Budget 2013: Osborne does it best when he does nothing at all

“The last thing we need is more tinkering”.

Asked what he wanted from next week’s budget, one successful entrepreneur I spoke to this week replied “not much".

A couple of others in the same discussion agreed. None had a list of proposals at the ready. It wasn’t that they don’t care what Mr Osborne says (although all agreed their focus was more on their businesses), it’s more that they want him to do very little. It fits with the general theme I hear from business that the government’s role should be to create a positive growth environment and then get out of the way.

And with the national finances in a pickle, the entrepreneurs were unanimous that the boldest thing Mr Osborne could do was nothing.

“The last thing we need is more tinkering,” said one. Her point is one ICAEW made in its submission to George Osborne, in which it suggested that instability in tax policymaking undermines future confidence. Whatever the good intentions, the culture of constant change in the tax system ends up leading to complexity.

After last year’s omnishambles, Osborne might himself wish he could get away with doing nothing. But with forecasters pointing to a triple-dip recession, sitting on his hands isn’t a political option for Osborne any more than it’s an economic one.

Assuming he ignores calls (some from within the coalition) for a switch to a plan B, or a plan A+, and instead sticks rigidly to fiscal austerity, he will have very limited scope for manoeuvre. As a result, rather like the wizard in the Wizard of Oz, he’ll be using all the political trickery, smoke and mirrors he can to create the illusion of doing lots to help the country (and will be especially keen to be seen to help what he calls strivers and “the working poor”) without really being able to do a great deal.

The best outcome for business would be a Budget that really grasps the need to inject growth and confidence into the economy. As ICAEW explained in its Budget submission, this means putting in place the right mechanisms for getting finance to small businesses. This doesn’t mean another rebranding of the government’s lending scheme (which has already been re-launched on several occasions) but it does mean getting the proposed Business Bank up and running properly. It requires the funds already made available, whether through the Local Enterprise Partnerships or other mechanisms such as Funding for Lending to actually get to the frontline.

Accepting the limited scope for action open to the chancellor, combined with the need for a little political magic, (these occasions are often as much about pulling political rabbits out of the hat as they are sensible economics) there will doubtless be a whole raft of changes to various types of taxation.

Personal allowances will be raised, some commentators are expecting a tactical reduction in VAT (possibly for the hospitality sector), while others point to a continuing reduction in corporation tax (this one coming into force in 2014).

In the absence of much room for real action, it is fair to assume there will be a number of consultations announced into a whole host of potential schemes many of which will never amount to much, but which look good on the day.

There will be the usual media flurry listing winners and losers from the budget, all filtered through the current political lens of austerity and Labour’s constant jibe that the Tories are more concerned with helping the rich than the poor.

It’s hard to think that there would be more winners if Mr Osborne listened to the entrepreneurs and made next week’s the shortest Budget in history.

This article first appeared in economia.

Photograph: Getty Images

Richard Cree is the Editor of Economia.

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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