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Without the advocate labour carried out by service users and their accomplices, the current crisis in trans healthcare would be far deeper, Amy Cohn writes

”Wages for Advocacy” is the acknowledgement that our labour is just as – if not more – important than the formal labour of administrators and clinicians to the provision of trans healthcare. Those systems necessitate and demand our labour, and it is those systems – not service users – that should bear the cost of it.

The caring component – that is the overwhelming part – of trans healthcare is almost exclusively underpinned by our networks and peer groups. In calling for Wages for Advocacy we recognise – and wholeheartedly echo – longstanding demands that caring labour be remunerated.

The Economics

Before you reach for your copy of Kapital, let’s clarify. A demand for wages isn’t a demand to subsume all informal labour into the wage relation – much as we might welcome its subsequent inevitable collapse. Rather, it’s an acknowledgement that we can’t eat, sleep upon, or clothe ourselves in the moral highground.

That is to say: fuck you, pay me.

If your departmental budget doesn’t have a line item for voluntary hours worked, your figures are a fantasy. If your patient pathway lacks boxes and arrows for mutual-aid, it’s pure fiction.

A demand for wages makes the value of our work legible in a form that can be understood by people whose lives don’t depend on it: cash.

And if not even a single penny changes hands, accounting for how many trans hours go into undoing the mistakes of paid staff should at least hint at where things are going wrong.

The Contradictions

Professionalisation

As the NHS concedes the importance of what it calls “voluntary sector organisations” (i.e. vehicles for advocate labour, or disingenuous imitations thereof), there’s an increasing drive to standardise and professionalise advocate labour. Resist it.

(The topic of how is another discussion entirely. But we can)

If professional choreography were going to fix the crisis, there would never have been a crisis. It’s precisely our independence from that professionalism that allows us to disrupt its operation for the better.

Advocate labour should be accountable to the people it serves. Professional regulation, by contrast, is accountability to power. Ideally those would be one and the same thing, but in such a circumstance “professionalism” (the elevation of a distinct class with unique command over the Right Way of Doing Things) would lose all meaning.

(Wages for Digression? Please)

Wages in Perpetuity

So how does power hold labour accountable? Wages! Which leaves us with a bit of a problem. While our labour is sometimes optional on an indvidual level, someone has to do it. And continuing to do it for free is crap.

But money changing hands changes the relationship between people. If one of us is getting paid for advocacy, it’s in our interest to keep getting paid. There are two main ways we do that:

1. Avoiding any action that might incline someone to sack us.
2. Avoiding entirely solving the problem so that there’s always more of the problem available to pay us for solving.

How we reconcile those points with the demand for wages is an open question – but that’s our problem to solve, and shouldn’t deter us from making the demand.

Who Blinks First?

There’s an elephant in the room whenever we discuss advocate labour – and the systems that necessitate it – with administrators and clinicians. Our lives, and the lives of our communities depend on us being in that room. Theirs don’t.

To add insult to injury, it’s they who decide who speaks, and they who are remunerated for their time.

We will never stop advocating and caring for our peers. We will continue to perform advocate labour for free for some who need it.

(The assumption that everyone who needs advocate support can or does access it is a dangerous one. It’s not accessible and we severely lack the capacity to provide it)

So how do we maintain a demand for Wages for Advocacy on that basis? They know we can’t strike, as such. Developing alternate tactics is vital in securing that demand.

The PreConditions

So what needs to be in place for our labour to be recognised? First and foremost, we ourselves must recognise and value it as such. Our advocacy is skilled, it is valuable, and it is necessary.

The confidence in that belief must be the starting point for all interactions with the systems that necessitate our labour. We are not equal partners with formal staff. (Under patient-worker control things might of course be different…)

Those of us who have secured material support for our labour – be that as wages, access to premises, whatever – need to share that knowledge. Every advocate should know (or have unmediated access to knowledge of) how to navigate these systems, from asserting the value of their labour through to filing a tax return.

Of course individual demands remain individual. Winning recognition and remuneration is a collective fight. Some of us can’t afford to give our labour freely. Some of us can. The latter must never be used as an excuse – and must never let themselves be used as an excuse. We need a collective position of negotiation, and collective red lines.

Next Steps…

This isn’t a concrete set of answers as to how, why, and in what form we should secure Wages for Advocacy, but it hopefully provides a basis for considering those questions.

Develop these ideas, rubbish them, reformulate them. You might decide not to demand wages from the systems you pay your labour into. But that should be a conscious decision – and you should support those who do.

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