I really must catch up on the books I've read this year during my blogging hiatus, but I'll start from this month's.

August
The Used Women’s Book Club by Paul Bryers
This was a pretty good page-turner, even if I did see the end coming a mile off. It's kind of like Robert Goddard but better written. A good holiday read, undemanding but interesting. (56/100)

A Perfect Life by Raffaella Barker
I loved this book at the time I read it, really identified with the central character, a woman whose marriage seems strong but is going down the pan. Her son is also well written, and the rest of the family are all believable. Barker tries to make the husband sympathetic too, but she doesn't quite succeed. The strength of this book is how real it feels; its descriptions of places and emotions are original and ring true. Its weakness is that it doesn't stay with you - it took me a while to remember anything about it, even less than a month later! (85/100)

Arlington Park by Rachel Cusk
I enjoyed this book almost all the way through, for many of the same reasons as the Raffaella Barker book. It is a series of sometimes-interconnecting vignettes of the lives of some of the women in Arlington Park. Some of these come off better than others - Julia is particularly engaging. But then towards the end it becomes a bit over-written, and I found the ending itself a bit pointless. Or maybe that was the point, and I missed it! (84/100)

NHS managers are on the whole such a bunch of conniving, swindling, privatising, meddling, paper-pushing numbskulls that one might be tempted to think that Labour Party officials were in charge of appointing them, all the better to destroy the NHS.

So here, hidden away from the main news rags, is yet another example, with some interpollations from me, because even the Manchester Evening News doesn't have it all straight:

Patients forced to move
Amanda Crook
29/ 8/2007

SERIOUSLY ill psychiatric patients have been bussed more than 100 miles to other units ahead of a massive strike by nurses.

Most of them have been sectioned because they are considered a risk to themselves or others and suffer from conditions such as schizophrenia, manic depression and dementia.

But health bosses have opted to close three wards and move patients from the Park House unit at North Manchester General while health workers take part in a three day walkout. Staff are protesting at the suspension of union official Karen Reissmann, a senior psychiatric nurse who has worked in Manchester for 25 years and has led opposition to a controversial review of care.

Just to be clear on this, the staff are not protesting against any managerial investigation or disciplining of this nurse, they are protesting at her suspension prior to investigation. The charges against her do not relate to patient care, and her competence is not in question, therefore there is no reason to suspend her.

Over five hours yesterday afternoon it is understood that 21 patients were moved by bus to Darlington and a further 15 by cab to Bury. Thirty were sent home.

In past strikes - in line with NHS practice during industrial action - union leaders in talks with bosses have agreed to allow essential staff to remain on duty to care for the sickest patients along with managers and agency staff. But on this occasion bosses said all hospital staff were needed and negotiations collapsed.

Which is obviously what the managers wanted. In effect, they were trying to deny Unison members the right to strike: a right which no nurse abuses.

It has cost Manchester Mental Health and Social Care Trust (MMHSCT) an estimated £36,000 for the patients’ care in other hospitals. The trust is already in special financial measures with a predicted debt of £2.5m.

Both sides today agreed patients were suffering as a result of the dispute but blamed the other for the stalemate.

Nurses were said to be devastated at the impact on their patients and insisted it was not necessary to close wards because they would have made sure enough staff did not strike in order to keep them open.

And it is worth emphasising that in previous disputes they have done this.

Unrest
Almost 90 per cent of Unison workers who took part in the ballot voted to walkout at 7am today until midnight on Friday. The unrest happened after trust bosses charged Ms Reissman with bringing the trust’s reputation into disrepute 10 weeks ago. She is accused of behaviour undermining their confidence in her as an employee; and misusing her time as a community psychiatric nurse. She has been an outspoken critic of proposed staff cuts at the trust and the transfer of NHS services to the voluntary sector.

She has good reason to speak out too. Instead of cutting managerial jollies or posts, Trust management has decided to scrap patient services: services which are already ranked as third worst in the country. As a result of the ongoing rows about further proposed cuts (called 'Change in Mind' by managers - 'Mindless Change' by staff), the medical director (Frank Margison) has resigned, and a patients' group is calling for a public enquiry into the Trust management.

Not surprising really. The proposals for community mental healthcare include plans to change a 24/7, 365 days a year service into a 9 to 5 weekdays only one. We're talking here about the most vulnerable members of society: the severely mentally ill. 'Out of hours' they will be expected to go to A and E departments if they relapse or have a crisis. They either won't bother, or will go and end up in a worse state than before - possibly in a prison cell, since pressurised A and E staff rarely have the time or skills to treat the severely mentally ill with the kid gloves they require.

Last night Stephanie Thomas regional head of health for Unison said: “We are disgusted at the way the trust has chosen to deal with this, we have been in constant contact with the trust to try to arrange emergency cover, we were ready to do this until 3pm yesterday.

“We believe the trust’s action have not only put patients at risk but also members of the community – we would ask for the trust’s action over the last few days to be fully investigated.”

“This decision will have a long term impact on industrial relations with the trust which were just starting to improve – it has only made staff more determined to take action in support of Karen."

MMHSCT chief executive, Sheila Foley said “Our first priority is and always will be patient care. It is deplorable that Unison has decided not to provide an adequate level of cover for these acutely ill patients therefore we have had no option but to seek care for them elsewhere.

“We understand the disruption and upset that may be experienced by our patients and carers as a result of this strike action.”

Understand and don't care.

Sheila Foley, of all people, should be aware of the need for strong community services for the mentally ill. She was Chief Executive of East London and the City Mental Health NHS Trust, the Trust that was caring for Peter Bryan when he killed and tried to eat Brian Cherry in 2004.

Yesterday staff were given one hour to get in-patients on three wards ready to move, some to private units where the usual cost is £350 per person, per night.

MMHSCT has units at North Manchester General, Manchester Royal Infirmary and Wythenshawe hospitals as well as providing community care across the city.

Impact

Patients have not been moved from MRI and Wythenshawe because the strike is expected to have more impact at North Manchester as this is where Ms Reissmann was based.

Ms Reissman said: “Unison has made every effort to come to arrangements with the trust but they were not interested, they asked for all staff who work on the wards to be exempt and they have not been prepared to negotiate with us.

“We have provided safe cover for patients during industrial disputes previously and we were happy to do this again, there was no need for patients to be bussed across the country or to leave them at home without community support.”

Unison leaders estimate 600 of the trust’s 1,500 staff are expected to join the walkout.

Trust bosses refused to confirm how much the arrangements would cost, saying some of the rates were still being negotiated, and insisting patient safety had to come above financial concerns.

Shame those priorities only hold true during strikes.

They also confirmed they would provide transport for relatives to visit patients in the units.

Alan Hartman from patient group Manchester User Network said: “We are very worried about this last minute decision to bus patients all over the country it is unprecedented, we have never seen anything like this.

“Some patients don’t even know what the arrangements are for them getting medication. We also have carers worrying themselves sick and asking for advice. We support the nurses who have been sticking up for patients and their jobs have been under threat, they have just been pushed too far.”

When relationships between managment and staff break down to this extent, it is a sign of complete managerial incompetency and arrogance. These people need replacing and soon.

What has been most worrying to me about this case (and to a lesser extent the prison officers' strike) is that what pitiful coverage there has been has mostly centred on attacking nurses for striking. The media seems happy for public sector workers to have the right to strike so long as they don't use it under any circumstances.

Personally, I think that all the health unions have been pussyfooting around for too long, ever since Thatcher started the managerialisation (is that a word?!) in the 80s. Since then, every reform seems to result in more managers and more spending on monitoring fewer and fewer staff providing fewer and fewer services. Of course, the fiddled figures hide this. Got a long waiting list for hernia repair? Want to meet your government imposed 8-week waiting time for all surgeries? Just decide that hernia repairs are not clinically warranted and cancel them all! Simple!

No wonder there's so many managers. Gotta be hard work spinning so fast.

This morning I was reading Arlington Park by Rachel Cusk, and a paragraph jumped out at me:

All men are murderers, Juliet thought. All of them. They murder women. They take a woman, and little by little they murder her.

And as if it isn't enough for just the men to do it, the whole of society jumps in there and helps out. If the women are brave enough to give up corsets, they'll soon find they are having to starve and purge themselves in an attempt to achieve the same effect 'naturally'. If they give up lead painting their faces, they'll end up botoxing in the end. The social death and disapproval of growing old or being unfashionable ('ugly') has always resulted in women sacrificing their health.

At least there was one time in our lives when we could eat what we wanted without worrying about our waistlines for nine precious months. No more:

The Independent 15th August 2007

Overeating in pregnancy could lead to child obesity
By John von Radowitz

Pregnant mothers-to-be who "eat for two" by increasing their intake of fatty and sugary food could unwittingly be putting their children at risk of obesity, according to new research.

Unborn babies and developing infants can have their eating habits programmed by their mothers' food choices, according to the findings.

Children exposed to "maternal junk food" in the womb or early in life may find it harder to resist an unhealthy diet as they grow older, say the researchers.

Dr Stephanie Bayol, from the Royal Veterinary College in London, said: "Our study has shown that eating large quantities of junk food when pregnant and breastfeeding could impair the normal control of appetite and promote an exacerbated taste for junk food in offspring.

"This could send offspring on the road to obesity and make the task of teaching healthy eating habits in children even more challenging."

Controlling appetite involves hormones which act on the brain to regulate energy balance, hunger and satiety - the sensation of "feeling full".

However, feeding is not merely mechanical. It is partly governed by "reward centres" in the brain whose pleasure responses may override normal "feeling full" signals. Previous research has shown that junk foods rich in fat and sugar inhibit satiety while promoting hunger and stimulating the mind's reward centres.

The way this finding has thus far been reported leads one to think that it must be the result of a huge, ongoing, prospective study of thousands of women from different countries and ethnic backgrounds. One would be mistaken:

The new research, carried out on rats, indicates that even before birth, exposure to junk food may induce an unhealthy taste for fatty, sugary treats.

Dr Bayol's team studied 42 pregnant and lactating female rats as well as 216 offspring from weaning to 10 weeks of age. Offspring of females, fed junk food while they were pregnant, or when they were lactating, showed a marked preference for foods rich in sugar and fat compared with those whose mothers were given a normal diet. They also ate more.

Writing in the British Journal of Nutrition, the scientists said the same kind of trends could be expected in humans. Dr Bayol said: "Exposure to a maternal junk food diet during their foetal and suckling life might help explain why some individuals might find it harder than others to control their junk food intake even when given access to healthier foods later on in life."

Or maybe mothers who eat junk food during pregnancy are more likely to feed their children junk food once they are born? This research is meaningless unless you are a rat. And even then, you may not share much on common with a lab rat or its foetus.

Dr Bayol's co-author, Professor Neil Stickland, who heads the research group at the Royal Veterinary College, said that mothers should be made more aware of risks associated with poor diet.

"The Government is trying to encourage healthier eating habits in schools, but our research shows that healthy eating habits need to start during the foetal and suckling life of an individual," he said.

This man should get out more. He should read any one of the countless women's magazines that clutter the shelves of newsagents everywhere. They all repeatedly slam home the message (for after all, we are but stupid women) of healthy eating and what foods we are and aren't allowed to eat.

He might also like to review this paper (a review of the limitations of testing drugs on pregnant animals as a predictor of their effects on humans):

No one species absorbs, metabolises and eliminates test substances just like a human nor possesses the same placental transfer properties; no one species has the same pre-term developmental and metabolic patterns as do humans;

and then go out and design a proper research trial: one that tells us something useful about pregnant women.

Daily Mail 13th August 2007:

Current child growth charts should be scrapped 'to encourage breast feeding'

Child growth charts used for 30 years in the UK should be ripped up and replaced with a new World Health Organisation guide, according to a new report.

The joint report, by the Scientific Advisory Committee on Nutrition (SACN) and the Royal College of Paediatrics and Child Health (RCPCH), says WHO Growth Standards should be applied to children aged between two weeks and 24 months.

Current UK growth charts are based principally on formula fed babies and reflect "how babies are growing" in the UK. However, because breast fed babies grow at a slower rate than those on formula milk many breast feeding mothers have been concerned their babies were developing too slowly.

The new WHO charts prescribe "how babies should grow" on an exclusive breastmilk diet. The new standards can be used for assessing and monitoring growth of all babies and encourage mothers to breastfeed for the first six months of a baby's life.

So here’s what I don’t get. These ‘standards’ will still be made up of an average (presumably the mean) of the weights of hundreds of babies at different ages. How is this supposed to give me any guide to my individual baby’s healthy weight? Babies aren’t convenient numbers, they are individual human beings.

I’m lucky, in that I am a physio and so I know not to take the words of a midwife, doctor or other health professional as gospel. My breastfed baby went from 8lb 3ozs at birth to 11lb 2 ozs in two weeks. ‘He’s too heavy’ said the midwife. I ignored her. He was constantly hungry by 16 weeks, so I introduced solids. The new WHO guidelines to only begin solids at 6 months would have had me worried, stupid as I am that way, but he weighed 20lb 5 ozs and was constantly hungry, and the guidelines in those days were to allow solids at four months. The midwife still thought he was too heavy. I ignored her. At 10 months he stopped breastfeeding of his own accord, and shot up in height. By a year, the midwife was really worried. ‘He’s underweight.’ I ignored her.

What no growth chart can possibly show is how individual children grow in fits and starts. My child was breastfed and was theoretically overweight all that time. In fact, by looking at his body I could see he wasn’t fat: he was just chunky. That’s not a euphemism, he genuinely had no rolls of flesh, he was firm.

Dawn Primarolo, Public Health Minister said: "We welcome this report from the Expert Group on Growth Standards. We are committed to promoting breastfeeding and these new standards will help alleviate mothers' concerns regarding the difference in growth patterns often observed between breastfed and formula-fed babies."

Presumably if you are reckless enough to bottle feed, you won’t be concerned about your baby looking ‘fat’ on these new scales?

Breast milk is the best source of nutrition for babies and the Department of Health recommends exclusive breastfeeding up to the age of six months. Recent evidence suggests that breast fed babies which develop more slowly have a lower risk of obesity later in life.

Professor Peter Aggett at the Royal College of Paediatrics and Child Health said: "The recommendations to adopt the WHO Standards for early life are an important means to support the exclusive breast feeding of babies in the first six months of life and the development of early growth patterns that could reduce the risk of these children becoming overweight and developing life threatening diseases in later life."

The Department is working with the RCPCH to pilot the new standards

I strongly believe in breastfeeding, but I don’t believe in ‘experts’ telling us what is right for our babies. It’s disempowering and de-skilling.

Watching Channel 5 at the weekend I was horrified to see all these people bigging up Gina Ford like it was a good thing to send your baby to bootcamp. Her ‘Contented Little Baby’ book contains routines that are total and utter madness. Parents and children up at 6.45 whether they feel like it or not. There are even half hour periods specifically set aside for ‘kicking’.

Don’t get me wrong, the book isn’t worthless, and some of the advice (like blackout curtains, swaddling, and ‘teaching’ baby the difference between day and night) was useful. But how can someone possibly say that my baby won’t be contented if I don’t get it up at 6.45? Even the book that I loved and found most helpful (Tracey Hogg's 'Baby Whisperer') had to be adapted to suit my baby, who liked to feed as soon as he woke.

Yet Gina Ford gives the impression that if you don’t follow her ‘correctly’ and your baby ‘fails’ then you are a bad parent. Why does it not cross her mind (or the minds of her flock of followers) that her method is pants? That if it works in your case, that’s pure luck, not a miracle method?

As a first time parent I was looking for guidance and help and jumped on anything that might have helped give me a few hours uninterrupted sleep. Prescriptive books like Gina Ford’s that offer a ‘guaranteed’ fix are exploitation of that natural tendency. Growth charts are presumably there to reassure parents, but like these books they can in fact be setting parents up to fail, and can undermine the fragile confidence of new parents. Second time around, does anyone give a damn about them?

A 5 year old girl I know recently transferred from another local school to ours, as she had been becoming increasingly distressed and had been frightened of her teacher. When her mother spoke to the head about this, he said, ‘I don’t know what you are worrying about: we all have to conform eventually (baaaaaaaaaa!).’

Surely even he would think that birth is a little too early to start?