It was inspired in part by Hilary Mantel's own experiences as a social work assistant at a geriatric hospital which involved visits to patients in the community and access to case notes, the loss of which play an important part in the novel.

[1] It is a black comedy set in the mid-1970s and begins with the widowed spiritualist Evelyn Axon's discovery that her mentally-handicapped daughter Muriel is pregnant.

Isabel Field is the latest social worker to tackle the Axons but Evelyn is determined not to let anyone interfere with Muriel, whose condition she blames on her daughter's recent weekly visits to a daycare centre.

Isabel Field herself is having an affair with the brother of Evelyn's neighbour and the story of this relationship is interwoven with that of Evelyn and Muriel's and the birth of the baby...

The story is continued in Hilary Mantel's next novel Vacant Possession.