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Lord Bethell

Lord Bethell discusses being in DHSC during Covid, the importance of experts in government and 'hating' leaving office

Lord Bethell
Lord Bethell, former life sciences minister

Lord Bethell is a hereditary peer. He was appointed as a government whip by Boris Johnson, before becoming minister for life sciences in the Department of Health and Social Care from March 2020 until September 2021.

Tim Durrant (TD): So, to start at the beginning, you entered government as a whip in the House of Lords in July 2019. What was the conversation like when you were asked to join the government?

Lord Bethell (LB): I was at a music festival, standing in a field surrounded by world music enthusiasts at WOMAD [World of Music, Arts and Dance], and the chief whip phoned me and asked me if I wanted to join the government.

"I was in a really great mood, feeling warm about the world... [I] immediately said yes."

I was in a really great mood, feeling warm about the world, he made a very charming pitch and [I] immediately said yes. I am not sure I fully thought through all the implications, but I was instinctively keen to serve.

TD: Did the chief whip tell you what it would entail? Did you have a sense of what it would entail?  

LB: Well, overall, the induction process for a House of Lords minister is quite minimal. The Whips’ Office is relatively straightforward because there are several of you, it’s a strong team ethic and you’re all in a room together.

We had a slight problem that there wasn’t very much longevity. We had hoped that [Lord] George Young [of Cookham] was going to join and then at the last minute he balked. We were very lucky to have [Baroness] Carlyn Chisholm who had been a whip before, and she’s very experienced and knows the ropes, but other than that we were all new. So we were feeling our own way.

TD: You’d entered the House of Lords about a year previously, so did you have a sense of how the House worked and how parliament worked, before taking on those responsibilities?

LB: Yes, although it was quite a steep learning curve to understand the personalities, the procedures and the internal politics of the place. I regarded becoming a whip as part of that learning curve. I covered Home Office and DHSC [the Department of Health and Social Care], which are high-traffic portfolios with some heavy-weight issues that engage peers, particularly during the post-Brexit legislative tidy-up. They say that whipping is [the] best way of learning how the House of Lords works, and I would certainly endorse that experience.

"It was quite a steep learning curve to understand the personalities, the procedures and the internal politics of the place."

TD: A Lords whip is not like a Commons whip – you are effectively a minister, in terms of answering questions and so on. How did you manage that role?

LB: So I had quite a broad scope. I did Treasury, Home Office and health. So some quite meaty portfolios. [Then Lords Home Office minister] Susan Williams [was] very much master of her brief, she knew the role incredibly well, so generally speaking didn’t need a huge amount of support in the chamber but did need support organising outreach to peers. But health is a really broad subject and [then Lords health minister] Nicola Blackwood was doing quite a lot of work on the EU as well as travelling the world to cement some of our international relationships, so there was more stuff coming up there.

My first OPQ [oral question] that I had to stand up for was a PNQ [private notice question] on a Monday morning, and Susan was out of town unexpectedly. The Home Office had lost 130,000 records of some of the nastiest criminals that had entered the country. Due to a breakdown in communications between the Home Office and Interpol [the International Criminal Police Organization], traces of these criminals had been mislaid. It’s quite a well-known story, you can look it up. I was briefed on this at about 11 o’clock, to stand up at about 3 o’clock. And it was [a] quite grim admission by the department and quite complicated because it involved a complex story about international data management mishaps and had been going on for 20 years. It wasn’t an entirely new thing, but it was a very sad story. It was an incredibly tough experience for me personally, but I suspect the Labour frontbench gave me a bit of an easy ride, recognising that this was quite a tough call for a brand new junior whip to take on.

TD: Is that reflective of the House of Lords in general? The atmosphere of questions in the House?

LB: Yes, there’s no way it’s as performatively confrontational as the Commons. On the other hand, they have this joke that the person in the Commons who knows the most about the subject is the minister and the person in the room who knows the least about the subject in the Lords is the minister.

You are aware that there are some very heavyweight, serious people who have been either at the top of government or at the top of their profession, who are extremely accomplished and used to a very high level of debate. And when they don’t get that, they get frustrated. It’s like stepping out of school-boy cricket and you’re suddenly at the Oval facing the West Indian fast-bowlers. And although it’s not nakedly combative, you have to be respectful of the seniority of the people in the room. If you fail to do that, you can lose the “mood of the chamber” very quickly indeed, and then you’re toast.

Emma Norris (EN): So the pressure’s still there.

LB: Oh yeah. It’s a different type of pressure. And MPs, whenever they come over, that’s what they always remark on. They’re like, “Wow, you have to deal with some very serious players.”

TD: You entered the government at a very difficult time. It was the height of difficulties around Brexit, Boris Johnson had just taken over as prime minister and that autumn prorogued parliament. What was it like being in parliament at that time? What was the atmosphere like?

LB: Well, it shifted. I started in September, which was very difficult. Then we went into the election quite quickly in December, and that was a remarkable moment in British history when our future was on a knife-edge, very exciting. So I threw myself into the election campaign and travelled up and down the country. I think I did 65 constituencies, I visited about 100 hospitals.

"I was struck by this amazing political shift that was going on. When I was in London, where I live mainly, it was very difficult as a Conservative to knock on doors; you got a pretty rotten reception. Outside of London, literally the further you went, the warmer the response was."

I was struck by this amazing political shift that was going on. When I was in London, where I live mainly, it was very difficult as a Conservative to knock on doors; you got a pretty rotten reception. Outside of London, literally the further you went, the warmer the response was, and there were some people who were absolutely passionate. Either passionate about making sure [Jeremy] Corbyn didn’t get in, or they’d really bonded with Boris. So coming out of that victory left us all very fired up and optimistic that we might be able to make a big difference for the country.

EN: So then in March 2020, you moved over to the Department of Health and Social Care as parliamentary under secretary of state, just as the pandemic was really beginning. How did it feel to join the department at that moment?

LB: I mean, it was a hell of thing. The chronology of it was that I was the health whip, and I had a good relationship with [then health secretary] Matt Hancock. So I was in quite a lot of the meetings from the beginning of January, when [English chief medical officer Professor Sir] Chris Whitty had come in.

"By about mid-January, we in the top floor of the DH [Department for Health and Social Care] had a pretty clear idea of what the train was looking like coming down the tracks."

He came in in the first week of January and said, “There is this thing that we’re all keeping a close eye on.” By about mid-January, we in the top floor of the DH [Department for Health and Social Care] had a pretty clear idea of what the train was looking like coming down the tracks. That hadn’t been fully acknowledged or socialised across government, but there was this sort of shadow moment when we were all trying to get our heads around it. And then I became a minister. So I was kind of inducted into the pandemic from the beginning.

It went through many different phases. But certainly, in the first phase, there was a sense that it was all on our shoulders, that it was considered in Whitehall to be a DH problem. So we had to stretch a lot. The [health department] permanent secretary, Chris Wormald, moved off being perm sec of the department and became perm sec of the pandemic, and David Williams became second perm sec in the department. So there was an acknowledgement within officials in the department that this was going to be a really big thing very early. That helped a lot, but it put a lot of pressure on ministers.

"In the first phase, there was a sense that it was all on our shoulders, that it was considered in Whitehall to be a DH problem."

EN: For you, did it feel right from the start that the pandemic was the only thing that you were working on?

LB: Yes and no. We still had EU stuff. We had to sort out EHIC [European health insurance], so there was still that process. We had to hold together the life sciences strategy, and we came out of the election with a very clear reform agenda for that based on getting the people right, getting the technology right, and getting prevention right. So there was a board on the wall with those three priorities.

Our philosophy was ‘let’s make the most of the pandemic, let’s use it to try to accelerate our reform agenda’. I was the life sciences minister, so that mission was hugely motivating. We had to mobilise the life sciences industry, so that is a classic mainstream life sciences minister role. I also had a lot to do in terms of House of Lords business around the NPIs [non-pharmaceutical interventions, meaning lockdowns and other measures] and other pandemic legislation, although more of that came later. And I had firefighting to do for the secretary of state, who I had a good relationship with, and tried to help out where I could.

EN: As you were saying, you’d already been covering health as a whip, then you moved into the department. Given you had that background, how big was the change? Did it feel fundamentally different being in the department, or did it feel smoother?

LB: It was smoother because I knew the senior officials, having been around. There was definitely help in suddenly having a private office to myself. I had been previously tasked with various things either in the House, or looking into things for the department, where I didn’t have a desk, so I was sort of sitting in reception on my mobile phone. So actually, having a desk – that was brilliant! And also a Rolls Royce private office. But then I also had my responsibilities in the House, which were suddenly massively increased. Nicola [Blackwood] left in, I think, mid-January, but I only got my role on 8 March, so there was a six-week period where I was not a confirmed minister, where I was doing the role but didn’t have the office.

EN: I wanted to talk a bit about decision making during the pandemic, particularly what the decision-making process was, what the policy-making process was, and how you saw your role within that.

LB: I had probably three different roles. One straightforward one was as the House of Lords health minister. There was a huge amount of health-related legislation from DHSC, and the department also handled most of the pandemic legislation, so all of the lockdowns, all of the red listing [bans on travel to and from certain countries]. I did most of the red listing and travel arrangements. Obviously, everything to do with the non-pharmaceutical interventions, the NPIs. And then quite a lot on answering a lot of questions about the pandemic. Whether that was PPE [personal protective equipment], or restrictions, or new waves of infection. I think I did 1,600 despatch box appearances. So quite a lot. I mean, there were days when I was up doing four or five different bits of business. And I’ve just done a commission on the legal arrangements around statutory instruments. Some of that, I think, could have been done better, but actually I don’t think we did too badly. So there was a huge amount of sort of processing the legislation and answering parliamentary scrutiny.

Then secondly, there was the departmental work of my life sciences role. That changed quite a lot during the course of the pandemic. At first, it was very amorphous and unclear. Some of it was liaising with the life sciences industry. At the very beginning I was doing quite a lot on vaccines, and on testing, and on drugs and clinical trials, and on medicines and medicine preparedness. There was quite a long list. Then different bits got given to me and taken away from me. In particular, an odd thing is that Downing Street, during that period, would grab things and then give them away. So that was an odd, not very good way of running things. Obviously, the vaccine taskforce came in and took that off my desk, and then much later Nadhim Zahawi came in and became the vaccines minister, so that was great. On the other hand, I looked after test and trace all the way through, but then red listing and the border came and landed on my desk. Which was good because I felt very strongly about it, but it was quite a lot of work. So that was the departmental stuff.

"An odd thing is that Downing Street, during that period, would grab things and then give them away. So that was an odd, not very good way of running things."

Then there was ministerial support. I was in the room a lot with the secretary of state for the 8:30am meeting for some of the big decisions, helping him with pressers [press conferences] and parliamentary statements and things like that. I have a background in communications so that was quite helpful, and I am a friend of his. So those were the three categories in which I was involved.

EN: Across all three of those categories, you would have been needing to draw on all sorts of different kinds of advice. How easy was it to access and integrate, for instance, scientific advice?

LB: I had more access to the system than I think any life sciences minister has ever had in the history of the country. Because of the pandemic, partly because of Zoom and partly because of WhatsApp, I suddenly met a very, very large number of people in the system, in a way that wouldn’t ordinarily have happened. I said to one of my forebears, “Did you have any problems getting hold of that NHS data? I finally got access to the dashboard; boy it was a bit of a struggle.” And he said, “I never even got an NHS email. I’m staggered you’ve got an NHS email.”

So the pandemic broke down a tonne of barriers. Normally, DH is like the command module sitting on top of this massive spaceship, flying through the galaxy – like in Alien or something – and you’re just in the captain’s quarters and you’re not allowed out. And I thought I might have a walk around the spaceship… “Oh no, no, no, minister, someone once tried that and look what happened to them.” Whereas we were running round, visits and so on. I met a lot of the senior health care and life science leaders. I could then follow up with meetings because I had their number. So that was incredibly helpful.

"The scientific advice was astonishing. I haven’t used my brain so hard ever in my life."

The scientific advice was astonishing. I haven’t used my brain so hard ever in my life. It was really daunting to be in high-level, complex conversations where you’re not noodling on political nuance, which is what a lot of politicians spend a lot of time on. You’re actually looking at, or trying to understand, big data-driven judgement calls and commissioning research, primary research. Sometimes on a scale that you would never normally do, with millions of candidates involved, in order to try and understand the fundamentals of the virus. We knew so little about the virus; it bounced around and changed, and things that we thought we understood then proved to be wrong. We spent a huge amount of time actually trying to crack the behaviour of the flipping virus. And that was intellectually incredibly challenging, but also very satisfying. And it meant that, in terms of my life, I spent time sitting at a table having analytical conversations with the best scientists in the world, at a level that ministers, who typically focus on the politics and policy, wouldn’t ordinarily do. And I found the advice shared was incredibly impressive on the whole.

EN: You don’t have a science background – how did you manage having to deal with incredibly complex advice?

LB: So, three principles. One is you have to have some humility. There’s no point trying to take your day-to-day understanding of the world and trying to apply it to complicated challenges. You need experts to explain the issues – I am pro-experts. And the good scientists, like Chris Whitty and [Oxford University immunologist and vaccine taskforce member Professor Sir] John Bell and [former health minister Professor the Lord] Ara Darzi, the really good people, are good at briefing. Some are not, but we had access to some of the best. Definitely have some humility and accept that you don’t fully understand it all. Even if you think you’re being given a thorough briefing, you’re probably being given a slightly simplified version of it all.

Secondly, positivity. It’s very easy to get frustrated, particularly with something like the virus, because it doesn’t behave how you want it to behave. Things that you thought were true prove to be wrong. People have told you stuff and then – shock horror – it wasn’t right. You’ve got to be positive about the whole thing. You’ve got to take the view that we’re going get through all of this together, that people have good intentions and we’ve just got to collaborate in order to figure things out.

But thirdly, you have to challenge. You’re a minister, that’s your job. And there is groupthink and people are, sometimes, either frightened of the consequences of their own thinking or worried that there might be problems with the implications of their deductions. And you have to encourage them and clear the route for them to see through the idea. “Oh, so what you’re saying is we won’t have enough vaccines for everyone immediately, so we’re going to have to write a prioritisation list and only do the top two million to begin with?” “Yes, I suppose that’s what we’re saying.” “Okay well let’s do that then.”

"I spent a lot of my time urging people to do things 10 times as fast and a million times bigger than they were coming to the table with."

Or “Oh, so we’re going to have to create a massive national system and have the whole country testing two or three times a day, even though at the moment we only do 1,000 a day?” “Yes, we are.” “Right, okay!” I spent a lot of my time urging people to do things 10 times as fast and a million times bigger than they were coming to the table with. And sometimes trying to walk the really crazy ideas quietly out of the door.

EN: We’ve talked about science advice. Obviously, other areas of advice played into decision making as well. How easy did you find it to access economic advice, or other areas as you were working through this?

LB: I didn’t have any economic advice. None. I think that was a mistake, and it was noticeable, and it was a shame. It was definitely noted by parliamentarians. I was, quite rightly, given a very hard time by peers for coming to the despatch box without proper cost-benefit analysis or economic assessments. I hated doing it, but I had to explain, “We’re the health department. We’re not the department for economics, or the Treasury.” It was the part of the pandemic that frustrated me the most.

I was really surprised that we never got any kind of economic briefing. I asked for it many times. And I wrote speeches to give in the Lords, where I articulated the economic thinking that I was personally working from. But my officials intervened, quite reasonably and quite correctly, and said, “It is not your role as the health minister to try to make up the government’s economic policy. The Treasury will go mad if you try to do that, we will not get the speech cleared by their officials, and – by the way – it’s neither smart nor right.” And they had a point, so that stuff got deleted.

"I was really surprised that we never got any kind of economic briefing. I asked for it many times."

My back-of-the-envelope thinking was the British economy turns over about £6bn a day. In a lockdown, it moves at about half its normal pace. So a lockdown costs something like £2 billion, £3 billion, £4 billion a day. It’s an astonishing cost to the country. That was my working assumption: a day of lockdown is many billions. And a cycle of national lockdown, including the ramp-up and the ramp-down, is normally about 20–30 days. So the national costs of a lockdown could be around £100bn, I estimated. Not £10 billion, not £1,000 billion. Something in between. That was the rough scale of the challenge.

So if you are thinking about measures that might make a difference to avoiding a cycle of lockdown, that’s the lens through which you should make that decision. Something like test and trace, or red-listing, or spit-tests, or anti-viral drugs. If there’s a chance they’ll make a big difference, you should not hold back.

Obviously, there are basic reasonableness filters about if something is a complete waste of time or not. But I never had an officially-mandated framework or an assessment of what the economic implications of our measures were. And that made it difficult to apply formal decision-making and it made many of the ministerial decisions essentially political because there was no economic yardstick. I do not think that in the middle of a fast-changing global pandemic it would be possible to run a meaningful economic slide-rule over every intervention – the data was changing too fast and there is no historic analysis. But it did not help that we completely avoided any economic discussion or publishing any economic guidance, as we did in other areas of the pandemic.

EN: Sticking on the role of other departments, how well do you think different perspectives and advice across departments were synthesised? Were No.10 or the Cabinet Office playing some role?

LB: I think there were different times, and different issues, and different things. Certainly, in the first year, things were pretty turbulent. No.10 didn’t want to prioritise the pandemic in early 2020, even though the evidence was mounting – there was a post-election, ostrich-head-in-the-sand mentality, which I saw again around the invasion of Ukraine. Its priority, and what we were told many times, was Brexit and levelling up.  “We have to deliver Brexit, so could your pandemic quietly go and mind your own business please,” we were told. So we had several weeks of this brushing off, and then they switched into it eventually. After that we got a lot of erratic dipping in – in Yiddish, it’s called ‘kibitzing’, erratic and ill-informed interference. “Put a bit more salt in there. Oh, not that much pepper.”

I was a junior minister, so I didn’t have huge amounts of personal interaction with Downing Street, and actually it’s quite unhelpful to have too many people involved. But from what I could see, co-ordination within government got a lot better after [former Johnson adviser] Dominic Cummings left.

“From what I could see, co-ordination within government got a lot better after [former Johnson adviser] Dominic Cummings left.”

EN: You were also minister when the vaccines taskforce was set up. What kind of thinking went into its setup? It was obviously lauded as one of the big success case studies of the pandemic.

LB: The taskforce did a good job. It showed the benefits of bringing in GOATs [government of all the talents], experts in their field and giving them the authority to make important decisions. I was very confused about the fact that government did not know how to turn on a coin, to change shape and bringing in new people. Maybe I have been in too many agile organisations that routinely change direction as circumstances evolve. But this wasn’t the first time Britain had faced a national emergency, obviously, and yet there was seemingly no capability for changing the responsibilities of agencies and departments, of creating new capabilities, or recruiting and re-assigning key people. For instance, I think DH doubled in size. But that took a long time, and it should have been made 10 times bigger. For goodness sake, only 3,000 people to 6,000 people. And it was trying to provide oversight of huge swathes of government decision making. Test and trace grew to 150,000 people at one point and the government was stood up on the fly, instead of applying a pre-drafted playbook.

"I think DH doubled in size. But that took a long time, and it should have been made 10 times bigger."

There were exceptions. Paul Deighton, Dido Harding, Doug Gurr, Simon Thompson. There were some fantastic people who stepped up. Bringing Nadhim Zahawi into the department made a big difference. But I am confused why didn’t we get, like, five ministers on day one?

Places like Taiwan have pandemic acts, after 2003, after SARS. And they changed, like in Transformers – Bumble Bee goes from being a car, then he becomes a robot. And he changes shape to fight the enemy, and then changes back after the battle. We should have a Transformer government, that when there’s a war or a pandemic or an electromagnetic pulse that wipes out however many people, the shape of government changes and different decision making gets put in place – and, by the way, we get five more ministers and a load of people come in. We face an age of polycrisis. I am surprised we are not taking a pandemic act through parliament to introduce ‘Transformer government’ as they are in other countries.

So we recruited a tonne of people – [‘PPE tsar’] Paul Deighton did brilliantly on PPE. There should be a book about what he did. I mean, he hasn’t banged on about it, he’s kept a very low profile. He was fantastic. Dido [Harding, head of NHS Test and Trace] did brilliantly on test and trace. She’s taken one for the team. She’s had nothing but opprobrium but actually she was a total star and had to deal with some really, knotty problems. Mike Coupe [Head of testing at NHS Test and Trace and DHSC NED], Doug Gurr [DHSC NED], Andrew Feldman [former Conservative Party chairman who worked on PPE procurement]… There were 10 people who came in, often unpaid, sometimes paid a little bit, but who all frankly put their reputations on the line and leant in. We really needed that, because a lot of the things we were trying to do were either very, very technical or needed high-level leadership. Things where a perm sec is not necessarily all you needed, though we did deal with some perm secs.

EN: So you essentially needed other incredibly senior people, either at a leadership or a technical level, that just weren’t there in this department?

LB: Correct. And who could take quasi-political roles, bluntly. The kind of stuff that junior ministers might do.

EN: Was there something about them being external to government that was helpful?

LB: I think it was helpful having risk takers. That’s not to say that officials don’t take risks, because they do. And that’s not to say officials don’t show leadership, because some of them are incredibly effective leaders. But if you’re in the middle of an emergency, bringing in an outsider who has spent some time at a very high level, who is expert in their field, has the right networks, and who is used to taking risks and getting things done and moving quickly and interacting with the private sector – that has a role. And you could see that on what Kate did with the vaccine, with Paul on PPE, Dido on test and trace, and so on and so forth. Eddie Gray [chair of the antivirals taskforce] on drugs was another great star.

EN: On test and trace, obviously it has been the subject of a reasonable amount of criticism. Do you think any of that is fair?

LB: No, most of the criticism about operational matters is wrong. I’m very proud of some of the things we did, and my suspicion is that we will be judged very well. We really did build something that was the best in the world at what it did. But I would also accept that it’s too early to say whether it had the effect we hoped, so I’m really looking forward to the [Covid] Inquiry. I wish it was happening quicker.

"We didn’t have a habit of testing in the country because we’ve run down our public health."

My suspicion is that we actually did brilliantly. We didn’t start with any mass testing capacity. We didn’t have the right machines. We had no data framework. We didn’t have a habit of testing in the country because we’ve run down our public health. PHE [Public Health England] was science-led and incapable of moving at scale, or didn’t have agility, so it didn’t step up. So there were some fundamental, massive problems at the beginning.

But then we built this absolutely extraordinary national platform that became, literally, the envy of the world – I can say that with great confidence – and delivered. There are reports, there’s a Cabinet Office and a PHE report, [saying] that it saved tens of thousands of lives and that helped slow down, but never stopped, the progress of the disease.

It never was going to beat the virus on its own, but it could slow things down and ultimately it was a fall-back plan in case the vaccines didn’t work. And it was set up at a time when we didn’t know the vaccine was going to come through. So in terms of its ambition and scale, part of the thought was that we may have to live with this disease: what happens if we try to restart the economy and we’ve still got the disease amongst us and no vaccine? We forget that that was one of the reasons for doing it, a big reason for doing it. And if that had been the case, my goodness we would have been glad we had done.

"I regret, greatly, that we have dismantled the testing capability, the data and the testing habit, and the science behind it."

So I don’t know what the end result will be. My instincts are that we will look back and think that we did something very valuable there. And I regret, greatly, that we have dismantled the testing capability, the data and the testing habit, and the science behind it. I think that’s going to have proved to have been a big mistake. The Tony Blair Institute has written about that a bit.

EN: I wanted to come back to your image of department being a command capsule with these huge bodies beneath it. As you say, the department is dwarfed by its public bodies, particularly NHS England. How well do you think those relationships work, and could they be improved?

LB: I had 22 ALBs [arm’s-length bodies] under me, including MHRA [Medicines and Healthcare products Regulatory Agency] and HRA [Health Research Authority]. Because of the pandemic I was very immersed in pretty much all of them, I got to know all of them. And we had an overall reform agenda that was accelerated by the pandemic. So I saw a lot of those relationships in a very positive light, and I could see what we were capable of when we needed to swing into action. HRA completely rewrote the way in which in clinical trial ethics were handled and cut the time down from, I think, eight months to six weeks. That’s an extraordinary achievement. I guess my question is, why did it take a pandemic for something like that to happen? And there are countless examples – NHSBT [NHS Blood and Transplant] did amazing things in the pandemic but has been much criticised for other things in the past.

"Why does it take a national emergency to be able to move at that speed and scale? Why does the elastic band snap back so much to something that is so slow moving and so resistant to change?"

So I saw what the capabilities were and I saw remarkable people achieving terrific things. For me, the question is, why does it take a burning platform, why does it take a national emergency, to be able to move at that speed and scale? Why does the elastic band snap back so much to something that is so slow moving and so resistant to change, and so entrenched and risk averse?

EN: It’s interesting that you say that, during the pandemic and as a minister, you felt it was possible to access those organisations.

LB: There were a few exceptions and a few shockers, but my overall experience was extremely positive.

EN: One of the things that we’ve heard a lot of is that decision making was necessarily highly accelerated during the pandemic. You had to make decisions quickly, policy making had to happen fast. Do you think that has continued post-pandemic? And do you think there are any kind of downsides to that accelerated decision making and policy making?

LB: I think money’s tighter. We had a lot of money, so we could commission. We sometimes just skipped pilots and just did a trial beta run. That does help a lot, and it also meant that we had a higher tolerance of risk and of mistakes. I can give you some examples of some things that really didn’t work, but we removed the blame.

After the first wave, there was a survey done of NHS workforce about what the good things that went on in the first wave. It sounded a bit odd, but we were really keen to do it. Obviously, you know, people worked incredibly hard, and there was a scramble over PPE, and we had to move people into social care. There were some tough things. But we actually got very, very positive response. And I thought it would be, “Yeah, the free pizzas were amazing. And car parking, oh my God, I’m so glad I don’t have to pay for car parking.” It wasn’t that at all. The thing that came through, loud and clear, pretty much consistently, was, “For the first time in a very long time, I didn’t get the feeling I was going to be judged on my mistakes. I didn’t have the feeling that someone with a clipboard was hanging over my shoulder, marking my homework. I had the sense that I could apply my professional training, and I had agency to make my own decisions.” It was this huge sense of relief that was the striking experience of healthcare workforce, and I am very sad we’ve lost that.

That cultural permission was, for me, the most striking thing. People really appreciated it. People always ask me about process, the electronic red box and WhatsApp. It wasn’t that, because actually we didn’t change the decision-making processes very much. We did not throw out the rule book. No way – (a) the officials wouldn’t have let us, and (b) that wasn’t our intention. We knew we were going to be judged at the end of it, so we didn’t do that. We did a COPI [control of patient information] notice on data but look at the COPI notice. It just says, “You should have an inclination to share.” It did not abandon cybersecurity and privacy rules. We knew we had to preserve trust and confidence amongst the public and we thought that this might go on for years. It was the cultural shift, that’s what really made a big difference. For me, what’s sad is we’ve gone, almost immediately, back to a risk-averse culture.  

EN: You mentioned WhatsApp – the government is judicially reviewing the Covid Inquiry’s decision to ask for WhatsApp message. Do you think that ministerial WhatsApp should be open to the public?

LB: Well, they were. I’ve handed over all my WhatsApps. On all my official WhatsApp groups, there were officials on there, and they were archiving. I do think people need to know how WhatsApp works. There isn’t an archive. It doesn’t backup the WhatsApp. So WhatsApp is used because it’s secure, because you know the Russians and the Chinese aren’t hacking it, whereas other methods you’re obviously more worried about. That’s why we all use WhatsApp over everything else. It’s also very easy to throw together. Oh my goodness, it made such a big difference. Being able to, for example, if you have a meeting and you agree a thing you can say, “Right, let’s throw together a WhatsApp group around this meeting and we’ll have updates and people can exchange details.” Oh my goodness, it made such a big difference.

By the way, [Microsoft] Teams was very, very helpful. Officials were very keen on Teams. We don’t talk about Teams chat much. You ought to look at Teams chat – that’s mainly what officials use. I sometimes forgot that I was on the Teams chat. Zoom is incredibly good too, and then I’m on a new project now and we’re using Asana. Of course, we should be using these things.  

TD: So you did that job for a year and a half. What was it like leaving government?

LB: I hated it. Life sciences ministers are often only in post for 18 months. I absolutely loved the job, basically. I had a very, very clear sense of what I wanted to do: I published this life sciences vision, which had six missions in it. I really knew what I was trying to do, and I cannot hide the fact that being sacked was really sad.

"I cannot hide the fact that being sacked was really sad."

TD: As you say, you knew what you wanted to do. Were you able to use your experience as a minister to carry on working on those issues outside government?

LB: Yes. I didn’t come from a health space, but I have found that I’ve been bitten by the bug. Having been the minister does give you a bit of a licence, and it gives you a bit of insight into the whole thing. So I will continue doing it.

It’s the health prevention space that I’m particularly interested in. I think that we should be pivoting from sickness service to public health – by the way, so does everyone else, and it’s written into the NHS Long-Term Plan, but we’re just not quite getting there.

In the great snakes and ladders of life, I regard being recruited to become a minister under emergency circumstances, and then kicked out with no thank you letter, as being a net benefit. But I wouldn’t disguise the fact that it’s quite a bruising experience.

TD: Thinking more broadly about the role of Lords ministers, do you think they get the kind of right kind of support to do the job well?

LB: I did. DH [the Department of Health and Social Care] looked after me really well. I inherited a great private office from Nicola Blackwood, and I had some real stars in there who’ve all gone on to do some great things. And they did beef up my private office during the pandemic. On the parliamentary work, there were issues around the legislative team not having the capacity to keep up with their very large amount of work around lockdowns. So that was a glitch. But I think that was a glitch rather than an endemic problem.

TD: Did the department react to your desire to want to get stuck in?

LB: Oh yes, definitely. Just one final point about life science ministers, one of the reasons why Lords ministers are better as life sciences ministers is that it doesn’t have a huge amount of electoral kudos. You’re not going to win any votes for it. But it is absolutely fascinating, probably the best job in government. And a lot of it is outward facing: you’re dealing with business and with industry. So it’s the perfect Lords kind of job.

"[Life sciences] doesn’t have a huge amount of electoral kudos. You’re not going to win any votes for it. But it is absolutely fascinating, probably the best job in government."

TD: Just a few wrapping-up questions. First, from your time in office, what’s your proudest achievement?

LB: It’s a bit early to say, because we haven’t been judged. My lasting sentiment is that, when Chris [Whitty] came into the office and told us the pandemic was coming, I made a conscious decision that I would just going to lean in and do whatever it took, and if that was the only thing I ever did in politics, that was fine. This was my moment to ride to the sound of guns and get stuck in, and I’m pleased that I gave myself the licence to do that. And I’m grateful for the opportunity, genuinely.

I think the greatest achievement we did was to keep it positive. Because in the middle of a pandemic, the worst thing you can do is have a great falling out. The effectiveness of our national response totally relies on collaboration. One of the things that I learned about medicine, in particular, but also complex scientific endeavours, is that no one has the monopoly on truth. You’ve got to work together. Success depends on a whole bunch of people working together, collaborating to a common end. And the only way you can do that is if in every meeting people feel better when they leave the room than when they walked in. To do him credit, Matt Hancock was very good at that. His personal resilience is absolutely extraordinary. But also his emotional ability to keep it positive, however secretly frustrated or disappointed he might be with the given person or situation or data or what have you, he emoted a sense of forward progress. That was one of the things that kept us going, and I hope I made a contribution to that.

TD: What advice would you give to a new minister about being as effective as possible?

LB: The three things you’re always told are, first, love your officials – that, I think, is absolutely essential. Second, pick one thing. I didn’t do that, I picked like 100 things. But it was a pandemic, so I didn’t really have any choice and I’m not really emotionally very good at that. And then, third, think about what you want your legacy to be.

"Love your officials – that, I think, is absolutely essential."

I think the thing I would also say though is to keep it positive. It’s quite a gruelling job and you can feel pretty frustrated at the end of a gritty week. You’ve just got to enjoy it somehow. I know that sounds really kumbaya, but you just won’t be effective unless you are emoting a general sense of enjoying it.

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