Organising in the Care Sector-Calderdale Solidarity Federation

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An account of a workplace campaign in the social care sector, from Calderdale Solidarity Federation.

A member of our Local was recently involved in organising and industrial action within the social care sector.

They work for an individual with a personal budget – where a person who has care workers is given the money by Social Services for them or their family to employ their care workers directly. This method of commissioning services is very much the future of social care (“Personalisation”) and currently is highly unregulated. Issues for workers and people who use support include:

Cuts to individual budgets being much easier to make on review than cuts to block services, resulting in reduced hours and people not getting the support they should have.

Deskilling of care profession – employees in personal budgets do not need any training whatsoever and there is little oversight of who and how people are being employed.

Insecure working conditions with zero hours contracts and insecure working conditions abound and people employing workers are driven into this by lack of funds. The typical money awarded for a budget is often less than is really needed.

Because personalisation is basically the wild west of social care a variety of new, highly unstable companies and roles have grown up around helping people to manage their budgets (“brokerage management”), often taking large fees from budgets and with very, very minimal regulation by anyone of the work that is actually done.

The person who our member worked for had a personal budget managed and administered by their relative but they struggled with the workload and various issues e.g. lack of cover staff so a “brokerage management” company was paid relatively high fees to solve issues.

The brokerage managements approach was to appoint a “temporary” manager who quickly told staff she expected to be their permanent manager. The manager employed their friends as bank staff without interviewing them and granted them permanent hours taken from existing staff – to the point where one staff member had their hours cut in half. The manager introduced new contracts in which all staff were given less hours than they had previously worked, were to restart their probationary period despite many working for the person for years, and the manger threatened the team leader with the sack if they did not get other staff to comply with the contracts and harassed them constantly on a range of other issues to the point where they were struggling to sleep, had skin conditions caused by stress and were interviewing for other jobs.

Staff initially raised grievances individually, joined reformist unions who wouldn’t help because they hadn’t been members long enough, etc – they were dealt with by divide and rule by the manager and most considered quitting. The atmosphere was poisonous, dispirited and not good for the person being supported let alone the staff.

After a talk on workplace organising from the Manchester Local, our Local’s newest member introduced the idea of workplace organising in wildcat fashion. They held workplace meetings, decided on a set of objectives, including 1) to ensure contracts did not contain a probationary period and stated the correct number of hours, and, 2) to get rid of the manager.

They formulated a list of demands related to the contracts and the way staff were treated and took them as a united front to the manager. She responded by phoning the complainants up individually to try and sow discord and lie about different things that had happened. When staff held more meetings and stood firm she agreed to a group meeting with the person’s relative who held ultimate responsibility but did not want to be involved too closely. By lying and generally sweet talking the relative the meeting was commuted to staff having individual meetings which they were then told were performance reviews.

Staff responded by refusing to attend the meetings. Instead they contacted the relative and arranged a separate meeting where they raised a list 20 issues including serious concerns about the way the manager treated the person we worked for, this with the backing understanding that we were very close to walking out of employment en masse. At this point the relative seeing that staff were united in opposition, the duplicity of the manager and the seriousness of the issues sacked the brokerage management company and contracts were rewritten without the probationary period and with the correct number of hours. Both demands were achieved relatively quickly by organising, sticking together and not being intimidated.

A quick victory was achieved in an unregulated sector by organising and sticking together. The Calderdale Local member would like to thank Manchester Local for their help and clear advice.

Calderdale Solfed are interested in speaking to others in the Social Care sector about setting up a social care sector network to act in solidarity and discuss issues e.g. how to organise in the face of the massive cuts the sector is experiencing, how to organise with the people we work with so we can fight for better living and working conditions together rather than being divided into employees and employers.

What do we mean when we say “Syndicalism”?-The Sedge Wick

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What is Syndicalism?

The word syndicalism comes from the French word for an industrial or trade union. Put simply, syndicalism just means revolutionary unionism. Syndicalists are revolutionary socialists who believe that unions, rather than socialist parties or activist groups, are the driving force for social change.

All socialists and communists think that unions are important to some extent. Most socialists believe that workplace unions are useful because they let the workers protect themselves from being exploited by the bosses. If bosses try and cut pay or push up hours, for example, the union defends the workers with strikes and industrial action.

For most socialists, though, this is all the union is good for. Most socialists and communists believe that, while the unions can be useful in the short term, to make meaningful political changes a separate political party is needed outside of the workplace, to represent the workers in government. This can be a revolutionary party, like the Bolsheviks in the Russian revolution, or a parliamentary party, like the UK’s Labour party.

Syndicalists reject this. They see the separation between the workplace union and the political party as false. Instead,  they argue that if the union can fight for economic improvements in workers’ lives then it can also fight for social and political change.

How?

Socialists (including syndicalists) believe that capitalism exploits workers by making them work. Workers produce goods and services through the work they do. Because goods and services have value, the workers, by working, also produce wealth. But if the worker works for a boss, then it is the boss who gets the wealth, in the form of profit. The worker usually gets paid a wage instead, which is a small fraction of the overall profit made. The boss can do this because, under capitalism, the boss owns the factory, shop, office or other workplace where the goods and services are produced. Socialists believe that the workers should get all the money that they make through their labour, not just the small part which the boss pays them. To do this, the working class as a whole (all the waged workers in any society) need to take over the workplaces (called the ‘means of production’) and run them themselves, without bosses, sharing the wealth between them.

Different groups of socialists and communists have disagreed about the best way to do this. Marxist Leninists (the types of communists who took over Russia, China, Cuba, North Korea, and the other countries we usually think of as ‘communist’) believe that a communist party is needed to do this. Rather than the workers seizing the means of production themselves, Marxist Leninists use the Communist Party to take over the whole economy of a country, with the aim of distributing its wealth out to the whole county’s population. The result is usually a Government dictatorship in which the economy is strictly regulated. Syndicalists think this is the wrong strategy. Instead, syndicalists think the workers in each specific workplace should try and take control of that workplace themselves, and run it democratically, without a boss or manager. This is called Industrial Democracy or, more simply, Workers Control. Syndicalist workers aim to do this by using strikes and other forms of industrial action to challenge and undermine the boss’s control over the workplace. Crucially, syndicalists aim to do this without relying on governments or political parties to do it for them.  Workers in their places of work have a lot of power. Whether it be growing food, caring for the sick or designing computer programs, nothing in society gets done without waged workers being paid to do it. Why would the workers rely on outside organisations to beat the bosses when they have so much power themselves?

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What does a syndicalist union look like?

In the UK, when we think about unions, we tend to think about the big trade unions like Unite, Unison or the GMB. These are called ‘representative’ or ‘service’ unions. The members pay into the union, and when they need help, the union fights their corner for them.

Syndicalist unions work differently to this. A syndicalist union is an associational union rather than a representative one. In an associational union, the members, i.e. the workers in the workplace itself, are the union. There is no hierarchy or organisation above them that run their campaigns for them.  If ten workers decide to walk out of work one day, and not come back until they get a pay rise, then those ten workers are acting as a union. Whether the ‘official’ unions approved their action is not important.

This kind of strike action, where workers use their own initiative to organise a strike without involving outside agencies, is sometimes called a ‘wildcat’ strike. Wildcat strikes can seem difficult to organise, but it is worth remembering that most of famous strikes in UK history, from the General Strike of 1926 to the Miner’s Strike of 1984, actually began as wildcat strikes, with the representative unions only making the strike official well after it had already started.

Because of this, syndicalist unions can be very flexible and tend to vary in size, structure and composition depending on what sort of workplace they are in. Syndicalist unions are run democratically, from the ‘bottom up’, with as much power as possible being given to the workers themselves rather than to reps, stewards, or steering committees. There are lots of different ‘types’ of syndicalist unions, ranging from the ‘one big union’ of the IWW, which aims to organise all workers across the globe into one big, democratic union, to the loose, informal networks of activists and agitators favoured by some anarcho-syndicalists.

Revolution and the general strike

As we said, syndicalist unions are revolutionary. They are not just concerned with protecting the workers’ pay and conditions, but seek to bring down the whole capitalist system through revolution. Syndicalists believe that, rather than using revolutionary political parties to seize control of the government, the best way to bring about the revolution is through industrial action in the workplace. Specifically, they aim to do this using something called a revolutionary general strike. A general strike occurs when a large number of workers, across a range of different sectors and industries, go on strike at the same time. General strikes are very powerful political tools and have historically brought down governments and caused massive upheaval and social change. It was widespread union militancy which ousted Edward Heath’s Conservative government in 1974, for example.

Bringing down one government is not a revolution, though. A general strike becomes revolutionary when the striking workers seize control of their workplaces and begin to run them themselves, without bosses or the government. Worker’s control often happens organically during times of industrial unrest, simply as a point of common sense; workers realise that even during a strike, work still needs to be done, so rather than give up and hand control of the workplace back to the boss they simply begin doing the work themselves without the bosses. At various times in history, striking transport workers have delivered food to striking mine workers as a sign of solidarity, striking firemen have given lights and heaters to picket lines of office workers, and striking tram workers have given lifts to their fellow workers in other industries. Small scale acts of solidarity like this can sometimes escalate to much larger acts of industrial democracy. Sheila Cohen, in her study of the ’78/’79 general strike known as the Winter of Discontent, wrote that ‘within a short time, strike committees were deciding what moved in and out of many of the ports and factories… In some cases, strike committees controlled the public services of whole cities’

This is called dual power, when the bosses and managers haven’t been beaten yet but the workers are beginning to run their workplaces without them, based on solidarity and mutual support. Syndicalists believe these solidarity actions that arise during industrial unrest are not just important for practical reasons but are in fact the first actions in the revolution. If workers can run their workplaces themselves then there is no need for bosses. Without bosses, there will be no more capitalism. What’s more, if the workers are running their industries by giving their products and their labour to those who need it, not just to those who can afford it, then they are not only bringing down capitalism but building socialism.

The syndicalist revolution is not planned or staged; it arises spontaneously as individual industrial actions escalate into strikes, strikes become general strikes and general strikes become revolutionary. This can only happen under the right conditions; syndicalists see their role as building those conditions, organising their fellow workers into unions and preparing them for the revolution.

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What ‘went wrong’ with the winter of discontent? – Sheila Cohen

Great article by Sheila Cohen on class struggle and the revolutionary potential of the Winter of Discontent.

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Often portrayed as responsible for bringing down a Labour government and ‘letting in’ Thatcher’s Tories, the 1978-79 ‘Winter of Discontent’ remains a high point in the history of the class struggle in Britain.

 

The Winter of Discontent (WoD) has not had a good press – either from the right or, less predictably, from the left. The most recent diatribe against this historic wave of struggle comes in a relatively recent publication whose author claims that “The Winter of Discontent marked the democratisation of greed…It was like the spirit of the Blitz in reverse”. A former Labour minister’s comment on the WoD that “it was as though every separate group in the country had no feeling and no sense of community, but was simply out to get for itself what it could” is used to illustrate “the callous spirit which characterise[d] the disputes”.

This moralistic tone is sustained even by the openly revolutionary Paul Foot, who describes the strikes as “bloody-minded expressions of revenge and self-interest…”. The sense of sniffy distaste for what is seen as unacceptably “economistic” activity is reproduced in the argument by another left-wing writer, John Kelly, that “the strike wave [was] an example of an almost purely economistic and defensive militancy”. Poor old WoD; it just doesn’t come up to scratch.

So what could be the explanation of the Winter’s lasting fame, its sustained role as a symbol of everything that the ruling class loves to hate? Readers may remember photos of the notorious piles of rubbish used in Tory election posters of the 1990s; even today, the WoD is routinely invoked to raise a spectre of industrial struggle that must, of course, never again be seen. 1978-9 must have done something to rile the ruling class.

The Winter of Discontent was the longest and most comprehensive strike wave since 1926, with nearly 30 million working days lost embracing more than 4,500 industrial disputes. However, as suggested above, its analysis has always been riddled by mystifications and misconceptions. One such, very common, is that the WoD was a public sector strike – an assumption bolstered by the various urban near-myths of the dead being left unburied, rubbish piling up in the streets, etc. While these are not untrue, they are exaggerated – and in any case ignore the class basis for such supposedly “selfish” acts.

The focus on public sector workers also ignores the fact that this was originally a private sector strike wave. As such, the focus on action by relatively low-paid public sector workers draws attention away from the roots of the strike wave in the determination of the 1974-79 Labour government to restore “economic stability” on the backs of the whole working class through years of (initially) union-backed pay restraint. As shown below, it was this, and not the need to curb “trade union power”, which let in Thatcher.

By late 1978, British workers had already endured over four years of both voluntary and statutory incomes policy. Working-class incomes, which had risen in real terms during the late 1960s and early ’70s, began to see the beginning of the end of this improvement; statistics show that average earnings have never, despite ups and downs, returned to their peak levels in 1973.

What began the decline? The British labour movement’s devotion to corporatist approaches to combating the evils of capitalism, expressed in this case through the “Social Contract” introduced as part of Labour’s early 1974 election package. While the Contract, immediately and accurately rechristianed the “Social Con-Trick”, contained impressive reforms such as price curbs, pension increases and pro-trade union legislation (yes, that kind does exist) this was on offer from the first only in return for what was at first widely promoted as “voluntary” pay restraint.

It was hardly in accord with the times. Labour had come to office “in the wake of a tremendous wave of militant action…”: the new government could now “contain militancy only by running before it”. In part at least, the action expressed understandable outrage at the fact that Labour had inexplicably retained Heath’s “Phase Three” wage freeze, resentment over which triggered a wave of strikes by nurses, BBC staff, GE factory workers and many more.

It was not until that supreme architect of left social-democracy, Jack Jones, blessed the Social Contract with the sacrament of the flat-rate £6 limit, prompting a chorus of praise for “equality of sacrifice” from the likes of Tony Benn and Barbara Castle, that the gut-level militancy of the early Social Contract years turned into some semblance of acceptance. Trade unionists bit the bullet, accepted their £6 increase across the board, and gave class struggle a breathing space. For almost a year after August 1975, when the policy was introduced, workers withheld their power; strikes fell to their lowest levels in a decade.

It didn’t last, perhaps because the “reward” workers received for their year of sacrifice was to be – more pay restraint. When the government insisted on imposing a year-long 5% pay limit in mid 1976, the reaction was not long in coming. In early 1977 a strike by British Leyland toolmakers pointed to the increasing discontent of relatively “privileged” workers; not long afterwards, steel industry electricians, seafarers and Heathrow Airport workers were also on strike. The unrest was not unconnected to the fact that prices were now rising by 15 per cent and the purchasing power of the average worker had fallen by 7 per cent in the past two years.

By the autumn, firefighters and power workers were on strike, and a hysterical flood of headlines – ‘Callaghan Warns of Winter Strikes’; ‘Lights Stay Off’; ‘Blackout Threat to Kidney Patients’ – gave some indication of what was to come. The mass of workers had clearly been prepared to continue with some notion of ‘equality of sacrifice’ to aid the survival of a Labour government – but only as long as it seemed to make any sense. And after mid 1976, it clearly was not. By late 1976 and early 1977, working-class militancy had burst from its restraints in a resurgence of resistance, and a legacy of bitterness, which culminated in the 1978–79 ‘Winter of Discontent’.

The WoD, then, hardly fell out of a clear blue sky; rather, it was the culmination of a long series of strikes and struggles against drastic attacks on workers’ standards of living. Nor does its launch sustain the misconception that it was only weak and/or low-paid workers who took part. The first in the unbroken chain of disputes from late 1978 to mid 1979 was a 9-week strike over pay by Ford car workers which “drove a coach and horses” through Callaghan’s incomes policy with a 17% settlement. The “speedy and unprecedented degree of external support Ford workers received from the outset” was attributed by a convenor to widespread resentment of the pay policy.

The ‘Ford effect’ was felt in a wave of strikes. Workers at British Oxygen won an 8% rise in October; 26,000 bakery workers, novices to industrial action, walked out in November and gained 14%. By December, oil tanker drivers from Esso, Shell and Texaco had begun strikes and overtime bans, while in early 1979 lorry drivers used flying pickets to spread their strike throughout the country.

As the lorry drivers departed the industrial stage, however, on came the public sector workers in whose name the Winter of Discontent is normally commemorated. On 22 January a one-day strike brought out over a million public sector workers; from this time on a variety of groups began coming out on strike in pursuit of their own pay claims. School caretakers struck at the beginning of February, supported in many cases by teachers. Water workers broke through the pay code at the end of February with a 16% increase; on 23 February, civil service unions began national action for a substantial claim. The public workers’ struggle continued to stampede through almost every sector; picket lines appeared in front of hospitals, ambulance stations, refuse depots, schools, colleges and a host of other workplaces.

The media barrage is well-known, with “Rats on the Rampage” a typical comment. Yet rather than coming to the strikers’ defence against this ideological barrage, much of the labour movement leadership seemed equally horrified by the sight of uncollected rubbish and other reminders of their members’ indispensability. TUC leader Len Murray was ‘near to despair: this was not trade unionism, this was “syndicalism”. Yet stentorian condemnations did nothing to stem the quasi-revolutionary dynamic. Not only ‘syndicalism’, but elements of dual power began to characterize the dispute: ‘Within a short time strike committees were deciding what moved in and out of many of the ports and factories… In some cases strike committees controlled the public services of whole cities’ .

Thatcher herself records in her memoirs that ‘the Labour government had handed over the running of the country to local committees of trade unionists’; her fellow Tory James Prior complained that Britain was now being run by ‘little Soviets’ – local strike committees of lorry drivers, train drivers and other public sector groups beginning to come into the strike movement.

Paul Foot’s account affirms the dynamic: “I still recall a sense of wonder and admiration at the way in which the transport drivers of Hull took control of their industry and ran it…in the best interests of the community. The ability – and the yearning – for democratic control was there in abundance”.

As so often in disputes large and small, the action mobilised and built working-class participation and solidarity. Journalists reported that during their six-week strike “The impressive thing was how people who had never been on strike before manned the picket lines…they were totally at home with it, they accepted it. What comradeship there was!” FBU members turned up to the journalists’ picket lines with braziers, while pallets of fuel “fell out of the back” of a Royal Mail pantechnicon. Hardly the selfish sectionalism so disparaged by critics of the Winter.

Yet the outcome of this mobilisation, this solidarity, was not the triumph of the ‘little Soviets’, but victory for the emissaries of neo-liberalism. On 3 May 1979, Labour surrendered to Thatcher and all that she stood for.

This victory was by no means a foregone conclusion. During the election campaign itself, opinion polls varied sharply; two days before polling day, Labour was ahead 0.7 per cent.

Yet the Tories won by 7 per cent, more than enough to authorize Thatcher’s mission to destroy social democracy.

The conventional explanation for the loss was the electorate’s disgust with “trade union power” as symbolized in the industrial chaos of the Winter of Discontent. Yet the undoubted “unpopularity” of the strikes only accounted for about 1.5 to 2 per cent of the swing; the Tories’ policies on industrial relations were not even at the top of voters’ agendas. Nevertheless, almost the entire labour movement leadership took it for granted that it was “the unions” who had let in Thatcher. The question of what, or who, was lumped together in that formulation was not considered, any more than was the question of who held the “trade union power” she promised to vanquish.

There was indeed a form of power in the land during the Winter of Discontent – workers’ power. It was shown only embryonically, but it was based not on ‘greed’, not on the Satanic motives with which the press embellished their tales of evil, but on the usual reasons – attacks by capital on workers’ lives which go beyond the bounds of the tolerable. As one post-mortem pointed out, those who blamed Labour’s defeat on ‘union intransigence’ might be hard put to it to explain “what it was that turned the social contracting trade union saints of 1975-78 into the demonic fiends about whom we read in the Daily Mail of last winter”.

Those ‘demonic fiends’ did the only things that workers in struggle can do – they struck, they picketed, they stopped the movement of goods, they disrupted services. In that sense, these prosaic struggles of tanker drivers, gravediggers and dustmen also displayed the only power that workers can have; they withdrew their labour, with a force and to an extent that seriously challenged the organisation and structure of society. What they did not do was to display ‘trade union power’ in the monolithic, dictatorial way which the press, aided by politicians of right and left, sought to depict it.

Like all upsurges of struggle, the Winter of Discontent was raw, imperfect, lacking in ideal politics and strategy. Yet what its critics fail to recognise is that this is the character of grass-roots worker struggle in all its “spontaneous” and grassroots glory. The potential indisputably posed by such “economistic” activity – what are workers to struggle over, if not the price of their labour-power? – is that of a challenge to the capitalist class and state, as the rulers of that state undoubtedly recognised.

Originally published in The Commune.

What does a union mean to you? #2-New Syndicalist

New Syndicalist

What does a union mean to you? This is the question that we are posing to friends, workmates and fellow Wobblies in our new series. Traditionally, trade unions have an association with heavy industries, transport, the public sector and professions – mostly stable work with a degree of social recognition. The IWW has always run against this thinking, maintaining that not just these but all workers in every workplace should be united under “One Big Union”. This has been shown throughout its history by organising sectors of the working class who have been marginalised, ignored or excluded from other unions – migrant and itinerant labour, women, children, people of colour, queer and trans workers amongst others.

It is in this spirit that this new irregular series focuses on the experience of work that is located outside of traditional spaces, is organised informally or atypically, is poorly known or misunderstood. In…

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A Simple Guide to Avoid Receiving a Diagnosis of ‘Personality Disorder’-Recovery in the Bin

 

Taken from Recovery in the Bin https://recoveryinthebin.org/a-simple-guide-to-avoid-receiving-a-diagnosis-of-personality-disorder/

This is a leaflet based on a discussion on personality disorder diagnoses that we had on the Facebook group. Thanks to the wonderful Dolly Sen for her design.

The leaflet has been in Clinical Psychology Forum No 279, March 2016 , published by the British Psychology Society.

If you like this, you may be interested in our sister group: PD in the Bin https://recoveryinthebin.org/2016/02/25/pd-in-the-bin-facebook-group/ 

PD GuidePD Guide2PD Guide3PD Guide4

A simple guide to avoid receiving a diagnosis of ‘Personality”Disorder’.

Disclaimer: unfortunately our suggestions above are not foolproof and we’re not encouraging…

Recovery In The Bin (TM)

1) Try not to be female (for BPD).

2) Do not argue your point of view with the professionals.

3) You cannot be seen to like some staff members more than others (this is SPLITTING behaviour).

4) Do not under any circumstances harm yourself. (This will more than likely be seen as a) manipulative b) attention seeking c) a communication of your distress caused by your underlying PD).

5) Do not make statements, which can be interpreted as black and white thinking. For example, the nurses all hate me. Try instead to make unrealistic, robot like, rational statements such as ‘Enid, Mary, Silvia, John, Mark and Boteng have all shown epic disdain at my presence on the ward, but an agency nurse once smiled at me in 1992.’

6) Do not admire or pin any hope to a professional who appears to understand the social context of your distress (this is idealization, my dear).

7) Do not complain about anything. Ever.

8) Try to avoid working with professionals who look a bit tired. If they eventually go off sick you will inevitably be blamed for this. (Of course, because you are a difficult patient).

9) Things you can talk about: how medication is helping you, mood swings (BUT only extreme ones that last long enough to fit within a diagnosis of bipolar, that’s an ok one as Stephen Fry made it a bit edgy), Do talk about how much the system is helping you, be eternally grateful to every professional you meet, tip your hat slightly to the side and say the words ‘thanking you kindly for your ‘help sir’.

10) Things you should not talk about: Abuse – of any kind, patterns in your relationships because of this abuse, existential dilemmas, perceived flaws in the system or anything to do with individual staff members.

11) You never ever; over/under eat, drink, exercise, and are never impulsive with sex, shopping, driving and you LOVE being alone.

12) If you are from cultures seen as “traditional”, never say you even think about sex unless you are in a proper family approved heterosexual marriage.

13) To avoid BPD diagnosis you must not point out that the psychiatric teams are blaming you for their own inadequacies, their ‘externalised locus of control’ and ‘refusal to take responsibility’.

14) Do not tell the psychiatrist you think you may have PTSD. (Don’t be stupid now, everyone knows only soldiers can get this, are you a soldier?).

15) Try somehow not to be addicted to medication you are forced to take. Prepare yourself to be accused of lacking in coping skills when addiction inevitably does happen.

16) Talk with enthusiasm at the idea of being abandoned. Relish the idea whether it’s real and/or imagined.

17) If you attempt suicide make sure you are successful or it will be deemed attention seeking.

18) If you do by chance happen to self harm, make sure it is a life threatening, Stephen King style canyon of a gash, anything less than this will be clinically defined as ‘superficial’ adding to the likelihood of the PD label being applied.

19) BPD diagnosis is a mirror to professionals’ behavior, described as the personal characteristics of the service user.

20) Never phone the crisis team and say you’d like another visit (tick box dependency issues).

21) Hide any teddy bears or suchlike when they come round to visit (“too childish”).

22) Never refer to your psychiatrist’s affection for the DSM as ‘ideas of reference’…

23) When they suggest cutting back on support, appointments etc, pause and think and then say, “yes, that’s good, I feel I am ready to be more independent”.

24) Be attractive but not ‘coquettish’.

25) Do not at any point mention that you sometimes question who you are. You should know exactly who you are, be definite, unchanging about this (only people with PD ever question their identity

26) Do not change your hair colour too frequently. This will be interpreted as evidence of the above.

27) Always repeat when questioned that your attachment with your mother & father was always loving and supportive.

28) All depression, voice hearing and suicidality is ‘pseudo’ so please ensure the death certificate is recorded as ‘pseudo death’ and according to Joel Paris MD it was a ‘career’ so make sure your CV is updated posthumously.

29) Remember that inequality does not exist; it is your perception that is flawed.

30) Never, if you can manage it, express anger to MH professionals. Even when it’s understandable, genuine and valid!

31) The appropriate response following an OD to the question ‘how much did you take’ is ‘clearly not enough’. This is also likely to get you sectioned.

32) Never become a ‘skilled’ Service User. Understanding the games that nurses play will only get you described as ‘playing games’.

33) Your mental health team believes in its adequacy, despite all evidence. Do not do or say anything that threatens professionals’ fixed delusional beliefs, they may ‘decompensate’, becoming either coldly punitive and violent or weirdly smiley and dissociative, forcing you to have too much ‘service’ and then none at all.

34) Don’t ever ask a MH prof to ‘see you all the time and kiss your cuts better’ (as stated by a PD expert).

35) Act dumb as intelligence is viewed as a facet of PD (unlike psychosis where it’s assumed you’re less intelligent).

36) Failure to respond to medication or recover (or the CMHT needs to reduce numbers with discharges) means reclassification to PD.

Another Disclaimer: “You do not have the right to say anything without it being used against you. Anything you say can and will be used against you. You have the right to legal assistance. If you cannot afford legal assistance, you are buggered. Do you understand the rights I have just read to you? With these rights in mind, do you wish to engage in our therapeutic relationship?”

Critical articles:

http://fap.sagepub.com/content/15/4/483.extract

http://www.sistersinside.com.au/media/papermepstein.pdf

http://discursiveoftunbridgewells.blogspot.co.uk/…/bord…

http://pb.rcpsych.org/content/31/5/194.1

Shaw, C. & Proctor, G. (eds.) (2004) Women at the Margins: Special Issue on women and Borderline Personality Disorder. Asylum magazine 4(3).
Sulzer (2015) Does “difficult patient” status contribute to de facto demedicalization?

https://www.madinamerica.com/…/scarlet-label-close…/

http://www.haringey.gov.uk/equilibrium_magazine_issue_46…

page 23 ‘The most savage insult’  http://www.scie-socialcareonline.org.uk/…/a1CG0000000Gg…

Refs:

Between 3 and 4.07 mins “you want me to see you all the time and kiss your cuts >better”:https://www.youtube.com/watch?v=kasiSXppCVA

Joel Paris: Half in love with easeful death: https://drive.google.com/…/0B2o15rQwZLh7MlRjc2F…/view…

Linehan: https://www.nimh.nih.gov/news/media/2011/linehan.shtml For the research funding she had to choose between BPD and Major Depression as the named mental disorder – she chose BPD, the diagnosis was attached to fit the intervention for the funding. She wanted the most difficult & challenging patients. So who was in the control group?

http://www.rcpsych.ac.uk/pdf/Wilkinson%20Paul%20Sept14.pdf

Source: A simple guide to avoid receiving a diagnosis of ‘Personality Disorder’

Occupy and win: a manual for fighting hospital closures-London Health Emergency

A pamphlet produced in 1984 by London Health Emergency which is a guide for hospital workers on how – and why – to occupy hospitals to prevent their closure.

 

Contents
Why Occupy?
What is occupation
Will the workers get paid?
General Practitioners
Do you need to stay overnight?
The run-up to closure
Building a campaign
Spotlight on the DHAs
How do we actually occupy?
Unions
Declaring the hospital occupied
Who runs the occupation?
Management; should they stay or go?
Supporters
Press/Publicity
Relatives/Patients
Supporting strike action
The law
Is it all worth it?

Why occupy?
Hayes Cottage and Northwood and Pinner hospitals were both due to be closed on October 31 1983. They were occupied, and as a result they are now still open, with a temporary reprieve. Thornton View hospital in Bradford, occupied since last summer, now faces the imminent danger of a raid by District Health Authority bailiffs seeking to implement the order for closure issued by Health Minister Kenneth Clarke; but had it not been for the occupation, Thornton View would already long ago have closed down, and its geriatric patients bundled off to other hospitals.

One general rule stands out from the whole experience of fighting the health cuts: it is not certain that occupying a threatened hospital will keep it open, but it is certain that if you do not occupy, it will close. Hospital occupations are not new. In 1922 workers at the Radcliffe Hospital in Nottingham occupied! Since the late 1970s occupations have increasingly been used to defend the hospitals scheduled for closure. Workers who have taken part in occupations have learned valuable lessons about how to organise them and how to anticipate some of the problems which may arise. With the present round of financial cuts, hundreds of hospitals are faced with closure. Since August 1983 there have been three occupations in hospitals which are still open in 1984 and many campaigns have asked for information about how to organise them.

Every occupation is different, but there are things which are common to all occupations and that is what this pamphlet is about. Good early organisation can help to ensure that an occupation is strong within a short period of time and makes it much more difficult for management to move against it at the onset.

This is not a failsafe guide or a list of easy answers. It is a sharing of tactics and strategies, learned in long, hard and often bitter struggles. It may not answer all the questions which apply to your particular hospital. Every occupation throws up new problems, new questions and new answers, but it will provide a basic framework for you to follow.

What is an occupation?
An occupation means that workers in a threatened hospital take a decision to actively oppose the closure of the hospital by ensuring that patients and equipment are not moved out and by refusing to leave their jobs at the hospital.

The main area where control is taken is in the movement of patients. A hospital can only be closed if there are no patients in it. So the main goal of an occupation is to keep the patients it has, if it is a long stay hospital, and to ensure new admissions if it is an acute general or cottage hospital.

Will the workers get paid?
This is usually the first question which is asked. The answer is yes. As long as there are patients in a hospital, the Secretary of State is legally bound under the Health Services Act to ensure that they receive treatment, there must be workers; ancillary workers, nurses, doctors, technicians etc.

Hospital doctors and particularly consultants will rarely support an occupation. This should not be a decisive factor in deciding whether or not you should occupy.

The obligation to treat the patient means that even if the regular consultant resigns, a locum must be appointed as long as patients remain. Sometimes the consultants will be hostile and deliberately try to frighten workers and the public. If a consultant says, for example, that a hospital is ‘unsafe’, it is potentially very damaging. It is worthwhile checking your consultants’ commitments to private medicine, etc, as often they have a vested interest in a hospital closing — you can use the information in press statements to show why the consultant is not backing the occupation. Indeed the medical arguments are very often quite spurious; patient mortality during the St Benedicts occupation fell way below the national average, yet within six months of the end of the occupation 30% of the patients had died.

Despite their hostility and lack of concern it is important to try to keep a good relationship with the consultants. Keep them informed of what is going on and explain in detail what the occupation means.

Hounslow Hospital picket

General Practitioners
GPs are the doctors who feel the sharpest edge of the cuts. They sometimes spend endless time trying to find a bed for patients and then following them up after a too early discharge. They are often very sympathetic to any attempt to stop cuts and closures. Doctors are organised in several different ways but the more radical and militant GPs are usually in the Medical Practitioners Union which is part of ASTMS. GPs are particularly important to approach if you are fighting to save a general hospital or a cottage hospital. Involve them from the beginning and get them to refer as many patients as possible to the threatened hospital. They will often require much encouragement because they are often not used to explaining themselves or their opinions to the public.

Do you need to sleep in the hospital overnight?
Hospital occupations involve mainly women workers. (75% of health workers are women!) Women usually have heavy domestic commitments and need to know how long they will have to spend at the occupation. The second question normally asked is does an occupation mean that we all have to stay there overnight? The answer is no. In factory occupations, if all the workers go home as normal they would be locked out when they reappeared in the morning. This does not happen in a hospital occupation because there are still patients in the wards. But it is usually necessary to have someone involved with the occupation in the hospital overnight on a rota basis. (This question is discussed further under the ‘Organisation’ section)

The workers in the threatened occupied hospital continue to come in and work their normal shifts. They may of course feel under more pressure, especially in the beginning, simply because they are taking a form of industrial action which is very different, and it may be unclear to them exactly what will happen.

Occupations do put extra demands on the workers. There are extra meetings, pressure from the media for statements and interviews, extra time put in picketing, and dealing with management. Family life is often disrupted from its normal routine and it is important that people know this. But an occupation does not mean that all the workers need to stay in the hospital day and night until it is saved.
What happens in the run-up to closure?
Normally a threatened hospital is run down for a period either before closure — or, often, even before consultation on closure. At such a point the rundown has not been authorised by the District Health Authority, but is being done by an entirely unaccountable group of administrators and bureaucrats.

Over the last five years there has been an almost identical pattern of management preparations for closures. Ancillary and nursing staff who leave are not replaced. Ancillary vacancies are left unfilled to ensure that there are fewer workers left to fight in defence of the hospital. There may be more agency nurses than permanent nurses. Maintenance and repairs are not carried out, making it virtually impossible to get routine health and safety work done or replace obsolete equipment.

As a result, conditions for both patients and workers deteriorate. A steadily lower percentage of the hospital workers will feel committed to defending such a hospital, regarding its closure as inevitable. Some sections of workers may even be made vague promises of alternative posts in other hospitals, promises designed further to divide and confuse the workforce and weaken union resistance. Then, suddenly, the administrators announce that the hospital is becoming “unsafe”. Having deliberately created conditions to make the hospital unsafe, they then use this as a pretext to justify closing it down. These phase of “creeping cuts” is the insidious primary step towards closure. At each point it must be resisted.

COHSE, NUPE and NALGO all have policies of “no cover” for unfilled vacancies. Shop stewards should ensure that this policy is implemented. At St Mary’s, Harrow Rd, the domestics were told to clean floors, when they had never done it before. Management were preparing the rundown of the hospital, and did not want to hire new people. The domestics refused this additional job, and in so doing provided a focus for other workers in the hospital who wanted to oppose the closure.

Building a campaign
Health and safety committees are particularly important — at the South London Hospital the Health and Safety committee forced management to make major repairs that they were hoping to leave and use later as fuel for their arguments about the hospital being in a “run down” condition.

As soon as the word leaks out that a hospital is threatened (there are dozens in London alone) the workers and local community must organise. It takes time for the implications of closure to sink in. Most workers, although they are aware that other hospitals have been closed, think it can never happen to their hospital. But all health service facilities are threatened by the Tory cutbacks: to think that if another hospital in your District closes yours will be OK is disastrous. In Wandsworth, five hospitals have closed since 1978, and now the South London is earmarked for closure. Management use the fear of closure and the false hope of saving one place at the expense of another to try to pit worker against worker.

All work necessary to close hospitals should be blacked by the unions. Stewards should oppose three and six-month contracts which make it easier to assimilate people from the hospital about to be closed. Usually a District will only issue “temporary” contracts for a whole year’s run-up to closure. So, new staff are effectively sacked in order that workers from the closing hospital can be “slotted in”.

The whole process undermines trade union activity and militancy and makes some workers wary of even joining a union in case they jeopardise the renewal of their contract. Workers in the threatened hospital must refuse even to discuss alternative employment with management. They should ignore any letters or demands that they get from supervisors telling them to attend meetings (usually on their own) to have preliminary discussions.

Health Service managers are now experienced in the techniques of closing hospitals. They try to do it quickly and quietly through administrative measures and intimidation. They do not like well-organised campaigns with experienced people who know their tactics.


Hounslow occupation evicted

Building up support
The must successful fightbacks — EGA, St Benedicts, Longworth (Oxfordshire) and St Mary’s — have involved workers and supporters meeting together either weekly or fortnightly. Meeting in the hospital is best, because the workers will see people coming in every week to sup port them and the supporters will feel part of the hospital (and know its layout).

It may seem too frequent at first; but managers work very quickly, and things can change on a daily basis. There is no need to ask for permission for these meetings; management will almost certainly refuse. Just pick a room and have the meetings. It is unlikely that administrators will make an issue of it as they do not want to provoke action early on.

A public profile is essential. Everyone in the community should know that their hospital is threatened. Leaflets, posters, petitions, pickets and demonstrations are all good for attracting interest. Workers who are a bit frightened about fighting management and are not sure about the levels of support they will get can be bolstered by seeing a large demonstration or a lot of people turning up to picket outside the hospital.

It is important to challenge management at every step of the campaign. The administrators and consultants will constantly be putting out statements about the terrible financial conditions, weeping crocodile tears that they have to close the hospital, and claiming that they really have no choice since there is no money available.

Workers should be reminded that in 1982 health workers were given the same arguments about why we could only have a 4% increase in pay. There was “no money” then; but suddenly billions were found for the Falklands War, and extra money was handed to the judges and the police. Money is available but the Tories refuse to spend it on health.

Spotlight on the DHAs
Health Authorities are weighted in favour of the wealthy and the ruling class; Norman Fowler, who appoints them, sees to that. However in several Districts in London there remains a real possibility of DHAs taking a stand against cuts if only the Labour Party representatives on the DHAs would vote against. Labour Party activists should get their General Management Committees to adopt a position that members of the Party who sit on health authorities must oppose cuts, closures and privatisation. Health workers who fight the cuts will be putting their jobs on the line. Any industrial action is likely to bring them up against the Tory anti-union laws. Workers will be fighting management, often the police, and even some trade union leaders reluctant to take a stand. Workers face possible fines and imprisonment for strike action and picketing. The very least Labour Party and trade union members on health authorities could do is argue and vote against closure. Yet at meeting after meeting we have heard some of them saying that they must stick within the Tory cash limits (because Norman Fowler says so); and therefore they must make the cuts. This is a scandalous argument. Let the Tories try to make their own cuts. The task of the labour movement and its representatives is to defend the working class.

Nor should District Health Authorities be allowed to make their cuts in a quiet room with only a few people there. Members of the public are allowed into the meetings. Many people do not know this. Indeed DHAs in many cases hold their meetings in rooms too small for more than handful of observers to get in. This can and must be challenged. In Oxfordshire, persistent mass lobbying and the invasion of DHA meetings forced them to begin holding meetings in large, public venues: a small but significant blow for democracy and accountability. Make sure that there are a lot of people at the meetings where cuts are being discussed. You are technically not allowed to speak: but why should a totally unelected and unaccountable body be able to ruin the health of the community in silence? Disruption of DHA meetings has proved valuable in the past, and it shows the administrators that they will not have an easy time trying to close the hospital.

But the real way to win and to save hospitals is by united industrial action, focussed on occupation. There have been several successful hospital occupations since 1977.

Thornton View occupation

How do we actually occupy?
The decision to occupy is not taken overnight. There needs to be preparation. If you are thinking of occupying your hospital, contact someone who has done it. Get her/him to come to the hospital and talk to people, answering questions and explaining directly what an occupation means.

Sometimes it is only a handful of workers who decide that they will not let the hospital close. They take the initial action and bring the other staff along with them throughout the course of the occupation. This happened at Hayes Cottage in Hillingdon and also at Thornton View in Bradford.

In other occupations there have been mass meetings with ballots. This happened at Northwood and Pinner Hospital. All three have been successful occupations. Obviously the more staff who are involved the better. However, experience has shown that even when only a small number of workers take the initial action other workers will continue to come in and work and can be won over to supporting the occupation.

It is often domestic workers who take the initial action, with very passive support from nurses. But once nurses see the hospital still running “normally” as far as patient care goes, and see management powerless to stop the normal running of the wards they may increasingly give active support.

Workers will naturally be worried about being sacked, victimised, struck off or blacklisted. It is important not to dismiss these fears, but to have a frank and honest discussion with them. Nobody has ever been struck off the nursing register for supporting an occupation. Even the Royal College of Nursing has given tacit support, usually instructing its members to “stay with the patients”.

The fear of victimisation is more difficult to dispel. The strength of an occupation lies in collective action. The more staff who are involved, the more difficult it is to victimise anyone. Decisions are made collectively. But it would be dishonest to say that there is no possibility of anyone being victimised. Unions must be pushed to demand no victimisation, and to give assurances that they will fully back any member who is threatened, with strike action in other hospitals if necessary.

Unions
Many workers who have occupied their hospitals have not been in a union at the start of the action. It is important that the workers in the occupied hospital do join a union and that there are stewards elected on site. The union full-timers should be informed as soon as the occupation has been declared and be asked to make the action official. NUPE, COHSE, TGWU, GMBATU, and ASTMS have policies of supporting occupations and will usually make them official immediately.

Although they will give you official support, most full-time union officials do not have much knowledge or experience of occupations. They should be pushed to provide practical support from the beginning – money for leaflets, posters, stickers, duplicators, paper, equipment, etc. You should also ensure you are able to contact an official at all times.

If you can contact someone who has had practical experience of occupations to be at the hospital for the first few days it will be an advantage.

District Joint Shop Stewards Committees, where they exist, should be actively involved from the beginning. If there is not one in existence then a meeting should be convened of all the NHS stewards in the District in order to get support. It is essential that workers in the other hospitals know what is going on and give their support to the occupation.

Declaring the hospital occupied
When a hospital is declared occupied there are some things that need to be done immediately.

a) An office
It is almost impossible to run an occupation without access to an office and a telephone, or a room in the hospital to be used as a base. In planning the occupation, you should decide in advance which office is best to take over. Often it is the Administator’s or Nursing Officer’s. This has the added advantage of displacing the people most likely to try to intimidate and disrupt the occupation in the first few days.

Arrive prepared to change the locks on the door. This gives you possession and means that management have to go to court to get the office back. You will need to put up a notice which informs people of your rights. As long as you have not done any damage to the property for example breaking a window or door to get in — you have a right to be there. Put up the following notice:

LEGAL WARNING (Section 6 Criminal Law Act 1977)
Take Notice
THAT at all times there is at least one person in this hospital;

THAT any entry into this hospital without our permission is a criminal offence as anyone of us who is in physical occupation is opposed to any entry without their permission;

THAT if you attempt to enter by violence or by threatening violence we will prosecute you. You may receive a sentence of up to six months imprisonment and/or a fine of up to £1,000.

THAT if you want to get us out you will have to take out a summons for possession in the County Court or in the High Court

Once the occupation has been made official by the unions add “THAT this is a trade dispute and is an official trade union occupation.” Have this notice already written out and put it on the office door, the hospital entrance and on the gates of the hospital immediately.

b) Telephones
If there is a switchboard, talk to the operators immediately, preferably with their union steward present. If they have not been involved in the planning stage explain to them exactly what is happening. Ask them to keep on giving you lines. If management are still in the hospital it may be necessary to have someone — a steward, official, or occupation committee member on the switchboard to keep management Out and stop any harassment of the operators.

Contact the Post Office Engineering Union (POEU) immediately. Tell them what has happened and ask them to black any instruction to cut off the phone. Tell them you will be applying for a new line the next day and ask them to give the application top priority. Get an application form in for a line independent of the hospital. This has been invaluable in recent occupations. It ensures that you cannot be cut off, If you do not know the local POEU rep, either contact the Trades Council, or ring the operator and ask for the engineers to ask them for the name of the steward.

c) Support from the Ambulance Service
Contact the local ambulance service stations. Talk to the stewards and tell them what you are doing and ask them not to cross the picket line to remove any patients without prior consultation with the occupation. If you are occupying an acute general hospital with an accident and emergency department, ask them to continue bringing patients into the hospital unless instructed not to by the occupation committee. If you are trying to keep an A&E open it will require very close consultation with the ambulance drivers and with the casualty clerical officers, to ensure a continued in-flow of patients. London Ambulance Service, unlike that in many rural areas, has a long history of support for occupations. At least 50% of London Ambulance workers are in NUPE.

d) Pickets
If you are occupying a long stay hospital, lock the front gates with a padlock and put a picket there to let staff, supporters and visitors in, but to keep management and the police out until the occupation is secured. Bring the padlock and locks with you on the day you declare the occupation and make sure that there are enough people around to cover all the immediate jobs that need to be done.

A twenty-four hour picket may be necessary from the beginning. Ensure that pickets know the rules and regulations, are well-informed and have up-to-date information on who is to be let in, who is to be kept out, etc.

Make sure that someone capable of making quick decisions and who is reliable is in the office.

Patient care continues

e) The Staff
Get a meeting together to explain exactly what has happened for the benefit of staff who have not been involved in the planning and the timing of the occupation. Reassure staff that what they should do is continue to work as normal. It is often useful to have a sympathetic nurse on hand who has been involved in an occupation. If a meeting is not possible, go around to all the wards and departments and explain what is going on. This is essential in order to bring people who are unsure, frightened or hostile into at least passively supporting the occupation.

Prepare a leaflet for distribution the day after the occupation begins. Also prepare a press statement.

Regular bulletins for staff are essential because of the shift patterns and the impossibility of getting everyone to a meeting at the same time. It is also important to change the exterior of the hospital. Fences should be covered with posters and banners proclaiming the occupation, displayed in prominent positions. Make sure every passer-by knows that a struggle against health cuts is going on.

St Benedicts occupation

Who runs the occupation?

It is the workers who must make the decisions about how the occupation will run. If there is good unionisation then the Joint Shop Stewards Committee may be the occupation committee. If, as is quite often the case, the hospital is weakly organised, then there will need to be an occupation committee set up with representatives of all departments and all staff. It does not have to be the same people all the time. As many staff as possible should be encouraged to attend. It is useful at first to have someone at these meetings who has experience of occupations and who can answer questions that arise. But any decision must be made by the workers themselves.

The committees may need to meet every day during the first week or two and then it should meet as regularly as the staff think necessary (once a week is usual).

Management: should they stay or go?
At some point in nearly every Occupation, management have been barred. The time to do it depends very much on the strength of the occupation and the role of the managers. There are no hard and fast answers to this question but some norms can apply to most occupations In almost every instance administrators will be working to break the occupation as quickly as possible. They may appear friendly, paternalistic and nice but their role is to regain control of the hospital in order to close it. Do not trust them.

The lesson which all of us involved in occupations have learned, is that hospitals run perfectly well without senior administrators and managers.

You will have to decide when to ban the hospital administrator and nursing managers; but a general rule is that any manager who does not normally come to the hospital or who is not involved directly in patient care should not be allowed in. As soon as the occupation begins you will have district and sector administrators and nursing managers appearing at the gates or front door demanding to be let in. Refer them to the legal notice, tell them the hospital is running as normal, the patients are not at risk, the workers are in control and that they cannot come in without permission

Both management and police — if they arrive — will ask who you are, whether you work in the hospital, who is in charge etc. You are not obliged to give your name to anyone and you should not give it. Don’t mention names of anyone ‘in charge’ or connected with the occupation. Management will have the names of stewards and they can contact them if they want.

Be firm and polite. The legal notice is clear. Neither an administrator nor a nursing officer, nor even a police officer has any right to enter without permission If the administrators say that they are worried about the patients, tell them that they can ask a doctor of their choice to come in and check on the patient care.

The recent pattern has been that senior management who are not normally based at the hospital, come back for the first three of four days demanding to be let in. Then they tend to give up, go away and try to think of another way to harass the occupation.

Once the more reticent workers see that very senior managers have been turned away but that no-one has been sacked for it, and there has not been any action taken, they tend to get a bit more confident in supporting the activists.

The occupation committee should discuss and monitor the position or any management normally on site; administrators are usually easier to ban than nursing officers. In many occupations the senior nursing officers have been allowed to stay but they have been “shadowed” by a supporter or member of the occupation committee. This reinforces the impression that the workers are in control and making the decisions in the hospital. It also prevents these people from undermining the occupation by intimidating staff individually.

The whole question of what to do with nursing officers is very delicate and should be discussed fully with the nurses before any decisions are reached. But always be wary of back-door agreements, and refuse to have anything to do with them. They can only undermine your base and endanger the politics of the occupation.


Hayes Cottage occupation

Supporters
Occupations need a lot of help to run smoothly and to win. It is essential to get as much outside support as possible. Hospitals belong to the community and they will want to help defend their local hospital. There should be a rota set up for pickets which will include both staff and supporters. Factories and other workplaces, tenants organisations, Labour parties and community groups all need to be approached for help.

There should be regular supporters’ meetings so that everyone knows what is going on, there should be good liaison and communication between supporters and the occupation committee. Regular bulletins are good for sharing information.

An occupation diary should be kept in the office. Pickets should be encouraged to read it when they come in for their stint, and to write up details which they feel to be of use.

Get names, addresses and telephone numbers of anyone who offers help. Get them to give a regular commitment to picketing. Begin to work on developing a telephone tree, which is a system of contacting people by phone in an emergency. It usually works by three people telephoning three other people who in turn phone three people until all the supporters are contacted.

The important point for supporters to remember is that the hospital is running as normal, as far as patient care is concerned. Patients’ privacy is a top priority. No supporters should be allowed in the ward areas. No drinking should be allowed on the site during an occupation. Health workers are not used to ‘outsiders’ walking around hospitals. Management will inevitably play on this, trying to discredit pickets who are not staff members.

Everyone has a right to defend their hospital that is why people come to support occupations. Staff at occupied hospitals are doing their normal job — often physically and emotionally exhausting. They are also taking an active role in running the occupation and so cannot keep the pickets going on their own. If they are women, they are often under intense pressure at home because of their increased commitment. They need support.

The labour movement was built on solidarity; and that is what occupations are about. This Tory government has no conscience about bringing in its own outsiders to run down the NHS – Griffiths, a grocer from Sainsbury’s, is advising them on how the NHS should be run! Private outside contractors are looking to increase their profits by getting NHS contracts. We should make no apologies for taking advice and help from people prepared to help save hospitals.

Press/publicity
Get the local press on your side. Management will try to discredit the occupation by saying that patients are at risk. Have a press conference as soon as possible. Issue a press statement as soon as you have occupied. Invite the press in to film or photograph the occupation and let them see for themselves that everything is running well. Patients will usually gladly give their permission to be filmed if it means good publicity for the hospital. Delegate someone to he the press officer and make sure that whoever speaks on behalf of the occupation is authorised to do so, and that reporters know who to ask for. A sympathetic story in the local paper is worth more than a thousand leaflets. Always stress that “patient care” is being maintained.

St Benedicts patients

Relatives/patients
Get the relatives involved immediately. Let them all know what the occupation means. A leaflet should be produced and a relatives meeting organised as soon as possible. Workers in geriatric hospitals in particular have had great success in getting relatives to take an active part in supporting occupations.

Get the patients involved if possible. They will be the most affected by the closure. At St Benedicts, patients joined in with picketing, and in Thornton View they have given radio and television interviews. Try to get relatives to make a supportive press statement in the first few days of the occupation.

Supporting strike action
Occupations cannot win without support. In order to avoid the kind of raids which ended the Hounslow, St Benedicts, Longworth and Etwall occupations, it is necessary to get sufficient outside support to make the District Health Authority hold back from sanctioning a raid. This has to be done by getting other workers in the District and the Region to pledge supporting strike action immediately any piece of equipment or patient is forcibly removed from the hospital.

It is not easy to get these pledges, and they must be worked for from the first day of the occupation. Management tactics are to divide and rule health workers. They know the importance of strike action, and that is why they try to exploit other health workers’ fears of redundancy and cuts by threatening them that if the occupied hospital is saved, their hospital will be cut.

Such claims have to be dealt with very quickly. Every cut, every closure makes each subsequent one easier for management to accomplish. Every victory against cuts and closures makes it more difficult for Districts to make more cuts, because it encourages others to fight. That is why promises of supporting action are so essential. They break down the isolation of occupations, and make them a focus for broad resistance to the cuts.

Experience has shown that while trade unions will give quick recognition to occupations, union officials will not build for supporting strike action. In some cases they have deliberately worked against it, defusing and diverting the issue, and making the workers occupying think it is impossible to win supporting action. It is by no means easy or automatic: but it is certainly not impossible. Don’t leave the work of building for supporting strike action in the hands of union full-time officials. Get stewards and workers from the occupation in every branch to raise the issue, ask for support and to explain why support from other workers is so vital.

The law
Increasingly the law is being used against trade unionists, and the health service is no exception. Injunctions were used for the first time during the St Benedicts occupation, and have been used in several occupations since then. The law is complex and has been used in different ways in different occupations. The best thing to do is to contact your local law centre, and ask one of the solicitors to come to the hospital to explain the legal position. If you don’t have a law centre try to find a sympathetic socialist lawyer in the area.

Injunctions can be issued to named individuals and to “any others”, to demand that they comply with certain conditions. Management may take out injunctions early on; or maybe not at all. The fewer names they know the better. When they are applying for injunctions you will be informed. Contact the law centre solicitors and/or the union legal officers immediately.

If the injunction is granted, it must still then be served. During the Hayes occupation, administrators were only able to serve one out of three injunctions, and eventually they just gave up.

The use of the law is a frightening and intimidating process for people who have never come up against it. It is important that the workers involved in occupations have things explained to them by someone who knows what the current legal position is. The main thing to stress is that an occupation is not a criminal offence and is not “illegal”. Recently, in the Hayes and Northwood occupations, the law was used for the benefit of the occupation. This was an unusual and exceptional event! It is always worth pursuing any legal points which may help an occupation, but the law is not usually on the side of people fighting cuts and should not be seen as a substitute for action. An occupation should never be called off pending legal action or a court action. The Hayes occupiers themselves declined to take part in the legal action against the DHA, preferring to rely on their base of support in the working class rather than trust the courts.

Why should we occupy when other occupations have not kept hospitals open?
This question is always asked. There is no easy, sure way to keep a hospital open. Workers at St. Benedicts spent ten long, exhausting months occupying to see, at the end, a vicious raid by private ambulances with the help of the police, taking the patients out and closing the hospital. There had been no pledges of supporting strike action; and so management had felt confident that they could move. But the public disgust at the methods used and the closure of the hospital provoked such a backlash that it was another three years before that health district has even suggested that another hospital should be closed. Hayes Cottage, Northwood and Pinner and Thornton View hospitals are all still open more than six months after they were due for closure, thanks to determined occupations. Remember, it is not certain that occupying your hospital will keep it open — what is certain is that if you do not occupy it will close.

It is also certain that every time we fight a cut or a closure, the ripples are felt. If there had been no resistance to the closures in the past, we would be facing even more devastating cuts than the Tories are now proposing. Every time a hospital, ward, or department is occupied, it is a clear sign to the government that they cannot easily cut our services.

Occupations are never a waste of effort. They politicise workers very quickly. Health workers are locked into a very hierarchical system which is extremely undemocratic and oppressive. Decision-making is entirely out of our hands. Occupations give the decision-making back to the workers. A cleaner who stands at a gate telling an administrator to go away is in control. The hospital is running, ‘under new management’, under workers’ control. The whole process of occupying shows workers that they can make major decisions about their hospital, and that when they are in control it usually runs better and smoother.

It makes us think about the reasons for the cuts and closures. Where does the money go? Why can’t we keep the services for local people and cut out the vast profits that go to the drug companies and other suppliers and contractors? Why do health authority accounts have to be so secretive? Why can’t health unions and other trade unionists examine the books to expose the details of how the District allocates its money?

Occupations rally whole communities around defence of health care. For the first time, ordinary people go to Health Authority meetings and see the scandalous group of non-accountable, appointed people who make life and death decisions with no thought for what we have to say about it.

People start talking about not only defending what we have, but demanding what we want.

Occupations are not easy. They require a lot of hard work, a lot of commitment, and can be exhausting. The alternative is to let successive governments ‘rationalise’ the health service right out of existence. At the moment there are three hospitals which would have been closed in 1983 which are still open because the workers occupied. Those three could be multiplied by hundreds. The possibilities of keeping hospitals open exists. That is a good enough reason to consider occupation of your hospital.

On London Health Emergency
* London Health Emergency was set up in 1983 with GLC support to coordinate local campaigns against health cuts in London. We are run by a Steering Committee drawn from local campaigns and union delegates.

* We are committed to: reversing the present health cuts; combating privatisation; and democratising the NHS.

* We will be producing a regular bulletin as well as pamphlets, leaflets, posters to support the local and London-wide struggles against the cuts. We can provide speakers for trade union, Labour Party and other meetings on the cuts. Our aim is to support struggles under way against the cuts and privatisation, and to create the kind of local campaigns which can encourage health workers wherever necessary to take industrial action — strikes, work-ins, or supporting action — to defend jobs and services.

* There are now campaigns in all 31 London health districts.

* Also affiliated to London Health Emergency are: NUPE; GMBATU (Southern Region); Districts and branches of NALGO; ASTMS; COHSE and NUPE; and several Trades Councils and Community Health Councils.

* To succeed we need far more affiliations from union branches, Labour Parties, community and other organisations. A single (1~lO) fee affiliates your organisation both to the local health campaign and to London Health Emergency. In exchange we will send up to 100 copies of our bulletin, and regular mailings on events and struggles London-wide.

* Make sure your organisation affiliates.

335 Gray’s Inn Road 50p London WC1 Tel: 01-833 3020

The GLC supports our organisation – keep GLC working for London

Picture captions:
3 A mass picket of the Area Health Authority as part of the occupation of Hounslow Hospital (1977) supported by the Confederation of London Area Health Stewards – “CLASH”.

4 Bethnal Green Hospital campaigners lobbying the DHSS at the Elephant and Castle in 1978: They successfully held up the closure of casualty for over two years.

5 The aftermath of the management raid which ended Hounslow occupation in October 1977; this type of management vandalism can be prevented only by firm pledges of supporting strike action by groups of health and other workers.

12 Thornton View occupation, Bradford: in this instance a small core of workers decided they would not let the hospital close. Their lead was strongly supported by their fellow health workers, patients and relatives.

13 Still perhaps the best-known of the hospital occupations, the work-in at the Elizabeth Garret Anderson Hospital was the first major fightback against government spending cuts, beginning in 1976 and lasting into 1978.

15 Once nurses see the hospital still running “normally” and caring for patients, many will give increasingly active support to occupations.

17 Mass picket outside the St Benedicts occupation, which was brutally raided after nine months of work-in in 1980.

19 Occupations in Hayes Cottage and Northwood and Pinner hospitals in the autumn of 1983 were both successful in winning at least temporary reprieve. Without the action, both would have been closed.

23 The main victims of government cuts and enforced closures are of course the patients; within six months of the raid on St Benedicts (above) 30% of the patients were dead.

Notes on this text
Published by London Health Emergency (GLC funded [! – libcom]) 335, Grays, Inn Rd London WC1. Typeset by Lithoprint (TU); Printed by Dot Press (TU), 32 Cowley Rd. Oxford. June, 1984

Taken from https://libcom.org/library/occupy-win-manual-fighting-hospital-closures#comment-584561

Sherry R Arnstein- A Ladder of Citizen Participation

Sherry Arnstein’s 1969 article on ‘participation’; community control over the provision of services, and the way people without power are manipulated by people with it.

1. Citizen participation is citizen power

Because the question has been a bone of political contention, most of the answers have been purposely buried in innocuous euphemisms like “self-help” or “citizen involvement.” Still others have been embellished with misleading rhetoric like “absolute control” which is something no one – including the President of the United States – has or can have. Between understated euphemisms and exacerbated rhetoric, even scholars have found it difficult to follow the controversy. To the headline reading public, it is simply bewildering.

My answer to the critical what question is simply that citizen participation is a categorical term for citizen power. It is the redistribution of power that enables the have-not citizens, presently excluded from the political and economic processes, to be deliberately included in the future. It is the strategy by which the have-nots join in determining how information is shared, goals and policies are set, tax resources are allocated, programs are operated, and benefits like contracts and patronage are parceled out. In short, it is the means by which they can induce significant social reform which enables them to share in the benefits of the affluent society.

1.1. Empty Refusal Versus Benefit

There is a critical difference between going through the empty ritual of participation and having the real power needed to affect the outcome of the process. This difference is brilliantly capsulized in a poster painted last spring [1968] by the French students to explain the student-worker rebellion. (See Figure 1.) The poster highlights the fundamental point that participation without redistribution of power is an empty and frustrating process for the powerless. It allows the powerholders to claim that all sides were considered, but makes it possible for only some of those sides to benefit. It maintains the status quo. Essentially, it is what has been happening in most of the 1,000 Comm-unity Action Programs, and what promises to be repeated in the vast majority of the 150 Model Cities programs.

Figure 1.  French student poster. In English, “I participate, you participate, he participates, we participate, you participate…they profit.”

French student poster. In English, "I participate, you participate, he participates, we participate, you participate...they profit."

2. Types of participation and “nonparticipation”

A typology of eight levels of participation may help in analysis of this confused issue. For illustrative pur-poses the eight types are arranged in a ladder pattern with each rung corres-ponding to the extent of citizens’ power in deter-mining the end product. (See Figure 2.)

Figure 2. Eight rungs on the ladder of citizen participation

Eight rungs on the ladder of citizen participation

The bottom rungs of the ladder are (1) Manipulation and (2) Therapy. These two rungs describe levels of “non-participation” that have been contrived by some to substitute for genuine participation. Their real objective is not to enable people to participate in planning or conducting programs, but to enable powerholders to “educate” or “cure” the participants. Rungs 3 and 4 progress to levels of “tokenism” that allow the have-nots to hear and to have a voice: (3) Informing and (4) Consultation. When they are proffered by powerholders as the total extent of participation, citizens may indeed hear and be heard. But under these conditions they lack the power to insure that their views will be heeded by the powerful. When participation is restricted to these levels, there is no follow-through, no “muscle,” hence no assurance of changing the status quo. Rung (5) Placation is simply a higher level tokenism because the ground rules allow have-nots to advise, but retain for the powerholders the continued right to decide.

Further up the ladder are levels of citizen power with increasing degrees of decision-making clout. Citizens can enter into a (6) Partnership that enables them to negotiate and engage in trade-offs with traditional power holders. At the topmost rungs, (7) Delegated Power and (8) Citizen Control, have-not citizens obtain the majority of decision-making seats, or full managerial power.

Obviously, the eight-rung ladder is a simplification, but it helps to illustrate the point that so many have missed – that there are significant gradations of citizen participation. Knowing these gradations makes it possible to cut through the hyperbole to understand the increasingly strident demands for participation from the have-nots as well as the gamut of confusing responses from the powerholders.

Though the typology uses examples from federal programs such as urban renewal, anti-poverty, and Model Cities, it could just as easily be illustrated in the church, currently facing demands for power from priests and laymen who seek to change its mission; colleges and universities which in some cases have become literal battlegrounds over the issue of student power; or public schools, city halls, and police departments (or big business which is likely to be next on the expanding list of targets). The underlying issues are essentially the same – “nobodies” in several arenas are trying to become “somebodies” with enough power to make the target institutions responsive to their views, aspirations, and needs.

2.1. Limitations of the Typology

The ladder juxtaposes powerless citizens with the powerful in order to highlight the fundamental divisions between them. In actuality, neither the have-nots nor the powerholders are homogeneous blocs. Each group encompasses a host of divergent points of view, significant cleavages, competing vested interests, and splintered subgroups. The justification for using such simplistic abstractions is that in most cases the have-nots really do perceive the powerful as a monolithic “system,” and powerholders actually do view the have-nots as a sea of “those people,” with little comprehension of the class and caste differences among them.

It should be noted that the typology does not include an analysis of the most significant roadblocks to achieving genuine levels of participation. These roadblocks lie on both sides of the simplistic fence. On the powerholders’ side, they include racism, paternalism, and resistance to power redistribution. On the have-nots’ side, they include inadequacies of the poor community’s political socioeconomic infrastructure and knowledge-base, plus difficulties of organizing a representative and accountable citizens’ group in the face of futility, alienation, and distrust.

Another caution about the eight separate rungs on the ladder: In the real world of people and programs, there might be 150 rungs with less sharp and “pure” distinctions among them. Furthermore, some of the characteristics used to illustrate each of the eight types might be applicable to other rungs. For example, employment of the have-nots in a program or on a planning staff could occur at any of the eight rungs and could represent either a legitimate or illegitimate characteristic of citizen participation. Depending on their motives, powerholders can hire poor people to co-opt them, to placate them, or to utilize the have-nots’ special skills and insights. Some mayors, in private, actually boast of their strategy in hiring militant black leaders to muzzle them while destroying their credibility in the black community.

3. Characteristics and illustrations

It is in this context of power and powerlessness that the characteristics of the eight rungs are illustrated by examples from current federal social programs.

3.1. Manipulation

In the name of citizen participation, people are placed on rubberstamp advisory committees or advisory boards for the express purpose of “educating” them or engineering their support. Instead of genuine citizen participation, the bottom rung of the ladder signifies the distortion of participation into a public relations vehicle by powerholders.

This illusory form of “participation” initially came into vogue with urban renewal when the socially elite were invited by city housing officials to serve on Citizen Advisory Committees (CACs). Another target of manipulation were the CAC subcommittees on minority groups, which in theory were to protect the rights of Negroes in the renewal program. In practice, these sub-committees, like their parent CACs, functioned mostly as letterheads, trotted forward at appropriate times to promote urban renewal plans (in recent years known as Negro removal plans).

At meetings of the Citizen Advisory Committees, it was the officials who educated, persuaded, and advised the citizens, not the reverse. Federal guidelines for the renewal programs legitimized the manipulative agenda by emphasizing the terms “information-gathering,” public relations,” and “support” as the explicit functions of the committees.

This style of nonparticipation has since been applied to other programs encompassing the poor. Examples of this are seen in Community Action Agencies (CAAs) which have created structures called “neighborhood councils” or “neighborhood advisory groups.” These bodies frequently have no legitimate function or power. The CAAs use them to “prove” that “grassroots people” are involved in the program. But the program may not have been discussed with “the people.” Or it may have been described at a meeting in the most general terms; “We need your signatures on this proposal for a multi-service center which will house, under one roof, doctors from the health department, workers from the welfare department, and specialists from the employment service.”

The signatories are not informed that the $2 million-per-year center will only refer residents to the same old waiting lines at the same old agencies across town. No one is asked if such a referral center is really needed in his neighborhood. No one realizes that the contractor for the building is the mayor’s brother-in-law, or that the new director of the center will be the same old community organization specialist from the urban renewal agency.

After signing their names, the proud grass-rooters dutifully spread the word that they have “participated” in bringing a new and wonderful center to the neighborhood to provide people with drastically needed jobs and health and welfare services. Only after the ribbon-cutting ceremony do the members of the neighborhood council realize that they didn’t ask the important questions, and that they had no technical advisors of their own to help them grasp the fine legal print. The new center, which is open 9 to 5 on weekdays only, actually adds to their problems. Now the old agencies across town won’t talk with them unless they have a pink paper slip to prove that they have been referred by “their” shiny new neighborhood center.

Unfortunately, this chicanery is not a unique example. Instead it is almost typical of what has been perpetrated in the name of high-sounding rhetoric like “grassroots participation.” This sham lies at the heart of the deep-seated exasperation and hostility of the have-nots toward the powerholders.

One hopeful note is that, having been so grossly affronted, some citizens have learned the Mickey Mouse game, and now they too know how to play. As a result of this knowledge, they are demanding genuine levels of participation to assure them that public programs are relevant to their needs and responsive to their priorities.

3.2. Therapy

In some respects group therapy, masked as citizen participation, should be on the lowest rung of the ladder because it is both dishonest and arrogant. Its administrators – mental health experts from social workers to psychiatrists – assume that powerlessness is synonymous with mental illness. On this assumption, under a masquerade of involving citizens in planning, the experts subject the citizens to clinical group therapy. What makes this form of “participation” so invidious is that citizens are engaged in extensive activity, but the focus of it is on curing them of their “pathology” rather than changing the racism and victimization that create their “pathologies.”

Consider an incident that occurred in Pennsylvania less than one year ago. When a father took his seriously ill baby to the emergency clinic of a local hospital, a young resident physician on duty instructed him to take the baby home and feed it sugar water. The baby died that afternoon of pneumonia and dehydration. The overwrought father complained to the board of the local Community Action Agency. Instead of launching an investigation of the hospital to determine what changes would prevent similar deaths or other forms of malpractice, the board invited the father to attend the CAA’s (therapy) child-care sessions for parents, and promised him that someone would “telephone the hospital director to see that it never happens again.”

Less dramatic, but more common examples of therapy, masquerading as citizen participation, may be seen in public housing programs where tenant groups are used as vehicles for promoting control-your-child or cleanup campaigns. The tenants are brought together to help them “adjust their values and attitudes to those of the larger society.” Under these ground rules, they are diverted from dealing with such important matters as: arbitrary evictions; segregation of the housing project; or why is there a three-month time lapse to get a broken window replaced in winter.

The complexity of the concept of mental illness in our time can be seen in the experiences of student/civil rights workers facing guns, whips, and other forms of terror in the South. They needed the help of socially attuned psychiatrists to deal with their fears and to avoid paranoia.

3.3. Informing

Informing citizens of their rights, responsibilities, and options can be the most important first step toward legitimate citizen participation. However, too frequently the emphasis is placed on a one-way flow of information – from officials to citizens – with no channel provided for feedback and no power for negotiation. Under these conditions, particularly when information is provided at a late stage in planning, people have little opportunity to influence the program designed “for their benefit.” The most frequent tools used for such one-way communication are the news media, pamphlets, posters, and responses to inquiries.

Meetings can also be turned into vehicles for one-way communication by the simple device of providing superficial information, discouraging questions, or giving irrelevant answers. At a recent Model Cities citizen planning meeting in Providence, Rhode Island, the topic was “tot-lots.” A group of elected citizen representatives, almost all of whom were attending three to five meetings a week, devoted an hour to a discussion of the placement of six tot-lots. The neighborhood is half black, half white. Several of the black representatives noted that four tot-lots were proposed for the white district and only two for the black. The city official responded with a lengthy, highly technical explanation about costs per square foot and available property. It was clear that most of the residents did not understand his explanation. And it was clear to observers from the Office of Economic Opportunity that other options did exist which, considering available funds would have brought about a more equitable distribution of facilities. Intimidated by futility, legalistic jargon, and prestige of the official, the citizens accepted the “information” and endorsed the agency’s proposal to place four lots in the white neighborhood.

3.4. Consultation

Inviting citizens’ opinions, like informing them, can be a legitimate step toward their full participation. But if consulting them is not combined with other modes of participation, this rung of the ladder is still a sham since it offers no assurance that citizen concerns and ideas will be taken into account. The most frequent methods used for consulting people are attitude surveys, neighborhood meetings, and public hearings.

When powerholders restrict the input of citizens’ ideas solely to this level, participation remains just a window-dressing ritual. People are primarily perceived as statistical abstractions, and participation is measured by how many come to meetings, take brochures home, or answer a questionnaire. What citizens achieve in all this activity is that they have “participated in participation.” And what powerholders achieve is the evidence that they have gone through the required motions of involving “those people.”

Attitude surveys have become a particular bone of contention in ghetto neighborhoods. Residents are increasingly unhappy about the number of times per week they are surveyed about their problems and hopes. As one woman put it: “Nothing ever happens with those damned questions, except the surveyor gets $3 an hour, and my washing doesn’t get done that day.” In some communities, residents are so annoyed that they are demanding a fee for research interviews.

Attitude surveys are not very valid indicators of community opinion when used without other input from citizens. Survey after survey (paid for out of anti-poverty funds) has “documented” that poor housewives most want tot-lots in their neighborhood where young children can play safely. But most of the women answered these questionnaires without knowing what their options were. They assumed that if they asked for something small, they might just get something useful in the neighborhood. Had the mothers known that a free prepaid health insurance plan was a possible option, they might not have put tot-lots so high on their wish lists.

A classic misuse of the consultation rung occurred at a New Haven, Connecticut, community meeting held to consult citizens on a proposed Model Cities grant. James V. Cunningham, in an unpublished report to the Ford Foundation, described the crowd as large and mostly hostile:

Members of The Hill Parents Association demanded to know why residents had not participated in drawing up the proposal. CAA director Spitz explained that it was merely a proposal for seeking Federal planning funds -that once funds were obtained, residents would be deeply involved in the planning. An outside observer who sat in the audience described the meeting this way: “Spitz and Mel Adams ran the meeting on their own. No representatives of a Hill group moderated or even sat on the stage. Spitz told the 300 residents that this huge meeting was an example of ‘participation in planning.’ To prove this, since there was a lot of dissatisfaction in the audience, he called for a ‘vote’ on each component of the proposal. The vote took this form: ‘Can I see the hands of all those in favor of a health clinic? All those opposed?’ It was a little like asking who favors motherhood.”

It was a combination of the deep suspicion aroused at this meeting and a long history of similar forms of “window-dressing participation” that led New Haven residents to demand control of the program.

By way of contrast, it is useful to look at Denver where technicians learned that even the best intentioned among them are often unfamiliar with, and even insensitive to, the problems and aspirations of the poor. The technical director of the Model Cities program has described the way professional planners assumed that the residents, victimized by high-priced local storekeepers, “badly needed consumer education.” The residents, on the other hand, pointed out that the local store-keepers performed a valuable function. Although they overcharged, they also gave credit, offered advice, and frequently were the only neighborhood place to cash welfare or salary checks. As a result of this consultation, technicians and residents agreed to substitute the creation of needed credit institutions in the neighborhood for a consumer education pro-gram.

3.5. Placation

It is at this level that citizens begin to have some degree of influence though tokenism is still apparent. An example of placation strategy is to place a few hand-picked “worthy” poor on boards of Community Action Agencies or on public bodies like the board of education, police commission, or housing authority. If they are not accountable to a constituency in the community and if the traditional power elite hold the majority of seats, the have-nots can be easily outvoted and outfoxed. Another example is the Model Cities advisory and planning committees. They allow citizens to advise or plan ad infinitum but retain for powerholders the right to judge the legitimacy or feasibility of the advice. The degree to which citizens are actually placated, of course, depends largely on two factors: the quality of technical assistance they have in articulating their priorities; and the extent to which the community has been organized to press for those priorities.

It is not surprising that the level of citizen participation in the vast majority of Model Cities programs is at the placation rung of the ladder or below. Policy-makers at the Department of Housing and Urban Development (HUD) were determined to return the genie of citizen power to the bottle from which it had escaped (in a few cities) as a result of the provision stipulating “maximum feasible participation” in poverty programs. Therefore, HUD channeled its physical-social-economic rejuvenation approach for blighted neighborhoods through city hall. It drafted legislation requiring that all Model Cities’ money flow to a local City Demonstration Agency (CDA) through the elected city council. As enacted by Congress, this gave local city councils final veto power over planning and programming and ruled out any direct funding relationship between community groups and HUD.

HUD required the CDAs to create coalition, policy-making boards that would include necessary local powerholders to create a comprehensive physical-social plan during the first year. The plan was to be carried out in a subsequent five-year action phase. HUD, unlike OEO, did not require that have-not citizens be included on the CDA decision-making boards. HUD’s Performance Standards for Citizen Participation only demanded that “citizens have clear and direct access to the decision-making process.”

Accordingly, the CDAs structured their policy-making boards to include some combination of elected officials; school representatives; housing, health, and welfare officials; employment and police department representatives; and various civic, labor, and business leaders. Some CDAs included citizens from the neighborhood. Many mayors correctly interpreted the HUD provision for “access to the decision-making process” as the escape hatch they sought to relegate citizens to the traditional advisory role.

Most CDAs created residents’ advisory committees. An alarmingly significant number created citizens’ policy boards and citizens’ policy committees which are totally misnamed as they have either no policy-making function or only a very limited authority. Almost every CDA created about a dozen planning committees or task forces on functional lines: health, welfare, education, housing, and unemployment. In most cases, have-not citizens were invited to serve on these committees along with technicians from relevant public agencies. Some CDAs, on the other hand, structured planning committees of technicians and parallel committees of citizens.

In most Model Cities programs, endless time has been spent fashioning complicated board, committee, and task force structures for the planning year. But the rights and responsibilities of the various elements of those structures are not defined and are ambiguous. Such ambiguity is likely to cause considerable conflict at the end of the one-year planning process. For at this point, citizens may realize that they have once again extensively “participated” but have not profited beyond the extent the powerholders decide to placate them.

Results of a staff study (conducted in the summer of 1968 before the second round of seventy-five planning grants were awarded) were released in a December 1968 HUD bulletin. Though this public document uses much more delicate and diplomatic language, it attests to the already cited criticisms of non-policy-making policy boards and ambiguous complicated structures, in addition to the following findings:

  1. Most CDAs did not negotiate citizen participation requirements with residents.
  2. Citizens, drawing on past negative experiences with local powerholders, were extremely suspicious of this new panacea program. They were legitimately distrustful of city hall’s motives.
  3. Most CDAs were not working with citizens’ groups that were genuinely representative of model neighborhoods and account-able to neighborhood constituencies. As in so many of the poverty programs, those who were involved were more representative of the upwardly mobile working-class. Thus their acquiescence to plans prepared by city agencies was not likely to reflect the views of the unemployed, the young, the more militant residents, and the hard-core poor.
  4. Residents who were participating in as many as three to five meetings per week were unaware of their minimum rights, responsibilities, and the options available to them under the program. For example, they did not realize that they were not required to accept technical help from city technicians they distrusted.
  5. Most of the technical assistance provided by CDAs and city agencies was of third-rate quality, paternalistic, and condescending. Agency technicians did not suggest innovative options. They reacted bureaucratically when the residents pressed for innovative approaches. The vested interests of the old-line city agencies were a major – albeit hidden – agenda.
  6. Most CDAs were not engaged in planning that was comprehensive enough to expose and deal with the roots of urban decay. They engaged in “meetingitis” and were supporting strategies that resulted in “projectitis,” the outcome of which was a “laundry list” of traditional pro-grams to be conducted by traditional agencies in the traditional manner under which slums emerged in the first place.
  7. Residents were not getting enough information from CDAs to enable them to review CDA developed plans or to initiate plans of their own as required by HUD. At best, they were getting superficial information. At worst, they were not even getting copies of official HUD materials.
  8. Most residents were unaware of their rights to be reimbursed for expenses incurred because of participation – babysitting, trans-portation costs, and so on. The training of residents, which would enable them to under-stand the labyrinth of the federal-state-city systems and networks of subsystems, was an item that most CDAs did not even consider.

These findings led to a new public interpretation of HUD’s approach to citizen participation. Though the requirements for the seventy-five “second-round” Model City grantees were not changed, HUD’s twenty-seven page technical bulletin on citizen participation repeatedly advocated that cities share power with residents. It also urged CDAs to experiment with subcontracts under which the residents’ groups could hire their own trusted technicians.

A more recent evaluation was circulated in February 1969 by OSTI, a private firm that entered into a contract with OEO to provide technical assistance and training to citizens involved in Model Cities programs in the north-east region of the country. OSTI’s report to OEO corroborates the earlier study. In addition it states:

In practically no Model Cities structure does citizen participation mean truly shared decision-making, such that citizens might view them-selves as “the partners in this program. …”

In general, citizens are finding it impossible to have a significant impact on the comprehensive planning which is going on. In most cases the staff planners of the CDA and the planners of existing agencies are carrying out the actual planning with citizens having a peripheral role of watchdog and, ultimately, the “rubber stamp” of the plan generated. In cases where citizens have the direct responsibility for generating program plans, the time period allowed and the independent technical resources being made available to them are not adequate to allow them to do anything more than generate very traditional approaches to the problems they are attempting to solve.

In general, little or no thought has been given to the means of insuring continued citizen participation during the stage of implementation. In most cases, traditional agencies are envisaged as the implementers of Model Cities programs and few mechanisms have been developed for encouraging organizational change or change in the method of program delivery within these agencies or for insuring that citizens will have some influence over these agencies as they implement Model Cities programs … By and large, people are once again being planned for. In most situations the major planning decisions are being made by CDA staff and approved in a formalistic way by policy boards.

3.6. Partnership

At this rung of the ladder, power is in fact redistributed through negotiation between citizens and powerholders. They agree to share planning and decision-making responsibilities through such structures as joint policy boards, planning committees and mechanisms for resolving impasses. After the groundrules have been established through some form of give-and-take, they are not subject to unilateral change.

Partnership can work most effectively when there is an organized power-base in the community to which the citizen leaders are account-able; when the citizens group has the financial resources to pay its leaders reasonable honoraria for their time-consuming efforts; and when the group has the resources to hire (and fire) its own technicians, lawyers, and community organizers. With these ingredients, citizens have some genuine bargaining influence over the outcome of the plan (as long as both parties find it useful to maintain the partnership). One community leader described it “like coming to city hall with hat on head instead of in hand.”

In the Model Cities program only about fifteen of the so-called first generation of seventy-five cities have reached some significant degree of power-sharing with residents. In all but one of those cities, it was angry citizen demands, rather than city initiative, that led to the negotiated sharing of power. The negotiations were triggered by citizens who had been enraged by previous forms of alleged participation. They were both angry and sophisticated enough to refuse to be “conned” again. They threatened to oppose the awarding of a planning grant to the city. They sent delegations to HUD in Washington. They used abrasive language. Negotiation took place under a cloud of suspicion and rancor.

In most cases where power has come to be shared it was taken by the citizens, not given by the city. There is nothing new about that process. Since those who have power normally want to hang onto it, historically it has had to be wrested by the powerless rather than proffered by the powerful.

Such a working partnership was negotiated by the residents in the Philadelphia model neighborhood. Like most applicants for a Model Cities grant, Philadelphia wrote its more than 400 page application and waved it at a hastily called meeting of community leaders. When those present were asked for an endorsement, they angrily protested the city’s failure to consult them on preparation of the extensive application. A community spokesman threatened to mobilize a neighborhood protest against the application unless the city agreed to give the citizens a couple of weeks to review the application and recommend changes. The officials agreed.

At their next meeting, citizens handed the city officials a substitute citizen participation section that changed the groundrules from a weak citizens’ advisory role to a strong shared power agreement. Philadelphia’s application to HUD included the citizens’ substitution word for word. (It also included a new citizen prepared introductory chapter that changed the city’s description of the model neighborhood from a paternalistic description of problems to a realistic analysis of its strengths, weaknesses, and potentials.) Consequently, the proposed policy-making committee of the Philadelphia CDA was revamped to give five our of eleven seats to the residents’ organization, which is called the Area Wide Council (AWC). The AWC obtained a subcontract from the CDA for more than $20,000 per month, which it used to maintain the neighborhood organization, to pay citizen leaders $7 per meeting for their planning services, and to pay the salaries of a staff of community organizers, planners, and other technicians. AWC has the power to initiate plans of its own, to engage in joint planning with CDA committees, and to review plans initiated by city agencies. It has a veto power in that no plans may be submitted by the CDA to the city council until they have been reviewed, and any differences of opinion have been successfully negotiated with the AWC. Representatives of the AWC (which is a federation of neighborhood organizations grouped into sixteen neighbor-hood “hubs”) may attend all meetings of CDA task forces, planning committees, or sub-committees.

Though the city council has final veto power over the plan (by federal law), the AWC believes it has a neighborhood constituency that is strong enough to negotiate any eleventh-hour objections the city council might raise when it considers such AWC proposed innovations as an AWC Land Bank, an AWC Economic Development Corporation, and an experimental income maintenance program for 900 poor families.

3.7. Delegated Power

Negotiations between citizens and public officials can also result in citizens achieving dominant decision-making authority over a particular plan or program. Model City policy boards or CAA delegate agencies on which citizens have a clear majority of seats and genuine specified powers are typical examples. At this level, the ladder has been scaled to the point where citizens hold the significant cards to assure accountability of the program to them. To resolve differences, powerholders need to start the bargaining process rather than respond to pressure from the other end.

Such a dominant decision-making role has been attained by residents in a handful of Model Cities including Cambridge, Massachusetts; Dayton, and Columbus, Ohio; Minneapolis, Minnesota; St. Louis, Missouri; Hartford and New Haven, Connecticut; and Oakland, California.

In New Haven, residents of the Hill neighborhood have created a corporation that has been delegated the power to prepare the entire Model Cities plan. The city, which received a $117,000 planning grant from HUD, has subcontracted $110,000 of it to the neighborhood corporation to hire its own planning staff and consultants. The Hill Neighborhood Corporation has eleven representatives on the twenty-one-member CDA board which assures it a majority voice when its proposed plan is reviewed by the CDA.

Another model of delegated power is separate and parallel groups of citizens and power-holders, with provision for citizen veto if differences of opinion cannot be resolved through negotiation. This is a particularly interesting coexistence model for hostile citizen groups too embittered toward city hall – as a result of past “collaborative efforts” – to engage in joint planning.

Since all Model Cities programs require approval by the city council before HUD will fund them, city councils have final veto powers even when citizens have the majority of seats on the CDA Board. In Richmond, California, the city council agreed to a citizens’ counter-veto, but the details of that agreement are ambiguous and have not been tested.

Various delegated power arrangements are also emerging in the Community Action Program as a result of demands from the neighborhoods and OEO’s most recent instruction guidelines which urged CAAs “to exceed (the) basic requirements” for resident participation. In some cities, CAAs have issued subcontracts to resident dominated groups to plan and/or operate one or more decentralized neighborhood program components like a multipurpose service center or a Headstart program. These contracts usually include an agreed upon line-by-line budget and program specifications. They also usually include a specific statement of the significant powers that have been delegated, for example: policy-making; hiring and firing; issuing subcontracts for building, buying, or leasing. (Some of the subcontracts are so broad that they verge on models for citizen control.)

3.8. Citizen Control

Demands for community controlled schools, black control, and neighborhood control are on the increase. Though no one in the nation has absolute control, it is very important that the rhetoric not be confused with intent. People are simply demanding that degree of power (or control) which guarantees that participants or residents can govern a program or an institution, be in full charge of policy and managerial aspects, and be able to negotiate the conditions under which “outsiders” may change them.

A neighborhood corporation with no intermediaries between it and the source of funds is the model most frequently advocated. A small number of such experimental corporations are already producing goods and/or social services. Several others are reportedly in the development stage, and new models for control will undoubtedly emerge as the have-nots continue to press for greater degrees of power over their lives.

Though the bitter struggle for community control of the Ocean Hill-Brownsville schools in New York City has aroused great fears in the headline reading public, less publicized experiments are demonstrating that the have-nots can indeed improve their lot by handling the entire job of planning, policy-making, and managing a program. Some are even demonstrating that they can do all this with just one arm because they are forced to use their other one to deal with a continuing barrage of local opposition triggered by the announcement that a federal grant has been given to a community group or an all black group.

Most of these experimental programs have been capitalized with research and demonstration funds from the Office of Economic Opportunity in cooperation with other federal agencies. Examples include:

  1. A $1.8 million grant was awarded to the Hough Area Development Corporation in Cleveland to plan economic development pro-grams in the ghetto and to develop a series of economic enterprises ranging from a novel combination shopping-center-public-housing project to a loan guarantee program for local building contractors. The membership and board of the nonprofit corporation is composed of leaders of major community organizations in the black neighborhood.
  2. Approximately $1 million ($595,751 for the second year) was awarded to the Southwest Alabama Farmers’ Cooperative Association (SWAFCA) in Selma, Alabama, for a ten-county marketing cooperative for food and livestock. Despite local attempts to intimidate the coop (which included the use of force to stop trucks on the way to market) first year membership grew to 1,150 farmers who earned $52,000 on the sale of their new crops. The elected coop board is composed of two poor black farmers from each of the ten economically depressed counties.
  3. Approximately $600,000 ($300,000 in a supplemental grant) was granted to the Albina Corporation and the Albina Investment Trust to create a black-operated, black-owned manufacturing concern using inexperienced management and unskilled minority group personnel from the Albina district. The profitmaking wool and metal fabrication plant will be owned by its employees through a deferred compensation trust plan.
  4. Approximately $800,000 ($400,000 for the second year) was awarded to the Harlem Commonwealth Council to demonstrate that a community-based development corporation can catalyze and implement an economic development program with broad community support and participation. After only eighteen months of program development and negotiation, the council will soon launch several large-scale ventures including operation of two super-markets, an auto service and repair center (with built-in manpower training program), a finance company for families earning less than $4,000 per year, and a data processing company. The all black Harlem-based board is already managing a metal castings foundry.

Though several citizen groups (and their mayors) use the rhetoric of citizen control, no Model City can meet the criteria of citizen control since final approval power and account-ability rest with the city council.

Daniel P. Moynihan argues that city councils are representative of the community, but Adam Walinsky illustrates the nonrepresentativeness of this kind of representation:

Who . . . exercises “control” through the representative process? In the Bedford-Stuyvesant ghetto of New York there are 450,000 people – as many as in the entire city of Cincinnati, more than in the entire state of Vermont. Yet the area has only one high school, and SO per cent of its teenagers are dropouts; the infant mortality rate is twice the national average; there are over 8000 buildings abandoned by everyone but the rats, yet the area received not one dollar of urban renewal funds during the entire first 15 years of that program’s operation; the unemployment rate is known only to God.

Clearly, Bedford-Stuyvesant has some special needs; yet it has always been lost in the midst of the city’s eight million. In fact, it took a lawsuit to win for this vast area, in the year 1968, its first Congressman. In what sense can the representative system be said to have “spoken for” this community, during the long years of neglect and decay?

Walinsky’s point on Bedford-Stuyvesant has general applicability to the ghettos from coast to coast. It is therefore likely that in those ghettos where residents have achieved a significant degree of power in the Model Cities planning process, the first-year action plans will call for the creation of some new community institutions entirely governed by residents with a specified sum of money contracted to them. If the groundrules for these programs are clear and if citizens understand that achieving a genuine place in the pluralistic scene subjects them to its legitimate forms of give-and-take, then these kinds of programs might begin to demonstrate how to counteract the various corrosive political and socioeconomic forces that plague the poor.

In cities likely to become predominantly black through population growth, it is unlikely that strident citizens’ groups like AWC of Philadelphia will eventually demand legal power for neighborhood self-government. Their grand design is more likely to call for a black city achieved by the elective process. In cities destined to remain predominantly white for the foreseeable future, it is quite likely that counterpart groups to AWC^ will press for separatist forms of neighborhood government that can create and control decentralized public services such as police protection, education systems, and health facilities. Much may depend on the willingness of city governments to entertain demands for resource allocation weighted in favor of the poor, reversing gross imbalances of the past.

Among the arguments against community control are: it supports separatism; it creates balkanization of public services; it is more costly and less efficient; it enables minority group “hustlers” to be just as opportunistic and disdainful of the have-nots as their white predecessors; it is incompatible with merit systems and professionalism; and ironically enough, it can turn out to be a new Mickey Mouse game for the have-nots by allowing them to gain control but not allowing them sufficient dollar resources to succeed. These arguments are not to be taken lightly. But neither can we take lightly the arguments of embittered advocates of community control – that every other means of trying to end their victimization has failed!

Originally published as Arnstein, Sherry R. “A Ladder of Citizen Participation,” JAIP, Vol. 35, No. 4, July 1969, pp. 216-224.