This article is from the April issue of Total Politics

He’s the most prominent of the small group of Lib Dem MPs who desperately tried to kill off the NHS bill. I went to speak to the Cornish MP with the most south-westerly constituency in the country to discover what it feels like to rebel regularly against his own party, why he is concerned about a focus on Lords reform in the next Queen’s Speech, and whether he would feel comfortable in a coalition with Labour.

BD: Do you think your constituency being so far away from London – St Ives and the Isles of Scilly − influences you to be a particularly independent MP?
AG: I don’t know if it’s the geography, but I was born and brought up in my constituency. My family go back millions of years [laughs]. We were, sort of, smugglers and ne’er-do-wells down on the Lizard. And I don’t know whether there’s something genetic, but we’ve never been part of the establishment. My beloved (but no-longer) nearby neighbour, Julia Goldsworthy, is probably one of the most obedient, loyal MPs. Like me, she was born and brought up in the same area, and now she’s working in the government. I went to state school, she went to public school, I come from a very poor background, and so on… so that might make it different.

On a national level, you’re best known for your opposition to the NHS reform. What does it feel like, voting against your own government’s legislation?
It’s hard, because I'm as much – if not more – enthusiastic about the concept of coalitions as anyone else. I find tribalism in politics tiresome. The Punch and Judy, the opposition for opposition’s sake. Politics is seen through the prism of the Westminster Village, where often it becomes a political virility contest, rather than about the merits of a policy argument.

I really want the coalition to succeed, on the basis that, although the Tories are my mortal enemies locally, we still need to be grown-ups and come together. If that’s what the arithmetic of the last general election gave us. We need to say, let’s go ahead, be mature and do it. But the other great thing about this coalition – and I hope future coalitions will learn from this – is that we don't all have to become obsequiously loyal about everything. The great strength is the opportunity for the country as a whole to engage in, and try to influence, the parliamentary debate, and for Parliament to become more powerful − not necessarily just in the debating chamber, but also in the legislative body, making the decisions about whether the government’s programme is acceptable or not. That means, particularly, that those MPs sitting on the government benches need to demonstrate that they are engaged in the ideas of the policy.

Which lobby I’ll be in is something they can’t predict. I’ve got myself and my balance of judgment − I don’t call it 'conscience', because then I’m implying they don’t have a conscience – but I make my own mind up on these issues, the best I possibly can. And I reach measured conclusions. It's good and healthy for any government to have a range of views on its benches, and for those views to be expressed.

When you threaten to derail a piece of legislation, and vote with Labour, Conservative MPs, who are your coalition partners, view that as being tribal against their health secretary.
Labour is voting with me – I don’t really care who’s in the lobby with me. I don’t choose the people who vote in a particular direction, but I know which way I’m going to vote. I voted against the Health and Social Care Bill at the third reading, which is the most totemic and significant of events. If the bill had fallen by one vote, and I was that person, would I really feel that was the right thing to do? Or was I just emotionally driven because I was disappointed with the minister’s response on that day? Or did I want it to play for a particular audience? I genuinely wanted the bill to fall. Although the Lords have made the bill less bad in some ways, it’s still not good enough. Although the pause last year made it less bad in some ways, in others it made it worse. At the end of that process, it was still disruptive and destructive to the NHS.

It was taking our eye off the ball, trying to get the £20m efficiency gain, and a missed opportunity to try and deliver real, local decision-making, rather than just handing it to this group of clinicians. There’s a whole range of things really wrong about the bill, and I still want it to fall, but not because I want Labour to win. I hate the fact that Ed Miliband is on a bandwagon with this issue. If it falls, it shouldn’t be seen as a victory for him, it should be a victory for the NHS. And it shouldn’t be a defeat for the government, just a victory for the NHS and for those who care about it.

You’ve talked about the pause last year making the bill worse. But was that a Lib Dem request?
Yes it was. We’d fought hard for it. When I said the pause made it worse, I said “in some ways”. There are rarefied areas of policy to do with the balance of private versus public sector roles and the autonomy of foundation trusts and clinical commissioning groups. GPs benefit from the NHS, but they’re also private practitioners and they have an interest – increasingly over time, thanks to the Labour government – in delivering services for which they’ll earn a commission. That was never properly recognised. We moved away from actually trying to deal with it, but we’re back to it now, latterly and incompetently.

There are other issues, around how foundation hospitals are going to be taking private work. From my studies in this area, the risk isn’t what proportion of a foundation trust’s work might be private, it’s how that private work interrelates with public work. In other words, will they actually drive patients into the arms of the private side of their business? Under the cloak of foundation practice itself, you want to have further safeguards in place to stop that kind of thing happening. And that’s not there. I’m just highlighting a couple of areas that have not been part of the debate, to give you an indication of the other issues I’ve raised in the select committee. No one takes a blind bit of notice, but they are still issues that need to be addressed.

So, in an ideal scenario where the bill gets dropped, what kind of NHS reform do you want to see? Any?
The coalition agreement was spot-on. You start with the institutional infrastructure of the NHS that currently exists, and then graft in your GPs, other clinicians, clinician representatives – but a much wider base – and then your patient and local authority-elected representatives forming the shared agenda on the strategy of health in an area. So, in all the boundaries where you had to have coterminosity with social care, you won’t have to explode everything, sack people and then reappoint them expensively.

Instead, you can use the institutional infrastructure. Get rid of all those government placed-people who come through the primary care trust process of government appointment systems, and then start building an NHS from a local area that's much smaller, more practical, much more strategic and integrated with social care. That’s what was in the coalition agreement. But we destroyed that, and it was insane.

I don’t dislike Andrew Lansley – I’ve got a tremendous amount of admiration for him. I question his judgement, not his commitment or sincerity. He’s done it with the best of intentions.

What damage do you fear the Health and Social Care Bill, if passed, will cause to the Lib Dems as a party?
It’s only from people like me, from our benches, who have said we’re not happy with this, that the message is getting across and resonating with people. I’m not saying it’s going to build us up as party, that people will have more faith in us, but providing there are people like me speaking up for the party’s values, and for the party’s membership, then that resonance is out there. People know; in my own area, they see this as ‘Tory legislation’, and the local MP is fighting hard to protect against it − that’s the narrative locally.

As far as damage to the party is concerned, it’s done us a tremendous amount of good. Nick Clegg trying to achieve further concessions on this bill is the right kind of narrative. It’s clearly not going far enough, but Clegg isn’t my poodle. He’s the leader of the party, he’s the deputy PM, and works within greater constraints than I do. I have relative freedom. I’ve no political ambitions. If someone hooks me out and says, “Andrew, we want you to become deputy prime minister”, I’m not going to turn them down, but I’m not going round brown-nosing. That’s not my style. I’m concerned about policy, and so I alienate the people I'd have to impress to chin my way up any 'greasy poles'. The greasy pole lies beside me, and I’m not interested in it.

It’s interesting what you say about Lib Dem involvement with the bill, trying to improve it, as a good thing. You’re still voting against the bill. Would it not just be better if your leader said: “I’ve seen that with the arguments we’ve had, the bill is irrecoverable and we should drop it”?
He can’t do that. He’s under different constraints. Where the government is now is partly the failure of our political system. Because of Ed Miliband’s initiative to make this a totemic issue, it’s become a political virility contest. So Cameron or Lansley killing the bill – doing something else dramatic with it at this stage – is therefore less likely. The media would portray it as ‘climb-down humiliation’ or ‘Lansley has to go’.
There’s no dignified route for withdrawal. I wish it hadn’t been cranked up − I haven’t done it. I haven’t called big meetings to try to make any dramatic gestures. I’ve asked questions at PMQs, but if I can’t make headway going through that back door I’ve got to go through the front. But I’m not angry with the government, I just think they’re wrong – I hope that comes across.

Has this damaged the relationship with your party leadership or colleagues?
Not as far as I’m concerned. If they're concerned, they haven’t told me. I’ve also voted against the government on the Welfare Reform Bill. All the way through I’ve been independent-minded, and proud of it. We go through this regular ritual of reminding ourselves that disloyalty doesn’t impress anyone, that it makes the party look split and weak. These are the mantras that are always trotted out to dissuade us from being independent-minded. But the less self-reliant we are, the more our identity is submerged.

You have to depend completely on the initiatives and photo-calls of our illustrious leaders and ministers. But that won’t do for the party. If we continue to use every opportunity to express its values, in a manner that's not wholly belligerent, it's good for the party's health.

Do the Lib Dems need to distance themselves more from the Conservatives?
There is a convention that not only should there be shared cabinet responsibility, but that also everyone goes out, irrespective of how they feel about things, picks up the brief and repeats the mantra. You’re fed the lines. You’ve got “These are the points to make” and “These are the attack-lines for the opposition”. The opportunity of the coalition should, I think, be about how to demonstrate how a political debate and disagreements can be resolved in government and openly.

The most effective policy is to reconcile opposites in the goldfish bowl, with everyone watching, in a mature manner. It reassures the country and also engages them. If they think that everything is up for grabs, that the views of everybody actually matter, then people engage. They take an interest, and things matter to them. The coalition should be used to engage the country in the political process, instead of shutting it out. ‘The cabinet’s decided, nobody else can have any say.’ But they come out with this polished mantra, use their thick skins and silver tongues, and that’s it, end of story.

Would you like to see Lib Dem cabinet ministers taking collective responsibility less seriously and stating what matters to the Lib Dems?
That’s always the tension, isn’t it? Even in a one-party government. If ministers say: “I’ll support the government, but actually this is where I want to go”, people will respect that. Politics has become risk-averse; we’re under such pressure all the time. We have to play these yes/no, black/white word games, and with a syllable out of place, people jump on you: “Does that mean you’re disagreeing with…? You need to explain yourself.”  
We should be saying: “Yeah… but, we’ll talk about it. When we come to that conclusion, I’ll vote for it, but first let's have that debate.” Why do it behind closed doors? Let everyone engage with it. I don’t see a problem – people need to chill out. Unfortunately, today's media will just throw petrol on the flames if there’s a little ember of disagreement, to turn it into a raging fire… I don’t have a permanent downer on the media. Just occasionally.

Are you completely signed up to the government’s economic strategy? Are you nervous about lack of economic growth?
I’m a natural Keynesian: in order to stimulate growth, you need to spend – alongside having responsible cuts. We need to do more in that area, and to identify the future winners, and try to accelerate their success. I also don’t think we’re doing enough on affordable housing. We’re pretending to ourselves that this new homes bonus is going to help, but it won't. The good thing about expanding affordable housing is that – I don’t want to say ‘killing two birds with one stone’, but you’re helping two birds with one hand-up.

Why are you a Lib Dem MP rather than an independent?
Social justice, devolution, the environment – in all those areas the party leads the way. Speaking up for the silent voices. There is no other party that can possible do all of those things. Yeah, it’s a shopping basket of policies at the end of the day, not everyone agrees with them all. But I’ve got quite a chilled out view – which is not terribly good for my career – about what constitutes the way forward. And people have a less chilled out view. The whips, for example, are paid to have a less chilled out view about relaxing one’s commitment to absolutely unblemished loyalty.

The Lib Dems are not polling well at the moment. Are you fearful for the 2015 election?
We went into the coalition with our eyes open and we knew that it was a make-or-break moment for the party. The alternatives would have been a break, anyway. It was the right thing to do, because that’s what we believe in. I’m realistic about the future. We will pull things around. As we come to a general election, people will recognise that we aren’t just poodles to the Tories, that we have restrained what would otherwise have been a lurch to the right with a Tory government.

We’ve achieved a number of outcomes ourselves, and, even though I say it myself, there are those who've made sure that the debate on the different value between the parties is in the public domain, rather than hidden away. The distinctiveness of the Lib Dems from the Tories will be understood and conveyed to people out there. Clegg is performing extremely well. I admire his perpetual affability; he’s incredibly silver-tongued. His values are right, too. He comes from a very different background to me, and therefore tends to be interested in more conceptual human rights and constitutional change issues, which don’t resonate on the doorstep. I’ve said to him: “Don’t forget the social justice issues which are part of the bedrock of where we stand.” Forcing him through his interventions in the health bill, for example − he shouldn’t be irritated that he has to look at these things again − really helps him, because he would otherwise sound like someone interested only in conceptual issues. It resonates on the doorsteps of lawyers, with House of Lords constitutional experts, and what I’ve often described as dinner-party politics – the 'dinner-party party set' – who get terribly excited and always try to outdo each other…

Who are the dinner party set?
They define themselves. I wouldn’t use any names. And they’re absolutely right. But that’s a subordinate issue in terms of the public presentation of the party. You should direct your message at those concerned about human rights and constitutional reform, without having to send the message as your only comment on the mass media – they can receive their messages through very direct and targeted messaging anyway. So you don’t need to worry about them – you need to make the sales pitch.

So, you want to see Lords reform dropped out of the Queen’s Speech on 9 May? Should that be an opportunity to talk about greater social justice, perhaps?
Lords reform is really important, because I strongly oppose patronage in politics, and the Lords is a classic example of where patronage is severely abused. An independent appointments commission for the Lords is right. The Commons does things in a tribal manner, and we need people at that end [in the Lords] who aren't tribal. We need to begin by asking: “What do we want a second chamber for?” It’s for independent scrutiny, to give things a second thought. That implies an appointments system, really. I’m not persuaded by elections.

The worst-case scenario is for the Lib Dems to tout Lords reform as a ‘big prize’, as something with which we can go to the country and say: “Don’t you want to congratulate us for having achieved Lords reform?” Voters would reply: “We’re more concerned about our housing, health service and the economy.” It’s a worthy thing to do, but not to the exclusion of everything else; it sends the wrong message. It also helps Cameron paint us into a corner, which he is very capable of doing. He’s already done very well at presenting us as manically and blindly pro-European. And he could very successfully have us branded as interested in rarefied, conceptual politics that voters don’t understand.

Do you sense a trap?
Yeah, a massive one. I don’t question that it's important, but presentationally, it's not wise.

How difficult would it be for the Lib Dems to form a coalition with Labour?
Not more difficult. Grown-up political parties can form coalitions. Immature ones can’t. If we become immature, we won’t be able to do it. If Labour indulges in playground politics – ‘we don’t want to be with you because you’re smelly, because you’ve been tainted by Tories’ – we won’t be able to. But Labour will be capable, taking it outside the theatre of the Commons chamber, and we'd talk rationally to each other. That's not what we get in the chamber. Any mature political party can do grown-up politics.

There are no personalities who would prevent that from happening?
I don’t see any. I’ve heard that some on the Labour benches so pathologically hate Clegg that they wouldn’t want to sit in the same room. But again, that’s immaturity. You just need to get on and do the job.

Tags: Andrew george, David Cameron, Health and Social Care Bill, In conversation, Issue 46, Julia Goldsworthy, Lib Dems, Lords reform, NHS reforms, Nick Clegg