I am currently working as a Research Fellow within the School of Health Sciences. Here I am based in the Workforce, Organisation and Wellbeing (WOW) research theme. The vision of this group is to lead high quality research and educational innovation that will inform practice and support the wellbeing of the healthcare workforce to ensure optimal staff and patient outcomes.
I work closely with Professor Jill Maben in Health Sciences on an NIHR study that is being led by Professor Aled Jones at Cardiff University and which is evaluating the implementation of a new role in NHS England designed to support staff who wish to raise concerns about the quality of patient care. Together with a research associate at Cardiff University, I have been conducting ethnographic research in acute and mental health trusts across NHS England to understand out how this role is being introduced and whether it supports staff to speak up about their concerns.
I am an anthropologist with an interest in health and care settings in developed countries. I am particularly fascinated by the kinds of social relations that are fostered in these environments and what this might indicate about what it means to be human more generally. As an anthropologist, I work ethnographically and this allows me to spend long periods of time with people, to focus on the minutia of their everyday lives and social relations with a view to understanding how these often seemingly mundane encounters reveal something more fundamental about our lived experiences of the world.
At the University of Surrey I am informally mentored by Dr Hrafn Asgeirsson, a Senior Lecturer in Philosophy and Law, whose expertise in ethics and philosophy provides guidance and insight around the complexities relating to personhood and what it means to live well for people with learning disabilities, as well as other individuals with cognitive impairments who require care and support for the duration of their lives.
Areas of specialism
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
My individual work to date has focused on social care support for adults with learning disabilities and the social and political rhetoric that often underpins public representations of how people with learning disabilities can live well. Amongst developed countries, this rhetoric is rooted in liberal philosophical traditions in which autonomy and self-determination are highly valued and are the cornerstone of these societies. I seek to explore and understand how these values are played out in the lives of people whose autonomy and self determination is limited by their cognitive and/or physical impairment(s).
My doctoral research comprised an ethnographic study of how government policy is experienced by people with learning disabilities and the staff supporting them in everyday social care support settings in the UK. I was particularly interested in policies which focus on empowering people with independence and inclusion and sought to explore how these goals sit in relation to the fact that people with learning disabilities have cognitive - and possibly physical - impairments, meaning that they are in varying ways reliant on others for support with aspects of their lives. I found that there are limits to learning disability policy and practice which is organised around empowerment approaches because these approaches are at risk of discounting the needs that people experience as a result of their condition(s). Further to this, I also found that in focusing heavily on the importance of professional boundaries in support settings, everyday care providers are unintentionally at risk of depriving people with learning disabilities of important emotional connections with others around them.
I am interested in experimenting with the medium of film in research, particularly in the context of working with people with cognitive impairments who can encounter difficulties in expressing their thoughts and experiences verbally. In July 2018 I was awarded a competitive bursary from Methods@Manchester, University of Manchester to take part in the Filmmaking for Fieldwork (F4F) Summer School. This is a hands-on course providing an understanding of the foundations of ethnographic documentary filmmaking for anthropologists. I am keen to incorporate filmmaking into future research endeavours and I am open to potential collaborations with academics and non-academics interested in applying this approach in innovative ways.
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’.
Postgraduate research supervision
Together with Professor Cath Taylor and Professor Jill Maben in the School of Health Sciences, University of Surrey I co-supervise two MSc Nursing student on the Dissertation module (NUR112).
Secondary supervisor to Susan Blacker, University of Gilbratar, PhD study: Are social defences present in small residential learning disability services and can the reverie research method detect these?
I welcome enquires from students seeking supervision in areas including:
- Anthropology of health and social care
- Applied health and social care research
- Ethnographic methods
- Qualitative research with people with learning disabilities
- Ethical and philosophical tensions in the care of people with disabilities.
June 2010: Training and research dissemination workshop for clinical staff at Addenbrookes Hospital, Cambridge.
Oct 2013: Teaching session to Social Pedagogy students, Department of Health and Society, University of Malmö, Sweden.
2015-2016: Teaching assistant for the Chinese stream for the MA in Interpreting and Translating (MAIT) (THPL-AFM31), University of Bath.
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 Disability. https://www.tandfonline.com/doi/full/10.3109/13668250.2020.1799161
Banks, C.A. (2019). Professional distance versus human touch. Community Living. https://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
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.
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.
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.
Banks, C.A. (2015). Lifting the veil on concealed vulnerability: the impact of the ethnographic experience. Medical Anthropology Theory. http://www.medanthrotheory.org/read/5149/lifting-veil
Banks, C. (2013). Social Care Support within UK-Based Supported-Living Homes for Adults with Intellectual Disabilities: A Qualitative Interview Study of Support Workers' Accounts of the Nature of Everyday Care and Support. SAGE Research Methods Cases. dx.doi.org/10.4135/978144627305013501439
Redley, M., Banks, C., Foody, K., and Holland, A. (2012). Healthcare for men and women with learning disabilities: understanding inequalities in access. Disability & Society, 27(6), pp. 747–759. https://doi.org/10.1080/09687599.2012.673080
Banks, C. (2012). Interpreting and ‘doing’ empowerment and protection care imperatives in a supported-living environment for intellectually disabled adults: findings from an ethnographic study. Suomen Antropologi: Journal of the Finnish Anthropological Society, 37(3), pp.75-88. https://researchportal.bath.ac.uk/en/publications/everyday-ethnography-interpreting-and-doing-empowerment-and-prote
Banks, C. A., K. Foody, M. Redley and A. J. Holland 2010. Report to the Cambridgeshire Learning Disability Partnership Board: Understanding the Access and Provision of Healthcare to Adults with Learning Disabilities in Cambridgeshire. Cambridge: Cambridgeshire County Council.
Banks, C. and Redley, M. (2009). IMCAs in their second year: the experience of key stakeholders. The Second Year of the Independent Mental Capacity Advocacy Service: 2008-2009, London: Department of Health, pp. 44-54.