Shahrar Ali’s Response to Young Greens 19 July 2021
Also available as Pdf here.
I have become aware through social media that Young Greens at their 2021 Convention have passed a motion seeking to have me removed as a national party spokesperson. They have criticised me on account of two past statements or policy proposals I have made. Let me attempt to address these concerns, in turn, followed by some observations about internal democratic practice and culture.
1. Maintaining professional boundaries in patient care
I have asserted that it is unprofessional to advertise sexuality to patients in a clinical care setting. I stand by this claim and regard it is neither contradictory nor inconsistent with Green Party policy; but rather more in tune with what we would want to say than its opposite. It is also what the medical profession expects of its practitioners, as codified in fitness to practice and other professional ethics codes stipulated by the GMC and other regulators.
A couple of references might help here. See
· Maintaining a professional boundary between you and your patient (General Medical Council)
· Clear sexual boundaries between healthcare professionals and patients Information for patients and carers (Professional Standards Authority for Health and Social Care)
What these documents emphasise is the need for clinicians and carers to maintain clear professional boundaries in the assessment and treatment of patients. The GMC document says that practitioners must not use their professional relationship to pursue a sexual relationship with a patient; nor should they put themselves at risk of being seen to be doing so. The PSA goes into detail about why sexual boundaries are so important, emphasising the responsibility upon the health professional and giving some examples of behaviour that might be regarded as problematic. For example, requesting details of sexual orientation that are not necessary or relevant; or telling patients about their own sexual preferences (see Appendix A of PSA for reference to these). Both regulators also emphasise the unequal power relationship that exists between practitioner and patient and special care that needs to be taken not to risk abusing or exploiting this in care settings.
The statements I have made in a series of tweets to which the Young Greens have taken exception simply make these points in relation to professional boundaries in patient care settings. The context is that of the CQC promoting, over Twitter, Stonewall materials in a medical environment. It is absolutely the case that employees should be able, if not encouraged, to express solidarity with the LGBTIQ+ community at work, which they may also be a part of; but I am simply drawing attention to the particular sensitivities that need to be taken account of, and when care needs to be taken, in a medical environment.
There is a difference in content between wearing a rainbow lanyard, for example, and a badge which makes a claim about oneself, referring specifically to the wearer. A badge which makes a claim about one’s own sexuality, whatever that sexuality, carries a far greater risk of intruding upon a clinical encounter with a patient and transgressing the aforesaid professional boundary (not to tell patients about one’s own sexual preferences). This is what I mean by the danger, or indiscretion, of advertising one’s sexuality, especially in a relationship where professional integrity in a position of power is paramount, and the appearance of that.
The criticisms made by the Young Greens motion with specific reference to paragraphs of our Health policy are not relevant. These paragraphs and the Young Greens’ criticisms refer to protecting against discrimination at work on grounds of the protected characteristics, including sexual orientation. I have neither said nor implied anything to the contrary. An employer, including a medical one, must ensure that they do not discriminate against an employee on grounds of sexual orientation in their hiring or employment practice. That is not the subject of this discussion, at all. Young Greens have also misattributed to me the claim that practitioners should “hide” their sexuality. I have not said that at all. To be discouraged from wearing a badge that specifically announces one’s sexuality, in order to avoid a potential breach of professional boundaries, is not the same as being asked to hide one’s sexuality. It is simply to be advised not to be too overt about it, in that context, for professional reasons. We may wish to disagree about exactly where that threshold lies, but such a disagreement in itself would be neither unreasonable to have, nor indicative of prejudice.
Moreover, the GMC also emphasises the need for practitioners to take special care in divulging personal information in social media accounts – and clearly the CQC tweets were not mindful of that risk either. Perhaps these regulations upon medical practitioners sound overly prescriptive, or prohibitive, but I happen to agree with them and believe they are firmly in tune with Green Party policy and ethos, too.
HE1505 in Party health policy explicitly references Regulation of Practitioners, including
· A minimum set of standards for practice are maintained
· Treatment, or non-treatment, and advice should be determined, as far as is possible/practical, by the patient's best interests.
It should be no surprise to learn that our policy prioritises patient-centred care and the upholding of the highest professional standards.
2. Emergency Motion against GenderGP
Young Greens, in their criticisms of my Emergency Motion to Spring Conference 2021, have already linked to the full motion http://electshahrar.co.uk/gpew-em-prohibit-gendergp-from-uk, which also contains resources to public investigations and press reports, on the basis of which I regarded this to merit Emergency motion status. I must not have been alone in thinking this as well over a hundred members signed that motion in just two days of its being listed as in order and it was not far short of being prioritised at conference. I maintain that the motion would do exactly what it says on the tin:
Prohibit GenderGP from Operating in UK on Grounds of Patient Safety, Lack of Child Informed Consent & Safeguarding Failures
The General Pharmaceutical Council intelligence-led inspections identified serious failures in governance and risk management at two of GenderGP’s UK partner pharmacies, and a lack of safeguarding, which posed an unacceptable risk to patient safety. Because the Green Party also cares about patient safety, child consent and safeguarding, I regard it as credible to suppose that we would also seek to campaign against the risk of medical negligence directed at especially vulnerable patients.
Specific passages of our current Health policy are relevant here:
HE1404 We shall improve the protection provided under the law to users of medicines. Prescribed and over-the-counter medicines will be monitored more rigorously with regard to both efficacy and toxicity. [GPhC enforcement actions relevant here]
HE1410 We shall identify health areas where existing treatments available under the NHS are either so expensive that they are unsustainable, where existing treatments have a poor record of restoring patients to health or where existing treatments pose a significant health risk in themselves.
The reference to both NHS and health risk is significant. The Dec 2020 Bell vs Tavistock case resulted in the NHS imposing a moratorium on the prescription of puberty blockers from its GIDS clinic. It should then present Green Party with a prima facie case to proscribe a private clinic from administering the very same medicine that had been deemed unsafe by our medical provider of choice, the NHS.
An emergency motion to conference is a policy statement that would not be making new policy as such. We have put, and passed, an emergency motion before which singled out an organisation for criticism or sanction. This EM was already deemed in order by our Standing orders committee; so for Young Greens to seek to subject me to some form of sanction, or removal from post, for putting a motion that had already been granted that status by SOC would be pretty subversive of our internal democracy. It would also give the lie to the notion that Young Greens were not seeking to affect my membership status – for to impose a sanction against me for putting a well-founded emergency motion would be to do nothing short of limiting my rights as an ordinary member.
Now, let me take this opportunity to address another criticism that has been made about this EM, both by Young Greens now and at the time of my proposing it. I have since addressed this point on the members’ site but will now do so publicly. The criticism is that this motion would deprive trans patients of needed health care. Unfortunately, this simply begs the question about the quality of that care in this instance – especially in cases where a court has judged that treatment to be experimental and too life altering to reasonably expect the age-cohort of patients in question to be able to meaningfully consent to it. Moreover, my motion was amended by SOC before it could be deemed in order. Let me reproduce the text that I was asked to take out:
Conference calls upon the Government to provide extra mental health and well-being support services for children, young people and their families and to urgently review the regulatory regime which would allow child patients to gain access to medicines which they would not otherwise have been prescribed by the NHS.
This should help address the criticism that I was proposing to remove the facility for private provision (that I took to be unsafe) without replacing it with anything in its stead. My assumption is that SOC believed this paragraph to be strictly superfluous to requirements because already embedded in party policy. Another motion to that same conference (this time a late motion) had also been proposed by me, before this one, and the resources listed there should confirm that mental health support is indeed a vital aspect of our party policy (see http://electshahrar.co.uk/late-motion-prohibit-private-clinics-from-exploiting-nhs-moratoria-on-puberty-blockers).
That said, it was my intention, had the EM reached conference debate, to put the original paragraph back in as an amendment (which attempt would have been allowed, procedurally).
All told, I take this EM to be fully in line with Green Party policy and ethos – and the proposed amendment to have carried useful assurance of the same.
3. Internal democratic culture
I believe that Young Greens would seek to uphold the highest standards of internal democracy. Therefore, the following must be relevant:
a) GPEx spokespersons were appointed by a rigorous process, including an application deadline.
b) Discussion has already been had in GPEx regarding these appointments, as recently as June executive.
c) A special interest group or other grouping in the Party is not of itself empowered to make party policy.
It would surely not be appropriate to insist that GPEx continue to revisit this matter until one “side” gets the outcome they desire. Nor would it be uncontentious, say, for the Party to attempt to add to its contracts with its spokespersons clauses or conditions when they had already signed up to some – this would be akin to shifting the goalposts or introducing differential standards, especially if they were motivated by a perceived need to tackle the transgression of one of their number.
I contest the notion that I have said or done anything contrary to Party policy or acted in a way to harm our good reputation. I do not doubt that I have sometimes put motions, as is my right, that may incite passions on either side of a debate (and I wouldn’t be alone in that). But nor do I think the job of a politician is to shirk difficult conversations, including internal ones, especially where patient safety or dignity is concerned.
Point c) is also relevant here. Currently party policy is decided by every member acting in unity, as one among equals, or certainly the opportunity for that being given – through conference and its processes. Policy is not decided by a sub-group of the party to which not everybody may be invited.[1] I believe there is something vitally important about this opportunity for all-member scrutiny and approval of party policy. For one, it encourages all of us to take an interest in the rights and well-being of us all, even if some of us may take ourselves (through groups or individually) to have special interest or insight into some of those needs.
I do take myself, in the best tradition of Green politics, to want to consider the impact of our policies on everybody, not just those who might be most obviously addressed by them. I regard advocacy of trans rights, and their inclusion, for example, to sometimes impact upon the like rights of women. I would regard it as especially important to include women in the conversation – and indeed, negotiation – if they themselves were telling us about their concerns over their rights being impacted. Not all of us may wish to engage in those debates, but we should not be preventing those who do wish to from doing so. Greens will routinely advocate for talk nor war when seeking to resolve conflict. These debates, while they may be testy, require the same approach.
As an example of the fact that a special interest group in the Party may not necessarily align with the only, or best, interpretation of party policy - if only because it had not been created yet – take as an example this response to an LGBTIQ+ Greens pledge request to GPEx candidates last year. As a candidate, I chose not to blanket endorse every pledge but provide my own, more detailed response here https://shahrar-ali.squarespace.com/s/LGBTIQA-Pledge-Response_-Shahrar-Ali-160720.pdf. It certainly was not through a lack of interest or concern for promoting Green values that I chose to do it in this way.[2]
Finally – yes, I know, the planet is burning.
[1] It would be good to know how many attended the YG convention – to know the actual figures voting for the motion.
[2] Some responses on Twitter appreciated this approach: "Thank you so much for responding in such a thoughtful way. There are so many knee jerk responses to these issues and it's rare to see someone think through the consequences of signing up to a pledge." Another said, "Very impressed by this thoughtful and grown up approach - wish more would respond to pledges in this way."