This article is from the June 2012 issue of Total Politics
Andrew Lansley is surrounded by chairs. There must be at least 20 in his plush, cream office, where the carpet is so deep that you sink slightly with every step. It feels like a waiting room for a private hospital – and Lansley is the grey-suited, breezy physician who greets you at the door.
“The former health secretary sat here,” says Lansley, pointing to a chair halfway down a vast conference table, “but I sit at the head. The department went into a kind of spasm. Change is a terrible thing.
“Time for change,” he adds with a grin.
Time for change, indeed. Lansley wants to move on after enduring the longest waiting list ever with his Health and Social Care Act. But it may not be that easy. On the day we meet, Lansley reveals that he will not publish the risk register of NHS changes. Labour MP John Healey described it as “a desperate act which will backfire badly”.
So, have the NHS reforms been Lansley’s most difficult time as an MP so far? He jumps up to fetch something from his desk. It’s his Act, all 457 pages and 309 chapters of it.
“No, the hardest bit as a politician was the general election campaign of 1992. I was director of the Conservative Research Department,” he says, placing his hand, fingers splayed, over the hefty tome. “I’ve learned this in politics: you can’t expect, while you’re doing stuff for people, to be other than… they point the finger. And they did – including many from inside the Conservative Party. They said, ‘We’re going to hell in a handcart. We’re going to lose the election, and it’s all going to be your fault.’ Well, that’s pretty stressful. But you come through it.”
He points again at the Act between us: “The beauty of this – and in politics it matters tremendously – is that the Conservative Party was always absolutely onside. David… and, actually, the cabinet… was always supportive.”
Despite his attitude, reshuffle rumours continue to waft across Westminster. Lansley denies he’s concerned about his position. “There’s no point worrying. If the prime minister wants to make a change, then the prime minister will make a change.” He shrugs. “That happens. I pursued a strategy, and one that the PM was always very supportive of.”
It can’t hurt that he used to be David Cameron’s boss, I suggest. “And George Osborne’s.” He smiles.
“And Ed Llewellyn. And Kate Fall. And Steve Hilton.” Lansley laughs. He certainly isn’t showing the stress of a man about to fall from grace.
“In the run-up to the 1992 election, I was working with Cameron,” he says. “Yes, he did work for me, but there wasn’t a sense of having to teach him a load of stuff. The relationship wasn’t like that. We worked together extremely well.”
The health secretary wants to stress that he still works with Cameron. A lot. “He understands what I’m doing and why,” he says. “He has been continually supportive, and every bit as frustrated as I have by the misrepresentations. He talks to people like the British Medical Association (BMA) and the Royal College of Nursing (RCN), and they say the same things in private to him as they say to me. And they say different things in public. That’s what happens in politics.” The message is clear: ‘This is on the PM’s head as well as mine.’
“He probably understands the NHS better than any prime minister since it was founded,” Lansley continues. “Margaret Thatcher didn’t really understand it properly. Tony Blair talked about it, because Labour always does, but I don’t think he understood it. He sat on a platform with the NHS Confederation, trying to explain to them about thrombolysis for stroke, but he didn’t know how to announce ‘thrombolysis’ because he’d never encountered it before. Come on!” He throws his hands up in the air.
With this kind of fighting talk, perhaps people should stop taking bets about when he’s going to go, and start looking at what his next step might be. Would he like to be Conservative Party leader? “No,” he says almost immediately. “It’s an appalling thing to have to do.” He laughs again.
A month ago, it would have been hard to imagine a Lansley so carefree. There was widespread anger over his NHS plans. One Downing Street source was quoted as saying: “Andrew Lansley should be taken out and shot.” There was a significant online campaign against him, and he was even berated by an old lady outside No 10.
Lansley swats away the criticisms. “One woman out there,” he says, waving across the road to Downing Street. “This legislation lasted 13 months, and there were about three demonstrations, with no more than about a dozen people… It was a media frenzy, trade union and Labour-inspired.”
He acknowledges the online campaign, but dismisses it with an air of vague annoyance. “Most of it was a misrepresentation. There’s nothing in the Act that permits or promotes any privatisation. They said it will lead to charging in the NHS. Absolutely not.”
It was also a divisive time within the health industry. The BMA called on Lansley to scrap his “dangerous” bill, holding an emergency meeting, the first of its kind for 20 years. And in April, 96 per cent of 497 RCN conference delegates backed a motion of ‘no confidence’ against his handling of the reforms.
How is he rebuilding those links? Short answer: he’s not, really. “With the BMA, there’s an element that this is no different,” Lansley says. “They were opposed to the Labour government. There was a campaign petition in the NHS, which they launched against Labour before the election. I’ll continue to have dealings with the BMA. Sometimes we don’t agree, and that will simply be the case in the future.”
But he adds: “The RCN, to a larger extent, supported the bill up until December 2011, to the extent where Parliament was virtually finished. If there was a breach with the RCN, in my view it’s short term, part of pay and pensions differences with the government. The things they said they were worried about aren’t going to happen.”
So their objection was part of a wider concern over pay then? “Well, otherwise it’s completely impossible to work out what their problem was with the legislation… It was about the RCN being unhappy about the continuation of pay restraint beyond the pay freeze and the pensions issues.”
Lansley blamed a lot of the fracas on poor communication. It’s odd, considering his father worked in an NHS pathology lab for 30 years, his ex-wife is a doctor, and he suffered a minor stroke in 1992. A great personal tale to sell the reforms, surely?
“I’ve told that story,” Lansley maintains. “What I found staggering is there were people in the NHS who knew me, knew my background, what my beliefs are, who worked with me to improve stroke care for the best part of a decade, who still said, ‘These reforms are all a Tory stalking horse for privatisation.’ And I’m thinking, ‘You know that’s not true.’ Yeah, ok, [there were] failures of communication, but failures of communication are the meat and drink of government. It happens all the time… People find it incredibly difficult to talk about the way the NHS works.”
He glances at the Act on the table. I notice the hard copy costs £44.75. No wonder people find it hard to talk about how the NHS works…
What does his first wife, Dr Marilyn Biggs, make of his reforms? (Friends of Lansley say they do not get on well since they separated in 1997.) “I don’t discuss it with her,” he replies. There’s an awkward silence.
We turn to his father. What did he learn about the NHS from his dad? “Anybody who knew us would say that we’re good at being a calm in a storm. The closest he ever came to an expletive was, ‘Righto, then’.” Lansley chuckles – and we’re fine again.
Andrew Lansley has been the party’s spokesman on health since 2004. “Many people think they ought to be against me because I’m Conservative,” he states. “They still can’t get their heads around the NHS being supported by Conservatives. It’s somehow counter-intuitive to them.”
The MP for South Cambridgeshire arrived Parliament in 1997, and was signed up to the health select committee almost immediately. But his engagement in politics can be traced back nearly 30 years. He was private secretary to Norman Tebbit when the IRA bombed Brighton’s Grand Hotel over Conservative Party conference in 1984.
Lansley credits the former trade and industry secretary as his biggest political influence. “I was his private secretary for three-and-a-half years,” he remembers, “and at the end of it, I concluded that we didn’t agree necessarily on things. What influenced me was his ability to make decisions based on his passionate feeling. He felt strongly about stuff, more than people know. And that changed things.”
His time on the other side of the Whitehall fence also earned Lansley the nickname “the permanent secretary”. He does not really like the reference: “I was quite successful at it. I was obviously on the fast-track, but you leave the civil service because you don’t want to be somebody else’s adviser. You want to argue for things.” He admits that he would probably still be part of that world if he weren’t a politician.
What’s next for the health secretary? This week, he’s concentrating on extending patient choice. “It’s the whole structure of how we can give patients more information, choice and control over their healthcare,” he explains. This includes the government information strategy – setting out a 10-year vision on how to use IT better. This will include more information about which hospital to go to (such as operation waiting times at different facilities), booking appointments online and repeat prescriptions online. “It’ll be what we expect the NHS to deliver,” says one departmental insider.
Lansley’s also pushing ahead on his obesity strategy. “We published the obesity Call to Action at the end of last year, which is the most ambitious in the world,” he claims. “It says we should take five billion calories a day out of the total consumption for this country. For two decades, our national obesity levels have been rising – and for much of that time as fast as anywhere in Europe. We need population behaviour change.” Lansley is now involved in a debate over front-of-pack food labelling – “so that people get better access to information to make decisions about their diet”.
How’s his diet? “It’s not bad,” he replies, leaning back in his chair. “I’m overweight, but not obese. Typical for men of my age. A lot of men look at me and say, ‘Well, that seems normal’, but we’ve got to try and bring it down. A BMI of 28 isn’t right.” It probably isn’t helped by his guilty pleasure – New York cheesecake from Waitrose.
On the morning of our interview, a coalition of 78 charities warned that millions more pensioners would be condemned to a life of “misery and fear” without an improvement in social care. Lansley is adamant that the reform of social care white paper will be published “in the spring”, but no bill dealing directly with the system’s funding or structure is planned for this session of Parliament. “What people could be more reassured about is, we haven’t gone away into Whitehall in order to think about what people need,” Lansley says.
He believes the white paper will set a framework to allow more choice, information and control over social care. “We set an objective for everybody involved in social care to have access to a personal budget,” he says. “Here’s the cash; it’s up to you how you spend it.”
It’s not just legislation that needs updating, however. Lansley nods: “It’s working the Care Quality Commission to boost its capability. The CQC’s performance has improved but it needs to improve more,” he adds. It’s a rather emotive-less response to a publically sensitive issue.
But Lansley’s outlook is quite detached. What does he think is the public’s perception of him? “Probably a bit serious and technocratic,” he admits. And that’s incorrect? “It’s not entirely wrong,” he replies, carefully. “When you’re in government, it doesn’t hurt sometimes to be good at the detail and make stuff happen.”
It also translates to caution in other areas of life. He doesn’t tweet, for example: “I’ve seen too many people put down things on the spur of the moment. I am – and my father was – very considered, and tweeting isn’t a medium for people who want to consider carefully. I tend to think more than I say. Remember that film with Mel Gibson, What Women Want? Turn it the other way around. If people could actually see inside my brain, all the things I was thinking, it really would be a very bad day. And tweeting is like letting what you think out. Probably best not to.” He laughs. It’s a head-back, mouth-open kind of hooting.
The health secretary is not ‘unlikeable’, though. There’s no sign of the calculating ‘permanent secretary’ when he talks about his family. What do his five kids think of his job? “Ah, well I have many children. Every time anything pops up that’s to do with health, Martha, who’s nine, says, ‘Well, you must know because you’re the secretary for health’. Half the time, I don’t. This job doesn’t make you a medical expert. Her latest joke is, ‘Are you off to the cupboard today?’ She means cabinet.”
He’s also susceptible to celebrity-gawping, like the rest of us. “I went to the American Embassy and Kevin Costner was there,” he exclaims. “There’s something very sss-… (for a moment, I fear he’s going to say ‘sexy’)… sss-starry about him.” Lansley was also impressed by George Bush Senior: “He was quite a thing,” he confides. “So funny. He was such a pleasant and amusing man, which you’d never imagine.”
We leave his clinical, cream office with its many chairs and head to the photoshoot. There, he jokes about his double chin, and is told off for smiling too much.
If Andrew Lansley is a man on the verge of losing his place in the coalition cupboard, he doesn’t show it. He’s not easily disposable, like an Ikea flatpack – and former underling Cameron seems to know it.
The health secretary seems to be under the impression he will have a seat at the top table for a while yet.
But never in the centre chair.