Inclusiveness in practice

The Mid and South Essex, and Suffolk and North East Essex Allied Health Professionals (AHP) Faculty wanted to celebrate the successful work of AHPs in each system and to showcase our role in improving the integrated care systems according to its four principles:

• Improving outcomes in population health and healthcare.
• Tackling inequalities in outcomes, experience and access.
• Enhancing productivity and value for money.
• Helping the NHS support broader social and economic development.
   

They asked staff members to nominate colleagues who went “above and beyond” plus any projects, innovations and service improvements that demonstrated the brilliance of AHPs. 

David Haggerty

Inclusive pregnancy

I won the Research, Innovation and Public Health category for my efforts instigating an inclusive pregnancy status (IPS) form in our department and trust.

My colleague Tacha Clarke and I had been trying for some time to devise ways to support our trans, non-binary and intersex (TNBI) service users and be more inclusive in terms of pregnancy checking. 

The release of the Society of Radiographers’ recommendations gave us a solid foundation on which to build this project at a local level. The process to get to where we are now has at times been rather combative but the overriding message is one I feel strongly about. 

In 2020, I worked with a local LGBTQIA youth group and challenged the members to design posters to explain to our trans and non-binary service users that pregnancy checking was required. The posters worked well but, ultimately, they did not feel robust enough because they relied on the patients seeing and understanding the message. 

Sensitive topic

This is understandably a sensitive topic and one with clear legal protection for our TNBI patients. We needed to find a method that adhered to our radiological legislation while complying with equality and diversity legislation. This topic required specific attention and increased urgency because our department had experienced a number of radiation incidents/near misses when trans males were imaged without the necessary pregnancy queries being undertaken. 

This experience is reflected nationally by the Care Quality Commission, whose IR(ME)R annual report 2019/20 documented errors caused by inadequate checks and how IR(ME)R employers must use inclusive language in all procedures. 

Fortunately, none of these patients were pregnant. However, there is still a risk of pregnancy even if cross-sex hormones are being taken and we were remiss for not checking. If an IPS form had been in place, these instances would not have occurred. 

Proud legacy

Sadly Tacha left our department recently but I am proud of the legacy that we began to create together. She will always be credited for this because we worked well as a team. We did not claim to be experts but we read the literature, attended webinars and spoke to the SoR team responsible to educate ourselves. I have continued to forge ahead after we managed to get divisional and Trust approval for our adapted version of the SoR recommendations. The only way this vital update is going to work is through education and support. 

 
Before the official SoR recommendations for the IPS were published, we had been working with the blood services team because it shared similar concerns for patient safety regarding TNBI service users, notably trans males and the non-binary community. Now our IPS form has been given the green light, I am passionate about highlighting this issue to help raise awareness and help the blood services team to strike the right legal/health and safety balance and find a practical solution to protect this identified risk group.

 
Waiting and watching

I believe many Trusts and Health Boards are waiting to see how things develop with the introduction of a diagnostic IPS form. I fully appreciate that change can be unsettling and staff are anxious about offending patients unintentionally or having their clinical time extended by more paperwork. However, the risks are still the same regardless of the size of the population involved. Ultimately, I see the IPS as another vital update to our pregnancy protocol, which I have seen evolve during my 22 years of registration. I remember the unease when we started to ask patients about their last menstrual period and now it is common practice. 

I feel we have generated more support for the introduction of the IPS than for any other initiative previously implemented in our department. I hope it will be given the best opportunity to become embedded in our everyday practices.

However, the risks are still the same regardless of the size of the population involved and we should always try to aim for best practice recommendations when it comes to radiation protection and reducing inequalities in healthcare.

Fortunately our Trust has a proactive stance when it comes to the topic of equality, diversity and inclusivity.

A solid foundation

I must thank the SoR for working so hard on this issue and publishing the recommendations in the first place – this gave us a solid foundation to build on. One of the lead authors Rachael Webster and SoR professional officer Lynda Johnson have been superb points of contact throughout the process and, as a Society member, I have truly felt supported and reassured by hearing their first-hand experiences of implementing their work.

SoR comment

Professional officer Lynda Johnson, who was instrumental in developing and promoting the Society’s Inclusive Pregnancy Status (IPS) Guidance, gives a personal view of David’s work

We shouldn’t underestimate how much of a personal achievement this is for David and Tacha. It takes strong character and leadership to pick up this work, believe in its value and make the case for change. They and other radiographers leading this work are an inspiration.

It’s been a joy to hear of David and Tacha’s progress with this work, which is such an excellent example of what we can achieve as advocates of inclusive practice. I share their enthusiasm to spread the word across the radiographic workforce as we approach the first anniversary of the publication of the IPS Guidance in December. David and Tacha’s efforts are a shining example of how reading the evidence and making best use of professional-body guidance can make a real impact for patients.

The whole team at the SoR and the LGBTIQ+ cancer charity, Live Through This, congratulate David on his well-earned award.