English National Research Articles

Using the Candidacy Framework to understand individual, interpersonal, and system level factors driving inequities in women with breast cancer: a cross-sectional study

BackgroundPersistent inequities in breast cancer outcomes exist. Understanding women’s experiences along the care pathway is the first step to finding solutions to tackle these inequities.MethodsSecondary data analysis of the 2017/2018 English National Cancer Patient Experience Survey (n = 25,408) using logistic regression to explore inequities in care experience by sociodemographic factors (age, ethnicity, socioeconomic position, sexual orientation) across 59 survey questions. We used the Candidacy Framework to interpret and organise our findings.ResultsCompared to older (65–74) and White British women, young (35-44, OR = 0.55 [0.44, 0.69]), Asian (OR = 0.52 [0.41, 0.67]), Black (OR = 0.67 [0.46, 0.97]) and White Other (OR = 0.63 [0.49, 0.81]) women were more likely to rate their overall care experience less positively, respectively. Similar findings were observed along all domains of the cancer pathway. Through a candidacy lens, we identified multilevel factors related to this variation including prolonged help-seeking behaviours (individual), poor patient-provider communication (interpersonal), and variation in access to healthcare professionals and resources (system level).ConclusionMultilevel factors influence inequities in the experience of care along the breast cancer pathway for young women and women from minoritised groups. Interventions are necessary to ensure cancer care systems are responsive to women’s health needs and provide equity of care to all patients.

Are acute hospital trust mergers associated with improvements in the quality of care?

This study aims to assess the extent to which acute hospital trust mergers in England are associated with quality improvements. We apply an event study design using difference-in-difference (DID) and coarsened exact matching to compare the before-and-after performance of eight mergers from 2011 to 2015. We find little evidence that mergers contribute to quality improvements other than some limited increases in the proportion of patients waiting a maximum of 18weeks from referral to treatment. We postulate that financial incentives and political influence could have biased management effort towards waiting time measures. Inherent sample size constraints may limit generalisability. Merger costs and complexity mean they are unlikely to offer an efficient strategy for helping to clear elective care backlogs. We recommend further research into causal mechanisms to help health systems maximise benefits from both mergers and emerging models of hospital provider collaboration. This paper is the first to study the quality impact of a new wave of acute hospital mergers taking place in the English National Health Service from 2011 onwards, applying a group-time DID estimator to account for multiple treatment timings.

Lynch syndrome diagnostic testing pathways in endometrial cancers: a nationwide English registry-based study

BackgroundFor female patients with Lynch syndrome (LS), endometrial cancer (EC) is often their first cancer diagnosis. A testing pathway of somatic tumour testing triage followed by germline mismatch repair (MMR)...

Application of Duty of Candour legislation in post-colonoscopy colorectal cancer: a prospective cohort study.

Background & Study Aims The study investigates the application of Duty of Candour (DoC) legislation in the context of post-colonoscopy colorectal cancers (PCCRCs). DoC mandates transparent disclosure of notifiable safety incidents to patients in the English National Health Service, including those leading to severe or moderate harm. This study aims to analyse the application of DoC in PCCRCs, improve understanding of the legislation and identify challenges in its implementation. Patients & Methods A national audit of PCCRCs was conducted between September 2021 to May 2022. PCCRCs were identified using linked administrative datasets and root-cause analyses were performed using a structured template. 1,724 PCCRCs were included. 'Avoidability' and harm categorised into specific levels, with guidance provided to improve consistency in judgments. Results 16% of PCCRCs resulted in major harm or death, of which 27%(75) were at least probably avoidable. Hospitals deemed DoC discharge necessary in only 53% of these cases. When including moderate harm, 11% of all PCCRCs would trigger DoC discharge, yet this was deemed necessary in only 41% of these cases. Conclusions There is inconsistent application of DoC in PCCRC cases. Challenges include determining 'avoidability' and harm, particularly when there is a delay in diagnosis. Clearer guidance and definitions of harm are needed to improve adherence to regulations.

Counter Accounting and Counter Accountability: A Post‐COVID‐19 Study of England's Hospital Infrastructure Crisis

Post‐COVID‐19 England's health‐care system remains in crisis, with growing waiting lists for elective care and rising backlog maintenance in its hospital infrastructure. The government indicates that its delivery plan issued in 2022, involving additional funding and greater use of the private sector, will tackle this problem. Framed as a consequence of the pandemic, in England, such a framing denies the historic problem of underfunding as well as the rise of financialization. Notably public accountability for health care has received little prominence over the past decade. This study uses an approach based on counter accounting to challenge the prevailing hegemony of English National Health System (NHS) health‐care infrastructure policy and offers a counter‐explanation of the current hospital infrastructure crisis. It examines an alternative set of evidence drawn from publicly available financial statements and other documents to make visible data relating to hospital infrastructure capital and revenue costs. This shows that health care has been systematically underfunded since the start of austerity in 2010, and that even additional funding during COVID‐19 was insufficient to make up the shortfall. Previously weakened accountability mechanisms have been further displaced from the public eye by the rhetoric around COVID‐19, meaning there is little challenge of private sector legitimacy in public health‐care provision, despite its financialized nature. The study considers that instigating strong oversight and evaluation of hospital infrastructure policy is necessary as over the next decade many private sector contracts will terminate and funding is likely to be in short supply.

Challenge of cardiovascular prevention in primary care: achievement of lifestyle, blood pressure, lipids and diabetes targets for primary prevention in England – results from ASPIRE-3-PREVENT cross-sectional survey

BackgroundImplementation of the cardiovascular disease (CVD) prevention guidelines in the UK has been repeatedly evaluated under the auspices of the British Cardiovascular Society in three Action on Secondary and Primary...

Factors affecting prostate cancer detection through asymptomatic PSA testing in primary care in England: Evidence from the 2018 National Cancer Diagnosis Audit.

Background Prostate-Specific Antigen (PSA) is used in primary care for prostate cancer detection, either for symptomatic assessment or asymptomatic testing following an informed decision. Aim To estimate the proportion of prostate cancer cases diagnosed following asymptomatic PSA testing, and patient and practice factors influencing this route. Design and setting 2018 English National Cancer Diagnosis Audit (NCDA) data were analysed, with linkage to the national cancer registry, practice-level Quality Outcomes Framework (QOF), and General Practice Patient Survey (GPPS) data. All 2018 NCDA patients with a diagnosis of prostate cancer were included (n = 9,837). Method Patients with recorded biomarker testing and no recorded symptoms prior to diagnosis were classified as asymptomatic PSA detected prostate cancer. Patient (age, ethnicity, deprivation, co-morbidities) and GP practice (geographical location, area deprivation, list size, urgent suspected cancer referral rate, QOF outcomes, GPPS results) factors were analysed for association with asymptomatic PSA testing using mixed effects logistic regression models. Results 1,884 out of 9,837 (19%) prostate cancer cases were detected following asymptomatic PSA testing, 982 (52.1%) of whom were patients aged 50-69 years. Younger age, non-White ethnicity, lower deprivation, and lower co-morbidity count were associated with an increased likelihood of diagnosis following asymptomatic PSA testing. There was a 13-fold variation between practices in the odds of asymptomatic PSA-detected cases, without clear explanatory GP practice-level factors. Conclusion One in five patients with prostate cancer in England are diagnosed after asymptomatic PSA testing in primary care, with large variation in asymptomatic PSA detection between GP practices.

‘Towards a modern democracy’? The constitutional politics of the 1990s British left

ABSTRACT This article argues that a ‘constitutional lens’ sheds light on British political contestation in the 1990s. It is commonly suggested that 1990s politicians merely consolidated the hegemony of ‘Thatcherism’. Yet, this struggles to encompass the decade’s political volatility, from the Conservatives’ descent into internecine warfare over the Maastricht Treaty to the fraught Irish peace process. Though varied, these developments shared a key theme: controversy over the constitution of the United Kingdom. To illustrate its case, this article applies the constitutional lens to the 1990s left. Existing accounts emphasise Labour’s concessions to Conservative opponents. By 2001, however, the first Blair government had enacted contentious constitutional changes: devolution, proportional voting systems, and a Human Rights Act. These policies reflected a dynamic, new, liberal-left politics of constitutional reform. From the 1980s, liberals, social democrats and Marxists forged a new constitutional agenda, responding to trends since the 1960s—growing ‘popular individualism’, agitation for ‘human rights’, European integration, and Scottish nationalism—and to the end of the Cold War. By the 1990s, campaigners had developed a bold programme for ‘modernising the constitution’, which influenced Labour’s programme. Through New Labour’s governments, this agenda profoundly reshaped the institutions of British politics in the twenty-first century.

Association between kidney function, frailty and receipt of invasive management after acute coronary syndrome

BackgroundReduced estimated glomerular filtration rate (eGFR) is associated with lower use of invasive management and increased mortality after acute coronary syndrome (ACS). The reasons for this are unclear.MethodsA retrospective clinical...

Validity and timeliness of cancer diagnosis data collected during a prospective cohort study and reported by the English and Welsh cancer registries: a retrospective, comparative analysis

Cancer places a high burden on society and health-care systems. Cancer research requires high-quality data, which is resource-intensive to obtain. Using administrative datasets such as cancer registries could improve the efficiency of cancer studies if data were valid and timely. We aimed to compare the validity and timeliness of diagnostic cancer data on-site during the SYMPLIFY study to that obtained from the cancer registries of England and Wales. Cancer data were collected from 5461 participants across 44 hospital sites during a prospective observational study in England and Wales, SYMPLIFY (ISRCTN10226380). Linked cancer data were obtained from Digital Health and Care Wales (DHCW), the Welsh Cancer Intelligence and Surveillance Unit (WCISU), and the English National Cancer Registration Dataset (NCRD) and Rapid Cancer Registration Dataset (RCRD), regularly between April, 2022, and September, 2023. The primary objectives of the study were to evaluate the validity (via assessment of the proportion of completed data fields and concordance with SYMPLIFY sites), and timeliness of the data in all datasets, for all cancers diagnosed within 9 months of study enrolment. Data fields investigated were cancer site via International Classification of Disease, 10th Revision (ICD-10) code; cancer morphology via International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) morphology histology code and broad morphological grouping; overall stage; and TNM classification. For data collected between April, 2022, and September, 2023, completeness at the last data cut available for each dataset ranged from 84% to 100% for ICD-O-3 morphology, from 43% to 100% for overall stage, and from 74% to 83% for TNM stage. The concordance between SYMPLIFY data and NCRD was 96% (95% CI 92-98) for ICD-10, 60% (53-66) for ICD-O-3 morphology, 83% (78-88) for ICD-O-3 broad morphology groupings, 73% (67-78) for stage, and 51% (44-59) for TNM; and with WCISU was 89% (95% CI 81-94) for ICD-10, 63% (53-73) for ICD-O-3 morphology, 80% (70-87) for ICD-O-3 broad morphology groupings, 83% (74-90) for overall stage, and 49% (38-61) for TNM stage. Concordance between SYMPLIFY and RCRD was 95% (95% CI 92-98) for ICD-10, 67% (60-74) for ICD-O-3 morphology, 85% (79-90) for ICD-O-3 broad morphology groupings, and 73% (65-80) for overall stage; and between SYMPLIFY and DHCW was 96% (91-99) for ICD-10, 74% (64-83) for ICD-O-3 morphology, 84% (75-91) for ICD-O-3 broad morphology groupings, and 87% (74-95) for stage. The SYMPLIFY dataset reached completion at 12 months post-enrolment in November, 2022, compared with 13 months for NCRD in December, 2023. RCRD and DHCW reached completion at 13 months and 15 months post-enrolment, in December, 2022, and February, 2023, respectively. We report similar completeness of data fields, concordance, and timeliness between on-site and centrally collected cancer outcomes data. Our findings suggest that central registry data can help alleviate the resource burden in clinical trials and improve cancer research. Cancer registries might need additional resources to provide data for registry-based trials at scale. GRAIL Bio UK.

Breastfeeding trajectories for preterm infants over the first 6 months of life in England 2010–2020: surveys using large representative birth samples

BackgroundBreastmilk is the optimal source of nutrition for infants, particularly preterm infants. Preterm infants face unique feeding challenges and these change with the birth gestation of the infant. Preterm infants’...

Unearthing Identity: the Role of Archaeology in Shaping English National Identity and Heritage Interpretation

ABSTRACT This study examines the significant impact of archaeology on English national identity and heritage interpretation, focusing on key sites like Stonehenge, Sutton Hoo, and Hadrian’s Wall. Using a multidisciplinary approach, we analyze how archaeological discoveries shape national narratives, emphasizing continuity, rootedness, and cultural uniqueness. Through qualitative methods, including interviews and focus groups, we find that public perceptions of these sites highlight themes of engagement, inclusivity, and the need for more comprehensive interpretations. Our results reveal that archaeological interpretations evolve with societal values and political agendas, often reinforcing or challenging notions of national identity. This study underscores the dynamic relationship between archaeology, nationalism, and cultural memory, advocating for a more inclusive and nuanced approach to heritage management and public engagement.

Corporate governance and financial performance: the case of English NHS hospitals

PurposeHospitals’ corporate governance (CG) mechanisms oversee critical operational issues and evaluate the outcomes. This paper investigates the impact of CG (i.e. board size, board independence, board expertise, board meetings, board gender diversity, CEO gender, and academic directors) on the financial performance of English National Health Service (NHS) hospitals and separately by hospital type (i.e. trusts and foundation trusts).Design/methodology/approachThe sample includes 128 NHS hospitals. The data were collected through document analysis and archival work from annual hospital reports from 2014 to 2018.FindingsThe findings indicate that board expertise, board meetings, board diversity, CEO gender, and academic directors significantly and negatively affect NHS hospitals’ financial performance. For NHS trusts, the results reveal that board expertise, board diversity, and CEO gender have a significant negative effect, while for NHS foundation trusts, only CEO gender has a significant negative impact.Originality/valueOverall, this study contributes to the literature on the healthcare system. It holds significant practical implications for hospital governance and has important implications for theories.

Propositional Idea Density in the Writing of Native Speakers and Asian Learners of English: A Corpus-Based Contrastive Interlanguage Analysis

The present study is a contrastive interlanguage analysis of propositional idea density in the written language of native English speakers and Asian learners of English. The study adopted a quantitative method to analyse the ICNALE written essays v2.4 using CPIDR v5.1 software. The study aimed to identify the level of propositional idea density in the writing of English native speakers and Asian learners of English and to examine the effect of the type of English, the theme type, the proficiency level and nationality on propositional idea density. The study is one of the very few studies about propositional idea density in ESL and EFL contexts. Many statistical analyses were performed on CPIDR results using jamovi v2.3 software, and the results of the tests revealed that the propositional idea density in native speakers’ essays was higher than that in Asian learners’ essays. Moreover, the results showed that there was a statistically significant difference among all the participants based on the theme types of part-time jobs and smoking, among native speakers based on occupation type (students, teachers, others) and among Asian learners of English based on the type of English proficiency level and nationality. The findings of the study showed that propositional idea density is a psycholinguistic index of the amount of presupposed knowledge language users have on a specific topic. In other words, propositional idea density is a window to language users’ schemata. Additionally, the findings of the study can be considered an insightful contribution to contrastive interlanguage analysis.

Depiction and Description: Insights into Southern Alps Glaciers Conveyed by John Gully’s Paintings and Julius Haast’s Paper at the Royal Geographical Society

In June 1862, Julius Haast (1822–1887), the Canterbury Provincial Geologist, wrote to Joseph Hooker, Assistant Director of the Royal Botanic Gardens at Kew, informing him that “being now naturalized I think it my duty to offer my work to the scientific societies in England.” Haast informed Hooker that as soon as his topographical map was finished, he would send the botanist “an account of the geological features of the Alps, on deposits of the glacial period, accompanied by maps, sections and sketches,” requesting him to present the account to the Geological Society of London.[i] Although this anticipated initial foray into publishing in British scientific journals did not eventuate until 1865,[ii] on 12 November 1863 Haast sent a copy of his large topographical map of the Southern Alps,[iii] accompanied by extensive notes on the physical geography of that region and a set of 12 watercolour paintings (e.g. fig. 1), to the geologist Sir Roderick Murchison,[iv] President of the Royal Geographical Society. Haast hoped that those landscape paintings would “best enable the members, to gain an insight into the wild mountain masses [of the Southern Alps], with their snowfields, glaciers and lakes [emphasis added].”[v] [i] Sascha Nolden, Esme Mildenhall and Simon Nathan, The Correspondence of Julius Haast and Joseph Dalton Hooker, 1861–1886 (Wellington: Geoscience Society of New Zealand, 2013), 22. Haast became a British citizen in February 1861. [ii] See Julius Haast, “Notes to a Sketch-Map of the Province of Canterbury, New Zealand, Showing the Glaciation During the Pleistocene and Recent Periods as Far as Explored,” Quarterly Journal of the Geological Society of London 21, nos. 1–2 (1865): 87–96. [iii] On 11 June 1863, Haast informed Hooker that he was sending Murchison a large map with a set of watercolour drawings by the next mail (Nolden, Mildenhall and Nathan, Correspondence Haast-Hooker, 42–43). [iv] Ibid., 57. [v] Julius Haast, “Notes Accompanying a Map of the Province of Canterbury” (Royal Geographical Society Manuscript Archive, 1862), 1.

The European Union Settlement Scheme Data Linkage Project in Wales: Findings relating to mental health and education

Objective Following the UK’s exit from the European Union (EU) a settlement scheme was introduced for EU nationals currently living in the UK to apply to continue living in the UK. The European Union (EU) Settlement Scheme project compares the living experiences of EU and UK citizens in Wales. ApproachWe conducted a retrospective population cohort study within the Secure Anonymised information Linkage (SAIL) Databank to explore the mental health, educational experiences and involvement in the Welsh labour market of EU citizens living in Wales in comparison to British citizens. UK Census data relating to country of birth, sex, week of birth, date of arrival in the UK and socio-economic status have been linked to variables of relevance in the Education for Wales and Welsh General Practice datasets respectively and analysed. ResultsFindings indicate statistically significant differences in secondary school attendance and attainment between Welsh born pupils and pupils born in EU countries. We will present findings on our exploration if differences exist between Welsh born and EU country born individuals in relation to diagnosis of depression and anxiety. Additional findings from this linking and analysis reveal other interesting differences between EU and UK born citizens. ConclusionsLinking data in this way has gained a better understanding of the experiences and outcomes of EU citizens in Wales, generating better evidence to inform policies and services that address the needs of this population and a dataset of interest to academics. Reproduceable analytical pipelines have been created for other researchers to use.

FP1.11 - An audit of post colonoscopy Colorectal cancers within a Northern Ireland Health and Social Care Trust

Abstract Background Post colonoscopy colorectal cancer (PCCRC) is defined as colorectal cancer found within 48 months of a colonoscopy in which no cancer was found. The British Society of Gastroenterology (BSG) proposes PCCRC rates as a key quality indicator of colonoscopy. Rates documented vary between 2-8%, with higher rates shown in Inflammatory Bowel disease (IBD). The English National Post Colonoscopy Colorectal Audit was established after recommendations from the World Endoscopy Organisation (WEO). We aim to establish the rates of PCCRC within this Health and Social Care Trust (HSCT). Method All CRCs diagnosed in our HSCT between January 2021 to December 2022 were retrospectively reviewed. Our definition for a PCCRC was one diagnosed between 0-48months after a colonoscopy. Information included whether the colonoscopy was complete, quality of bowel preparation, lesions detected, if resection of lesion was complete and if IBD was present. Results In this timeframe 524 CRCs were diagnosed in this HSCT, with 33(6.3%) having had a colonoscopy within the previous 48 months. Of the 33 PCCRCs, 21(63.6%) had a complete colonoscopy, 22(66.6%) had at least fair/satisfactory bowel preparation, 24(72.7%) had a lesion detected and 3(9%) had a prior diagnosis of IBD. Of those who had a lesion detected (n=24), 13(54%) had a complete resection and 10(41.6%) had a biopsy only or incomplete resection. Conclusions Our PCCRC detection rate is in keeping with previous published literature. Further analysis of the 33 cases should provide information on how we can reduce future PCCRCs.

This Is Not a ‘Drill’: Young People’s Understandings of and Hopes for Sustainability Education in England

Global surveys show that young people are concerned about sustainability and climate change and how it will affect their future. Education for Sustainability is seen as a key approach that can equip young people with the knowledge, skills, and competencies to act for climate justice. Despite much policy attention on Education for Sustainable Development (ESD), this paper argues that current educational approaches inadequately prepare young people to understand and engage with climate change and sustainability issues. Drawing on a unique survey of 1655 young people in England, this study identifies significant knowledge gaps in understandings of sustainability concepts and a strong demand for educational reforms. Quantitative data reveal variations in sustainability understandings across age, gender, and income, while qualitative insights uncover young people’s feelings about the gaps in their education, exposing their fears, anger, powerlessness, and hopes for change. This study highlights the dominance of consumer choice in young people’s perceptions of sustainability, emphasizing the need to shift from individualistic to collective actions. This paper concludes with a call to integrate sustainability education into the English National Curriculum to promote holistic and action-oriented learning and create opportunities for nurturing hope through transformative education.

The use of locum doctors in the NHS: understanding and improving the quality and safety of care.

The use of locum doctors in the National Health Service is widely believed to have increased, and there have been widespread and sustained concerns among policy-makers, healthcare providers, professional associations and professional regulators about the quality/safety, cost and effective use of locum doctors. To provide evidence on the extent, quality and safety of medical locum practice and the implications of medical locum working for health service organisation and delivery in primary and secondary care in the English National Health Service, to support policy and practice. Four interlinked work packages involving surveys of National Health Service trusts and of general practices in England; semistructured interviews and focus groups across 11 healthcare organisations in England; analysis of existing routine data sets on the medical workforce in primary care and in National Health Service trusts in England from National Health Service Digital and National Health Service Improvement; and analysis of data from the Clinical Practice Research Datalink in primary care and of electronic patient record data from two National Health Service hospitals in secondary care. In primary care, about 6% of general practice medical consultations were undertaken by locums in 2010 and this had risen slightly to about 7.1% in 2021. In National Health Service trusts (mostly secondary care and mental health), about 4.4% of medical staff full-time equivalent was provided by locum doctors. But those overall national rates of locum use hide a great deal of variation. In primary care, we found the National Health Service Digital workforce returns showed the rate of locum use by Clinical Commissioning Group varied from 1% to almost 31%. Among National Health Service trusts, the reported rate of locum use varied from < 1% to almost 16%. We found that there was poor awareness of and adherence to national guidance on locum working arrangements produced by National Health Service England. Our research showed that locum working can have adverse consequences for the quality and safety of care, but that such consequences were probably more likely to result from the organisational setting and the working arrangements than they were from the locum doctors themselves and their competence, clinical practice or behaviours. Our research was hampered in some respects by the COVID pandemic which both resulted in some delays and other challenges. Our efforts to use electronic patient record data in secondary care to explore locum doctor working were stymied by the problems of data access and quality. Locum doctors are a key component of the medical workforce in the National Health Service, and provide necessary flexibility and additional capacity for healthcare organisations and services. We found that the extent of reliance on locum doctors varied considerably, but that an over-reliance on locums for service provision was undesirable. Some differences in practice and performance between locum and permanent doctors were found, but these seemed often to arise from organisational characteristics. We found that patients were more concerned with the clinical expertise and skills of the doctor they saw than whether they were a locum or not. Organisational arrangements for locum working could be improved in many respects. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128349) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 37. See the NIHR Funding and Awards website for further award information.

Windrush Members’ Encounters with the ‘Hostile Environment’ and a Deficit of Citizenship: Centring an Agentive Citizenship Experience

This article is part of a broader, collaborative Oral History project working with members of the Windrush community to explore their experience of the ‘Hostile Environment’ and their own reckoning with a historical injustice, beginning pre-2012. This article focuses on the experience of three Windrush members and their encounters with the ‘Hostile Environment’ regime from 2012 onwards, particularly the actualisation of their exclusion from British citizenship as a denial of access to ‘everyday’ citizenship. Citizenship is interpreted from a grassroots level, through the individual’s lens on how their life was uprooted in terms of their livelihood, security, wellbeing and social connection through encounters with the ‘Hostile Environment’ regime. During the data gathering process, a shared understanding of the activist nature of this research was established, creating a space within which participants were asked to reflect on and critique the state’s bordering of British citizenship and the participants’ identification as illegal within this. This article defends an agentive interpretation of citizenship as an experience that is holistically felt and made meaningful, consciously negotiated within state-imposed structures of law, enforcement and entitlement access, and then wielded as a subjectivity whereby individuals claim a more dignified existence. For members of the Windrush Generation who were left de facto stateless due to a lack of sufficient legal identification in the eyes of the state, their deficit of citizenship experience from the margins of British citizenship leaves them well positioned to critique and challenge the entrenched form of citizenship expressed through the ‘Hostile Environment’ regime.This article is part of a broader, collaborative Oral History project working with members of the Windrush community to explore their experience of the ‘Hostile Environment’ and their own reckoning with a historical injustice, beginning pre-2012.