Category Archives: Stress Management

This is what the blood donor service does after an attack – and how you can help | Jane Green

I was overwhelmed by how generously the people of Manchester responded to this horrific attack. Both our blood donor centres in Manchester had queues outside the doors before they even opened. Our national call centre was taking about 1,000 calls an hour by 10am, from people who wanted to help save lives by donating blood.

The response was driven by well-intentioned social media posts from the public. The desire to help was incredible. However we already had enough blood to supply the hospitals treating the victims, and we did not appeal for extra donors. We plan ahead to build in reserves to deal with major incidents. We hope that people who want to help will now become regular donors, because that is how they can best help us save lives when there is a tragedy.

Many people wanted to donate to help that day, but when you donate blood, it is not taken straight to a patient. We need time to test it and process it. The different components such as platelets and red blood cells need to be separated out. Typically, your blood donation will only reach a patient two or three weeks after you donate. The blood used to treat the Manchester victims would have been donated several weeks earlier, and those donors would have been from across the country.

Hospitals order blood from us in advance, without the need for blood to be brought in for each patient. We supply hospitals through our regional stock-holding units (what people refer to as “blood banks”) mainly through routine deliveries. Over Monday night we made 21 deliveries of blood to hospitals in Manchester, including 15 “blue light” emergency deliveries, delivering 346 units of red blood cells. We were able to meet all the hospitals’ requests, and our stocks remained good. We don’t know exactly how this blood was used, and much of the blood from the routine deliveries would have gone to patients not affected by the attack. But this was an exceptionally high level of local emergency demand and many of those precious donations would have been transfused into attack victims.

Trauma patients require more than just red blood cells. They also need platelets to help their blood clot, and other more specialised products: O-negative blood is especially important in emergencies because it can be given to anyone when time is short and you don’t have time to test for blood groups. We always need new O-negative donors because their blood is so valuable.

As Tuesday morning progressed, people began queueing to donate. Some had friends or family members caught up in the incident. We were worried they might be confused or upset about why there was no capacity or urgent need for them to donate that day.

We were inspired to see the diversity of people coming forward, because we need more black and Asian donors

We tried to spread the message about how people could best help across social media and through the press. I was working at Plymouth Grove donor centre, next to Manchester Royal Infirmary, where many victims were being treated, and I spoke to many people face to face. We were inspired to see the diversity of people coming forward, which was moving and very important – because we need more black and Asian donors. Patients benefit from closely matched blood, which will often come from donors of the same ethnicity.

Our message is that blood can best save lives in a tragedy when our stocks are already good through regular donations. Thanks to our loyal army of nearly 900,000 active donors, many of whom give blood three or four times a year, we can do that. But every year many of these donors have to drop out because of age, ill health and many other reasons. We need nearly 200,000 people to register as new donors every year.

If people have been inspired to donate for the first time, please go online, make an appointment, and donate. Blood saves lives, and your donation will help other people in urgent need, and make sure we are again ready for any major incident.

NHS chief tells ministers: face up to the pay crisis

Ministers should address mounting disquiet among NHS staff about pay and recruitment if the health service is to avoid a full-blown staffing crisis, the head of the official body that represents hospital trusts and mental health services says today.

The stark warning from Niall Dickson, chief executive of the NHS Confederation, comes as GP leaders predict that 2,000 European-born doctors could leave the country because of uncertainty about their status caused by Brexit, with disastrous consequences for patient care.

Writing on, Dickson says nurses who complain about pay increases being capped at 1% – meaning they suffer real terms decreases– “have a point” and suggests the government think again about the effects of stagnating pay on morale and rates of staff retention.

“There may now be a case for looking again at pay,” he writes. “Given the financial and demand pressures on the service in recent years, some pay restraint has been necessary and inevitable. But it is also obvious there will be a limit on how far this can be taken before it affects recruitment and morale.”

The intervention by the confederation, whose chairman is former Tory health secretary Stephen Dorrell, is significant on an issue as sensitive as pay rates for NHS workers.

Last weekend, the Royal College of Nursing announced that nearly four out of five of its members (78%) who had taken part in a consultative vote backed a walkout in protest over pay while 91% favoured industrial action short of a strike.

Dickson says the RCN should not resort to any form of action that would harm patients but highlights rising vacancy rates as evidence of a problem that must be addressed. Nearly a quarter of NHS trusts now have a vacancy rate for registered nurses of more than 15%, he says. Specialities such as psychiatry face a constant struggle to fill training places and the number of child and adolescent, and old-age psychiatry posts. has declined.

Parts of the country, Dickson says, are finding it “almost impossible” to entice GPs, while some hospitals are being propped up by doctors in training because they can’t fill consultants’ posts.

The Royal College of GPs, the professional body for family doctors, says today that the manpower problems will be exacerbated as GPs from EU countries return home, because of Brexit. A total of 2,137 GPs in surgeries across Britain are from countries in the European Economic Area: the other 27 EU members plus Switzerland, Norway and Iceland.

Dr Helen Stokes-Lampard, chair of the RCGP, said: “We risk losing well over 2,000 family doctors from the NHS if their position is not secured as part of Brexit negotiations, and that is just not safe or acceptable.

“Our greatest fear is that hardworking, dedicated doctors from EU countries will simply cut their losses and leave, instead of waiting to have their fate determined for them. This would be a disaster for patient care, and it also makes long-term workforce planning for GP practices impossible.”

The RCGP wants the next government to stem the potential outflow of EU national GPs by guaranteeing their future status. Ministers should add family doctors to the migration advisory committee’s shortage occupation list, as happened several years ago with nurses, to make it easier to recruit GPs, it argues.

The British Medical Association claimed last week that general practice “is on the brink of collapse” because it is “several thousand GPs short”, and that family doctors are buckling under an “avalanche of work”.

Research published last week by NHS Improvement warned of “future supply problems” in many parts of England in which large proportions of GPs are over 55 and thus likely to retire in the next few years, including Kent and Medway (24.2%) and Somerset (24%).

Jonathan Ashworth, shadow health secretary for Labour – which has said it will end the pay cap for public sectors workers – said: “The NHS should be an absolute priority in the Brexit negotiations. The Tories’ chaotic approach to workforce management in the NHS has already left us thousands short of the number of GPs we need, and we simply can’t afford to lose the 2000 European GPs working here. Labour are pledging … to guarantee the rights of EU citizens working in our health and care system.”

A Conservative spokesman said only that: “Our manifesto said explicitly that we will make it a priority in negotiations with the EU that the 140,000 health and care staff from EU countries can carry on making their vital contribution.”

As a personal trainer, I’ve seen the human proof: you can be fat and fit | Louise Green

On Wednesday a major UK study came out with headlines proclaiming that you cannot be fat and fit. For me, someone who promotes ditching the diet, it was sad to see that associated coverage lacked any solutions for people to improve their health and seemed, more than anything, to dish out more fear-mongering to fat people, who already feel sidelined by society.

Over the course of 10 years and thousands of training sessions working specifically with obese clients, I can say this: I have witnessed incredible feats in fitness by obese clients. I have trained both healthy obese clients with sound athletic disposition and immobile clients who couldn’t stand on two feet who were not metabolically healthy. Over time, I had them running up hills, boxing, lifting weights and making fitness a sustainable part of their life. During this time, their risks of disease greatly decreased without significant weight loss. Medications were lowered, cardiovascular health, physical mobility and quality of life were greatly improved.

I’ve seen first-hand the difference physical exercise can make if offered in a safe and inclusive environment. Regrettably, such spaces for fat people are sorely lacking. That’s a big part of the problem. Our fitness culture is an elite club where only slim, ripped, young people have the privilege of being represented in fitness media, advertising and gym culture. The rest of us pretty much don’t exist. How can we be what we cannot see?

We are living in a society that accepts weight bias and discrimination as the last form of openly acceptable oppression. Fat people are heckled from cars as they run, cursed at on the internet to get their “fat asses” moving. And, in this case, they are publicly called unhealthy by the medical profession. Fat people are damned if they do and damned if they don’t. Studies like this only amplify that message, especially when there’s no solutions offered alongside it.

What motivates people to get physically active and keep health risks at bay? I know that fear-mongering statistics, studies and advice do the exact opposite. They intimidate and oppresses individuals. Heckling, shaming and name-calling can end someone’s fitness endeavours or prevent them from starting at all.

It takes a huge amount of courage for a fat person to step into the wolf’s den to exercise; compassion and support are key. We have a responsibility to work hard at motivating people to find health solutions that are plausible and sustainable.

We need to stop assuming all fat people are unhealthy. There are many unhealthy reasons someone might be thin: disordered eating, smoking, atrophy or lack of muscle mass, yet studies regarding these specific topics don’t make eye-catching headlines.

Fashionable body sizes have changed throughout the ages. In the 1800s lush, big bodies were considered healthy, and showed signs of wealth. In the 1990s there was “heroin chic”, referring to underweight runway models. We are now in an era when our bodies have become larger because of the food chain, technology, desk jobs and stress, yet we still measure our health by an archaic body mass index standard developed in the 1830s for population studies, not individuals.

Our times have changed, and we need to change with them. As a fitness professional I am committed to making fitness accessible to everybody and providing sustainable health solutions to millions of people who have desperately tried and failed at the dieting way of life.

After working with thousands of obese clients, and consistently helping them improve their lives, my findings for better health are this: stop spending your money and ditch the diet; move your body often and rigorously; eat nutritionally dense food as much as possible but enjoy the occasional birthday cake. Be the healthiest version of yourself, each and every day.

Big Fit Girl: Embrace the Body You Have published by Greystone Books (£10.99)

Warning pregnant women over dangers of alcohol goes too far, experts say

Women are being unfairly alarmed by official guidelines that warn them to avoid alcohol completely during pregnancy, experts claim.

Some mothers-to-be may even be having an abortion because they are worried they have damaged their unborn child by drinking too much, it is claimed.

The British Pregnancy Advisory Service, maternal rights campaign group Birthrights and academics specialising in parenting say official advice on drinking in pregnancy is too prescriptive.

Revised guidelines that came into force in January 2016 are not based on reliable evidence, they say. The advice, endorsed by the four UK nations’ chief medical officers, deleted a longstanding reference to pregnant women potentially having one or two units of alcohol once or twice a week while expecting and instead said that they should not drink at all.

“We need to think hard about how risk is communicated to women on issues relating to pregnancy. There can be real consequences to overstating evidence or implying certainty when there isn’t any,” said Clare Murphy, director of external affairs at BPAS, the contraception and abortion charity.

“Doing so can cause women needless anxiety and alarm, sometimes to the point that they consider ending an unplanned but not unwanted pregnancy because of fears they have caused irreparable harm.”

Ellie Lee, director of Kent University’s centre for parenting culture studies, said the advice means pregnant women also shun social occasions unnecessarily.

“As proving ‘complete safety’ [of drinking in pregnancy] is entirely impossible, where does this leave pregnant women? The scrutiny and oversight of their behaviour the official approach invites is not benign. It creates anxiety and impairs ordinary social interaction. And the exclusion of women from an ordinary activity on the basis of ‘precaution’ can more properly be called sexist than benign,” Lee added.

Last year’s revised guidelines followed the first in-depth UK review of the evidence on drinking in pregnancy since 2008. It concluded that “definitive evidence, particularly on the effects of low-level consumption [on a baby’s health] remains elusive”. Despite that, it nevertheless recommended that: “If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.”

The NHS’s start 4 life website, which promotes healthy behaviour, says: “What you drink, your baby drinks too. Play safe and cut out alcohol.”

Jennie Bristow, senior lecturer in sociology at Canterbury Christ Church University, criticised the negative effects of advice to mothers to be. “Does it simply make for healthier pregnancies or is it scaring women about their bodies and their babies? Promoting fear is not a good way to care for pregnant women.”

The guidelines state that: “Alcohol, like a numbr of drugs, is a teratogen, which means something that can disturb the deveopment of a fetus. Teratogens may cause a birth defect, or may halt the pregnancy.” The risks to the child also include the child being born prematurely or very small or having behavioural problems.

The Royal College of Midwives believes that any woman who is or is trying to become pregnant should shun alcohol altogether. “Our message [is]… that there is no evidence that any level of consumption is safe for the growing baby,” it said when the guidelines came out last year.

The life-changing flying eye hospital treating blindness across the globe

In Kitwe, the second largest city in Zambia, young mother Verah is carrying her one-year-old daughter, Racheal, into the consultation room at the eye annexe. The only dedicated paediatric eyecare centre in the country, the Kitwe annexe also attracts patients from neighbouring Angola and Congo. Racheal is here for surgery to remove the bilateral cataracts that prevent her from seeing.

A few months after Racheal was born, Verah noticed that something didn’t seem right with her vision. “I would move my hands in front of her face but she would not react. I would move things past her eyes but she would not follow them,” she explains.

The team of nurses, anaesthetists and paediatric ophthalmologists treating Racheal have been trained and are being continually supported by peers from some of the world’s most respected eye hospitals, who fly in on a specially adapted plane – the flying eye hospital – thanks to an initiative of Orbis, an international blindness prevention charity.

“Orbis volunteers who come to share their knowledge and give technical support are very good – most of them have been working for a long time so they have very good experience,” says Chineshe Mboni, the paediatric ophthalmologist treating Racheal. “So we have some from the US, Britain and Israel etc. Techniques are different around the world, so we get a mix of everything.”

A volunteer ophthalmic nurse in the recovery room.

A volunteer ophthalmic nurse in the recovery room. Photograph: Geoff Oliver Bugbee/Orbis

Sharing experiences and discussing cases with the visiting Orbis medical volunteers “raises your confidence, to see that what you are doing is what everyone else is doing around the world”, Mboni concludes.

Globally, 285 million people are blind or visually impaired and yet for 80% of them, this could be prevented with access to the right treatment like the surgery Mboni is able to give Racheal. Orbis focuses its efforts in Africa, Asia and Latin America because 90% of the world’s 39 million blind people live in developing countries. Many of the conditions causing blindness – such as cataract and trachoma – can be easily treated. The loss of sight these conditions can cause have a huge impact as it will impede a person’s ability to gain an education, prevent them from finding employment and can plunge families into a life of poverty.

Ann-Marie Ablett, a nurse from the University Hospital of Wales in Cardiff, has been giving up four weeks of her annual leave to volunteer with Orbis since 2003. “You can’t change everything overnight but you can start with one patient and help them,” she says. “If everyone plays their small part together, you can make changes.”

Ablett is speaking in a terminal at Stansted Airport and just outside is the flying eye hospital, here for a short promotional visit. The white MD-10 aircraft on the tarmac looks like a typical passenger plane. In fact, this is a 46-seat classroom complete with audio-visual equipment that transmits live surgeries that can be watched in 3D. The lead surgeon, who is just next door in a state-of-the-art operating theatre, can be asked questions throughout the procedure. The aircraft, donated by FedEx, also features pre- and post-op spaces and a laser suite.

A patient wakes up from surgery.

A patient wakes up from surgery. Photograph: Orbis

Orbis’s main aim is to train eyecare teams and strengthen hospitals in the 92 countries where it works. It’s for this reason that Ablett first chose to volunteer. She says: “We’re not in the developing country just for numbers, we’re there to teach so that means we do less surgeries but when we fly off to the next country, the local doctors have got the skills to treat their own patients because they were trained up.”

Dr Jonathan Lord, global medical director for Orbis, went from being a regular volunteer to giving up his position as a consultant at Moorfields eye hospital in London and becoming a staff member for the charity before being promoted to his current role.

“I was just hooked after my visit trip,” he says. “Seeing the flying eye hospital work in real life, in the field with the patients being treated on the plane and that treatment being part of a really comprehensive training package that is upskilling all the groups of staff that are needed for each surgery, is amazing.

“The need round the world is huge. You realise the magnitude when you look at some of the statistics. In Ethiopia, there is a population of over 80 million, but [until recently] there was little over 80 ophthalmologists practising in the whole country. When I left Moorfields, it had over 150 covering just the catchment area of London.”

Recovery Room

The flying hospital’s recovery room. Photograph: Orbis

Programmes usually last two weeks, and require a lot of pre-planning with a team from Orbis flying in ahead to consult on what would be most helpful to the healthcare professionals in that country. The plane will land at a local airport and the team of local surgeons, nurses and anaesthetists board to join their volunteer counterparts. Meanwhile, another team of volunteers goes to the local hospital to provide training using the equipment in situ. At the end of the week, the teams swap.

Becoming hooked after stepping foot on the plane is a running theme among staff and volunteers, including the pilots, all FedEx employees who volunteer their time. Gary Dyson, who has been involved since 2001, says: “On my first trip, which was to China, I saw a child who couldn’t see on Monday but could see on Wednesday. It’s such a life-changing event for them.”

For Racheal, the short surgery will have undoubtedly had that effect. As Mboni removes the patches, she blinks a few times and waves her hands in front of her eyes, before looking up and seeing her mother for the first time.

News is spreading across Zambia of successes like this, Mboni says. “[People] know we can act fast, so they are telling patients with eye conditions – ‘This problem? Go to Kitwe central hospital’.”

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GP recruitment crisis intensifies as vacancies soar to 12.2%

Vacancies for GPs are at their highest ever level, research suggests.

A survey of 860 GPs for Pulse, a news magazine for general practitioners, found 12.2% of positions were currently vacant – up from 11.7% at the same time last year and from 2.1% in 2011, when Pulse started collecting the data.

The findings show 158 GPs (18%) have been unsuccessful in filling a vacancy in the past 12 months. In that period, the average time taken to recruit a GP partner has risen from 6.6 months to 7.4.

Pulse said some practices were having to hire non-GPs to fill the gaps, while others had closed after failing to recruit a GP partner.

A report from the Commons public accounts committee in April found there had been “no progress” in the previous year on increasing the number of GPs, despite a government target to recruit 5,000 more by 2020. The report said the number had actually fallen, from 34,592 full-time equivalent doctors in September 2015 to 34,495 in September 2016.

MPs said more trainees needed to be recruited and that existing GPs should be encouraged to stay on.

Prof Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said of Pulse’s findings: “We know that practices across the country are finding it really difficult to recruit GPs to fill vacant posts, and the degree to which this problem has increased over the last six years is staggering.

“In the most severe cases, not being able to recruit has forced practices to close, and this can be a devastating experience for the patients and staff affected, and the wider NHS.”

Stokes-Lampard added: “At present, UK general practice does not have sufficient resources to deliver the care and services necessary to meet our patients’ changing needs, meaning that GPs and our teams are working under intense pressures, which are simply unsustainable.

“Workload in general practice is escalating – it has increased 16% over the last seven years, according to the latest research – yet investment in our service has steadily declined over the last decade and the number of GPs has not risen in step with patient demand … This must be addressed as a matter of urgency.”

To improve mental health, start with benefits system | Sarah Chapman

Two-thirds of British adults have experienced mental health problems at some point in their lives, according to the Mental Health Foundation. For people forced to use a food bank like ours, the figures are even higher.

It’s no wonder. The NHS says depression can be caused by “an upsetting or stressful life event, such as bereavement, divorce, illness, redundancy and job or money worries”. People who use food banks face many of these – often at the same time.

A blister from new work boots leads to an ulcer; you’re struggling to walk round the building site and the foreman lays you off with no warning and no sick pay. It takes weeks to access sickness benefits. Your marriage breaks down and you’re suddenly homeless. This is just one story, of a man in his 60s facing an onslaught most of us would struggle to withstand.

Our research highlights that poor mental health is both a cause and a consequence of poverty. Of 20 food bank users we interviewed during one week, 18 said they had experienced poor mental health – stress, anxiety and depression – in the last 12 months. Six said they had considered or attempted suicide in the past year.

Philip*, for instance, had just left hospital when he came to us, after being sectioned six weeks earlier when he attempted to take his own life. Sue*, a grandmother in her 50s, told us, “I’ve had suicidal thoughts. Sometimes I do feel it is the answer. I constantly think of different ways, you know – that can take up a whole evening”.

This is the reality of food banks across the country. Research with referrers to our food bank (such as GPs, mental health services, schools and children’s centres) highlights the same issue; nine out of 10 cite seeing poorer mental health as a direct consequence of poverty.

Time and time again, research [pdf] shows that poverty exacerbates mental health issues by increasing feelings of humiliation, fear, distrust, isolation, insecurity and powerlessness.

Insecurity when you lose your low-paid temporary job or you don’t get the hours you need in a zero-hours contract; when your benefits are due to change as a child turns five, or your Disability Living Allowance needs replacing with Personal Independence Payment; when your private landlord calls time and you join the queue at the council, desperate to be accepted on to the housing list.

Humiliation when your benefits are sanctioned for missing one appointment and “you can’t complain because they’ve got control of you by the money”, as one lady told us after being referred to our food bank by the job centre that sanctioned her. “They can do what they want with you, unless you say please and thank you, and beg.”

Policies that create appalling situations that damage people’s health make me more angry than I can say

Isolation when your “one offer” of temporary accommodation is miles away in another borough, where you don’t know anyone but you’ll still need to get your children back to primary school every day (and you’ll receive no financial help for the extra travel costs).

Fear and distrust when you are called for a medical assessment and the report bears little relation to the interview you had, and even less relation to the expert testimony of your GP, hospital consultant or support worker. Your benefit stops.

We listen to these stories every day at the food bank, keeping how we feel to ourselves as we nod, hand out tissues and make more tea. The short-sightedness of policies that worsen – sometimes even create – appalling situations that damage people’s health makes me more angry than I can say.

You try it. “The job centre told him he needed to do his job in a wheelchair,” says Asha*, mum of three, about her husband, a supermarket delivery driver whose back problems mean he can’t walk properly. “His job? It doesn’t make sense. But to even get to work, he needs to get out of his depression first. Last week he took an overdose.”

“It’s like a nightmare,” she continues. “The system makes it worse and in the end they just leave you with your problems. Any small change and you can lose everything. When it will stop?”

If politicians are serious about tackling poor mental health, our social security system needs to be strong – and for those lining up at our door every day to put food on the table for their kids, it just isn’t.

We should be a country in which people are treated with humanity, fairness, respect and compassion. We need a safety net that is more responsive to unexpected changes in circumstances and health, and less quick to penalise people for whom, at one particular moment in time, life has become an unbearable struggle. That would mean a benefits system which actually boosts people’s chances of improving their life prospects. Until then, we’ll have to keep training our volunteers in mental health issues, because we’re not just handing out food – we’re a source of solace.

* Some names have been changed

Sarah Chapman is a trustee at Wandsworth food bank

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Home alone? Dealing with the solitude of self-employment

Working from home has plenty of perks – you can work in your underwear, go for a nap anytime you like and showering is optional. But the freedom of having only yourself to answer to and no one to see you all day, apart from maybe the cat, has downsides – the most pernicious to your health being the potential for loneliness to set in.

Debbie Clarke, a digital marketing consultant based in Nottingham, found it hard to adjust to working alone after leaving an office job to go freelance. “I’d had lots of opportunities to get feedback on what I was doing, go out for lunch with people and talk to people throughout the day,” she says. “Working in a box room in your house, the worst thing is not having anybody to bounce ideas off so you’re just left wondering if what you’re doing is actually any good or if it’s all rubbish.”

Emily Rockey had a similar experience when she moved from London to Sussex to set up her own marketing firm, Humm Media. “I’d been a very social person and suddenly everything switched, and I found myself in the house all day everyday,” she says. “I found it difficult to make myself take breaks or have anyone to talk to other than clients.”

Nearly 40% of self-employed people say they have felt lonely since becoming their own boss, according to a survey released in March by Aldermore.

The effect of loneliness on health can be wide-reaching; it is linked to depression, heart disease and even makes the symptoms of a common cold feel worse.

Dr Rebecca Nowland, a senior lecturer in psychology at Bolton University who has conducted research on the health impact of loneliness, warns that if you work alone you need to make socialising a priority.

“Someone who works in an office could be just as lonely as someone who doesn’t,” she says. “But if we choose to isolate ourselves, we need to make time for social interaction with other people. I don’t think we generally realise how important it is for our psychological and physical health to have good quality, meaningful connections with other people.”

In her quest for some company during her working day, Emily Rockey formed a social group on Facebook earlier this year. “I put a message out saying that I work from home and asking whether, if I set up a group, anyone would be interested. I got fifty responses.” The group now has 47 members who meet up regularly. “It’s not about work and it’s not a networking group. They are just people at home who want to get out have a coffee and a chat,” she says.

Debbie Clarke also took matters into her own hands after trying out a few business networking events. “[The networks] were full of men in grey suits just wanting to give you their business cards. They weren’t really about building relationships,” she says. As well as taking over a business network from her former boss, she launched the Blue Stockings Society, a group for professional women in Nottingham that holds regular gatherings and events. “It’s where people can be honest about running a business because a lot of times at networking events you have to pretend that everything’s brilliant,” Clarke says. “This wasn’t about trying to get business, it was a support network. It made me feel like I wasn’t alone.”

“A co-working space allows you to flourish much more than sitting at a kitchen table or in a coffee shop”

Danny Bulmer

Co-working is another option for freelancers missing the social interaction of a busy office. Danny Bulmer launched a co-working space, Co Up, in Slaithwaite, West Yorkshire, after finding it difficult to adjust to working alone in the early stages of setting up his design business. “A co-working space allows you to flourish much more than sitting at kitchen table or in a coffee shop,” he says. “There’s the social aspect of feeling part of a community but there’s also the professional aspect of it, with ideas flying around the room and connections being made.”

Katy Carlise, a web designer, set up a freelance community in Manchester two years ago after she left an office job with a charity. “After a few months [of being freelance] I felt the isolation creeping in,’’ she says. “It was surprising how much it affected me … I felt really stuck and uninspired.”

Initially she tried working from coffee shops in an effort to meet other freelancers. “I sat next to people and tried to catch their eye. But everyone was being very British about it. There was no way of getting into that conversation,” she says.

Carlisle had the idea of forming a pop up co-working space for freelancers after visiting a Ziferblat café in Manchester, where customers pay for the amount of time they spend there, rather than the food and drink they consume. She set up a freelance group through MeetUp, an online platform for organising gatherings around different interests and communities. Her group, called Freelance Folk, holds co-working sessions at Ziferblat and, with almost a thousand members signed up, it has just expanded to Sheffield.

“We work together every week and on the last Friday of every month we go out for drinks,” Carlisle says. “It feels like I’ve recreated the good bits of having a job, while still retaining the benefits of being freelance.”

How do we know we can trust the latest polls? | Brief letters

Drs Mellon and Prosser explain (Letters, 6 May) why the opinion polls were wrong at the last general election – a failure to obtain representative samples. Specifically, pollsters did not contact enough people from hard-to-reach groups that do not vote in elections. What I want to know is, has this mistake been eliminated in the current polls, which are being respectfully reported, on voting intentions? Are the pollsters now doing the job properly? Can we trust these polls?
Oliver Williams

I agree with Chris Birch (Letters, 9 May). Subtitles flash on and off, cover translations, appear at different places on the screen and sometimes continue over the following programme. Theresa May gabbles, Jeremy Corbyn has a beard, both impossible for lip-readers. It’s no wonder we retire to bed, exhausted.
Jean Jackson
Seer Green, Buckinghamshire

I don’t find it at all strange that a teenager would have Margaret Thatcher’s picture on his bedroom wall (G2, 9 May). Our son had her picture on his dartboard.
Barbara Freeman

Richard Carden (Letters, 8 May) perhaps misses the point when he attributes English councils’ democratic deficit to first past the post. Since 2001, every council without an elected mayor has by law had a quasi-mayor (the leader) making almost all the decisions. In effect that’s one-person rule (give or take a small sofa cabinet chosen by the leader) irrespective of the council’s political balance.
Nick Beale

The correspondence regarding grandparents (Letters, passim) reminds me of a very old joke: My grandparents were called Pearl and Dean but we knew them as Grandma and Grandpapapapapapapapapapapa.
Steve Vanstone

A friend of mine used to refer to his daughters’ long-term unmarried partners as his “sons-in-love” (Letters, passim).
Dr Brigid Purcell

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Fashion models in France need doctor’s note before taking to catwalk

Fashion models in France will need to provide medical certificates proving they are healthy in order to work, after a new law was introduced banning those considered to be excessively thin.

A further measure, to come into force on 1 October, will require magazines, adverts and websites to mark images in which a model’s appearance has been manipulated with the words photographie retouchée (retouched photograph).

Doctors are urged to pay special attention to the model’s body mass index (BMI), a calculation taking into account age, height and weight. However, unlike similar legislation passed in Italy and Spain, models will not have to reach a minimum BMI.

Under World Health Organisation guidelines an adult with a BMI below 18.5 is considered underweight, 18 malnourished, and 17 severely malnourished. The average model measuring 1.75m (5ft 9in) and weighing 50kg (7st 12lb) has a BMI of 16.

Announcing the introduction of the new rules on Friday, France’s health minister said they were aimed at preventing anorexia by stopping the promotion of inaccessible ideals of beauty.

“Exposing young people to normative and unrealistic images of bodies leads to a sense of self-depreciation and poor self-esteem that can impact health-related behaviour,” the health and social affairs minister, Marisol Touraine, said.

Given Paris’s iconic role in the fashion industry, the measures – passed in 2015 but only just coming into effect – are likely to have a symbolic impact around the world.

The proposals had originally suggested a minimum BMI for models but, following an outcry from fashion executives and modelling agencies, this was ditched in favour of allowing doctors to decide whether a model is too thin.

Agencies who use models without valid medical certificates will face a fine of €75,000 (£54,000) and staff face up to six months in prison. Failing to flag-up retouched images will incur a fine of €37,500, or up to 30% of the amount spent on the advert.