Working to make government more effective


Alistair Burt

Alistair Burt reflects on his time in government for the Institute for Government’s Ministers Reflect project.

Alistair Burt
Alistair Burt, former minister of state at the Department of Health

Alistair Burt was a minister in the Department of Social Security between 1992 and 1997 and in the Foreign and Commonwealth Office and the Department of Health between 2010 and 2015. He was a Conservative MP (1983–97, 2001–19).

Burt returned to government as a Foreign Office minister (2017–19) after this interview took place.

Alistair Burt (AB): I have always been interested in HR and development for colleagues. After being in Parliament from ’83 to ’97, I worked as a head-hunter in Central London for four years and that obviously taught me much more about HR and personnel than I had ever come across before. When I went back into Parliament I realised, like many of us do, just how antiquated the parliamentary processes are, particularly within the parties. I wanted to do something about it. So I worked on a programme in the Whips Office to make it more personal and to recognise that people were not coming into Parliament like they did in the 1950s, from a military background. The Whips Office while I was there was not good and resistant to any changes that would mean looking at colleagues as individuals and seeing what they wanted to do and working with them. Your greatest talent is your people, in every business and company that’s true. But your greatest problem here in Parliament is your members – that’s what the Whips Office think and that had to be changed. It is the same for ministers – the less you can have a situation of ‘sink or swim’, the better. The more preparation you can give to people, both before they might take office and when they’re in office, the better. Whether or not someone is a good or poor minister will emerge in time but at least you can give people the best chance to do the job.

"When I went back into Parliament I realised, like many of us do, just how antiquated the parliamentary processes are, particularly within the parties. I wanted to do something about it."

Nicola Hughes (NH): Yes – give them a head start. When you went in first, in 1992, did you have any kind of preparation then?

AB: In 1992, I was made junior Minister for Social Security. Effectively the induction was done by the perm sec [Permanent Secretary]. We had a very good perm sec at the DSS [Department for Social Security], Sir Michael Partridge, he was a very experienced, very kind natured individual. I was working with an experienced Secretary of State, Peter Lilley, although he was new to the department, and an experienced colleague in Nicholas Scott, who was then Minister for Disabled People. I had been around a bit, I had been in the House for nine years so I had a feel for it. But no, if I remember rightly there was very little induction. I remember being in meetings, being asked to make decisions and saying to officials ‘I don’t know the impact of the decision I’m making, I find this very difficult.’ They were asking me to sign up to basic pieces of delegated legislation or something, but in the benefits field there’s a lot of that. I said at one stage ‘I feel uncomfortable because I don’t know the impact of this, so before I can make any serious decisions, I need to really understand a bit more.’ But you gradually get into it. I enjoyed being a minister, I did not find it too difficult.

I was thrown in at the deep end, because the first and most difficult thing I had to deal with was the Child Support Agency. The legislation to set it up had all been passed but it was going to go live in April 1993, so we had a year of preparation. During the course of that year, it became obvious that the computer systems were not up to scratch and it was going to be much more difficult than people had thought. The public debate had tended to be about whether or not women were to be pressurised into naming the fathers of their children, but what was actually going to happen would be quite significant increases in the amount of maintenance being paid, which of course, was the point of it. But that had been much underplayed and suddenly the Secretary of State and I realised that there were going to be quite big losers out there and they were going to be very angry; we had to change the orientation of it. The experience of going through all that meant we learned a lot on our feet. So in terms of basic induction, no, but I had a perm sec, had good officials working with me and I never felt, really, at sea.

"Suddenly the Secretary of State and I realised that there were going to be quite big losers out there and they were going to be very angry…"

NH: If we fast forward to 2010, you came in then to a different department, the Foreign Office. Had a lot changed in government in the intervening years?

AB: Yeah, huge amounts. I think we had been through a period where the authority of Parliament and government had been ripped apart by two things. Firstly, as far as Parliament was concerned, there was the expenses scandal and the fallout of that. I’m afraid there was fallout from Blair and Peter Mandelson [Labour politician] and the way in which politics was seen to be a bit of a fraud on people; the manipulation of politics had become very obvious. It meant that authority – which had obviously steadily been challenged from the 60s and everybody understands that – but authority in government and in Parliament had been much undermined. So that was the background. The Foreign Office however is, in a way, an island. It is not a policymaking department and therefore it is a very different experience and has a very different atmosphere – it’s not exactly isolated from the rest of Whitehall, but in terms of the day-to-day work that’s done, it is totally different from a policymaking department, which I found when I went back into that world, into the Department of Health.

There was much to repair from that loss of confidence and authority in government that had taken place between ’97 and 2010. I think, in a way, the Coalition Government helped to do that: the mere process of going to the public and saying ‘Here are two parties that fought each other at the election but for the good of the country we’ve come together.’ In hindsight it is difficult to remember that period in 2010, after the result and people thinking ‘Well, what’s going to happen?’ Actually, something stable emerged and we all got on with it.

"There was much to repair from that loss of confidence and authority in government that had taken place between ’97 and 2010. I think, in a way, the Coalition Government helped to do that…"

NH: Did you know before the election that the FCO was the department you’d go to?

AB: Absolutely not. I had been Assistant Chief Whip, I’d been working on development issues amongst colleagues and I thought I would be staying in the Whips Office. But I also thought it likely I would be transferred to a department because I had departmental experience: it was quite some years since we’d been in office and therefore I thought the Prime Minister would be looking to use colleagues with departmental experience while a new generation of colleagues found their feet. I quite expected to either go to International Development because I worked with Andrew Mitchell [as Shadow International Development Secretary] on his Rwanda projects and was interested in that, or that I would go back into a domestic social policy department. So I was really surprised when I got the phone call saying I was going to the Foreign Office. The reasons, the PM said on the phone, were ‘I know you’ve got an interest in the Middle East, in Israel and Palestine in particular and we need someone to work in that area – the rest of it you will pick up, I think your brief will probably be the wider Middle East area.’ I thought it was great, I thought Christmas had come! Having been engrossed in domestic policy over the years, because I thought that’s what you had to do, being in the Foreign Office seemed very glamorous. Almost it didn’t seem like work and I really should be doing something much more nitty-gritty – previously I did regeneration work on drafty estates around the country, I enjoyed that and I thought well some Conservative has got to do this! And I’m committed and interested in the development of people, so I thought maybe it would be the Whips Office. So the Foreign Office was great, it seemed like a dream, something that other people did.

NH: As you said you were the one of the few people in that cohort that had been in government before. Did you therefore find yourself helping and guiding colleagues, as one of the few people that had done it?

AB: Yes, you do because at its best this is a collegiate place and you do find you’re sharing experiences and things like that. There’s no particularly formalised system, which is why your work at IfG is so important. I think we need to do this much better. I mean there were induction meetings prior to 2010, I think the Institute put those on, as the election was close, for people who might become ministers. I am pretty sure I spoke at one, as someone who had been a previous minister. That was there in a way that was never there before ’92. I don’t remember anything like that before ’92. In the run up to the 2010 elections there was quite a strong possibility that there would be a change of government, so colleagues were getting involved in what being a minister might entail. But it didn’t, understandably, go as far as the Prime Minister selecting his government before an election, which would have looked terrible and of course, would have turned out to be wrong anyway.

A shadow minister has got the opportunity to be involved with thinking through what they would actually do if they were in office. If you do hold one of those positions, particularly shadow Cabinet, at the back of your mind there must always be the thought, ‘Well, next week I could be doing this for real.’ It conditions behaviour as a shadow minister, because if you stand up and say or commit to something completely outrageous in the House of Commons, everything these days is written down and recorded. It will be produced and people will say ‘Well, you said x in opposition, why have you changed your mind?’ Every time you object to something, someone says ‘Will you pledge to repeal it, if you come into government?’ and you have to say ‘Well, no, not necessarily because we’ve got to look at what’s happening there.’

I’d been to the States for their Congress induction in 2008, to the week that they run at Harvard. They invite three or four British Members of Parliament to join. It’s in that gap between the end of the elections in November and before Congress takes its seats in January – they’ve got that period that we of course don’t have. They get all their newly elected Congressmen up to Harvard, all together, Republicans and Democrats and they mix them up. They give a series of lectures from people often outside politics but sometimes inside politics on the basis of ‘Forget your stump speeches: you’ve been elected. Let’s tell you what you’re going to face when you go into Congress.’ It was really pretty good, they get top people who come and talk to them about national security, about the state of the country, who strip away all the daft things you have to say to get elected. I wanted to introduce something similar to that here. In 2010, there were some opportunities because I thought bringing Members together was a good thing, because whether you’re in government or opposition you have to forget your attacks on each other: ‘This is the truth, this is actually what the country faces and in both opposition and government you have responsibilities to deal with it.’ We ran some lectures here on site, because everybody had become MPs, you didn’t have that break they do in the States.

NH: Interesting. Before we move onto Health, when you were at the Foreign Office, it was a new subject for you, so how did you establish what your priorities were going to be?

AB: I had a very good private secretary [PS] and universally I am fond of private offices, they have served me incredibly well in all the different posts I have been in. An experienced PS is the greatest gift that you can have. I had someone, Russ Dixon, who is now Deputy Head of Mission in Oman, he had been round the service for a while. So he was a bloke roundabout my sort of age, very well known in the department, he took me through it.

The world I was looking at in 2010 was very different to the Middle East it became in 2011. I was in office before the Arab spring started and during the Arab spring. We looked at a set of priorities based on what the Foreign Secretary wanted to do, and remember we had a Foreign Secretary who had been understudying being Foreign Secretary for five years; William Hague had committed himself to foreign affairs when he came back into the Party for David Cameron. He’d worked on it with special advisers, Arminka Helić, Chloe Dalton and Denzil Davidson, they worked very much as a team.

"The world I was looking at in 2010 was very different to the Middle East it became in 2011. I was in office before the Arab spring started and during the Arab spring."

We worked out the priorities based on what was going on around the world and it was ridiculous because at that stage North Africa seemed pretty quiet, we heard ‘These are the bits and pieces you need to know about North Africa, but Egypt’s reasonably stable, Libya is pretty stable under Gaddafi, Tunisia is stable’, all that. There could always be a flash point between the Israelis and the Palestinians and I was particularly interested in that, because I believe very firmly that is a dispute that won’t go away, it’s got to be sorted. So I wanted to get involved in that, but I had an early indication from Number 10 that they didn’t. David Cameron said ‘Nothing is going to happen; the Americans aren’t going to do anything. We can invest a lot of energy but nothing is going to happen there.’ I was very disappointed but I took the hint.

We developed a new Gulf Initiative. The Prime Minister had taken the view in opposition, as had William, that our relationships with friends in the Gulf had deteriorated over the years. We had taken them a bit for granted and he wanted to stimulate an initiative based on security and trade with the Gulf. So I was to handle something called the Gulf Initiative and set up task forces with each of the Gulf nations. So, I had an agenda that was set, it was based on William’s experience in opposition and it seemed pretty credible.

I was also minister for Afghanistan. Afghanistan was obviously the number one foreign policy issue in 2010. I was urged to get there to get immersed. The big decisions on Afghanistan were always going to be taken by the Foreign Secretary and the Prime Minister, of course, in terms of military action. But in terms of the building of civil administration in Kabul and everything else that we were committed to, that was with me. So I got out there. I met President Karzi the second day I was appointed to the Foreign Office. He was on a visit to London and I was told 24 hours after becoming a minister that I was to meet and spend a day with him. You learn, very, very fast! You get a great briefing and then you just do it.

"I met President Karzi the second day I was appointed to the Foreign Office… You learn, very, very fast!"

Sri Lanka was in a bad way because civil war was still dying down with the problems between Tamils and a very oppressive ruler, Rajapaksa. There was always Pakistan and the terrorist issues there. So the agenda and the priorities in my patch were pretty well set by events, that tends to be the rule in foreign affairs. And then of course, the end of 2010 beginning of 2011, the demonstrations in Tunisia happened: the young man Mohamed Bouazizi set himself on fire and started the chain of events. And then of course, the world changed massively as a result of that. Events dominated the rest of my time at the Foreign Office, there was so much going on. I had a great Secretary of State who was incredibly supportive, everybody was involved in everything but they let me just do the work. So, we did as much as we could.

NH: Yes. Then let’s talk about the move to the Department of Health, did you know that was coming before the appointment?

AB: Absolutely not. Mr Cameron had needed to make room in government in October 2013, October 9 at 9.30am – I have forgotten the exact sequence of events! I was very sorry to leave the Foreign Office. I loved the Foreign Office and enjoyed the work, but understood entirely. The Prime Minister doesn’t like making changes, but I’d have had a good run, it was my third ministerial appointment under two governments, I’d been around a long time. I didn’t have any hard or bitter feelings towards him at all and I said so on the phone, I said I would be forever grateful for having had the chance to do the job and I would spend my time thinking of what I had done, as opposed to worrying about the fact I now no longer had the chance. I said it changed my life and it did, that appointment. So, the fact it had come to an end, as all ministerial jobs come to an end: fine, somebody else will now get the chance to do it. My political world and my life would be immeasurably different because of what he had asked me to do, why would you complain? So I was disappointed but I got back on it.

Of course, when we had the 2015 election I thought no more about it. What I really wanted to do was be Chairman of the Foreign Affairs Select Committee, that’s what I would have run for. But then I got this phone call at the beginning of the week – it was a surprise. You get no time to think about it in those circumstances. You get a phone call, ‘The Prime Minister would like to see you at 4.30pm.’ And it is 3.45pm at the time and what do you do? I did ask, ‘What has he got in mind?’ and the secretary said ‘Well I can’t possibly tell you that!’ The moment you’ve committed then you accept that if the Prime Minister asks you to do a job, you do it. I was pleasantly surprised. The patch of the health service I was being offered was mental health, David made it very clear he was very engaged in mental health issues, which had been seen as a bit of a Liberal Democrat thing because Norman Lamb had done it so well. David was keen on it and he wanted me to carry it on and I said ‘That’s great.’ It was a good combination of social care, primary care – my dad is a doctor – and mental health. I was very happy to accept it.

"You get no time to think about it in those circumstances. You get a phone call, ‘The Prime Minister would like to see you at 4.30pm.’ And it is 3.45pm at the time…"

NH: And how did the departments compare?

AB: Ah. How can I put this as kindly as possible? The Foreign Office is genuinely a complete Rolls Royce department. It is full of very bright able people, all around the world. It operates completely differently to Health because it does not have the same policy making issues and it does not have the back-breaking efforts of running the world’s fifth largest organisation with all the difficulties that involves. It is a completely different operation.

The quality of most of the people at a senior level at Health is high. I think I was immediately aware of the distinction between the department and the NHS. The government has made the NHS autonomous, effectively. That means that a minister’s writ does not run in the NHS in the same way as other places. I began to learn quite quickly that there was a frustration about getting things done and that made policy making quite difficult. I became aware of the dreadful slowness of getting change, you are turning around a tanker. What you say, at Richmond House, will take ages to have any effect through the system and in the meantime you just get shelled from all directions because anything that goes wrong anywhere in the Health Service is your fault. Whereas anything that is done well in the Health Service is down to our marvellous NHS staff who do wonderful things despite the government. And it’s a bit wearing. I think it was wearing on civil servants and the department as well as ministers and people around the place.

"…anything that goes wrong anywhere in the Health Service is your fault. Whereas anything that is done well in the Health Service is down to our marvellous NHS staff who do wonderful things despite the government"

To go back to processes, I had a first-rate private secretary who had experience at Number 10 and is a very capable young woman who I think will be a very good public servant in the years to come, if she stays in public service. There was a good team that knew what they were doing, they worked well with my predecessor and I took over most of his portfolio. I think they prepared well. I got two or three good dossiers saying ‘This is what the department does, this is what your responsibilities are.’ I got a good induction process where I met members of each of the teams that I was working to, good written presentations and slides taking me through what I was responsible for. That was pretty good and I felt that quite quickly after a couple of weeks I had a grasp of what the five-year forward view was for the NHS, and what my responsibilities and priorities were in it. My private secretary was quite keen to talk me through priorities and then give me time. I said that having had some experience now in doing this I knew how to be a minister, but that I had not been a minister in this department, so I wanted to spend a bit of time looking around the field and then say ‘Right, these are the priorities’, on the basis the Health Service is so big you can’t do everything. So, we tried to work through what the quick wins were: what could I apply myself to that would make a difference in a relatively short period of time? And then what were the longer time priorities as we looked ahead towards 2020?

Jen Gold (JG): Just then thinking about the day-to-day reality of being a minister in Department of Health, can you give us a sense of how your time is actually spent, because there’s a lot of competing demands on your time?

AB: Yes. It’s the usual mixture for a minister. Because of the tight parliamentary arithmetic, effectively Monday to Thursday you would be in London. Any visits to hospitals or to local authorities dealing with community care then were pretty well London based. Thursday you tended to get out around the country. The days in London would include meetings connected to the Secretary of State’s priorities. There were a couple of areas that the Secretary of State was looking at as well as me, so I had to prepare meetings for him with the civil servants and we would go through his priorities. There would be meetings connected with the areas that I was involved in and they would involve stakeholders from outside, I would see obviously the professions with which I was involved: doctors, dentists, pharmacists. I would see the professions and people in local government responsible for adult social care, people from the care home sector, a whole series of external stakeholders. We had a couple of boards on which I sat: one to do with autism, one to do with learning disabilities and families. Then there were policy meetings in the middle of that, looking at the development of policy in different areas: mental health, the future of primary care and all that. So mostly the days were pretty solid meeting days from 9-9.30am right through most of the day.

The Department of Health is also quite high on colleagues’ agendas in Parliament, so there was a pretty regular scattering of debates, adjournment debates, backbench debates, Westminster Hall debates, you had good parliamentary interaction. Heavy letter postbag. But I was used to that – I think I’ve had the heaviest postbag in each of the departments I have been in! In DSS it was child support. I mean, William Hague does say he came into my room one day and couldn’t see me! He thought I was not in the room, because at the time we had the folders of correspondence stacked up and I was at the table and he literally couldn’t see me and left the room because he thought I wasn’t there! So you’ve got to fit the letters in.

"I think I’ve had the heaviest postbag in each of the departments I have been in… I mean William Hague does say he came into my room one day and couldn’t see me!"

JG: We are interested in people’s approach to decision making. I wonder if you could talk us through an occasion when an unexpected event or crisis hit one of the departments you were working in and how you went about dealing with that?

AB: Where do you want to start! Let’s go back to square one, the Child Support Agency. Two funny stories. Michael Jack had been my immediate predecessor at the DSS, he was very good. He left Parliament some years ago. In 1992, I came back after the election to deal with all the jolly stuff and meet colleagues and all that and I met Michael in the House of Commons. We had a chat and I said ‘Well I am taking over your portfolio, well done moving on to be Minister of State at the Home Office.’ Just as we broke to walk away, he did that Colombo thing: he said, ‘Oh one more thing… that Child Support Agency stuff will be quite interesting’ and he walked away. I always teased him about it because it did turn out to be probably at the time, the biggest computer disaster and the biggest administrative failure of a government department for as long as anyone can remember! As I said, we worked on the orders bringing it into force over the course of the months heading up towards April, but we were always concerned about whether the computer systems could do the job that was required. It was a big change, moving from the courts to this external agency. The weekend before it went live, there was a farewell party, a thank you party, for all the officials who had been working on it, including the senior civil servant who had been responsible for the year’s process leading up to the launch. He was going onto another job and I remember saying to him, ‘After you have done all this work, it must be disappointing to be going just before it all kicks off? He looked at me and he just smiled and I realised at that moment what was going to happen. You bet he smiled, he knew exactly what was going to happen. It was a disaster and it was a disaster from the word go. The files began to pile up at these centres all over the country. The computer systems couldn’t handle it.

"It was a disaster and it was a disaster from the word go."

With benefits, the effort to make an individual calculation based on need and a variety of factors to tailor either a benefit or payment to an individual’s circumstances inevitably makes it complex. The simplest things in benefit are straightforward eligibility or not, fixed payments, then you know what you’re doing. The process we went through to try and tailor it to the situation of the person paying maintenance, the circumstances of the child, the circumstances of the parent with care of the child just made a calculation unbearably complex. The system couldn’t cope. So firstly, there was the realisation of this. I am forever indebted to Peter Lilley, because we stood by each other through this process. There was a director of the Child Support Agency, Ros Heppelwhite, and we had to stand by her as well to try and get a grip on this process. But it was pretty bad and it was all hands to the pumps. There was a huge reaction in Parliament, there was a huge public reaction. I went to some really, really hairy meetings and things like that.

So what did we do? Firstly, there was the understanding that we have a problem. The Secretary of State and I had recognised in advance that this was going to turn out to be difficult. The actual process of working through the computer systems was a nightmare, because it always is in Whitehall. When we went onto tax credits, the Rural Payments Agency and God bless us this Universal Credit programme, for which the timescale is now a little bit more sensible, government does not do these huge computer changes well, it seems to me. It does not seem to learn from the lessons of each one. We brought in outside consultants, changes were made to the computer system. The big decision was whether to hold on to the policy or not. It was a concerted decision in Parliament that we would. The idea of increasing payments to children was, really, really important and on that Mrs Thatcher had been right and John Major was right. We made the policy decision that this was such an important policy we had to trim it and make it work, but we weren’t going to abandon it. We weren’t going to send people back to the courts, where a £10 a week was the standard payment for a child. It was what a bloke expected to pay and people were outraged when they had to pay more. That principle was very important, we had to stick to that and we had to make the system work. So, once we decided we would keep the policy in place then Ken Clarke [then Chancellor] had to be approached for more money, to get the support. Ken in office of course, is nothing like the cuddly image of Ken that everybody has. He stuck to the line and said ‘No, no, I’m not giving you more money. I mean you’ve already thrown away everything you are doing!’ So Peter had to work on him to get the extra resource we needed, because we needed to put a reform act through as quickly as possible. I had to go around and see all the centres. I was responsible for driving up the standards and the improvements. It was miserable. Because people would come into my office, computer experts, and they promised step-changes. I learned to fear the words ‘step-change’. People would produce breakdowns and pathways and demonstrate that if they did x and y, the amount of money we were currently receiving, which was about zero, would become exponentially much higher, ‘Oh yes, we can do it’. It seemed unrealistic that we would be working on a system that no-one else in the world is working on and producing results anything like this, of course it was rubbish. There was nothing you could do, you were completely in the hands of people who could fix computers and systems.

"Government does not do these huge computer changes well, it seems to me. It does not seem to learn from the lessons of each one…"

So how did we react? We held our nerve, we kept the policy but we worked on all the basics and we did our best to say to colleagues and friends in Whitehall ‘Don’t ever do this again. If you’re going to make this sort of change make sure it is properly researched. When you do something like this, remember, what is a bit of delegated legislation in a committee room upstairs and a debate on the House of Commons, changes somebody’s life if you get it wrong.’

I think the most important thing is that for a minister, you’re here in Westminster during the week, but then you go home and you do your constituency surgeries and it’s just you and people come to see you in a room in tears. It brought democracy home in a big way: you realise the impact of everything that we do here on real people and real people’s lives. It is a hugely instructive lesson. MPs would come back at the start of the week and I used to count the number of seconds I would be in the Member’s cloakroom as I walked in to Parliament for how soon someone would come and talk to me about the Child Support Agency. On average it was between 30 and 40 seconds. The first person that I would see after the weekend would say, ‘I’ve got to talk to you about my surgery.’ So the pressure was absolutely massive, but the system worked through it. We got a reform in place and we started the process that, I think, 20 years later probably produces as far as I am aware, something that is vaguely better. We don’t get as many letters as we used to. But I remain sorry – the public suffered more than it should because we got things wrong; it was poor Government.

"…you go home and you do your constituency surgeries and it’s just you and people come to see you in a room in tears."

JG: Maybe we can look at the other side of things and the Department of Health?

AB: The Child Support Agency was interesting because we could work through it and do something about it. When I got problems with Health Trusts in my area, that was hard. There was one where a young man died in a bath and the Chief Executive didn’t resign: that was terrible because I could do nothing about it. A minister could not intervene in a process where quite clearly the Chief Executive had to go and no-one was prepared to make the decision in the Trust or in the NHS. I thought the decisions they made about resolving that situation were profoundly wrong and not designed to move the Trust or its personnel on and I couldn’t do anything about it. One of the reasons I left ministerial life and the NHS was because I got frustrated at the lack of ability, as a middle ranking minister, to do anything about certain things. I just thought ‘I don’t want to do this anymore.’ I thought I could make a difference elsewhere.

"One of the reasons I left ministerial life and the NHS was because I got frustrated at the lack of ability, as a middle ranking minister, to do anything about certain things."

JG: So thinking about your time as a minister, what achievement in office are you most proud of?

AB: All sorts of things really. Going back in chronological order, I had to fight very hard to keep the commitment made in the 2015 Budget to children and young people’s mental health of £1.25 billion over the course of the Parliament. I had to fight very hard to keep that commitment in place and to make sure the commitment was for the Parliament and not for some extended period, where if you fiddle about with the financial systems, you could actually run it over a longer period and thus reduce the amount of money that the government was committed to. I fought very hard to say that was wrong and spoke publicly, I just said from the despatch box ‘We’re going to spend x by so and so,’ against the advice of officials that I couldn’t say that, because that’s not what the Treasury wants us to say. Well, stuff it.

"I just said from the despatch box ‘We’re going to spend x by so and so,’ against the advice of officials that I couldn’t say that, because that’s not what the Treasury wants us to say. Well, stuff it."

I had a big fight over perinatal mental health when the NHS did not spend the amount they should have spent in the first year, and I thought fine, carry it over and spend it the next year. But no, they can’t carry it over, this money will just be put into the deficit. Eventually, after a lot of effort, I had to get an NHS financial official on the phone, who again told me ‘This is just the process.’ And I said ‘No it’s not. You’re going to spend this money, you’re going to carry it over, I expect to see this done.’ But it was very difficult, the attitude was almost ‘Who the hell are you, the minister, I don’t answer to you.’ So I fought for those things in mental health and they stuck and I’m pleased with that. I think I alerted people to the fact that there are more risks in both care home treatment and mental health treatment than we seem to allow in acute mental care. I made a speech at Westminster Hall towards the end of my time as minister, when I said I think there is a greater tolerance of poor care in mental health and adult social care than we allow elsewhere, and I said it has got to stop. So, I have raised all those things as issues and I’m quite proud of that.

In foreign affairs, being the minister during the period through the Arab spring and keeping the UK’s relationships with some of these countries going in very difficult circumstances was good. I think we helped with some of the changes that came about in Sri Lanka by being very firm on our relationships with the then Rajapaksa government to show what we were not prepared to do. But in foreign affairs the big decisions are obviously those of the Secretary of State and the Prime Minister, I don’t claim any credit for any of the big interventions or anything like that.

I am proud of what we tried to do in so many of these states that went through difficulties, to support them afterwards, despite the fact that the outcomes in Libya and Iraq will be very long-lasting. I think we did some good work in a number of these states I was engaged with and was very pleased with that.

I signed the arms trade treaty on behalf of the UK and the UN. I keep the picture on my wall! When we came into office in 2010 all the supporters of the arms trade treaty said ‘Oh well that’s it – Labour supported this but the Tories because you’re in bed with all the people who make guns and money, you’re never going to do this.’ So, we had to persuade people that we were and that we were just as committed to it as they were. We signed it and that was great.

"I signed the arms trade treaty on behalf of the UK and the UN. I keep the picture on my wall!"

Going back to the DSS days, I was pleased I signed off the Disability Discrimination Act. I worked through some changes after the Bill had been passed that are lasting to this day, like access rights. And honestly keeping the Child Support Agency policy going when it could easily have been sunk was good. So there’s been something in each of the departments I have worked in that I am proud of doing.

JG: We have had a number of ministers who have talked about fighting to protect a portion of budget. You talked about making public statements, but was there anything you had to do behind the scenes?

AB: No, because by and large I didn’t have contact with the Treasury, it was the Secretary of State and he fights very hard for budget and settlement. I mean, I think Jeremy Hunt knew how difficult the adult social care situation was because that’s the biggest pressure on the health service at the moment, because if people don’t get cared for at home, they end up at the hospital and they end up in hospital for longer and that’s a cost on the system, as well as it not being the most appropriate care for them. I think encouraging the Chancellor to allow local authorities to raise money through a precept on social care was a very big step to take, the Secretary of State did well in relation to that. I did have Treasury officials in and I said, very bluntly, ‘There isn’t enough money in adult social care, you’ve got to be aware that we’re going to have to find more money to do this properly. Otherwise this system is going to collapse. We are not making a partial case on behalf of the NHS or local authorities, it is just the truth.’ But it must be very difficult for them – everybody they see will probably say that. You don’t get much chance to influence George Osborne but when you see him passing in the corridor you say ‘Look, I know the Secretary of State is going to see you about this and it is true George, anything you do here will be really, really important.’ But I didn’t take part in the negotiations or anything. And as I said, internally, making sure the NHS spend the money that you’ve allocated is quite hard. I remember again, a meeting with officials saying ‘We don’t have the levers to do x and y.’ I said ‘Why the hell don’t we? We’re the government!’

"I remember again, a meeting with officials saying ‘We don’t have the levers to do x and y.’ I said ‘Why the hell don’t we? We’re the government!’"

JG: So was that for you the most frustrating bit about being a minister? Was there anything that you found frustrating about the role?

AB: No. I loved the role. I loved being a minister. I like the external contact with stakeholders. I enjoy listening to what they are concerned about, what changes they want to see – I hope I do that quite well. I think I translate that into what the department and the NHS can do. Don’t get me wrong, there’s a lot the system does incredibly well under great pressure. I worked with very good people, right the way through the system from primary care, mental health trusts and the like, who really do work incredibly hard. Outstanding individuals make a difference. I found that outstanding leaders of trusts or of hospitals or community services can make things happen. But the sheer scale of it and the inertia and the fact that people are incredibly stretched and under pressure, means they are very tired and it is very, very tough work. But I found all that really enjoyable and good to do.

"Outstanding individuals make a difference. I found that outstanding leaders of trusts or of hospitals or community services can make things happen."

In the end for me, leaving was partly because there were so many other interesting things going on in the world, that I was still very attached to. I never got over the Foreign Office and the fact was that I was in a department where it had very little foreign engagement. Of course, as a minister you can’t talk outside your subject so that meant I was constantly wanting to do things I wasn’t able to do as a minister. I think in those circumstances, if you feel that way, you should leave the job to someone who is going to concentrate on it full-time. Do the job as well as you can, but pick a time at which you’re going to go. Because I wanted to be engaged with other things: the European referendum was going on – I couldn’t take a full part in that and I wanted to be more engaged. Then, in all fairness, there were the frustrations of the job as a minister dealing with the NHS, when so much revolves around the structure of the NHS, the decision making structure of the NHS. Ministers can prod and push and I think we can do that well and I hope I did that well and I was able to raise the issues that were important. But you lacked the executive authority that I think you have in some other places: Damian Green [now Work and Pensions Secretary] can make decisions on benefits and the system responds to that, it’s the same at the Home Office. The Department of Health is one step removed, which politically suits any government of the day because of course you don’t take the blame for anything. But the downside is that you don’t get the opportunity to make all the changes you want to make.

NH: You mentioned the referendum just then, how did the referendum campaign affect your working life as a minister?

AB: Not a huge amount, not as much as I would have wanted it to really. The referendum campaign chose people that it was going to put up and all that, I did the work locally in my region and I found whatever time I could to do it. It didn’t impact on the ministerial work, the ministerial work went on more or less the same. Because of course, the Health Service has to keep running. Other departments could shut down for the last few weeks and put everything on hold. But the Health Service keeps on working. I actually thought the best thing I could do was show it was business as usual. I went out of my way in the last month or so to make sure that I was still going to engagements, still doing things that the department had to do and doing that cheerfully and well, no matter what the result was going to be the Health Service was going to be there the next day. You had to keep working through it. I was very conscious that we had to demonstrate it was business as usual, otherwise if the whole government was going to close down for two or three months, that would have been very difficult.

"I was very conscious that we had to demonstrate it was business as usual, otherwise if the whole government was going to close down for two or three months, that would have been very difficult."

NH: The other thing, during your time as a minister, was at FCO it was coalition government and then coming back in 2015 it was a Conservative majority.

AB: The Foreign and Commonwealth Office was hardly affected by any of the coalition disputes and difficulties. I think it must have been very different in Vince Cable’s department and I’ve heard stories. Firstly, the Foreign Office minister from the Liberal Democrats was Jeremy Browne and he was excellent to work with. With the atmosphere and what William created, there weren’t any policy differences to be sorted through. By and large the UK has a foreign affairs interests that are bought into by virtually all the parties. I brought in my counterparts from the Labour benches, so I would see Ian Lucas, I would see John Spellar, when something happened I would give them a briefing on what we were doing and that seemed to work well. I gave briefings to all the colleagues in all the parties on an open basis. Never got let down by anyone betraying a confidence or anything like that. The FCO functioned so well when Jeremy left it, Nick Clegg didn’t replace him with another Liberal Democrat.

When I came into Health, Norman [Lamb] had again done an exceptional job in mental health. I was the first Conservative they had seen for 20 years, because it had been a Labour department, then my predecessors Paul Burstow and Norman Lamb were Liberal Democrats and then I came in. So they weren’t quite sure what they were getting and I hope I reassured them. There wasn’t much of a problem because effectively I carried on exactly what Norman had been doing and I made a point of that when I spoke to stakeholders who believe all the stuff they get in the papers that we’ve all got two heads and want to sell everybody to the American health system and all that. I offered a bit of reassurance, saying that I thought what Norman did was great and I wanted to carry it on effectively and fine-tune it and take us forward. So I didn’t go through some of the problems I know other colleagues went through, when there were quite bitter disputes between ministers and rivalries about Cabinet positions and all that. I avoided all that.

NH: Finally, looking back across all of that, what advice would you give to a new minister?

AB: I think we need still better preparation. I think all colleagues who are thinking about the possibility of being ministers – and it is not for everybody, there are colleagues who won’t want to do it – but if you’re thinking about it, take seriously the opportunities to listen to other people, study case studies and things like that.

"I think we need still better preparation… if you’re thinking about it, take seriously the opportunities to listen to other people"

In the Foreign Office particularly, I wish I had known as much about the Middle East when I started as when I finished. One of the things that I think MPs should do, and the party system should do better, is when colleagues come into Parliament and as they’re working through their early years, to identify the areas that they’re really keen on and have a process of instruction and experience that would fit them. For the Foreign Office, for example, I think we need to identify a cohort of colleagues from all parties, at a relatively early stage and say, ‘Look you may or may not ever be a Foreign Office minister. But if that’s what you’d like to be in the running for, these are the sort of things you should now be doing, these are the places you should go, the committees you should join, the outside bodies you should see.’ And every now and again they could come to Ditchley Park or Wilton Park or something like that, and talk it through with people who are currently doing things, factual situations and responses. I think particularly for foreign affairs you need those range of contacts and you need to have thought through some of these things. When you go abroad you are the appointed person, not the ambassador. My first foreign visit was to Syria and Lebanon. I remember meeting Muallem, the foreign minister of Syria, who is still there. It was long before anything current was on the cards. You have the brief, you ask the questions, your ambassador sits beside you and gives you a run down, but it is very hierarchical. If you’re not in charge asking the questions, they assume you’re not important. So, as a minister you have to do it all even though you have somebody sitting beside you who has got more knowledge about Syria than you can possibly ever remember. You’re pitched into it very quickly with great responsibility. I think therefore that preparation in that, before you actually become a minister, is helpful. I remember asking Muallem ‘I’ve been in my position for four weeks, you’ve been in your post 40 years, how do I get to do it as long as you!’ and he laughed. He said ‘You listen.’ For someone who is now in a position of supporting that terrible regime, whatever his personal position may be,  I think it was quite enlightening, quite interesting. But as I say, the important thing is, the moment you become a minister you take on these responsibilities.

So the more preparation you could do in advance the better. Now I know some people won’t want to do it because it will be tempting fate. Others won’t want to do it because it marks you out as having high ambition – well so you should! There will be some people who do it and it won’t be for them. But I think preparation for a ministerial role, bearing in mind the chances of being a minister are pretty good for a colleague who is going to do maybe more than two spells in Parliament, is the key thing.

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