Welcome back for another episode of the Mason Institute Investigates podcast. In this episode I’m joined by Dr Piyush Pushkar (Twitter: @DrPiyushPushkar), a higher trainee in forensic psychiatry in the NHS and NIHR clinical lecturer at the University of Manchester, and Dr Louise Tomkow (Twitter: @ljt2211), a geriatric medicine registrar in the NHS and NIHR academic clinical lecturer at the University of Manchester. Dr Piyush and Dr Tomkow talk about their research on clinician-led evidence-based activism (CLEBA), a form of activism that utilises the clinical authority of doctors to challenge various political issues concerning healthcare.
They describe the role CLEBA played in two issues: migrant health in the UK and the ongoing marketisation of the NHS.
“I think the role of it was to try and challenge the political environment, and I think that was the overall aim is that everybody involved; so the migrants themselves and the doctors who are taking part in the activism, felt that things needed to change… there were very particular policies that were being enacted that we felt shouldn’t be in place and we wanted reversed… there was also a memorandum of understanding between the NHS and the Home Office. And this essentially meant that the Home Office was allowed to make disclosure requests to the health service to access migrants’ medical records… this was used to find people who owed the NHS money because they were chargeable and to use that in cases against them to get them deported from the UK… There was a strong feeling that this was fundamentally wrong. And in light of that, there were cases of doctors giving evidence to Parliamentary Health Select Committees about the harm of these hostile policies…
Dr Louise Tomkow
However, they also explain the danger CLEBA can have in consolidating the societal position of doctors:
“… what happens if you strategically use your authority, even if you’re using it for some progressive cause; are you embedding and consolidating unequal hierarchies? … you just have to be aware of the way in which your tactics at any particular moment can have a number of different consequences that can consolidate unequal power relations; even while contesting other unequal power relations… the thing with clinician-led evidence-based activism is that to some degree it can work… what Louise and I are just calling for a bit of wariness about is, that the tactics that you use can themselves or will themselves influence the social structures that we’re trying to change… We might not question it partly because we benefit from it… And so, our class position as doctors, a) remains unquestioned, and b) further consolidated…”
Dr Piyush Pushkar
Dr Pushkar and Dr Tomkow’s discussion illustrates the position of a doctor as the UK’s healthcare landscape becomes increasingly political and their role in advocating policy change.
For more information, please see the below links to further resources. Happy listening!
Written by Leyla Noury (Twitter: @dheggacad)
Links and further resources:
Piyush Pushkar & Louise Tomkow, ‘Clinician-led evidence-based activism: a critical analysis’,(2020) Critical Public Health, 31:2, 235-244
Louise Tomkow, ‘Health and hostile hospitality: Understanding asylum applicants’ narratives of life and health in the UK’, (2020) Social Science & Medicine, 265
Piyush Pushkar, ‘NHS Activism: The Limits and Potentialities of a New Solidarity’, (2018) Medical Anthropology, 38:3, 239-252
Louise Tomkow et al, ‘Healthcare access for asylum seekers and refugees in England: a mixed methods study exploring service users’ and health care professionals’ awareness’, (2019) European Journal of Public Health, 30:3, 527-532
Cara Kang, Louise Tomkow & Rebecca Farrington, ‘Access to primary healthcare for asylum seekers and refugees: Service user experiences’, (2019) British Journal of General Practice, 69:685, p537-e545
Stan Constantina Papoulias and Felicity Callard, ‘A limpet on a ship’: Spatio-temporal dynamics of patient and public involvement in research’, (2021) Health Expectations, 24:3, p810-818
‘Mason Institute Investigates’ is produced and edited by the Mason Institute and made with funding from the Edinburgh Law School.
The intro song is ‘Secret to Success’ by Scott Holmes Music
The outro song is ‘Inspirational Outlook’ by Scott Holmes Music