Evaluate anti-oppressive practice in the workplace (hospital). Demonstrate an understanding of the development of anti-discriminatory practice in social work

In an evaluation of anti-oppressive practice in the workplace, it is important to first define what we mean by oppression and anti-oppressive practice. The Oxford Dictionary definition of ‘oppress’ is to “govern or treat harshly” (Hawker, Cowley, 1998, p 350), yet here, oppression may have further connotations. As well as ‘harsh treatment’, oppression here pertains more specifically to the discrimination and disempowerment of traditionally disenfranchised groups, including women, people from BME (Black and Minority Ethnic) communities, refugees, lesbian, gay or bisexual people, transsexual or intersex people, and people with a disability or learning difficulty, although this list is not exhaustive. With regard to oppression in a social care setting, Lee (2001) states that: “all oppression is destructive of life and should be challenged by social workers and clients” (Lee, 2001, p 60). Anti-oppressive practice, therefore relates to practices that minimise and challenge oppression within the workplace.
Firstly, it is important to note that anti-oppressive practice within a hospital setting relates to both the hospital staff and the service users, as well as on a wider organisational and governmental level, and these will be examined in turn. With regard to hospital staff, anti-oppressive practice relates to recruitment, training opportunities, promotion opportunities and practices that seek to eliminate harassment, bullying or prejudice. Oppression here can be thought of on two levels: an overt level, in terms of harassment or bullying, or inherent within an organisation (institutional), for example, unequal promotion prospects. Anti-oppressive practice within a hospital should seek to eliminate both. Perhaps one of the most apparent ways in which workplaces seek to promote anti-oppressive or anti-discriminatory practice in terms of hospital staff is through their equal opportunities policy, which should consider both the overt forms of oppression and discrimination, and the more subtle form such as institutional oppression. Indeed, an example of part of an NHS equal opportunities policy is as follows:
“Surrey & Sussex Healthcare NHS Trust is committed to an Equal Opportunities Policy, whereby all staff employed by the Trust shall be offered equal opportunities in employment irrespective of their sex, sexual orientation, marital status, race, religion, creed, colour, ethnic origin, disability or age. In operating recruitment, training and promotion policies, the Trust and its employees shall develop and practice positively the concept of equal opportunities.” (Sussex & Surrey NHS Health Trust, 2004)
The policy clearly relates to oppression on an institutional level through its reference to opportunities in employment, promotion and training. It then goes on to acknowledge its responsibilities with regard to the Sex Discrimination Act 1975, the Race Relations Act 1976, and the Disability Discrimination Act 1995, and also states that “direct or indirect… discrimination or harassment will be treated as a serious disciplinary offence” (Sussex & Surrey NHS Health Trust, 2004). Within this, there are a number of key ideas, the first of which is the statement the employees will ‘develop and practice positively’. This is a key point, because although workplaces such as this hospital have policies in place, it is important that those policies are translated into practice; it is not sufficient to have a policy that is ignored, and this statement is perhaps recognition of this fact. So, with regard to this first key point, how well is this achieved in reality?
In terms of equality of employment opportunity, there appears to be a disparity between the policy and the reality on a number of fronts. With regard to gender, Oakley (1993) notes that there is a gender divide in terms of the kinds of employment men and women have within the NHS. She states that although “three-quarters of workers in the National Health Service are women… only about twenty percent of British doctors are women” (Oakley, 1993, p 6). So in terms of gender, the policy seems somewhat removed from the reality. However, it is important to note that Oakley was writing in 1993, and that these figures, whilst serving as an illustration, may no longer be entirely accurate. A more recent illustration of the disparity between policy and reality can be gained with regard to race. Neuberger and Coker (2002) assert that in 2002, the NHS was “finding it difficult to attract and retain staff from BME communities” (Neuberger, Coker, 2002, p 84) and Collard (1995) revealed in a study that “66 per cent of black nursing staff… ‘Had difficulties with patients for ethnic reasons’ and 37 per cent of black nursing staff reported that they ‘had difficulties with colleagues for ethnic reasons'” (Neuberger, Coker, 2002, p 84). This could indicate the substantive reality within the hospital(s) in the study did not match the policies that were in place, illustrating the difficulties of reaching the ideals set out within a policy. It seems then, that in reality, anti-oppressive practice is difficult to achieve. But why is this case?
One answer to this may lie within the second key point in the above policy: the distinction between direct and indirect discrimination. It is perhaps easier to recognise and act upon direct discrimination and oppression than it is in cases where the discrimination is indirect or subtle, so although there may be oppressive practice occurring, it may be going unnoticed and unquestioned. This may in turn, lead to the difficulties of attracting and retaining staff from traditionally oppressed groups, for example, the black nurses in Collard’s study. Indeed, Deitch et al (2003) state that “subtle, ‘everyday’ forms of discrimination may persist largely unchecked” (Deitch et al, 2003, p 1302) in the workplace. This indirect or subtle oppressive practice can be in the form of institutional discrimination, or it can be a result of a particular work culture, for example through ‘jokes’ or ‘microaggressions’, such as unfriendliness, or failure to help someone (Pettigrew and Martin, 1987). In this case, these ‘indirect’ forms of oppression have at least been recognised within the NHS and the NHS is therefore presumably attempting to incorporate these considerations into its anti-oppressive practice, despite the aforementioned practical difficulties in achieving this aim. It is perhaps the case that anti-discrimination practice must start from the bottom-up within a hospital setting: the responsibility lies with each individual member of staff to minimise oppression and discrimination within the workplace and it is not sufficient to merely have a policy in place, although the top-down practices of equality in terms of recruitment and promotion are also important.
Anti-oppressive practice within a hospital setting, however, also relates to the patient, and the practices in place that prevent them being discriminated against or oppressed. It is inevitable that within a hospital setting, the service users will come from all sectors of the community. Indeed, Neuberger and Coker (2002) suggest that people from BME communities and refugees are more likely to suffer poor health, and therefore need to access health services, whilst Gitterman (2001) states that social workers, which would include those working within a hospital, “deal with profoundly vulnerable populations, overwhelmed by oppressive lives, and circumstances and events they are powerless to control” (Gitterman, 2001, p 1). So, what anti-oppressive practices can be implemented within a hospital setting?
One such practice is that of ’empowerment’. Empowerment has been defined as “using interventions which enable those with whom we interact to be more in control of the interactions in exchanges” (Mancoske and Hunzeker, 1989, p 34). Some features of empowerment as anti-oppressive practice include: viewing the service user as a unique individual with ‘dignity and worth’, providing the resources to help the service user lose the label and internalised beliefs that she is a victim, and encouraging her to reframe her experiences in language meaningful way (Lee, 2001).
It is difficult to say how far these values and practices are being implemented at a grass roots level, and just as anti-oppressive practice must in part begin with staff with regard to employment, it must also begin at this level with regard to anti-oppressive practices towards service users. This makes anti-oppressive practice difficult to evaluate, in that individual health practitioners and individual hospitals will differ in the extent to which these practices are successful. However, there may be examples of patient choice, which can also be viewed as empowerment and anti-oppressive practice, which may give some indication as to whether empowerment is taking place within a hospital setting. In 2006 the Department of Health produced a report (Choice Matters: increasing choice improves patients’ experiences) that outlines the improvements that have been made by increasing choice in the NHS. It claims “there is growing evidence to show that patients experience better health outcomes when they are more involved in such decisions” (Department of Health, 2006, p 18). There is also an example that relates particularly to anti-oppressive practice within this report; this is their commitment that “By 2009, all women will have choice over where and how they have their baby and what pain relief to use” (Department of Health, 2006, p 18). So it would seem that in terms of choice, anti-oppressive practice is being increasingly recognised and implemented. A further example of an effective anti-oppressive practice in terms of choice has been highlighted by O’Cathain et al (2005). They suggest that people feel empowered by NHS Direct, a telephone helpline, because it allows “people to be in control of their health and health care interactions” (O’Cathain et al, 2005, p 1761). This is clearly an initiative that has increased patient choice and control, and therefore contributes to Lee’s criteria of providing resources whilst challenging the ‘victim’ label.
However, in contrast, it is arguable that in some areas of hospital practice, choice and empowerment, is somewhat lacking. One example where anti-oppressive practice within hospital settings can be seen to be lacking is within medical practice itself in cases where babies born with intersex conditions. These are conditions that result in the sex of the newborn child being ambiguous. According to Liao and Boyle (2004), “surgery is carried out to ‘feminise’ the genitals, even for children who are known to be genetically male but whose penis is considered too small”. (Liao, Boyle 2004, p 447) This is often performed when children are too young to consent, or in secrecy “secrecy has been central to the traditional management of intersex… [Ranging] from non-discussion to outright deception” (Liao, Boyle, 2004, p 460). Here, there are clearly multiple levels of oppression, including a lack of choice for the intersex individual, in terms of both whether or not to undergo surgery for a non-life threatening condition, and of which sex they identify with, but also in terms of the fact that intersex people are ‘feminised’: assigned the traditionally oppressed sex, even when he is genetically male. This instance of oppression stems not only from medical practice, but from Western society at large which barely acknowledges the existence of intersex conditions; yet it is within the hospital where the most tangible oppression of this group takes place.
Similarly, Singh et al (1998) have noted that black patients with mental health issues are twice as likely as their white counterparts to experience compulsory admission, and Johnstone (2003) highlights the fact that of those who receive electro-convulsive therapy (ECT), “two thirds were women, 41 per cent were over 65, and 15 per cent had ECT under section, or without consenting” (Johnstone, 2003, p 236). It is arguable that ECT is in itself, an oppressive practice, and patients have experienced “feelings of terror, shame, humiliation, failure, worthlessness and betrayal, and a sense of having been abused” (Johnstone, 2003, p 239) as a result of ECT, yet it also seems that it is most commonly used in populations that are already oppressed, i.e. women and the elderly, once again, without consent in some instances. These examples seem a far cry from viewing individuals as being of ‘dignity and worth’ and the power in these circumstances lies clearly with practitioner, rather than the service user. This highlights some of the most extreme failures of anti-oppressive practice in a hospital setting, although these could be viewed as oppression within medical practice and a case for medical ethics, rather than oppression within a hospital per se. Overall, it seems that for patients, there are some effective practices in place, yet in other areas there is room for considerable improvement.
Anti-oppressive practice has been evaluated with regard to hospital staff, and with regard to patients, and in both instances it seems that in order for it to be effective, it must be practiced on both the individual and institutional level. The institutional level is policy driven, and policies are in turn informed by legislation. As has already been noted, the Sex Discrimination Act 1975, the Race Relations Act 1976, and the Disability Discrimination Act 1995 have all shaped policy within a hospital setting. A further piece of legislation that relates to anti-oppressive practice is the NHS and Community Care Act (1990). This is credited as having heralded “a new era in community care” (Parry-Jones, Soulsby, 2001, p 414) in which practice became based on a needs-led approach. This is an important step for anti-oppressive practice in that a needs-led approach can take into account the differing needs of people from a variety of backgrounds, rather than applying a ‘one-size-fits-all’ approach to practice. In this way, individuals should be able to access “responsive services in which differing needs are identified and accommodated so that each person benefits equally” (Neuberger, Coker, 2002, p 90). Once again, it is important to note that the aims and ideals can be different to the substantive reality, yet this is surely a positive step towards anti-oppressive practice.
It is clear then, that there are a number of approaches to anti-oppressive practice, some of which are more readily implemented than others, and although there are some good practices in place, anti-oppressive practice must continue to evolve.