Andra Day, Breast Cancer, Autistic Barbie

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Hello, I'm Nuala McGovern and welcome to Woman's Hour from BBC Radio 4. Just to say that for rights reasons, the music in the original radio broadcast has been removed for this podcast. Good morning and welcome to the programme. Well, we're going to hear about, just as you might have been hearing a little in the bulletin there, about a new DNA test that can predict how well some patients with breast cancer will respond to various treatments. We're going to hear all about that.

the details. Also, Andra Day, Grammy Award winning singer, songwriter and actor will be with us in the Women's Hour studio. Andra is in a new movie called Is This Thing On? It's based loosely on the life of the comedian John Bishop. Loved it. It's midlife and marriage in all its glory. There was also an employment tribunal win for a group of nurses from Darlington. We're going to hear about the significance of that case.

Is a new wave of products pushing their social awareness credentials and targeted at women and girls progress or manipulation? And we'll hear from Rebecca. She is a mum of a child with SEND, special educational needs and disabilities, but also a SEND caseworker. She'll tell us about the difficulty of straddling both worlds. You can text us the programme.

Number is 84844. On social media, we're at BBC Women's Hour. Or you can email us through our website. For a WhatsApp message or a voice note, that number is 03700 100 444.

Let us begin with that story that you heard. New research bringing hope to thousands of women in the UK living with secondary breast cancer. A simple blood test will be able to tell how well they will respond to treatment. even before it starts. Now, secondary cancer means it has become incurable and has spread to other parts of the body.

Until now it has been a case of sticking with a drug until there are clear signs that it's not working. This research could mean being moved to a more efficient treatment earlier to talk to us about this. In studio with me is Dr. Essel Brown, a clinical research fellow at the Institute of Cancer Research who worked on this study. It sounds very exciting, Doctor, and welcome. Tell us a little bit more.

Well, thank you very much for having me on to discuss our research today. Essentially, what we did was we use a liquid biopsy in patients with advanced breast cancer on the plasmat trial. Liquid biopsy is a non-invasive way, a blood test. Is it a blood test? Is it another way of saying blood test? It is, yes. So it's a blood test, which we can use to measure CT DNA levels. We can use this to monitor treatment. What is a CT? Circulating tumour DNA.

levels of this is tumor cells that is released from the tumor essentially and we're able to detect this in a blood a simple blood test now normally what we would do to detect this would be to be using a bio These are invasive procedures and they can't always be done. So the use of a liquid biopsy is non-invasive and it gives us a way we can monitor treatment response and detect the levels of circulating tumour DNA.

We used this in this study. Essentially what we did was we looked at levels of this circulating tumour before treatment was started and early on treatment. What we wanted to do was assess if this associated with both how patients responded to the treatment so how their tumours shrank in response to treatment and how long they were able to stay on the treatment with their cancer kept at bay and what we did

From our study, we showed that patients who had a low level of the circulating tumour DNA at baseline were more likely to respond to treatment. Also, very early on treatment, after four weeks, we identified patients who cleared their CT DNA. They had a much better outcomes on treatment and that was cross therapies and multiple subtypes of breast cancer.

So when you talk about CT DNA, just for the layperson as well, and you talk about it as a circulating tumour DNA, is that how we would think about... Cancer in the blood? Absolutely, yes. And normally how we would determine that would be to do an invasive procedure, so an invasive biopsy, for example, a liver biopsy. To take a tissue sample. To take a tissue sample. And again, as I said, particularly...

In patients with advanced cancer, this is not always possible. You know, there are technical issues. Sometimes patients are not well enough. So being able to use this non-invasive liquid biopsy to assess number one for cancer itself and be able to monitor treatment. extremely exciting. So for let's say an estimated 61,000 people that are mainly women with secondary breast cancer

What does this mean? Is it about now or is it about the future? So what is really important is, and I must flag, over the last five to 10 years, our treatments for patients with advanced breast cancer have significantly improved. People are living... much longer with advanced breast cancer. However, there are some patients who will need escalated treatment and may not respond to standard of regard treatment.

So normally what we do is we would scan patients every three months, OK? When they have. When they have, when they're on treatment. So we do CT scans to assess how they're responding to treatment, if the cancer is shrinking, if it's getting bigger, if it's staying the same. by patient symptoms. If they are feeling unwell, we may do a scan at an earlier date.

This test offers us the non-invasive opportunity to be able to assess extremely early on treatment, so just a month into treatment, as to whether these patients are responding to treatment or not. If we do identify that they are not, the CTD and NA levels are not suppressed, it gives us the chance to potentially escalate their treatment or change their treatment. And this overall alpha is...

improved you know personalised therapy for patients with advanced breast cancer. I mean just by that again as a layperson you've knocked a couple of months of waiting off. Absolutely. Which, of course, can be so important. It's so important because, you know, these...

treatments don't come without side effects. So we don't want patients to be on treatments with unnecessary side effects if that treatment is actually not working for them. We want to give these patients the best chance we possibly can and if we need to change their treatment to know that earlier on than just waiting for the scan.

three months time. So I imagine it was people involved in this. It was all... trial purposes? Absolutely, yes. So the plasmat trial was a proof of concept trial in itself. So this was in 2020, this trial looked at using liquid biopsies to match mutations to targeted therapy. So they compared the liquid biopsy to the actual invasive tissue biopsy and they were...

both extremely good at identifying the mutations. And for some mutations the liquid biopsy was even better at identifying these mutations. So that essentially, that trial did show that we could use liquid biopsy to identify mutations. and match patients to this treatment. Our study essentially looked at the levels of the circulating tumour DNA and whether they increased or decreased on treatment and how that corresponded with outcomes. And will this be... purely for those

With secondary breast cancer, how do you see this being used? No, so this trial obviously was an advanced breast cancer, but absolutely there are ongoing trials for patients with early stage breast cancer. So one in particular in the Royal Marsden enrolling at the moment is called tracheaure. This is using the liquid biopsy blood test for circulating tumour DNA in patients with early stage breast cancer who are at a higher risk of recurrence for different clinical pathological reasons.

And if the test becomes positive for circulating tumour DNA, the patient has a CT scan done. If that CT scan shows no signs of metastatic disease or disease that had spread elsewhere, they are randomised to... an escalated therapy on top of their normal hormone therapy or to continue standard of care therapy. And I guess the role of this is to assess whether escalating therapy on the basis of ctDNA presence, so what we term molecular relapse, actually does benefit patients in the long run.

be in the de-escalation of patients in an early stage setting. So a trial... which is nearly open to recruitment in the Royal Mars and Safety EB, is looking at HER2 positive breast cancer patients. So you want to explain what that is? So that is one of the subtypes of breast cancer that expresses the HER2 protein when we look down the mic.

And also triple negative breast cancer, which is another subtype of breast cancer patients, which doesn't express any proteins when they look down the microscope, the pathologists look down the microscope. And essentially what we are doing is looking at these patients after their surgery.

And we know that patients with very early stage HER2 positive and triple negative breast cancers have very good outcomes. So stage one disease. And they don't necessarily need chemotherapy. They are cured essentially from their surgery. However, most people still do get adjuvant chemotherapy.

chemotherapy after surgery in this setting. So what this trial is looking to do is to take CT DNA blood test after surgery. If the patient is positive and the circulated in tumour DNA is seen, then they are given their chemotherapy. as planned. If it is negative, they will not be given their chemotherapy, but they will continue to have serial CTDI blood tests and only be given chemotherapy if that becomes positive. But that sounds to me...

like a huge change. But it is a huge change but studies have shown that these patients do extremely well without chemotherapy and they are. But I suppose like a huge change I mean that in a positive way in the sense that They will have some hard evidence on...

why they don't need to do chemotherapy. Well, this is it, exactly. I think chemotherapy with it, you know, a lot of the times you forget about how, you know, it is a needed treatment. But if we could tell patients they safely do not need the chemotherapy.

that would be incredible. And that would be on the basis of a liquid biopsy test. So it comes with a lot of toxicities, etc. So if we can safely avoid it for patients, that would be brilliant. And just before I let you go, Iselt, going back to those with... secondary breast cancer.

How quickly do you think it can be used in a clinical setting? So obviously this is a retrospective analysis of the plasma match study. So what we do need is large scale prospective trials for this to be actually brought into the clinical practice. So we're not there just yet because obviously, you know, this needs to happen first. So hopefully in the next few years, we'll be able to use this CT DNA guided treatment in our practice, but not just yet. Dr. Isild Brown.

Thank you so much. Now, I want to take a moment this morning, give you a treat and get you to listen to this voice. That is the glorious voice of... Andra Day with her anthem Rise Up. It earned her two Grammy nominations and a quick search this morning showed me that there has been over 540 million streams of that song on Spotify alone. There is more on other...

platforms. This woman is multi-talented. She's not only a singer but also a songwriter and an actress. Her acting debut was her portrayal of Billie Holiday in the United States versus Billie Holiday. Won her a Golden Globe for Best Act. Only the second black woman to do so. Also an Oscar nomination for Best Actress and a Grammy. Well, Andra has just strode into our studio and taken a seat opposite me because we want to talk about her later.

his role as Christine in the film Is This Thing On? Yes. Oh, I got to watch it last week. I loved it. I was there by myself in a dark theatre laughing and crying. By yourself in a dark theater. It sounds amazing, actually, to me. It really was. I love that. It's loosely based on the life and career of John Bishop. It is. You know, Andrew, I didn't actually know going into it. And I was wondering why one of the characters of...

wearing a Liverpool football shirt. But tell us a little bit about the film. Will is actually a fan. Oh, he is a fan, so he's keeping the t-shirt. Or maybe he brought it with you. No, I'm so glad to hear you love the movie because the movie has just such a special place in my heart. Maybe I'm biased. I'm in it. But no, it is. It's loosely based on the life of John Bishop. Really, I describe it as, you know.

Will Arnett, this has been his passion project for a while. And him and Bradley have been friends for a long time. That's Bradley Cooper. Yes, yes. Drop, drop that. That was a name drop in case anyone was wondering. No, so it is based on. John Bishop's life and just the story is so fascinating it's you know it's it's John Bishop obviously he wasn't always a stand-up comic and that wasn't really his plan for his life and he sort of fell into it organically

Because he was, you know, him and his wife were going through a separation. They were really going through a divorce. And he found himself at a bar one night and he had the option of either paying the $15 cover or doing a set of stand-up. Which I feel like should be...

we should dive into a little more because it takes a different type of brain to go, oh, I'll do the standup, right? And he had a couple of drinks. I don't think he was eating a kebab. Which I don't know about you, but if I was posed with that choice, like I'm losing $15. Like I'm not doing standup. I would pay people so I don't have to. 100%. If it was $100, I'd be on $100. But it was really amazing how through this medium, he just started telling the truth about his life, about his marriage.

And him sort of going through this transformation and it was really through this medium that he was able to find his way to what his truth was, his new truth in this season of his life.

and then find his way back to his wife. So it's a very hopeful movie with a happy ending, which I think is so necessary right now. And it really deals with the idea that... As people, right, we are constantly changing. We're constantly transforming. But why are we always trying to figure out how to be exactly the same person? It's not realistic. And so it names it, which is really nice. And I think it's also a story about midlife.

People are in their 40s and 50s, maybe a couple of young kids, maybe an empty nester with the kids leaving, which is really your character, Christine, who's married to balls, played by Bradley. Cooper. I did text Bradley one day and I was like, can we just make his whole name actually Baldwin and Vols be his nickname? He was like, okay. And brings your character and his interactions bring a lot of laughs as well. Absolutely. They're together for a long time. They're on the verge of...

Their son leaving for college. How would you describe that relationship? I think the relationship with Balls and Christine is, it's really interesting. I just think that they both. bring out aspects of each other that they admire right and that's people always ask how did they find themselves in love and I was like you know it's not really far-fetched to me you know the I think there is something to the opposites attract but I think it's because they're not technically opposite

There are similarities to them. Christine is very much a truth teller. You know, she is. You will be confronted with the truth in exactly how she sees it at any given moment. And I think that's what I love about her character. And I think that Balls' truth is him. pursuing his dream and his career and he he also inadvertently says what exactly is on his mind just in a less

In a more comedic way. And so I think that she admires that he's always pursued his dreams. And I think he admires that she is a truth teller and she is she's she has a lot of things. She's in control of a lot of things and she's, you know, very clear. But I think that they. There's a lot that they have not spoken about in their marriage. And I think this...

Their friends now getting a divorce is like very jarring for them, not just because who are we in our friend group now, but it's like, well, are there things we need to talk about? And I think for the first time, Christine is faced.

With this crossroads, her child is now going off to college. She's an empty nester. Her husband has pursued his dreams. Their friend group might be breaking up because of this divorce. What side does she choose? And what has been her life's passion? And what are the goals and the things she's pursued outside of?

being a support to other people in her life. And so it definitely deals with the idea that, again, she's changing as a person. And the things that she was passionate about when she was 20 are not the things that she's passionate about in her 40s. And so I think that...

that it deals a lot with that dynamic of the friend group and how we change it. And how a potential impending divorce can cause an earthquake. It's true that. Within the friend group. We see it even when they go to Oyster Bay. And, you know, how do we now configure? So this is the group trip that's going and this kind of pressure to go on the trip. And I love that they deal with, you know, I think Bradley and I, we've spoken about it the whole.

cast and you know will just this idea that we really truly identify ourselves we define ourselves through our relationships through our friend relationships our marriage relationships our relationships to our kids and You know, we don't often sit with ourselves and just figure out who we are on our own. And so I love that the movie deals with that.

actually it being a therapy session they're just going through life and it's it's life and it's funny and I think there's also an aspect of friends might think Another marriage is rocky or not. Yeah. But you really don't know what goes on behind closed doors. That's what it made me think of. Because, you know, you think of your closest friends. It's like we share everything. But it's like, but do we? You know what I mean? Especially for someone like Tess, you know.

You know, Christine, I think both of them are similar in the sense that like they're, you know, they're private and they are best friends and they share everything with each other. But they also like there is control for both of them. Christine needs control. And I think Tess needs control as well. And so there are certain things you don't.

Let on. Because they're also not admitting it to themselves. Absolutely. And as we talk about, Alex is Will Arnett, Tess is Laura Dern, who's been on this program as well. Yes, I love it. That must have been fun to work beside her. Oh, it was incredible. I think just...

It's funny because everyone asks, one of the questions I get is, you know, what made you sign on to this movie? And I'm like, okay, Bradley Cooper, Laura Dern, Will Arnett. You know what I mean? And let's not forget Sean Hayes. Sean Hayes and Scott Isenogel. Singing to you in the kitchen. Oh, my God. Amazing Grace. It was. such an amazing scene to shoot and I have to say it was not Can you describe that for people because I just felt like that was we stopped as an audience member we stopped we

took everything in that was happening. And we're in the now instead of thinking of the future or the past. Or the past. I love that that's how you just, that's the best way I think on this entire press tour that someone has described that. Truly, I mean that. Because I think, again, being able to do it with this cast of actors who I've just admired for.

Ever. You know, I love their work. To be able to have this moment with them was incredible. It was not in the original script. Oh, really? Yeah. Bradley called me the night before and was like, what do you think about singing Amazing Grace? Because we had really developed this. theme and it was it's a humorous theme but this theme of like grace throughout the movie because it is a true theme throughout the movie and so

You know, it's a scene where Christine is preparing breakfast and this is her yearly annual trip that she looks forward to getting the trip together for her friends. And so she's singing Amazing Grace while she's cooking. And then. You know, their friends, Stephen and Jeffrey, come down and are singing with her, which is Sean Hayes. To be able to sing with him was an amazing, just to hear the harmonies was a beautiful moment.

And then to be able to do that with the entire group. I think what was so brilliant about the scene is that you, like you said, I don't need to know exactly what the past is. And I don't need to know what the future holds. But what I do know in this moment. is that this group of friends has been together for 15, 20 plus years, you know? And I told, you know, Bradley, I said, what a genius way to...

add years to their friendship. It really grounded the friendship and established these people as so familiar with each other because it established what they do in their quiet moments. And I think that's how you really know. a relationship. And that's why it's one of my favourite scenes in the movie. I have to read a message. This is coming in from Eilish. She says, Hi Nuala, please can you tell Andra that I absolutely adore her and her music. Thank you. I fought a battle to get Andra's...

first album on vinyl and it's one of my most precious possessions. I'm waiting to hear her second album become available on vinyl so I can get it. Please could you ask her when it will be available in the UK as I'm desperate to add it to my collection.

Rise Up, that is an anthem for those that are not familiar. On the Doctor Who episode, Rosa, and I sobbed my way through the credits the moment the song started playing. It's such a beautiful song and it stuck with me all these years. I can't wait to see Andrew's new movie. It sounds so inspiring. That message is coming in from Brighton today.

Thank you, first of all. I appreciate you. Thank you so much. And I will get that vinyl to you. So tell me, how did you come to singing? You were kind of San Diego, Chula Vista, that area of California. Oh, my God, I love your show. No, I, yes, I am from San Diego originally. And there was actually an incredible performing arts school that I went to out there that's kind of under the radar. It's called San Diego School for Creative and Performance Arts.

on the nose but um uh so i i was blessed enough to be able to attend that school and and uh You know, because there was, in particular in the neighborhood I grew up in, San Diego is a beautiful city, but there's also areas of it that, you know, people who've not necessarily even seen the water or don't have access to these things. So this school was really a bright light.

And but I came to sing just because I've always loved it. I've always been a musical person. My father could sing. My mother could sing. We've always loved music. It was always in the house. And, you know, I just admired growing up. For me, obviously, it was like the Whitney Houston's first and the Mariah Carey's and the Aretha Franklin's.

And then around like the age of 11, 12, I discovered jazz music and jazz singers. And that's when I was like, oh, my God, like Billie Holiday's voice to me was so iconic, not because it was the most magnificent, you know, or. technically capable voice but because it was so identifiable and I really struggled I loved singing but I didn't like my own voice and she really oh thank you

Thank you. I know. It's so funny. I listen sometimes and I'm like, oh, God. But I think we're all like this. I think all singers are a little bit like this. But her voice to me, I would hear an interview where she would say, my voice is my voice. It goes up a little, it comes down a little. And, you know, you like it or you don't. And that really helped me to sit in my voice. And then I just through doing a lot of trying to connect with local producers.

and then getting to LA and trying to meet producers there and making music, my music found its way into the hands of Stevie Wonder, actually, who really became, yeah, he's like, even when I say it now, I'm like, right, another name drop.

I don't know whether it gets better than Stevie Wonder. No, my God. I don't think I could have actually. I don't know if I would have even dreamed that big if someone had asked me. And what was that like? That was. You can find her Stevie Wonder online very quickly. That was an incredibly surreal moment. I always describe it as, you know, he had...

His wife at the time, Kai Millard Morris, had introduced him to my music and he just loved the sound of my voice. He loved that I was also making songs that were about two minutes long that were sort of reminiscent of these old jazz records and jazz and doo-wop records. And so we just – he called one day. They orchestrated a call. And I'm –

in a tiny one-bedroom apartment that I shared with my mom behind a 7-Eleven, like next to a dumpster. And then I was like, Stevie Wonder's voice is on the phone, which is, you know, it just felt like this huge thing had crashed my world. My mom was like, I don't believe you come do these dishes. And I was like, no, I'm really on with Stevie, Mom. And he just talked about making music. And so eventually...

The relationship led to him introducing me to the producer who did my first record, Adrian Gervitz. And so the rest has been history. He's been sort of like my godparent in the business. Yeah, it's incredible. That's a good godparent. Yeah, it really, really is. I mean, God, I've always loved him. But loving him and his family in an even more familial way now has been amazing.

Thank you so much for coming in today. Best of luck with the film. Is this thing on? It's in cinemas from the 30th of January. For our listener, a second album will be there. We will get you the second album on the final, I promise you. Now we have to figure it out. I got to get her contact information. My team know how this goes. They know how this goes. Andra, thanks so much. Thank you so much, friend. I appreciate you. At the BBC, we go further so you see clearer.

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Now I want to turn to a ruling. On Friday, an employment tribunal ruled that the dignity of a group of female nurses at Darlington Memorial Hospital was violated because they had to share single-sex changing rooms with a transgender colleague who was born male but identifies as...

a woman. We did invite the nurses to come on this programme but nobody was available. The judgement comes at a significant moment as the NHS and other employers await an official Equality and Human Rights Commission guidance which has to be approved by government.

This follows the recent Supreme Court ruling, which confirms that in equality's law, the definition of woman is based on biological sex. Well, joining me to discuss the significance of this case is the BBC's health correspondent, Dominic Hughes. Dominic, good to have you with us.

If you can, remind us why the Darlington nurses decided to take this case to an employment tribunal in the first place. Sure thing, Nuda. Good morning. So this is a pretty complicated... case but the nub of it is that a group of nurses, eight of them originally, who were based at Darlington Memorial Hospital, they found they were sharing their female changing room with a trans colleague called Rose Henderson.

Now, Rose Henderson was born a male but now identifies as a woman. Now, the nurses work in a surgical unit, so they have to change into their uniform at work. They can't come into work. wearing their scrubs for obvious sort of infection control reasons. So they have to change when they get to work. They have to get down to their underwear and put their scrubs on. And they felt that the presence of Rose in that female change room...

was intimidating, embarrassing and distressing. But really it was the Trust's response to their concerns that lay at the heart of this case because they argued that managers had prioritised the rights of Rose Henderson over their own. And the Employment Tribunal agreed. It said that having to share a changing room... violated the dignity of the nurses. The ruling said had the effect of violating the dignity of the claimants and creating for the claimants a hostile, humiliating...

and degrading environment. And the trust was also found to have not taken the nurses' concerns seriously. The Trust, for example, referred to the need for them to be educated on trans rights and to broaden their mindsets. But interestingly, the tribunal also found there was no fault on the part of Rose Henderson. because Rose was simply doing what the Trust permitted to act as and to be treated as a trans woman. To all intents and purposes, the Trust regarded Rose as a woman.

How have the nurses reacted to the ruling? Yeah, so I was there on Friday when the ruling was made public. I interviewed... three of the seven nurses. It started off with eight nurses. One of them has had a bit of ill health, so her case was sort of suspended or delayed. It went ahead with the other seven. So I interviewed three of the seven on Friday and they were delighted. It was absolutely obvious that they were delighted with the ruling. They suggested to me that this was a ruling for...

You know, a victory for common sense. And really, it was very clear that their argument was with the trust. You know, it was with how the trust had handled. What is a difficult, tricky situation? I think everyone acknowledged that. They said they didn't ever want to harm Rose. They didn't want to single Rose out. But they felt that... The trust had prioritised Rose's rights over their own, and they felt the trust had really mishandled the situation. So they were very, very pleased with...

The tribunal result. They didn't win every aspect of the case. Some claims that they were harassed by Rose were rejected, claim that they were victimized by the trust that was rejected. But overall. They really very much did win the bulk of their case and the main points on which they brought the case. So they were very pleased. So that's the nurses. Then the response from the trust, Dominic? Yeah, so the trust, we...

repeatedly have asked the trust for a comment. The trust were also sort of looking after Rose Henderson, if you like. So we contacted the trust to ask if Rose Henderson wanted to provide a comment or to be interviewed about the tribunal findings. The trust sort of acknowledged our approach, if you like, but they didn't come back beyond that. But the trust did issue a statement of its own where it said it will review the judgment carefully.

And we'll comment further once it's had the opportunity to consider that ruling in full. And we're still waiting for that.

The Equality and Human Rights Commission's new guidance has not been published by the government. Yeah. What has been the response more broadly if we think about NHS England as opposed to that specific trust? Yeah. So interestingly, the employment tribunal ruling only has relevance to the people who are involved in that case. You can't extrapolate.

its findings to other trusts, but obviously it will have an impact. Other trusts will be watching this case and will take note. So we know that the EHRC, the Equality and Human Rights Commission... has prepared a services code of practice, and that is what is with the Minister for Women and Equalities waiting for... for approval, the EHRC says its employment code of practice, which is more closely related to the areas covered by this tribunal, is still a work in progress.

So we don't know what that is going to look like, but it's absolutely obvious, I think, that a lot of trusts will be looking at the way that this trust handled this case and will be taking note. So they are two distinct codes of practice, one for services and one for employment? Yeah. And if I'm absolutely honest, Nuala, I don't understand quite what the difference might be. I think the services relates to provision of things like changing rooms. But the EHRC says that is also covered by...

For example, the health and safety executive, because there's a workplace regulations legislation that means that changing facilities have to be suitable for. men and women where necessary for the quote is for reasons of propriety. Yeah. No, forgive me. And as you mentioned there, that it has been sent, these codes of practices, for ministerial approval. But do we know what's behind the delay in publishing it? No.

In short, we don't. I guess it's a really, really complicated field. There are lots of competing claims, I think, in this area.

And it's highly contested. So I think ministers, you know, you couldn't blame them for thinking long and hard before they came down one side or the other. But for employers then who are trying to review their single space... policies right now but without that particular guidance will have probably a complicated picture as well yeah i think i think a lot of employers will be

thinking very hard about this. I mean, the EHRC said that since the Supreme Court clarified the law on the 16th of April 2025, they said that they have consistently said that the duties under the Equality Act should be following the law, updating their policies if needed, and seeking independent legal advice where necessary. I'm not entirely sure that helps many employers when they're struggling with the day-to-day reality of this.

Has the HRC said anything about the tribunal judgment? Not specifically, no. It issued a statement which was broader, but it wasn't very specific. What it did say is that employers, especially those that offer changing facilities for their staff, should consider the issues raised in this ruling for their own policies and practice.

This would include being aware of the kind of actions found to constitute indirect discrimination and harassment of staff in this particular case. So they looked at that ruling and found where the nurses were found to have been harassed by their employer. And so they're obviously referring to that. The BBC's health correspondent, Dominic Hughes, who has been covering this story for us. Thank you so much for joining us.

Now, today, another episode of our Send in the Spotlight podcast drops. And this one is all about the local authorities' role in the SEND system, which stands for Special Educational Needs and Disabilities in England. It is different, though similar schemes available elsewhere. in the UK. You may know that local authorities come in for a lot of criticism from some of our guests.

as they feel they need to go to battle with their council in an attempt to get their child's needs met. We decided to hear directly from those working for local authorities to help us see the world through their eyes. And I want to bring you Rebecca. She's a SEND mum. She's also a SEND caseworker for a local authority. And Rebecca got in touch because she wanted to talk about the realities of her job.

As she wanted to remain anonymous, her words are spoken by an actor. I first asked her why she wanted to become a SEND caseworker. So, yeah, it was my experience as being the parent of a child with special educational needs. Our journey started about 10 years ago when our child was in primary school. We were struggling to get the support that he needed, so we thought, let's get him an education, health and care plan. But...

Of course, as is the case for many parents, first of all, they refused to carry out the needs assessment. So we took them to tribunal. Then once we had the assessment agreed, they refused to issue the education, health and care plan. So we took them to tribunal again. We got there in the end, but it was a long struggle for us. And, you know, my husband and I were just a bit baffled as to how, like, too reasonably intelligent.

well-educated people couldn't navigate this system on their own. I started thinking about all the families out there whose children's needs were perhaps greater than ours. And I thought I had something to offer. in terms of not only now understanding a little bit better how the system works, but also being able to empathise with parents and support them through the process. So I suppose that's what I hoped.

So you wanted to give back and make a difference, obviously. And I'm wondering, do you feel you've been able to do that? Not remotely to the extent that I'd hoped I'd be able to. No. I think there are some small wins. Sometimes the child you're supporting gets the placement that they need. And I'd like to think that some of the hours I've put into working with other professionals, gathering evidence, putting together a strong case that for them has helped in the right decision being made.

And sometimes a parent's just really grateful that I've called them unprompted to see how things are going. They've not had to chase me for an update. And I feel in that way I've built good relationships with the families I work with. I try and take time to clarify, to be transparent and to explain our internal processes because that's something we really struggled with as parents. But ultimately the outcomes still aren't always what they hoped for.

But I think if in some way I can make the process a little bit less painful, then I suppose that's making a small difference. Right. So you talk about small wins there, but what are the big wins that you haven't been able to achieve that you thought you might be able to before you went into this role? I think...

Ultimately, there are always families who are disappointed and feel that their child is not getting the support that they need to, to do as well as they could do in school. And you'd like to see all of your families get what they need. That's never going to happen. And because it's the local authority that is making those decisions. But what about your job, the actual role, the pressures that you're up against? Can you tell us a little bit?

what it's like yeah I mean I think simply it's just the hardest and most stressful job I've ever done I was a project manager for 12 years before I did this I thought I had a lot of the skills that I would need to do this job relatively well. I had no idea how complex the role would be. You've got to have a really good understanding of the law around education and scent. There's lots of legal documents, the Children and Families Act, the Equality Act, the Code of Practice.

To get the best outcomes, you've got to work closely with social care, health care professionals, sometimes youth justice, all of these professionals that are working with the families that you work with. And it's just the sheer volume of work. Caseloads are insanely high. And this is not the case for me personally, but I've heard that sometimes caseworkers can have up to 300 cases.

And it's simply not possible to stay on top of all the phone calls and emails and admin to give every case the time, the time it needs and, you know, deserves. I...

Try and prioritize communication with my families because I think that's so important. But then I fall behind on the admin and on my performance targets. But then when I'm under pressure, if I prioritize my performance targets... my communication with family suffers so I can't I feel like I can't win and you know when I first started the role I worked late into the night several nights a week but

I quickly realised that wasn't sustainable. And, you know, no number of extra hours is enough to stay on top of the workload. And I know that's hard to understand unless you've been in the role, but it's just... incredibly difficult. And, you know, I'm also remembering that you are a SEND parent in the middle of all of this. I'm wondering what tension or challenges that brings up.

Yeah, the reason I came to the role was because I hope to be able to empathise with and support parents through the process. But of course, having been through that process and understanding just how kind of... heartbreaking and lonely and stressful it can be having a child with Send, it makes it all the harder for me to leave my work behind at the end of the day. I also live in the borough that I work in.

My children go to local schools and sometimes, yeah, sometimes I find myself working with families who live on neighbouring streets or who we know through school. And also... I'm on a number of WhatsApp groups for local parents of SEND children. And I'm on these groups because they're really useful sources of information for us as parents.

But a lot of the messages posted on there are really fiercely critical of the local authority and the people who work there. And yeah, sometimes they make me cry. Sometimes they make me angry. And I feel like...

coming out of hiding and saying, do you have any idea how hard this job is and how hard we're all working and how much we care? Because the implication is that we... just don't care sometimes but I I'm afraid of exposing myself in that way and Also, I understand it's almost impossible to appreciate the complexity of the job and the volume of work unless you've actually been in a job and, you know...

I have been one of those furiously angry parents myself. So, yeah, I understand. You know, many of the parents that I've spoken to have said that the system is broken. Do you agree with that? I try and avoid saying that because I try to stay positive and... work with what we've got but i think you know the system just wasn't designed for the scale and complexity of the challenge that we've got on our hands where do you think

There could be improvements, perhaps to even fix it, if that's the right word. I'm thinking about the things that we struggle with daily at work. The shortage of specialist placements for children where mainstream schools say they can't meet needs, one of the biggest challenges we have. And so many of those children, if they do have a placement agreed, are being sent to private.

out of borough schools and it's expensive. It puts financial pressure on the local authority and also because they're going to schools out of borough, send transport costs are high. So, yeah, there needs to be more local authority maintained specialist provision for those with the highest needs. But... I think also there's got to be something about mainstream schools being better equipped with the right resources and support and training to meet a broader range of needs.

And I think that way interventions can be earlier to prevent things escalating. And also children can stay in schools close to home, which I think is really important to families. And I think, you know... Perhaps an EHCP shouldn't be the only way to get support. I'm wondering about you. I mean, I don't know whether you'd recommend anybody else to take on a job like yours. Will you continue with it?

Yes, I'm carrying on for now. My husband would very much like me to give up and do something else. But for now, I'm sticking with it. Thanks very much to Rebecca there. That's not her real name, I should mention. You can hear the rest of that episode and all episodes of Send in the Spotlight. It's on BBC Sounds now.

I want to turn to Mattel. Did you see they recently released Autistic Barbie? It is the latest in their range of dolls that they say expands its commitment to representation and inclusion. Well, each time they do such a release, there is praise. and criticism. And Barbie isn't alone. Many companies are working to target women and girls to appeal to their socially conscious ideals. But is it? As one take I read said, just capitalism doing what capitalism always does. Or...

Does a marketing opportunity mean companies are actually thinking about what women and girls want and also need, which could lead to better representation? Well, to discuss this, I'm joined by Catherine Shuttleworth. She's CEO of the Marketing Aid. Also, Dion Nickerson, Assistant Professor of Marketing.

at the Goy Sweater Business School at Emory University in Atlanta, Georgia. So got up very early for us. Thanks very much for that, Dionne. Let me turn to you. Do you see an influx of brands that you're following who've been doing this? women and girls specifically around the issues of social awareness. Yes. Yes, I have. So, of course, Barbie is engaging in these types of marketing activities, but they're not the only ones. You see more.

brands like even Lego, other children's brands that are appealing to more diverse Children's toys, so children who have physical disabilities and the like, again, appealing to this kind of social awareness, but then also having toys that cut across genders. You're seeing it in even brands like Delta, Delta Airlines in the United States, who have recently partnered with the WNBA. and their official sponsor, and they've been targeting women's sports as well. So we see this across many different.

brands tapping into the fact that women tend to make many of the purchases for their homes. So yes, absolutely. But what about this perception? of inclusion. I mean, can it transfer to sales, particularly from women buying these products, do you think? It can. And, you know, the question you started off with, is it just capitalism doing capitalism?

I think that we have to understand that companies are going to be focused on their bottom lines, number one. And so as they do market research to understand that women consumers are. wanting to see more representation. in the marketplace in terms of not only the products, but even just the advertisements that they're seeing and seeing more women represented in different kinds of ways in those advertisements, they're going to adapt to that.

Let me bring in Catherine here. I mean, it can be difficult, right? Because they might want to connect with a brand or a cause, but... also make it appear like it's not just about the bottom line. What do you see?

You're right. I mean, all these things have got to be authentic. If you just stick a badge on something, it's a little bit like we've seen some of the LBTQ plus, you know, rainbow washing, it's called, where you stick a rainbow on something and you suddenly say, well, that's us done. Well, it can't be. Increasingly, consumers want honesty from brands and they're going to look into things. It's easy to investigate brands these days.

They want to know that if, let's say, you partner up with a female sporting organisation, that your employment... strategies are right for women that there are women in senior positions in the organization we don't just want these sort of sticking plasters

But it's a real challenge for brands because, you know, only 2% of people in the UK that are disabled feel that they're accurately portrayed in the media, in advertising. And you think that's 98% of people who don't feel... accurately portrayed so it's really important that brands understand how people are feeling and how their potential consumers are feeling how

Clued in, do you think the average consumer is Catherine? Because you talk about, I think that's a good example to think about, to not just have a badge on something that it is women friendly for whatever reason. Do consumers know how many women, for example, are on the board or employed in high level positions within a company?

I don't know whether consumers go into that much detail. Some consumers will, won't they? And you see the growth, particularly in the UK, of female founded businesses. And that's a new badge, isn't it? You know, I've had a female founded business for 20 years, but I've never said that. you have now i have now yeah to the world so good that's great it's out there um but

But that's an interesting thing. But I think that's because consumers have got more curiosity about the brands and the retailers that they have a relationship with. And I think increasingly they want to understand who's running them.

What are the decisions that they make? That's why we're suddenly really interested in... uh brand owned businesses you know so you i don't know so you've got at one end you've got charlie biggan making his um his meals for us to eat at dinner time and at the other end you've got people like rihanna having her own lines people want to know who's

behind the products do they do they look into that detail i don't know but of course increasingly there are more women in the workplace and becoming more senior in organizations which is a good thing which may be making some of the decisions. Back to you, Dionne. You're working on research looking at the effects of inclusion in both traditional and underrepresented communities. I mean, really interesting to hear from Catherine there when it comes to...

people who are disabled, for example, and really not being marketed to in the way that they could be. How do you understand it on what companies decide to target or who and who they don't? Well, I think that companies are doing more marketing research that looks at a wider range of... consumers, right? So I think that that's something that's going on just because of the public discourse and you're having more underrepresented groups saying that they do want to be represented. They do.

want to see more products for them. As Catherine just mentioned, Rihanna's makeup lines, Fenty Beauty is a great example of that, but it's not the only one. Sephora, the makeup retailer. also did a study some years back to understand the needs of many of their underrepresented consumers. And I think to Catherine's point.

Doing it in an authentic way is really important. And part of that authenticity is understanding the market, like clearly understanding the need so that you're able to provide products and communication, you know, in terms of your promotions. to consumers in a way that speaks to them and understanding them and and actually investing in those strategies are what's really, really going to make that authenticity shine through and result in, you know, kind of a positive.

outcomes for the consumers and for the brands. Catherine, what do you see in terms of women at the moment, where they're being targeted or marketed to? Well, I mean, an interesting one is the growth of menopause products. Oh, yeah. That's an area that that was taboo, I suppose, to a large extent until women found the voice and, you know, some of the work that.

that people have done in that sector and suddenly we're being marketed to. But then there is, I think we come up against that fine line again because some feel, and we've spoken about it on this programme, that then the pendulum swings too far. Absolutely. that there's over-marketing, for example, or, you know, and some people could see it as a cynical move by certain companies, for example.

But then you could also say, thank God we're now having a conversation about the menopause, which we weren't having before. And it's something that every single woman will go through. It's not a kind of, you know, you might.

You might not. But so, yeah, there is always this criticism. And it's the same with this work that Barbie have done, you know, with the autistic doll. There are people saying, well, they shouldn't have done that. But you know what? At least we're having a conversation about it. And I think normal.

Personalisation of things is really important. And for too long, women's issues, thoughts, considerations in the consumer world have been managed by men. So isn't it fantastic that women are able to speak to women and bring the things... They want to see and in a voice they want to be heard. Yeah, I suppose as you talk about menopause as well, I'm feeling all period.

products have changed over the past few years to be more realistic in some sectors. Still not really 100% realistic but let's say moving in that direction. Do you think that marketing follows where society is going or society follows where marketing is going.

Good marketing should follow where society is going. So and that's about listening to people and really understanding your consumers. And I think that's how good marketing goes. It shouldn't be a fad. It should be really understanding what's happening in society and reacting to it. Dionne, do you think that this is happening for male dominated markets as well? Or is this really a moment of where women are in the spotlight when it comes to certain campaigns?

Um, I think I want to make sure I understand what you're saying, but I think that we're seeing more conversation about women, even in male dominated markets. One example that I saw recently in prepping for this discussion is that Barbie has partnered with Hot Wheels, which is the toy, Hot Wheels is a toy brand.

It's associated with little boys and cars. And the thing is, women drive, too. And those little girls are going to be drivers. They may be interested in cars as well. So I think that we're seeing that. more understanding that we are interested in all kinds of areas of life. And I mean, it makes sense. It's not something that's kind of like, oh, wow, some great revelation. It's nothing like that. It is just they are finally tapped.

into that. I want to thank my guest Dion Nickerson who got up very early for us in Atlanta, Georgia and also Catherine Shuttleworth great to have you too on Women's Hour as we talk about marketing whether it is Bottom line or progress with representation. I want to let you know tomorrow the writer Caroline Mitchell will be with me talking about her latest book, a Nordic noir crime story called The Ice Angels, partly inspired by her former experience of work.

working as a police detective. Also, it has been a year since US President Trump's inauguration in January of 2025. So how has the past year affected women globally in terms of the policies coming from the administration? We will also talk about that. Thanks very much. A message coming in thanking Rebecca Arsend interview saying she loved that she used the word need instead of want what children need instead of want. I'll talk to you tomorrow.

That's all for today's Woman's Hour. Join us again next time. I'm Paul Kenyon, and for Radio 4 and the History Podcast, this is Two Nottingham Lads. When the invasion happened, it was completely hell on earth with the sounds. The sad thing about war is people lose their empathy and their humanity. I want to know how two men from Nottingham ended up on opposite sides in the war in Ukraine and what became of them after a chilling encounter in a prison.

in donetsk out of all the places in the world where i meet someone from nottingham it's in captivity on two sides of the conflict it's a story about how and why you pick a side in a war that's not your own You can listen to two Nottingham lads first on BBC Sounds. At the BBC, we go further so you see clearer.

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