Gove's ultra-partisan style is a sign of things to come

Tory MPs see the Education Secretary's politicisation of his department as a case study in how to beat the Whitehall system.

It is usually a safe bet that any political story with Twitter in the opening paragraph is of marginal consequence to the overwhelming majority of British people, including those who use Twitter. It follows that a blog post, considering the political implications of such a story is of even more … let’s call it niche interest. Yet for those of us who are professionally obliged to get up and inside the workings of Westminster like a journalistic colonoscopy there is something pathologically fascinating about the row between the Observer newspaper and Michael Gove’s staff.

One side of the story is contained in yesterday’s Observer front page splash. The essence is that Gove minions have been using the @ToryEducation Twitter account as a device to launch personal attacks on journalists and generally wreak digital mischief in a way that has attracted internal censure and flagrantly ignores the code of conduct for ministerial special advisors.

The rebuttal from the Department for Education seems to amount, in essence, to a call from Dominic Cummings, one of Gove’s most trusted and loyal lieutenants, for the Observer to grow up, get over it and move on.

Depending what prejudice you bring to the party, this could be a shocking, bang-to-rights breach of protocol revealing a department out of control, raising serious questions of judgement, competence and morality; or it is a case of a desperate newspaper puffing up a bit of Westminster gossip to pursue a tribal vendetta. (The ill-feeling between the Observer’s political team and the Gove operation goes back a while, starting when the newspaper waged a vigorous and partly successful campaign against cuts to school sport funding in the coalition’s first year.)

Labour has joined the fray, calling for an inquiry into Gove’s advisors in relation to the Observer story and other vindictive briefings (the anonymous mauling of ex-minister Tim Loughton in the Spectator recently raised a few eyebrows as a particularly spiteful bit of briefing). But for the most part, Westminster players are hardly taking sides, preferring to watch the duel from the sidelines in bemusement.

There is, however, little doubt in Westminster that the Department for Education, under Gove’s leadership, has become a law unto itself. I have heard advisors boasting of their complete independence from Downing Street. The Education Secretary has surrounded himself with senior staff – both as special advisors and civil service appointments – who are loyal to him personally and committed to his urgent political agenda of liberating (as they would see it) as many schools as possible from local authority control as quickly as possible.

When Gove first became Education Secretary he and his immediate entourage saw the Department as hostile terrain, captured by the vested interests of the educational establishment and peopled with closet Labour sympathisers. That feeling was reinforced by leaks and briefings that felt like acts of deliberate sabotage. But Gove is a powerful and shrewd political operator. He has, in effect, broken resistance inside the DfE and created a parallel machine for delivering his policy agenda. There is more than a whiff of Bolshevism to the Gove style of politics. He is conducting a schools revolution and feels he cannot be held back by reactionary civil servants or weak-minded, pushover junior ministers or, for that matter, journalists who don't get it. The ends, in his view and the view of his inner circle, justify the means. With that culture of raw expediency, it is hardly surprising that the odd Twitter excursion gets a bit, er, political.

One point of wider significance in all of this: Gove is generally considered to be one of the more effective ministers in the government. Other Tories complain about their plans being foiled, occasionally by Liberal Democrats, but more usually by civil servants. The sense that Downing Street lacks a coherent agenda and cannot drive bold change through the sclerotic, risk-averse, Whitehall machine is the topic of frequent Conservative lament. At times the situation has been described as a Cold War between ministers and civil servants. Of the many reform programmes promised at the start of the parliament, Gove's is the biggest and most advanced.

In that context, Gove is seen as a conquering general on the side of political action against the forces of bureaucratic suffocation. His model of reformist Bolshevism is seen by some MPs, especially in the new 2010 Tory intake, as the only viable model for actually getting things done in power; far better than queasy, mealy-mouthed surrender to the principle of a non-partisan operation. Gove, say his cheerleaders, has politicised the department – and rightly so since it has worked. The reconfiguration of the whole schools system and curriculum might not otherwise be happening, certainly not at the current, hyperactive pace.

The spat with the Observer will blow over. But MPs and aspiring ministers will for some time to come be studying the example of how one Secretary of State built himself a mini-empire in a corner of Whitehall and deployed it in ruthless pursuit of his own personal revolution.

Michael Gove speaks at last year's Conservative conference in Birmingham. Photograph: Getty Images.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

Christopher Furlong/Getty Images
Show Hide image

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