Labour's pro-Europeans are wilting away

At the top of the party there are no real evangelicals for Europe any more.

There was a time in Labour circles when to be pro-European was regarded as A Good Thing. Actually, it was more than that. Being pro-European was something that those ambitious, clever, upwardly mobile people in the party were proud to call themselves. It was a sign of both moderation and modernisation. Not any more it seems.

Pure naked opportunism mostly explains last night’s decision to side with Tory ultras in calls to cut Britain’s EU budget contribution. Europe is a fantastic inter-party wedge issue for dividing the coalition, but it's catnip for stoking intra-party tension among Conservatives. On the specific issue of curbing the budget, it also, helpfully, gives Labour something concrete to say about cuts.

But this creeping euroscepticism in Labour’s ranks is also partly informed by experience in office. The enduring, lofty ideal of Europe is tempered by seeing the often sclerotic decision-making and undeniable waste up close. As shadow foreign secretary Douglas Alexander declared this morning: "Europe must learn to do better with less and that is why we voted for a real terms cut." The party’s once self-confident and numerous pro-Europeans are quiescent these days. Lions in winter, with neither grassroots support or much interest coming from the leadership.

The trade unions, once hostile towards the EC for being a "capitalist club", changed their tune in the late 1980s when the commission stated getting interested in social policy and workplace rights and proved instrumental in warming Labour’s attitude to Europe. But that was then. Now, the unions are narrowly focused on holding what they have amid domestic spending cuts. Europe can whistle.

At the top of the party there are no real evangelicals for Europe any more. Ed Balls is famously the architect of the five economic tests, wielded as a crucifix to repel any prospect of Britain joining the euro. Policy review head Jon Cruddas has called for an immediate referendum on EU withdrawal, while Ed Miliband didn’t mention the EU once in his recent party conference speech.

Instinctive pro-Europeans in the party like Denis MacShane now seem like curiosities from another age. Especially when compared to former comrades-in-arms like Gisela Stuart, who now believes Britain should actually quit the EU. There is also, perhaps, a generational shift occurring in the party, away from a post-war class which instinctively saw the European project as a force for good in the world and a bulwark against further conflict, and towards younger Labour politicians who take a far more pragmatic view of Europe.

Part of the EU problem is that it has always been a strategic geo-political partnership, not a popular movement. As former SDLP leader John Hume once put it, the EU is the longest-running peace process in the world. But it is not enough for diplomats, bureaucrats and the Westminster cognoscenti to "get" Europe when so many of the public do not. Europe has always failed to find a popular message and populist messengers. After last night, that challenge is now even harder.

"Ed Miliband didn’t mention the EU once in his recent party conference speech". Photograph: Getty Images.

Kevin Meagher is associate editor of Labour Uncut.

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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