In vitro maturation of oocytes (IVM) describes a process whereby immature oocytes that have been collected as part of an assisted reproductive treatment cycle are matured in a laboratory. After maturation, they are usually fertilized with sperm, via intracytoplasmic sperm injection (ICSI), and the resulting embryos cultured. The perceived benefits of this technology are that it involves a shorter duration of time between the commencement of a treatment cycle and oocyte collection, and it avoids the risk of ovarian hyperstimulation syndrome (OHSS). OHSS is a very serious medical condition that women with polycystic ovary syndrome (PCOS) are particularly susceptible to developing. IVM technology has been used for several decades, but in the last ten years there has been a resurgence of interest in its use with the development of enhanced maturation media to assist the IVM process and the initiation of several randomized trials to compare potential benefits and drawbacks in comparison to the standard in vitro fertilization (IVF) approach.

Co-enzyme Q10 (CoQ10), transported in the blood by lipoproteins, is an essential component of the inner mitochondrial membrane and is responsible for electron transport in the mitochondrial respiratory chain for oxidative phosphorylation to generate the energy substrate adenosine triphosphate (ATP), and acts as an anti-oxidant within the oocyte. Observational studies suggest that the follicular fluid concentration of CoQ10 diminishes with age (1), and low CoQ10 antioxidant status may indeed correlate with oocyte aneuploidy (2). Consequently it would appear there is a sound rationale for the use of CoQ10 during infertility treatment, perhaps for women with perceived ‘poor oocyte quality’. Furthermore the scientific rationale is supported by several animal studies which demonstrate a beneficial effect of CoQ10 supplementation on embryonic development. However, before all clinicians are encouraged to prescribe Coq10 as the eternal elixir of reproductive youth, evidence for a benefit of supplementation in the IVF clinical setting is required.

One weekday morning in the summer of 2004, over a hurried breakfast before joining the daily rush of London’s commuter throng, along with an estimated audience of around nine million other radio listeners I tuned in to the Today programme on the BBC.

The Shadow Chancellor, Oliver Letwin MP (2004) of the Conservative Party, was being interviewed about one of his favourite themes in the run up to the following year’s general election. This was how a new Tory administration would reduce taxes, not by cutting front line public services, but by reducing ‘wasteful’ expenditure on the ‘fat bureaucracy’ of government. Searching for an example to best illustrate the Labour government’s alleged profligacy, he remarked that among the ‘huge number of quangos’ employing ‘armies of bureaucrats’ the government ‘even has a council for children’s play’.

As the chair (shortly to become director) of the very same Children’s Play Council (CPC), this sideswipe from the would-be Chancellor of the Exchequer was not what I was accustomed to hearing over breakfast. It was not just the dismissive nature of the remark that caught me off guard. The mere mention of children’s play on the Today programme, let alone in a discussion of economic policy by a senior politician, was in itself enough of a surprise to cause our then-director, Tim Gill (2008a), to later confess to nearly choking on his toast.

CPC was not, in fact, a government agency or ‘quango’, but a membership body of voluntary and public play organisations hosted by the National Children’s Bureau (NCB), a registered charity. Although we did hold a small government contract, we were also funded by various charitable trusts and membership fees. Our role was very much that of an independent advocate for children’s right to play. Researching and disseminating evidence about play and play provision, CPC’s main aim was to build a consensus about how society in general, and government in particular, should respond to what we knew were increasing barriers to children’s natural enjoyment of this fundamentally important part of their lives.

After checking with colleagues that we had no particular engagement with Letwin’s office, let alone of the kind that might invoke such disapproval, we quickly came to realise that we had been singled out, not for anything we had said or done, but for what we represented to a particular school of thought.

CPC’s role in first suggesting, then helping to design and deliver the Better Play Programme, had far-reaching consequences. Not least of these was the proximity it gave us to the senior team of a new, supersized funding body at a time when there was much to play for – and much to lose.

Unusually for the head of a large funder, New Opportunities Fund’s (NOF) Chief Executive Stephen Dunmore had taken a personal interest and involved himself directly in some of Better Play’s activities, particularly towards its latter stages. CPC’s partnership with Barnardo’s, one the country’s oldest, largest and most respected children’s charities, may well have helped to engender such a commitment – or perhaps it was simply that there is a ‘feel-good factor’ to good play projects that even CEOs find irresistible. Whatever the reason, Stephen Dunmore was a surprisingly frequent speaker at Better Play events and an engaging and interested contributor to the round of workshops that CPC and Barnardo’s staged to finalise the programme and help to inform its conclusions. Prominent among these was the challenge of sustaining new projects within a wider policy and funding climate still largely disinterested in children’s play.

In October 2004, there was still a good deal of uncertainty about the fate of the Play Review’s recommendations and the prospects for a Lottery programme for play. Many in the sector wanted us to challenge what was being seen as a broken promise to children and continue to put pressure on the government to honour its election pledge. Having met with Tessa Jowell, we knew that her response to Frank Dobson, which had been a long time coming and was made in full consideration of the imminent changes to the laws governing Lottery funding, was final.

Crucially, Frank Dobson was no longer a minister. His report was in the way of recommendations to the government and to the funder, NOF. It was not government policy and could not, therefore, be construed as ministerial directions. We knew that the best chance for a national funding programme for play now lay in persuading not the government, but the newly created Lottery distributor, that this would be a popular, successful and worthwhile use of £200 million.

Play practitioners and advocates tend to resist the imposition of extraneous agendas onto the play environment. It is one of the playwork principals (PPSG, 2005). But in the policy world of quantifiable outcomes, measurable impacts, cost–benefit ratios and the like, this can be a problem. Politicians – and perhaps electors too – want policy to be demonstrably effective. If public money or legislative authority is to be invested in something, then it had better produce results. Playing does not produce results; at least, not predictable ones of the kind that can easily be measured, evaluated and reported on.

Playing is an instinctive and universal human behaviour. In its way, it is as simple and as complex as anything else in nature. It is self-evident when children are playing, yet difficult to pin down where it starts and where it finishes (Sutton-Smith, 1997). This paradoxical quality – of something natural and innate on the one hand, yet complex and indefinable on the other – is further complicated for play advocates by the inconvenient truth that the more we learn about it, the clearer it becomes that play’s primary purpose is simply to enjoy and become better at playing. Children play because it is in their nature, but it serves no subjective purpose other than to be enjoyed and to enhance itself.

Of course, we know in general terms that children’s play does enhance their prospects. We can say that children who are allowed a good amount of time to play in the right environments will tend to be healthier, develop faster and do better in school than those who are not (Lester and Russell, 2008); but the specific benefits, and the risks too, are unpredictable.

But even accepting the important role of play in children’s development, any approach that seeks to capture and measure the impact of different variables is going to quickly come up against the dilemma of how to monitor it without manipulating it. Theorists and practitioners alike – and not only those advocating the playwork approach – have argued that even introducing the concept of measurable outcomes to children’s play risks perverting a complex, ancient and delicate dynamic, interfering with the child’s experience and undermining a profound biological process (House, ed, 2011).

The actor, producer and former children’s TV presenter Floella Benjamin, now Baroness Benjamin OBE of Beckenham, rises to speak in the House of Lords, where she is a member for the Liberal Democratic Party. The Baroness, familiar to everyone of a certain age from her time on Playschool, the BBC’s iconic daily programme for pre-schoolers in the 1970s and 1980s, asks Lord Nash, a junior Education Minister in the new Conservative government, about nutrition in schools. She is rewarded with the promise of a new ‘national obesity framework’ by the end of the year and a meeting with the Minister to discuss what it should contain.

It is a mark of the very different world we now inhabit compared with the one of 2007 – when the Play Strategy was announced with a £225 million flourish by Ed Balls in the House of Commons – that this brief exchange about school food between two minor politicians in the upper chamber may represent the best opportunity for progressing policy for play in England over the course of the new Parliament. The general election of 7 May 2015 not only saw Ed Balls’s Labour party spectacularly fail to return to government in the face of an unexpected Conservative majority, but he himself lose his seat in Parliament altogether. If the result was widely regarded as a shock, this was nowhere more true than within the play movement, where there was a reasonable hope – if not quite an expectation – that our strongest political champion of recent years, far from leaving politics altogether, as he has subsequently announced, would be the new Chancellor of the Exchequer and might be persuaded to resurrect his vision for a child-friendly public realm supported by a long-term strategic government policy for play.

It was not to be. The leading party of a coalition government that, as CRAE (2015) asserts, ‘undermined children’s rights under Article 31 by abandoning a ten-year national play strategy (and) […] breaking a public commitment to develop an alternative cabinet-led approach to play policy’, now had a mandate to pursue its low-tax, low-intervention vision of a minimalist state unencumbered by centrist partners. Children’s play is unlikely to feature in its plans. Unless…

At a meeting of Play England’s strategic advisory group in 2010 – within the slender window of opportunity’ between the termination of our central government contracts to support the Play Strategy (DCSF/DCMS, 2008b) and the conclusive elimination of children’s play from government policy altogether, which would be confirmed by that autumn’s comprehensive spending review (HM Treasury, 2010b) – Ryan Shorthouse, founder of the Conservative think tank Bright Blue and a key researcher for the shadow cabinet’s child policy review three years earlier (Willetts, 2007), was addressing a somewhat shell shocked gathering.

The coalition government had made reducing government debt its ‘most urgent task’ (HM Treasury, 2010a), and reducing public expenditure the means to achieve it. The two parties agreed, as their basis for sharing power, ‘that the days of big government are over; that centralisation and top-down control have proved a failure’ (HM Treasury, 2010b). If Oliver Letwin’s comments in 2004 had sounded ominous – for CPC and the many other specialist agencies holding government contracts to support particular policy areas – the subsequent economic crash of 2007–8 had presented the new government, for which he was now Minister of State for Policy, with its justification for following an agenda of deep cuts to public administration to a degree not previously imagined. That independent economists attributed the crash not to excessive government spending but to the recklessness of inadequately regulated financial markets (Farlow, 2013) did not deter them from pursuing such cuts with vigour.

The Play Strategy support contracts held by Play England and its partners were among the first casualties of the coalition’s ‘deficit reduction’ programme. These were cancelled as part of the emergency budget announced by new Treasury Minister David Laws (HM Treasury, 2010a) less than two weeks into the new administration, in order that the restructured Department for Education could contribute £670 million to what were presented as ‘efficiency savings’ (HM Treasury, 2010a). The contracts had been due to run until 2011 and their sudden termination precipitated a major restructuring of Play England’s staff, including many redundancies. External members of the advisory group that day in July were also considering an insecure future, as their own services and organisations began to take stock of a landscape that had changed beyond recognition.

To anyone able to accurately read the political runes, the premature end of the Play Strategy after only two of its planned 12 years could have been foretold even before it was launched in 2008. However, contrary to appearances since 2010, the prospects for a serious Conservative government play policy, before the financial crash of 2007, had been surprisingly good.

On succeeding Tim Gill as director of the Children’s Play Council in 2004, I was granted a meeting with the Conservative Shadow Chancellor, Oliver Letwin, whose comments about us on Radio 4 had been so dismissive. After a slightly tense introduction, he eventually acknowledged that his characterisation of us was illinformed and promised he would do what he could to help sow the seeds for a more enlightened approach from his party, before cutting the meeting short to rush off and vote.

The Conservatives, in opposition, then had not had much to say about children’s play until a letter appeared in The Daily Telegraph in September 2006 (Abbs et al, 2006). Earlier that year, former head teacher Sue Palmer (2006) had published a book about what she termed the ‘epidemic of misery’ in the children of affluent developed nations. Palmer examined the big statistical increases in the numbers of children and young people with mental health, behavioural and eating disorders, and the rising levels of pupils classified as having additional needs in school. She suggested that these modern childhood ailments were the result of human evolution not being able to keep up with the pace of technological advances that had so changed the way that we live. Simply, modern life – including the radical reduction in children’s freedom to roam and to play – was, according to Palmer, making them unwell.

Over a hundred academics, writers and medical experts signed the Telegraph letter endorsing Sue Palmer’s diagnosis. It called for a closer examination of the quality of children’s lives, saying that they were increasingly tainted by overexposure to electronic entertainment, lack of play space and the emphasis on academic testing in schools. ‘[Children] still need what developing human beings have always needed’, it said, including ‘real (as opposed to junk) food, real play (as opposed to sedentary, screen-based entertainment), first-hand experience of the world they live in and regular interaction with the real-life significant adults in their lives’.

The story of the Play Strategy for England, and our overview of some of the key ideas and research on children’s play and how it is constrained in the modern world, suggests that no society that values human rights or wants a dynamic, sustainable economy can afford to neglect play. A public realm – space, services and culture – that supports the basic needs of all its people must treat the innate and expressed desire of all children to play with at least as much seriousness as it does their anticipated future needs as employable adults.

Indeed, the evidence strongly indicates that these needs are complementary. How, indeed, could they not be? If playing stimulates brain growth, adaptability and emotional intelligence; engenders resilience and creative initiative, develops the child’s sense of self and relationship and enables him or her to practice assessing and navigating risk, how could it not be a fundamentally important aspect of the growth and development that will equip him or her to do well in life and be a valuable member of society? To ask whether children play because of the deferred benefits they seem to derive from it, or simply because it’s the best fun they can have, is the wrong question. The ‘play for its own sake’ versus ‘play for positive outcomes’ argument is a false dichotomy. No child has ever played to improve their future life chances, but there is plenty of evidence to suggest that, in playing, they do just that. From a policy perspective, however, the distinction is crucial.

Although what we know about children’s play does not in fact support the unquestionable assertion that it is or must always be ‘self-directed or intrinsically motivated’ (there is too much evidence of the transpersonal, communal nature of much playing for that statement to stand unchallenged), we also know that the optimum conditions for playing are those which support and respond to children’s own initiative, provide them with resources and space to manipulate and explore and give them permission to be spontaneous and expressive. The real question to ask is to what extent our expenditure on services and spaces for children – and on housing, streets, parks and public spaces for their communities – affords them such opportunities.

Of all the human rights specific to children as defined by the UN Convention on the Rights of the Child (1989), the right to play has become known as ‘the forgotten right’. The UK, in this respect, is not untypical; although it has a reputation internationally for its progressive thinking on play (Hart, p xvii, this volume), only in Wales is there a clear statutory duty on local authorities to make universal provision for it. And it is not only governments that seem to neglect the importance of play relative to other children’s rights; in particular, the dominance of education over play provision as a recognised issue tends to be reflected in the work of children’s rights’ advocacy bodies too.

The Children’s Rights Alliance for England (CRAE), for example, in its annual review of government action on the CRC, found that ‘a child’s right to play and recreation suffers from poor recognition of its importance, and a lack of investment by government at national and local level’ (CRAE, 2014). The review refers to the UNCRC’s own report of 2008, which called on the UK government to guarantee Article 31 for all children. The review also found that, across the 32 (of 152) local authorities able to comply with a Freedom of Information request on play budgets, there had been an ‘overall reduction’ of 54% between the years 2008-9 and 2014-15; despite this, in its subsequent recommendations the CRAE report calls for subsidies and quality benchmarks in early years settings and a statutory universal youth offer but has no proposals for play policy (CRAE, 2014)

However, while the right to play may have been largely overlooked not only by the parties of government but also by those who would influence them on behalf of children, it was in fact a central part of the argument of the modern children’s rights movement at its origins early in the last century. The UN’s General Comment No. 17 (2013) notes that an earlier Declaration of the Rights of the Child (UN, 1959) proclaimed that: ‘society and the public authorities shall endeavour to promote the enjoyment of this right [to play]’. In fact, it was in 1913 that the right to play was at the forefront of the changes demanded by the embryonic movement that would lead all the way to the CRC.

With a strong playwork tradition and more adventure playgrounds (Shier, 1984) and play associations than anywhere else in the country, it was perhaps no surprise that the big breakthrough for play policy in England occurred in London. However, there were political factors, unique to the capital, which were to have an equally significant bearing on events.

When New Labour won its landslide victory under Tony Blair in the general election of 1997, its policy on London contained something of a conundrum of realpolitik. Blair and his chancellor, Gordon Brown, had led an extensive modernising agenda with a more business-friendly political culture than previous Labour governments had a reputation for. For example, key Blairite, Peter Mandelson (cited in Wighton, 1998) declared the party to be ‘intensely relaxed about people getting filthy rich, as long as they pay their taxes’. For the traditional party of the working class this was something of a departure and was to set Downing Street on a collision course with the heir apparent to the London throne.

In 1986, the Conservative government of Margaret Thatcher had abolished the Greater London Council (GLC), led by ‘Red’ Ken Livingstone, after which he became a champion of the left-wing of the Parliamentary Labour Party, standing against Tony Blair for the leadership after the sudden death of John Smith in 1994. Upon the party’s 1997 victory it was no surprise, given his uncompromising stance on socialist principles, that Livingstone was passed over for ministerial duties. Just as he had been a bête noire for Prime Minister Margaret Thatcher – opposing everything she stood for from his alternative power base across the Thames – so he now became, this time from the backbenches, a thorn in the side of the Blair government; New Labour’s ‘Bête Rouge’ (Rawnsley, 2001). The conundrum for Blair was that Labour had opposed the abolition of the GLC and had an established policy to reinstate some form of devolved regional government for the capital: an authority that Ken Livingstone was widely regarded as the natural candidate to lead.

By 1999, Livingstone had become one of New Labour’s most vocal internal critics and Blair was determined that he should not be Labour’s official candidate.

In a typical English residential street of Victorian terraced houses either side of a road, usually lined bumper to bumper with parked cars, children are playing in the manner of children everywhere: noisily; randomly; in small groups, pairs or just on their own.

Play perennials like skipping, hula hoops and hopscotch abound, although other games in evidence are more specific to this generation of children, this neighbourhood or this moment. Bikes, scooters and roller blades are in ample evidence but there are still more children on foot, though rarely walking. Running, skipping and jumping – or a combination of all three – seem to be the default modes of movement, leading nowhere in particular but full of intent.

The play seems infinitely varied, spontaneous and freeform. Although some adults are present, they are not in charge; no one is coordinating or directing save for the children themselves, who seem to be entirely at home in the happy chaos of it all. Much of the anarchic activity is happening in the middle of the road, the pavement being far too narrow to contain it all.

It is summer and at one end of the street someone has brought out a hose. Children are screaming with delight as they try – but not too hard – to evade the water’s cold, wet arcs. Others are having a race, which is fiercely competitive but none too organised. There is little agreement about the winner, but no one seems to care much – or not for long anyway.

Such a scene, one might imagine, is commonplace. A normal day, perhaps a weekend, a school holiday or an early summer evening, in a normal street where families live and children gravitate towards one another in the one common space that is within sufficiently easy reach of their homes that they can come and go at will.

But look again, as we zoom out from this picture. There are no children playing in the adjacent street, or any of those parallel to it, though they house roughly the same demographic. Zoom back in and notice that at either end of the street are adults in ‘high-vis’ jackets wearing badges and holding clipboards. They have erected barriers and are keeping out traffic, apart from the occasional resident’s vehicle, which is escorted at walking pace by one of these voluntary stewards.

By a coincidence of government restructuring, the department with responsibility for the National Lottery under the New Labour government of 1997 was also the one that had contracted CPC to deliver a small policy and research programme (HM Treasury, 2003). The Department for Culture, Media and Sport (DCMS) had inherited such responsibility for children’s play as there was at that time within Whitehall from one of its predecessors, the Department for National Heritage.

There were two main problems with play policy residing at the DCMS. First, this placed it outside of the main locus for child policy – the Department for Education and Employment – which, especially under New labour, was to very explicitly broaden its reach and ambition to drive up improvements in every area of children’s lives touched by public services or the public realm (HM Treasury, 2003). Second, it simply did not have the budget to promise any substantial changes to an area of public life as universal as children’s play. It was an ‘arm’s length’ funder of the arts and sport, and also managed the government’s relationship with the BBC.

Nevertheless, the DCMS is where play policy resided. Fortunately, the department also had two saving graces as far as the play movement was concerned. The first of these was that the lottery distributors were accountable to it, and to some degree took their policy direction from it – especially in the case of NOF (see Chapter Four). The second was Culture Secretary, Chris Smith.

A couple of years before the CPC meeting with NOF, in October 1998, the Secretary of State was invited to speak at London Play’s first annual meeting. As an Islington MP renowned for his support of local action, the minister was a long-term friend of the Islington Play Association and the 12 adventure playgrounds in the Borough. He accepted our invitation and the event was a huge success, sending out a message that the ‘new kid on the block’ in London meant business (and so impressing our funding officer from London Boroughs Grants that he immediately took us off the ‘high-risk’ category!).