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Gemma Hughes: Okay, so can everyone hear me? Okay? And can you see my screen? Great.

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Yeah.

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Gemma Hughes: thanks very much for that introduction. it's it's a bit of a strange view, because I I can't see how many people in the room. So I've got no idea whether there's

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Gemma Hughes: just 2 people or 6,000 who knows? you got 6,000. It's a full house

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Gemma Hughes: that that that helps with the nerves. Thanks. And so I'm I'm Jemma Hughes and I've led the I'm leading the ethnographic work that the paper we will present today draws on

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Gemma Hughes: and as this is indicated, I've had to think quite long and hard about whether or not I should participate in this panel this evening as it is in the Uk.

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Gemma Hughes: Because of the ongoing industrial action in the Uk across universities and colleges. and I've decided obviously to give this paper. I'm here. But I want to be clear that I'm doing this actually in a voluntary, unpaid capacity, because, although the organisations listed on this slide have financially supported this research, and indeed paid a not insignificant amount of money for me to attend this conference. They're not paying my salary today because my wages have been unfairly stopped.

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Gemma Hughes: due to participation in the marking an assessment boycott in the Uk, as indeed have many other academics been affected in that way. I'm now going to hand over to Francesca, who will introduce herself and give the first part of our paper before handing back to me to deliver the second half.

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Gemma Hughes: and, Francesco, I can move your slides on if you give me a nod when you're in

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Francesca Ribenfors: perfect. Thank you. And thanks, Gemma. Hi, Yup. I'm Francesca Reynolds, and I'm a researcher at Manchester. Metropolitan University.

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Francesca Ribenfors: I'm not striking, but I am actually on maternity leave at the moment, and I I guess I say that for 2 reasons. firstly, I think it kind of it shows the pressure that researchers are under particularly early career researchers. And why strikes are important, and but also from the practical point that we might get interrupted by a crying baby. And so I apologize in advance for that, because it is, it is late at night here.

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Francesca Ribenfors: so the first slide. So in terms of the presentation, I'm going to just introduce the study a little bit and talk about the background.

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Francesca Ribenfors: I'm going to draw attention to our standpoint and the problematic of the witness in fitness to practice hearings.

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Francesca Ribenfors: I'm then going to talk, and I'm going to talk about one part of our findings. This concept witness work

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Francesca Ribenfors: and then I'm going to hand over to Gemma, who's going to talk about how ruling relations cause epistemic and justice? gem is then going to talk about our emerging theoretical explanation for the problematic as a form of itogenic injustice.

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Francesca Ribenfors: I really want to stress, though, this is a work in progress. we're currently in the midst of analysis. And so we really do welcome your feedback and kind of discussion or comments suggestions for further development. whether in this session, or whether kind of ventilated date by email or Twitter, or how

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Francesca Ribenfors: you wish to communicate.

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Francesca Ribenfors: So in terms of what the study is concerned about, we're we're really focused on what happens to people who have been harmed during the course of their care.

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Francesca Ribenfors: And that's health and social care. And because they have been harmed, they get involved in raising a concern about that health and social care professional who caused their harm to the regulatory body.

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Francesca Ribenfors: And there's 13 different regulators within the Uk covering 2 million registrants.

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Francesca Ribenfors: and the regulators of obviously have a role to uphold and professional standards. If concerns are raised about someone who's registered with them, then the regulator will investigate and potentially conduct a hearing of their fitness to practice. And there's thousands of concerns raised each year, but only a small amount are investigated, and and even fewer of those kind of filter through to a full fitness to practice hearing

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Francesca Ribenfors: and taking part in a fitness, practice hearing. If you have been harmed or someone close to has been harmed is potentially a really difficult process. we know that going over traumatic experiences can be difficult, and indeed potentially re traumatizing.

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Francesca Ribenfors: and but little is known about the experiences of witnesses in fitness to practice hearings, nor whether they're well supported throughout the process. And most of the research to date focus focuses on the professionals rather than the witness.

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Francesca Ribenfors: And so we're really focused on kind of wanting to fill that gap by finding out about witnesses, experiences, and using those just findings to develop a range of resources for regulators, professionals, and witnesses.

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Francesca Ribenfors: So yeah, the next slide. Demo, please. Thanks. So our standpoint, we're really, we're really focused on the standpoint of the witness.

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Francesca Ribenfors: and and kind of why we're focused on this. it's really kind of guided by personal experience, continues to be guided by personal experience.

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Francesca Ribenfors: So the study was conceived by Professor Sarah Ryan, who's to Api on on the study.

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Francesca Ribenfors: And it's following her experience of fitness to practice hearing of the doctor responsible for the medical care of her son Connor Sparrowhort, who's nicknamed Laughing Boy or L. B. And his in this picture here on the front of her book.

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Francesca Ribenfors: and Connor sadly died in 2,013 at the age of 18, whilst in an Nhs and assessment and treatment unit and so our study has always been focused on the standpoint of the witness and concerned with what we've learned to call the problematic of the witness. Hence our turn to institutional ethnography as our mythological framework

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Francesca Ribenfors: next slide. Jama, thanks. And so just an overview of the data. the data kind of we're drawing on. And myself and Gemma discussing today, is is part of the the much larger kind of data gathered through the overall fitness practice witness to harm study.

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Francesca Ribenfors: And so our work package has been an ethnography of fitness, practice hearings. and our empirical work has included this orientation period between November 21 and March 22,

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Francesca Ribenfors: and then 15 hearings, which we observed across 8 Regulators, and 5 of these hearings were in person, and 10 were held remotely

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Francesca Ribenfors: and between 4 of us, on the research team. In this work package we covered 71 days of observations.

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Francesca Ribenfors: and we've also interviewed a number of people involved in hearings, and although because of the legal process involved in the finished practice hearings, we've had to go through the Regulators to get in touch with participants to interview and not surprisingly, we've had very low response from public witnesses. which is, you know, we highlighted as a limitation of our data.

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Francesca Ribenfors: and we have, however, had a number of interviews with panel members and staff witnesses involved in the hearings. We observed.

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Francesca Ribenfors: as well as public witnesses who attended other hearings, and so hearings which we didn't observe, and people who raised concerns. But their concerns didn't make it through to a full hearing.

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Francesca Ribenfors: and just for people who are familiar, a bit of background about fitness to practice hearings and how they're set up. on some of the slides in the next slide, for example, I think this, we we've used images from regulators, websites of hearings, and they've picked people who are formally dressed, sitting in corporate type rooms or on teams meetings.

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Francesca Ribenfors: as you can see at the bottom there. It's this very formal meeting.

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Francesca Ribenfors: and a typical hearing will open with the Regulators case presenter, and who's usually at barrister, supported by a legal team solicitor stating the allegations.

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Francesca Ribenfors: Once the regulator's case has been presented, the registrant, so the professional or the representative again. Usually a barrister will respond.

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Francesca Ribenfors: and it's send that witnesses a call to give evidence under oath or affirmation. And this includes cross-examination of the witnesses.

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Francesca Ribenfors: Once all witnesses have been heard from the regulator, and restraint will make their final submissions, and the panel will deliberate.

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Francesca Ribenfors: and the balance of evidence needs to be with the regulator to prove facts. not for the registrant to prove that things didn't happen.

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Francesca Ribenfors: Once deliberations have taken place, the panel will hand down their determination on facts and whether that there's been misconduct or unprofessional conduct. and whether any sanctions are necessary

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Francesca Ribenfors: and sanctions can rain from admonishment, and through to striking off, and with suspensions and supervised practice as other options

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Francesca Ribenfors: erez agmoni. So a little bit about the problematic of the witness. And and this really kind of focuses on this conflict between authorized and experiential knowledge. 150

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Francesca Ribenfors: witnesses raise a concern because they've been harmed, and and they're expecting a resolution or an explanation and an apology, or for it not to happen again. So for the harm not to happen to someone else.

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Francesca Ribenfors: there is support available from regulators. However, most witnesses don't feel supported. or they don't find that support useful, and it's a difficult process. There's a lot of waiting involved, and people aren't kept informed of what happens.

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Francesca Ribenfors: Oh, what's happening?

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Francesca Ribenfors: And whilst, although the witness is a witness, they're also systematically doubted and undermined as part of this kind of fair process.

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Francesca Ribenfors: So during the cross-examination, for example, but also through the kind of other investigations which take place before that point.

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Francesca Ribenfors: and there's a number of costs and consequences of being a witness, which I'll talk a little bit about in a bit. But it's this real onerous process.

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Francesca Ribenfors: So our first main finding about ruling relations is that being a witness involves work. And we've got this concept. Witness work. and our thinking on this really draws on the work of Ahmed. her her work on complaints as well as Dorothy Smith's Institutionalist Ethnography.

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Francesca Ribenfors: And although Ahmed's work draws in different institutional settings to those of our study. It's concerned with what doing complaint does.

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Francesca Ribenfors: and the the institution becomes visible through the lens of complaints.

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Francesca Ribenfors: and we've found that the power institutions have become knowable through the way in which witnesses have to work.

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Francesca Ribenfors: and that work has multiple dimensions to it.

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Francesca Ribenfors: And and there's work done before, during and after hearings. And on this slide here we've just drawn attention to just kind of some of the work involved as a witness.

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Francesca Ribenfors: so before they hearings, witnesses have to work to raise the complaints they have to navigate the referral process, write the concerns out. and provide evidence of their complaints. Remember details of events.

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Francesca Ribenfors: and and then, once they've raised the complaint, there's a lot of waiting involved. and

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Francesca Ribenfors: at the hearing itself, if it does go through to hearing. They they they have to have a presence at the hearing whether that's virtually or physically they have to go through this cross examination by barristers.

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Francesca Ribenfors: of embarrassed. And and there's a number of micro rules which have to be followed, and this is often fitness. Practice. Hearing is often a very unfamiliar kind of territory for witnesses, one

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Francesca Ribenfors: And so all these new rules kind of new to them. So where to sit when to speak, indeed! How fast to speak? How to answer questions, what you're allowed to say and not allow to say so, not telling your story.

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Francesca Ribenfors: Not discussing the case with anyone else, and again more waiting, waiting to be called into the hearing which can go on for days, if not weeks.

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Francesca Ribenfors: After the hearing this, finding out what happened or not, so not all regulated and automatically tell witnesses the outcome, and they might have to find out for themselves, and kind of work through that determination themselves. And there's dealing with the costs and consequences. of being a witness, and of attending that hearing.

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Francesca Ribenfors: and so whether they had to take time off work to travel to a venue if it was held in person and time away from family, perhaps. as well as the emotional work of being represented in certain ways and in the determination of the panel. And again, there's kind of a lot more waiting involved.

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Francesca Ribenfors: So I'm going to hand over to Gemma here.

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Gemma Hughes: So the most difficult work that witnesses do that we think that they do, based on our observations and on the interviews is the work of cross examination.

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We observed the sometimes very lengthy processes of cross-examination. We observed responses from witnesses that seem to indicate frustration, despair, even trauma.

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Gemma Hughes: One interview he described being shell shocked by cross examination in this extract from an interview.

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Gemma Hughes: and talked about the frustration of cross examination that seemed to fail to get to the point despite repeated questions. Now this interviewee was a member of staff, so not someone harmed by the registrant or considered vulnerable, but still affected by the gruelling nature of cross examination.

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Gemma Hughes: Cross examination was described as terrifying by a panel member. That's one of the people who is on the committee to decide the findings. and these accounts, as well as our own observations, have led us to interpret this experience as being one that systematically causes epistemic injustice.

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Gemma Hughes: And this is our second key. Finding that we'll talk about today very briefly, Miranda Fricker wrote about epistemic injustice in her book of 2,007. The root cause of epistemic injustice is structures of unequal power and the systematic prejudices they create

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Gemma Hughes: Frick. It distinguishes between 2 kinds of economic injustice, testimonial injustice. Where someone is discredited. Their word is not trusted, perhaps because they are, for example, a patient somehow unreliable.

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Gemma Hughes: And the second kind of injustice is hermeneutic injustice when someone's understanding or interpretation of their own events is not trusted. For example, if someone feels they've experienced certain comments or words to have sexual overtones is told. No, they're mistaken. There was no sexual intention to that interaction.

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Gemma Hughes: so epistemic injustice is the injustice done to people in their capacity as a Noah, as someone who knows something which seems to really accurately describe the deliberate process of cross examination in hearings where witnesses are discredited and their interpretation challenged in order to deliver adversarial justice. The system of justice used in these hearings, which allows a judgment about truth to be made from 2 opposing accounts of events.

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Gemma Hughes: And this is the kind of the heart of what is so frustrating, upsetting, and destabilizing. We asked. a panel member, why do you think cross examination is so stressful, and his answer really gets at this whole frustration of not being believed. When you genuinely believe something has happened. And the reason this is so frustrating is that epistemic and justice undermines our very humanity, being rational and being able to know something is part of our humanity.

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Gemma Hughes: So the social meaning of being doubted in your custody as Noah. As someone who knows something means you are treated as somehow less than fully human. And yet this process of doubt is integral to the fitness to practice hearings.

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Gemma Hughes: So we've very, very briefly shared 2 key findings from our ongoing analysis of our data. The idea of witness work and this perpetration of epistemic injustice. But in the last couple of minutes we wanted to try something else out with you, which is our attempt at the theoretical account of what we think might be going on in our data.

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Gemma Hughes: So while epistemic injustice seems to accurately account for the sense of being wronged that we observed and heard in relation to cross examination. We also have other data to draw on which goes beyond the experience of cross examination, and indeed, beyond the experience of the hearings

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Gemma Hughes: interviews, for example, with people who have raised concerns but haven't been cross examined, and they also narrate a sense of being wronged.

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Gemma Hughes: The mismatch between what people expect or should be able to expect from the very institutions that are ostensibly there to help them, and what they experience when they receive, not help, but harm. And then what follows when they seek to raise concerns about that harm appears to be both deeply unjust and to be felt as a deep wrong.

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So we want to develop this idea of irogenic injustice to account for how these wrongs have occurred and are experienced.

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Gemma Hughes: This is a kind of a synthesis of the idea of epistemic injustice being wronged as a Noah, and the idea of Iatogenesis. The harm caused by health care.

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Gemma Hughes: Now, we need to do some more work on this. Synthesis and hydrogenesis, for example, comes from concerns with the limits of medicine. And actually, we're concerned, not just with medicine, but with the broader system of services intended to help people. And I think we need to a bit more work to justify the idea of iitronic injustice rather than simply just iitrogenesis.

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Gemma Hughes: However, what we are trying to do is to articulate the wrong done to people who have been harmed in their capacity as patients or service users who raise concerns with the institution that, as A caused them harm, and B. Systematically doubted the concerns of the witness through the use of adversarial justice, to investigate that harm.

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Gemma Hughes: We think that synthesizing the concepts of epistemic injustice and nitrogenesis potentially account for this wrong, and we'd be really interested to hear your views, to see if you think this is a helpful way of conceptualising what's going on.

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Gemma Hughes: I just want to close by just drawing attention to how we've chosen to illustrate this concept, which is with a pitcher at picture of a Rachel White read installation.

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Gemma Hughes: Rachel White read. As an artist who creates negative spaces, she takes everyday objects, a shelf of books, a hot water bottle, and places a room or a library, and makes moles of them, which reveal not the object, but the negative space created by that object. Sarah Ahmad uses a picture of White Reed's doors on the cover of her book Complaint.

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Gemma Hughes: This sculpture is of a whole house created by White Read in 1993,

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Gemma Hughes: and I think it's a really fitting illustration of that huge, unexpected, negative wrong that witnesses encounter when they attempt to engage with the ruling relations of health and social care. Regulation in the Uk.

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Gemma Hughes: Thanks very much. We'll stop there.

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Thank you so much, Chairman Francesco.

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for that really moving and and important work. we're now going to move on to the next speaker, all of Murray. who is talking about beyond reform, using feminist abolitionist discussions with institutional ethnography.

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And so, You're very welcome to begin sharing when you're ready.

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Órla Meadhbh Murray: Amazing! Thanks very much. I'll just get my slides up.

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Órla Meadhbh Murray: And can you just see my slides, not my notes.

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We can just see a slide

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Órla Meadhbh Murray: amazing and

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Órla Meadhbh Murray: well, Hi, everyone, I'm I'm so raging not to be a Melbourne, not just because it's half 11 or no almost midnight here in the Uk. And but also to actually see lots of you and me in person, and but thank you very much.

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Órla Meadhbh Murray: for coming to the panel, and also just to say that I'm I'm also on industrial action at the moment, and full of solidarity with Jama. And we're going to win this dispute. Hold the line, Durham, just take off my pay for my current page to tech. So I'm here

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Órla Meadhbh Murray: at presenting as a lecture in sociology from the University of Durham, but feeling extremely ambivalent about my institution at the moment. so

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Órla Meadhbh Murray: I think it's appropriate, then, that my presentation today is about Uk University audit processes, which was what my Phd was about. But taking a sort of step back from that research project

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Órla Meadhbh Murray: to think about this sort of bigger question and in relation to institutional ethnography, and which is basically about the idea of going beyond reformist approaches and suggestions. And as a result of institutional ethnography research. So I'm going to be speaking about how feminist abolitionist discussions can be used and sort of mixed with institutional ethnic feed to go beyond a reformist approach

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Órla Meadhbh Murray: and so see as to briefly to do this, I'll introduce my Phd. Research, which was on Uk University audit processes, and then discuss what feminist abolition is, and how it can relate to audit and universities before ending with some questions and provocations for discussion about what this raises for institutional ethnography in general.

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Órla Meadhbh Murray: and very quickly. I want to plug our Uk and Ireland Institutional Ethnography network. The website is on the bottom of the slide there, which I co-founded last year with Liz Ablett, Adriana, as far as de Lucy and Granny Kearney here also on the call, and so please do and look at the website and find our contact details to get in touch and see the resources that we're increasingly adding to that website.

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Órla Meadhbh Murray: So. Yes, so briefly. The Phd. Project that I did was an institutional ethnography of Uk University audit processes. And basically, I was thinking about

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Órla Meadhbh Murray: how academics negotiate and the the boss texts or the regulatory texts in Uk universities. And I did this 3 analyzing 3 textually mediated processes that I've listed on the slide there. And I did this. 3 extensive text analysis of the documents associated with these processes and interviews with workers and university to put these processes into practice, and then some auto-ethnographic reflections as well.

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Órla Meadhbh Murray: The firstly I looked at the national student certified, which is basically a satisfaction survey for final year undergraduate students in the Uk. And I was thinking about that in relation to my experiences as a former student, and then postgraduate student and tutor and teaching at the University of Edinburgh, where I was doing my Phd. And I'd been an undergraduate.

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Órla Meadhbh Murray: and I was thinking about how the generalising survey format how it did or didn't fit with the local context at Edinburgh, and thinking through that kind of disjuncture between this institutional text and how it got taken up and used to create something quite odd, called the student experience and in universities.

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Órla Meadhbh Murray: And then, secondly, I looked at Uk government research funding application processes specifically in the social sciences through the Economic and Social Research Council research grant funding an application process. And so this involved

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Órla Meadhbh Murray: looking at that particular application process and also speaking to 6 Social scientists who had applied for funding, asking them about how they translated their ideas into the format of the application, and how they were thinking about what was fundable, and how they sort of read and wrote about that.

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Órla Meadhbh Murray: And then, lastly, I was looking at the research excellence framework, the Ref which is a widely heated and and much discussed academic research audit process, which basically distributes money and prestige between universities and departments, and every kind of 6 to 7 years, and from that I was looking at how 5 physicists

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Órla Meadhbh Murray: who had responsibilities for implementing the Ref in their departments across 5 universities, asking them about how they applied this supposedly national process in their departments.

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Órla Meadhbh Murray: So that's like, you know.

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Órla Meadhbh Murray: 5 years work in like 2 min. And but just to give you a sense of the research that I'm thinking with around these questions around reform.

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Órla Meadhbh Murray: And if you want more details on the specifics of how I did that, or some of my findings. I wrote this journal article to sort of talk through, like, what did I do with the text and how to do, ie. Text analysis. in relation to these free processes.

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Órla Meadhbh Murray: And so basically.

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Órla Meadhbh Murray: the things that I kind of find in the Phd and the kind of high level findings were that using an institutional ethnography approach really helped me to see this disjuncture between supposedly Uk wide, very rigid audit processes, and then the very varied ways that they were implemented at a local level. So I find that you know, we we see these processes is very rigid, but actually the

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Órla Meadhbh Murray: a lot of interpretive agency in how academics and professional service staff in universities implemented these 3 processes across different contexts.

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Órla Meadhbh Murray: And so this may be sort of think about. You know, there is room here for collective, interpretive par which can be used to do audit in more or less harmful ways at a local level, and we see that at the moment, with the extremely different responses, some more candidates, and others with the industrial action around and paid deductions. Some places there are no pay deductions, some places it's 100% pay deduction

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Órla Meadhbh Murray: for not for participating in the marking and assessment boycott. So.

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Órla Meadhbh Murray: of course, all of these kind of local level interpretations of audit processes occur within a very stressful higher education context. In the Uk, where these processes have a big material impact on the finances and the reputations of universities and departments and courses, and sometimes down to individuals in how they're used for individuals, sort of

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Órla Meadhbh Murray: you know, assessment about like whether you get a job, whether you get promoted things like that. So

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Órla Meadhbh Murray: part of that The reason why they're so powerful is because, these audit processes are used in leaked tables and course comparison websites that produce a very intense competition between universities and encourage a sort of marginal games approach where universities and departments and many academics enthusiastically participate in trying to gain the audit process. in order to do well and hopefully

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Órla Meadhbh Murray: secure more funding or prestige, or even just the survival and of their department or their university. So

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Órla Meadhbh Murray: in the Phd. I was trying to sort of highlight that, as academics, many of us often critique these processes or hit these processes and speak about them as if they're separate from us. But actually, I wanted to kind of highlight. Why, we are doing them. We are putting these things into practice. We are reproducing them. 3 are often very Monday and bureaucratic, you know, practices. So our reading and writing and performing of audit text

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Órla Meadhbh Murray: in our everyday lives is enacting them and depending on your role, and how much power you have and who you are.

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Órla Meadhbh Murray: Some of us have a lot of interpretive agency and interpretive power in how we enact them. And so there's an opportunity to do them differently, especially collectively.

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Órla Meadhbh Murray: So basically, I got to the end of the Phd. And I was like, right, what are my suggestions. And you know what are the opportunities for change here to make this a sociology for people, and because it's an institutional ethnography. And I sort of thought. Well, a lot of people are already actively resisting in quite and small what I like to call bureaucratically cheeky ways, or through collective action, such as 3 trade unions, and I wanted to kind of document some of those strategies

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Órla Meadhbh Murray: to sort of showcase how monthly way people had to do things differently and hopefully in par front line workers to do audit and less stressful ways, or less punitive or burden some ways.

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Órla Meadhbh Murray: but in terms of the audit processes themselves. I I felt very uncomfortable about. Almost do I want to suggest reforms to these processes? Because really, when I got to the end of the Ph. D. I just thought

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Órla Meadhbh Murray: they're all fundamentally, you know, bad like they are at odds with good working and learning conditions, and take up so much time and stressful energy. And there's so much busy work around gaming audit processes instead of dealing with the underlying structural issues, or just doing your research and teaching that I was like, I don't actually think it would be helpful for me to suggest reforms or sort of policy changes except

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Órla Meadhbh Murray: to abolish them, which I don't think is going to be taken up any time soon in the sector. So I was trying to think about okay, well, what I do with this discomfort, and this is When I started thinking about like, well, what is audit actually, for what are we doing with this?

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Órla Meadhbh Murray: So as shore and right as a audit encourages the displacement of a system based on autonomy and trust to one based on visibility and coercive accountability. And I think this idea for being a form of coercive accountability was very interesting to me, because it made me begin to think about bureaucratic policing, and Michael poor, a prominent accountancy scholar, who writes on audit culture does explicitly refer to audit as a form of policing.

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Órla Meadhbh Murray: And then I was reading David Grabber's book, The Utopia of Rules, and he put it very interestingly, calling academics reluctant bureaucrats, and then slightly later, calling the police bureaucrats with weapons. And so I was thinking, well, you know, academic audit seems very far away from the violence of literal policing. But there are some interesting similar logics around, punitive and coercive forms of accountability that I wanted to think with.

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Órla Meadhbh Murray: And so then I started to think with feminist abolitionist work, particularly around non-reformist reforms. And I was learning about this, you know, from friends involved in prison and policing abolition work in Britain. And then, of course, you know, after the police murder of George Floyd in the United States, there was this massive increase in the amount of coverage of abolitionist activists and thinkers that was sort of seeping into my thinking. While I was trying to write about audit and universities. And so it sort of

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Órla Meadhbh Murray: became sort of apparent that, you know. Of course, I was going to start thinking with those approaches and use them as a sort of way to think about change beyond reform.

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Órla Meadhbh Murray: So this kind of provided a helpful way to think about, how could we change institutions. using non-reformist or abolishing type reforms. So that means changes that do not add improvement or legitimacy to the prevailing system. And this distinguishes between reforms that reproduce harmful systems versus those that push for system change.

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Órla Meadhbh Murray: So I was trying to think with this around audit culture and universities like, how do we take time and money away from more coercive or punitive audit processes, and redirect it back to the sort of actual, more positive sort of aims of these institutions around teaching and learning.

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Órla Meadhbh Murray: and

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Órla Meadhbh Murray: and then we'll sort of coming up with some suggestions that okay, what would non reformist reforms look like in Uk universities. And so, you know, these are some things, you know. I'm not the first person to say a lot of these things, but I thought I'll just put them out here, and what I'm thinking about it. And so basically, you know.

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Órla Meadhbh Murray: democratized universities. And so staff and students should, you know, not just have a voice or sort of surveys about what they think. They should be part of democratic decision making processes. And we're overpaid and attached. Senior management are not in charge, but maybe cons of the staff and students and all types of staff in the university.

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Órla Meadhbh Murray: And this, of course, requires you to trust frontline workers more and have sort of alternative accountability practices rather than punitive top dying approaches to perhaps using more transformative justice principles rather than mimicking kind of courts or legal processes to do with issues.

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Órla Meadhbh Murray: But of course, this requires much more time than any of us actually have, and which leads to number 3, that staff and students need more time that required, you know, secure funding to of security and manageable workloads.

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Órla Meadhbh Murray: And then, of course, to facilitate this, we have to think about, how do we fund this sector? And I think one of the things that became apparent from the research and audit that I was doing was that competitive funding mechanisms and league tables, you know, really are poisonous and produce this neoliberalizing and competitive market dynamic that that is just a nightmare. And it really doesn't work. So new student fees.

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Órla Meadhbh Murray: proper caps, and student numbers to stop the competitive hoarding of students on their fees by elite institutions, including my own, which really and perpetuates, you know, a real boom and boss cycle in the sector and local housing prices. Crises are massively increased because of the hoarding of students in some institutions and not others.

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Órla Meadhbh Murray: And then also thinking about like, why do we have competitive funding structures? Why should it not be more equitable so that everyone gets to do some research at some point, and we redirect all the time spent on successful brand applications into just doing research and teaching.

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Órla Meadhbh Murray: And then, lastly, this collective refusal of the legitimacy of things like rankings or blunt metrics, which are not accurate measures of research, quality, or impact, or how comparatively good universities, people, courses, research, outputs, etc. Are, but we often treat them as if they are accurate representations of that. And I think

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Órla Meadhbh Murray: in this there's some like need for complex ego dis entanglement from our emotional attachments as academics or people who work in universities like disentangling from these markers the so called success. And I think many of us, because the factors so bleak sort of hang on to these things because, there's there need something to hang on to. But I do think that we need to kind of disentangle ourselves from these.

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Órla Meadhbh Murray: But of course that's just audit. And once you start to think with abolition, you start to take a much more critical stance in relation to the University in general, so, as Harney and Moton pit it, one can only sneak into the university and see what one can to be in, but not off it.

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Órla Meadhbh Murray: And increasingly, there is this field of abolitionist University studies which questions the idea that universities are just nice positive institutions that are doing good things in the world, and instead, having, very, you know, deep decolonial critiques of universities and their colonial histories, and alongside their contemporary complicity in actual policing, in prisons, in bordering

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Órla Meadhbh Murray: you know, and in like Neil, Imperialist ventures in terms of satellite companies with Uk universities like predatory recruitment of students from the global size for massive fees, where they're often not really looked after properly when they come to university in the Uk, for instance, and and also things like in the Uk universities, are entangled and reassist everyday bordering practices, monitoring staff and students on visas to prevent on behalf

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Órla Meadhbh Murray: or having the prevent duty, which is a anti terrorism strategy that involves teachers reporting students at risk of radicalization that gets used in very racist and Islamophobic ways to basically taking seriously by universities are often very violent and discriminatory institutions that fundamentally reproduce elitism and inequality through the selective awarding of qualifications and the saddling of students with debt.

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Órla Meadhbh Murray: so yeah, so basically taking seriously this sort of complicity to varying degrees that we have in quite a lot of bad things in these institutions that are often seen as just an a priori kind of good.

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Órla Meadhbh Murray: And so where, if I leave me with institutional ethnography. I think there can be a reformist impulse often in, ie. Studies, including one that I felt in my own Phd. Project, where it can be difficult to analyse an institution or a process on its own terms, to understand how it really works.

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Órla Meadhbh Murray: but still retain this critical perspective beyond the institution and not get institutionally captured. And I think this is particularly difficult when you're an insider. And if you take the standpoint of frontline workers or professionals, and particularly if they are disproportionately privileged in terms of class, race, nationality, and citizenship, and sometimes gender and age. So I think we need to think carefully about whether or not our use of standpoint and research both tie actually reproduce structural inequalities in the research itself.

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Órla Meadhbh Murray: and then also think about, you know? Do we want to suggest straightforward reforms to processes? And if they are reproducing unequal and often violent institutions, or can non reform its reforms, provide a way to think differently about that, whilst keeping in mind Utopian long term visions and pathways towards abolition, or something very different.

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Órla Meadhbh Murray: So because we are complicit in our reproduction of institutions like universities, we do have agency collectively to reproduce them differently. But maybe we should also try to end some of them because they're so fundamentally flawed.

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Órla Meadhbh Murray: So I'll leave that there.

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Thank you so much, Ola. And that resonated, I think, with a lot of people sitting in this room and across context. thank you. And so our next speakers are in person. so that is Sue Adams and Josephine Davies.

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who will be speaking about institutional processes in colonising practices, indigenous nurse, practitioner, workforce development. So you're very welcome to come up.

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 can you refresh them? Oh, yeah. So what we'll do is

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Yeah. we will

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share screen.

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Yeah.

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send them. We just

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yeah.

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Yes, perfect. That's good. Great, thank you.

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Kyotata, Iternai, Kanoi, Takumi.

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Notira, Tinaakoto Tinaakota, Tinaakota.

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co Hekranita mana Gawaii had a kikiti.

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call Natty not tokimata photo tiwaka

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called Natiko paki tehapo kumar pohiti away

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for josephine David to go in. Well.

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so I've just acknowledged those who have passed

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people of the land that we stand on and you in the room today

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I've stated my place where I come from, based on where my fauna and my 2 P. Now my auntie's just come from an altar.

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I work for the University of Auckland, and I co-lead a nurse practitioner and an enrolledness workforce program alongside my colleague

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Noreet, in a Kita

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more in a

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 for Godening Surrey to Fenwatupu

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and I,

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Koparoo Bay, Eroto to to Tokara, Toko, Kayena in I, and a

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Brahma, Adams, or Kufano Kogukunu Hepukanga matua eroto Itikura nihi o ii- Papatoma

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because sue Adams a whole, not ever

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Tenakoto, tenacoto.

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Tato, Katoa

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And and just. That's my mimic Mimi. I came from

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England nearly 20 years ago. and I've now been working in New Zealand since that time.

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and I am a senior lecturer in the School of Nursing at the University of Auckland. I'd like to just very briefly, also acknowledge our colleagues in the Uk. Going through the strife they're going through.

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and to say that New Zealand is undergoing some pretty serious strife to. So our colleagues at Victoria University

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of 8 senior lecturers, 5, are going to be losing their jobs. They've been told that, but they haven't told them and hold who the same will be happening at a target. We think Massey again, aut, but has been through a structure. And currently we we are fingers crossed at University of Auckland. So across the globe it sounds like there's been a real

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challenge to Academia. So

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thoughts are with you on that So I'm co-leader of the program with Josephine. And just to very, very briefly introduce our colleagues, Coral, Weopol.

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and Ebony Komenei and Lisa Sami and So our we team has me as pakihat toiwi. So you're a white European non Maori.

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Alongside our 4 team members are for absolutely fabulous. Joaquin amori, nurses and academics, and that is a real powerhouse that we are understanding. However, what we're presenting today is where we are getting stuck

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and looking forward actually to asking

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some some, you know, some feedback on where we are going.

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So down inside the contract. So just just in brief

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And and I'll come to my doctoral study and a little bit more about my entrance into all of this. But, in brief, Josephine and I are co-leaders of a national nurse, practitioner workforce program, actually and enrolled nurses.

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there is our beehive which houses our our parliamentarians. And

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and there's another huge building just a bit further up the road, which is the Ministry of Health, which has

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thousands of workers in there at the moment, because we're going through health reforms, and in order to do successful health reforms, it seems, according to the

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according to the spiel, that you need to bring in so many people from the front line and put them in the ministry, and then they all run around, creating what seems to be a level of chaos, and not a lot seems to be happening.

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So so so that that's the ministry up the road. We've got a contract, and that is our

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the problem are. And and that's where we're stuck. Then there's that there's us and our team, and then in the the bottom is a a Moray, and this is a marine we've got.

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I'm not sure

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nurses. But this, this is our communities that we are trying to serve both in terms of health workforce and also the population.

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So Just in brief, nurse practitioners in New Zealand have a full scope of practice. They practice in an equivalent way to general practitioners, but of course, we believe they bring their nurses, the nursing paradigm, and a strong social justice paradigm. So that's sort of embedded in in our work

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in terms of numbers. We're seeing rapid increases in the numbers of nurse practitioners.

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At the bottom the bottom slide is life expectancy. So this is the inequity space of Maureen Nomori

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with. We're still at about a 10 year life expectancy, expectancy, gap for those born. Now.

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that would be the expectation. And in some areas of

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Alter Row and New Zealand that gap is is even bigger 14 years. So that's that's grounds us every day that grounds us. The top right hand slide shows the ethnicity of our nurse practitioners compared to our population. So you can see European Pakiha.

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In fact, it's 79% of all our nurse practitioners of the 700 oddness practitioners are European, Pakistan.

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8%, 8, 9% to Maori, compared to a 17% population and Pacific just under 2% Mps compared to a 9%

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population of pacific people.

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So so we're seeing that page is are the injustices that we are wanting to try and solve

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in part through our contract.

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My! my doctorate, is there? Is this a fricking singing at the top? Isn't that? How do we move the belly?

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He?

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Oh, yeah, do we want to keep the

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you want to get rid of that? And

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so who?

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Because we didn't have that

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fighting, mating. And

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okay, really, yeah, thanks so much. No, no, thank you.

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There we go. Thank you. So my doctorate was about the establishment of nurse practitioners in rural primary health care.

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but as a a researcher was, was not explicitly looking at Maori, and this was the scaffold map. So this came from Laura Clone did lots of work on scaffolding, and most of which she hasn't published apart from her. Phd. But it's a lovely way of looking at all the the work processes involved in becoming a Np. From a registered nurse.

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and each stage of it. So I mapped each stage of those processes to become a nurse practitioner, each one of those places has a huge amount of work process involved for

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for those registered nurses moving towards a masters and then gaining their registration to be a nurse practitioner, and it takes a minimum of 4 years, usually 4 and a half years

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a minimum, and many of our our most practitioner colleagues have been on that pathway for 1015 years.

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So that's the basis of this. Now we are now moving on.

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Where is my.

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that's fine. So we, what we're now focusing on is particularly to address those inequities through our work.

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And so I'm going to hand over to Josephine. So we're taking the knowledge that we've been building up. We're taking

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our knowledge and lived experiences of being in the field. I was a Wannabe nurse practitioner, which was how I got into this whole area, and I've now been 15 years in in alterairoa fighting funerals, practitioners. Josephine is a nurse practitioner, and a Maori nurse practitioner as well as now moving into the research field. So I'm going to hand over to Josephine just to talk about how we.

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how we really

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support Maori are ends because we need more Mps. If we're going to achieve social justice.

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Is it

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so? pudako? So Piraco is our word in Ted Almadi for storytelling or stories. Yeah. And in Ti almadi.

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It is an oral language. It's not a written language it is now, obviously, but it never was a written language. And so all our traditions, all our practices, or our ways of being, have always been handed down orally.

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And there's a big resurgent now to looking at Piraco and unpicking that, and and taking the lessons from our tupona, from our ancestors through into our contemporary lives today.

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So I'm just going to share some of the pool that we have from within our program. And in recent times.

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so as part of our program, we've set up co-governance. And it was really important to us that our program was based on a tertiary principles, you know, tiddity or white honey in New Zealand as our founding document. And it's

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it's

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it's a document that sets out the way of behavior between us and Toe Ewi, so be reminded us, was a document written and signed in 1840,

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and at the time it was a document that was written and signed because of the lawlessness and the bad behaviors of people coming to New Zealand and the impacts that was having on the indigenous people

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so co-governance very important. So we have equal representation, Marty, non-marty on our code governance and alco governance. Now, in recent times, when I say recent times over the last 18 months there has been a subtle shift with an alco-governance, and that with the health reforms and changing in

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our contracting and our funding people. There has been this kind of expectation that they can overall

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the decisions that the governance

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has made, you know. So it's a bit of power and control trying to be exerted within the Space

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comfort, 19 up, there is an impact that has has really made

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negative.

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It has been negative negatively impacted our mighty nurses. Many of our not-minded nurses responded and were on the front lines of supporting Farno and harpering families and communities with Covid. So we have got a roughly in New Zealand. Our mighty nursing workforce is about 8 out of 70 or 1,000. So

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out mighty nuisance

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well at the front line early.

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and they remain at the front line now, so what has happened as almighty nurses that we had on pathways towards nurse, practitioner, academic pathways and clinical pathways have been impacted and that their studies have been delayed

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so they either couldn't get away, or actually they were locked out of where their study institutions were, or they didn't have the access to the online resourcing to allow them to participate.

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Marty, are into Np meaningful support. So you know, as Sue mentioned, I'm I'm a nurse practitioner. I work with a team of 3 other Maori Rn. I engage a lot with Maori Arians and nurse practitioners nationally.

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and so I get told what are the challenges? What are the barriers? What are hindrances for them. So things like Almighty, a Marty worldview is living collectively, operating collectively. It's not an individual focus.

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So when you operate collectively, you know, you. You have final commitments. You have community commitments. You often have tribal commitments. So that impacts on whether you have the resourcing to enable you to participate in in what is required to become a nurse practitioner. It means that sometimes your car, you don't have the

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the finances to put petrol in your car to get to your academic institution just 3 h away, and it's a 2 day block cost. But you can't afford the petrol, or, if you can afford the petrol. You can't afford the accommodation. So you're travelling. So you can imagine what the impact that has on Alfano. And who are doing this?

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Okay, we we know, you know, at the end of all this study, when you're finally ready to go to nursing council, it costs $1,500.

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$1,500 is a lot of money to. To most of us it's an extreme lot of money to someone who is the the main income earner and their family. So we know that our news practitioners are delaying, going to nursing council, or they're saving for months and months a month, stressing about. Am I going to be able to get this? Because not only do they carry their own.

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a desire to succeed, they carry the weight of their community with them.

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Devaluing of nurses, knowledge and devalling of indigenous, indigenous knowledge. This goes back a bit to that meaningful support, but a lot to that government governance

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power and control changes that are that are trying to be forced on us

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and then

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into professional power and control. scope challenges. So in New Zealand our medical colleagues are very resistant to news practitioners.

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that's a very broad statement. So recent. Earlier this year, a certain medical group decided that they would issue a statement around the scope of nurse practitioners. No news practitioners were involved, and it was very paternalistic.

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Obviously there was push back. But you know, there's this, there's a sense that that's okay. They can still do that. That's all right.

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So you know we've had. We've had we've had. We're in the middle of a health reforms within Ayoti or so. We no longer have district health boards. We have to fatu order regions. So we've

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how many, how many dhs did we have? 20 odd Dhb's? And I think now we've got 5 Tifa, 2 order regions, so you can imagine they're big. So what has happened is that we have got work forces that set and one

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big entity who' just basically rolled their chairs across, but not even across the corridor. They've turned around in their chairs, and they are now employed by a new entity, and expected to

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oh.

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work differently.

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with no idea of what working differently means.

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So we don't have any collective prioritization of marty workforce development. And not only is there no prioritization, there's no accountability for that so for years and years, and I'll t it, or P. Has been this rhetoric of we will increase our mightiness in workforce. We haven't 2030 years we haven't. We remained really static.

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And that's okay, because there's no accountability for that.

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 our focus of our nursing leadership that hold the funding is on our secondary and tertiary sectors. Primary health care is our preventative, proactive workforce is very much the poor cousins.

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we

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we've got racist contracting. We we face racist contracting with the agreement that we work under. But our our health providers in our rural and indigenous settings, face, you know, multiple multiple hundreds of contracts, all racist and all siloed.

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Yeah, and that no nurse, practitioner workforce development.

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So I've mentioned to Tidt, you know. we've got a white on your tribunal in alter, or it's a

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It's an it's an agency that

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collectives can make claims to on breaches on to breaches of Titidi or White hanging.

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So

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we had early.

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So 2019 are

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y. 2, 5, 7, 5 was released out of the waitanging tribunal, and out of that. It it acknowledged the failures of the health system in supporting well-being. For Marty

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it acknowledged the failures of increasing the Maori workforce not not particularly nursing, but workforce the mighty health workforce, and it made strong recommendation that there needed to be the establishment of a Maori health authority

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which has happened just why we now have the health reforms.

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So that's in place talked about discriminatory contracting, which is at that higher level. We've talked about the same same people work in the same way, expecting different results, unequal resourcing. So you know, we we train our nurse practitioners in their final year of training

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roughly about 38, 38,000.

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And we know that our medical colleagues get

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5 times more than that, you know. Per person.

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Okay, there's no. We we currently don't have a national workforce development strategy.

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And obviously, if we don't have a strategy, we don't have a plan. And it's election year this year.

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So this is the environment and the constraints that we are working with them. and like. Just if I just go back

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to this

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developing of indigenous knowledge I've set in numerous meetings, but one of the meetings I sat in is, we developed this beautiful workforce pain that we have implemented, and I sat in this meeting. I was only Marty in this meeting, and I was told about this workforce plan.

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how well it's doing and how it's been implemented. I wasn't asked anything about that, although our team deliver it, designed it and delivered it. I wasn't even acknowledged that I was in the room, and might have some clothes about that

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I've asked questions of. If we can't support our mighty nurses this way.

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how can we support them?

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And the person that I asked the question to White middle Class. What woman told me that she would go and ask her colleague, her other white middle class woman what the whats and solutions would be.

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So that I'm just painting these pictures

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so that you can see the climate that we are.

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Yeah. very briefly talk about.

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Rob Campbell, who was the chair of Tfatura.

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and Rob was sacked just in the last handful of months

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because he made a comment about he was challenging

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 the National Party's position on Co-governance.

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In other words, they didn't. Our right wing party did not have a you know, did not want co-governance, and so he stood up and mentioned about it, and he was sacked on those grounds because he was not supposed to have any political say as chair of of this organisation.

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but he feels he. He also was sack because he was making and endeavoring to make some real changes. within that organization. So, and is is publishing about this now. But this is almost our only source of textual data.

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of what robs us because we're not getting over. We can't access

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this this

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institution at the moment we've been warned about contacting the press. The press have told us that

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they can't access people in the ministry anymore. So the freedom of press. But you know the the freedom to access material and find out what is happening is enormous.

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We were. We made an inquiry where we? We spoke to the press, who asked us, and how how's your project going about supporting Maori R. Ends to Mps and said, Oh, no, didn't like that they wouldn't, they wouldn't accept that.

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And so the press raised an inquiry, and we were firmly told off

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by the ministry, by, you know, by by everybody, and not to not to be doing that.

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So there's a real silencing going on in the space at the moment, and we are being run by, as Josephine said, the people who were running the previous system that was failing, who just were up the the CEO of the Ceos of all the district health boards were just given positions in the new Health reform organization

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to do same old, same old.

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the nurse, who's the supposed head of our nursing workforce pipeline development was at one of the Dhb's that were the least progressive for

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nursing and nurse practitioners and entirely tertiary, some secondary but secondary tertiary focused.

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So so we we're moving very far away from from justice and equity. As far as we can see at the moment. Now, some of you will be familiar with Dorothy Smith's small, small hero.

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Diagram about, you know, from the standpoint and looking up to the ruling relations. And so we we're at this point of of trying to work out where we go next to get that that information and and knowledge. Really.

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we've got these incredibly powerful discourses

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sat near liberal new public management, biomedic and colonization racism.

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all very firmly, we're feeling, you know, very challenged across all those spaces.

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and just of in terms of to fat aura, which is the.

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So we got Ted to Akaf. Aora is the Maori health authority. This is a little blob little problem, and

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to fat Aura is is a huge organisation where all the money is now. So Akafi Aura is supposed to sign off on anything to to fatounce. So we've almost got a brown and white

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going on here and Takafi, or is supposed to sign out. However, they're tiny, whereas to fat Aura huge. So we've suddenly got this real mal distribution of resource.

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the regions don't know what they're doing, because they're just all in turmoil, and everybody is fighting and competing for their work. Our regulatory profession is finally possibly coming to the party in terms of developing a Maori committee.

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However, the terms of reference for that. So we're not sure if they're going to be a Tokenistic

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committee committee, or whether they are going to actually have any power in that space.

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 so that's sort of where we are at. And of course we keep going back to universal health coverage and social justice.

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But it's getting blocked all the way down. so I guess. And and this is this is our final slide.

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In many ways there is some great intent that seems to be written, but the extent to which that is rhetoric and the extent to which that is being enacted is.

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we're not sure to tidy sustainable development goals. health reform. The health reform. The

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Healthy Futures Act says all the right stuff. It was quite exciting, you know, we really were optimistic, hopeful, but actually the enactment.

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Well, it is not the enactment of that act, it is the implementation of something else by the same old.

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and we are stuck with this contract which is completely blocking our ability to really do the changes that we were wanting to change

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because they keep, say, Oh, it's not in the contract.

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Well, semantics it often is in the, you know it is in the contract. But no, these are the rules. This is what you've got to do. No, we don't agree with that. We're not having that. So at each step of the way we are being pushed back and particularly push back around mori workforce.

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so that's where we are and and we we've got some little pieces of research. But I guess some of the questions is.

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when you've got those same people stuck in the places with the same frame of mind. How do we move that on? How can how can we, as institutional ethnographers, help to shift

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the mindset of of people.

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and that's that's where we'll end with that.

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Fiona.

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Thank you both for such a powerful talk, and I believe we have.

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one more. But I'm not sure she's here. Jess, are you online

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consensus?

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No.

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because I don't just come up with this one. Yeah.

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in the Uk.

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So in that case, how do I bring the? I will stop share screen. And I will just go to the, I should be fine.

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Yeah, is everyone okay with the moment you're all massive on the screen. But I hope that's okay.

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Now, I can maybe put you.

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Should we put you in a gallery. It's slightly less intimidating. And then I

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how do you hide the non? so we've got quite a while for conversation. so thank you again to all our speakers. I think of some really nice

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connections across what you're all saying. so I was thinking about time, as some of the kind of themes that kept kept coming up and around time. How long it takes to train to become a nurse practitioner, and the barriers that are in place, that to do that.

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the the time it might take to do abil in it, abolitionist or non-reformist work, that all I was talking about and the time it takes, and that where that becomes an obstacle for witness to practice hearings.

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and that Gemma and Francesca were talking about and also the the kind of the resources that you need to persist and to resist right, and how that these resources are unevenly distributed across different people. but also the the kind of the potentials and the future focus. I think that we heard in a couple of the talks about okay, how do we? How do we collectively kind of move forward and use our institutional ethnography to

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to advance? yeah, news forms of knowledge, but also material kind of benefits people. So I want to open up to any kind of reflections or questions that people might have and invite. those online as well. If you would like to jump in, and I don't know if Josephine, and so do you want to sit up here or do? Are you happy where you are. That's that's fine. We might need to come to the microphone if anyone in the room has got a question just so that everyone online can hear.

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However, yeah.

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any kind of initial reflections.

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Firstly, thanks very much to all of the presenters. And the last session, I think, will resonate very much with what Janine and I will be talking about on Saturday, which is

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the problems of doing I in circumstances. Now, where you can't get behind certain barriers. So we'll be talking about Pwc, and they role in disability funding in schools in Australia very much the same. You can't talk to people. You can't access any texts. just to red. But, as as you've said, and

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you know, the reflection on everyday Utopia really resonates is what I love that idea of abolitionism. But.

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on the other hand, you know, I'm sure, for you, your community. It's important that those nurses are working with community, and for us teachers want to be ensuring funding for students with disabilities. So

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how? How do you actually research, how do you do? I. E. When you can't access text, and you can't access people.

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and you still need to work within the system to a certain extent to protect vulnerable population. So I guess it's just a reflection that we're at the same point you are that we don't know what the way for, what is for I in the the current policy circumstances. So thank you so much for your presentations. Maybe someone else has got great ideas for where i. E. Can go next.

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Thank you so much. It's you what, Jason, did you? You want to respond to that or

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anyone on line?

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Yeah, sorry.

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we yeah, exactly the same same questions of how do we? Because ultimately we want to make change institutional ethnography. is firmly based within an activist approach. It's it's about explicating what's happening.

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showing what is happening, and then advocating and

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recommended, and change, and all this change, of course, love it. because I feel the same sort of change for yes, abolishing in some ways we've got a our health system. And and one of the problems with with many of our systems and and within our neoliberal policy world is that it becomes each time we have a reform it becomes increasingly more fragmented.

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and so we get more and more and more and more, and we get more and more groups and ideas and things that aren't quite happening. We get more and more policies.

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put into place.

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and so the world gets so complex and so complicated that actually, it's very hard for for people on the ground floor to navigate I'm thinking about you, you know also, in

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in a world of hospitals and policies, and the number of policies that nurses are expected to be guided by, and to know about, which, of course, paradoxically reduces

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safety.

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and so that, you know, leads back in some way to Gemma and Francesca's yeah.

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So so there's a lot of hiding in institutions at the moment. There's a lot of difficulty accessing what is going on, a lot of invisibility, and even us in our position cannot get visibility of of much of what is happening.

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And we're getting told. Oh, yeah, somebody's dealing with that. We're even getting told that a group is dealing with that. But our head of school of nursing, who sits on the group says, No, nothing's coming through.

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So yeah, it's where all this stuff is going. I was thinking when you were speaking about, like Ahmed, the non-performativity of Text. You know, they're having a text there to show that we've got the document, but it's thoroughly inaccessible. Unusable as yeah, as a way of organizing work.

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Does anybody else have any questions?

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Thank you for the question, Bella. I'll just read it out. Thanks for all the insightful presentations. I wonder how your understanding of, ie. Have evolved through the practice of doing it.

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Anyone have any kind of initial

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thoughts to that question. Thank you better for the question.

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I

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Órla Meadhbh Murray: I can speak of

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great thanks. All this.

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Órla Meadhbh Murray: No, no, don't you want to go first.

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Gemma Hughes: That's okay. I don't. I don't mind going first or second, or whatever I I was actually

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Gemma Hughes:  I I I I wanted to comment a little bit on the previous comment, if you like. And also all this presentation as well.

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Gemma Hughes: and I think just to reflect on our concerns that we've had from our research around. What? What we do next? what do we do with this? Yes, we've we. We think we've done some interesting

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Gemma Hughes: thinking. But we have really found that the

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Gemma Hughes: the hearings have been really quite

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Gemma Hughes: terrible. things, really, that that have been created and done.

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Gemma Hughes: and we're expected to produce some outputs from our research

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Gemma Hughes: that all it is it's expected to kind of somehow improve those processes.

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Gemma Hughes: And there's a really, you know, that we we? I certainly kind of go between. We want to tear it down to well, we could make things a little bit better, and then, if you make things a little bit better. We're not just complying and and condoning the the practices that we we think are really awful, and it's really hard to know ha! How to balance that. And we we we struggle with that. We talk about it quite a lot.

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Gemma Hughes:  but it's it's also been really interesting reading about it. Genesis, which is.

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Gemma Hughes: you know, this, this, this idea with the limits of medicine, which is a very I mean, it's written in the 1970. S. I think it's almost as old as me. but You know

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Gemma Hughes: it in it writes, and that, and I'll have to go back and we read it recently. and it writes about how we have to be really careful with the kind of he's not talking about institutional ethnography. He's talking about

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Gemma Hughes: thinking deeply around

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Gemma Hughes: medical practices, and he talks about the danger. And there's a lovely quotes. I wonder if I can find it? The danger of being co-opted where we end up oiling a care delivery with our goodwill. We're doing engineering research on simpler means that might produce higher rates of client perceived utility.

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Gemma Hughes: So this is. And I I kind of. I read that. And I think it's the preface to to recent addition of the limits of medicine, and it just made me go. Oh, God! Are we going to end up? Our research is going to be oiling the kind of wheels of not very good care because we've done this work. So

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Gemma Hughes: the the fitness to practice the hearings can continue the Regulators and say, Well, we did this work on the witness standpoint. And we we you know we we we've got some stories from witnesses, and we we heard it's terrible for them. So now we've done some training. We've made it a bit better. So there's that there's a real anxiety that by doing this, what you become complicit with the and and perpetuate the systems that you've you've kind of identified as being problematic. And I guess that's maybe that's one of the things I've I've one of my one of the ways in which my understanding of institute stephenography is

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developed through doing it, but also it. It does make me feel concerned about

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Gemma Hughes: what then happens with the the of our thinking and and of our

418
01:17:59.190 --> 01:18:06.040
Gemma Hughes: of what we've learned, and I mean, and again to go back to Ilich. He he sort of says, well, you know.

419
01:18:06.250 --> 01:18:19.549
Gemma Hughes: medicine is is harmful socially, culturally and clinically. but it's not for the medical professionals to to regulate themselves, which change. This is a. This requires political change from lay people.

420
01:18:19.590 --> 01:18:30.129
Gemma Hughes: and I think there's that there's that I think our role of of going in and and investigating the fitness to practice hearings as kind of ethnographers and outsiders.

421
01:18:30.480 --> 01:18:39.449
Gemma Hughes: but being funded to do it and working with the Regulators, we we become complicit as any. So far we can go. And actually, it needs a whole lot of other people to come in and and kind of test stuff down.

422
01:18:40.840 --> 01:18:45.509
Gemma Hughes: Sorry. That was a bit long-winded and a bit rambling.

423
01:18:45.920 --> 01:18:48.920
Or did you want to respond to that?

424
01:18:49.580 --> 01:18:59.379
Órla Meadhbh Murray: Yeah, I'm I'm making really like chaotic notes of all the things I'm thinking, which response to the questions and comments. And I think the thing that has come up

425
01:18:59.890 --> 01:19:14.299
Órla Meadhbh Murray: for me is this, the central question for me is like, who are we accountable to? And I think this is, I suppose, where we can like learn so much from like indigenous research methods and approaches, and and participatory research.

426
01:19:14.300 --> 01:19:36.499
Órla Meadhbh Murray: and where there is a political commitment to a community or a group or something and and a sort of ethical commitment beyond the institution of of Academia or the State, or whoever is paying us to do the research. And these expectations of outputs. And this idea of like coming back to being accountable to

427
01:19:36.500 --> 01:19:44.869
Órla Meadhbh Murray: to something that is more explicitly political and maybe more radical than we might. And then what we might end up doing? Because, you know.

428
01:19:44.910 --> 01:20:00.179
Órla Meadhbh Murray: we we we all have to be hypocrites to some extent, because we live in this at the sort of broken world. And and and there's something about How can I elbowite a bit of space and time, or some resources

429
01:20:00.530 --> 01:20:03.129
Órla Meadhbh Murray: for people with like

430
01:20:03.170 --> 01:20:25.820
Órla Meadhbh Murray: fear constraints, or less accounting for what is done with them. And that's that's why I really like the Harnie and Moton quote that I put up about, you know, stealing what you can, and being in, but not off the institution, and I think that sometimes that can look quite similar in terms of what is produced. You know a paper, some suggestions of changes, and whatever. But I think

431
01:20:25.970 --> 01:20:27.710
Órla Meadhbh Murray: there is something

432
01:20:28.080 --> 01:20:48.500
Órla Meadhbh Murray: there's something so still to find and silencing about institutional processes. But I think, maybe speaking to Bella's question, that we can get caught up in about like, who am I allowed to say this? Am I allowed to suggest that. Do I need to put this in place to make it proper? And I think for me trying to think about, like

433
01:20:49.050 --> 01:21:08.400
Órla Meadhbh Murray: you know, in academic papers, thinking about them, as you know, leaving breadcrumbs for the next person who might try and push it a bit further. We can write quite like free critique in those papers, and then we might write a more diplomatic thing and our policy discussions, or we might write something very

434
01:21:08.790 --> 01:21:16.380
Órla Meadhbh Murray: a cover, an intentional institutional capture to use Lauren East with very, very helpful, ie. Concept idea. And

435
01:21:16.810 --> 01:21:22.330
Órla Meadhbh Murray: you know, when we speak to the institution like with the the Health Ministry, and

436
01:21:22.390 --> 01:21:26.409
Órla Meadhbh Murray: or something like that. So so I think I think for me, I'm always trying to think about like.

437
01:21:26.530 --> 01:21:34.909
Órla Meadhbh Murray: you know, how can I avoid a bit of space, and and almost be like very suspicious of institutions, and have quite a bad faith engagement with them.

438
01:21:35.040 --> 01:21:55.909
Órla Meadhbh Murray: I like to have a good pay engagement with people, but quite a bad communication with institutions, and say, I will play your game. But then I will try to do this in in in accordance with my like political and ethical beliefs, and forgive myself that that isn't perfect, because, you know, it's all shit kind of thing. So I think those those are one

439
01:21:59.750 --> 01:22:01.529
that was great. Thank you. All that.

440
01:22:04.310 --> 01:22:07.839
And does anybody else have any kind of reflections?

441
01:22:08.470 --> 01:22:09.210
Yes.

442
01:22:12.650 --> 01:22:19.230
no. I just wanted to say thank you all for that, because that's something I think we all struggle with in there.

443
01:22:19.390 --> 01:22:29.700
We all take up institutional ethnography because of the emancipatory potential. And so we're using it deliberately to achieve that outcome if we can.

444
01:22:30.250 --> 01:22:40.349
we all have to compromise to some degree. We've all found ourselves in the position of him to compromise to some degree. So what you just explained there about playing the game of the institution

445
01:22:40.450 --> 01:22:45.649
and still working on the Mahi of the people. And what you're trying to achieve.

446
01:22:45.730 --> 01:22:55.619
I mean that that stretches it out, and it makes it longer, and maybe a bit harder in all of those things. But still it comes down to what you can live with and what you can reconcile for yourself in terms of.

447
01:22:55.980 --> 01:23:05.450
I'm operating in 2 worlds deliberately, so that I can achieve something over here. Yeah. So thank you. That's probably the best articulation. I've heard of that conundrum.

448
01:23:05.860 --> 01:23:07.730
So yeah, I appreciate that. Thank you.

449
01:23:16.350 --> 01:23:19.120
I just used to it. My killer.

450
01:23:20.820 --> 01:23:32.560
that that's a keyword. Private conversation not so important. Thank you for 3 very wonderful presentations. I've been really beneficial. I'm trying to do some work with a Phd. Student at the moment

451
01:23:32.750 --> 01:23:40.299
where we contact all of Australia and all of New Zealand's University administrators to get the information we need.

452
01:23:40.510 --> 01:23:52.869
And we're applying an I. E. Lin. It's not to the project results we want, but to the process of rewriting a different paper about that difficulty. And although your point is, in fact, of course, that

453
01:23:53.080 --> 01:24:01.630
I it's not just what we do, but, as you say, relating outside, those are the ruling revisions in which we.

454
01:24:01.900 --> 01:24:04.290
he admitted that

455
01:24:04.520 --> 01:24:09.620
I want to make a specific comment to Jim as efficient about

456
01:24:09.680 --> 01:24:19.250
hydrogenic injustice. I wrote a book on professions in 2,019, and one of the late chapters was about the

457
01:24:19.940 --> 01:24:25.620
social work. I had used this word for fesogenesis. So all

458
01:24:25.700 --> 01:24:29.820
all the areas of expertise have this

459
01:24:30.420 --> 01:24:38.000
internal doing it wrong, not just the other. That wrong that's been done out there by the internal process of trying to perhaps create things

460
01:24:38.130 --> 01:24:40.880
I have done into titles, which, of course.

461
01:24:40.960 --> 01:24:51.540
a medical word that by atrogenesis means. So so I developed there quite a bit what was about an and sociological introduction to professions.

462
01:24:51.850 --> 01:24:53.500
and I'm sure

463
01:25:13.670 --> 01:25:25.640
I share your one day pain of I'm not getting paid. I've just been given 3 months of notice, so I I share the New Zealand experience at the moment of restructuring.

464
01:25:26.540 --> 01:25:46.420
So that book talked about our introduction to the sociology of professions. And there's a lot of work being done on that in the past, but I don't think always the contemporary understandings. and so I was trying to get at the student question that I was at first to a second paper today, talked about the dilemmas

465
01:25:46.450 --> 01:26:07.699
that come out of institutional processes that you know, and audit processes. So. I'm happy to You'll see me in the in the list of our participants. I'm happy to go in the detail of that. But thank you very much for the I. It's really beneficial. you really good quality, conversations.

466
01:26:08.180 --> 01:26:18.760
And I'm totally sympathetic to the thing that we get the insight, but that doesn't make the change. So thank you. I'll I'll get your details as well. The book and I can share that with our speakers as well.

467
01:26:19.290 --> 01:26:21.580
thanks to that contribution.

468
01:26:22.250 --> 01:26:24.279
any other comments in the room.

469
01:26:26.370 --> 01:26:27.090
Yes.

470
01:26:30.330 --> 01:26:41.619
thank you for the presentation that's really stimulating. I was struck by. I think it's the

471
01:26:41.970 --> 01:26:50.589
All Us. Presentation, whether the whether our I research is institutional, captured.

472
01:26:50.830 --> 01:27:04.780
and I do indigenous community. work! And I found that when I interviewed the frontline worker. They have the. They know how the system work, and they have some innovative weight

473
01:27:04.900 --> 01:27:15.740
to resist. The system! I want to give one example, that the the aged care in the indigenous community

474
01:27:16.130 --> 01:27:23.880
the workers are required to divided the activity. Whether this is a culture or this is health related.

475
01:27:24.030 --> 01:27:37.890
but actually, they are all integrated, and they hate that. Invasion of this division. So the worker decided that they they are going to write, feel the phone

476
01:27:38.010 --> 01:27:40.810
in indigenous language.

477
01:27:41.010 --> 01:27:58.860
so those auditing they cannot read, but they cannot challenge that. They they do that. So they tell each other. Let's do this together. So they have to learn our language and our culture in order to tell whether this is culture or this is health.

478
01:27:59.080 --> 01:28:06.069
So I would say, sometimes we researcher the way we look at change.

479
01:28:06.180 --> 01:28:35.069
outcome fine because we live in that system for such a long time. So if we interview or go to the field, there are. They are rare, but there are some something to that we can learn. So I I never thought of that. I always thought that. How can we kind of distort or ignore? And but the system's still there. But we never really, fundamentally challenge

480
01:28:35.070 --> 01:28:36.410
the system.

481
01:28:36.410 --> 01:28:42.650
So let's keep going and learn from our interviewees. Thank you.

482
01:28:43.240 --> 01:28:59.880
Thank you for that in division, and I think aye can help us remember and and see that sometimes that people are living their lives with so much knowledge and are already kind of resisting and organizing. So yeah, thank you for that. Common, did anybody online want to?

483
01:29:00.480 --> 01:29:01.880
And anything?

484
01:29:01.990 --> 01:29:04.149
Any other reflections in the room.

485
01:29:07.940 --> 01:29:09.790
Suzanne Vaughan: So I'm online.

486
01:29:10.870 --> 01:29:23.220
Suzanne Vaughan: I'm online, Suzanne. Okay? a couple of things, one with Jenna's material. I have. I guess her

487
01:29:23.460 --> 01:29:27.579
Suzanne Vaughan: co-person or a S. Not here now, anyway.

488
01:29:27.870 --> 01:29:33.709
Suzanne Vaughan: What if the things that your project reminded me of

489
01:29:33.760 --> 01:29:47.669
Suzanne Vaughan: was something that Eric Michaelowski and Colin Hastings has worked on in Canada, and that is the criminalization of

490
01:29:47.790 --> 01:29:55.889
Suzanne Vaughan: HIV, you know, identifying yourself as being HIV

491
01:29:56.170 --> 01:29:58.479
Suzanne Vaughan: and the criminalization.

492
01:29:58.700 --> 01:30:05.310
Suzanne Vaughan: And although I can't find this any more online. I used to talk about

493
01:30:05.430 --> 01:30:07.540
Suzanne Vaughan: the ways in which

494
01:30:07.640 --> 01:30:11.560
Suzanne Vaughan: different people and I have

495
01:30:11.620 --> 01:30:13.700
Suzanne Vaughan: taken their results

496
01:30:13.800 --> 01:30:20.749
Suzanne Vaughan: to various groups. and anyway, you might

497
01:30:22.030 --> 01:30:25.749
Suzanne Vaughan: in essence. What they did is that

498
01:30:26.070 --> 01:30:42.349
Suzanne Vaughan: judges a judge. I said, I don't know the Canadian  proper names. Let's just put it that way. Okay, but it is a a council of judges

499
01:30:42.410 --> 01:30:59.640
Suzanne Vaughan: in Canada that often, in fact, made judgments in criminalizing. you know, if you did not. And they passed sentences, and so they, in fact, wrote

500
01:30:59.770 --> 01:31:06.400
Suzanne Vaughan: a proposal to provide a kind of workshop

501
01:31:06.640 --> 01:31:07.800
Suzanne Vaughan: for

502
01:31:07.860 --> 01:31:15.440
Suzanne Vaughan: judges, and they delivered this material so that their findings to that they?

503
01:31:15.610 --> 01:31:21.939
Suzanne Vaughan: And so I was sort of thinking that those who are part of

504
01:31:22.200 --> 01:31:48.630
Suzanne Vaughan: that this council that you've talked about deciding about witness witnesses complaints and things like that that, in fact, your your findings couldn't that be provided to them? Not in paper form, but into face to face, workshop or presentation to them, or something like that.

505
01:31:48.680 --> 01:32:00.040
Suzanne Vaughan: And that is sort of a way in which you get at those, you know participants in these processes, that

506
01:32:00.350 --> 01:32:02.940
Suzanne Vaughan: although they thought about this

507
01:32:03.060 --> 01:32:08.390
Suzanne Vaughan: from your interviews they might be able to in that

508
01:32:08.440 --> 01:32:15.640
Suzanne Vaughan: talk about ways in which they may change this process.

509
01:32:16.300 --> 01:32:22.669
Suzanne Vaughan: Things like that. So that's that's one of the things that I wanted to bring up.

510
01:32:22.760 --> 01:32:24.870
Suzanne Vaughan: I also think that

511
01:32:25.980 --> 01:32:30.259
Suzanne Vaughan: in terms of I mean my own work.

512
01:32:30.940 --> 01:32:36.109
Suzanne Vaughan: my my published work is not in activism.

513
01:32:36.350 --> 01:32:42.530
Suzanne Vaughan: but I've worked with something called Arizona Bridge to independent women.

514
01:32:42.600 --> 01:32:56.379
Suzanne Vaughan: And so I've brought a lot of research that others have done. For example, my Campbell to this organization has been a volunteer and a participant.

515
01:32:56.520 --> 01:33:00.250
Suzanne Vaughan:  in this organization.

516
01:33:00.500 --> 01:33:13.129
Suzanne Vaughan: and we talked a lot about ways in which individual people apply for disability, and things like that can navigate.

517
01:33:13.230 --> 01:33:19.390
Suzanne Vaughan: What are the roadblocks? And so to kind of coach people

518
01:33:19.410 --> 01:33:43.800
Suzanne Vaughan: and have someone else go with them as they apply to this process, so that they, in fact, can qualify for disabilities. So I haven't done work in this area. I've only brought other people's, ie. Research to this organization that is comprised to people

519
01:33:43.880 --> 01:33:52.470
Suzanne Vaughan: that are both volunteers and people who work in the organization who guide people.

520
01:33:52.870 --> 01:33:54.110
Suzanne Vaughan: 2.

521
01:33:54.160 --> 01:33:57.759
Suzanne Vaughan: Yeah funding for

522
01:33:58.120 --> 01:34:01.430
Suzanne Vaughan: You have different resources, or.

523
01:34:01.580 --> 01:34:11.150
Suzanne Vaughan: provide people. some help in terms of navigating various state and Federal

524
01:34:11.379 --> 01:34:24.510
Suzanne Vaughan: different groups. So those are some of the things that you you could think about in terms of making change. It seems to me that

525
01:34:25.320 --> 01:34:30.629
Suzanne Vaughan: what you know our research results don't necessarily

526
01:34:31.120 --> 01:34:32.570
Suzanne Vaughan: resolved to

527
01:34:33.150 --> 01:34:39.840
Suzanne Vaughan: bringing about change. Okay, you have to get it in the hands of people.

528
01:34:39.940 --> 01:34:48.370
Suzanne Vaughan: And often it is best in these kind of face to face interactions of talking to them.

529
01:34:48.580 --> 01:34:50.870
Suzanne Vaughan:  and

530
01:34:51.000 --> 01:34:57.829
Suzanne Vaughan: not not just talking to them and telling that we are research results. But

531
01:34:57.920 --> 01:35:03.169
Suzanne Vaughan: you know, engaging them and trying to find solutions

532
01:35:03.480 --> 01:35:05.669
Suzanne Vaughan: from your findings

533
01:35:05.910 --> 01:35:11.919
Suzanne Vaughan: that that's my contact. It's called it, too.

534
01:35:13.120 --> 01:35:21.710
Thank you for that. And I think that really speaks to you. Know all those questions about you know. Who are we accountable to all? you raised your hand and do you want to respond?

535
01:35:22.309 --> 01:35:35.020
Órla Meadhbh Murray: And yeah, I had a I had a comment to the previous speaker in the room whose name I didn't catch, and then a question for Jama and and Francesca. but yeah, no, I I just, I really love the story of I.

536
01:35:35.129 --> 01:35:51.230
Órla Meadhbh Murray: yeah, he's in an indigenous language that you know people are not necessarily going to understand, like, I think that this is the embodies, but like cheekiness that I like to think about like bureaucratic cheekiness, but it made me think about

537
01:35:51.230 --> 01:36:14.039
Órla Meadhbh Murray: like I'm from Belfast, and there's There's an Irish language. Rap group called me Cap from Belfast here. Amazing! And they have a whole song about being arrested and speaking Irish and refusing to speak English, and sort of essentially like being like you have to get a translator. And I and I think it's just it's quite funny song, but I think there's something in

538
01:36:14.379 --> 01:36:19.860
Órla Meadhbh Murray: there's like a hopelessness and a bleakness to a lot of the research. Sometimes when you're looking at really

539
01:36:19.980 --> 01:36:21.759
Órla Meadhbh Murray: horrible at

540
01:36:21.940 --> 01:36:50.129
Órla Meadhbh Murray: systems that don't work or like what? just ven. And say, we're talking about up like there's, you know, no response for all of this, this not letting you in, and I think that, but like having a a silliness and a joyousness, and retaining that it is like really important. And anyway, that was just like a I thought, I feel like I'm sort of getting really into the like. It's like 10 past one in the morning, and I feel like I'm going to. But but the question I have for Gemma Francesca is

541
01:36:50.209 --> 01:37:06.690
Órla Meadhbh Murray: I I was interested in in this comment about the adversarial nature of these tribunals, and if that like, on the impact of that. But I was wondering also if there's something about the individualizing nature of the tribunal process, and like.

542
01:37:07.000 --> 01:37:24.230
Órla Meadhbh Murray: if if that excludes any space for structural critique, or if there is space for structural critique when it is sort of focused purely on individuals, and and maybe that also speaks to some of the discussions. from the presentation about nurse practitioners. And you know.

543
01:37:24.330 --> 01:37:28.789
Órla Meadhbh Murray: when it's by like individual processes of becoming a practitioner

544
01:37:29.180 --> 01:37:34.509
Órla Meadhbh Murray: like, does that stop discussions about structural racism? Or you know that? Yeah.

545
01:37:37.700 --> 01:37:46.019
Gemma Hughes: yeah, I mean, I can. I can try and answer that question. also feeling the 10 possible in the morning sensation, which is not usually

546
01:37:46.500 --> 01:37:47.680
Gemma Hughes: awake.

547
01:37:47.730 --> 01:37:52.330
Gemma Hughes: We're awake and sober at this time of night. But

548
01:37:52.690 --> 01:38:07.830
Gemma Hughes: so, and for serial justice. and I'm not an expert on this we've got a a legal scholar on our team, who? Who? Who guides us around some of this. but that's the description of the system that you have when you when you kind of it. It's the fair system of

549
01:38:08.060 --> 01:38:18.419
Gemma Hughes: someone says, makes an allegation about someone. That person has a right to defend themselves. And, as I think, Francesco explained in the presentation, the balance has to be

550
01:38:18.460 --> 01:38:27.179
Gemma Hughes: on in the fitness practice hearings. It has to be on the the regulator to prove that something happened, and not for the registrant to prove that something didn't happen.

551
01:38:27.800 --> 01:38:29.320
Gemma Hughes: So that is the

552
01:38:29.350 --> 01:38:33.460
Gemma Hughes: that is the system of justice, that

553
01:38:33.630 --> 01:38:36.999
Gemma Hughes: which leads to cross-examination that leads to that process of

554
01:38:37.160 --> 01:38:49.280
Gemma Hughes: systematically doubting, discrediting not only what somebody says who they are, and therefore what they say is not credited, but also their interpretation of what what has gone on.

555
01:38:49.560 --> 01:38:55.880
Gemma Hughes: and that is this system that is used. And

556
01:38:56.070 --> 01:39:07.250
Gemma Hughes: it's shaped our whole research program. So we've not been able to try and recruit people for interviews or do ethnography that involved following people prior to the hearing, because if they talk to us

557
01:39:07.470 --> 01:39:09.769
Gemma Hughes: about their experiences.

558
01:39:10.210 --> 01:39:19.250
Gemma Hughes: those those interviews that all that conversation could then be used as evidence in the hearing. We could be asked to go and and

559
01:39:19.280 --> 01:39:33.810
Gemma Hughes: say what was said to us, or or or share our interview transcripts, or whatever which we didn't want to do. And actually, that could change the course of events. if someone disclosed something to us in a research interview which actually they weren't planning to talk about in the hearing.

560
01:39:34.080 --> 01:39:47.879
Gemma Hughes: So that is the nature of the system. and it it cannot be changed, is the is is the You know the view of the Regulators and the view of the barristers who are obviously being paid to

561
01:39:48.170 --> 01:40:01.300
Gemma Hughes: do this work. And I think what's important is that we we reflect and we say, Well, these are choices that are made. We choose to deal with these problems through this adversarial process.

562
01:40:01.330 --> 01:40:14.430
Gemma Hughes: That is a choice. It's not an individual's choice, but that is, that is a that is a historical set of decisions that have arisen, and that's where we are now. So I think it's really important that we might not be able to tear it all down. But we are reflecting back and saying.

563
01:40:14.700 --> 01:40:29.120
Gemma Hughes: the work the witnesses have to do is created by this. These choices over time and those experiences, those quite damaging experiences, are created by the choices that we make, and by those of us that continue to kind of

564
01:40:29.190 --> 01:40:41.649
Gemma Hughes: allow them to continue to unfold in terms of the individual versus structural one. I think that's a that's a really interesting question. one of the very first observations. I did so before we were starting collecting data properly.

565
01:40:41.750 --> 01:40:45.299
Gemma Hughes: I did an observation of a social work,

566
01:40:45.530 --> 01:40:57.439
Gemma Hughes: fitness to practice hearing, and the kind of the defence of the registrant was. Look. This social worker was so overworked they had a ridiculous number of cases to deal with.

567
01:40:57.810 --> 01:41:07.989
Gemma Hughes: There was staff shortages, there were local staff, they had things going on their personal life. They weren't very well. There were other things going on. and that's why they did. They let their standards slip.

568
01:41:08.150 --> 01:41:19.879
Gemma Hughes: but that was not of any interest to the regulator because the regulator is interested in the individual practice. So any of that kind of

569
01:41:20.190 --> 01:41:40.500
Gemma Hughes: contextual stuff is not really relevant to the the panel making the decision as to whether or not stands have slipped. It sometimes has come in in terms of the It's talked about as as a a kind of a mitigating circumstance, or perhaps, when it comes to thinking about what sanctions should be applied.

570
01:41:40.500 --> 01:41:55.010
Gemma Hughes: then those kind of perhaps more structural issues might come into play. an and and a registrant might be expected to do. I don't know for the training or whatever, but it's it's very individualised. and it doesn't allow for a critique of the

571
01:41:55.120 --> 01:42:01.169
Gemma Hughes: overworks under funded under resourced services that people are having to operate within.

572
01:42:14.500 --> 01:42:20.140
Yes, thank you, Gemma, for that. And is this on? Can you hear that?

573
01:42:20.250 --> 01:42:24.240
You can either? It's soon again.

574
01:42:24.330 --> 01:42:38.399
So I was just yes, at that point about The the blame ultimately of the individual rather than any understanding of the organisational or institutional role in what is happening.

575
01:42:38.440 --> 01:42:44.819
 and my hunch is that that is getting worse and worse.

576
01:42:44.910 --> 01:42:52.239
and need to find somebody who's at fault for that incident. And it it took me back to

577
01:42:52.460 --> 01:42:55.310
one of those

578
01:42:56.800 --> 01:43:08.529
I can't remember the name where you have a really good look after a major event, and you analyze it institutionally. And there was a death in the Uk. And somebody got

579
01:43:08.750 --> 01:43:17.939
10 times the amount of an aesthetic drug or something, but they trace that back, and there were something like 150 points at which

580
01:43:17.980 --> 01:43:31.989
that one practice at the end could have been stopped, which included labeling of medication, storage of Medicare. You know there were just oodles of things that were at fault, and it seems, you know I'm really sad that

581
01:43:32.340 --> 01:43:49.970
that that so many individuals are blamed for an an incident where actually it's an organizational responsibility for that place. And then the other point is that because of this, this whole process.

582
01:43:49.980 --> 01:43:54.030
and this is a question that there seems to be a lack of

583
01:43:54.140 --> 01:44:01.729
a of interest when an adverse event happens to somebody that the the institutions sort of

584
01:44:01.890 --> 01:44:14.620
they don't want to engage in talking cases of risk of. You know you don't want to apologize, I don't want to. So the the opportunity for that sort of restorative relationship is also being removed from

585
01:44:14.860 --> 01:44:16.760
through this system.

586
01:44:20.550 --> 01:44:24.289
and we've just got a couple of minutes left for

587
01:44:25.350 --> 01:44:35.470
So, picking up on a couple of points that are circulating, one is Dorothy saying to us very clearly. Rachel and I were fortunate enough to go and spend a week with her in Toronto.

588
01:44:35.840 --> 01:44:50.399
and and we but she wasn't quite rapping us on the knuckles with the ruler, but it was close whenever we said institution. She's like, that's people people operate it, you know, and that's what I think. That's the point you were talking about all, or to and Gemma that

589
01:44:51.030 --> 01:44:57.439
it's a choice. People operate the system. People are complicit of the system, and therefore.

590
01:44:57.600 --> 01:45:12.519
you know they are either being served or not served by it, but it doesn't have arms, and it doesn't have agency of its own. It's being operated by the social by the people. So that's our only opportunity to really resist and rise up against this is to galvanize more people to do so.

591
01:45:13.230 --> 01:45:22.499
And the other thing I wanted to say is a little bit about this resistance from within. But I really love that translation. They're kind of indigenous languages.

592
01:45:22.680 --> 01:45:24.880
We resist just quietly. We're resisting

593
01:45:25.450 --> 01:45:33.129
what's happening in New Zealand, and you'll have the opportunity to hear us talk about this on Friday, and should you choose to come to your sessions.

594
01:45:33.180 --> 01:45:43.639
It is the most so. Staffing project in New Zealand. We wouldn't. We designed something to help? They're being more nervous at the you know, to keep patients safe.

595
01:45:43.950 --> 01:45:48.859
We have not achieved that. and rather than

596
01:45:49.610 --> 01:45:52.040
pitch right the risks of that.

597
01:45:52.200 --> 01:45:59.019
And one of the ways in which nurses form within our resisting is in their pleasure notes is that he's been in the

598
01:45:59.630 --> 01:46:03.380
that we got a stamp. Now that says the environment was

599
01:46:03.430 --> 01:46:08.890
orange will read as in it was all on fire. We were short staffed, it was hideous.

600
01:46:09.100 --> 01:46:13.320
and then they ride underneath. Care is being compromised. The cure is being missed

601
01:46:13.400 --> 01:46:14.580
so

602
01:46:14.670 --> 01:46:18.789
morally and professionally. Nurses are conflicted

603
01:46:18.940 --> 01:46:31.949
about the fact that they happen to write this and having to do this. But it's not to see it's the organization's failure to create an environment in which nurses can succeed and providing the care.

604
01:46:32.020 --> 01:46:36.019
And so it's the way. In the same way as this form. It's a way of saying.

605
01:46:36.030 --> 01:46:37.569
we went to after 6, 8,

606
01:46:37.580 --> 01:46:38.590
yeah.

607
01:46:39.560 --> 01:46:49.630
But again, we're no closer to solving the problem. We're just trying to find ways to

608
01:46:49.740 --> 01:46:53.710
to alert the fact that there are these.

609
01:46:54.330 --> 01:47:22.859
Thank you so much. we are coming to the end of the session. So I just want to say a big thank you to all the speakers, especially joining. One must be like half one. I don't know what time really ready for bed, or at least a drink, and everyone in the room. I think it's probably coffee time. So thank you again