Life as a civil servant, how to manage red boxes and lessons from NHS reform: Lunch with… Andrew Lansley
Baron Lansley reflects on life in government versus life as a civil servant, over a pot of Earl Grey with Suzannah Brecknell
Who? Andrew Lansley spent eight years in the civil service – including a stint as Norman Tebbit’s private secretary – before moving to the private sector and then becoming head of the Conservative Research Department in 1992. There, he not only met the young David Cameron and George Osborne but was credited with orchestrating John Major’s unexpected election success. He was MP for South Cambridgeshire from 1997 to 2015, serving as shadow health secretary, then health secretary and finally as leader of the House of Commons. He is now an active member of the House of Lords.
The venue: Portrait Restaurant: Nicer-than-average food with tip-top views down Whitehall, on the top floor of the National Portrait Gallery
The menu We shared an afternoon tea for one – with two pots of delicate Early Grey tea. The spread included traditional sandwiches and scones alongside a chocolate pot with salted caramel, upside down rhubarb cake, a mini lemon meringue pie and a canelé served with griottine and vanilla whipped cream.
His early interest in politics
At school the only prize I got was the civics prize, because that was the only one you could get simply by reading the newspapers every morning and remembering the stories. I also had a teacher called Geoffrey Thomas who taught us politics – this was in the mid-1970s, when politics was not commonly taught – and he inspired quite a lot of us. He retired in 1999 and came up to the House of Commons to have tea on the terrace. At the tea there was me, Howard Flight, Fabian Hamilton and Jack Straw so two Conservative MPs and two Labour MPs. He inspired people without biasing them. He didn’t give rise to any Liberal Democrats, which was clearly because he taught his politics extremely well… no disrespect to our Liberal Democrat friends. So I was always interested in politics, and I went to university, and I did student politics but not especially with one side or the other. I was elected president of the guild of students down at Exeter with the support of the Conservative Club, the Labour Club and the Liberal Club. Of course, this being the 1970s I won by 12 votes against the Trotskyites. That means I can say I haven’t actually lost an election, although at the time I’m not sure my campaign team were utterly confident – they got all the wine from the off licence for the celebration party on sale or return.
His proudest achievement as a civil servant
In late ’84 I was Norman Tebbit’s private secretary when he and [his wife] Margaret were injured in the Brighton bomb attack. Norman’s objective and Margaret Thatcher’s objective was that he would not relinquish control of the [trade] department so there was a special need for us [the private office] to act as his eyes and ears, to get everything right for him. We were about six weeks away from the BT privatisation and we made it all happen; it was a great success, especially the fact that Norman was not a bystander, he was an active participant. I remember at one point I was in Stoke Mandeville Hospital with him, he’d had a skin graft so he was in bed. We had a telephone with a line down to somewhere in the City where there must have been an enormous table with the civil servants, the investment bankers, the lawyers the stockbrokers, everyone. We were deciding what the share distribution should look like. It had been heavily oversubscribed and of course the City was pushing for limitations on the distribution for everyone, with a guaranteed distribution to their investment fund. Norman was absolutely clear that up to £200 the public subscription was going to be fully met. He said to me at one point: “Mute it.” So we put the phone on mute. I had my minute book with all the computations and numbers and he said: “Let’s have a look at that, let them stew for a bit…”. He always knew he was going to give a full distribution. He just wanted to make them sweat, and make it absolutely clear he was making the decision.
Why he left the civil service
During the 1987 election I thought to myself: “Could I really comfortably stay and do the same job for a Labour secretary of state? Actually, I can’t.” It wasn’t about being a Conservative. In ’87 it was all about: did one believe in the liberalisation of the British economy or not? Was one a free marketeer or not? That was the choice and I actually couldn’t do it, I couldn’t have reversed all this stuff in my mind. So I had to leave. Well I didn’t have to leave because Conservatives didn’t lose the election, but I thought “I’m no longer civil servant – if I feel that, I shouldn’t do it.”
Proudest achievement of his political career
The first was as director of the [Conservative] Research Department during the ’92 campaign, where they constantly told us we were going to lose, and we knew that, increasingly, we were likely to win. The point was to have, as is always the case in elections, the right strategy. If you have the right strategy firstly there’s little that [opponents] can do about it and secondly it delivers you not only strategic advantage but constant tactical opportunity. In terms of what I think in the long run will make the biggest difference from my time at [the Department of] Health, what I created that will – I know – persist, is the sense that the NHS, through NHS England and other bodies, should take the lead responsibility for its own organisation and delivery. We created more independence for the NHS. People can argue about the Health and Social Care Act, but there is a specific absurdity in people saying NHS England is trying to junk the Health and Social Care Act: no 2012 act, no NHS England, no independence. Whenever the NHS wanted to change things, do things differently – and innovation is absolutely critical for its success – it would get bogged down in a political argument. You can feel the desire of political parties still to try and get in there and micro-manage the NHS, but there is now a statutory firewall that makes it more difficult [to interfere].
What the passage of the act taught him about enacting change
The first thing is: no rational government should introduce a large scale health bill. I knew that, and I knew that it was not, in the narrow political sense, a wise thing to do. But, at the beginning of the coalition government, by virtue of the curious conjunction of the coalition and its majority, we suddenly had an opportunity to do something that was radical. That opportunity was not going to stay around. You can’t do [big change] at the end of a parliament. If I said it once, I said it 100 times to my ministerial colleagues: “We must make the changes that are needed in the first two and half years of this parliament so that the second half of the parliament we can make sure we get the investment in and do the things that are necessary to make sure that we deliver on the formal objectives.” That is how it worked out – in the end I think it was just short of three years for the transition, which is to the credit of the department: they had a timetable and they stuck to it; there was a budget and they bettered it. The savings from the change were subsequently measured at £5.5bn: £1.9bn costs, £6.6bn savings. I knew it was going to be tough for the same reason as Alan Milburn back in 2003. He had an appalling time with his bill: because every health bill imports every kind of political argument that can be manufactured. People said: “Well why don’t you do what Michael Gove did on education which is a bit of this and a little bit of that [rather than wholesale change]?” The answer is actually he did better politics but worse policy, because there are bits of the education system reforms which have never been done. There is no regime out there to deal with a failing school – all you’ve got is a top down system where the department has to step straight in. Is that the right system? We should be looking, in health and in education, for a more independent system which is accountable for results, with an independent, transparent regime to provide support and deal with failure.
Whether it was brave for a Tory minister to take on such a big reform of the NHS
Some would say foolhardy. I can remember Conservative predecessors [as health secretary] to whom I had spoken, whose entire approach to the health service was “I’ll try to avoid doing anything and I’ll keep a pot of money that I can use in the run up to the election to try to solve any problems.” In 2010 we didn’t have that luxury. I had no pot of money.
Yes, Minister moments
When Norman Tebbit left government in 1985, Leon Brittan arrived as secretary of state for trade and industry. I was his private secretary for a short while before I was seconded to the Cabinet Office to follow Norman. There was a discussion at that time about a levy on blank video tape. Leon Brittan as home secretary had written round in order to argue in favour of this levy; about two weeks later as private secretary I gave Leon Brittan, as trade secretary, a letter to sign disagreeing with himself. I assumed he would say that another minister in the team should sign it, but no – he signed it.
Changes he would make to our system of government
I think the dominance of the Treasury inside Whitehall is an unhealthy dominance. I don’t think it’s possible simply to construct a different relationship between the Treasury and government departments, because it’s founded on money. But, as a parliamentarian and especially as leader of the House of Commons, it became perfectly obvious to me that the process of scrutiny of public expenditure by the House of Commons is woefully inadequate. There’s some contemporary scrutiny by the National Audit Office and the Public Accounts Committee and obviously some retrospective scrutiny, but there is virtually no prospective scrutiny of the priorities and budget allocations. I think if parliament were to do that job much better it would mean government departments would have to justify what their priorities and forward programmes were and the relationship between resources and priorities. That would diminish the ability of the Treasury simply to play fast and loose with the money, which they do from year to year. In fact they do it in-year, and those in-year controls very often have the more pernicious effect on the the long-term outcomes.
“What I think will make the biggest difference from my time at health, what I know will persist is the sense that the NHS – through NHS England and other bodies – should take the lead responsibility for its own organisation and delivery. We created more independence for the NHS"
Managing red boxes
I’m a night owl – I find the business of trying to go to sleep with an unopened red box quite disturbing. Most of my time as secretary of state I didn’t stay in London anyway, I went back home, so generally I could work in the car so I had about an hour and quarter to make sure that I’d at least seen everything. Actually, Norman [Tebbit] had a lot more in his box – he had more issues at one time. I remember in the private office at the Department for Trade and Industry on one occasion we measured in a day how many issues came through the office and the answer was 50. In a day.
Decisions he would make differently now
There is a complicated set of issues that were associated with the process of trying to turn two parties’ policies into a coalition programme. I would say we reached a compromise which was all about creating a new structure which incorporated my desire for clinical commissioning, and the Liberal Democrats’ desire for local authority participation. We resisted successfully elections to NHS boards but we ended up with quite a complicated set of arrangements between these two organisations. Frankly, what we should have done is simply change the constitution of Primary Care Trusts so as to put clinicians on those boards and local authority representatives on them, and make them work together. It would have been simpler. I know why we ended up where we did, because it was trying to do the two things, and it all sort of happened in about a fortnight. There was incredibly little time to make that happen if we were going to get a bill in the first session. I would definitely go back and revise and revisit that and make it much simpler, although has that actually strengthened the local authority voice? It has. Are combined devolved authorities able to pick up this structure and work with it? Yes, they can. So if we had just left it as local authority nominations into a health service body... would it have felt like the local authority really had a handle on this? Who knows.
What had changed when he returned to Whitehall?
Judicial review: it consumed a lot of time and energy. It didn’t mean we couldn’t do things, but other departments clearly were often really stuck with how they could do things consistent with potential judicial review – that judge over your shoulder. Quite a big deal. The influence of NGOs inside Whitehall had grown dramatically compared to the 1980s. In the 1980s there were powerful interests – business, trade unions – but there wasn’t this further, even more influential set of pressure groups that tried to dictate to ministers all the time. In the civil service I would say the impact of the Freedom of Information Act was quite a big deal and I think it has undermined what might otherwise have been the frankness of advice. It’s not that officials were telling me something that they were writing for history, but it just made them very loath to write down even in emails all the considerations because they were constantly fearing that somebody would be reaching in to look at it straight away. Of course at the DH people did try to reach in, they tried to reach in to the risk register and if they had succeeded then there would have been no honesty in the risk register. There was also less of what I call strength in the depth of the civil service. Of course it has reduced in numbers. What that meant was not that there weren’t high quality civil servants, but the numbers of them were less and therefore the need to deploy them in priority areas was greater. Often it was only in your priority areas that you actually had the extent of policymaking expertise that you really needed and if something happened somewhere else you didn’t necessarily have it.
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