Hammond, Cable and May: the ministers who could resign over cuts

If Osborne refuses to give way in the Spending Review, cabinet ministers may choose to walk out.

When the coalition was formed in 2010, debate quickly began about who would be the first cabinet minister to resign over government policy, with the answer usually involving Vince Cable and spending cuts.

In the event, while there's been no shortage of resignations, not one has been over a point of principle. To refresh, David Laws resigned as chief secretary to the Treasury on 29 May 2010 after claiming expenses to pay rent to his partner, Liam Fox resigned as defence secretary on 14 October 2011 after  his lobbyist friend Adam Werritty was revealed to have joined him on official overseas trips, Chris Huhne resigned as energy and climate change secretary on 3 February 2012 after he was charged with perverting the course of justice by allowing Vicky Pryce to claim speeding points on his behalf, Andrew Mitchell resigned as chief whip on 19 October 2012 after allegedly calling the police "fucking plebs" and Tom Strathclyde resigned as leader of the House of Lords on 7 January 2013 to return to his business career.

But with government unity fraying over the Spending Review, it's worth asking whether we could soon see the first principled resignation. When George Osborne announced yesterday that seven departments had agreed "in principle" to cuts of up to 10 per cent, he simultaneously revealed those that had not, including Defence (Philip Hammond), the Home Office (Theresa May) and Business (Vince Cable). While Osborne now intends to revive the government's "star chamber" to coerce uncooperative ministers into accepting cuts, Hammond made it clear on the Today programme this morning that he was prepared to do battle with the Treasury: 

We should be very clear that there is a difference between efficiency savings, which may be difficult to achieve but are painless in terms of the impact on the front line, and output cuts, which are of a very different order and require proper and mature consideration across government about the impact that they will have on our military capabilities.

Should Osborne nevertheless demand more than mere "efficiency savings", it is no longer unthinkable that the hitherto loyal Hammond could walk out. After his recent interventions over welfare spending (cut it, rather than defence), the EU (he would vote to leave were a referendum held today) and gay marriage (wrong and a waste of government time), speculation has been growing among Tory MPs that Hammond could quit and set himself up as the leader of the traditionalist right. While Hammond's allies dismissed the suggestion as "ridiculous", the possibility of such a resignation increases as the election draws closer. If it looks as if the Tories will lose, the temptation for ministers to quit and position themselves for the leadership election to come could prove irresistible.

Another minister to watch, as ever, is Vince Cable, who has been lobbying hard for his department to be protected on economic grounds and has warned that "further significant cuts will do enormous damage to the things that really do matter like science, skills, innovation and universities" (he even suggested at one point that the Spending Review be abandoned) . If Osborne refuses to give way, Cable could well choose this moment to use his "nuclear option". 

Finally, there's Theresa May, who argued at the weekend that the budget of the counter-terrorism police should be fully protected, as it was in the 2010 Spending Review. She said:

I'm absolutely clear that we need to ensure that the intelligence services and, indeed, in policing CT (counter-terrorism policing)  … in the last spending review we ensured that CT policing was not treated the same as overall policing and I see every reason to take that same view in the next spending review.

Osborne said yesterday that he was "not going to do anything which is going to endanger the security of this country at home or abroad" but David Cameron's spokesman later refused to confirm that this amounted to a guarantee that the anti-terror budget would be shielded from cuts. Should this area fail to escape Osborne's axe, May, who, like Hammond, has been positioning herself for the post-Cameron era, could also choose to walk. 

Vince Cable has warned that "further significant cuts" to skills, science and universities would do "enormous damage". Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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The surprising truth about ingrowing toenails (and other medical myths)

Medicine is littered with myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery.

From time to time, I remove patients’ ingrowing toenails. This is done to help – the condition can be intractably painful – but it would be barbaric were it not for anaesthesia. A toe or finger can be rendered completely numb by a ring block – local anaesthetic injected either side of the base of the digit, knocking out the nerves that supply sensation.

The local anaesthetic I use for most surgical procedures is ready-mixed with adrenalin, which constricts the arteries and thereby reduces bleeding in the surgical field, but ever since medical school I’ve had it drummed into me that using adrenalin is a complete no-no when it comes to ring blocks. The adrenalin cuts off the blood supply to the end of the digit (so the story goes), resulting in tissue death and gangrene.

So, before performing any ring block, my practice nurse and I go through an elaborate double-check procedure to ensure that the injection I’m about to use is “plain” local anaesthetic with no adrenalin. This same ritual is observed in hospitals and doctors’ surgeries around the world.

So, imagine my surprise to learn recently that this is a myth. The idea dates back at least a century, to when doctors frequently found digits turning gangrenous after ring blocks. The obvious conclusion – that artery-constricting adrenalin was responsible – dictates practice to this day. In recent years, however, the dogma has been questioned. The effect of adrenalin is partial and short-lived; could it really be causing such catastrophic outcomes?

Retrospective studies of digital gangrene after ring block identified that adrenalin was actually used in less than half of the cases. Rather, other factors, including the drastic measures employed to try to prevent infection in the pre-antibiotic era, seem likely to have been the culprits. Emboldened by these findings, surgeons in America undertook cautious trials to investigate using adrenalin in ring blocks. They found that it caused no tissue damage, and made surgery technically easier.

Those trials date back 15 years yet they’ve only just filtered through, which illustrates how long it takes for new thinking to become disseminated. So far, a few doctors, mainly those in the field of plastic surgery, have changed their practice, but most of us continue to eschew adrenalin.

Medicine is littered with such myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery. Until the mid-1970s, breast cancer was routinely treated with radical mastectomy, a disfiguring operation that removed huge quantities of tissue, in the belief that this produced the greatest chance of cure. These days, we know that conservative surgery is at least as effective, and causes far less psychological trauma. Seizures can happen in young children with feverish illnesses, so for decades we placed great emphasis on keeping the patient’s temperature down. We now know that controlling fever makes no difference: the fits are caused by other chemicals released during an infection.

Myths arise when something appears to make sense according to the best understanding we have at the time. In all cases, practice has run far ahead of objective, repeatable science. It is only years after a myth has taken hold that scientific evaluation shows us to have charged off down a blind alley.

Myths are powerful and hard to uproot, even once the science is established. I operated on a toenail just the other week and still baulked at using adrenalin – partly my own superstition, and partly to save my practice nurse from a heart attack. What would it have been like as a pioneering surgeon in the 1970s, treating breast cancer with a simple lumpectomy while most of your colleagues believed you were being reckless with your patients’ future health? Decades of dire warnings create a hefty weight to overturn.

Only once a good proportion of the medical herd has changed course do most of us feel confident to follow suit. 

This article first appeared in the 20 April 2017 issue of the New Statesman, May's gamble

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