Cameron pulled in all directions on Europe

Ed Miliband accuses Cameron of leading the UK to the EU "exit" as David Davis demands two referendums.

Ken Clarke is one of the few prominent Conservative politicians still prepared to make the case for EU integration and he did it with gusto on the Today programme this morning. It was "complete folly" to put our membership at risk, he said, lamenting that the country had gone into "a nervous breakdown" over the subject. He dismissed the 53 Tory MPs who voted for a real-terms cut in the EU budget as "extreme Eurosceptics" and revealed that David Cameron had assured him that he was committed to continued British membership of the union.

"David Cameron assures the public, he’s always assured me, that he believes, as I do, that Britain’s place in the modern world has got to be in the EU.

It would be a disaster for our influence in global political events; it would be a disaster for the British economy, if we were to leave the EU. It damages our influence in these great critical events of the moment if we keep casting doubt on our continued membership."

Cameron, meanwhile, is being pulled in all directions on Europe today. In a speech at the CBI's annual conference, (which will also hear addresses from Cameron, Vince Cable and Boris Johnson), Ed Miliband will accuse him of allowing Britain to "sleepwalk towards exit" in a "betrayal of our national interest."

The Labour leader will say:

For more than three decades, our membership of the EU has seemed to be a settled question. Not any more.

Public scepticism about the EU has been on the rise for some time. Some cabinet ministers in this government now openly say we would be better off outside the EU.

And many of our traditional allies in Europe clearly think Britain is heading to the exit door. Those of us, like me, who passionately believe that Britain is stronger in the EU cannot be silent in a situation like this. I will not allow our country to sleepwalk towards exit because it would be a betrayal of our national interest.

He will add that were the UK to leave the EU, it would be "the United States, China, the EU in the negotiating room - and Britain in the overflow room. We would end up competing on low wages and low skills: an offshore low-value economy, a race to the bottom".

At the same time, Cameron's former leadership rival David Davis will use a speech at St Stephen's Club to call for the PM to offer not one but two referendums on Europe. The first would be a vote on what powers the government should seek to repatriate from Brussels, the second, to be held following the conclusion of negotiations, would be a vote on whether to remain in the EU.

Cameron is still expected to use a speech before Christmas to outline plans to hold a referendum after the next election on a "new EU settlement" for Britain, but Davis and other Tory MPs are growing increasingly impatient. As Davis said on the Andrew Marr Show yesterday: "Nobody believes it and why should they? The British public have been promised a referendum by the three major parties, and every single one has not delivered. Now, they may have their reasons, but they haven’t delivered and so the public feel they’ve been lied to – they won’t believe any more promises on referenda actually."

Elsewhere, the ever-helpful Boris Johnson uses his Telegraph column to warn Cameron that nothing less than a veto of the EU budget will do. He writes:

It is time for David Cameron to put on that pineapple-coloured wig and powder blue suit, whirl his handbag round his head and bring it crashing to the table with the words no, non, nein, neen, nee, ne, ei and ochi, until they get the message.

Yet a veto, by compelling the EU to set annual budgets through qualified majority voting, would almost certainly lead to a large increase in the UK contribution. If Cameron wants to make a eurosceptic gesture, it could prove a costly one.

David Cameron is expected to announce details of an EU referendum in a speech before the end of the year. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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All doctors kill people – and the threat of prosecution is bad for everyone

We must recognise the reality of medical practice: just because a doctor makes a mistake, that doesn’t mean they’ve all broken the law. 

On 15 November the Court of Appeal quashed the 2013 conviction for gross negligence manslaughter (GNM) of a senior consultant surgeon in London, David Sellu. Sellu, who had completed his prison term by the time the appeal was heard, will never get back the 15 months of his life that he spent in jail. Nor will the personal and family trauma, or the damage to his reputation and livelihood, ever properly heal. After decades of exemplary practice – in the course of the investigation numerous colleagues testified to his unflappable expertise – Sellu has said that he has lost the heart ever to operate again.

All doctors kill people. Say we make 40 important decisions about patients in a working day: that’s roughly 10,000 per annum. No one is perfect, and medical dilemmas are frequently complex, but even if we are proved right 99 per cent of the time, that still leaves 100 choices every year where, with the benefit of hindsight, we were wrong.

Suppose 99 per cent of those have no negative consequences. That’s still one disaster every 12 months. And even if most of those don’t result in a fatal outcome, over the course of a career a few patients are – very regrettably – going to die as a result of our practice. Almost invariably, these fatalities occur under the care of highly skilled and experienced professionals, working in good faith to the very best of their abilities.

If one of these cases should come before a crown court, the jury needs meticulous direction from the trial judge on the legal threshold for a criminal act: in essence, if a doctor was clearly aware of, and recklessly indifferent to, the risk of death. Sellu’s conviction was quashed because the appeal court found that the judge in his trial had singularly failed to give the jury these directions. The judiciary make mistakes, too.

Prosecutions of health-care professionals for alleged GNM are increasing markedly. The Royal College of Surgeons of England identified ten cases in 2015 alone. This must reflect social trends – the so-called “blame culture”, in which we have come to believe that when a tragedy occurs, someone must be held responsible. In every one of these cases, of course, an individual’s life has been lost and a family left distraught; but there is a deepening sense in which society at large, and the police and Crown Prosecution Service (CPS), in particular, appear to be disconnected from the realities of medical practice.

Malpractice investigation and prosecution are horrendous ordeals for any individual. The cumulative impact on the wider health-care environment is equally serious. In a recent survey of doctors, 85 per cent of respondents admitted that they were less likely to be candid about mistakes, given the increasing involvement of the criminal law.

This is worrying, because the best way to avoid errors in future is by open discussion with the aim of learning from what has gone wrong. And all too often, severely adverse events point less to deficiencies on the part of individuals, and more to problems with systems. At Sellu’s hospital, emergency anaesthetic cover had to be arranged ad hoc, and this contributed to delays in potentially life-saving surgery. The tragic death of his patient highlighted this; management reacted by putting a formal rota system in place.

Doctors have long accepted the burden of civil litigation, and so insure themselves to cover claims for compensation. We are regulated by the General Medical Council, which has powers to protect patients from substandard practice, including striking off poorly performing doctors. The criminal law should remain an exceptional recourse.

We urgently need a thorough review of the legal grounds for a charge of GNM, with unambiguous directions to the police, CPS and judges, before the spectre of imprisonment becomes entrenched for those whose only concern is to provide good care for their patients. As Ken Woodburn, a consultant vascular surgeon in Cornwall who was accused and acquitted of GNM in 2001, has said: “You’re only ever one error away from a manslaughter prosecution.”

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage