Why Labour has not "surrendered" on public spending

Contrary to what conservatives suggest, Balls hasn't capitulated to Osborne. He supports stimulus now and investment after 2015.

Daniel Finkelstein is the latest fiscal conservative to hail Labour's apparent Damascene conversion to austerity. In today's Times he writes of Ed Balls's alleged "intellectual surrender", "the argument he once boldly made, that deficits don’t matter, has gone". 

Balls's speech last week was a significant moment. Not only did he reaffirm that Labour would have to keep most or all of the coalition's spending cuts, he stated that it would have to make its own (and suggested some too). But Finkelstein is wrong to present this as an epoch-defining capitulation to compare with 1976. 

To begin with, Balls's support for stimulus now remains unwavering. Under the political cover of the IMF, he called for the coalition to bring forward capital spending increases from 2015, "financed by a temporary rise in borrowing", in order to promote growth. Contrary to what Finkelstein suggests (recalling Jim Callaghan's famous words), he still believes that you can "spend your way out of recession". More borrowing, more spending remains the Keynesian remedy  prescribed by Balls. The consistent error of the right has been to equate support for stimulus with support for a larger state. As Balls has always acknowledged, a stimulus is, by definition, temporary. In the words of his hero Keynes, "The boom, not the slump, is the right time for austerity at the Treasury." The true intellectual surrender would be for Labour to endorse Osborne's strategy of piling cuts on cuts, a path it has rightly rejected. 

But Finkelstein also overstates the extent to which Labour has committed itself to austerity after 2015. For Balls, Osborne's spending limits are a "starting point", not a blueprint. With growth of just 1.1 per cent since 2010 (compared to 2.9 per cent in Germany and 4.9 per cent in the US), he has adopted the prudent stance of preparing for the worst. But should growth surprise on the upside, he will be able to raise the baseline.

Nothing in Balls's speech precluded the possibility of Labour spending significantly more once a genuine recovery is underway. After all, the surge in expenditure under the last government (an average annual increase of 3.4 per cent) only came after Gordon Brown had stuck to the Tories' "eye-wateringly tight" spending limits. In the case of capital spending, Balls has already hinted that Labour will pledge to invest more than Osborne. As he said, "And for the future, we need to invest in the homes, transport and infrastructure Britain needs and ensure a recovery made by the many. Of course, here too we will only set our plans for investing in Britain’s future in the light of the economic circumstances at the time, and the needs of economic growth". 

Last week was not an "intellectual surrender"; it was an attempt to give Labour the political cover to be radical. 

George Osborne and Ed Balls attend the State Opening of Parliament on 8 May, 2013 in London. 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