East London Research Articles

If only we could, Call the Midwife! Gender, class and the hegemonic power of television costume

The starting point for this article was a chance encounter with an episode of the BBC’s Call the Midwife (‘Episode 12.7’ 2023) whilst visiting my elderly mother on a Sunday evening. The brutal and graphic portrayal of women’s health issues and abject poverty in Poplar, East London during the latter part of the 1960s elicited feelings of warmth and nostalgia in my mother, not anger or frustration at the lack of progress for working-class women like her with regard to some of the issues represented, this was difficult for me to understand. Indeed, as recently as August 2022, the UK government published data that confirmed that there remains a gender gap in healthcare; the 51 per cent of the UK population that is female will spend a significant portion of their life in poor health compared to men, and this is further compounded for those women that live in poverty. What is it about this text that produces a form of soporific nostalgia that seems to dissolve feminist recognition that women’s health is still an issue, thereby nullifying the drive for change? This article suggests that the reasons for such reactions are symbolized through and within the costuming. The language of clothing employed, particularly the use of print and colour saturation work to render the clothing items as meaningless within the text, actually negating the power of the narrative in relation to the intersection of gender and social class. The costumes do however produce a different type of meaning at the margins of the text that articulate not only the production team’s creativity but also their subjective understanding about class dressing that, it is argued, is in part responsible for producing the gendered form of alienation embodied by my mother and others like her. This article employs critical theory across cultural studies, sociology, film studies and the philosophy of language as a useful and emerging cross disciplinary framework to examine costume and costume drama. Applying theories that may appear disconnected to costuming is a means by which to suggest that the shift in perceptions of working class sexuality and relationships experienced by the working class during the 1950s and 1960s and represented within Call the Midwife via the costuming has had far reaching effects on gendered class identity and consequently on contesting the negative material effects of the current UK class system including the issue of women’s health.

British Muslim men and clothes: the role of stigma and the political (re)configurations around sartorial choices

ABSTRACT This article examines the changing perceptions of dress, focusing on the lungi, funjabi and the thobe, amongst the British Bangladeshi Muslim male diaspora in the East End of London. Through various historical trajectories, I argue that the research participants in this article dress their bodies according to the current meanings attributed to the garments. These meanings are (re)-configured using a meta-constructed stigma guideline they interpret using their faith, Islam, and the wider dominant discourse around acceptability and respectability. Drawing on in-depth interviews with British Bangladeshi Muslims in East London, I demonstrate how the ubiquitous presence of the Islamophobia arc is invisible yet dictates everyday behaviours and responses. In addition, framing masculinity via the Muslim gaze has intensified clear demarcations of what constitutes religious and/or ethnic dress. To extrapolate the continuous interplay in constructing a British Bangladeshi Muslim male identity via clothing, I explore this as paradigmatic of how stigma is located, consequently determining men’s sartorial choices. The article ends by considering how the socio-positioning qua the political landscape facilitates a structural restriction that trickles down to individual’s choices in what the appropriate Muslim male body can look like in the public sphere.

A-165 Test Harmonisation Is a Key Enabler of Pathology Transformation

Abstract Background In April 2021 a new joint venture was formed to deliver and transform services across South East London. Two large NHS Foundation Trusts (Guy’s and St Thomas’, and King’s College hospitals) partnered with SYNLAB who are specialist pathology providers, bringing extensive global experience and expertise in setting up, transforming and running diagnostic services. The Trusts had been working in partnership for many years but were operating in numerous areas as two separate entities. There was duplication of services and tests, with different analytical platforms and very different ways of working, which led to variations in resulting and reporting. Our aim was to establish a single consolidated service, with a harmonised test catalogue, facilitating the provision of consistent results regardless of the origin of sample, and to have a single governance framework to drive improved accountability and optimisation of resources. Our view was that test harmonisation was essential to enable the deployment of a common core Laboratory Information Management System (LIMS) from the 24 legacy systems, and that the harmonisation process should be clinically led. Method We established forums (through a series of workshops) for comprehensive engagement and dialogue to allow key clinical leads from all services to meet and agree the path forward. After extensive collaborative engagement, a new model was created with a single “Strategic Clinical Lead” with pan-site responsibility appointed for each service from the existing senior clinical staff. The Strategic Clinical Lead works with their colleagues to drive consensus, seeking wide stakeholder engagement from end service users as required. Results From an initial repertoire of circa 7100 tests, test harmonisation has resulted in a 25% reduction, and in some services such as Virology, we identified 31% duplication in tests. The establishment of the new clinical model has resulted in improved efficiency and better use of resources including staffing as well as a reduction of variation of services. Importantly, test harmonisation is essential to move samples seamlessly in a hub and spoke model. The implementation of a single common core LIMS this year will significantly improve business continuity by facilitating seamless transfer of work between sites. Conclusion Extensive clinical engagement is key to transforming pathology services. The benefits of consolidation include an overall reduction in process variation leading to improved standardisation and therefore enhanced patient safety as a result of consistency in result reporting. We established a framework and new clinical model which has resulted in improved links between staff across all sites who are working collaboratively on the new target operating model (hub and spokes) which will be live in April 2024.

Validation of a dynamic method of measuring households and populations from primary care Electronic Health Records: Cross-sectional comparison with Office for National Statistics Census 2021 estimates

ObjectivesWe have developed a dynamic method for identifying household members from Electronic Health Records (EHR). We compared the 2021 Census estimates of household number and demography with similar estimates derived from primary care EHRs on the Census date using primary care EHRs for the population of north east London (NEL).
 MethodWe included 2,115,017 patients registered with a general practitioner on the 2021 Census date in NEL and assigned households from encrypted Unique Property Reference Numbers. We compared household number and size by Local Authority (LA), Middle Layer Super Output Area (MSOA) and area’s Index of Multiple Deprivation quintiles (IMDq) to Office for National Statistics (ONS) 2021 Census estimates and by LA to ONS Admin Based Housing Stock (ABHS) 2020 estimates. We assessed differences in EHR and Census 2021 populations by sex, age, LA, MSOA and IMDq. Sensitivity analyses will exclude those without a recent recorded clinical encounter.
 ResultsEHR population estimates (2,115,017) were 116,346 (5.8%) higher than Census estimates (1,998,671), higher among men (9.2%) than women (2.5%) in almost all age groups, especially men aged 30-50 years and higher in the most (8.7%), than in the least (2.5%) deprived IMDq. EHR household estimates (660,789) were 68,047 (9.3%) lower than Census estimates (728,836), and 19,719 (3.1%) higher than ABHS occupied addresses (641,070). EHR household size estimates were 15.6%, 29.2%,12.5% and 8.4% lower for household sizes 1,2 3 and 4, and 13.3%, 42.1%, 82.1% and 195.8% higher for household sizes 5, 6,7 and 8 respectively when compared to Census estimates. EHR population and household estimates were respectively 5-10% higher and 5-11% lower for almost all NEL local authorities.
 ConclusionEHR- and Census-derived population and household estimates differ, mainly in the prevalence of larger households. While data were extracted on the same date, person-level validation was not possible. Differences may reflect deregistration delay in EHR when changing residence. Analyses based on clinical encounters recency may identify registered patients who are no longer residents.

Learning to labour in the gym: Training to fight to reimagine the self and work under neoliberalism

AbstractThis paper explores the motivations of those who train to fight at a Muay Thai and Kickboxing gym in East London, who view fighting (and training in the gym) as a means of coping with the harshness of work, as a financial supplement to work, and as an alternative form of work. It explores how the repetitive regimes of the body employed by fighters, such as dieting, twice‐daily training sessions and sparring, as both individual and collective bodily work, contrasts with their experiences of social life under capitalism, which is seen as unfair and unmeritocratic. This, it argues, leads people to seek refuge within the meritocratic sphere of the gym, which offers new opportunities, possibilities and a unique ability to master the self. It subsequently argues that we can understand training to fight as a response to class exclusion, stigmatisation, and helplessness under neoliberalism.

End-of-life care costs and place of death across health and social care sectors

ObjectivesThis study explores the relationship between end-of-life care costs and place of death across different health and social care sectors.MethodsWe used a linked local government and health data of East...

Strangers in the Archive: Literary Evidence and London's East End by Heidi Kaufman (review)

Strangers in the Archive: Literary Evidence and London's East End by Heidi Kaufman (review)

349 How a Service Evaluation Carried Out by Junior Doctors Helped the Post Pandemic Management of Lumps and Bumps

Abstract Aim The GI surgery department deals with many clinical conditions including lumps and bumps that affect the torso, posterior neck, groin, buttock, perianal and perineal areas. Over the pandemic it was noted that there were many referrals for ‘lumps and bumps’ at a time where theatre capacity and staffing was limited. To create a referral pathway to assess patients for suitability for referral and treatment in the secondary care setting/ to determine which lesions were suitable for treatment in the community. Method A review of 374 cases of lumps and bumps referred between 2019 and 2021. Various patient factors were taken in to account, as well as the size and type of lesion to determine whether it could be managed in the community under local anaesthetic. Results Of the total cases, 45% were deemed to be suitable for treatment in community. Of all lesion types, epidermoid cysts were most suitable for GP treatment. Patients were travelling long distances to reach the hospital and we were treating patients outside our catchment area. We also found that the average waiting time from referral until treatment for lesions managed in community was nearly 9 times shorter than when managed in the hospital setting. Conclusions A new referral pathway was created for all of South East London to reduce the number of lumps and bumps referred. This ultimately allowed for increased theatre capacity for more complex cases, ensured faster treatment and reduced travel distances for patients.

SP9.5 Outcomes after Emergency Cholecystectomy: A Multicentre Retrospective Cohort Study

Abstract Aims Gallstone disease affects 10-15% of the UK population and represents a significant proportion of emergency general surgical admissions. Consensus international guidelines recommend cholecystectomy for all stable patients within 7 days of admission for emergency biliary pathology. This study sought to evaluate the outcomes of emergency cholecystectomy at a regional level over a 5 year period. Methods Retrospective multicentre study of all patients undergoing cholecystectomy at 4 acute hospitals in East London, UK, covering a population of 2.9 million, between 2016 and 2021. All previous hospital attendances with biliary pathology were retrieved to 2010 from prospectively maintained electronic patient records. The primary outcomes were time to surgery (TTS) from index attendance and total length of stay (TLOS) stratified by timing of surgery. Multivariable linear regression was used to identify independent predictors of TTS and TLOS. Results 2056 patients were identified. 1786 (86.9%) underwent elective cholecystectomy and 270 (13.1%) cholecystectomy during an emergency admission. Median TTS was 108.3 days overall with 5.8 days for emergency cholecystectomy, median TLOS was 5.0 days overall and 7.6 days for emergency cholecystectomy. After adjustment with linear regression, emergency cholecystectomy reduced TTS by 112.3 days (95% CI 140.2-84.4), whilst each year of age increased TTS by 0.80 days and male gender was associated with 38.1 days greater TTS. For TLOS, emergency cholecystectomy was associated with an increase in admission time by 3.54 days (95% CI 2.04-5.03). Conclusions Emergency cholecystectomy significantly reduces time to cholecystectomy from index attendance with biliary pathology at the cost of increased overall time admitted.

Economics Teachers' Content Knowledge and Teaching Strategies Used to Teach Economics in Selected South African Schools

Economics is a subject offered at the Further Education and Training (FET) section in South Africa, the subject has recorded performance that is not impressive, and the low enrolment and statistics of pass rate are of major concern. Therefore this paper explores the teachers’ content knowledge and strategies used to teach Economics in some selected schools in South Africa. The paper adopts a qualitative approach to phenomenological research design. Purposive sampling techniques were used to select 12 teachers from six schools, two teachers from each school in Buffalo City Municipality in East London, South Africa. A semi-structured interview was used to elicit information from the respondents. The findings among others revealed that Economics is very useful to be a better citizen and to make rational life decisions, the use of the right pedagogy can improve performance, and the content knowledge with adequate on-the-job training will be a match in delivering the content of the subject. It is concluded that a low level of understanding of the basic Economics concepts could be attributed to less professional development training of Economics teachers in content knowledge and pedagogy. It is recommended among others that the Economics teacher have to strike a balance between theory and practice. Teachers should be innovative and improvise by using technological skills, they should move towards the use of technology as a tool to enable learners to become creative, empathetic and high-order thinkers in this digital world.

Using quality improvement to tackle the triple aim for children and young people with asthma: improving outcomes, experience and costs

Background/Aims Asthma in children and young people represents a substantial burden to the healthcare system, with these patients requiring frequent emergency care and having poorer health outcomes, leading to high system costs and poor patient experiences. This study used quality improvement methodology to achieve the triple aim of improved outcomes, better experience and reduced costs for those aged 0–16 years with asthma in north east London. Methods A multidisciplinary project team used quality improvement methods to implement and assess two interventions: a community high-risk asthma clinic and educational asthma-friendly school groups, both of which were delivered by a specialist asthma nurse. Population-level outcomes included asthma control test scores, accident and emergency department admissions and costs. Intervention-specific outcomes included number of clinic consultations delivered, did-not-attend rates and participant confidence ratings following the school sessions. Results Accident and emergency admissions for asthma reduced by 52%, with a 50% reduction in average monthly acute care costs. Asthma control test scores improved significantly, from an average of 18.56 to 22.34 out of a maximum score of 25 (P=0.000) following the interventions. Participants in the asthma-friendly school groups reported increased confidence in both day-to-day and emergency asthma management at the end of their sessions. Conclusions Having dedicated specialist asthma nurse input in the community and using school-based interventions can help to improve asthma care for children and young people, reducing the burden of frequent accident and emergency department admissions. Using quality improvement methods in pursuit of triple aim outcomes can help teams to work towards a shared goal.

A reflective space for social care staff: Preliminary findings from Schwartz Rounds

Over the last year, the Keeping Well in South East London service have offered Schwartz Rounds to social care staff in response to the significant impact of Covid-19 on staff wellbeing and ongoing post-pandemic pressures (e.g. recruitment and retention). This text shares preliminary evaluation data and key learnings around implementation.

Testing the accuracy of Foti’s dental age estimation methods on a London UK sample

Background and aimTooth development and eruption are widely used in assessing dental age estimation, and one of the methods in using tooth development and eruption is Foti’s method. However, the population used in the original study was French. Therefore, the aim of this study was to test the accuracy of Foti’s four dental age estimation regression models against the East London population, mainly of the Bangladeshi and Caucasian ethnicity. These count the number of erupted teeth and tooth germs using a radiograph (Foti 1), absence of a radiograph (Foti 2), maxillary erupted teeth (Foti 3) and mandibular erupted teeth (Foti 4). MethodsThe test sample was archived panoramic radiographs of 754 healthy patients aged 6–20 years (380 males and 374 females). The difference between dental and chronological ages was tested using a t-test. The mean absolute difference was also calculated for all models. The most accurate method was defined as the smallest mean difference, smallest standard deviation (SD) and mean absolute difference between dental and chronological ages. ResultsFoti model 2 was most accurate with a mean difference of 0.11 years (SD 1.70 years) and a mean absolute difference of 1.33 years. Models 3 (maxillary erupted teeth) and 4 (mandibular erupted teeth) were marginally less accurate, whilst model 1 (radiograph) overestimated age on average by more than 5 years. ConclusionOur findings show that estimating age using erupting teeth was most accurate using Foti model 2 (least bias).

“Carnal conviviality” and the end of race?

ABSTRACT This paper seeks to address some confusions and contestations surrounding Paul Gilroy’s conceptualisation of conviviality. In particular, it seeks to argue that conviviality cannot be reduced to mere tentative co-existence, nor does it designate the absence of racism. Rather, it aims to demonstrate the messy complexity of everyday life, as people attempt to build lives alongside one another as they find themselves throwntogether on the margins of society. It does this through the qualitative exploration of fighters at a Polish-owned Muay Thai/Kickboxing gym in East London, where fighters enact what I refer to as “carnal conviviality”, a form of intimate, bodily togetherness constituted through training to fight that bonds fighters across racial, ethnic, religious and gendered lines. Although inherently local and messy, I argue that the production of social relations that see the human in the other are essential in times of mounting crises.

How has the Olympic legacy transformed the heart of East London? Understanding socio-economic exclusions and disproportionate COVID-19 impact on minoritised communities through a rights-based perspective.

This research paper explores the experience of British-Bangladeshi and Black African Caribbean communities living in the areas surrounding London's Olympic Park, in terms of how they are appropriating the legacy-led socio-spatial changes, applying Lefebvre's right to the city perspective. Highlighting the top-down legacy-led regeneration process, the empirical evidence suggests that the games-led regeneration is contributing to an unjust trade-off between pre-existing minoritised ethnic residents and wealthier gentrifiers, ignoring the real needs of the socially and economically disadvantaged ethnic minority communities in East London. The findings provide a further understanding of factors such as housing and health-related inequalities and sub-standard living conditions, which may have contributed to the disproportionate impact of COVID-19 on the Bangladeshi and African Caribbean people living in East London boroughs. Given the scale of the pandemic, the paper argues that a greater understanding of the socio-structural problems and barriers arising out of poverty and deprivation is needed in order to formulate appropriate policy interventions to reduce disproportionate social, economic and health-related impacts on some minoritised communities, which could be achieved through residents' active participation and appropriation at different stages of the legacy-led regeneration process.

Kray Twins of East London

The paper addresses the thin line between the world of criminals and celebrities. It focuses on questions how role models and their media representation as well as biographies, memoirs, and their film adaptations have created and kept up the image of gangsters, more specifically, the infamy of the two East London criminals, Reggie and Ronnie Kray since the 1950s. After an introduction to aspects of organised crime, mafia, and a few examples of famous gangsters and the role models of the Kray twins from American Al Capone and Frank Sinatra to the English gangster Billy Hill, the paper highlights the life, representation, and image-making methods of the Krays in postwar London until they died in prison (Ronnie in 1995 and Reggie in 2000) as well as their strange, ever-growing popularity and fame even 20 years after their death. The author argues and aims to prove that the systematically built and promoted Kray brand and their legend served as the forerunner to and paved the success of the 2015 American blockbuster under the same title, Legend, and further documentary films and biopics on the Kray twins ever since.

Faecal Immunochemical Testing to Detect Colorectal Cancer in Symptomatic Patients: A Diagnostic Accuracy Study.

(1) Background: NHS England recommended faecal immunochemical testing (FIT) for symptomatic patients in June 2020 to rationalise limited diagnostic services during COVID-19. (2) Aim: to investigate the diagnostic performance of FIT, analysing the proportion of FIT-negative colorectal cancers (CRC) missed in symptomatic patients and how this risk could be mitigated. (3) Design and Setting: a retrospective study of biochemistry and cancer databases involving patients referred from primary healthcare with suspected CRC to a single secondary care trust in North East London. (4) Methods: a retrospective cohort diagnostic accuracy study was undertaken to determine the performance of FIT for detecting CRC at 10 µgHb/g. (5) Results: between January and December 2020, 7653 patients provided a stool sample for FIT analysis; 1679 (22%) samples were excluded due to inadequate or incorrect specimens; 48% of suspected CRC referrals completed FIT before evaluation; 86 FIT tested patients were diagnosed with histologically proven CRC. At 10 µgHb/g, FIT performance was comparable with the existing literature with a sensitivity of 0.8140 (95% CI 0.7189-0.8821), a specificity of 0.7704 (95% CI 0.7595-0.7809), a positive predictive value (PPV) of 0.04923 (95% CI 0.03915-0.06174), a negative predictive value (NPV) of 0.9965 (95% CI 0.9943-0.9978), and a likelihood ratio (LR) of 3.545; 16 patients with CRC had an FIT of ≤10 µgHb/g (18.6% 95% CI 11.0-28.4%). (6) Conclusions: this study raises concerns about compliance with FIT testing and the incidence of FIT-negative CRC at the NICE recommended threshold and how this risk can be mitigated without colonic imaging. Whilst FIT may have facilitated prioritisation during COVID-19, we must be cautious about using FIT alone to determine which patients are referred to secondary care or receive further investigation.

A Pilot Study to Establish the Leadership Development Needs of Community Pharmacist Leads in Lambeth, South East London.

Primary care networks (PCNs) are geographical networks consisting of 30,000 to 50,000 patients and groups of general practices working in a multidisciplinary team, including community pharmacists. Community pharmacy (CP) neighbourhood leads act as a conduit between pharmacy contractors and general practitioners (GPs) in these networks, sharing information and providing a voice for the community pharmacy locally. The Lambeth medicines team (NHS South East London Integrated Care Board) recognised the need to continue funding these leadership roles to address barriers to relationship-building between community pharmacies and general practices, the consistency of service delivery and effective communication. The aim of this study was to understand the current experience of CP neighbourhood leads to inform their further development. All eight CP neighbourhood leads individually completed a semi-structured interview over Microsoft Teams, which was then reviewed using content analysis. Ethical approval was received. Leads reported the use of common communication methods such as emails, text messaging applications and telephone calls to engage GPs and pharmacies in their neighbourhoods. Barriers to undertaking their roles included time constraints, delays in responses, high workloads and competing pressures. Other factors impacting their effectiveness and ability to undertake their roles included the scheduling of meetings outside of working hours, finding time during busy working days and organising locum cover on an ad hoc basis. The leads also reported they spent more time focussed on building relationships with their peers and less time focussed on general practice colleagues. Support for CP neighbourhood leads could include ensuring that funded time is protected; communication and technology training; and the provision of more structural support for communication with GPs. The findings of this study can be used to inform future work.

Young People's Attitudes, Perceptions and Experiences of Social Distancing and Self-Isolation During the Second Wave of the COVID-19 Pandemic.

Objectives: Social distancing and self-isolation were key parts of the UK's strategy for reducing the spread of COVID-19. This study explored young people's attitudes, perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic. Methods: Qualitative individual, family and paired-friendship interviews were conducted. All 26 participants lived or worked in East London and were aged between 20 and 39years. Results: Qualitative analysis revealed three main themes: 1) trust and breaking of the social distancing and self-isolation rules-trust in their friends to be careful and say if they are unwell; 2) own rule making-making their own household rules which made them less guilty about breaking national rules as they were adhering to rules (albeit their own); and 3) lack of clarity around self isolation and the need for practical support-confusion around length of time needed to self isolate and what self-isolation really meant. Conclusion: Developing more effective and targeted communications and practical support mechanisms to encourage better adherence to social distancing and self-isolation rules among young people will be essential to prevent the spread of COVID-19.

Improving mental healthcare access and experience for people from minority ethnic groups: an England-wide multisite experience-based codesign (EBCD) study

BackgroundLong-standing ethnic inequalities in access and mental healthcare were worsened by the COVID-19 pandemic.ObjectivesStakeholders coproduced local and national implementation plans to improve mental healthcare for people from minority ethnic groups.MethodsExperience-based...