Implementation of the UNCRC in England: Implications for children and young people’s participation in health services

On 1st July 2015 the Children’s Rights Alliance for England published two very important reports on the implementation of the UN Convention on the Rights of the Child (CRC): the civil society report to the United Nations on the implementation of the CRC and the state of children’s rights in England (CSR) and a related report ‘See it, say it, change it: Submission to the UN Committee on the Rights of the Child from children in England’ (SiSiCi). I immediately started combing both reports for references to children and young people’s (CYP) participation in health services, which I am sharing as a blog post in case they are of interest to others*. Page numbers are given in brackets.

*Please bear in mind however that this post is only my summary (admittedly a long one, but there is a lot in the reports!) and is not in any way intended to be authoritative or official. Comments and discussion would be very welcome indeed! It would be fantastic to hear what others think about the report and what it could mean for children and young people’s participation in health services.

Children’s rights in legislation and policy

Since the last UN report in 2008 the Government has introduced some measures including “the reform of the Children’s Commissioner, the Ministerial commitment to give ‘due consideration’ to the Convention on the Rights of the Child (CRC) and the statutory guidance to Directors of Children’s Services, requiring them to have regard to the CRC General Principles and ensure children are involved in the development of local services… and the attempt at a child budgetary analysis” (CSR, p1). However the CSR report points out the 2014 Government report to the UN fails to fully address the 20 recommendations made by the UN Committee in 2008 which aim to ensure that all children have all their rights respected with enforceable means of redress. While some aspects of the CRC are replicated in UK legislation, the CSR report suggests that the failure of successive UK governments take forward the UN Committee’s recommendation to expressly incorporate the CRC into domestic law, or as a statutory obligation in relation to the development of policy which affects CYP, has resulted in a piecemeal approach which means rights are dependent on where children are located or what services they receive, rather than the entitlement of every child without discrimination. (CSR, p1) Recommendations related to these general points on rights in legislation and policy, which need consideration in relation to health and other public services (CSR, pI) include:

  • A mandatory, transparent system of child rights impact assessment for all policy, legislation and spending decisions.
  • A clear set of child rights indicators should be developed alongside the collection and publication of disaggregated data, which cover the full range of children’s rights, and includes data on how well children believe their rights are being realised. Such data should be used as a means of monitoring the resourcing and implementation of the CRC.
  • Transparent and participatory budgetary decision-making processes should be established and disaggregated budgets showing spending on children should be published regularly.
  • A national strategy for increasing awareness, knowledge and understanding of the CRC should be delivered.
  • All professionals working with and for children should receive statutory, pre and post qualifying comprehensive and ongoing training on the CRC.
  • Resources should be developed on the CRC for a range of audiences especially parents and specific groups of children, including younger children and disabled children.

And from the young people involved in ‘See it, say it, change it’ (p50):

  • All professionals who come into contact with children, including those in the justice system, social services and health-care settings should be trained to trust in children’s voices and stop punishing them unfairly or leaving them in positions of risk. Children should be involved in delivering this training.
  • All children need to be listened to and taken seriously in all settings. They must be involved in making decisions about their lives.

CYP’s views on being listened to and decision-making in health care settings (See it, Say it, Change it, Ch6: Health, p35-36)

The majority of CYP who responded to the ‘See it, Say it, Change it’ survey “said that they had not been involved in decisions about their own health care or about the health services in their local area. Only 29% of children [said that] they had had a say in relation to their health care or health services more generally. Of those children who had been involved in decision-making on health care issues:

  • 45% said something had been done differently as a result;
  • 51% got what they wanted as a result of being involved in the decision-making process;
  • 62% felt listened to and respected”

CYP in the focus groups repeatedly said that they did not feel listened to by medical staff. Other children gave examples of medical staff double checking with adults or ignoring their explanations and disabled children in particular often felt they were not listened to medical staff struggle to communicate with non-verbal children. Children also reported repeated incidences of not being believed by medical professionals.

CYP’s voices in health care

Although the CSR report acknowledges that progress has been made in giving CYP a voice in national and local strategic health decisions, it was felt that a key barrier to this is ‘England’s health complaints and advocacy system, which is complex, inadequately resourced and fragmented’(CSR, p8) There are so many other really interesting points in the report related to CYP’s experience of, and participation in health services including:

  • The participation of CYP is not yet universal or inclusive. There are considerable regional variations and disabled CYP and CYP in care and care leavers, among other ‘less frequently heard’ groups, are still not routinely or systematically involved in individual or strategic decision-making (throughout both reports). Related to this new duties to reduce health inequalities have not yet led to a strategic, coordinated approach between health and other policy areas (such as welfare, poverty and criminal justice) which have a potential impact on childhood health inequalities (CSR, p23).
  • Much national participation activity is focused on young people of secondary school age, and there is a lack of Government-funded provision for younger children to engage in decision making (CSR, p8)
  • Due to reductions in public funding and a lack of coordination across health services, many CYP are still not receiving care when they need it or in an age-appropriate manner. There is also insufficient early intervention and community-based services and, possibly related to this, increased rates of CYP attending A&E departments (CSR, p24)
  • Transition from paediatric to adult care continues to be poorly coordinated, with families and CYP reporting a lack of information and support (and presumably therefore also a lack of participation) (CSR, p26)
  • Hospital-based paediatrics is not mandatory in General Practitioner (GP) training, posing a barrier to GPs learning how to identify and care for sick children. Only around 5% of nurses are trained to look after children. Government is yet to set out a strategy for developing the children and young people’s health workforce (CSR, p26)

See also the report of the UK Children’s Commissioners to the UN Committee, also published on 1st July, which says that ‘austerity measures have reduced provision of a range of services that protect and fulfil children’s rights including health and child and adolescent mental health services’ (p2).

Key recommendations related to CYP’s participation in health services (all apart from the first from the CSR report, pVII-IX)

  • All children should be listened to and given clear information and explanations about their health. This should include better information in schools and hospitals for disabled children and those with special educational needs and also for children whose families do not have English as a first language. Key health-care professionals should have basic training in sign language and Makaton so they can communicate with deaf and non-verbal children (SiSiCI, p52)
  • There needs to be an overarching strategy for promoting children’s physical and mental health, outlining clear goals and accountability mechanisms – for the full range of services for children, from health promotion to acute care. This should include measures to address health inequalities affecting children, in relation to poverty as well as the specific health challenges affecting groups of children particularly at risk of poor health or who face barriers to accessing services.
  • Children should be included in all relevant indicators in the NHS Outcomes Framework, to ensure the NHS is held to account for child health outcomes.
  • Children should be included in all relevant patient surveys or other mechanisms for recording patient experience, to ensure their voices inform commissioning and service development. All such mechanisms should be fully accessible for all children (including for disabled children).
  • The health complaints and complaints advocacy system should be reformed to ensure it is accessible for all children (including disabled children) and families, and that it helps drive service improvement. In particular, the Government should clarify where complaints about the lack of a particular service should be made.
  • A programme of action to ensure better integration across children’s health (including in-patient and community), social care and education services should be developed. For example, a Children and Young People’s Social Care Outcomes Framework should be developed, to sit alongside the public health, NHS and adult social care outcomes frameworks, to support better joined up accountability and approaches across children’s health and social care services.
  • Children’s transition between different health services, and especially into adult services, should be well supported.
  • The child health nursing workforce should be increased and developed and all GPs should have training in hospital-based paediatrics.

In summary – a lot of food for thought for those of us working in , and with, child health services. The reports also contain a lot of discussion around child mental health services (CAMHS), social care and other areas which relate to the points made above. But I have tried in this post to focus on the points which I think are most relevant to taking a children’s rights-based approach to children and young people’s participation in health services.

It is interesting to note that, in a CQC survey for NHS England published on the same day as the CRAE reports, 43% of 12 to 15 year olds said that they were not fully involved in decisions about their health care and 38% said that a member of staff did not ‘completely’ tell them what would happen after they left hospital. This great blog by Kath Evans and Ruth Hudson from NHS England and Amy Frounks from the NHS Youth Forum summaries some of the implications for the survey and touches on some elements of the CRAE reports highlighted in this post. So hopefully, with people like them driving change, we’re on the way to truly embedding children and young people’s participation and rights in the NHS.

Brave Adam: a call to arms

Like many people in the Twittersphere with an interest in children’s rights in health, the recent loss of the amazing Adam Bojelian has resonated for me on both a personal and a professional level. Adam was a poet and campaigner who packed in so much into his 15 short years. Although like many, I was never able to meet Adam in person, I nonetheless miss him very much and there is a huge Adam-shaped gap in my Twitter world. But other people have written about this really well, including Carmen Soto, Rob Webster, Paul Clarke and many others (see #braveAdam and #celebratingAdam on Twitter). So I won’t duplicate what they’ve written, although I would echo much of it, instead I want to focus on what Adam’s life and death mean to me in relation to my work on children and young people’s rights in health services.

This post was inspired by one written by Adam’s mother Zoe, which I found simultaneously heartbreaking, amazingly brave and utterly inspiring. In the midst of the analysis of mountains of PhD data I find that it is easy to lose sight of the bigger picture. But Zoe’s post brought home to me why children’s rights in health matters now more than ever, and why those of us working in this area should keep fighting to make a difference. So this post is from my heart as much, if not more, than my head. As Zoe writes, we should all seek to be ‘similar to Adam’  and ‘ensure the voices of children and young people, most notably disabled children and young people, are heard loud and clear within the NHS’.

I have written about this in the past (see for example post on 2014 UCLan seminar, and one from CSCY conference) but it’s perhaps best summed up by one of the young people with whom I’ve been working who wrote a guest post in which she says ‘when good participation happens, both parties learn and gain from each other in equal measure’.  Lessons certainly need to be learnt about what happened to Adam, but I think lessons can also be learnt about how social media can be one way for children and young people to have a voice. Although it doesn’t work for everyone, and many platforms aren’t accessible to all children and young people, the way Adam was able to use Twitter to engage with ‘movers and shakers’ in the NHS and beyond was I think a lesson in the democratising potential of social media. I always remember one interaction early on in our Twitter relationship when Adam, who had I think been in hospital for six months or so at that point, tweeted that he hadn’t been able to have a bath during that time because of access issues. His reach on Twitter was such that this issue was rapidly escalated and suddenly, after months of face-to-face requests being denied because it ‘wasn’t possible’ Adam tweeted that he’d been told a way had been found to make it happen and the twitterstorm abated*.  As Adam communicated by blinking the way he used Twitter to create change and raise issues highlights the need to consider what we mean by, and how we enable, children and young people’s voices. Participation need to happen at both a personal level: with children, young people and their families involved in decision-making about individual care and the services they use, as well as at a more strategic level: in planning, shaping, delivering and evaluating services and influencing  policy.

I don’t have many answers yet but, inspired by Adam’s life and Zoe’s post, I will now return to my studies with a renewed zeal to play my small part in promoting children and young people’s rights and voice in health services and the research which informs them. I will become one of “Adam’s Allies” – will you?

If you would like to donate to the cause which Adam requested be his legacy:

*Although Adam’s mother told me after I first wrote this post that he never did actually get a bath – so maybe there’s a lesson there about social media being good for raising issues/generating heat but that this doesn’t necessarily mean it leads to real-life action?

More on involving children and young people in research: guest post on the BMJ Archives of Disease in Childhood blog

Paediatric clinicians and others in related fields are very aware of including young people in their clinical work, but what about making it happen in research? Following the recent INVOLVE conference, I was asked to write a guest post for the BMJ Archives of Disease in Childhood which briefly outlines why this matters and how it could be taken forward:

Guest Blog: Involving children and young people in health and social care research: the need for a new perspective

Comments and ideas – as always – are very welcome!

Public involvement with children and young people – some reflections from INVOLVE 2014

I’m still buzzing with ideas after last week’s INVOLVE conference. It was great to launch the social media guidance, which generated some really interesting conversations  – watch out for a tweet chat in January, further details to be confirmed. But the focus of this post is on the involvement of children and young people in research (although of course social media does come into this), and I wanted to follow up my last post on this topic with a conference-related update.

I was part of a great session on children and young people’s involvement which was chaired by Erin Walker, who supports the CRN CC Children Specialty’s Young Person’s Advisory Group in London. Fellow presenters included Hayley Reed talking about the exciting work DECIPHer are doing with their ALPHA young people’s research advisory group. Having had links with ALPHA in the past it’s great to see them going from strength to strength and developing some really innovative ways of working with researchers. The final presentation was by Valerie Dunn on ‘engaging young people in care through animation’. More information on the fantastic films she made with young people can be found here.

Both presentations linked really well with the one I co-presented on ‘involving children and young people in research: the usual suspects’. My co-presenters were Lorna Templeton and S, a young advisor to the project. Our presentation (below) focused on our attempts to involve young people in the ‘Youth Social Behaviour and Network Therapy’ (YSBNT) Study*, and explored what we are learning about involving a ‘seldom heard’ group of young people  in research:

A few reflections:

It was great to meet so many people with an interest in children and young people’s involvement in research, and to feel that the interest in this area is growing. A few people commented on the lack of children and young people at the conference (a recurring theme), and the need for a specific stream at the conference and/or a dedicated national event on this topic. This has come up in the past (for example here) and is certainly something I’ll discuss further with the INVOLVE advisory group.

  • Any other thoughts from people who attended the conference?
  • Are others also interested in a community of practice on children and young people’s involvement in research?

*The Y-SBNT project is funded by the National Institute for Health Research HTA programme (project number 11/60/01). The views and opinions expressed in this post are those of the author and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.

Researching children’s everyday lives: presentation from CSCY conference

I’ve just come back from a great couple of days in Sheffield at the Centre for the Study of Childhood and Youth conference ‘Researching children’s everyday lives: socio-cultural contexts’. I’m just sorry I had to leave before the end! But while it’s all still fresh in my mind I thought I’d post up the slides on and some background notes from the presentation I gave on some of the ideas emerging from my research:


The starting point for my research is that, despite increasing profile of children and young people’s participation, there’s a lack of evidence about how to ensure it is meaningful, effective and sustained – and especially in health services and research.

As came up in quite a few of the other presentations, ‘childhood’ has many and varied definitions including ‘the status of being a minor, the early-life state of immaturity whether actual or ascribed and the process of growing towards adulthood’ (Alderson, 2013; my italics). Theoretical approaches to childhood in the minority world have been dominated by developmental psychology, and the idea ‘that what children mainly do during childhood is develop towards adulthood’ (Mayall, in press). Also the idea that children are above all to be protected and provided for in order that they may develop well and be prepared to enter into the public domain upon reaching adulthood. Childhood studies, and in particular the sociology of childhood, has challenged these ideas of children being apolitical adults-in-waiting, and instead developed paradigms of children as social actors and childhood as a social space in which children can and do have agency (see references below).

Navigating the landscape

Within England there is widespread acknowledgement that children and young people should be involved in decisions which affect them, and this is increasingly reflected in law, guidance, regulation and policy in relation to health and more widely. The Children and Families Act 2014 mentions children’s rights and the UN Convention on the Rights of the Child, and public involvement is also a key element of the Health and Social Care Act 2012. Increasing awareness of the importance of developing children and young people’s participation in health services in a strategic and systematic way. Patients working in partnership with clinicians and carers in decisions about their healthcare is one of the guiding principles of the 2013 NHS Constitution. In their response to the Children’s Health Outcomes Forum report the UK government acknowledged the importance of children’s rights and the CRC being at the heart of health and social care. The recent Chief Medical Officer’s Report talks about the expectation inherent in the NHS Constitution ‘that patients, service users and the public participate nationally and locally in the development, implementation and accountability processes of health and social care policy and services’. The report goes on to emphasise the importance of the CRC to these participation processes and say that:

“This expectation for patient and public participation has no age limit. Children and young people…should be encouraged and facilitated to participate in decisions about their own care and, more broadly, about the health and social care services and policies that affect them”.

Recent developments at a national level include the NHS England Youth Forum, new children’s experience measures within NHS, The Care Quality Commission involving CYP in their inspection activities, and the involvement of children and young people on the board of Healthwatch England and within local Healthwatch bodies. I also discussed the use of rights-based tools and quality criteria such as ‘Hear by Right’, ‘You’re Welcome’ and Young People Friendly.

Children’s rights

I briefly touched on definitions and models of participation (a topic for another post!) and the UN Convention on the Rights of the Child (CRC), in particular Articles 12 (every child and young person has the right to express his or her views freely in all matters affecting them) and Article 24 (children have the right to good quality health care and information to help them stay healthy). A key implication of the CRC is that all children have needs that must be met in order to optimise their health and wellbeing, and the CRC establishes international recognition that all children and young people have a right to the highest possible standards of both healthcare and participation. In a 2013 General Comment on Article 24 the UN Committee on the Rights of the Child emphasised ‘the importance of approaching children’s health from a child-rights perspective’, and say that:

“Article 12 highlights the importance of children’s participation…This includes their views on all aspects of health provisions, including, for example, what services are needed, how and where they are best provided, barriers to accessing or using services, the quality of the services and the attitudes of health professionals, how to strengthen children’s capacities to take increasing levels of responsibility for their own health and development, and how to involve them more effectively in the provision of services, as peer educators. States are encouraged to conduct regular participatory consultations, which are adapted to the age and maturity of the child, and research with children, and to do this separately with their parents, in order to learn about their health challenges, developmental needs and expectations as a contribution to the design of effective interventions and health programmes (General Comment 15, section II.E. My emphases).

This quote sets out in far more detail that the CRC itself the Committee’s view on what these rights mean in practice for children and young people, both within decisions about their own care and in the development of health services and research.

My research

I then outlined my research in a bit more detail and talked about the two case studies with whom I have now been working for almost a year, exploring how the rhetoric around children and young people’s participation in health services and research becomes reality.  We’re currently coming to the end of fieldwork so I’ll post more later in the year about emerging findings.

We then discussed the ideas on what it means to ’embed’ children and young people’s participation in health services and research, and I outlined the discussions which took place at last summer’s workshop with the Children’s Commissioner and others – the report on the day includes details of the elements discussed on the penultimate slide.

Many thanks to everyone who came to the presentation and/or who I met at the conference later on. I came away buzzing with ideas and inspiration, and hopefully we can continue to keep in touch via twitter, the blog or more traditional means! If you’re interested in contributing to the debates and weren’t at the conference please feel free to comment on this post or via twitter too!

Selected references

Alderson, P. (2013). Childhoods Real and Imagined. Volume 1: an introduction to critical realism and childhood studies. London: Routledge

Alderson, P. (2014). Children as Patients. In G. Melton, A. Ben-Arieh, J. Cashmore, G. Goodman, & N. Worlet (Eds.), The Sage Handbook of Child Research (pp. 100–117). London: Sage.

Brady, L.M., Davey C., Shaw, C. and Blades, R. (2012) Involving children and young people in research – principles into practice. In Beresford, P. and Carr, S. (2012) Social Care, Service Users and User Involvement: building on research. London: Jessica Kingsley, pp.226-242.

Cockburn, T. (2005). Children’s Participation in Social Policy: Inclusion, Chimera or Authenticity? Social Policy and Society. 4 (2), pp. 109-119.

Franklin, A., & Sloper, P. (2005). Listening and responding? Children’s participation in health care within England. International Journal of Children’s Rights, 13, 11–29.

Freeman, M. (1998). The sociology of childhood and children’s rights. The International Journal of Children’s Rights. 6, 433-444.

James, A. and Prout, A. (1997). Constructing and reconstructing childhood: contemporary issues in the sociological study of childhood. London, Falmer Press.

Jans. (2004). Children as Citizens: Towards a Contemporary Notion of Child Participation. Childhood.11(1), 27-44.

Jenks, C. (2005). Childhood. 2nd ed. London: Routledge

Kirby, P., Lanyon, C., Cronin, K. and Sinclair, R. (2003) Building a Culture of Participation: involving children and young people in policy, service planning, delivery and evaluation. London: DfES.

Mayall, B. (in press). The Sociology of Childhoood and Children’s Rights. In Vandenhole. W. et al (eds) Children’s Rights: Global perspectives and critical perspectives. Publisher tbc

Percy-Smith, B., and Thomas, N. eds. (2010) A Handbook of Children’s Participation: Perspectives from Theory and Practice, London: Routledge.

Qvortrup, J.,Corsaro, W.A., and Honig, M.S. (2009).The Palgrave Handbook of Childhood Studies. Basingstoke: Palgrave Macmillan




Embedding children and young people’s participation in health services and research – UCLan seminar May 2014

Last month I was invited, along with Dan Moxon from People, Dialogue and Change, to present at a one of the regular seminars organised by the UCLan Centre for Children and Young People’s Participation.

The seminar was on children and young people’s participation in health services and research (see flyer:12 May Louca Mai Dan Moxon POSTER). Both Dan and I discussed the work we’re doing in this area and, although a select audience, then had some really interesting discussions with those who attended. The recording of the event can be found here.

In my presentation I explored emerging findings from my research on what it means ‘embed’ children and young people’s participation in health services and research, including reflecting on learning from workshops in July and October last year:

Dan then went on to discuss some of the great work he’s doing in this area:

The discussions that followed raised some really interesting issues, which will inform the next phase of this work. Many thanks to Nigel Thomas and UCLan for hosting. It also very much like the start of a conversation, which you’re very welcome to join via this blog if you couldn’t make it on the day.

Good participation in health services – a young person’s perspective

As this blog is all about children and young people’s participation, another contribution from a young person was well overdue. The post below was written by Felicity, a young woman I’ve been working with at the Community Children’s Health Partnership in Bristol, as part of the research we’re doing together on embedding children and young people’s participation in health services and research. The post needs no further introduction – other than to say that this is why children and young people’s participation in health services matters…


The Community Children’s Health Partnership is a partnership between Children’s Services in North Bristol Trust and a Barnardo’s Project called HYPE (Helping Young People Engage).

As a young person that has been involved with CCHP for nearly five years (and CAMHS for seven years), I jumped at the chance to become involved in developing the new ‘Participation Strategy’. Over the last six months I have been working with seven other young people. Collectively, we have experience of ten different services within CCHP and as a result, we know first-hand that there is a lot of great participation happening but also that the journey is not complete.

We wanted to be involved in developing the strategy to help embed participation on every level across the partnership. Drawing up this strategy gives participation the same importance as any other policy and provides a standard and formal tool for professionals to measure their performance against.

We met on several occasions with staff from CCHP. This partnership seemed to ignite a lot of enthusiasm and discussion. We tried to use creativity in our meetings, which was somewhat novel for some of the staff, but really facilitated expression and cohesion. By the end of our meetings I really felt as though we were an equal group and that there was no disparity between YP and staff. The one thing that is really poignant in my memory is the word collaboration. I left feeling really hopeful that this collaboration was definitely the way forward and the thing that was going to make this strategy authentic and meaningful. It would be a pretty hypocritical participation strategy if it was written without any participation from the Young People!

Now the strategy is written, the next step is to work together to make this strategy come alive, be truly meaningful and become more than words on paper. How do we communicate to YP what they can expect from good health care and what ‘good’ looks like in practice? The challenge now is how CCHP make the strategy really mean something to children, young people and their families.

As a group of Young People, we have some ideas about what we would like to do next. YP cannot hold staff to account when they have no idea of what they should be expecting in terms of good participation. We want to work on translating the strategy in to something that is accessible to all young people, their families and carers. We hope that there might be some scope to work with a graphic designer to produce a poster and leaflets that can be distributed around waiting rooms. We are also looking into the possibility of producing a film.

When good participation happens, both parties learn and gain from each other in equal measure. I’ve learnt new skills, regained the confidence and purpose that my mental illness had unceremoniously stolen and gained voluntary experience that has helped in applying for jobs and university. This work has revealed my passions and convictions, allowing me to carve out some direction in my life.

I would hope that the professionals have learnt something from us too!

As well as the strategy, another young person and I worked with Barnardo’s to produce a film of our participation journey. The past few years of our lives have been quite a difficult journey. We both agree that a big part of the progress we have made can be attributed to the participation we have been involved in. We made the film to convey the impact and difference good participation makes to individuals on a more personal level. For me, making this film was kind of like a closing chapter as I try and make the leap from having the identity of a service user to that of a recovered student/professional with lived experience. I’ve been inspired to choose a career in the NHS from the work I have seen and done in CCHP. Our film tells the story of participation, recovery and friendship:

In May the CCHP had a visit from Kath Evans, National Head of Patient Experience for Children and Young People. We were delighted to be able to present the Participation Strategy and our film to her. I don’t think I have ever met someone so enthusiastic and passionate about championing the voice of Young People. It is very reassuring to know that people like her are in charge and such a privilege to share the work we’ve been doing with her. We have even been invited to show our film at an event in London in a few months time.
I truly owe a lot of my recovery from mental health problems to the things I’ve been involved in with CCHP. It’s really exciting to see the progress we’ve already made and I can’t wait to see what the future holds.

Felicity Hathway