Labour must not turn its back on pluralism

Tribal differences have obstructed progressive change in the past. They must not do so again.

In one day last week we saw the UK Independence Party (UKIP) record its best ever by-election result, a Liberal Democrat Deputy Prime Minister speak against his own government to support Labour's leader (whose own party was chalking up solid by-election wins as Lib Dem support evaporated) while a panicky Tory vice chair called for a deal with UKIP. Let's be suspicious of instant punditry that tries to tell us 'what this all means'.  But, at the very least, it's safe to conclude that politics is not going to return 'to normal' anytime soon.

Normal, to my generation, meant an essentially two-party battle with those odd (Liberal) Lib Dems occasionally winning. A younger generation saw that disappear in Wales and Scotland years ago, and a three-party system became the norm in England. But that, too, is now crumbling. We may not know where the votes of the disaffected will go, but with each passing election, fewer and fewer are likely to return en masse to Labour, the Tories or the Lib Dems.

While that much is commonplace, too few people have asked what this means for progressive politics and for the chances of achieving progressive change. Labour instinctively believes that, even if politics is more volatile, it can become the default choice for progressive voters.

In the short-term, that may be true in parts of England where the Lib Dems attracted a part of the progressive vote. It no longer works in Scotland and Wales, though, and all the signs are that it's not a long-term bet for England either. Rather than Labour re-establishing itself as the sole party of choice for progressive voters, it's more likely that the progressive vote will be split as it has now been for decades.

In these circumstances, the chances of progressive change will depend on a political system and a political culture that enables the progressive views of voters to be reflected in the government of the day.  It requires a pluralist political culture, a willingness to cooperate with others in order to deliver values that are shared among the voters of different political parties.  A one nation Britain not only needs a one nation Labour Party capable of garnering support from many different voters in many different parts of the country, but an open approach to politics that builds alliances for progressive change.

The launch of Labour for Democracy on 4 December is an attempt to break down tribal sectarianism and promote a pluralist culture within the Labour movement. The focus is not on coalitions or cross-party deals, but on finding ways of delivering what progressive voters want. We've already shown that, in the main, past Lib Dem voters hold similar values to Labour's, and quite different to most Tory voters. It's also clear that, despite the failures of the coalition, the public still generally want politicians to work together when they can, rather than exaggerate their differences.

This isn't the easiest time to make the pluralist case. The Lib Dems' governmental and electoral performance is hardly encouraging, and has revealed a culture at times as sectarian as anything Labour has to offer. Meanwhile, Labour is doing well, and, of course, every party activist will work as hard as they can for every Labour vote. It is tempting to see pluralism as a sign of weakness, a lack of confidence; even an unwanted attempt to give Nick Clegg a permanent and undeserved place in government.

But we must be bigger than that. Tribal differences have obstructed progressive change in the past. Voter allegiances to the major parties are declining as fast as the icecaps are melting. There are even signs that the ‘progressive majority’ that split its vote in the 1980s is itself shrinking in the face of recession and insecurity.  If we want to change Britain in a progressive direction, Labour must show it is willing to work with, not just lead, everyone who will support all or part of that change.

Labour leader Ed Miliband was supported by Nick Clegg in calling for the implementation of the Leveson report. Photograph: Getty Images.

John Denham was a Labour MP from 1992 to 2015, and a Secretary of State 2007 to 2010. He is Director of the Centre for English Identity and Politics at Winchester University

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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