Nick Clegg, kingmaker?

The Lib Dems' options in a hung parliament must not be looked at in isolation

The fight for the general election has begun, and talk of a possible hung parliament continues to rumble in the background. Amid the rhetoric about fighting "every inch of the way" (as Gordon Brown said yesterday), Jackie Ashley says in the Guardian this morning that behind the scenes, politicians from both camps are discussing the options for compromise.

A kingmaker may be emerging: Nick Clegg.

Clegg has already said that, in the event of a hung parliament, he would back whichever party had won. But in our archaic voting system, this might not be clear-cut -- the Conservatives could win more votes than Labour but not quite enough to secure more parliamentary seats.

In this eventuality, Clegg must decide whom to back. This poses yet another set of questions for Brown's beleagured leadership. As Ashley writes:

Clegg [would not] find it easy to agree a power-sharing deal with Brown himself: the gap in style and age is just too great.

So Labour ministers are talking of a scenario in which, if no party won the election, Brown might stand down quickly. He would then be replaced by a more Lib-friendly leader, prepared to go further on constitutional reform; and a deal would be agreed, leading to that "realignment of the left" that has long been a staple of Guardian columns.

The New Statesman has consistently argued for a progressive realignment. As our leader argues this week, Labour will always be the more natural ally of the Lib Dems.

It's an interesting debate whether, in the event of a hung parliament, Brown's departure would be a requirement for a Lib-Lab pact.

Quite apart from the personal contrasts between Clegg and Brown, there is the problem of image. Some might argue that the public's frustration with Labour has come from disillusionment with the political system as a whole. But Brown has, in many ways, come to be emblematic of a tired government. Could the Lib Dems really be seen to be propping him up?

As my colleague George Eaton pointed out last week, Brown's tribalism may preclude a harmonious pact in any event, despite his apparent attempt to court the Lib Dems on the Andrew Marr show yesterday.

At PoliticalBetting, Mike Smithson suggests that James Purnell could be the man for the job, being "of the same generation as Clegg . . . [and] set to retain his Stalybridge seat". Certainly, Purnell's resignation last summer separated him from the current leadership of Labour -- as opposed to Harriet Harman or David Miliband, other names that have been touted.

But these arguments, by focusing on the Lib Dems and the decision to be made by Clegg, risk overlooking Labour and Brown's own psychology.

While a hung parliament would not present a victory in the usual sense of the word, it's entirely possible that Brown -- who has already described Labour as the underdog in this campaign ("When you are behind in the polls you have got to regard yourself as the fighter") -- could view the fight back from crushing defeat as an endorsement of his ability to lead the country in a power-sharing agreement.

The latest YouGov poll for the Telegraph showed the Conservatives with a lead over Labour of 35 points to 26. It remains to be seen whether the lead narrows further and a hung parliament becomes a reality. In any event, the multifaceted discussion of Brown's leadership looks set to run and run.

 

Follow the New Statesman team on Twitter

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

Getty
Show Hide image

The surprising truth about ingrowing toenails (and other medical myths)

Medicine is littered with myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery.

From time to time, I remove patients’ ingrowing toenails. This is done to help – the condition can be intractably painful – but it would be barbaric were it not for anaesthesia. A toe or finger can be rendered completely numb by a ring block – local anaesthetic injected either side of the base of the digit, knocking out the nerves that supply sensation.

The local anaesthetic I use for most surgical procedures is ready-mixed with adrenalin, which constricts the arteries and thereby reduces bleeding in the surgical field, but ever since medical school I’ve had it drummed into me that using adrenalin is a complete no-no when it comes to ring blocks. The adrenalin cuts off the blood supply to the end of the digit (so the story goes), resulting in tissue death and gangrene.

So, before performing any ring block, my practice nurse and I go through an elaborate double-check procedure to ensure that the injection I’m about to use is “plain” local anaesthetic with no adrenalin. This same ritual is observed in hospitals and doctors’ surgeries around the world.

So, imagine my surprise to learn recently that this is a myth. The idea dates back at least a century, to when doctors frequently found digits turning gangrenous after ring blocks. The obvious conclusion – that artery-constricting adrenalin was responsible – dictates practice to this day. In recent years, however, the dogma has been questioned. The effect of adrenalin is partial and short-lived; could it really be causing such catastrophic outcomes?

Retrospective studies of digital gangrene after ring block identified that adrenalin was actually used in less than half of the cases. Rather, other factors, including the drastic measures employed to try to prevent infection in the pre-antibiotic era, seem likely to have been the culprits. Emboldened by these findings, surgeons in America undertook cautious trials to investigate using adrenalin in ring blocks. They found that it caused no tissue damage, and made surgery technically easier.

Those trials date back 15 years yet they’ve only just filtered through, which illustrates how long it takes for new thinking to become disseminated. So far, a few doctors, mainly those in the field of plastic surgery, have changed their practice, but most of us continue to eschew adrenalin.

Medicine is littered with such myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery. Until the mid-1970s, breast cancer was routinely treated with radical mastectomy, a disfiguring operation that removed huge quantities of tissue, in the belief that this produced the greatest chance of cure. These days, we know that conservative surgery is at least as effective, and causes far less psychological trauma. Seizures can happen in young children with feverish illnesses, so for decades we placed great emphasis on keeping the patient’s temperature down. We now know that controlling fever makes no difference: the fits are caused by other chemicals released during an infection.

Myths arise when something appears to make sense according to the best understanding we have at the time. In all cases, practice has run far ahead of objective, repeatable science. It is only years after a myth has taken hold that scientific evaluation shows us to have charged off down a blind alley.

Myths are powerful and hard to uproot, even once the science is established. I operated on a toenail just the other week and still baulked at using adrenalin – partly my own superstition, and partly to save my practice nurse from a heart attack. What would it have been like as a pioneering surgeon in the 1970s, treating breast cancer with a simple lumpectomy while most of your colleagues believed you were being reckless with your patients’ future health? Decades of dire warnings create a hefty weight to overturn.

Only once a good proportion of the medical herd has changed course do most of us feel confident to follow suit. 

This article first appeared in the 20 April 2017 issue of the New Statesman, May's gamble

0800 7318496