Is Cameron's support for Warsi on the wane?

The Prime Minister utters the deadly words: "questions to answer".

David Cameron's declaration that Sayeeda Warsi has "questions to answer" is some indication of No 10's waning support for the Conservative co-chairman (recently profiled by Mehdi Hasan). Contrast that with the Prime Minister's fulsome backing of Jeremy Hunt, whom Cameron said had given "a good account" of himself to the Leveson inquiry.

There are now three strands to the allegations against Warsi: the first relating to reports that she claimed expenses while staying with the Tory official Naweed Khan rent-free, the second to claims that she did not declare a business interest to the House of Lords and the third to allegations that she misused her position as co-chairman to take foreign trips at taxpayers' expense (17 in the past two years).

Warsi's allies have provided a plausible response to the latter charge. The Independent reports that the trips, which included Pakistan, Indonesia, Uzbekistan and Saudi Arabia, were explicitly authorised by Cameron and William Hague. One senior Conservative (note the absence of on-the-record support) tells the paper:

The idea that somehow Warsi has been travelling the world for fun at the taxpayer expense is simply rubbish. Part of her job when appointed was to be a government envoy to that part of the world. Everything is signed off by William and the PM, and to suggest otherwise is just nonsense.

In response to allegations by the Sunday Telegraph that she did not declare her directorship and majority shareholding in a spice company, Rupert’s Recipes, Warsi said: "My shareholdings and, before becoming a minister, directorships have at all material times been disclosed as required on the register of Lords' interests and to the Cabinet Office and on the register of ministerial interests."

But Warsi has failed to close down the initial line of inquiry over her expenses. Notwithstanding the dubious credibility of her accuser, Dr Wafik Moustafa (see Mehdi's column in this week's magazine), she remains the subject of a House of Lords investigation and Labour MP Karl Turner has now written to the City of London police requesting that they open an investigation into whether Warsi broke the law.

He wrote in his letter:

Baroness Warsi reportedly claimed parliamentary expenses of up to £165.50 per night for overnight accommodation while she was staying rent-free in a house belonging to Dr Wafik Moustafa in 2008, along with her political aide Naweed Khan.

Dr Moustafa has said that he never charged Mr Khan or Baroness Warsi rent, and that neither Mr Khan nor Baroness Warsi ever paid him for staying in his house. It appears that Baroness Warsi may have claimed for expenses which she did not in fact incur, and that a criminal offence may therefore have been committed. I am writing to ask that an inquiry be undertaken into whether Baroness Warsi or her aide Naweed Khan have broken the law.

The final problem for Warsi is the distinct lack of affection for her in the Conservative Party. Cameron has faced persistent calls to replace her with Michael Fallon, the Tories' deputy chairman and attack-dog-in-chief, or housing minister Grant Shapps, both viewed as superior media performers. ConservativeHome editor Tim Montgomerie, for instance, has written:

Cameron also needs to reinvigorate his team. He should begin with getting a half decent Party Chairman. In tough times like these you'd normally see the Chairman all over the TV, defending the leader and lambasting Labour. Where's Sayeeda Warsi? She's been completely invisible. I asked CCHQ where she was. Is she ill? Is she out of the country? No, she's preparing for party conference which is still three months away. Pathetic. She needs to be replaced as soon as possible.

Under unprecedented pressure from his MPs over the Tories' diminished fortunes, Cameron now has an opportunity to do just that. It would be surprising if he weren't tempted to take it.

Chairman of the Conservative Party, Sayeeda Warsi could face a police investigation over her expenses. Photograph: Getty Images.

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