The session explored Francesca’s research:
Scholars have long demonstrated how urban planners and architects traditionally design cities for men, not for women.  Efforts to change exclusionary built environments, however, primarily focus on young women (seeking for example to make cities friendlier for girls at the park or child caring mothers), overlooking age as a factor of spatial discrimination. Her research explored how older women respond to exclusion by navigating and transforming hostile environments.

And explored the following questions:

• What does safety mean to different people, and how can we create places that allow multiple groups to feel welcomed?

• How do our memories affect the ways we use space?

• How does being a woman impact getting older?

This provocation focused on the particular spatial and environmental requirements for staff REST areas linked to healthcare buildings, and how these should not be dealt with as part of the rest of spaces in these buildings, e.g., clinical, office, or other work areas. The importance of good staff rest areas is gradually being highlighted in complementary frameworks and plans that focus on the NHS workforce. For example, the NHS Health and Wellbeing Framework (2021) specifically includes “Environment” as one of its seven elements, and its proposed “Diagnostic Tool” points to the need for “access to break rooms and outside space away from patients, where [NHS people] can relax in an ‘off-duty’ environment”. As is well known, the above were brought to sharp focus during the recent pandemic that highlighted the strain under which healthcare staff are regularly placed in their workplace. Unsurprisingly, the NHS Long Term Workforce Plan (June 2023) also refers to “good quality rest areas” under “Retain: We are safe and healthy” (paragraph 27), and actually uses this as an example of “getting the basics right”. 

The following questions have been discussed in the breakout sessions:

• What is your personal top priority during your rest time at work?

• In an ideal world, with no practical or financial limitations, how would your staff rest area look and feel?

• In your current staff rest area(s), think of that one characteristic that you find the least satisfying and how you would replace or re-design it to match your top priority in relation to your rest time at work. 

This session was led by Dr Bethan Evans, Senior Lecturer in Human Geography and co-director Centre for Health, Arts, Society and Environment (CHASE), University of Liverpool.

This provocation session is based on research from the `Disbelief and Disregard: Gendered Experiences of Healthcare for People with Energy Limiting Conditions’ project that analysed 962 responses to a survey carried out by Chronic Illness Inclusion.

The research found that 75% of respondents with a range of ELCs felt they were not listened to or believed by health or care professionals. This was worse for patients who also experienced forms of discrimination such as sexism, racism, homophobia, transphobia and fatphobia. Experiences of disbelief and disregard in health and social care settings had a much wider impact on people’s lives, leading to damaged self-esteem and self-confidence, and knock on effects in relation to work, education, welfare and benefits, creating a cycle of inequality.

In this session we’ll discuss the ways in which this cycle of inequality might be moved to a cycle of equality through simple changes in approaches to people with ELCs, and also discuss the difficulties faced by healthcare professionals in better supporting patients with ELCs, identifying resourcing and systemic changes that might be required.

The following questions will be discussed in the breakout sessions:

• Consider the potential consequences of energy limiting conditions going undiagnosed or disbelieved and how this can affect a patient’s wellbeing. Sort these potential consequences into the following categories: physical health, mental health, social wellbeing, economic wellbeing.

• Considering your answers to activity 1, think about how these consequences would be changed by a diagnosis and support from health and social care. Consider how this could change a patient’s wellbeing in the same four categories.

• Think of possible ways that health and social care professionals can attempt to combat the discrimination that patients with ELCs face. Try to list 3 ways that this can be combated by individual health and social care professionals and 3 ways this can be addressed by changes to health and social care systems. 

The fifth session in our provocation series two will be led by Dr Elham Amini who is a Lecturer in Sociology at Liverpool University.

This provocation session will encourage thinking about menopause and menopausal experiences as this relates to at least two key aspects of women’s lives, namely, gender and ethnicity through life course perspective and bring some examples from her research on menopausal experiences of Iranian Muslim women. So, instead of focussing on menopausal symptoms, such as hot flushes, anxiety and depression and vaginal dryness and how to fix them by ‘giving hormones’, Elham will aim to explain:

• What are the negative meanings that attached to menopause?  why menopause serves as a negative shift in women’s social status and their self-appraisals?
• How and why is it important to understand the menopausal experiences of ethnic minorities in Global North or women from Global South? How knowledge /producing knowledge might exacerbate social inequality and marginalisation and shape “otherness”?
• How a natural and inevitable part of a woman’s life course has been shaped as a catastrophe by celebrities and some journalists? Do we need to pause menopause?
• To what extent do you agree that medications such as Estradiol and lubricants can “fix” the menopause? 
• To what extent do you agree that current conversations and education around menopause are inadequate and shapes menopause as an illness? Do they address the underlying reasons of stigma and shame in experiencing menopause?

The session was based on two interlinked studies exploring the lived experiences of minoritised NHS employees living and working with visible (race/ethnicity) differences.

Black and Minority Employees (BME) working in the NHS account for over 20% percent(NHS England, 2023) of the workforce, however our findings showed that they continue toexperience discrimination, harassment, microaggression, inequalities in access and opportunities, unfair and disproportionate treatment, lack of career progression, incivilities and exclusions at work. These experiences have an impact on their wellbeing, job performance and level of patient care. 

So, what can we do as colleagues, managers and leaders to mitigate these experiences, become allys and improve the working lives of our colleagues?

In our provocation session, we will seek to create an understanding of the challenges experienced by BME healthcare workers, the impact of these experiences on the individuals, their teams and the organisation; and our roles as change agents, mitigators and influencers in responding to these challenges. 

Our overarching aim will be to create awareness and enable participants develop ‘Reflective Competencies’ needed to approach and support the necessary change required to better the experiences of BME employees working in the NHS.

The final session in our Provocation Series 2 was led by Professor Susan Pickard, Director of the Centre for Ageing and the Life Course and Professor of Sociology in the School of Law and Social Justice at the University of Liverpool. She will be joined by Dr. Victoria Cluley, Assistant Professor in the School of Sociology and Social Policy at the University of Nottingham, and Dr. Chris Williams, a practising GP and Director of Clinical Studies at Leicester Medical School. Together, we will explore critical perspectives on ageing, health, and social justice.

Their study – The Lived Experience of Frailty – has provided an in-depth exploration of the experiences of a diverse group of older people living with frailty.  The insights have been moving, thought-provoking and challenging; reflecting the need to foster positive attitudes to ageing amongst healthcare professionals, challenge negative assumptions and improve models of care to support greater trust and continuity of care.  We would like to use this Provocations seminar to work with health and care colleagues to share the research findings and work out how to make these changes happen.

The breakout sessions will consider the following questions:

1. How can we challenge negative professional assumptions and foster positive attitudes to ageing and age-related health problems?
2. How can we develop the right inter-personal skills and awareness across the health workforce?
3. How can we shape and advocate for better organisation of care to meet their needs?

We are keen to explore and co-create innovative approaches encompassing education, professional development, advocacy, policy and service improvement.