Dr Carys Banks


Research Fellow
Ph.D., M.Res., M.A., B.Soc.Sc. (Hons).

Biography

Areas of specialism

Social Anthropology ; Ethnography; Health and Social Care

University roles and responsibilities

  • Member of Workforce, Organisation and Wellbeing (WOW) research theme, School of Health Sciences, University of Surrey.
  • Member of Long-Term Conditions research cluster, School of Health Sciences, University of Surrey.
  • ECR Rep, School of Health Sciences and ECR rep for Faculty of Health and Medical Sciences, University of Surrey.
  • Member of Equality, Diversity and Inclusion ECR group, University of Surrey

    Previous roles

    January 2009 - January 2011
    In recognition of inequalities experienced by people with learning disabilities in NHS and social care services, this project sought to explore how these inequalities were being played out within a group of services in the East of England. The primary aim was to understand how inequalities might be reduced by determining the roles and responsibilities of all stakeholders involved in this service provision. This was a mixed methods project on which I was the primary data collector.
    University of Cambridge
    August 2013 - December 2013
    During my doctorate I was awarded ESRC Overseas Institutional Visit and Overseas Fieldwork funding to conduct ethnographic fieldwork in a learning disability social care service in Malmö, Sweden. I designed this project and sought collaboration with Malmö Högskola (University) and Malmö Stad (municipality) This work enabled me to develop a broader understanding of learning disability support beyond the UK. The funding was originally awarded for three months, but due to the success of the project a further two months of Overseas Fieldwork funding was awarded by ESRC.
    University of Bath, Malmö Högskola, Malmö Stad
    May 2015 - August 2015
    Towards the end of my doctorate I was awarded further funding from ESRC to conduct a placement with a policy team at the Local Government Association and NHS England who had been tasked through the Transforming Care programme to produce a service model for commissioners of health and social care service for people with learning disabilities, autism and behaviour that challenges: https://www.england.nhs.uk/wp-content/uploads/2015/10/service-model-291015.pdf. Following the end of this placement, I was employed by the Local Government Association as an external policy consultant.
    University of Bath, Local Government Association

    Business, industry and community links

    Research

    Research interests

    Indicators of esteem

    • My doctoral research was awarded the 2016 Radcliffe Brown/Sutasoma Award from the Royal Anthropological Institute (RAI). This is ‘a starred award and given to students of exceptional quality in recognition of doctoral research that is of potentially outstanding quality and likely to make an important contribution to social anthropology’.

      Supervision

      Postgraduate research supervision

      My teaching

      My publications

      Highlights

      Banks, C. (2021). Loneliness in the lives of people with learning disabilities: where are we going wrong? Academia Letters, Article 264. https://doi.org/10.20935/AL264

      Adams, M., Kelly, D., Maben, J., Mannion, R., Banks, C., & Jones, A. (2020). How do “heroes” speak up? NHS staff raising concerns during covid-19. [Online]. blogs.bmj.com: BMJ Publishing Group. https://blogs.bmj.com/bmj/2020/08/11/how-do-heroes-speak-up-nhs-staff-raising-concerns-during-covid-19/

      Jones, A., Blake, J., Banks, C., Adams, M., Kelly, D., Mannion, R., & Maben, J. (2021). Speaking up about bullying and harassment in healthcare: reflection and analysis on worker well-being and patient safety following the introduction of an innovative new role in NHS England. In Montgomery A (ed.). Connecting Healthcare Worker Well-Being, Patient Safety and Organisational Change: The Triple Challenge. Aligning Perspectives on Health, Safety and Well-Being, pp. 145-161. Springer Publishing. https://link.springer.com/chapter/10.1007%2F978-3-030-60998-6_10

      Banks, C.A., D. Wainwright, R. Gooberman-Hill. An ethnography exploring the limits of dedifferentiation in the lives of adults with learning disabilities. Special Issue in Journal of Intellectual and Developmental Disabilityhttps://www.tandfonline.com/doi/full/10.3109/13668250.2020.1799161

      Banks, C.A. (2019). Professional distance versus human touch. Community Livinghttps://www.cl-initiatives.co.uk/professional-distance-versus-human-touch/

      Banks, C.A. (2019). Care in the 21st century: what can mainstream services learn from the Camphill movement? Alliance for Camphill. https://www.allianceforcamphill.com/post/manage-your-blog-from-your-live-site

      Banks, C.A. (2019). Analysing Ethnographic Research Methods: The Importance of Retaining Immersion During the Analytic Process Using Research From UK-Based Learning Disability Social Care Settings. SAGE Research Methods datasets. https://dx.doi.org/10.4135/9781526495990

      Banks, C.A. (2018). Sometimes people with learning disabilities need a hug – but support staff aren’t meant to give them. In: The Conversation. https://theconversation.com/sometimes-people-with-learning-disabilities-need-a-hug-but-support-staff-arent-meant-to-give-them-100709

      Banks, C.A. (2018). Working through ethical and emotional concerns and uncertainties in ethnographic research with people with learning disabilities. In Ethnographies and Health: Reflections on Empirical and Methodological Entanglements. E. Garnett, J. Reynolds & S. Milton (eds.). Palgrave macmillan. https://doi.org/10.1007/978-3-319-89396-9_2

      Publications

      Lada Timotijevic, Carys Banks, Patrice Rusconi, Bernadette Egan, Matthew Peacock, Ellen Seiss, Morro Touray, Heather Gage, C. Pellicano, G. Spalletta, F. Assogna, M. Giglio, A. Marcante, G. Gentile, I. Cikajilo, D. Gatsios, S. Konitsiotis, D. Fotiadis (2020)Designing a mHealth Clinical Decision Support System for Parkinson’s Disease: A Theoretically Grounded User Needs Approach, In: BMC Medical Informatics and Decision Making2034 BMC (Springer Nature)

      Background: Despite the established evidence and theoretical advances explaining human judgments under uncertainty, developments of mobile health (mHealth) Clinical Decision Support Systems (CDSS) have not explicitly applied the psychology of decision making to the study of user needs. We report on a user needs approach to develop a prototype of a mHealth CDSS for Parkinson’s Disease (PD), which is theoretically grounded in the psychological literature about expert decision making and judgement under uncertainty. Methods: A suite of user needs studies was conducted in 4 European countries (Greece, Italy, Slovenia, the UK) prior to the development of PD_Manager, a mHealth-based CDSS designed for Parkinson’s Disease, using wireless technology. Study 1 undertook Hierarchical Task Analysis (HTA) including elicitation of user needs, cognitive demands and perceived risks/benefits (ethical considerations) associated with the proposed CDSS, through structured interviews of prescribing clinicians (N=47). Study 2 carried out computational modelling of prescribing clinicians’ (N=12) decision strategies based on social judgment theory. Study 3 was a vignette study of prescribing clinicians’ (N=18) willingness to change treatment based on either self-reported symptoms data, devices-generated symptoms data or combinations of both. Results: Study 1 indicated that system development should move away from the traditional silos of ‘motor’ and ‘non-motor’ symptom evaluations and suggest that presenting data on symptoms according to goal-based domains would be the most beneficial approach, the most important being patients’ overall Quality of Life (QoL). The computational modelling in Study 2 extrapolated different factor combinations when making judgements about different questions. Study 3 indicated that the clinicians were equally likely to change the care plan based on information about the change in the patient’s condition from the patient’s self-report and the wearable devices. 3 Conclusions: Based on our approach, we could formulate the following principles of mHealth design: 1) enabling shared decision making between the clinician, patient and the carer; 2) flexibility that accounts for diagnostic and treatment variation among clinicians; 3) monitoring of information integration from multiple sources. Our approach highlighted the central importance of the patient-clinician relationship in clinical decision making and the relevance of theoretical as opposed to algorithm (technology)-based modelling of human judgment.

      I conducted ethnographic research exploring how UK-based learning disability government policy, which focuses on improving people’s lives through a range of social, political and economically driven aims, impacted everyday relations in support settings. Whilst conducting the ethnography, I was confronted with a series of concerns and uncertainties relating to clarity over my positionality as a researcher. This led me to consider whether, through this approach, I was replicating similar power imbalances I was observing to be taking place between people within the research context. Although this brought to the fore the ethical riskiness of using ethnography with people with learning disabilities, through reflection, I was able to develop a deeper interpretative understanding of the power dynamics being experienced in these health-related care contexts.

      A Jones, J Blake, C Banks, M Adams, D Kelly, R Mannion, J Maben (2021)Speaking up about Bullying and Harassment in Healthcare: Reflections Following the Introduction of an Innovative “Speak Up” Role in NHS England, In: Connecting Healthcare Worker Well-Being, Patient Safety and Organisational Change125(3)pp. 145-161 Springer International Publishing

      Healthcare organisations reap significant benefits when workers’ concerns are adequately listened and responded to, including improved patient safety, reduced costs and improved staff experience. Although many concerns are dealt with satisfactorily, compelling evidence suggests that problems of silence (where employees do not speak up) and deafness (where organisations do not hear concerns or act) remain pervasive worldwide. In the English National Health Service (NHS) the response to these problems includes numerous policy initiatives and the introduction in 2016 of the “Freedom to Speak Up Guardian” (FTSUG) role. This globally unique role is described as potentially leading to huge improvements in the way staff concerns are handled and responded to leading to improvements in organisational learning and patient safety. Following their introduction thousands of NHS staff have already spoken up via FTSUGs. The majority of FTSUGs time is spent on bullying and harassment concerns, rather than direct patient safety concerns, which appears to have confounded FTSUGs’ and others’ expectations. This chapter opens by describing the background to the development of the FTSUG role. We then outline the literature on bullying and harassment; its shocking prevalence within healthcare workplaces and the damaging consequences of bullying borne by organisations and individual staff and patients. We also discuss our analysis of semi-structured interviews (n = 87) undertaken with FTSUGs, which illustrates the realities of dealing with colleagues’ concerns about bullying and harassment and how these realities are often overlooked in national, regional and local workplace guidance and training materials currently available to support the implementation of the role.

      Mary Adams, Daniel Kelly, JILL MABEN, Russell Mannion, CARYS BANKS, Aled Jones (2020)How do “heroes” speak up? NHS staff raising concerns during covid-19, In: BMJ BMJ Publishing Group
      Aled Jones, JILL MABEN, Mary Adams, Russell Mannion, CARYS BANKS, Joanne Blake, Kathryn Job, Daniel Kelly (2021)A mixed methods evaluation of the implementation of 'Freedom to Speak Up Guardians' in NHS England Acute Trusts and Mental Health Trusts, In: Health Services and Delivery Research(in press) NIHR Journals Library

      Background: The introduction of “Freedom to Speak Up Guardians” (FTSUGs) into every NHS England Trust was intended to support workers and Trusts to better raise, respond and learn from speaking-up concerns. However, only broad guidance was provided on how to implement the role. As a result, there is the potential for important local differences to emerge as the role is implemented across England. Objectives: The overall aim of this study was to better understand the implementation of Guardians in Acute Trusts and Mental Health Trusts. Design: The FTSUG role was conceptualized as a complex intervention consisting of several interacting and interlocking components spanning the macro level (national organisations), the meso level (individual Trusts) and micro level (employees, teams, wards/units). A mixed methods study was designed, consisting of three work packages: (1) a systematic narrative review of the international literature regarding interventions promoting ‘speaking-up’ by healthcare employees; (2) semi-structured telephone interviews with Guardians working in Acute Hospital Trusts and Mental Health Trusts; (3) qualitative case studies of FTSUG implementation, consisting of observations and interviews undertaken in four Acute Trusts and two Mental Health Trusts. Interviews were also undertaken with national stakeholders. Setting: Acute Trusts and Mental Health NHS Trusts in England Participants: Work package 2: FTSUGs (n=87) were interviewed. Work package 3: 116 interviews with key stakeholders involved in pre and early implementation decision-making and workers who had spoken-up to the Guardian and national stakeholders. Results: Wide variability was identified in how the Guardian role had been implemented, resourced and deployed by NHS Trusts. The role title “Freedom to Speak Up Guardian” is best considered an umbrella term, under which multiple versions of the role exist simultaneously across England. Any comparisons of Guardians’ effectiveness are only likely to be possible, or meaningful, when this variability is properly accounted for. Many FTSUGs identified how a lack of available resources, especially time scarcity, negatively and significantly impacted on their ability to effectively respond 3 to concerns and on their opportunities to collect, analyse and learn from speaking-up data and more generally the extent to which they developed their role and speak-up culture. Limitations: It is possible that those we interviewed were more receptive of FTSUGs, or may have been biased by ‘socially desirability’ and their answers may not always have represented respondents’ true perceptions. Conclusions: Optimal implementation of the Guardian role has six components: 1) establishing early, collaborative and coherent strategy congruent to the values of FTSU fosters the implementation of 2) policies and robust, yet supportive practices 3) informed by frequent and reflexive monitoring of FTSU implementation, which is 4) underpinned by sufficient time and resource allocation, that leads to 5) a positive implementation climate, which is congruent with FTSU values, and best placed to engender positive and sustainable FTSU culture and the well-being of a Guardian.

      Additional publications