Who Gave Tesco the Right to Shape Our Children?

I clearly missed the moment when we decided to appoint supermarkets as the powers that should determine our social norms, but it has become clear recently that this mantle has been assumed by at least one of these marketing giants. My attention was drawn to this when the campaigning organisation Let Toys be Toys discovered that Tesco was advertising its chemistry set as ‘for boys’, while its Hotpoint cooker was labelled ‘for girls.’

We need to stop and think about this for a moment – if it does not shock and outrage us in the 21st century, then it certainly should. Surely we have moved on from any suggestion that chemistry is only for boys (were the struggles of Marie Curie and Rosamund Franklin for nothing?) And as for the kitchen…

Can we imagine a school separating children by gender in this way? There would be outrage, surely? Even Michael Gove would think it was old-fashioned!

What is revealing is Tesco’s defence of their actions. When Let Toys be Toys challenged them about the signs on Twitter, they replied with:

So, what they are saying is that they have conducted market research and that is what dictates their policy. The fact that any ethical analysis of the situation can only conclude that toys do not need to be defined by gender apparently has no bearing – the market research (in other words, what sells) trumps any social obligations Tesco might be troubled by.

After some outrage on Twitter (helpfully stimulated by Ben Goldacre) the Tesco account went mysteriously quiet. Subsequently they have apologised for ‘causing upset’ (always apologise for upsetting someone, never for being wrong) and have promised to update the chemistry set as being ‘unisex.’ This they have done, while the kitchen remains distinctly ‘for girls.’ The kitchen is pink – shocking pink – is that enough of a reason to label it for girls, or should we question why on earth a kitchen should be pink in the first place? The answer is clear from the description of another kitchen in the same range:

CookerIt’s not about pink then…

Since then there has been media attention, and Tesco have apparently stated on Watchdog that they will ‘be conducting a review of the way it categorises its toys.’ Why a review and not just an apology and immediate change? Is it that hard? They have decided to change the chemistry set without requiring a review, but I can only assume that working out how to categorise a ‘Wild physic and chemistry set’ is more complicated, since it remains like this on their website:

Physics setWhy does this matter so much? And why talk about it on a health blog? Well, I don’t think we should under-estimate the subversive influences on how we shape our children, or the impact that this will have on their subsequent health as adults. Educational attainment is closely linked to health, and being told you can or can’t do something could have an enormous impact on a child. If parents wish to point their boys towards science, and girls to the kitchen, then that is something I may not agree with (my father is a chef, my wife a scientist, so I’m hardly likely to), but neither should I interfere in another’s parenting without very good reason. Tesco, on the other hand, are not parents and should not presume that they have the right to stereotype in this way.

And when it comes to stereotyping, it is not just how we educate our children that matters to health, but how we feed them. It is nearly a year since Tesco assured me that they would remove the direction to ‘Children’s cereals’ from all their stores, after I pointed out the harmful health message implicit in the signs. Well, as for my local store, I am still waiting…I imagine they are busy conducting a review.

The Wrong Kind of Virus on the Line – the Demise of the Binscombe Express

I’m delighted to say that this post needs to be amended. As you will be able to see from the helpful comment from the CQC below, they do not have a problem with wooden toys. The advice we received from the Surrey PCT infection control lead that we had to remove wooden toys in order to be CQC compliant was misguided, and the Binscombe Express can stay! I will be blogging again soon on how this came about, and have left the blog in its original form below, but am very grateful for the swift clarification and common sense approach of the CQC.

Here is the original post:

This week saw the Binscombe Express roll out from the station for the final time, pushed reluctantly into an early and unwanted retirement. It might never have rivaled the glamour of the Great Western, or the notoriety of the Orient Express, but in certain circles among the toddlers of Godalming it has ranked right up there in importance with Thomas the Tank Engine. I’m talking, of course, about the Brio train set in my consulting room. Lovingly home-made in a simple figure of 8, it has been the undisputed domain of my younger patients f or the last ten years. A room otherwise associated with illness, strange metal implements and painful injections has been given a friendly, familiar face by its presence, and I am desperately sad to see it go.

And the cause of its demise? Not, for once, austerity and the bankers, or even Michael Gove declaring it to be too educationally liberal – it is the edict of the Care Quality Commission (CQC) that has banished my train set, declaring it to be too hygienically hazardous to be allowed to stay.

The Binscombe Express
The Binscombe Express – condemned by the CQC

The CQC has turned its attention on GP practices this year, with the intention to improve health and safety, and in particular, infection control. This is not a bad thing – to have rigorous procedures for the sterilisation of invasive medical instruments, for instance, is clearly a very good thing indeed; nor should GP practices aim for anything other than a high standard of cleanliness, but is a wooden train set really that hazardous?

The CQC website states that the guidance it applies is based on the Health and Social Care Act 2008, which has a great deal to say about infection control, but does not actually mention toys in GP surgeries. Despite this, it has become de rigeur for infection control teams to target these hazardous objects in our rooms, and in particular to condemn wooden toys. I have not been told what evidence this is based upon although I suspect it is on the basis of swab results growing numerous bacteria on their surfaces, which is odd as the vast majority of infections that children might pass to one another via my Brio would be viruses. Plastic toys are deemed acceptable as long as they are swabbed with an alcowipe at the end of the day – which is also odd since viruses won’t survive the night outside of their host.

I have no doubt that some parents will be glad to see the train go, and I am sorry for any concern it might have caused, but it is important to remember that this is not a long-stay hospital ward where people with poor immune systems and open wounds run the gauntlet of super-bug infection, but a GP surgery where children bring the same germs that they merrily carry with them to schools, playgroups and nurseries. And without the child-friendly toys in my room, it would be naive to think that children won’t try to play with something – the options they are likely to head towards now will be the clinical waste bin, the hydraulic mechanism of my examination couch, or the old favourite of opening and closing various finger-trapping drawers. Is this an improvement?

What concerns me most about this dictat from the CQC is the way it focuses on the potential health risks associated with toys, but is entirely blind to any health benefits. What value should we place on a child being at ease when they visit the doctor? Many adults are fearful of seeing their GP, and I suspect that much of this stems from negative childhood experiences which set a lifelong pattern of health-seeking behaviour. Can a train set make the difference? Well, I can’t answer that, but I have seen the eyes of many anxious children light up when they come into my room. And for more immediate benefits you would just have to compare the quality of the conversation between adults when a child is happily and safely occupied than when they are bored, fearful or frustrated – it is hard enough to remember what the doctor has said at the best of times.

There is a worrying underlying trend here which pervades so many Government directives these days – which is where that which is easily measurable and defined trumps that which is less easy to describe, regardless of any relative merit. We see this in education, where SATS scores dominate how both teachers and schools are judged, and no value is placed on a teachers’ ability to inspire and develop their pupils outside the narrow viewfinder of the test. The obvious example in health is the Quality and Outcomes Framework of the GP contract, which is based entirely on what can be measured – like targets for blood pressure, cholesterol and diabetes control. These are not unimportant, but the end result is that the humanity of General Practice, like deep listening, counselling skills and patient-centred care (which cannot be measured so easily) is in danger of being squeezed out of the consultation entirely.

There seem to be no grounds for appeal to reprieve my train set, but I will continue to resist any pressure that threatens to reduce the relationship between doctor and patient to mere figures and targets, and every so often I will continue to stand up and say: “Now, hold on a moment!”