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Coalition? This is a Tory government

Lib Dems have little say in a cabinet weighted in the Conservative Party's favour.

Those of us who write about politics have been struggling with our terminology since Britain's first coalition government in 65 years was formed in May. Is it a Con-Lib coalition, a Lib-Con coalition or, in the words of the Daily Mirror, a Con-Dem coalition? As the dust settles on a tumultuous political year and the coalition prepares to enter its ninth month in office, I propose a rather simple solution. Call it a Conservative government - for that is what it has proved to be.

The recent debacle over higher education funding, in which only eight Lib Dem backbenchers voted with the coalition to increase tuition fees, is just the latest evidence suggesting that the party of Prime Minister - or should that be "President"? - David Cameron is calling the shots in this government.

Consider the personnel. Of the 29 coalition ministers who attend cabinet, five are Liberal Democrats. That might initially have seemed like a fair and proportionate allocation of jobs, given that more than five times as many Conservative MPs (307) were elected to the Commons as Liberal Democrats (57). But the distribution of portfolios and responsibilities inside the cabinet suggests that the Lib Dems secured ministerial salaries and chauffeurs at the expense of influence over key policy areas.

The three great offices of state - HM Treasury, the Home Office and the Foreign and Commonwealth Office - are held by Conservatives. So, too, is the Ministry of Defence.

Little voice

How can the little-known Lib Dem Michael Moore at the Scotland Office or George Osborne's red-headed, red-faced bag carrier at the Treasury, Danny Alexander, be expected to compete with Theresa May or Liam Fox? Lib Dem ministers have been conspicuously denied control of the big-spending departments.

Chris Huhne, a former candidate for the Lib Dem leadership, is in charge of the Department of Energy and Climate Change (DECC), one of the smallest ministries in government. In contrast, the former Conservative Party leader Iain Duncan Smith was airlifted from the back benches and parachuted into the Department for Work and Pensions, as Secretary of State, where he administers the biggest budget in Whitehall. Health and education are in the control of the Tories Andrew Lansley and Michael Gove, who have, respectively, embarked on a massive restructuring of the NHS and the schools system, both at breakneck speeds. Where, I wonder, is the Lib Dem influence over free schools or GP commissioning?

Consider, too, the range of core Conservative policies that the Liberal Democrats in government have had to accept. Much was made of Cameron's "big, open and comprehensive offer" to the Liberal Democrats on 7 May, the day after the general election; less comment passes on the "red lines" that the Tory leader imposed from the start around non-negotiable issues such as spending cuts, the immigration cap, the renewal of Trident and European integration.

Where were Nick Clegg's red or, for that matter, yellow lines? To abandon a pledge to scrap tuition fees is one thing; to vote for a trebling of those fees is quite another. Lib Dem ministers claim to have won concessions from their Conservative coalition partners but, on closer inspection, these tend to be exaggerated.

Was swapping one tax cut (inheritance tax) for another (raising the threshold to £10,000) the Tory equivalent of the Lib Dems' dropping of their historic support for PR or their iconic opposition to student fees? It is often forgotten that the Tories backed the idea of a pupil premium in their manifesto.

And the coalition's liberal approach to law and order has come from the Conservative Justice Secretary, Kenneth Clarke, and the Tory prisons minister Crispin Blunt rather than Lib Dems.

Meanwhile, Vince Cable, as Business Secretary, had to push through higher tuition fees in early December; Huhne, the once-vocal opponent of nuclear power, has unveiled plans for the next generation of nuclear power plants in his role as Energy Secretary; and Clegg, in charge of constitutional reform, has secured a promise from the Tories only for a referendum on the Alternative Vote (AV) - which he had described as a "miserable little compromise" as recently as April of this year - rather than the Lib Dem holy grail of proportional representation.

Can anyone point me in the direction of a Conservative cabinet minister who has had to push through a policy or proposal to which he or she had been personally, vocally and ideologically against in opposition?

There might be more humiliation to come for the Lib Dems. In the new year, a Home Office review of counterterrorism laws is likely to back the retention of control orders, which impose severe restrictions on terror suspects who have not been charged, posing serious difficulties for the junior partners in this coalition. Clegg has described the orders as a "fundamental" breach of human rights; Huhne has said that they undermine British "values". Will their views trump those of Theresa May, who is said to be in favour?

Common ground

Consider the view of Lib Dem voters. A recent poll of 2,000 people who voted for the Liberal Democrats in the general election, conducted by the former Tory deputy chairman, Lord Ashcroft, revealed that just 54 per cent would back the Lib Dems again in 2015 and that 44 per cent of them say that their view of Clegg's party has "got worse" since 6 May.

On the same day the polling was published - 11 December - Richard Grayson, former director of policy for the Liberal Democrats, described his party's leadership as "exceptionally close to the Conservative leadership" while noting: "Most Liberal Democrat members realise that we have more in common with members of the Labour Party and the Greens than we do with our own leadership."

And consider the history. Conservative-Liberal coalitions in Britain tend to end up being dominated by the Tories. As the constitutional historian Vernon Bogdanor wrote on these pages in May: "The Liberal Unionists of 1886 and Liberal Nationals of 1931 were swallowed whole by the Conservatives, while the independent Liberals left the Conservative-dominated national government after just one year in 1932, in protest at an imperial tariff." Why should it be different this time around?

If it isn't, the Liberal Democrats could be finished for good. l

Mehdi Hasan is a contributing writer for the New Statesman and the co-author of Ed: The Milibands and the Making of a Labour Leader. He was the New Statesman's senior editor (politics) from 2009-12.

This article first appeared in the 20 December 2010 issue of the New Statesman, Christmas 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