Gove’s full English, Kate’s body and Boris as prime minister

Michael Gove, announcing the abolition of GCSEs and the introduction of his full English Baccalaureate, requiring “success” in English, maths, sciences, a language and history or geography, claimed “a clear break from the past”. Well, sort of. In 1918, a coalition government of Liberals and Conservatives introduced the School Certificate, which required marks of at least 40 per cent in five academic subjects, of which three had to be English, maths and French. It was abolished after the Second World War because, as Cyril Norwood, the chair of a wartime committee on education, put it: “You cannot cramp secondary education in all its living variety into the strait waistcoat of any rigid scheme.”

The point of the GCSE was flexibility: in the subjects pupils could take, the syllabuses they could follow, the levels they could aim to reach, the way they were assessed, the timing of exams. The idea was to give as many children as possible a chance to shine and a sense of achievement and not leave their futures wholly dependent on a succession of three-hour memory tests during hay fever season.

Gove has swept all that away for another strait waistcoat. The special status given to the EBacc subjects will marginalise art, music, drama, computing, design and technology. The licensing of a single exam board to set papers for each subject will give the Education Secretary yet more power over the curriculum. Gove intends that all exams will be of the end-of-course variety (though he promises “flexibility” for practical subjects); that using “aids” such as calculators and periodic tables in exams will be “restricted wherever possible”; and that a significant number of candidates will be unequivocally told they have failed.

He denies that the new exams will be norm referenced – so that each grade is awarded to a fixed percentage of candidates – but he doesn’t like annual rises in success rates. As an example of “dumbing down” at GCSE, he quotes how candidates now get higher grades than those of similar ability (measured at 11) did in the past. Though this could be evidence of easier exams, it could equally signify better teaching.

Reporting in 1943, Norwood recommended a wide choice of single-subject certificates (which became O-levels and then GCSEs) but only as a transition to abolishing externally marked exams and allowing schools to assess pupils internally. Sometimes, history doesn’t repeat itself. It just never gets anywhere.

Sweeping changes

Gove is not just abolishing GCSEs but turning most secondary schools (and many primaries) into privately run academies. Iain Duncan Smith is sweeping away a variety of benefits for his universal credit. Andrew Lansley’s plan for the National Health Service survives for now. The coalition, which has a weaker mandate than any government in nearly 40 years, has embarked on transformative changes to each of the three main pillars of the welfare state.

As none of these will be complete by 2015, Labour could halt the lot, return to the status quo ante and promise to make these services work a little better, rather than turning them upside down. I suspect that this anti-reform platform would win handsomely. Labour could then concentrate on what really does need transformative, whole-system change but never gets it: taxation.

On the offensive

Can anybody be serious about Boris Johnson becoming PM? Isn’t this a silly-season story that has hung around too long? Leave aside adultery, cannabis smoking, dismissal from the Times for inventing a quote and dismissal from the Tory shadow cabinet for lying to Michael Howard, then party leader. Johnson has also offended Muslims, gay people, black Africans (“watermelon smiles” and “flag-waving piccaninnies”), the Irish, inhabitants of Papua New Guinea (“orgies of cannibalism and chief-killing”), Liverpudlians and the city of Portsmouth (“too full of drugs, obesity, underachievement”). Is it  possible to offend so many and win a general election? I’m not sure even Silvio Berlusconi had such a chequered past when he took office. It was called il sorpasso when Italy’s economy became (briefly) bigger than Britain’s in 1987. If Boris makes it to Downing Street, we shall have our il sorpassomoment, beating the Italians in making foolish choices for high office.

Deal or no deal

Kate Middleton chose to marry into royalty. She gets a job for life, with servants, free housing, free meals and unlimited travel. She faces dismissal only if she falls out with her husband. In return, she gives up her privacy. Her body (albeit usually clothed) is the subject of endless scrutiny and speculation, particularly about activity in the womb, and so is her sister’s (also usually clothed). That is the deal. So why does she expect an exclusion clause for topless sunbathing in, of all places, France, where people routinely strip off on public beaches and, indeed, micturate on railway platforms?

Talk about Kevin

Expect Kevin Pietersen, left out of England’s glamorous cricket tour to India, to be recalled for England’s 14 matches against the unglamorous New Zealand in the new year, on condition that, to manage his workload, he misses the glamorous and lucrative Indian Premier League. Justice, as his enemies (including many of his England team-mates) see it, will then be done. Whether Pietersen can survive the sniggering in the dressing room is another matter.


Peter Wilby was editor of the Independent on Sunday from 1995 to 1996 and of the New Statesman from 1998 to 2005. He writes the weekly First Thoughts column for the NS.

This article first appeared in the 24 September 2012 issue of the New Statesman, Lib Dem special

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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