that policy has played a role in driving up the welfare bill. For example, 30 years of housing policy – including the Coalition’s own ‘affordable’ rent policy – drove up social housing rents in the belief that the right model was to limit rent subsidies and let housing benefit ‘take the strain’. At the same time, a failure of new housing supply to keep pace with demand and the financialisation of the private housing market mean that housing costs have moved – seemingly inexorably – upwards.

These changes are of no real benefit to the households living in these more expensive properties. Indeed, there are good arguments that greater reliance on housing benefit has negative consequences for households. But engineering higher rents is a good mechanism for transferring money from taxpayers to landlords or lenders.

Breaking the link?
Yet, as government has sought to exercise control over the welfare budget using crude measures like the OBC it is households – not landlords or lenders – that will face the most acute negative consequences.

It could be argued that the OBC decisively breaks the link between household characteristics/housing costs and the amount of money a household is deemed eligible to receive. Under the new cap, for example, in the most extreme cases some larger families will find that they are now only eligible for 50p a week in assistance with housing costs. Effectively the Government is saying that for certain families it no longer accepts the obligation to assist in securing accommodation appropriate to the household’s needs.

Reducing the minimum
If that feels like too emphatic a position to take, we could argue instead that the OBC policy seeks to re-calibrate where the minimum standard might be and precisely the extent of the obligations upon the state to assist.

For example, before the arrival of the Coalition’s welfare reform agenda there was limited debate about the ‘where’ of government assistance. If I lived in Bristol, Bath or some other relatively expensive area and found that I needed assistance from social security to pay my rent then assistance would be made available. Of course, there were restrictions on the extent of that assistance, which meant that there were parts of the rented housing stock that I couldn’t afford. But, broadly speaking, the social security system would step in to help me maintain my current location.

There are good reasons for this. For example, if I have children in school then if social security helps me to stay in my current accommodation then it means current family and social support networks, access to services and amenities, and my children’s educational
progress are not unduly disrupted.

The current system in effect rejects the idea that you have a right to stay in your current area once you become dependent on social security. There is no longer any certainty that the government will provide sufficient assistance to allow you to afford appropriate accommodation locally – including your current accommodation – if you are subject to the OBC.

The OBC policy has already triggered mobility in London where the initial £26,000 cap rendered much of inner London unaffordable. Lowering the cap is now going to trigger another wave of mobility as more households in more parts of the country are affected and have to seek cheaper accommodation. Moving to accommodation in a cheaper area can result in housing quality being maintained, but other key contributors to quality of life –such as social and family networks – being lost. The alternative strategy, adopted by some households in the face of more limited assistance, is trading down locally. This means that location – hence social and family networks – is maintained but housing quality deteriorates. This can result in an increase in sharing, overcrowding and more informal housing arrangements.

Delayed danger
When it was originally proposed the danger with the overall benefit cap was never that it would have a widespread negative impact upon poor households straight away. Because the initial benchmark was median household income, relatively few households were affected. That presumably made it more palatable to politicians of different persuasions. The real danger was that having conceded the principle that a cap was an appropriate mechanism it allowed subsequent governments to tighten the cap as much as they wanted to.

We are about to see the cap lowered to a level that will cause a substantial number of households significant difficulty. And it is a moot point whether it will save any money overall as costs are shunted from one budget to another.

But there is nothing to say that that is the end of the matter. This may be only the first such tightening of the cap. It is not implausible to imagine a future government – perhaps a government facing sharply declining tax revenues as a result of a major economic shock –
arguing that in the interests of the country’s overall fiscal position the cap needs to be lowered further.

Avoiding an even harsher future
Perhaps the best way to minimise the risk of that happening is both to press the arguments for the importance of the principle of guaranteeing minimum incomes and to assemble and communicate effectively the evidence on the negative consequences of policy that is
already in train.

All we would need then is a government that, on the one hand, feels constrained to recognise rights-based arguments for ensuring standards of living and, on the other, is amenable to being influenced by evidence. If we had one of those then we could be well placed to ensure that the lives of the poorest are not unnecessarily made that much harsher.

The Bristol City Office

Tessa Coombes, PhD student in the School for Policy Studies, former councillor, ex-policy director at Business West, and part-time blogger considers the new plans for the City office and the impact this will have on the way Bristol is governed and the people who govern it.

city-office

Marvin Rees addressing his new office. (Image courtesy of Tesssa Coombes)

There’s a new approach to partnership working being proposed in Bristol.

Living as we do in the most centralised state in the western world, many different approaches have been taken over the years to try and break down barriers, grab additional local power and move away from the silo thinking that dominates our political and administrative systems. However, few of these have managed to make any significant difference to policy and decision making at a sub national and local level.

Recent years have seen more debate about devolution, leadership and collaborative governance. This has manifested itself in discussions around ‘place-based leadership and power’ where different ways of working are being identified to address the challenges faced by localities. There’s also been a change to the way some cities are governed, with the introduction of directly elected mayors providing clear, accountable local leadership with enhanced powers.

Robin Hambleton in his book “Leading the Inclusive City” (2015) sets a conceptual framework that identifies five intersecting realms of leadership: political leadership, public managerial/professional leadership, trade union leadership, business leadership, and community leadership. He suggests that where these realms overlap we create innovation zones where more creative and inventive behaviour takes place, particularly where it can be focused on aspects of unified action.

It is this very concept that is about to be tried in Bristol through the creation of a City Office. It’s an idea that seeks to address some of the challenges faced by the public sector, with ever decreasing budgets and reducing powers. It is about partnership and collaborative governance, bringing organisations, individuals and budgets together to tackle the issues that we have failed to tackle before, where collaboration and joint working are essential, alongside the willingness to be creative and innovative.

Whilst there have been many partnerships developed over the years in Bristol, some that have worked, others that have been less successful, somehow this new partnership feels different. Perhaps the increasingly challenging context for change is one reason why it feels different this time. With a new form of governance in the city, a directly elected mayor who can lead with greater power and greater visibility, maybe there is now the direction and clarity the city has needed to make this work.

There is also the ‘shadow of austerity’ across the whole of the public sector and local government in particular. The council in Bristol once again faces severe cuts that mean its ability to do anything beyond deliver on statutory services is significantly reduced. That in itself is a big restraint, when you are facing big problems in the city that cannot be solved without significant time, effort and resource. Yet, there is a history of partnership working in the city that has successfully delivered change, with business, public and voluntary/community sectors coming together to make things happen.

Bringing these elements together, in a new partnership approach, could provide the impetus needed to make a difference.

The idea is to enable the city to develop solutions to the issue that matter most, issues that to date we have failed to adequately address. It is also about learning, experimenting and innovating, about not being too afraid of failure and being brave enough to take risks in order to find that set of solutions that do work. The city office is unique in its aim of changing the way we do things, by working together and applying collective resources to the challenges we face, by taking a truly ‘total place’ approach to city development.

It will operate at both a strategic and tactical level, bringing organisations together on project activities that deliver in the short and medium term as well as focusing on creating a shared vision for the future. The concept of additionally is critical, all the projects and activity of the city office need to bring with them the ability to provide something extra as a result of working together.

In addition to the project activity, the Mayor introduced the idea of a ‘Single Plan for Bristol‘, a strategic level shared vision for the future of the city, in a similar vein to the OneNYC Plan. A bold idea that has the potential to really make a difference to the key challenges we face as a city. This is where the city office can bring people and organisations together to work collaboratively to set out a long-term simple but ambitious vision with measurable and achievable short and medium term targets. It should be about addressing the root causes of problems and providing sustainable solutions, and not ducking the difficult issues. It is also where we can set out how we address the ‘big’ issues, like how we eradicate inequality and poverty in our city, providing something that everyone should be able to sign up to.

There’s a long way to go on developing the city office and this new approach to ‘place-based leadership’ but so far the signs are positive and the potential is definitely there to influence and create change.

The UK Diet and Diabetes Questionnaire: A new tool for assessing dietary habits.

Dr Clare England, Senior Research Associate and Specialist Diabetes Dietitian, in the Centre for Exercise, Nutrition and Health Sciences and the NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, discusses the challenges of providing individualised dietary advice for people with Type 2 diabetes and introduces a new, validated assessment tool, that may offer a solution.

beer-and-sausage-roll

Diabetes UK estimates that over 3 million people in the UK are living with Type 2 diabetes, and a further 5 million are at high risk. Complications (for example, increased cardiovascular disease, kidney failure, blindness, foot ulcers and amputations) caused by poorly controlled Type 2 diabetes, costs the NHS an estimated at £7.0 billion.

There is an increasing choice of medication available for Type 2 diabetes which can help to reduce blood glucose, cholesterol and blood pressure, but a healthy diet, regular physical activity and good weight management underpin successful control.

There is strong evidence that regular dietary advice, provided by dietitians improves blood glucose control by improving diet. The National Institute for Health and Care Excellence (NICE) recommends that all people with Type 2 diabetes should receive individualised, on-going dietary advice from a health professional with expertise in nutrition, but many people aren’t getting this. Unfortunately, there are not enough specialist diabetes dietitians employed to provide this level of service, and there is considerable variation in provision. For example, the community dietetic service for people living in the north, inner city and east of Bristol is run by a different provider, on a different model, from that provided for people in South and West Bristol.

In the current environment the majority of people with Type 2 diabetes get their routine dietary advice from their GPs, practice nurses or community pharmacists. Some of these health professionals do an excellent job in providing good quality dietary advice but many say that feel they do not have the expertise to assess diets and give individualised advice. I have often heard people with Type 2 diabetes saying that the dietary advice they receive from their general practice is generic, and they struggle to see how to apply the advice they are given to make specific, beneficial changes to their own dietary habits.

avocado-tomato-salad

With this in mind, clinicians and academics at the Centre for Exercise, Nutrition and Health Sciences and School of Clinical Sciences felt there was a need for a brief dietary assessment tool that helps people assess their diets, and enables them to set dietary goals based on this assessment.

Over the last three years we have worked with dietitians, nurses, GPs and people with Type 2 diabetes to develop a brief dietary questionnaire to rapidly assess the dietary habits thought to be of most importance for people with Type 2 diabetes. The resulting questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), asks about consumption of higher energy foods and drinks, fruit, vegetables, oily fish, common higher fibre cereal foods and meal patterns. It takes roughly 10 minutes to complete and can be self-scored. We have just published the validation paper, which showed it to be reliable and compares as well with food diaries as other short dietary questionnaires. The UKDDQ is publically available for download and is equally applicable to people with a diagnosis of Type 2 diabetes, those at risk of Type 2 diabetes and the general population interested in healthy eating. Since the initial development, we have also worked with other researchers from the School of Sport, Exercise and Rehabilitation Science at the University of Birmingham, to check that the questionnaire is relevant to South Asian people (and made a few small changes to wording) and the UKDDQ was adopted by Birmingham South and Central Clinical Commissioning Group as the tool used for dietary assessment in the initial phase of the NHS Diabetes Prevention Programme.

We believe that using the UKDDQ in clinical practice would promote dietary change in people with, or at high risk of, Type 2 diabetes more effectively than the existing generic advice that people are currently hearing. We are planning further work to demonstrate this and would welcome interest from health professionals or people with Type 2 diabetes who would like to be involved in the project.

UKDDQ Project contact details:
Dr Clare England, clare.england@bristol.ac.uk
Centre for Exercise, Nutrition and Health Sciences / Bristol Nutrition BRU

‘Solidari-tea’ with Helen from The Archers

The Archers

Image of Ambridge courtesy of The Archers, bbc.co.uk

Dr Emma Williamson, Senior Research Fellow in The Centre for Gender and Violence Research, School for Policy Studies, discusses how the current storyline in The Archers raises the question of what justice means when it comes to abuse?

Social media has once again been a-twitter with discussion about The Archers.

I wrote back in April about the domestic violence and coercive control storyline and how the producers had managed to shine a light on the often hidden aspects of abuse. As the story moves this week into the Courts, the media is once again gripped by the drama, with people posting their pictures of solidari-tea with the central character, Helen. The Mail Online even ran a story with Barristers discussing the fictional case .

As with the issue of coercive control more generally, the programme makers are tackling an important aspect of the experience of abuse, namely what is justice when it comes to abuse? This links directly to our current ESRC funded research which is looking at Justice, Inequalities, and Gender Based Violence. This research includes looking at police case files to examine the trajectory of different cases in relation to inequalities and different types of abuse. In addition, we are currently recruiting victims/survivors to speak to us about their experiences of different types of gendered abuse and justice. This includes adult men and women who may have experienced forced marriage, sexual violence, sexual abuse, ‘honor-based’ crimes, and domestic violence and abuse. This project looks beyond the narrow focus of justice in terms of the police and courts, although this is not excluded, and includes people who, for a range of reasons, haven’t reported to the police or have used alternative forms of justice.

This project, like the current Archers storyline, is intended to illustrate what justice and injustice look like, and how formal and informal responses to abuse can highlight the wider responsibilities of society to address the issue and take a stand.

Whatever the outcome in The Archers, the everyday reality for many victims/survivors is that the very idea of ‘justice’ is more complex than a court outcome. Domestic abuse doesn’t just impact on the victims/survivors, but the perpetrators themselves (research shows they have higher rates of depression and anxiety), friends and family members, as well as wider communities. This is all too real for those who have themselves or know someone who has experienced abuse.

The Archers storyline sheds a light on the wider impacts of abuse as the manipulation of the perpetrator affects a whole raft of relationships within families and communities. Irrespective of whether Helen gets ‘formal’ justice in the coming weeks, the damage to those relationships will continue for many years to come. Some would question therefore whether we can ever get ‘justice’ when so many harms go unanswered.

We look forward to following the fictional court case as well as the on-going struggles which the main characters and the Ambridge community as a whole face as they come to terms with the impact of abuse. We once again commend the writers for staying true to the victim’s story and not turning away.

Anyone interested in taking part in our justice research can register an interest, or contact us to discuss in more detail, at:

Website: http://tinyurl.com/hj5oda5
Email: sps-justiceproject@bristol.ac.uk
Telephone: 07807 799967.

Disability hate crime – Why we need to change the narrative

norah fry logo webDr Sue Porter, Research Fellow at the Norah Fry  Centre for Disability Studies, School for Policy Studies, reflects on the horrific mass attack on Disabled people in Japan on the 26th July and what a Disability Studies lens can bring to our understanding of such hate crimes.

Those attacked in Sagamihara were living in a 150 bed unit for people with learning disabilities, and as such we must assume that the majority of residents were removed from their families and geographical communities. We know that a key factor that encourages hate crime is the “othering” of disabled people, which is reinforced by this sort of segregation. In the UK the Disability rights movement was born out of a desire to resist this sort of institutionalization of disabled people and campaigned to provide the means for disabled people to live within our chosen communities, whether independently or interdependently.

Since the 1980s this has been at the heart of UK government policy, informing personalisation‐related legislation and more recently the Care Act. Even at a time when many question whether austerity‐related cuts in funding to local authorities and changes in welfare benefits are undermining the practicality of independent living for growing numbers of disabled people in the UK, the importance of independent living is acknowledged as key to disabled people being active members of society. However, amongst people with learning disabilities and a label of challenging behaviour or mental health need, there are still over 2.5k living in institutional settings ‐ Assessment and Treatment Units ‐ at a distance from their home communities, for extended periods and without discharge plans. There is little provision in the community for these individuals and a growing number of mini‐institutions (18 or 20 bed) are either in operation or currently being built. So the ‘othering’ and segregation of this particular group of disabled people goes on in spite of the rhetoric, the policy and the promises made after the Winterbourne View abuse scandal.

At the same time cultural references such as the recent Hollywood film ‘Me Before You‘ continue to promote the message that it is better to be dead than disabled. For some it seems hard to imagine that a life lived with impairment or chronic illness is a life worth living. On 11 September 2015, MPs voted overwhelmingly against legalising assisted suicide, but some media coverage would have you believe that the large numbers of the UK population believe it’s a humane choice to legalise assisted suicide for terminally ill or disabled people. Opposition to assisted suicide is not confined to the medical profession and religious groups. Many disabled people, including the very people whom would be most affected by any change in legislation oppose the idea – it’s worth noting that no organization of or for disabled people has campaigned for assisted suicide (including those representing people with Multiple Sclerosis and Motor Neurone disease most often cited as likely to ‘benefit’ from such changes), and that disabled‐led groups like Not Dead Yet UK* continue to raise the issue, most recently protesting at the London premier of ‘Me before
You’.

At the time of writing the state of mind of the perpetrator of the attack in Sagamihara is unclear, what is apparent however is the culpability of the media in perpetrating and endorsing negative narratives of disability, potentially feeding the thinking and actions of some individuals.

The Sagamihara attack was a hate crime undertaken by an individual who denied the value of the lives he took, the 26‐year‐old former employee of the facility was quoted as saying. “It is better that disabled people disappear”. Hate crimes are defined as any crimes that are targeted at a person because of hostility or prejudice towards that person’s: disability, race or ethnicity, religion or belief, sexual orientation or transgender identity (UK Equality and Human Rights Commission). The UK Equality and Human Rights Commission report that there has been significant progress in the reporting and recording of disability hate crime since it was first included in national policy in 2008 . Police records show an increase from 800 in the first year to 2,508 in 2015/16. The number of prosecutions for hate crimes against Disabled people in the UK last year was up by 41.3% compared to 2014/15. In 2015‐16 there were 941 prosecutions for disability hate crimes. (Action Against Hate, The UK Government’s plan for tackling hate crime. July 2016). Disability hate crime represented 5% of police recorded hate crimes in 2014/15, but this is in contrast to the Crime Survey for England and Wales where disability hate crimes represented one‐third of hate crimes. The under‐reporting of disability hate crime demonstrates the importance of more victims
feeling able to come forward, and the prevailing attitudes and cultural references surrounding us in society risk some Disabled people internalising the negative perceptions of the value of their lives.

Regardless of its form and intention, prejudice always has the potential to cause harm because it reduces the value, status or importance attached to people from ‘the other group’. The ‘othering’ of Disabled people, and the belief that disabled lives are not of value raise fundamental questions about social justice in our society. We need to come together to fight for a global society where diversity is valued and where we can all live free from abuse, fear and oppression. And as the understanding of hate crime increases, it becomes even more important that officials across government engage with those working in the research community and with organisations of Disabled people to build the evidence base for policy interventions.

*Not Dead Yet UK is a network of disabled people in the UK who have joined a growing international alliance of disabled people, who oppose the legalised killing of disabled people. All those involved are disabled people including people with physical and sensory impairments, learning difficulties, and mental health conditions.

 

Looked after children and the youth justice system

JS

Dr Jo Staines, Director of BSc Childhood Studies programmes, reports a on recent seminar held by the School for Policy Studies focusing on the over-representation of looking after children in the youth justice system.

Over 30 academics and practitioners from across the country came together last week to discuss how to reduce the over-representation of looked after children in the youth justice system. Inspired by the Prison Reform Trust’s recent Independent Review, In Care, Out of Trouble, this event drew on current research and examples of innovative practice to consider how policy and practice – and changes in attitude – can reduce the number of looked after children who become involved in offending behaviour and who are drawn into the youth justice system.

Statistics indicate that looked after children are five times more likely to be involved in the youth justice system than non-looked after children – although due to the vagaries of recording practices, this is likely to be an underestimate. A review of international research, which I summarised in the first session, helps to explain how looked after children’s early negative experiences, the potentially adverse influences of the care system, and structural criminalisation all combine to increase the likelihood that looked after children will come into contact with the youth justice system. Anne-Marie Day (University of Salford), Julie Shaw (Liverpool John Moores University), Claire Fitzpatrick (University of Lancaster) and Julie Selwyn (University of Bristol) added depth and detail to these theories, drawing from their current research with looked after children.

The key messages from the presentations and ensuing discussions emphasised children and young people’s need for stability – of placement, of social worker, of educational placement, and of support – and the need for trusting, lasting relationships was overwhelmingly apparent. The challenges faced in achieving this were highlighted, particularly by Tanya Grey and Jennie Mattinson of West Mercia police, who have the unenviable task of working with 19 different care providers and no less than 107 local authorities to develop appropriate, non-criminalising responses to looked after children’s challenging behaviour.

Katy Swaine Williams, from the Prison Reform Trust, gave an overview of the findings of their review and the reforms to policy and practice that were recommended. Chris Stevens (Surrey Youth Support Service), Jamie Gill (1625 Independent People) and Darren Coyne (The Care Leavers’ Association) all passionately introduced the work their organisations have undertaken to provide stability and support to looked after children and to reduce their involvement in the criminal justice system. As shown by these examples, and as highlighted within the Prison Reform Trust’s review, many examples of good practice exist – we know that reducing the number of looked after children who become young offenders can be done, as it is being done – but we need to act as a megaphone to transmit our knowledge about successful approaches and interventions, and to invoke the political will needed to make sure that examples of good practice become standard practice nationwide.

In a post-Brexit environment and with a new Justice Secretary now in post, this event provided the enthusiasm, inspiration and evidence needed to help promote this message.

Thanks goes to Policy Bristol, the Centre for Poverty and Social Justice, and the Faculty Families and Parenting Group for their support.

European citizens who are disabled: what about them?

Val Williams, from the Norah Fry Centre for Disability Studies comments on the implications for disabled people of Brexit 

Val Williams

Val Williams

The shock of the BREXIT decision is not just an issue for disabled people who now have to live in a smaller, diminished country. It also has implications for disabled people across Europe, and particularly perhaps those with intellectual (learning) disabilities.

But what about our partnership with disabled people across Europe?  In 1973, when we joined the EU, disabled people in this country did not commonly have a ‘voice’, nor were they taken seriously as a political force. At that time, I had just started working with young people with learning disabilities, within a largely segregated system, which had only just started to recognise their right to an education. Since then, disabled people have themselves taken a lead, and are rightly proud of their achievements within the disabled people’s movement – for instance, over institutional closure, and the ideas of the social model and inclusion. During the 1990s and 2000s I took part in various EU Social Fund projects, where our experiences as UK partners was not just to speak English, but to offer progressive and supportive ideas, while learning alongside other member states. The European Disability Forum has posted the following since the BREXIT decision, which reminds us of some fundamental values:

We strongly believe that a common EU human rights agenda is better achieved together. The tone of the UK campaign, which was characterised by a divisive public debate on migration, reminds us of what is at stake and what we need to fight for, within a strong EU: common values of non-discrimination, human rights and freedom of movement.

Will UK ideas on disability now be discredited?  What of the gains in thinking on independent living?  Institutional closure across parts of Eastern Europe?  Turning specifically to the position of people with intellectual (learning) disabilities, during the latter part of the 1990s, People First groups in the UK set out to link with their European counterparts, and to set up a ‘Europe People First’, genuinely led by people with intellectual disabilities themselves. The movement in Europe has always been within the framework of families’ organisations, but the umbrella organisation ‘Inclusion Europe’ now has a self-advocacy section. This is a European Platform of Self-Advocates, which is composed of member organisations across Europe.  Nothing is perfect, but compared with the 1990s, there has been progress towards an understanding that Europeans with intellectual disabilities have a right to live like others, to self-organise and to get support to have a voice.  And importantly, UK self-advocates have always been strong in demanding these things, and in making a common cause across Europe.

In the UK we are still aware of the many steps that need to be taken towards including people with intellectual disabilities in the wider disabled people’s movement. There is also already a European network, not just through the Disability Forum and an EU umbrella organisation for disabled people’s organisations (DPOs) across Europe.  In the light of the BREXIT decision, they have themselves reached out to disabled people in the UK, as mentioned above in their moving statement on the need to continue the struggle for human rights together across Europe.

Not least, accessible information is key to a meaningful conversation with all disabled people, including those with intellectual disabilities – see the progress made for instance by public and Government organisations in communicating with all. One out of many examples would be Public Health England’s easy English guide to avoiding Flu. UK efforts to work for equality in information, in voice and within public debates and research are now widely recognised across Europe, with a recent publication in Austria on Inclusive Research for instance, written both in English and in German.

As with all disabled people, the position of people with intellectual disabilities has moved on. In the 1990s I was able to visit both Germany and France, on some visits accompanying people with intellectual disabilities. Both countries had strong segregated (albeit meaningful) policies on employment – people lived within a ‘network’ of services, particularly in Germany, and in both countries, they were to some extent treated (and addressed) as children, unlikely to have anything useful to say or to contribute to the debates.  Compare that with the debates in those countries today. On June 26th, the Frankfurter Allgemeine newspaper in Germany led its Society section with a discussion of sexual rights of disabled people with autism. The headline is that people with intellectual disabilities would have aspired merely to be ‘satt und sauber’ (fully fed and clean) until now; the argument is that they can also aspire to enjoy life!   That would not have happened before the progress made by bringing disabled people together, through the European Union. The UK voice is important, and the connection between disabled people across Europe needs to continue, so that disability rights remains a common cause.

Val Williams is Reader in Disability Policy and Practice, Head of the Norah Fry Centre for Disability Studies, and Executive Editor of Disability and Society.