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Ken Clarke warns: double-dip recession "still possible"

Former Chancellor says that early spending cuts may tip economy back into recession.

Ken Clarke has become the first cabinet minister to warn that Britain could fall back into recession as a result of the dramatic spending cuts and tax rises announced in George Osborne's emergency Budget.

In an appearance on BBC Radio 4's Any Questions, the Justice Secretary said that a double-dip recession was "quite possible still" and that no one could be sure of the effect Osborne's policies would have on growth.

"If we didn't do it (deficit reduction), my judgement is that interest rates would soar and if you want to stop recovery, if you want to make double-dip recession certain, and it's quite possible still, let British interest rates go up," he said.

He added: "My hope and my forecast is that we won't, but no one's sure."

As Chancellor during the last major period of fiscal retrenchment, Clarke's words carry weight in the Conservative Party and in the City of London and will increase market uncertainty.

His comments came as divisions between the US and Europe over economic policy burst into the open at the G20 summit in Toronto.

President Obama has warned of the dangers of a double-dip recession if all countries start to cut spending at once but leading European economies, especially Germany, are accelerating the pace of deficit reduction.

David Cameron insisted that he was not at odds with Obama over the timing and pace of spending cuts.

"The risk to us - which the Americans and others recognise - is not taking action," Cameron said. "I think that the G8 will conclude that those countries with the worst problems need to accelerate their actions, which is what we have done."

In an open letter to G20 leaders last week, Obama warned that cutting spending too quickly could "result in renewed economic hardship and recession".

As a result of the measures announced by Osborne in Tuesday's Budget, the Office for Budget Responsibility downgraded its growth forecast for this year from 1.3 per cent to 1.2 per cent.

But economists including David Blanchflower, a former member of the Bank of England's monetary policy committee, and Robert Skidelsky, the author of a three-volume biography of John Maynard Keynes, have warned that withdrawing fiscal stimulus, at a time when the private sector remains depressed, could tip the economy back into recession.

George Eaton is political editor of the New Statesman.

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide