“Two hours – two f***ing hours!” he screams as he bludgeons his partner to a pulp in front of her four children for returning home late from the shops. The onlookers are reduced to a stunned silence. I look around, see their disbelief and share it. The fuming perpetrator is Simon, played by Ray Winstone, and the victim is Maggie Conlan, played by Crissy Rock. Both are wonderfully directed by Ken Loach in his inimitable gritty style. The film we’ve just watched is Ladybird Ladybird.
It’s not long before the lights are on, chairs are being rearranged into the inevitable circle and my General Practice Vocational Training Scheme (GPVTS) group is preparing for a debriefing. To the envy of our hospital colleagues, general practice training has realised that practicing good medicine is not just down to cold evidence-based fact but an embracing of the arts to provide context and humanity to the application of these facts. Fellow medics, especially surgical trainees for some reason, are reduced to enquiring from GP trainees about the number of trees they hugged in their latest GPVTS training session.
The film itself was a brutal depiction of a woman’s journey from a troubled childhood through a chain of dysfunctional abusive relationships to an almighty dispute with Social Services over the care and custody of her children. Many of us were grateful for the admittedly fictional yet harrowing insight into the lives of an otherwise anonymous stream of faces we may see during the course of a clinic, reinforcing the need for continuity in providing context. The discussion flitted from the style of the production to guessing when it was filmed but eventually settled on the perpetually topical issue of safeguarding children.
Our seasoned programme directors shared their experiences of the interconnected triad of child protection, the public conscience, and the media. The Cleveland case, the not so distant Victoria Climbié debacle and the more recent high profile tragedy of Baby P provided chronological anchors to the discussion.
We were challenged to investigate our own triggers for initiating child safeguarding proceedings and to confront subconsciously held stereotypes: is the failing of a parent to conform to our own usually middle class social norms a justifiable trigger? Perhaps more importantly, is conforming sufficient reason to overlook? Unsurprisingly there were many questions and markedly fewer answers. The only unanimous point of agreement was that of the immense difficulty in striking the right balance between upholding the spirit of the Children Act in ensuring that the welfare of the child is paramount and the agonising decision to unleash the machinery of agencies that have the potential to scar individuals and fracture families.
The UK is the worst developed nation in which to be a child, according to both UNICEF and the Good Childhood Inquiry. General practitioners are at the forefront and therefore perfectly placed to guide a redressing of the balance. Encouraging trainees to discuss these issues in novel ways can only help this process.
Tauseef Mehrali is a GP registrar