The European Court of Human Rights. Photo: Mathieu Nivelles/Flickr
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David Cameron versus the human rights court: a populist hit

The Tories are preparing to take on the European Court of Human Rights, in what could be their most significant populist hit before the next election.

It began with cabinet departures. Former Attorney General Dominic Grieve and veteran Conservative frontbencher Ken Clarke left the government during this week’s reshuffle. It has been described as the cull of the Tory left – but more specifically with these exits, the PM has evicted two influential, weighty figures at the cabinet table who supported Britain’s EU membership, and it being signed up to the European Convention on Human Rights.

Now he’s rid of the euro-moderates, David Cameron seems to have cleared his way to all-out war on a European institution to which Britain is signed up aside from the EU: the European Convention on Human Rights. The BBC is reporting this morning that his party is drawing up plans for a new law designed to limit the power of the European Court of Human Rights and to make parliament the ultimate legal arbiter over human rights matters.

Clarke and Grieve were sceptical about tampering with Britain’s relationship with the human rights court. Clarke called Theresa May’s conference speech in 2011 – in which she claimed a Bolivian man was allowed to stay in the UK because of his cat ­– “laughable and child-like”. He said yesterday on the Today programme that it was “unthinkable” for us to leave the European Convention on Human Rights, labelling it the “bedrock” of the rule of law, individual liberty and justice for all. Grieve also was dubious about Cameron’s plans, reportedly (from the BBC’s Nick Robinson this morning) warning his colleagues that the plan, and its alternative – a British Bill of Rights – would be a “legal car-crash”, albeit one “with a built-in time delay”.

But senior ministers who have retained their positions, such as Home Secretary Theresa May and the Justice Secretary Chris Grayling, have long been critical of the human rights court, battling with the court on a number of cases including prisoners’ right to vote, deporting terrorist suspects, and deporting foreign criminals and racists. The right to a family life, ruled by the judges in Strasbourg, is often the stumbling block for such cases.

A group of Conservative lawyers recently presented the PM with proposals for new legislation that would assert parliament’s power over the power of the human rights court’s judges. Their plan is not to leave altogether, but to be able to disregard the court’s rulings. A sort of cherry-picking that Grieve, while he was still in his job, warned would create a “degree of anarchy”.

It’s clear why this is an attractive plan for Cameron. As the Guardian points out, it will allow him to hit immigration, crime and the tyranny of Europe all in one go – and if he can deploy more individual stories, like May’s cat anecdote (although it was inaccurate), he can use his plan to capture the imagination of an electorate already primed with horror stories about immigration.

However, though it may be a populist policy, it could ultimately do little for parliament’s so-called “sovereignty”. I interviewed the criminal lawyer Michael Mansfield QC last summer, and he pointed out that recent high-profile cases, such as that of attempting to deport radical cleric Abu Qatada, would be just as difficult without the European Convention.

He told me:

English Common Law, on which the Convention was based, actually itself embraces the same rights. For example, there would have been the same difficulty with Abu Qatada without the European Convention; it has everything to do with English law itself saying to the government ‘we are not happy that any process has the risk of being tainted by tortured evidence’. It’s an English principle. We’re not dealing here with trivial rights, we’re dealing with fundamental situations. Is there an English right to life that is different to everybody else’s?

Anoosh Chakelian is deputy web editor at 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