Inclusive medical schools are a must

Edge Hill Vice-Chancellor John Cater explains why the new non-Russell Group medical schools are so vital:

Two and a half decades ago, in my first full year in the day job, I am on the Euston Road in London. Half a mile away, 17 universities are meeting in the Russell Hotel.

Edge Hill did not qualify for university title in the early 1990s. Although it had recently merged with three schools of nursing and midwifery, it was, at best, what estate agents euphemistically call a “development opportunity”.

In 2006 it acquired full university status, and this week it was granted one of the five new medical schools.

The NHS is in difficulty. Unwise cuts in commissions early in the coalition government years have been compounded by budgetary shortages, the need for safe staffing levels and policy changes that are making the UK a less attractive destination for professionals from overseas.

In response, the cap has been lifted on nursing recruitment, although negative perceptions of the new tuition fee regime are stifling demand for less popular programmes, and last year the secretary of state announced plans to recruit 1,500 additional trainee doctors.

The first 500 places were allocated in the autumn to existing medical schools, and every such school has also participated successfully in the second bidding round, taking up a further 590 places.

But just over 400 places have been allocated to five new schools. Partnership arrangements between Nottingham and Lincoln and Kent and Canterbury Christ Church have been rewarded with just under half of this number, with three new free-standing schools being approved, in Chelmsford, Sunderland and, smallest of all…Ormskirk.

Geographically disparate, the three new schools all have something in common: resonance with the Department of Health’s clearly expressed commitment to widen participation in medical education.

Edge Hill University was founded in the 1880s with a mission to provide access to higher education, and it has sought to remain true to that vision for the past 130 years, working closely with schools and colleges as the regional lead for Aim Higher, the sponsor of the local lifelong learning network and the national host of Action on Access.

To twin-track excellence and accessibility has not always been easy, but the prize is worth fighting for. It is half a century since we pioneered innovative programmes that qualified graduates as both teachers and nurses of children with learning disabilities, and today we train individuals to qualify both as nurses and social workers, recruiting heavily from Merseyside, the overspill estates and the former mill and mining towns of the north west.

This integration is important to us. Hospitals and communities operate better when individuals bring skill sets, and parity of esteem, and work together in teams. The challenges in our region are substantial; my office is on the outskirts of one town and four miles from another. The difference in average life expectancy between the two, just 10 minutes’ drive away, is 10 years.

This also influences what our new medical school will do. We have eschewed the opportunity to start before 2020 because we intend to start in other ways before 2020; we begin today, raising awareness and ambition with Year 9, 10 and 11 pupils in schools and colleges in less privileged parts of the region, offering a foundation programme in 2019 for those with less conventional qualifications, before taking our first intake of medical undergraduates the following year.

Our specialisms will be different, too. While covering the full curriculum, we will have a particular focus on general practice, on primary care, health promotion, nutrition, psychiatry, palliative care, on the ability to treat patients at home not in hospital, and to help prevent preventable ills.

And we want our locally trained doctors to return to and work in local communities, communities where recruiting trained medics is challenging but where the healthcare needs are greatest.

Will it be tough? You bet. Will it cost us money? It will, as we invest in new staff, new equipment and a brand-new clinical skills centre, as well as outreach facilities in our hospitals and our community.

We are starting small, making sure that we get it right, but building on our experience in providing master’s of surgery and master’s of medicine postgraduate programmes for qualified doctors over the past decade.

Should we be doing it? Undoubtedly. Of course the perceived reputational benefits matter, but the fit is right – clinicians alongside our trainee nurses and midwives, social workers and nutritionists, paramedics and operating theatre staff.

More important, the fit is right ideologically, too. Universities have had a bad press over the past year, but we are here to improve life chances and to educate and train those who can improve others’ life chances.

A community-focused medical school on the fringes of areas of multiple deprivation is a wonderful opportunity to take that commitment, that ideology, and put it into practice.

Virtual reality experience helps demystify the family court process

As part of the Greater Manchester Court plan, a new virtual reality court experience has been designed to help demystify the family court process.

The project, supported by government and the judiciary, has been described as pioneering – claimed to be the first of its kind in the UK. The purpose is to help children, involved in vulnerable care or protection proceedings, understand what is happening and feel less intimidated or fearful of the court system. It can help children to understand how decisions about them are being made. The technology could also be beneficial for helping vulnerable adult witnesses providing evidence.

The project, devised by legal experts from the University of Salford, involves children watching a video with a virtual reality headset to get a clearer picture of how the courts work. The video can help children to understand what it is like entering the building and going through security. Crucially, it shows what it is like in a court room as the process of a court hearing is captured on film for children to watch. This innovative virtual reality experience could also be beneficial for those attending the youth court. Many young people in the justice system often find court a disengaging experience. The language used by magistrates is often complicated legal jargon. Power inequalities exist and they often only provide basic information, feeling, at times, their views are rendered invalid. Using this technology with children, prior to attending the youth court could potentially result in them feeling less anxious and increase their willingness to participate in proceedings.

To digress slightly, it is worth remembering, meaningful participation – where children influence change and shape decision-making processes – has the potential to be an empowering and life-changing experience. This was discussed at a Clinks event I attended with Peer Power, Everton in the Community and Beyond Youth Custody. The purpose of the event was to share best practice and discuss the challenges associated with youth participation. It was argued participation should not be tokenistic but rather young people should be treated as assets to the service.

Similarly, at a Peer Power event at Edge Hill University last week, it was argued youth justice and children’s services should prioritise building empathic relationships – creating a sense of mutual respect, trust and belonging. In addition to creating an emotionally safe workforce, Peer Power advocated shared decision-making and children’s voices being listened to and acted upon throughout systems.

However, children attending the youth court continue to find it a disempowering experience. They are often unsure of requirements and processes. For example, many of my PhD participants described the court process as scary and confusing.

The new virtual reality court experience could be adapted and used with children who are required to attend the youth court. It could help to demystify the process and make children feel more comfortable and relaxed about proceedings.

Sean Creaney is a Lecturer in Psychosocial Analysis of Offending Behaviour in the Faculty of Health & Social Care at Edge Hill University. He is a former Trustee at the National Association for Youth Justice. He is currently an advisor at the social justice charity Peer Power, and a PhD candidate at Liverpool John Moores University. He also writes The Youth Justice Blog in Children and Young People Now.

How it feels to be diagnosed with autism later in life

File 20180306 146666 8kqnh3.jpg?ixlib=rb 1.1
shutterstock

Michael Richards, Edge Hill University

“He is wired differently to you and me, this child of mine. He doesn’t like loud noises, or dark spaces, or strangers touching his head”. These are the first lines from a poem a mother penned about her son 11-year-old son who has Asperger’s syndrome.

Sophie Billington goes on to explain how her son Tristan’s brain works differently: “He can see in an instant the pattern, the layout, the solution to a puzzle”, but that “the world judges” and “sees only the outbursts and over-reactions”. It seems the poem struck a chord – going viral after being posted
on Facebook.

Although autism is predominantly diagnosed in childhood, increasing numbers of adults are finding out that they too have autism. This issue, of later life diagnosis, was brought to light recently after nature photographer and TV presenter, Chris Packham, went public with his experiences.

About 1% of the adult population has been diagnosed as on the autism spectrum – with more people diagnosed with autism than ever before. And yet, generally, the focus on who has autism is still mostly on infants, children and young adults.

This is despite the fact that autism can be defined as a lifelong neurodevelopmental disorder – characterised by differences in social communication and interaction with people and wider society – making it very much a label for people of all ages.

Not just for children

There are currently about 700,000 people in the UK who have been diagnosed with autism, in some form or another. But of course, there may well be many more who meet the criteria of autism but have not been diagnosed.

For these people, they will not have received the care, benefits, support or advice that people with a diagnosis are given. Instead, the judgements made about their behaviour may well have led to marginalisation, anxiety and insecurity and self doubt about who they are and how they fit into society.

Mental illness can also be more common for people on the autism spectrum – with higher rates of anxiety disorders and depression. These issues may well have developed from experiences of bullying, at home or the workplace, and from being seen as “being a bit odd”.

Then there is also the issue that since 2013, definitions of autism have changed. Now, Asperger’s Syndrome – one of several previously separate sub-types of autism – is no longer diagnosed separately, but amalgamated into “Autism Spectrum Disorders”. This may make some adults feel alienated and unsure about what their diagnosis actually means – as well as what support they may receive.

Diagnosed as an adult

For some adults who are diagnosed later in life, it is likely they have already found ways to cope and be resilient in the face of discrimination and stereotyping.

But this is not always the case. Some adults with autism still face daily and lifelong battles to cope in their day-to-day lives. They may also find things like getting a job, meeting new people and having personal relationships really difficult.

The NHS website highlights that it might be a positive step to be diagnosed with autism as an adult – presumably because you may receive support, care and benefits. To what extent a person will actually receive this additional help is another issue. And given the increasing rates with which children and young people are being diagnosed with autism, it is likely that adults who are diagnosed later on, are going to struggle to access the support they really need.

Celebrating differences

Even when adults do get referred for an assessment for autism they are likely to face lengthy waits and processes – with clinical language being used that can be misunderstood. It can also tend to focus on the deficit rather than the skills of autism – such as creativity, expertise and talents.

Without support, autism can make people feel isolated and vulnerable. Shutterstock

In this way, then, people who come to an autism diagnosis later in life are likely to continue to experience mental health issues, alongside the stigma, prejudice and discrimination associated with people with learning disabilities.

There are of course many different viewpoints to understanding autism – whether they be from a purely medical perspective, or from a social perspective that takes into account cultural and political factors.

The ConversationBut rather than seeing autism just as a deficit or something that is “not normal” we need to see it as a way to think about how different people are. Because after all, it is through difference that we learn more, achieve more and add more substance to day-to-day life in society.

Michael Richards, Lecturer in Applied Health and Social Care, Edge Hill University

This article was originally published on The Conversation. Read the original article.

The James Bulger case should not set the age of criminal responsibility

Sean Creaney

Sean Creaney, Edge Hill University; Roger Smith, Durham University, and Stephen Case, Loughborough University

On February 12, 1993, two-year-old James Bulger was abducted and murdered by 10-year-olds Jon Venables and Robert Thompson. It was a crime that stunned the world and the shadow of it still looms large over British culture and the English justice system. In her new book about the killing, James’ mother, Denise Fergus, talks about how she believes the legal system failed – and continues to fail – her family following the subsequent release of the child murderers. And just this week, the story was in the news again after one of the killers – the former Jon Venables – was jailed for 40 months for possessing child abuse images.

The Bulger case fed into a political, media and – as a result – public climate of opinion that young offenders were wicked, irresponsible, immoral and evil. But these perceptions are based on an extremely rare crime and invalid presumptions of an unfit system, fuelling more general stereotypes and knee-jerk responses.

The case has continued to generate strong feelings and fervent debate about how the two offenders should have been treated and this is as much a moral argument as it is a matter of rational reflection on rights, responsibilities and what the evidence tells us. For example, this one case is still highly pertinent to discussions around the age of criminal responsibility.

Out of step

Despite repeated criticism from the United Nations Committee on the Rights of the Child, in England and Wales the age of criminal responsibility has remained at ten since 1963 – one of the lowest in Europe. But this is incompatible with what we know of children’s “evolving capacities” (the way children mature).

With the average age of criminal responsibility being 14, the UK is out of step with the rest of Europe. This does not mean that other countries ignore crimes committed by younger children. Instead, they deal with them through the child protection and welfare systems, as in the Norwegian case which bore some notable similarities to that of the James Bulger murder.

Repeated calls to raise the age at which children can be prosecuted have never been taken seriously, at least partly because of the James Bulger case, as it continues to trouble the hearts and minds of the British public. Venables and Thompson were described as “cunning” and “wicked” and their behaviour as an act of “unparalleled evil and barbarity”. Although incredibly serious and shocking, this was a very rare crime. But it continues to influence how young children who cause harm are dealt with in general.

The persistence with which the law seeks to criminalise children contravenes international rights and is unfair, illogical and contradictory. At the age of ten, children are deemed capable of criminal intent yet not “mature” enough to seek paid employment until the age of 13. They cannot marry without parental permission until the age of 16, drive until 17 or vote in a general election until they are 18.

The UK government claims it is common sense to assume that 10-year-old children know the difference between right and wrong and to prosecute them for offences is perfectly legitimate. But this is much too simplistic and flies in the face of the available evidence. It runs counter to all we know about the processes by which children learn and develop the capacity to make fully informed moral judgements and behavioural choices.

Headlines v evidence

Despite recurrent headlines such as “Rise of the child offender? The under 10s linked to drugs, sex and violence crimes on Merseyside”, offences by young children of a seriously violent or sexual nature are very rare. Those who do commit such offences have often been harmed themselves and come from chaotic backgrounds, with histories of poor mental health, dysfunctional families and backgrounds of emotional, physical or sexual abuse.

Most offending by young people is relatively low-level, constituting only one part of a much broader and more complex identity. Subjecting young children to criminal justice intervention is counterproductive and developmentally damaging. A criminalising, stigmatising and labelling course of action prevents the child from pursuing a “good life” – one of purpose and meaning. Justice systems do not help to promote a non-criminal identity as the evidence confirms. In fact, contact with the justice system reinforces a criminal identity, making it harder for the children to escape the criminal path.

The ConversationDespite the evidence and the claim that society would be better served if the age of criminal responsibility was substantially increased, reform is unlikely. Government will not contemplate raising the age of criminal responsibility in England and Wales while the shadow of James Bulger looms large over any such discussion. If there is no change, children will continue to be denied justice appropriate to their age and maturity.

Sean Creaney, Lecturer in Psychosocial Analysis of Offending Behaviour, Edge Hill University; Roger Smith, Professor of Social Work, Durham University, and Stephen Case, Professor of Criminology, Loughborough University

This article was originally published on The Conversation. Read the original article.

Why we need to review joint enterprise laws

Joint enterprise is a controversial common law doctrine. It was claimed – in a recent debate secured by the Labour MP Lucy Powell – joint enterprise has ‘produced one of the biggest and most widespread miscarriages of justice ever to face our justice system’. Many MPs backed calls for a review.

Put simply, joint enterprise is when two or more people are deemed criminally liable for a single crime. You can be deemed criminally liable by being associated with a crime even if involvement was peripheral. In other words, they don’t have to have shown intent or have delivered the ‘killer blow’.

Joint Enterprise not Guilty by Association (JENGbA) co-founder Jan Cunliffe recently delivered an inspiring guest lecture at Edge Hill University, arguing that joint enterprise is an outdated, prehistoric law that draws innocent people – especially vulnerable children and Black Asian Minority Ethnic (BAME) individuals – into the criminal justice system.

At the Edge Hill event, Jan discussed her son Jordan Cunliffe’s case, explaining how he did not witness the murder of Gary Newlove as he was blind. Thus, Jan said he could not have understood what was happening let alone encourage what he could not see. Despite this, the jury found him guilty of murder and as Jan alluded to this was because of joint enterprise, or the notion of ‘possible foresight’ being applied.

It has been argued Jordan Cunliffe has one thing in common with others listed on the JENGbA website – they have not been found guilty ‘beyond all reasonable doubt’ but rather on the basis of a ‘possibility’.

The government need to take the JENGbA campaign seriously. I urge you to support the brave and persistent JENGbA campaign and help to address wrongful convictions of, according to JENGbA and acknowledged in the recent debate in the House of Commons, hundreds of innocent people.

Sean Creaney is a Lecturer in Psychosocial Analysis of Offending Behaviour in the Faculty of Health & Social Care at Edge Hill University. He is a former Trustee at the National Association for Youth Justice. He is currently an advisor at the social justice charity Peer Power, and a PhD candidate at Liverpool John Moores University. He also writes The Youth Justice Blog in Children and Young People Now.

Re Lancastrianising Leonora

‘Sex prescriptions’ may not be the answer but we must respect disabled people’s right to a sexual life

Disabled people have sexual needs. Darius Mcvay, CC BY-SA

Michael Richards, Edge Hill University

Sex for disabled people is an important aspect of their lives, as it is for most people. But there remains a taboo around sex and disabled people. Discrimination and marginalisation means disabled people often spend their lives denied the opportunity to explore their sexual identities. Consequently, the Green Party in Germany recently proposed “sex prescriptions” for the disabled and the seriously ill, which would allow people to claim back the costs of paying for sex as they might do the cost of a medicine.

Prostitution has been legal in Germany since 2002. Under the proposal, people need only to prove that they have a medical need and cannot pay to visit sex workers themselves. In the Netherlands, it is also possible to claim back the cost of sexual services on medical grounds. But it’s not for everyone – however comprehensive Britain’s NHS, it’s hard to imagine a law allowing the same in the UK.

The Sunday Telegraph reported in 2010 that money earmarked for disabled people was spent on “exotic holidays, internet dating subscriptions and adventure breaks, as well as visits to sex workers and lap dancing clubs”. These payments appear to have been ad-hoc arrangements by individual local authorities rather than a national policy, and using taxpayer money in this way has been controversial.

However, it isn’t illegal for a disabled person to spend their benefits on sex in the UK. Benefits such as Personal Independence Payments (PIP) and the Disability living allowance (DLA) exist to cover the extra costs of disability such as “personal care and transport”. How it is spent is up to the recipient.

Research conducted by the TLC Trust, an organisation that provides peer support and a dating club for disabled people, found that most local authorities do not have a policy on the use of sex workers by disabled people. So whether any particular local authority will condone payments for sex workers using money paid by them is a postcode lottery.

It is well documented that people with disabilities in the UK are losing their benefits to government funding cuts and changes in assessment criteria for benefits such as PIP – payments that are crucial for offering disabled people a life that is more than merely survival.

Alongside the marginalisation and discrimination that people living with a disability face every day, any discussion of sex is still a taboo subject. But that has begun to change – and organisations such as the TLC Trust and SHADA helping to change the public’s perception of disabled people’s sexuality and to connect disabled people with sex workers who can help them. But the issue of whether benefits are used to pay for these services remains.

Disability rights

Discussions about sex and sexuality for people with disabilities have previously been ignored, because the fight against discrimination has tended to focus on the rights of disabled people to work through the Disability Discrimination Act 1995 and 2005, or discrimination in the workplace under the Equality Act 2010.

Despite the intimate rights of people with disabilities being a central part of the UN Convention of the Rights of Persons with Disabilities to “provide persons with disabilities with the same range, quality and standard of free or affordable healthcare and programmes as provided to other persons, including in the area of sexual and reproductive health”, for the most part this doesn’t happen.

Sex and society

Sexual imagery dominates our daily lives, on film, television, through advertising and on the internet. The media is filled with images of perfect bodies and cultural rules concerning how or when you should date someone, what type of sex people enjoy, and all the rest. But the culturally dominant view of able-bodied, heterosexual lives does not align itself with the experiences, thoughts and perceptions of people with disabilities, or those with different sexual identities.

Those who identify as LGBTI and who are also disabled may experience additional stigma stemming from their disability and sexual identity, making it even more difficult for them to develop meaningful sexual relationships. So, for some, it may be necessary to engage with sex workers – and if you’re free to spend your benefits where you please, why not?

The German Green Party is unlikely to be in a position to take forward their legislative proposal, but it raises valid points about a controversial issue relating to whether there should be restrictions on how benefits are used, and the enduring taboo around sex and disabled people. It doesn’t seem conceivable that a British political party would ever make such a suggestion. But whether disabled or not, we all have sexual needs – and if we are truly to strive to end the discrimination disabled people face, part of that is to understand and support their right to a sexual life.

The Conversation

Michael Richards, Lecturer in Applied Health and Social Care, Edge Hill University

This article was originally published on The Conversation. Read the original article.