The Obama polling that inspired Labour's cost of living offensive

While Romney led on managing the economy and reducing the deficit, Obama led on living standards. Labour believes the latter is the key to victory in 2015.

Before Ed Miliband announced his plan to freeze energy prices for 20 months from May 2015, he and his aides knew that it would "be big". They had long been struck by polling showing that rising gas and electricity bills were voters’ primary concern, ranked above wages, employment and housing. But even they have been surprised by the extent to which the policy has defined political debate since the conference season. Three weeks on from Miliband’s speech, the Labour leader's team believe it has had even more impact than George Osborne’s 2007 pledge to raise the inheritance tax threshold to £1m, with "huge cut through to the public" in the words of one aide. (A poll published yesterday showed that voters rate it above all the other policies announced by the parties during the conference season.) To their satisfaction, the Tories have struggled to settle on a consistent line of attack, unsure whether to dismiss it as a "gimmick" or as dangerously "left-wing", or to match it in some form.

The policy was devised by Greg Beales (jokingly named "Mr Freeze" by his colleagues), Miliband’s director of strategy and planning, who had long urged the party to shift its focus away from the macroeconomy and towards living standards. It was a reorientation inspired by Barack Obama’s 2012 election campaign. In meetings with the Labour team in London and Washington DC, Obama aides including his pollster Joel Benenson emphasised how important the president’s stance on living standards had been to victory in tough times. A report on the election by the veteran Democrat Stan Greenberg for Miliband pointed to polls showing that while Mitt Romney had led on "handling the economy"(51-44%) and "reducing the federal budget deficit" (51-37%), Obama had led on understanding "the economic problems ordinary people in this country are having" (51-43%) and on "looking out for the middle class" (51-40%).

This left-right split is mirrored in the UK, where a recent ComRes poll found that voters think the Conservatives (42%) are more likely than Labour (33%) to maintain economic growth and keep public spending under control (47-28%), but also that they believe their own family would be better off under Labour (41-31%).

Labour is confident this trend will favour it in 2015. As the economy enters a post-crisis phase, the party believes voters will become less concerned with macro issues and more concerned with whether their family is sharing in the proceeds of growth.

After missing their original target of eliminating the structural deficit in one parliament, the Tories have sought to turn economic failure into political success by emulating Obama’s 2012 campaign message and urging voters to let them "finish the job". But they have failed to recognise that Obama was referring not to government borrowing but to living standards. As for the warning "not to give the keys to the guys who crashed the car in the first place" – similarly inspired by the US president – a Labour aide pointed out to me that Obama "actually ran on that line in the 2010 midterms and it was a disaster".

The Tories have derided Miliband’s focus on the "cost of living" as a distraction from the primary task of "fixing" the economy, but this message is ill suited to a time when 11 million people have had no increase in their real earnings since 2003. Aware of this, the Tories are preparing a barrage of cost-of-living measures for the Autumn Statement but, more than at any other point since 2010, they will be forced to fight on enemy territory. 

Barack Obama waves to supporters after his victory speech at McCormick Place on election night November 6, 2012 in Chicago, Illinois. 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