Careless communication costs lives

When I first started this blog, I mentioned that I sometimes notice examples of poor communication that aren't just annoying but actively dangerous. Here's an interesting example: a relative of mine was recently given a course of radiotherapy, and was given the timetable I've inserted below.

The last appointment, for some reason, is in black text on a dark purple background that could be quite hard to read and perhaps mistaken for a border and so missed altogether. My relative pointed this out to the nurse, who mentioned that several other people had indeed missed their final radiotherapy sessions (and so, presumably, received an incomplete or delayed dose) as a result of it.

I think we can forgive the initial mistake, but not the failure to fix it once its consequences became clear. The fact that the nurse did nothing to make it more readable makes this report all the more believable. It seems the NHS has some serious problems with communication; unlike with HMRC and other public bodies, the risks are not just to people's time and patience but to their health and lives.

'Poor communication' is very often a political euphemism for a controversial policy poorly implemented, as the NHS recently found with the Liverpool Care Pathway. Here, the ideal scenario would be a sensitive two-way consultation on a complex set of difficult decisions. If this consultation was an intrinsic part of the policy, then the policy failed, even if everything else about the policy was designed and implemented correctly.

Reading those stories, I was reminded of Charles Clarke's claim after the last general election that Labour lost because they'd failed to communicate their message well enough. It apparently hadn't occurred to him that — with the millions spent on press officers, special advisers and widespread advertising — the message had been communicated perfectly well, and that perhaps the real problem was a set of unappealing policies dreamt up by unappealing politicians. (Before I'm accused of any bias, it's worth pointing out that all other parties also lost the last general election, and no doubt for similar reasons but while deploying similar excuses.)

In the case of the LCP, relatives felt the NHS Trusts had failed to consult them properly; in my relative's case, the NHS was similarly inconsiderate in its communications with patients. In each case we can see the potential for slapdash communication — nothing more than the classic failure to fully consider the needs of the person at the receiving end — to cause serious suffering at crucial moments.

I once joked to a paediatrician friend that "if you make a mistake at work children die, but if I make a mistake at work the comma's in the wrong place". I must admit that I hadn't really considered the possibility of children dying because of doctors' inability to put the comma in the right place.

We are all liberals now

With the unsurprising re-election of President Obama, and with voters across the United States endorsing gay marriage and cannabis, we've heard a lot in the last week about the triumph of liberalism. What better time, then, to rid ourselves of an increasingly useless part of the political lexicon?

To a British politics 'n' history graduate like me, the word 'liberal' will always evoke John Stuart Mill's belief that "the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others". It also brings to mind the classical liberalism of political economy that began with Adam Smith and continued through Hayek and Friedman: the mantle that today would be claimed by libertarians.

At first, then, the L-word¹ meant 'being left alone by the government', as economic liberalism still does in Britain, or as neoliberalism now does around the world. Annoyingly, in many other cases it's often unclear whether it still means that or its opposite. We all like to consider ourselves liberal towards oppressive governments, but have very differing opinions on whether a particular government policy helps freedom (by freeing people from poverty, as the liberal left see it) or hinders it (by interfering in people's business, as the liberal right see it).

The waters got muddier after 1906, as Lloyd George's Liberal government introduced pensions and ramped up taxes on the wealth creators/parasites rich. Ever since then, it's been tricky to work out whether British Liberals and their successor parties are really on the left or the right — whether they want fairness or laissez-faireness — a fudge that recently helped get them back into government, but immediately became a problem again once they got there.

In the United States, 'liberal' is today almost entirely synonymous with 'left-wing'; when someone like Norman Mailer describes himself as a 'left conservative', we might take that to mean a Blue Labour-esque position that is conservative on social issues but left-leaning on the economy. I see no contradiction in that, but it strikes us as unusual because 'liberal' is now so often used to mean both left-wing (economically) and tolerant, permissive, etc (socially).

This also leaves us with the problem of why 'conservative' has become synonymous with right-leaning on the economy, particularly when conserving things is often the last thing on radical rightwing minds. I suppose this politico-linguistic problem really took off when the non-left, in Western countries, abandoned the Keynesian economic consensus in the 1970s.

In Australia, meanwhile, the Liberal Party is the equivalent of the US's Republicans (though they generally oppose a republic) or Britain's Conservatives (who are these days pretty liberal). They might be truest to the low church, small state origins of the idea, but we're left with a word that can mean its complete opposite, depending on the country, the context and no doubt the company.

Should we instead use 'progressive' to describe left-liberals, as many of them do? I would suggest not: any political idea to which no-one could reasonably object (in this case, 'progress') is not an idea at all. Similarly, the left in America seem to take offence at being accused (or take offence on Obama's behalf when he is accused) of 'socialism', a term many in Britain and Europe are still happy to use to describe their own set of beliefs. Might 'social democrat' (now a bit out of fashion in Britain) be less offensive, or does that suggest something more Mailer-ish; too much about responsibilities and not enough about rights? Would 'liberaltarian' be the most honest candidate, or is it just too much of a mouthful?

I suggest we seek guidance from the model offered by the excellent Political Compass, refining right and left economically into whether they are socially liberal or conservative (though even they use the rather loaded term 'authoritarian'; illiberalism and authoritarianism aren't quite the same thing, and there are plenty of constitutional conservatives who would pass as civil libertarians). The top left and bottom right of the compass have always seemed to me the most logical positions — either you accept government interference or social norms to constrain your behaviour or you don't — but that's for another post.

The point is that we have to use these terms with care, and should be quick to ditch them once they become interchangeable. Clarity in our political language might then become our best weapon against the lack of clarity in our political thinking.

^{1. [I've capped the L because so many sans serif fonts show a lower case l as indistinguishable from an upper case I: another serious failure of communications if you ask me.]↩}

Period drama

As our American cousins go to the polls, readers of this blog need not fear that important issues like full stops and exclamation marks have been overlooked in the campaign.

And yet, the best communicators are like field marshals, attending to the broad sweep of rhetorical strategy as well as the details of syntax and orthography. Obama was praised for just such 'soaring oratory' in 2008, though inevitably there's been less sign of that this time.

In the end, the result will probably come down to which candidate has done a better job of framing the language used to describe his policies, record and background — and surely no-one can seriously think that leaves us with Mitt '1%' Romney.