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There is a great deal of varied terminology used to refer to cultural heritage, and this chapter explores how definitions of these terms translate into practice the importance of cultural heritage to communities that care about it. At times the UK’s system of law and non-law instruments can lead to a fragmented approach to caring for cultural heritage. In addition, there is a body of jurisprudence where a cultural heritage object, place or practice is at the centre of the dispute, but where general legal principles (rather than specialist cultural heritage laws) are applicable; it is the way in which the judges in these cases construct notions of cultural heritage which present an opportunity to fully appreciate the way in which the UK, as a community, imagines cultural heritage. Concepts such as value, significance, interest, importance, uniqueness and value all demonstrate the recognition of the varied ways in which communities in the UK care about cultural heritage. Although the importance of cultural heritage to a community’s identity is frequently cited, this concept is rarely, if ever, translated into legal or non-legal instruments in the UK. This chapter explores how the relationships between different communities and cultural heritage have been translated into the various nested practices of care.
Given the centrality of communities to the care of cultural heritage, this chapter explores how the UK legal and non-legal instruments recognise the concept of the UK, as a community and as a network of communities. This chapter identifies and analyses the varied communities of care that directly and indirectly care for cultural heritage. These include international, national and local communities, but also institutional communities and those involved in law-making and policy. It also considers the smaller-scale communities that form to challenge the status quo and who seek justice, or wish to assume responsibility for the care of cultural heritage. What becomes apparent is the interrelationship between communities of care and the shared responsibilities at times for the care of cultural heritage, which is all too evident in the context of World Heritage sites in the UK.
This chapter focuses on the everyday. It considers how responsibility for the everyday, quotidian care of cultural heritage is assumed or allocated and the form that this takes. It analyses how care is translated into access, preservation and care of collections and places and how risk is managed when access has the potential to harm the long-term future of cultural heritage. This chapter analyses the ways in which access and preservation are supported, through financial support as well as in statutory provisions; it analyses the duties of care placed on custodians of cultural heritage and the role played by standard-setting.
The book concludes on a note of hope. The UK’s legal and non-legal landscape is often fragmented, but nevertheless facilities the efforts of communities of care, who care about cultural heritage, to care for it. This chapter sets the book in the context of being the start of a conversation about care of cultural heritage with a hope to expand the concept more widely in the future.
The focus of this introductory chapter is on identifying the importance of cultural heritage; the chapter thus addresses the fundamental questions about why communities care about cultural heritage.To this end, the chapter examines the search for the elusive definition of what cultural heritage is. By treating cultural heritage as an intangible concept one can focus on the value of cultural heritage to different people, rather than on its physicality as the subject of property; the human dimension and common features of cultural heritage of all types are therefore explored. There are clearly different ways in which groups value cultural heritage and this can change over time. The chapter identifies the areas of contestation and challenge regarding cultural heritage which lead to difficult questions that law and non-law initiatives need to address. The participation of communities as well as experts in decision-making is key to addressing some of these difficult questions. The chapter also addresses matters of terminology and methodology.
This chapter begins by exploring the causes of the uneasy relationship between cultural heritage and law and the relationship that has developed between law and other non-law initiatives to care for cultural heritage in the UK. In developing an integrated approach to the care of cultural heritage, by considering both legal and non-legal instruments, the terminology of ‘nested practices of care’ (drawn from the work of Joan Tronto) is adopted. These different practices of care form the corpus of study for this book and demonstrate the varied way in which care is provided in the UK. In addition to cultural heritage frameworks consisting of multiple nested practices, other sources of law and non-law dealing with general principles provide care and are therefore treated as nested practices of care. The analysis adopted in this book does not lose sight of the hierarchy of norms and enforceability of the different legal and non-legal instruments, but nevertheless does treat these different elements as contributing to the communities of care across the UK.
A key element of the notion of caring is the impetus to protect from harm. Harm is taken to include not only physical harm but also harm to the intangible elements to cultural heritage, including the association that might exist between an object, place or person. This chapter analyses how the UK law and non-law initiatives translate the concept of caring for heritage into duties on communities to protect cultural heritage from harm, or to respond to the risk of harm. This includes precautionary care, where policies and procedures are put in case, just in case they are needed in the event of war or conflict. Preventative care involves being alert to future potential risks and seeking to guard against these by prohibiting certain harmful activities (or at least subjecting them to scrutiny). The chapter also considers reactive care, where efforts are made in response to an actual or imminent risk of harm. It is recognised that often harm cannot be entirely averted and so the terminology of navigating harm is used. For that reason, where harm is inevitable, measures need to be in place to mitigate the effects of harm and these are considered.
This chapter explores the potential loss of cultural heritage objects to overseas purchasers and the apparent loss of public access to these objects. This is in the context of deferring the granting of licences for the export of ‘national treasures’ to permit time for public institutions to raise money to purchase the objects and prevent them from being exported abroad. The way in which the concept of ‘nation’ is constructed is analysed as well as how far other nations which may also have a connection with the object are considered. Does the ‘nation’ have a voice or is reliance placed on the expert advisor and the panel of independent experts who advice the Secretary of State at the exclusion of the views of communities or ‘the public’? The chapter explores what exactly the cultural heritage object is being saved from; frequently the trope of the American collector or the ‘Los Angeles museum’ is deployed when seeking to keep objects within the UK’s borders. The chapter considers how far such a system, which focuses primarily on the national community of care, represents appropriate care of cultural heritage.
This chapter analyses how communities of care challenge the status quo of who possesses cultural heritage; it focuses on the way in which the notion of caring for extends across the generations to claims made by the descendants of past owners, communities of origin or states and the multivocality in decision-making. Frequently the question has been asked: who owns cultural heritage? But it is more helpful to consider whether there is a reason to challenge the status quo and to analyse how decisions are made about the appropriate course of action to take. Many UK national museums have prohibitive governing statutes preventing them from acceding to repatriation requests (although these have been eased in the context of Nazi Era spoliation and some human remains). In some cases, a defensive stance is taken to challenges which represents paternalistic care.Some individual museums which have faced repatriation claims in the past for human remains or other cultural heritage objects have developed their own policies and processes in response to this which represents dialogic care.
This chapter defines care in the context of cultural heritage, drawing on the work of Joan Tronto, who treats care as both a disposition and a process. Central to this is the notion that care represents how people care about cultural heritage, but also the action of caring for it. Given the multitude of communities that care about, and care for, cultural heritage, it is clear that care is relational in nature. Building on the work of other academics who have analysed the nature of care, this chapter applies these to the context of cultural heritage and identifies the central elements of care as (a) developing and sustaining relationships; (b) acknowledging and assuming responsibilities; and (c) identifying and maintaining the appropriate care in the circumstances and revisiting this regularly. The need for caution with the concept of care is addressed, in particular to ensure that care is not paternalistic. Any system of care needs to build in space for revisiting the current allocation of care to determine whether it remains appropriate.
This book explores how cultural heritage and its care are translated in UK law and non-law instruments. It analyses how communities of care look after cultural heritage because they care about it. These communities include the international and national community, national and local governments, courts, professional bodies, institutions such as museums as well as community groups. 'Care' refers to the varied ways in which communities engage with cultural heritage to maintain it, sustain relationships about it and with it, use it and provide access to it, with a view to passing it on to future generations. The book also assesses how far these nested practices of care assist communities of care in providing respectful, empathetic and dialogical care to navigate harm to cultural heritage. It will be of interest to scholars of cultural heritage studies across disciplines, including law, sociology and anthropology, as well as policymakers and practitioners in cultural heritage management.
The Improving Access to Psychological Therapies (IAPT) programme aims to provide equitable access to therapy for common mental disorders. In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. However, limited research examines IAPT pathways to understand whether and at which points such inequalities may arise.
Methods
This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Routine data were collected on service user characteristics, referral source, assessment and treatment receipt from 85 800 individuals referred to South London and Maudsley NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Multinomial and logistic regression analysis was used to assess associations between ethnicity and referral source, assessment and treatment receipt. Missing ethnicity data (18.5%) were imputed using census data and reported alongside a complete case analysis.
Results
Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services. Black Caribbean, Black Other and White Other groups are more likely to be referred through community services. Almost all racial and minority ethnic groups were less likely to receive an assessment compared to the White British group, and of those who were assessed, all racial and ethnic minority groups were less likely to be treated.
Conclusions
Racial and ethnic minority service users appear to experience barriers to IAPT care at different pathway stages. Services should address potential cultural, practical and structural barriers.
Harassment and discrimination in the National Health Service (NHS) has steadily increased over the past 5 years with London being the worst performing region. There is a lack of data and research on the impact this is having on staff health and job satisfaction. Such data are necessary to inform the development of effective workplace interventions to mitigate the effects these experiences have on staff.
Aims
Examine the impact of harassment and discrimination on NHS staff working in London trusts, utilising data from the 2019 TIDES cross-sectional survey.
Method
In total, 931 London-based healthcare practitioners participated in the TIDES survey. Regression analysis was used to examine associations between the sociodemographic characteristics of participants, exposure to discrimination and harassment, and how such exposures are associated with physical and mental health, job satisfaction and sickness absence.
Results
Women, Black ethnic minority staff, migrants, nurses and healthcare assistants were most at risk of discrimination and/or harassment. Experiencing either of the main exposures was associated with probable anxiety or depression. Experiencing harassment was also associated with moderate-to-severe somatic symptoms. Finally, both witnessing and experiencing the main exposures were associated with low job satisfaction and long periods of sickness absence.
Conclusions
NHS staff, particularly those working in London trusts, are exposed to unprecedented levels of discrimination and harassment from their colleagues. Within the context of an already stretched and under-resourced NHS, in order to combat poor job satisfaction and high turnover rates, the value of all healthcare practitioners must be visibly and continuously reinforced by all management and senior leaders.
Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population.
Methods
Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017.
Results
We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73–12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60–4.87), chronic pain and depression (HR 4.14; 95% CI 3.69–4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36–4.95).
Conclusions
Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.
Evaluations of primary healthcare co-located welfare advice services have been methodologically limited.
Aims
To examine the impact and cost-consequences of co-located benefits and debt advice on mental health and service use.
Method
Prospective, controlled quasi-experimental study in eight intervention and nine comparator sites across North Thames. Changes in the proportion meeting criteria for common mental disorder (CMD, 12-item General Health Questionnaire); well-being scores (Shortened Warwick and Edinburgh Mental Well-being Scale), 3-month GP consultation rate and financial strain were measured alongside funding costs and financial gains.
Results
Relative to controls, CMD reduced among women (ratio of odds ratios (rOR) = 0.37, 95% CI 0.20–0.70) and Black advice recipients (rOR=0.09, 95% CI 0.03–0.28). Individuals whose advice resulted in positive outcomes demonstrated improved well-being scores (β coefficient 1.29, 95% CI 0.25–2.32). Reductions in financial strain (rOR=042, 95% CI 0.23–0.77) but no changes in 3-month consultation rate were found. Per capita, advice recipients received £15 per £1 of funder investment.
Conclusions
Co-located welfare advice improves short-term mental health and well-being, reduces financial strain and generates considerable financial returns.