Honour thy neighbour

It’s easier than you think to nominate someone for an honour, so why aren’t more physiotherapists being recognised? Dame Jane Dacre, chair of the healthcare honours committee, tells Tamsin Starr why and what we can all do to fix it

Dame Jane Dacre
Dame Jane Dacre, chair of the healthcare honours committee [Photos: David Harrison]

When the nation sent news it was bestowing one of the greatest honours at its command on Jane Dacre, it was mistaken for a tax bill.

Dame Jane – as she was soon to be – explains: ‘The envelope was very official looking, so my husband thought it was from the tax office, opened it and thought, “What?!” He left a message for me but I was having a really busy day so didn’t ring him for hours. When we finally spoke I was shocked, surprised but very pleased.’

It is typical of the modest and self-effacing Dame Jane (‘just Jane’) that she didn’t view her many achievements as automatically qualifying her for an honour. She is now on a mission to ensure recognition for others – including allied health professionals - as chair of the honours committee for health and social care nominations.

A rheumatologist by training, the past president of the Royal College of Physicians led the 2018 gender pay gap in medicine review, was made a Dame (DBE) the same year, for services to medicine and medical education, and is the recipient of numerous national and international prizes.

She credits her success to her upbringing, and good old-fashioned graft. ‘My father was a very wonderful, impressive person, so at age 12 I decided to be a doctor for no better reason than to do what he did,’ she says. ‘From there, I’ve worked hard and been lucky. But the older I get the more I realise the world is easier for some people than others.’ 

As a result, she’s now very vocal about tackling equity, diversity and belonging in healthcare and she believes the careers pipeline that ends with national recognition at Buckingham Palace, has many weak points for women, people from ethnic minorities, and those with disabilities or from disadvantaged backgrounds. While the honours system itself also needs to be more representative too.

‘We are not where we need to be on ethnic and gender diversity,’ she says. On her review into the medicine pay gap, her message is stark. ‘We have the evidence for the causes of the gender pay gap that are tricky to solve but there are some things we can do relatively easily. They just need to be done.’ And, she adds, other evidence bases may help to provide answers to reducing other pay gaps.

She certainly knows what it’s like to be a woman in a patriarchal structure, training when there was a maximum quota of female students still in place, and being ‘the only woman around the table’ regularly throughout her career.  And she cares less nowadays about the opinions of those who’d rather she didn’t speak up. ‘People think, “stroppy old bat, what’s she on about now?” But I always reply, “it isn’t my opinion, it is data and evidence that shows this inequality, and it’s up to organisations to fix the problems”.’

Her senior status drives her to help deserving people overlooked in traditional structures like health and social care. And one of the principal ways is leading a committee representing the full range of health and social care professions – CSP chief executive Karen Middleton is a member – to decide on the recipients of Royal Honours. 

Jane believes receiving an honour offers much more than a day out at the palace. The recognition can inspire and empower recipients to further contribute to their profession’s future, raising its profile and increasing members’ power to bring about change.

‘It’s not why you do the work, but it does makes you feel valued and that someone has noticed you are working really hard and they like it. That is a big part of recognition.’ 

But physiotherapists’ patient-centred approach can be a disadvantage. ‘The NHS culture is supportive and very nice for patients as long as it works, but it means people who are doing really good jobs and who deserve to be valued are potentially not recognised, or are overlooked for higher office, and are overlooked for honours.’

Dame Jane praises Prof Middleton for bringing a ‘huge sea change’ in increasing the number of AHPs put forward.

We are focused on equity, diversity and inclusion when we judge awards and want a breadth of people reflecting society,’ says Dame Jane. ‘However, with AHPs, and people from underrepresented groups, we can’t make awards if we don’t have the nominations.

A surprisingly high number – two-thirds – of nominations are successful. More than 2,000 people get a gong every year, with half being nominated by members of the public and the rest by government departments. Nominations can be made on paper, via email or online. Though public nominations can be made any time (there is no deadline as such), the cut off for each round is usually about 10 months in advance of the ceremony. 

For health nominees, the committee secretariat will do a first sift, filtering out entries that are too short, unclear or for someone simply doing the day job. 

So what are they looking for in a nomination? ‘Essentially it’s added value - it’s people who have very clearly gone above and beyond to do something that’s had an impact.’

This could be a physiotherapist working in a small hospital who, for example, was redeployed into a new role and team during Covid-19, then devised and implemented a change programme that got adopted nationally, creating a new and better way of working. 

‘We’d discuss what this person has achieved – they’ve changed the way something has happened nationally and they’ve just done it by hard work, by inspiration, by bringing people with them and being terribly collaborative.’

As chair, she is there to listen and achieve consensus. However, the tantalising glimpse of how she marshals disagreements is a telling reflection of her egalitarian bent. ‘There may be a person in a very powerful job who has a very swanky title at a prestigious organisation such as a big university. There used to be an expectation that people in those jobs get a high honour. However, while we may say they’ve done well to get into the job, we will look at whether they have really gone over and above working at that level in a way that deserves an honour.’ 

Those who view the honours as elitist would be heartened to see Dame Jane light up when urging Frontline readers to nominate their colleagues. ‘The honours system is so keen to be more representative – but we need the nominations in order to change the system.

We need more people nominated from underrepresented groups and more women! Especially women from minority backgrounds. 

‘We don’t want worthy people from diverse backgrounds to be overlooked as no one thought to nominate them or thought “People like us don’t get honours”.’

Just to drive home the point that more people need to apply, she shares tips on how to write a nomination. ‘You don’t need to be the best writer in the world, there is guidance on the website. However, the nominations do need to ring true, and paint a picture. 

‘Nominations that succeed are the ones that come across as being honest, that have evidence and facts rather than hyperbole, and give you some kind of insight into the person and their altruism.’ 

This may well be a springboard for some reflective practice, even if on behalf of a colleague. ‘We’re all good at looking at the struggles we see ahead, we’re not so good at looking back at where we’ve come from,’ says Dame Jane. ‘Writing a nomination gives you the opportunity to do that.’

And together, we really can start to challenge some of those past-their-sell-by-date traditions. ‘I’m an optimist so I wouldn’t be doing this role if I didn’t think it wouldn’t achieve change. The honours system is keen to be seen as being more representative but it all starts with people reading this thinking that their colleague is worthy of a nomination. I’m just here to help.’

CSP chief executive Karen Middleton said: ‘I’ve been on the health honours committee for some time now. I applied for it because I believe passionately in recognition and reward and also, having been on the civil service side of things, wanted to see if I could improve the diversity of those put forward and then honoured. ‘Jane, our new chair, is equally passionate.’

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