The final session in our provocation series two will be led by Professor Susan Pickard, Professor of Sociology and Head of Department for Sociology, Social Policy and Criminology at the University of Liverpool.

Frailty is increasingly operationalised as a medical condition that interacts with other conditions to put an older person at risk of adverse outcomes. Clinically, it is measured and approached through numerous tools and scores. These developments are generally viewed as positive and helpful in the clinical setting. However, as a label that has long been used in the English language to denote a state of weakness and fragility, it is strongly resisted and feared by older people themselves. At the same time, there is a social dimension to the experience of (both kinds of) frailty: it originates as much in the social as in the biological domain, co-exists with sources of strength, resilience and well-being and is dynamic and changeable for a combination of all these reasons.  Indeed, the connection between social events and health is corroborated in neuroendocrinology and potentially traceable through biomarkers conceptualised through the allostatic load.

The breakout sessions will consider the following questions:

1. How does it feel as a health care professional to be more aware of the lived experience of frailty and the way it is structured?
2. How would you use this understanding in your practice?
3. How useful would you find it for these concepts to be incorporated into a tool kit designed to help practitioners in your interactions with older frail people and what would you like to see in this toolkit?

This provocation focuses 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 will be 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. 

The fourth session in our provocation series two will be 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:

1. 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.

2. 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.

3. 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.