Woman's Hour - Leadership and the effect of Covid-19 on leadership styles, Sex, Gender & the Census, Breast Reduction

Episode Date: February 23, 2021

Is being a tough guy (or girl) no longer the key to getting on? How important is empathy in leadership now that we know the effect that working from home, juggling child-care, concerns about unemployment and dealing with grief are having on mental health and well being. Can businesses afford to be empathetic? Emma speaks to Chef Angela Hartnett and Belinda Parmar, CEO of the Empathy Business. The census is being held next month and for the first time the public will be asked about their gender identity as well as what sex they are. The campaign group Fair Play for Women isn’t happy about the guidance which has been issued to help people answer the sex question and they’re threatening legal action if the Office for National Statistics doesn’t make changes. Dr Nicola Williams from Fair Play for Women and the CEO of Stonewall Nancy Kelley talk to Emma Barnett about the issue. Kelly Michaud is 26 and has been left in ‘crippling pain’ due to her size H breasts. She’s now raising money to get a reduction after failing to get the operation funded by the NHS. She talks to Emma to her about why she decided to crowdfund for the operation and how to plans to raise awareness of the problem and help others too.Presenter: Emma Barnett Producer: Lucinda Montefiore

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme, peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, I'm Emma Barnett and welcome to Woman's Hour from BBC Radio 4. Good morning. Today we're going to explore leadership. After millions tuned in to Boris Johnson's press conference last night discussing the roadmap out of lockdown for England, some have been commenting on his changed style. Gone is the buccaneering Boris Johnson to be replaced by a more cautious figure, as some political commentators put it. He has

changed his personnel recently, apparently to detoxify leadership around him. Forceful leadership out, caring, more empathetic leadership is in, apparently. And not just in politics. We'll remind you of what happened at the accountancy firm KPMG recently. So is this style of leadership making your working life easier or have you heard none of it? It's not like that where you work if you do still have a job at the moment or if you're trying to be a boss or run a business whatever the size at the moment you're thinking I haven't got time for this. I can't afford to keep checking how everybody is, if that's how you indeed view empathy. What are your experiences? We'll hear from one of the toughest working environments shortly, the restaurant kitchen with the Michelin starred chef, Angela

Hartnett. Tell us about your take on this and whether you found it helpful at work, you're trying to do this, whether it's changed things for you or perhaps a lack of it made where you worked untenable. Text Women's Hour on 84844. Text will be charged at your standard message rate. On social media, we're at BBC Women's Hour. Email us your take through our website. Message is already in on this. Definitely seeing more empathy in action in mediation with workplace disputes, reads this tweet.

Listening and focusing on what's being said and noticing what isn't being said. People are attempting to see things from each other's lens and valuing strong mental health. John says, mourning empathy is our gateway to kindness. We are kind when we have empathy. More empathy is needed. And I think worth reading out this message as well, saying it's more who you work for, not where. A couple of jobs back, I never met my manager. I ended up having a mental breakdown at work. But last job I had, the manager was always on the floor with us. There was the one job where the manager also got violent. Those were not good times.

There you go. Some experiences already coming in. Please join in and let us know yours. Also on today's programme, why one woman is crowdfunding her breast reduction and why new guidance around the census, which is taking place next month, may prompt emergency legal action. Now, in a moment, we'll talk about empathetic leadership more broadly, as you're already doing in your messages. But first, let's talk about what's happened and happening around the Prime Minister in this regard. I'm joined by The Guardian

columnist and political commentator, Gabby Hinsleth. Gabby, a recent change of personnel for the Prime Minister, do you think that has led to a change of style? Yeah, I think we're definitely seeing the effect of what happened when obviously Dominic Cummings resigned just before Christmas and we've had a sort of new team coming in centred around Allegra Stratton, the new press secretary. And I think we are, anyone who watched the Prime Minister's press conference yesterday might have noticed that the old sort of very bombastic, overconfident, overpromise, underdeliver Prime Minister

seemed to sort of been bundled off into a cupboard and replaced by someone who admits that, you know, he may not be able to deliver exactly what he's promising now and he doesn't quite know what's going to happen. And who's making setting cautious targets that you feel, you know, we could possibly go faster than than he sort of said we can go on vaccination if all goes well. So you're seeing a different and an attempt to communicate with people about what their their actual lives will be like. You know, ministers never stop talking about when you're allowed to hug your granny now. Whereas last year, what we heard was all about when the economy would get going again.

I think they've realised that what people have really missed throughout this is human contact and what we've missed is each other. You know, and that's what people want to hear. When are we going to get back to being able to see the people we love. I mean, some people may say this is just a result of a pandemic and things will resume, if you like, normal service, the way that leadership is kind of characterised in this country after this. Of course, it's impossible for you to say right now on that. But I wonder if you've got a take on that, because I was thinking about the team that were around him. You know, some will say they're incredibly successful. From their point of view, those particular figures won the referendum. They delivered a landslide victory for the Conservatives and the worst defeat for the Labour Party since the 30s. Is it that the acquisition of power still has to be forceful, but then the retaining of power has to be more caring?

I think Boris is a leader who adapts very quickly to the circumstances in which he finds himself. That's why he's had such a long lasting career, despite sort of derailing it merrily several times in the past, is because he's very quick to pick up on what's needed, what's wanted at a particular time. You know, the Boris who, as you say, won a landslide election last time, the Boris who ran through Brexit is a very different one than the one who may be required to govern. And I think we're seeing a bit what we saw actually when Boris was mayor of, you know, people often find that Boris as mayor of London was this sort of, you know, metropolitan elite liberal who was very, you know, welcoming to immigrants and very socially liberal and entirely different than Leave campaign Boris. They might as well have been two different people. He's capable of adapting to circumstances.

And I think that's what we're seeing now. But I don't just think it's about the demands of the time. I would hope that there's a realisation that Number 10 runs more smoothly now, that Cummings' style was very abrasive. It was very confrontational. It was meet fire with fire. If the media attacks you, you attack back. You know, you never let anything pass.

And I think hopefully it's calmer now and that it works better now and that Number 10's relationship with its MPs is better now. And that's the point about empathetic management. It's not just about being kind. It's whether it's more effective. It actually works. Which we're going to get into shortly and broadening out from politics, I should say as well. But I think it's important to take a moment with what people are looking at themselves, which is the ultimate leadership of a country right now, because we've never been held under lock and key quite like this in peacetime,

have we, Gabby? So it's why we're having this bit of analysis now, especially after millions tuning into Boris Johnson's press conference last night. I'm very struck by the fact that you as a political commentator, former political editor, you've called Boris Johnson Boris throughout the entirety of your answers to me. And that's not a criticism from me per se, but some of our listeners. Would you have called David Cameron David or Theresa May Theresa the whole way through your answers? Because does that not speak volumes about the familiarity or the friendliness that Boris Johnson seems to engender in people? It's probably me. I'd have called Tony Blair, Tony and Gordon Brown, Gordon.

Okay. It's probably me. But people do comment on it, don't they? There is something, and people get very annoyed by it and think it's too personal and that if we called him Johnson, everyone would suddenly change their minds about him. And I think he does have he does have a sort of easiness about him or a sort of approachability. People somehow feel they know him, which actually in some ways is puzzling because he's a he's a less clubbable,

less sociable, more private individual than than many former prime ministers have been. And yet he's very good at performing to a public who don't know him, less good at opening up around in a small circle of people. But he does have that ability to project an approachable character. And I think it is a projection. You know, it is it is to someone who's got a hologram. But I think he's capable of projecting that. And talking about effective leadership, that's why we are looking into this, whether it is more effective or not. And some examples. There has also been talk of Boris Johnson getting more women around him and the idea that women soften your image. So to get into that side of things, what do you make of that? It's this awful thing that most people are familiar with. It used to be called a donut,

where you surround the male prime minister with female MPs on the benches. And then we're supposed to assume that just because there's 200 men out of shot and two women behind him, we're all supposed to assume that this is suddenly a new feminized party. I've never heard that, a donut. What a description. The prime minister is the hole in the middle and the women are the donut. Lovely, lovely. So we learn. My fat, sugary treat.

But yes, every day is a school day, Emma. Thank you. But to get back to the point, I think I hate i think i hate women being used for for just the window dressing drives me mad you know you're not there just for decoration you're there to be listened to and heard not just to be seen um and i think it always depends which women precisely you i mean if you'd bought some ann widdecombe back into cabinet at that stage would that project necessarily a more empathetic image probably Probably not. But I think if what this means is more ministers who are capable of communicating, and there are plenty of male ministers who can do that too, but are capable of communicating,

understand what people's real everyday lives are like and reflect that in what they say and do, that's a good thing. And also people who deal professionally with each other rather than screaming, shouting and throwing tantrums, which there was quite a lot of in number 10 over the last year. There's been a lot of that over many number 10s over the previous years. But thank you very much for teaching me, certainly, and maybe others around what that meant, that particular phrase. And also taking us into the court of Boris Johnson, as it were, Guardian columnist and political commentator Gabby Hinsliff there talking to us. Well, in terms of our next guest, we're going to be talking to the Michelin-starred chef Angela Hartnett shortly,

who definitely will know how to make a very nice donut. But how important is empathy in the wider workplace? Is it an essential leadership tool? A prominent member of the City of London's governing body and the former chairman of KPMG UK have both faced a backlash recently when, in effect, they told their staff to stop moaning and feeling sorry for themselves during the pandemic. I can actually play you a bit of what that former chair of KPMG, Bill Michael, had to say to staff. Take as much influence of your own diary, of your own life, of whatever, because I have spoken to a lot of partners and people at all sorts of levels

where it almost feels like this is being done to them. Well, you can't play the role of victim unless you're sick. So I hope you're not sick and you're not ill. And if you're not, take control of your life. Don't sit there and moan about it. He has now since resigned, talking about his position becoming untenable. Is being tough, some might say being a plain speaking leader, no longer acceptable, especially in light of the pandemic? Is there time for small business leaders on the other side of this to listen to staff and to offer empathy? Can we afford such an approach? Or is it not the role of bosses is Is that what you should be expecting when you go home? Angela Hartnett, chef patron of Murano and the Cafe Murano restaurants, joins us now, as does Belinda Palmer, chief executive of the Empathy business.

Angela, good morning. Good morning. Come to you first. I'm sure you do make a lovely donut, but I love that description. What do you think empathy eats, first of all? I suppose I don't want to say sympathetic, but I think it's being there for your staff or your teams, really, because one thing I've thought through this pandemic and listening to people, listening to your teams, listening to your friends, your family, I think people are going to be judged about how they treated their employees, their friends, their family, their neighbours in this pandemic. And I think we've seen some fantastic examples about brilliant leadership, brilliant people. And then we've seen some very poor ones as well. But I think you've got to be able to. It's interesting when people have said to me, why don't you just open up? Why don't you just rebel against the government and open your restaurant and break the law? And I sort of said,

how do I look a member of my team in the eye and say, I want you and break the law. And I sort of said, how do I look a member of my team in the eye and say, I want you to break the law, take the risk and then go and see your mum? You know, you can't. So I think, you know, you really have to look at yourself and look yourself in the mirror and say, have I done the right thing by my team? And I think that's critical in these times. Gordon Ramsay springs to mind when people think about leadership in kitchens. Of course, he's now not the only chef that will spring to mind, but he is on television rather a lot. Would you say his style fits into this? No, I wouldn't say so. And I think Gordon's way past that style.

And I think most kitchens are. I think there's definitely an area for direct talking. I don't think you have to be necessarily softly, softly, if that's the right expression. I think you have to be direct. You have to be honest and clear. But you don't have to be aggressive. You don't have to be harsh. You don't have to be rude and swear. But, you know, sometimes there's an energy in kitchens that you need to get a point across so you can sound rushed or hasty. But it's a live environment, isn't it? Live environment. And I think when there's a deadline, as I think there is in the news world, in the TV world, you know, I think that's when everyone, you know, you hear it in your voice, you feel it in your body, don't you? Like, come on, come on, let's go. You know, we've got 50 customers. Come on, come on. But you don't have to put every expletive behind it to make that point and get that across to your teams, I don't think. I'll bring Belinda in in just a moment. But to stick with with this do you feel any of the way you were trained now when you

were coming up is has made you a better leader or or do you think you've had to unlearn some of the things that perhaps were in fashion then um I don't know about unlearn I think it's more about you make your choices of how you want to be as a person I don't particularly like getting overly stressed I mean I can do and I can have be energized and be direct and come on a driver team but I don't want to be on edge the whole time and also I'm very philosophical in the sense that you know and I may get shot down by a lot of chefs it is food let's be honest you know it's a carrot it's a piece of beef it's you know, and I may get shot down by a lot of chefs, it is food. Let's be honest, you know, it's a carrot, it's a piece of beef, it's, you know, a donut. You know, we are giving people enjoyment and pleasure, but we are not in the critical line of the NHS or, you know, other jobs

that I think are far more, you know, serious in that respect. Keep that beef in perspective or that donut. I mean, can I just say we're all missing having other people cook our beef or carrot or whatever. So, you know, really looking forward to whenever that can come back. And I'm sure I speak for some people there as well, who's done with cooking for themselves in any way, form at the moment. Belinda, to bring you into this, good morning. You go into businesses and you conduct an empathy audit. How do you measure that? Tell us about that. So it's like a company doctor where we go into big companies and we look at their empathy deficits and empathy strengths. So things like their leadership style, how they communicate, even down to how they write emails and run

meetings. And we tie that to business profits, because I think what Angela said is spot on. You know, empathy is not about being nice. It's not about bringing your dog to the Zoom call. It really is about understanding that more empathic companies make more money. And we know that? How do we know that? Well, I've done studies on it. There is data. It's correlation. It's not causation. But in an index that I ran, the top 10 companies outperformed the bottom that we determined is more empathic.

But when we look at things like sickness, so if you take a business and you look at the number of days people are sick, if you look at loyalty, how loyal people feel loyal to their boss and also trust. When you look at those measures and you correlate that, what we determine is more empathic. You find that more empathic companies have less stress, more happier and productive employees, but also less sickness days. And a sickness day, for example, it costs a business a lot of money. So these are really important things for business. What about those businesses listening who are thinking, I'm just trying to get by at the moment? You know, they would never hire somebody like you, no disrespect,

because they just wouldn't have it in their budget or they would want to. They think they're doing all right, but their back's against the wall, you know, at the moment, and they can't even think about tomorrow, let alone if they've got enough empathy. I think they're not mutually exclusive. I think you have to think about tomorrow. I think empathy is not a luxury. We have a mental health pandemic going on. You know, you've got to manage people's emotions. People feel incredibly disconnected at work. We're seeing fear and anxiety with younger people who are living on their own, working on calls all day on their own.

So I don't think you can make a choice. You have to think about it. And you also have to think about, you know, a hybrid model where people are coming back into the office and at home. What does that look like? So I don't think it's a luxury. It's not about being nice. And I don't think there's an option. You have to think about it. But what about when it tips over into and I'm just going to paraphrase some of the KPMG clip we heard there. When, you know, some people are moaners. They are, aren't they? And just as empathy isn't being nice, which you and Angela have both stressed, some people come to work and want to

have all of their gripes and moans dealt with at work. And that's not the place for them to be dealt with. So if you're as a leader trying to be direct and to get the best out of people, how do you deal with persistent moaners? Well, I think you have to distinguish. Angela is smiling so widely, can I just say at this point? You have to distinguish between empathy and sympathy. And sympathy is what my niece calls a pity party. You know, the pity party is the moaners. And we're not saying that, but if somebody has an issue, you know, it's like a toddler. If a toddler is screaming on the floor, that is not the place to give them a

lecture on, you know, how they should behave. You have to deal with their emotions. Although you really, really want to at that particular point. Although you really, really want to. And the most direct bosses I know are incredibly empathetic. It's about having that conversation. You know, in the 80s at work, we were told, oh, you need to say something positive, then something negative and then something positive. You know, the sandwich. We don't need to do that. We need to create a parent to parent culture.

And a lot of businesses, they create this parent child culture, which is what I think where the monas fit in. It's not about parent. They're adults. They've made a decision to come to work. You can have an incredibly direct conversation, but You have to do it in a human way. Can you? In a human way. You can fire people in a very human way that gives them their dignity. Absolutely.

Let's bring Angela in on that, because the other side of trying to be this sort of boss and this sort of leader, as Belinda is describing, could be that you now feel you can't deal with the moaners in a way that you would like. Do you feel that or worry about that, Angela? It shouldn't be like that, but it's how some people may feel. I think there's probably elements that you do. You know, I'll be honest, I think back in the heyday when I was starting out as a young chef, you know, there was very much the expression, you just get on with your job. job you know you didn't have all the benefits that we give them now and you know you

were told this is when you work you were probably told the night before you were you know you didn't have rotas months ahead it wasn't all planned and stuff so I think there's there's definitely a change in culture which is for the good but I think you have to I think as Belinda said distinguish I think people can come in and there will always be certain people just by their very nature of life that will moan. And it's basically saying as long as you can feel that you've done everything in your power, in your environment, for their world right, then it is a case of I've delivered. Now you've got to deliver for me. I don't think you can just accept that someone's continually moaning. You have to sort of try and get to the bottom of it and know that you've done the right thing by them and delivered

your part. Angela I want to read you this and Belinda if you respond first Angela and then I'll come to you Belinda. Mary says on email why was that man made to feel he should resign? I don't blame him for what he said though he might have said it slightly differently but we've turned into a nation of whingers with a victim mentality. There's a worldwide pandemic. Many people act like COVID is being inflicted on them and them alone. It's a childish attitude. We've lost our backbone.

What do you say to that, Angela? I don't think we have lost our backbone. I think, I mean, I've got extremes, I suppose, in my teams. I've got the ones that I suppose in my teams you know I've got the ones that will just come in head down if they cut their finger to use an issue expression they'll carry on their job I'm the one going you know and then you've got other people that you will have to in a way nurture to you know corrupt yeah sorry not the right word now you know sort of nurture just look after a bit more have more sympathy for more

empathy for if you like but i don't think it means that we've lost our back do you do you think women are better at empathy women leaders you really get putting me on the spot probably in some respects yeah maybe yeah belinda are women better and have we lost our backbone final word from you well just picking up on the ceo i mean he could have said that message i think empathy and language he could have said that message in a much more empowering inspiring way that built trust so the message he could have changed his language in terms of whether women are more empathic women do tend to be empathic and professor baron cohen has looked at this in great detail but we don't know whether it's nature or nurture because we don't know when you're a young girl you get pleat you get rewarded for showing empathy so we don't know whether it's nature or nurture, because we don't know when you're a young girl, you get rewarded for showing empathy. So we don't know whether it's nature or nurture. But I

think what we know is in the workplace, those days of the alpha male traditional, you know, shouting boss have gone. And that's a good thing. Angela Hartnett, thank you very much for your time. Belinda Palmer, thank you to you. I can say you have definitely started a debate. We have many messages coming in and I will come back to those very shortly. Don't forget, you can always catch up with anything you've missed on Women's Hour at any point on BBC Sounds. For instance, last week, I don't know if you missed this, but if you did, I would recommend catching up. It was very powerful indeed. Harry Dunn's mother was on the programme, Charlotte Charles. She made a powerful appeal on air to the woman who was alleged to have killed her son to come back to Britain from America to face

justice. That's all over on BBC Sounds. Now, next month, people are going to be asked to fill out the census and there are a few new questions. For the first time, the public, for instance, will be asked about their gender identity as well as what sex they are. The campaign group Fair Play for Women isn't happy about additional guidance which has been issued to help people answer the sex question and they're threatening legal action if the Office for Statistics, which oversees the census, doesn't make changes. We'll hear from Dr Nicola Williams from Fair Play for Women, which is crowdfunding what could be emergency legal action in just a moment. But first, I can talk to Nancy Kelly, the chief executive of Stonewall, the lesbian, gay, bisexual and transgender rights charity. Good morning. Good morning.

Just thought I'd start by asking, why is the new gender question so important to you? Well, so this is a historic moment for the LGBT community, because for the very first time in the census, we will have two voluntary questions. One of them is about sexual orientation, and the other is about your trans status. And for too long, we've been a really hidden set of populations, and this will transform that landscape. It will give us fantastic quality data that will allow not just researchers, but more importantly, policymakers and kind of service providers to understand our communities and meet our needs better. So we're incredibly excited at Stonewall to have achieved this historic change.

And you're happy about the way the question on sex is presented too? Well, so the sex question hasn't changed. In fact, it's been answered in more or less the same way since 1801, I think. What has changed a bit since the last census is the guidance. So most people don't use the guidance on the sex question, but for those who want some guidance on how to answer the question, that guidance now suggests that people look at legal documentation. And we're happy. We think it's a kind of proportionate inclusive piece of guidance for people that need it. Do you know where that guidance came from? I think ONS consulted really really widely around

the appropriate guidance from the census I know we were consulted as was Fair Play for Women a range of other organisations academic and non-academic. And this is where ONS has arrived at. I mean, from our perspective, it's a good and proportionate guidance. And we should say at this point, we did invite the Office for National Statistics to take part in the item, but they declined. And I just wanted to get your take on that. And you talk about the guidance in terms of the documentation. If some trans people, understandably from their perspective, only want to say the sex that they feel rather than the sex on their birth certificate,

could the unintended consequence be that they won't be accurately counted and that could impact on the data which informs policy that you're saying is so important? So the thing to be really clear about here is that because the sex question has been more or less the same for hundreds of years trans people have always been able to answer as they are as opposed to the way in which they were kind of described at birth right so so that hasn't changed at all in fact because of the two new questions we will for the first time have the best possible

data on lgbt people and also on women we'll be able if lots of us in our communities, in LGBT communities, fill out both questions, we'll be able to understand better the trans population, to understand cis women and trans women, to understand bi women, lesbian women and straight women. So actually we'll have better data on women and on the population as a whole, not worse. Thank you, Nancy Kelly, Chief Executive of Stonewall. Let's bring in Dr Nicola Williams from Fair Play for Women. Your legal challenge then is about the guidance on how to answer the question,

what is your sex that we were just talking about? The guidance states, if you're considering how to answer, use the sex recorded on one of your legal documents, such as a birth certificate, gender recognition certificate, or passport. The fact that the guidance lists a passport as a legal document that connotes sex is the problem. Is that right? Can you explain for our listeners why? It is because passports are very easy to update. You can just get a letter online from a GP and you'll be able to get your passport updated to gender identity. So the issue is that the ONS are not making it clear that trans people

must put their birth sex or their legal sex. And the reason that that's an issue is because birth sex is a simple and important piece of information. We don't think it's right, really, that the ONS should be afraid to ask it, because data on sex matters. It matters most to women and girls, because if you don't have good data on sex, we can't monitor inequalities due to sex. And if we can't measure it, we can't put policies in place to remedy it. So, you know, it's great that there are two questions this year. We really welcome that. One on sex and one on gender identity. And we get opportunity to good data on both groups, women and trans people. But, you know, the problem is, is that just a few weeks before census day, the ONS have changed their plans now and will encourage

trans people to answer that question, both questions, according to their gender identity. So they'll be answering the sex question and the gender identity question according to their gender. Now that doesn't, that sudden change doesn't sound like evidence-based policy making to me. It looks like caving into policy groups and you know that's why we want this decision to be heard in open court with the judge so that we can trust what the ONS is doing here. So when you talk about it caving into groups, when we were just asking the chief executive of Stonewall about her understanding as to why the guidance was issued, the response was the ONS consulted widely, including your group. Is that the case?

It is. But what we found is that just two weeks ago, the head of the ONS, Sir Ian Diamond, told everybody that people would be answering according to legal sex. Now, just last Friday, the ONS have done a U-turn on that, and they've now said it's okay to use any legal document. And, you know, Nancy's saying this is really good, clear and inclusive guidance, but actually it's not that clear even for trans people, because what does a trans person do if they've got different gender markers on different pieces of legal documents. Because what people probably don't realise is that most trans people will have a mixture of gender markers, probably have male on a birth certificate and female on a passport. So it's not clear which one they should use.

And it's really important because it's a criminal offence to put the wrong answer on a census. And so the ONS shouldn't be encouraging people to break the law. And actually, the ONS don't have legal rights. That's quite a big allegation. Again, the ONS are not here to respond. We did invite them on. They declined to take part. But you were consulted on this as a group and people were widely consulted, other groups were consulted.

So what are you saying that you believe, just so I've got it clearly, what do you believe is the reason for, as you typify it, the U-turn? Because it's politically controversial to talk about sex and gender these days. And so the ONS have clearly come under some pressure to, they're more worried about their reputation, really, and to make sure people aren't upset by what they do, rather than collecting good data. And you've got to, you know, it's not just me saying that. Even though, do you not accept also the argument that most people will not use the guidance? It is, but the issue here is that birth sex information matters because sometimes we need it. And the census is the most comprehensive and expensive data collection exercise there is. It's a billion pounds worth of taxpayers' money. So it needs to be the richest data set that we can get and

there are scenarios where a very small misclassification of males into the female category makes a big difference so crime for example in prison there are 13 000 male sex offenders there are just 100 women so if even half a percent of those males are reclassified as female, that almost doubles the number of females in prison. So, you know, that really changes our understanding. And people get people start to misunderstand the data. And in fact, a couple of weeks ago, File on 4 did a documentary showing that there was an increase in the number of women reported to the police as sexually abusing children. Now what we know is that police record gender identity not sex so we don't know how many males could be in those figures. Sorry to cross across you but just

in terms of to get an answer around what the Office for National Statistics have said and you know listeners will have perhaps heard that File on 4 documentary that you're talking about. That's to answer why the data is necessary. What have the ONS said to you in response to potential legal action and what is the next step? Well, we've given them until six o'clock tomorrow to reply back because this is an emergency. You know, there's a deadline now, Census Day is the 21st of March. So they must either withdraw the guidance by tonight, sorry, tomorrow night, or we lodge with the court and we ask for an emergency judicial review,

which will have to happen in the first or second week of March to be in time to get this guidance. And have you heard anything back at all? No, we've not heard anything back from the ONS. So we're waiting to hear. We will get an update as and when. Thank you for your time there. You've just heard from Dr Nicola Williams from Fair Play for Women

and Nancy Kelly, the Chief Executive of Stonewall. Now, in terms of a question to ask you, you may relate to this. You may know someone who can relate to this. What is it like to be five foot two or on the shorter side and have, for instance, 34H breasts? Some of you may say, surely that's the dream. Large breasts, small frame. But the reality is far from ideal. And perhaps you know that yourself. Kelly Misho is 26. These are roughly her measurements, and she says her breasts leave her in crippling pain. So after being refused surgery from under the NHS's care, she's now crowdfunding to pay for the procedure.

She joins us now, as well as Dr Monica Forsey, consultant plastic surgeon and British Association of Plastic Reconstructed and Aesthetic Surgeons spokesperson Monica I'll come to you shortly but to start with you Kelly good morning why did you decide to do this? So basically I have been wanting to get a breast reduction for so long and as you know I've applied on through the CCG and was denied any help to get it done. That's your local clinical commissioning group, just to say. Yes. And I applied in 2018 and I've tried for so long to get it done. Kept being refused due to them not feeling I was suffering enough um so I basically just took that as I was never going to get it done really then it just got to

the stage where I've had my family now my GP told me that maybe it'd be best to wait until you've had your children um before you go down that route so after after my last baby, I then decided right now's the time. I mean, I can't even save for a mortgage, let alone seven grand for a breast reduction surgery. Well, let me just get this part clearly out to our listeners. We did request a statement from the clinical commissioning group, which represents the area where you live. And they say, in common with many other clinical commissioning groups in England,

breast reduction surgery is not routinely commissioned by NHS North Yorkshire CCG unless it relates to breast cancer treatment or surgery. It wouldn't be appropriate for the CCG to comment on the circumstances of individual patients. However, where an individual funding request for a particular treatment or procedure that isn't routinely commissioned has been turned down patients have the option with the support of their doctor to appeal the decision should they wish you are in the situation where you're now crowdfunding this and i just wonder for people who can't relate to this why does it cause you so much pain why why is it so difficult to live with such large breasts um the weight it's a sheer weight

on your back on your neck um walking around isn't too bad but standing still it's it's awful you just get such bad backache you feel like you just need to sit down all the time um bras so everyone I've had so many people say that a good fitted bra helps things like that and it doesn't the weight of them yes okay it might help a little bit at first but then after a while it it just starts to the weight just does not the bra does not help them so and also I imagine such a piece of infrastructure on you is also not comfortable. No, you have to wear it all the time. Or, I mean, don't get me wrong, there are really nice bras out there for women with my size,

but they're very expensive. So if you're wanting anything at a price some people can afford, then you're talking really unflattering bras as well and really uncomfortable ones so you can't win either way really this is a weird question to ask do you have any idea how much they weigh um they're about half a stone together oh you do know okay i didn't know so i'm not gonna ask how did you figure that out but go on i stood on the scales and got my husband to lift them up. If we can't have a bit of a laugh together despite the awful pain that you're in it wouldn't be Woman's Hour and it wouldn't be this sort of conversation and I'm happy to make

you smile. Let me bring in the doctor at this point, Dr Monica Fawzi, good morning. How common a problem is this and you know how difficult is it because I'm very aware that you know, how difficult is it? Because I'm very aware that, you know, we're talking to Kelly here and she's 26. It's difficult to know exactly how common it is. I assume that most patients, most women with this problem may not necessarily present to their GPs. And so it's impossible for us to know. I do know that about 4000 breast reductions were performed last year in the private sector, but I have no idea. And having spoken to women on the other side of this, because there'll be people listening thinking, you know, you don't want to have to go through

surgery if you don't have to. How do they feel? How's their life different? So it has been shown that this is a very successful procedure in improving both physical and psychological symptoms um so it's certainly worthwhile for those who are suffering um but sadly as kenny said it's as the ccgs have said well it's not routinely commissioned yes but it does have also perhaps you, benefits for their life depending on their job as well. You know, having any sort of impediment like that could be very difficult depending on your line of work. Yes, absolutely. So female police officers, for example, not being able to get into their stab vests. It also stops people from being active, potentially improving their health with sports and also the ability to self-examine for breast cancer.

Yes. And, you know, that's very important to point that out. Kelly, you've had quite a lot of support online, haven't you? Yeah. And there was one thing that I actually wanted to read out from someone that I received today, which really got to me. And it says, so hi, Kelly, I just wanted to message you as the story has really moved me. I am a 34 double H J breast. I'm five foot one, ten stone seven. And I've always hated my boobs. always like you, agony most days, bruises where the bra digs in, drops in on my shoulders from the weight, constant backache and dread summer every year as I struggle with wearing certain clothes and the attention it brings. I am desperate for surgery. And as much as I know, I meet all the requirements to have the surgery on the NHS as it lists on the website I now be rejected I also feel selfish I'm a midwife and see how stretched the NHS is so I feel bad for ever even considering asking for it but I'm at my wits end and I can't live like this much longer this story has really made me realise

I need to do something even if it even if it is so even if I have to get it on finance, I'm not stupid or selfish wanting to have it done. I think that does give a sense of how other people are also struggling with this. I mean, has it really blighted your life? Yeah, like I've had so many people messaging me and more than what I thought so when I first started the fundraiser it was for me like how many how much money have you raised now um it's just literally just over 10 000 okay so you are going to be able to do this now yeah and I put the amount up because I wanted to continue to keep raising and hopefully donate it to some, whatever's left to somewhere that can support women.

And maybe, I'm not saying for everyone to get the operation for free, but it's so expensive. It's not even accessible for some people to even save that amount of money. So even help towards a surgery anything like and do you feel just to pick up on that message that someone sent you do you feel that it's also something that can be laughed at you know if you say to somebody I'm really struggling having big big boobs because we kind of make out that big breasts are are where it's at you know it's what people want. It's what gets you attention. You know, were you concerned about that?

And have you experienced that? Yeah, definitely. So the amount of people that have messaged today and I wish you could donate breast tissue is unbelievable because they want larger breasts. And they say to me, how are you not happy with them? People pay good money to have big boobs. And then, you know, be grateful sort of thing.

Monica, a final word from you. What checks should you put in place, should women do when trying to find a surgeon? So the most important thing is to make sure that they're well-trained. And a good place to start would be our website, so the back-press websites. You just need to know that someone's well-trained

and be able to talk you through the risks. And that's that, really. And then, of course, you've got to find the money. That's the other side of it. Yes. Yes. But I would still encourage people to try and go through their GP because the CCGs do have different criteria.

And do check out your local one. We're going to have to leave it there. Dr Monica Forsey, thank you. Kelly Michaud, thank you for your time and all the best to you. That's all for today's Woman's Hour. Thank you so much for your time. Join us again for the next one. A new podcast series from BBC Radio 4. Join us again for the next one. My name is Shirley Hitchens. I'm 15 years old. I live with my mum, dad, brother, gran and Donald.

Subscribe to The Battersea Poltergeist on BBC Sounds. I'm Sarah Treleaven and for over a year I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started like warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth.

How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now.