Revealed: why the deficit actually rose today

Strip out all special factors and total borrowing was £400m higher in 2012-13 than in the previous year.

The boast that the deficit "is falling" and "will continue to fall each and every year" has been crucial to George Osborne's political strategy, so what do the final set of figures for 2012-13 show? At first sight, it appears as if the Chancellor's luck has held. Excluding the transfer of the Royal Mail pension plan and the cash from the Bank of England's Asset Purchase Facility, public sector net borrowing was £120.6bn last year, £300m lower than in 2011-12. It's worth noting that this includes the one-off windfall of £2.4bn from the 4G auction (without which the deficit would be £2.1bn higher) and that borrowing was originally forecast to be £89bn, but Osborne's boast still holds.

Or does it? Strip out all special factors (including the reclassification of Northern Rock Asset Management and Bradford & Bingley as central government bodies) and total borrowing actually rose in 2012-13. As p. 7 of the ONS release states, "on this measure Public Sector Borrowing (PSNB ex) for the year to date is £0.4billion higher than for the same period last year." These figures are of almost no economic significance. Whether borrowing marginally rose or marginally fell makes little difference to the parlous state of the British economy. But they are of immense political significance, which is why Osborne went to such extraordinary lengths to ensure the headline figures would show a fall. As I noted following the Budget, the Treasury forced government departments to underspend by a remarkable £10.9bn in the final months of this year and delayed payments to some international institutions such as the UN and the World Bank. Noting that the £10.9bn was around double the average underspend of the previous five years, IFS head Paul Johnson said:

There is every indication that the numbers have been carefully managed with a close eye on the headline borrowing figures for this year. It is unlikely that this has led either to an economically optimal allocation of spending across years or to a good use of time by officials and ministers.

That Osborne is forced to resort to ever more creative accounting is evidence of how badly off track his deficit reduction plan is. The government is currently forecast to borrow £245bn more than expected in 2010, a figure that means, as Labour's Chris Leslie noted today, that it will take "400 years to balance the books". To all of this, of course, Osborne's reply is "but you would borrow even more!" Finding a succinct response to that claim remains one of the greatest challenges facing Ed Balls and Ed Miliband. 

George Osborne leaves number 11 Downing Street in central London on March 19, 2013. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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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