With hindsight, Cable's deficit reduction plan looks better than Osborne's

Osborne's Plan A required the Chancellor to be lucky - and this Chancellor has not been lucky.

This year I am conducting a little experiment. I have two sealed envelopes in my office drawer. In one is a set of economic predictions made by astrologers at the start of the year; in the other a set of similar predictions made by ordinary journalists with no economic background. At the end of the year I intend to compare such random guessing with heavyweight economic soothsayers such as the Office of Budget Responsibility, the Bank of England, OECD, IFS and any economic think tank bold enough to make medium-term economic predictions on the nation's growth, employment, inflation, and so forth.

My money frankly is on the astrologers. The recent record of medium-term economic forecasting is lamentable - even if we ignore the unpredicted banking crash. What success we have seen amounts to little more than the suggestion that things will move in the direction they seem to be moving.

Now, I do not know if George Osborne trusted too much the entrail examining of economic experts, some of whom are now saying that he shouldn't have done exactly what they hitherto urged him to do. Nor can we be as sure as Ed Balls that the government went "too far, too fast" - particularly as Ed never got as far as telling anyone "how far or how fast" a government should go.

What we all can agree on, though, is that things are not going to plan. Yes, jobs are being created in the private sector, unemployment is not moving upwards, the deficit is down, our export markets are engaging with the emerging economies, inflation is low and our credit good.

However, friend and foe alike acknowledge that the plan hinges on economic growth and there's little positive news yet on that.

I write this as someone who has voted in Parliament for every bit of the Chancellor's strategy and bought into its broad objectives. Government MPs cannot meaningfully adopt an a la carte approach to Budgets. I did not know if it would achieve all its major objectives but I certainly did not know it would not. I do not claim to know how crucial events in the EU have been in derailing that strategy.

What I entirely reasonably claim is that George's plan conceived before the 2010 election and implemented after it was bolder and potentially riskier than that advocated by Vince Cable and the Lib Dem Treasury team. Retrospectively and with all benefits of hindsight, slowing a little the pace of deficit of reduction to better protect economically-useful capital expenditure as suggested by Vince looks as though it might have been a better bet.

It is not that Plan A could not have worked or that the sage of Twickenham was necessarily right. It required though a number of other things to go right or not go badly wrong - for the Chancellor to be lucky - and this Chancellor has not been lucky.

It probably did not help that in act of misguided hubris the Regional Development Agencies were given their marching orders from day one - particularly as the replacement Local Enterprise Partnerships have struggled either to find their feet or get real money flowing through the system. RDAs stood in need of reform but the incoming government's penchant for "radical restructuring" has led in more than one area to a lot of time being wasted doing just that.

One cannot help thinking that much of this is a poisonous consequence of the tribalism that bedevils British politics whereby incoming governments are expected to behave like the Taliban blowing up Buddhas. One hoped that coalition could offset this tendency.

That’s why the reasoned tone as much as much as the substance of Alistair Darling's intervention last week matters. Frankly positioned as George Osborne is between supply-side zealots who see manic deregulation as a cure-all and irritating post match analysis from the Lib Dem benches, anything that makes non-partisan discussion and decision-making easier must be welcome.

For regardless of what party we belong to or what sector of the economy we work in, it is becoming painfully clear that facile and easy solutions to our economic plight are not available and for better or worse - we are all in this together.

John Pugh is the Lib Dem MP for Southport

George Osborne hasn't had any luck. Photograph: Getty Images

John Pugh is the Lib Dem MP for Southport.

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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