3.15 Exploring anti-oppressive practice

Click to read: Anti-Oppressive Practice

One of the driving forces of anti-oppressive practice is being able to challenge inequality and recognise that challenges are not always successful and may be very painful both for the person or group being challenged and for those who are challenging. One important aspect of challenging inequality is being self-aware and understanding how your own social location affects the communication between yourself and the individual or group you may be challenging. The process of thinking and reflecting is a core part of working in an anti-oppressive way.

Burke and Harrison offer the following set of challenges for people wanting to work in an anti-oppressive way which:

• is flexible without losing focus

• includes the views of oppressed individuals and groups

• is theoretically informed

• challenges and changes existing ideas and practices

• analyses the oppressive nature of organisational culture and its impact on practice

• includes continuous reflection and evaluation of practice

• has multidimensional change strategies, which incorporate the concepts of networking, user involvement, partnership and participation

• has a critical analysis of the issues of power both personal and structural.

Describing the fragmented and highly contentious notion of anti-oppressive practice, Lena Dominelli argues that:

If Lena Robinson's approach draws on a psychological perspective, anti-oppressive practice clearly derives from a more critical, social model of ‘difference’. Anti-oppressive practice builds on a social constructionist model of ‘racial’ and ethnic differences, as well as differences of other kinds, as produced within a context of unequal power relationships in society. Rather than having a sensitivity to apparent ethnic or cultural ‘differences’, anti-oppressive practice argues that what is needed urgently is practice that challenges and changes structures of inequality at every level.

In terms of ethnicity, this means starting from an acknowledgement that racism is endemic in organisational structures in health and social care services, as in society more generally. The MacPherson Report, produced in the aftermath of the murder of Stephen Lawrence, offers the following definition of institutional racism:

Institutional racism has been a factor in the experience of black staff in health and social care services. Building on what Burke and Harrison say about the intersection of different kinds of oppression, it is worth noting that black women in particular have experienced discrimination, particularly within the National Health Service. The NHS, like many other organisations, reflects a history of discrimination in its employment practice. Research into the experiences of black women health workers has identified many areas of discrimination (Baxter, 1997; Doyal et al., 1980). Early studies showed clearly that black women from the Caribbean who migrated to England in the 1950s and 1960s were channelled into ancillary and auxiliary jobs within the NHS. Even when they attempted nurse training many were offered training opportunities within the less senior State-Enrolled Nurse (SEN) programmes. This reduced career opportunities severely and limited the career development of many black nurses up until the present time. Indeed, changes in nurse training and promotion policies in the 1990s have weakened the position of SENs still further (Beishon et al., 1995).

Black nurses were also channelled into the least prestigious areas of work – in particular, psychiatric and geriatric nursing. Baxter (1977) argued black nurses were an endangered species, with discrimination operating in schools and colleges. This coupled with the knowledge of discrimination and lack of promotion prospects has meant fewer and fewer black women are choosing to do nurse training. A report in the mid-1990s from the Policy Studies Institute (Beishon et al., 1995) highlighted the fact that ethnic minority nursing staff often suspected racial discrimination by their managers, that they identified racism within working relationships and often experienced blatant racial harassment from patients.

At the time of writing, there are very few black women senior managers in the NHS. A survey of non-executives of health authority and trust boards reported that only 45 out of 1531 non-executive members of regional health authorities, NHS trusts and special health authorities in March 1993 were from black and ethnic minority communities (3%) (National Association of Health Authorities and Trusts and the King's Fund Centre, 1993). Similarly, only 4 out of 534 chairs of health authorities and trusts were from black and minority ethnic communities and only one of those was female. This demonstrates the difficulty black and ethnic minority women have with both race and gender discrimination.

The staff shortages within the NHS at the time of writing have led to a recruitment drive somewhat reminiscent of the 1950s and 1960s, when people were recruited directly from the Caribbean to staff a newly developed NHS. At that point processes and policies were not developed to ensure Caribbean nurses and auxiliary staff were not discriminated against. Many agencies have employed Filipino and South African nursing staff on limited contracts.

An anti-oppressive approach to ethnic diversity and difference would begin by acknowledging the impact of racism on the experience of both staff and service users. The next step would be to challenge existing structures and practices, for example in relation to employment, training and promotion within services, to ensure they did not discriminate against people from particular backgrounds. In terms of work with service users, an anti-oppressive approach would challenge the ways in which current practices disadvantage, either directly or indirectly, patients or clients from different ethnic groups. This approach would not ignore ‘differences’ in terms of needs but, rather, would see such differences as the result, at least in part, of existing racist and discriminatory practices.