The Dissolution Honours

Four former defence ministers and Floella Benjamin are elevated to the House of Lords.

And through the round window, it's Lady Floella Benjamin. The actress and TV presenter, best known for her 14-year stint on the children's programme Playschool, has been honoured in the Dissolution Honours List for her work campaigning on education issues.

Benjamin is the founder of Touching Success, a charity that aims to link children with role models, and was a member of the Liberal Democrats' commission on primary education. She will sit in the House of Lords as a Lib Dem peer.

A few names had leaked out this morning, but the full list is now up on the Downing Street website. There are to be 55 new peers in all.

The list includes some predictable entries -- for instance, John Prescott and Michael Howard. (Incidentally, it is worth asking how his elevation to the Lords might affect Prescott's availability to make an effective party treasurer.)

Other former frontbenchers moving to the Lords include the former defence secretaries John Reid, Des Browne and John Hutton, the former chief secretary to the Treasury Paul Boateng and the former Northern Ireland first minister Ian Paisley.

Quentin Davies, another former minister of defence who crossed the floor from the Tories, will become a Labour peer. The former Metropolitan Police commisioner Sir Ian Blair, who was ousted shortly after Boris Johnson became Mayor of London, becomes a crossbench peer.

There are a few slightly more controversial political appointments, such as Michael Spicer, who until stepping down at the election chaired the 1922 Committee, and Sue Nye, the gatekeeper Gordon Brown blamed for his "Bigotgate" run-in with Gillian Duffy during the campaign in Rochdale. Anna Healy, a former adviser to Harriet Harman and wife of Jon Cruddas, also becomes a Labour peer.

The unions have their customary representation, with Margaret Wheeler of Unison and John Monks of the European TUC making an appearance. Single-issue campaigners, too, are present, with Helen Newlove, a campaigner against drink-related violence, and Deborah Stedman-Scott, chief executive of the employment charity Tomorrow's People, both becoming Tory peers.

But the prizes for the wackiest appointments most defintely go to Benjamin and Shireen Ritchie, grass-roots Tory campaigner and stepmother of Guy Ritchie, who was once interviewed in the Daily Mail about her love life as part of an article on "passionate pensioners".

Caroline Crampton is web editor of the New Statesman.

Christopher Furlong/Getty Images
Show Hide image

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