The politics of persuasion gone wrong

Lobbying is an important part of democracy - but where does the line of acceptable behaviour lie?

Lobbying is a fundamental part of democracy.  Everyone has the right to try and persuade a government of the justness of their cause and the need for particular pieces of legislation; but there are ways and means of doing this, and the testimony of News Corp’s representatives at the Leveson inquiry illustrates just how those ways and means can easily be abused.

The sight of James Murdoch squirming and suffering in front of the inquiry on 24 April no doubt delighted his critics.  The evidence that he, and others high up in News Corp, have let seep out about the extent of their links with the British government – a cosy Christmas lunch here, a nice ride through the English countryside there – have left many feeling very uncomfortable about the power and influence News Corp has, for a very long time, apparently wielded in the UK.  Heads may well roll as a result.

Attempts by companies to influence the policy process are not, of course, anything new.  And neither is it unique to the UK.  It was in Germany, for example, that the Flick consortium openly and brazenly claimed that they simply “cultivated the political landscape” by bankrolling all major parties (whilst concurrently persuading them to change tax laws in their favour) throughout the 1970s.  The role that big business plays in funding US politics is also nothing more than a statement of the obvious.

Whilst Murdoch’s tentacles may well have stretched too far in to the inner sanctum of British politics, it is not always easy to be clear on where it’s fair, appropriate and democratically legitimate, and where the line of acceptability is.  It is for that reason that the UK has some of the most well developed sets of rules, regulations and procedures on lobbying in the world.  Lobbyists, and the firms they work for, are faced with a myriad of dictats outlining what they can and cannot do, with whom they can and cannot speak, where, when and under what conditions they can say or do anything.  And the media – very much including the Murdoch owned part of it – love nothing more than coming down on miscreants who break these rules like a tonne of bricks.

Recently, the Freedom of Information Act (FOI) has added more weaponry to the self-proclaimed guardians of our democracy’s cause.  Ministers (as Jeremy Hunt is no doubt rapidly learning) should know that the public could theoretically end up seeing, reading or listening to more of their everyday business than ever before. Those who complain that this constrains the workings of government miss the point entirely; if government has been influenced by an outside source, if decisions have been taken based on the evidence (or indeed interests) of particular groups, then the wider world certainly has a right to know.  Hiding the business of politics in, say, private email accounts (as Michael Gove appears to have done) illustrates nothing more than a (perhaps deliberate) misunderstanding of how democracy really should work.  There are, with good reason, restrictions on FOI, of course – and there is always a case to be made for reviewing and revising such things.

But the point that public servants – and those engaging with them – need to remember is not that they need to cultivate friends to help them.  This is, like it or loathe it, true in all walks of life.  Rather, it is something that you could call the Daily Mail test; are you happy for your lobbying to be reported in public?  Are you confident that you have abided by the laws, rules, regulations and codes that shape political life?  Would you be happy reading about how your decision (or your attempt to influence a decision) was discussed in the Daily Mail?  If the answer is "yes", then you have nothing to worry about.  If, as James Murdoch and his associates are discovering, you are unhappy at having to discuss the details of how, when and under what circumstances you lobbied government, then that alone should tell you something.

Dr Dan Hough is Reader in Politics at the University of Sussex and Director of the Sussex Centre for the Study of Corruption

A protester wearing a Rupert Murdoch mask stands outside the High Court as James Murdoch appears before the Leveson Inquiry. Photograph: Getty Images

Dr Dan Hough is Reader in Politics at the University of Sussex and Director of the Sussex Centre for the Study of Corruption

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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