Exclusive: Jon Cruddas endorses David Miliband

“There’s a pluralism I detect in David that I hadn’t witnessed before.”

In this week's New Statesman, Jon Cruddas, the influential left-of-centre MP for Dagenham, and someone many on the left hoped would run for the Labour leadership, tells me why he is endorsing David Miliband.

Long before this year's general election, David Miliband and Cruddas were engaged in what their supporters described as "back-channel talks" over what would happen when Labour lost power -- as both knew the party would -- and Gordon Brown was forced to resign. Neither man was a supporter of Brown and each longed to remake the Labour Party as something bolder, more pluralistic and collegiate.

Many on the left of the party were urging Cruddas, who stood for the deputy leadership in 2007, supported by the powerful Unite union, to stand for the leadership as well. "There are circumstances in which Jon could run and win the leadership," his friend Neal Lawson, chair of the Compass group, told me back in February.

"I'm endorsing David," Cruddas says now, "because of a couple of contributions he has made -- one was the column on Englishness he wrote in your magazine [in our 5 July issue]. Another was his Keir Hardie Memorial Lecture [on 9 July]. What was interesting to me about this was when he started talking about belonging and neighbourliness and community, more communitarian politics, which is where I think Labour has to go.

"He's the only one [of the leadership contenders] that has got into some of that. He's tackling some of more profound questions that need to be addressed head-on. What is the nature of the reckoning? We should not just be running from the record but having a nuanced approach to some of the things that went wrong, as well as defending the things that went right."

In a column in last week's New Statesman, Maurice Glasman, an academic who has worked with the increasingly influential London Citizens movement for the past decade, warned of how, through the rhetoric of the "big society", as well as their desire to redistribute power from the overweening state to the citizen, the Conservatives had seized Labour's language and history by "stressing mutual responsibility, commitment to place and neighbours and the centrality of relationships to a meaningful life, and by laying claim to the mutuals, co-operatives and local societies that built the labour movements". This is language that Keir Hardie himself would have understood.

"The nature of the reckoning"

"I very much echo where Maurice is on some of this," Cruddas says now. "What is interesting is that David more than anyone has attempted to listen and respond to some of those ideas. At times, he stumbles a bit because this is a major shift in orientation for Labour -- or a reorientation back to what Labour was, pre-dating the new left-liberalism."

Cruddas continues: "David is not just going down a checklist of policies; he seems to me to be echoing a more fundamental sentiment, in terms of what Labour needs to do. I'm much more interested in that, rather than in just reciting some policy options, because the scale of the defeat was so great. It's a much more fundamental question of identity that we need to return to.

"I disagree with him on a lot of policy but I think, in terms of the nature of the leadership that's needed, he's beginning to touch on some of those more profound questions that need to be addressed head-on. What is the nature of the reckoning? We should not just be running from the record but having a nuanced approach to some of the things that went wrong, as well as defending the things that went right."

David Miliband is moving towards a new pluralism. It is slow-paced and tentative, but it is sincere: all part of an attempt to remake himself, unburdened by office and free from having to speak in a language of power that he no longer wished to articulate -- the language of New Labour in its terminal phase.

"There's a pluralism I detect in him that I hadn't witnessed before," agrees Cruddas. "We see it around issues of party reform, devolution and local government, and around the question of national identities within Labour -- are we heading towards a federal form of Labour, for instance? And, actually, he's not just attacking the Liberals, as some of the others have."

Cruddas warns that it's a grave mistake for Labour to attack and disparage the Liberal Democrats. "David is not just attacking the Liberals, as some of the others have been."

This could be taken as a reference to his brother Ed Miliband's comments in our last issue, in which he said he would not work with Nick Clegg, and his subsequent attacks on the Liberal Democrat leadership during an address in Scotland, in which he spoke of eliminating the Lib Dems as a political force.

"I think it's definitely a mistake to attack the Liberals," Cruddas says. "We should have a much more subtle approach to this, because what we're seeing is the first major political realignment following the economic crisis.

"The question is: what is the equivalent centre-left response to this moment of rupture?

"Attacking the Liberals is wrong. There's a danger of us spraying too much lead across the forecourt and not really thinking about how we need to regroup. We need to have respect for and show courtesy towards different traditions as part of an overall, plural realignment across the centre and the left -- that's what's going to be needed. Arguably, the era of majoritarian [sic] victories by single parties is at an end."

Read the interview in tomorrow's magazine.

Jason Cowley is editor of the New Statesman. He has been the editor of Granta, a senior editor at the Observer and a staff writer at the Times.

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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