The past is another country in Britain
GPs visited at night. Nurses knew your name. Is this why a series about Fifties midwives has struck such a nerve?
On Sunday night, the first series of Call The Midwife ended on a gas and air high. In the BBC’s period drama, yet more screaming babies were safely delivered into the grim, post-war streets of East London.
The nuns were happy, the mums blissed out, the dads in a daze as they smoked their Woodbines and worried about the future with another hungry mouth to feed.
Nurse Chummy, as played by Miranda Hart in a star role, bicycled off into the sunset, freshly hitched to PC Noakes. As grumpy Sister Evangelina noted, it just showed that there is a slipper for every old sock, an ounce of baccy for every pipe and a wet nappy for every mangle. Or something like that.
And speaking of pregnant pauses, the six-part series has delivered an unlikely, but long overdue, Sunday night ratings hit for the BBC, beating even that period drama smash of recent times over on rival ITV channel, Downton Abbey.
Indeed, once the figure of more than 11 million viewers for the last few episodes of Call The Midwife was confirmed, a second series was immediately commissioned.
Few could have imagined that an adaptation of Jennifer Worth’s memoirs of working as a district nurse in Poplar, East London, in the 1950s would be such a big success.
Yet the strong storylines about pain and poverty, about a sense of duty and selfless dedication by the various members of the medical profession struck a very big chord with the viewing public.
Even so, the secret of its success is actually quite hard to divine. After all, with the best will in the world, Call The Midwife is a bit too much like Heartbeat With Forceps for comfort.
Each episode quickly settled down to follow a familiar pattern of comforting but treacly cliché. Sooner or later, you could bet your last bib that someone would shout ‘Push!’, Sister Julienne (Jenny Agutter in a wimple) would always manage to weasel in another of her little sermons about duty in the community, while Jenny (Jessica Raine) listened intently after washing off her lipstick.
In the finest tradition of maternity-based drama, large pinny-wearing women hanging out the washing would suddenly clutch their stomachs and keel over like skittles as the call to the midwife went out. Rumour has it the midwives soon learned to tell how far the cervix had dilated by counting the number of pegs still clutched in her hand.
Meanwhile, useless menfolk boiled kettles while pacing outside. For six weeks on Sunday nights, babies were snatched, stillborn, unwanted, breeched and bloody. And the public couldn’t get enough of it.
Why? Perhaps we are comforted and even dazzled by the thought that once upon a time, nurses and doctors and midwives would do their absolute very best for you, no matter what. In every sense of the word, they cared. They would — I know this sounds incredible — even come to your house if there was an emergency.
They would bang on your door and charge up the stairs, without so much as a box to be ticked or a form to be filled or a health quango to assess the health and safety risks. Theirs, not yours.
And when they arrived at your bedside, there was a fair chance that they would know your name, your medical history and exactly who you were and what you did for a living. All the important stuff. The possibility of them speaking English was also high.
Can you imagine such a thing happening today? If you have a medical crisis in the middle of the night in modern Britain, you have more chance of seeing Lord Lucan on your doorstep than your own GP.
And despite David Cameron’s pledge before he came into power to deliver an extra 3,000 midwives for the NHS, no such thing has ever happened. In fact, there is still an estimated shortfall of nearly 5,000 midwives — and this at a time when the national birth rate is at a 40-year high.
No wonder the system is creaking at the seams, or that the midwife you see at the beginning of your pregnancy is unlikely to be the same one who is there at the end. No wonder we turned our rose-tinted NHS spectacles onto glorious full beam when watching Call
Even the prospect of clumsy Miranda Hart turning up at your bedside with a goofy smile and a 1950s standard issue glass enema nozzle in her hand was almost a cheering one. Almost.
No one wants to turn the clock back entirely to the medical badlands of the 1950s — especially, please, please, not to 1950s births. Back then, a woman dying in childbirth, in terrible pain, was not uncommon. Babies were lost who could have been saved.
Yet despite all that, what Call The Midwife reminds us is that doctors, nurses and midwives once really were at the very heart of every community, rich or poor, for better or worse.
You could depend on each and every one of them to do their best for you, in a selfless and noble way. People on both sides of the medical divide pulled together in a manner that seems impossible today.
Certainly, there was something very sweet and alluring about the old-fashioned midwives as depicted in this television adaptation. There were well-nourished young women of good birth, each of them facing the harshness of life and the hardships of others for the first time. ‘Your comfort is not important,’ Sister Julienne would tell them. And she was right.
Contrast that with the box-ticking, let’s-all-stand-around- the-nurses-station-all-night, me-me-me generation who terrorise the vulnerable in our medical institutions today.
Not all of them, of course. There are still a great deal of dedicated and wonderful nurses and doctors out there. Yet to many of the sick and the vulnerable and the pregnant, hospitals have become places to fear. In fact, we don’t even have doctors and nurses to trust to look after us there any more, we have so-called ‘health professionals’, whomsoever they might be.
Any concept of selfless devotion is ground down under the arduous weight of long shifts, poor pay and a system that does not support them any more than it does the poor patients crammed into overcrowded wards.
So in many ways, it is hardly surprising that Call The Midwife swiftly gathered such a devoted army of fans. It harks back to a simpler age.
Yes, there was post-war austerity — worse, by a long chalk, than the austerity we have today. Britain was still reeling after World War II. Cities were still bomb-scarred, some foods were still rationed or in short supply, the country was on its knees. Everyone had suffered: everyone had lost someone or something.
Yet the effects of the war concentrated everyone’s minds. People knew what was important, and they looked out for each other. Whatever was going to happen, they had to get through it together.
And it is this, perhaps, that is the secret of this period drama’s heartfelt allure. Because today, in this unsure world, we can’t really depend on anyone any more.
Call The Midwife depicts a very different world. Call the midwife? You can call her an anachronism, you call her what you like. But at least, once upon a time, you could call her.
The genius of using pigskin for hernia repair… so why does the NHS often refuse to pay for this remarkable treatment?
Hernia repair is one of the most commonly performed operations in the world. Cricketer Kevin Pietersen went into hospital for one last March, and Madonna has had three. The Prince of Wales and footballer Frank Lampard are other well-known names to have had it done – along with about 180,000 other Britons each year.
Standard inguinal hernias – small lumps in the groin pushing through a hole in the abdomen wall – may develop in a quarter of all men and one in eight women. They are easily repaired by patching the hole with a piece of synthetic mesh. But the latest research shows that very large hernias can be most effectively repaired using biological mesh made from pig tissue – dubbed ‘pigskin’ by some doctors.
Consultant general and colorectal surgeon Pasquale Giordano, who specialises in treating complex hernias at Whipps Cross University Hospital in East London, has been pioneering repairs using mesh made from pig tissue for nine years.
However, as pigskin mesh costs ten times more than its synthetic counterpart, whether patients get it is a postcode lottery – some Primary Care Trusts (PCTs) are reluctant to pay for it. And some sufferers are likely to face a wait of many months for the operation as other conditions such as cancer take priority. Since Mr Giordano’s PCT – Waltham Forest, North-East London – decided not to fund the biological mesh a year ago, he can do it only on a private basis.
The mesh costs about £8.50 for a section around half an inch square. Given that about 8in by 12in is needed for many larger hernias, that works out as costing as much as £5,000, compared with about £400 using the synthetic mesh.
‘Biological [pig] mesh has been available for more than 20 years,’ says Mr Giordano. ‘In more complex cases there is an increased risk of synthetic mesh becoming infected as the structure allows in bacteria, but not immune system cells. Ultimately the body will reject it.
‘Should it become infected, removal is inevitable, which of course makes it difficult to repair the area again. The biological mesh is made predominantly of collagen, which occurs naturally in our bodies, and the structure of the pig collagen is very similar to a human’s. The patient’s cells will grow and integrate naturally into the graft and the body won’t reject the patch.’
He adds: ‘All PCTs should take the long-term view. Biological mesh may be more expensive, but complex hernias can’t be repaired using synthetic mesh so patients on my waiting list are turned away and told there is nothing to be done. Their lives are made miserable by the condition – they cannot walk properly and can’t work and they are doomed to claim benefits for the rest of their days. That ends up being far more costly to the taxpayer.’
Smaller hernias develop spontaneously at a point of muscle weakness in the abdomen wall after heavy lifting, coughing fits or other forms of strain. Larger and more complex hernias usually result from trauma, accidents, being left open after an operation to clear out infection or post-operative complications.
Timothy George, a 47-year-old tourism consultant from Ilford, East London, is a good example. At the end of 2008 he began suffering severe stomach pains and, after being diagnosed with a hole in his intestine that was leaking toxins into his system, had a 12-hour operation at the King George Hospital in Ilford.
Three weeks later, Timothy’s post-operative scar developed an infection and he had to be restitched. In July he noticed his stomach had distended. He was diagnosed with a large and complex hernia (about 8in by 12in), and in October had an operation to repair it using synthetic mesh. But after two months the mesh became infected and the hernia returned. ‘My stomach protrusion was so large I looked as if I was nine months pregnant,’ he says.
‘I became depressed, turned down work and stayed inside like a recluse. I was so embarrassed – people would stare at me if I went out.’
Timothy was seen by Mr Giordano in November 2009, but the case he made to his PCT for a piece of biological mesh costing £4,000 was refused because a similar-size synthetic mesh cost just £400.
Eventually the manufacturers of the mesh agreed to let Mr Giordano have the material for Timothy’s operation free, for compassionate reasons. The operation went ahead in April this year. Timothy says he feels he has gained his life back – he can go to the gym and wear ordinary clothes.
Consultant plastic surgeon Kevin Hancock, who has worked with both types of mesh, says in the past few years there has been an explosion of the mesh market and estimates that pieces can cost up to £10,000.
‘In many situations the synthetic mesh is adequate, but in others the biological mesh is unquestionably superior – if the hernia has resulted from an infection, for example. ‘In such cases, the ongoing care of the patients is such that the cost of the biological mesh can be clearly justified.’
The Department of Health says it is up to PCTs to decide local policies on the use of biological or synthetic mesh for hernia repair – though PCTs are not allowed to operate a blanket ban and they must have a mechanism for considering individual cases as potential exceptions to the local policy.
‘I know of many more examples where it’s madness not to use the biological mesh,’ says Mr Giordano. ‘I’ve seen a woman with terrible infections and who is on intravenous antibiotics for six months. That treatment alone costs significantly more than one piece of equipment.’
Border scandal: failures of British border controls laid bare
In the last week of June 2007, Britain was in the midst of a terrorism crisis after car bombs failed to explode outside one of London’s busiest nightclubs.
Within days, the UK Border Agency had ordered that anyone arriving at British ports and airports was checked against a database which identified those potentially posing a risk to the country.
However, the Vine Report showed that the order failed to secure Britain’s borders and millions of people were able to enter the country with minimal checks.
The Home Office’s “Warnings Index” (WI), first introduced in 1995, is the “single most important electronic check” carried out to identify undesirable people, including suspected terrorists, criminals and paedophiles.
But, almost as soon as the order to check 100 per cent of passengers arriving in Britain against the index had been issued, exclusions already began to be introduced.
Initially, European nationals travelling from French “resorts” such as Disneyland Paris and the French Alps were not checked against the index. This is thought to have led to about 500,000 people arriving in Britain who had not been checked.
In June 2008, the then head of the Border Force also extended this exemption so that school coach parties travelling through Calais were also not automatically checked.
However, it was a more wide-ranging exclusion which led to some of the worst alleged loopholes emerging.
Border Agency executives were given the discretion to temporarily suspend the checks for “health and safety” reasons.
The Vine report found that the definition of a health and safety risk was not clearly defined but it was used regularly when queues became too long.
Labour claimed that the problem became worse after the election as government cuts began to hit the Border Agency, which was reducing staff.
For example, the report found that Warning Index checks were only suspended 6 times in Calais before 2010 – but 83 times since. The report says that some of these suspensions occurred because of a “moderate number of immigration officers on desks”.
In total, the crucial checks were suspended on 354 occasions.
The report concluded: “The Agency’s records relating to the suspension of the WI were poor. We found that records relating to some suspensions had not been kept, whilst other records did not capture important information, such as whether the emergency services had been consulted before checks were suspended.
“There was a lack of effective management oversight of the frequency with which checks had been suspended, the reasons for this and which ports were suspending checks.”
The lax system for checking people against the Warnings Index soon spread to other controls within the immigration system. A second check – Secure ID – is supposed to check passengers’ fingerprints when they are visiting Britain with a visa. This is designed to stop people fraudulently arriving in this country by checking those arriving are the same as the person who applied for the visa.
However, again, as the queues built up at airports and ports, the checks were quickly abandoned. On a total of 463 occasions at Heathrow in the past two years, the checks were suspended “from a matter of minutes to several hours”.
During 2011, Border Agency executives met ministers to discuss a new approach to checking people, the so-called “level two pilot” which effectively meant that only people deemed a higher-risk were thoroughly checked.
This meant it was no longer routine to open the biometric chip contained in the passports of European visitors. Warning index checks were also suspended for European children travelling “in obvious family units or school groups”. In September 2011, a further, potentially unlawful, scheme was also introduced by immigration staff code-named “Operation Savant” which meant that foreign students arriving to study were not routinely checked.
It also emerged that on 14,812 occasions the “biometric chip reading facility had been deactivated” at ports and airports. The Border Agency was unable to explain the exact reasons for this.
The picture that emerged from the 84-page report was one of chaos and confusion, where ministers’ orders to Border Agency executives were either misunderstood or ignored, and Border Agency staff do not consistently apply directives. There were signs that the situation deteriorated significantly under the Coalition.
The result was that millions of people were allowed to enter Britain without thorough checks.
The report also alleged that Brodie Clark, the former head of the Border Force, authorised officials to go beyond the terms of a pilot scheme agreed last summer. The biometric details of non-European visitors were also not checked, although Mr Clark is expected to argue that the instructions were unclear.
Mr Clark was forced to resign last autumn when details of the scandal first emerged. He is currently taking legal action against the Home Office.
For the Conservatives, the resulting scandal is deeply embarrassing as they made political capital out of a succession of immigration errors under Labour. Similar crises caused the resignations of several Labour ministers and the Home Office was branded “not fit for purpose.”
Last night, it appeared that the positions of Theresa May, the Home Secretary, and Damian Green, the Immigration Minister, were secure as the Vine report shared blame between ministers and officials.
However, this summer will see the biggest ever influx of visitors to London for the Olympics and one of the biggest security operations in Britain’s history. Any repeat of the circumstances laid bare in yesterday’s report would spell the end of ministerial careers.
British boy, 7, branded a racist for asking schoolmate: ‘Are you brown because you come from Africa?’
And the thought-police are not backing down
The mother of a seven-year-old boy was told to sign a school form admitting he was racist after he asked another pupil about the colour of his skin. Elliott Dearlove had asked a five-year-old boy in the playground whether he was ‘brown because he was from Africa’.
His mother, Hayley White, 29, said she received a phone call last month to say her son had been at the centre of a ‘racist incident’. She was then summoned to a meeting with Elliott, his teacher and the deputy head of Griffin Primary School in Hull.
Ms White, an NHS healthcare assistant, said: ‘When I arrived at the school and asked Elliott what had happened, he became extremely upset. ‘He kept saying to me, “I was just asking a question. I didn’t mean it to be nasty” and he was extremely distressed by it all.’
Ms White claimed she was asked at the meeting to read a copy of the school rules and in particular its zero-tolerance policy on racism. ‘I was told I would have to sign a form acknowledging my son had made a racist remark which would be submitted to the local education authority for further investigation,’ she said.
‘I refused to sign it and I told the teacher in no way did I agree the comment was racist. My son is inquisitive. He always likes to ask questions, but that doesn’t make him a racist.’
The school had launched an investigation after the younger boy told his mother about Elliott’s comment and she complained.
Ms White, who lives in a three-bedroom house with her son and nine-year-old daughter Olivia, has now applied to have Elliott moved from the school. She claimed she was told there were places at nearby Thanet Primary School, but the council informed her last Friday that this was not the case. ‘I am going to appeal against this decision because I think Elliott is being victimised,’ she said.
Karl Turner, Labour MP for Kingston upon Hull East, last night insisted that the school and Hull City Council had a statutory duty to take racism seriously. ‘However, having spoken to Hayley, I’m satisfied that her seven-year-old son, Elliott, was not being racist in his remarks but just inquisitive,’ he said. ‘It seems the matter has been taken out of all proportion and common sense seems to have gone completely out of the window.’
In a statement, Griffin Primary head teacher Janet Adamson said the school had acted ‘in accordance with the council’s guidance for schools on the reporting of racist incidents’.
Vanessa Harvey-Samuel, head of localities and learning at Hull City Council, said: ‘There is a statutory duty to report any incident that is perceived to be racist by the victim or any other person.’
Last year, it was revealed that teachers are branding thousands of children racist or homophobic following playground squabbles. More than 20,000 pupils aged 11 or younger were put on record for so-called hate crimes such as using the word ‘gaylord’.
Why lack of male teachers could be the reason boys fail in British classrooms
Schools need more male teachers because boys make less effort in women’s classes, a new study claimed today. The shortage of men in school staffrooms could be one reason for the under-achievement of boys, researchers found.
Female teachers tend to give boys lower marks than they deserve – and boys are less likely to work hard in their classes.
Men appear to be better at motivating boys but are vastly outnumbered in the nation’s schools, taking just a quarter of teaching jobs, and 15 per cent in primaries.
‘Boys often disengage in the educational process, and this is likely to be due in part to their perceptions of their teachers,’ said the study’s authors. ‘There is an under-representation of male teachers in both primary and secondary education in England.’
Girls also made more effort when they were graded by male teachers, according to research by the Centre for Economic Performance at the London School of Economics.
But teachers were found to be more lenient with students of their own sex. Girls actually received higher grades from female teachers than male. Male teachers, in turn, gave boys higher marks.
For the study, 1,200 pupils aged 12 and 13 in 29 schools across England were given £4 and asked to place bets on their performance in an exam. One group of pupils was marked by their class teacher – some male and some female – and another by an anonymous external examiner.
‘The results of the experiment show that male pupils tended to lower their investment when a female teacher marked their exams,’ said the study.
‘Further analysis confirmed that female teachers in the experiment did tend to award lower marks to male pupils than external examiners. ‘So male pupils’ perceptions seem to be roughly in line with female teachers’ marking practices.’
Girls placed substantially bigger bets when they knew they were being marked by a male teacher instead of an anonymous examiner. But male teachers did not mark them more leniently, and in fact tended to discriminate in favour of boys.
Campaigns staged over recent years to increase recruitment of male teachers have failed to change significantly the make-up of staffrooms. A quarter of primary schools do not have a single male teacher, according to figures released last year. Staffrooms in 4,278 of the 16,971 primaries in England are solely populated by women. And there are just 25,500 men teaching young children, compared with 139,500 women.
Conservative MP Philip Hollobone has raised the issue in the House of Commons. ‘This is especially a problem because there are more and more families where children are growing up without a father,’ he said. ‘The teachers in primary school are overwhelmingly women, and they do a great job. ‘But it would be even better if there were more male teachers to act as role models, particularly to young boys.’
Three cups of tea a day ‘protects against heart problems and diabetes’
This appears to be a rather casual look at existing epidemiological findings, and the authors themselves note the limitations in drawing inferences from such data. And the blather about antioxidants is just fashionable crap that goes against the evidence. A not very impressive job of work on behalf of the tea industry but it’s probably the best they could do
Drinking just three cups of tea a day may protect against heart attacks and type 2 diabetes, claim researchers. A review shows regular drinking of black tea, with or without milk, can reduce the risk of heart problems by cutting levels of bad cholesterol and blood sugar.
Experts say the benefits of tea are largely due to the flavonoid content – antioxidant ingredients that counteract cardiovascular disease.
One cup of tea provides 150-200mg of flavonoids and it is the best source of antioxidants in the nation’s diet. In terms of the delivery of antioxidants, two cups of tea is equivalent to five portions of vegetables.
A review in the journal Nutrition Bulletin found drinking three or more cups of black tea a day protects against heart disease and two or more cups a day may protect against type 2 diabetes.
In addition, a 12-week study in 87 volunteers found that drinking three cups of tea a day produced a significant improvement in various cardiovascular risk factors.
Almost 80 per cent of Britons are tea drinkers and 165million cups are drunk every day.
Overall, flavonoids found in tea are thought to control inflammation, reduce excess blood clotting, promote blood vessel function and limit furring up of the arteries.
Nutritionist Dr Carrie Ruxton, co-author of the latest review and a member of the industry-backed Tea Advisory Panel (TAP), said: ‘There is far more to the nation’s favourite drink than we realise. ‘With its antioxidant flavonoids, black tea packs a powerful punch with many health benefits particularly for the heart. And recent studies show that the flavonoids work their magic whether or not we choose to add milk.’
Dr Tim Bond also from TAP, added: ‘Black tea flavonoids are thought to be the compounds responsible for the protective effects of black tea on health. ‘Chronic conditions such as heart disease, stroke and diabetes are associated with inflammatory processes and the presence of excessive pro-oxidant free radicals in the body. ‘The proven antioxidant and anti-inflammatory effects of black tea flavonoids may therefore be responsible for the positive health effects of black tea.’
Is black tea consumption associated with a lower risk of cardiovascular disease and type 2 diabetes?
C. H. S. Ruxton & P. Mason
Type 2 diabetes mellitus and cardiovascular disease represent major causes of morbidity, which impact greatly on healthcare expenditure. Clinical studies suggest that ingestion of black tea, which contains a range of bioactive compounds, can inhibit oxidative damage and improve endothelial function. The objectives of this review are to: (1) evaluate observational evidence linking black tea consumption with the prevalence of cardiovascular diseases and type 2 diabetes; (2) consider the mechanisms by which black tea may have a protective effect; and (3) examine the potential role of tea drinking in relation to public health.
The findings from epidemiological studies suggested a significant association between regular black tea consumption and a reduced risk of coronary heart disease at around three or more cups per day. For diabetes risk, the data are restricted to a few large cohort studies that suggested a beneficial association at one to four cups daily. These findings need to be confirmed by intervention trials. While some studies suggest that drinking black tea may reduce the risk of stroke, likely mechanisms remain unclear, highlighting the need for more human intervention studies. Disparities found involving studies may have been influenced by variations in reported tea intakes, limited sample sizes in intervention trials and inadequate control of confounders. In conclusion, drinking black tea may have a role in lowering the risk of coronary heart disease and type 2 diabetes. Future research should focus on controlled trials and studies to elucidate likely mechanisms of action.