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Give us someone to care about

We need a BBC Director General who is popular, like David Dimbleby or Melvyn Bragg.

What happens to the BBC after the humiliating departure of George Entwistle? There need to be two kinds of change. First, structural reforms in BBC management and its news and current affairs. Second, two appointments at the top. If these are done sensibly the BBC will ride out this crisis. There are much bigger challenges ahead for the BBC: problems of identity, financial survival and audience share. But first what is to be done in the here and now?

BBC management needs to be thinned out. Licence-fee payers have watched aghast as the full byzantine weirdness of the BBC, especially its news and current affairs sections, has been exposed, with all its jargon and its legions of middle management. The BBC website listing “senior staff biographies” includes a Director of BBC People; Controller of Production, News; Head of Strategy, FM&T; Chief Operating Officer, News Group; Controller, Strategy, News and Audio & Music; General Manager, News and Knowledge; and we are still on D-F. Who knew the Swiss navy had so many admirals?

When the editor of Newsnight, Peter Rippon, “stepped aside”, he was replaced by Liz Gibbons, who as acting editor was answerable to Adrian Van Klaveren, controller of Radio 5 Live, who reported to Peter Johnston, director of BBC Northern Ireland. Ken MacQuarrie’s report on “the McAlpine Newsnight” said a big problem was the ambiguity around who was taking ultimate editorial responsibility for the programme. This is nonsense. When I worked on The Late Show, a daily arts slot, in the early 1990s, if the editor and two executive producers had been “recused”, there were at least half a dozen experienced senior producers who could have run the programme.

Shooting stars

Second, the news and current affairs department needs an overhaul. For years everyone said it was the jewel in the BBC’s crown. As a result, middle management has grown and has been given loads of soft commissions that no one watches or cares about.

How many BBC news or current affairs programmes have you watched recently? Around a superb core of programming (Today, The World at One, PM, the Ten O’Clock News, the News Channel, Question Time, Andrew Neil’s Daily Politics, occasionally Newsnight) has grown a weedinfested garden of uninteresting, sometimes surprisingly flawed documentaries and cheap studio shows. This needs to be cut back hard, saving money.

Next, the roles of director general and editor-in-chief should be split. The BBC has 6,000 journalists on radio and TV and online. At the same time, someone must prepare for the 2016 charter renewal and the debate about financing the BBC while overseeing the rest of the BBC empire.

Who should be the new editor-in-chief? There are two outstanding candidates: Tim Gardam, a former director of programmes at Channel 4, and Mark Damazer, a former controller of Radio 4. Both know the BBC inside out. Both are supersmart. Lord Patten’s first phone calls should be to them.

Who should be director general? Not Tim Davie. He is a bizarre choice, still remembered for bungling “Sachsgate”, when Jonathan Ross and Russell Brand got into trouble on his watch and he failed to handle it. He’s already been given the runaround by Mark Easton and Dermot Murnaghan.

The last shortlist for the post now looks ridiculous: Entwistle (“resigned”), Helen Boaden (“stepped aside”), Caroline Thomson (left), Ed Richards (policy wonk). It is worth noting how many of the rising stars at the BBC who emerged in the 1980s or 1990s have left: Michael Jackson and Mark Thompson to America, Roly Keating to run the British Library, Peter Fincham and John Whiston to ITV, Gardam and Damazer to Oxford.

The immediate task is twofold: 1) restore internal morale and 2) more importantly, restore the faith of licence-fee payers. This will not be achieved by some anonymous figure from corporate management. What is needed is a popular figure. Top of my list would be David Dimbleby, who gave a barnstorming performance on Monday’s Today programme. He has applied for the DG’s job once and the chairman’s job twice. I would sound out Melvyn Bragg, John Tusa and Michael Grade.

Any of these would be popular with audiences and staff. All those self-important MPs would back off. The lack of equivalent women of that generation says a great deal about the sexism in TV in the 1960s and 1970s. Of the younger generation, however, there’s been much talk of Marjorie Scardino, though (surprisingly) not of Jana Bennett and Janice Hadlow.

While this person restores morale, experienced executives would prepare for the charter renewal negotiations and the new editor-in-chief would sort out news and current affairs and the BBC’s byzantine management. It is a long time since the corporation was run by anyone we care about.

It’s time for a change.

David Herman is a former BBC television producer

This article first appeared in the 19 November 2012 issue of the New Statesman, The plot against the BBC

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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