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Kenneth Baker’s history lesson

The former Conservative Education Secretary is sceptical about Michael Gove's free schools.

No modern education secretary casts a longer shadow than Kenneth Baker. It is to Baker that we owe the National Curriculum, Sats, school league tables, delegated budgets and university student loans. His grant-maintained schools were abolished by Labour in 1998 only to be resurrected as “trust schools”, while his city technology colleges were relaunched as academies. Now, at 78, an age when most former cabinet ministers have retired to their country houses, Baker is out to transform English education again.

“In a funny way, it doesn’t take all that long to change education,” he tells me when I meet him at his office at 4 Millbank, a short walk from the Houses of Parliament. “Take Tony Crosland – there was no legislation to introduce comprehensive schools. He issued a directive; he issued a fiat!” In his new book, 14-18: a New Vision for Secondary Education, Baker argues that pupils should begin secondary school at 14 (“Eleven is too soon to change and 16 too late”) and that they should be able to choose between four types: the usual academic, technical (Baker has overseen the opening of five university technical colleges, with 12 to follow this year and 15 the next), career-based and creative or sports.

It is an approach markedly at odds with that of Michael Gove, who often appears entirely preoccupied with the first of these four. “I like Michael – he’s a friend – but I’m in favour of doing something different, obviously,” he says.

Baker describes the Education Secretary’s English Baccalaureate, which will replace GCSEs from 2015, as “a throwback”, comparing it to the School Certificate he sat as a 16-year-old in 1951. “I was in the last year that took it, because it simply wasn’t broad enough for most children. Only 7 per cent of young people went on to post-16 education. I was part of a privileged elite. The EBacc is a throwback to that.”

When I ask him whether he favours Labour’s proposed Technical Baccalaureate, he swiftly interjects, “That came from me!” Flashing the famous Baker grin (“I have seen the future and it smirks,” the journalist John Cole once wrote of him), he tells me that the party adopted the “TechBacc” after the Baker Dearing Educational Trust, which he founded and of which the Labour peer Andrew Adonis is a trustee, put forward its own plan.

Baker argues that the 317 technical schools that existed in 1946, which he is seeking to re-create in the form of university technical colleges (UTCs), were “closed by snobbery”.

“Everyone wanted their children to go to the school on the hill, the grammar school, not the one down in the town with the shabby premises.”

Is Gove guilty of similar bias? “He had a tough education. He came through it and did very well. And there’s always a feeling: ‘If I did it, others should do it.’” While praising the Education Secretary’s support for UTCs, he is troubled by his refusal to introduce a TechBacc for 16-year-olds. “The government approves of a TechBacc at 18 but not at 16, which is double Dutch, really, because if you have a TechBacc at 18, you’ve got to have some technical subjects that your students are required to take at 16.”      

Baker is sceptical of Gove’s free schools, remarking that the “jury’s out” until exams have been sat, and dismissive of those on the right who argue that their success depends on allowing them to make a profit. “I don’t think allowing them to be run for profit would necessarily change very much, quite frankly. I really don’t think it would.” Of the Education Secretary’s predilection for grass-roots involvement, he says sardonically, “Well, the private sector, on the whole, has got the attitude to parents correct: parents are only allowed to approach the school with a chequebook in their hands.”

One might expect Baker – as the man who introduced student loans in 1990, marking the end of fully state-funded university education – to favour the decision to raise the cap on tuition fees to £9,000 but he tells me that it was “all too sudden”.

“There was a case for an increase but, by doing it so quickly, they’ve guaranteed that applications will fall for years to come.”

My time is almost up and, after briefly discussing the political woes of his former PA David Cameron (he praises Cameron as “smart” and “quite brilliant”), Baker recalls an anecdote the Prime Minister once told him about a preelection visit to see Angela Merkel. “He told her he might have to form a coalition and asked her what it was like. She replied: ‘The little party always gets smashed!’” He laughs, flashes the Baker grin again and, on that note, we part.

George Eaton is political editor of the New Statesman.

This article first appeared in the 28 January 2013 issue of the New Statesman, After Chavez

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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