Matt Hancock

Tim Durrant (TD): You first entered government in 2012 as parliamentary under-secretary of state for skills in the education and business departments. What conversation did you have when you were appointed to that role?

Matt Hancock (MH): I was invited into the cabinet room by David Cameron and he asked me to be the minister for skills and explained that this was in two departments. He also said that he wanted me to learn from Michael Fallon [minister of state for business and enterprise, 2012–14], who was appointed into the business department on the same day, and for us to keep an eye on Vince Cable [secretary of state for business, innovation and skills, 2010–15]. So the political advice, if you like, from the prime minister on appointment was: support Michael Gove [secretary of state for education, 2010–14] and keep an eye on Vince. He had no particular detailed direction on the substance except that the apprenticeship programme had just started to get going and he said, “I want you to really drive apprenticeships”. So I got a very high level steer which was: drive apprenticeships, look out for Michael and keep an eye on Vince.

Actually, working with Vince Cable was a pleasure and that relationship was strong and he was incredibly professional within the context of the coalition. And I probably got on better with him than he got on with Nick Clegg [deputy prime minister, 2010–15] and so there was a positive dynamic there. But nevertheless that was the conversation.

TD: And the prime minister told you to learn from Michael Fallon. Were you able to learn things from him?

MH: Yes. I learnt a huge amount because Michael Fallon had been a minister under Major. He had then lost his seat in ‘92 and came back in ‘97 and was therefore a very senior backbencher. I got on with him very well and had established a relationship in my two years in parliament before becoming a minister and watched and learned how he operated within the department.

"Being a joint minister is complicated. I, for instance, insisted on a single private office that moved between the buildings and if anybody is appointed into two departments, I would strongly advise that."

So I then arrived in the business department, which was my primary base, and I spent two days a week there and two days a week in the Department for Education. Being a joint minister is complicated. I, for instance, insisted on a single private office that moved between the buildings and if anybody is appointed into two departments, I would strongly advise that. When I was later appointed into DECC [Department of Energy and Climate Change] alongside BIS [Department for Business, Innovation and Skills] as the minister for business and energy, I again insisted on a single private office and it caused quite a fuss because there was an existing private office in the energy department. And by then I was a fully-fledged minister and I arrived with my private office and obviously that required a bit of management to make it work. But Michael Fallon, when he was previously in two departments, had had the experience of writing to himself from one ministry to the other and I thought that was ridiculous because that was putting the silo through the middle of an individual minister, whereas the point of a joint ministerial appointment is to be able to bring two departments closer together.

TD: A broader question about being a minister: you’ve spoken previously about being dyslexic and how the government adapted to that and how the civil service supported you with that. Can you tell us a bit about that?

MH: Yes. My dyslexia means that my reading is not very quick. I’m lucky in that I absorb and hold numbers in my head in an almost photographic way, but it’s not the same with words, and in particular words that I don’t recognise. My biggest fear – the immediate thing that hit my mind when I worked out that I was about to be made health secretary by Theresa May a few years later – was ‘how am I going cope with all the Latin and Greek words?’, which came to pass when we found that dexamethasone reduced your chance of dying from Covid. And I’ve told the story before of a hilarious half hour I spent with Jonathan Van Tam [England’s deputy chief medical officer, 2017–22] as he said to me, “dexamethasone” and I jumbled it and jumbled it and eventually got it ready so that I could do a presentation to the public of this wonder drug and not garble its name.

Anyhow, the number one thing that meant was that I had to therefore have high-quality summaries. It was easier as a secretary of state, ironically, because you could read a one-page summary, which I insisted on going on the top of all of the papers in my box each night. And if I decided based on the importance of the decision, the political sensitivity of it and my own level of either background or interest in it, I would delegate that decision if I decided it wasn't for me. As a junior minister, you don’t have anybody to delegate that sort of thing to and so you just have to get on with it. But the one-page summary was a really important part of my daily method.

"My dyslexia means that my reading is not very quick [...] the number one thing that meant was that I had to therefore have high-quality summaries."

And actually, I honed over the decade I was in office what the one page looked like and I would recommend it to any minister. It’s quite simple really, but what we got to was: the date of the submission; the date they needed or wanted an answer; the one sentence description; then comments from special advisers and private office, who would have a wider view of how this fitted into the context of the business of the department or the views of other ministers, for instance. So if I got something and it said, “Vince really wants this to happen” and I’m the junior and I agreed with it then I’d really give it a shove; if it came in saying “Vince really doesn’t want this to happen” and I really wanted it to happen, or the centre did, then I’d also give it a shot, but I’d handle that differently – so steers like that. And then basically half the page is a summary of the paper with the decision questions in bold at the bottom; and then a bit of space to write on.

And then from one page, you can immediately synthesise, ‘is this immediate?’ – you know, the urgency-importance question: working out what is important, what is urgent, what is both and what is neither – and the amount of time it will take me to make that decision and therefore, ‘am I going to do it immediately?’, ‘am I going to put it to the bottom of the box and do it if I get to it?’. ‘How am I going to handle it?’, basically. So the top sheet from private office: really valuable.

TD: Your first cabinet role was at the Department for Digital, Culture, Media and Sport. You were appointed to that by Theresa May in early 2018. How did becoming a secretary of state change the way you did the role?

MH: Before I was made secretary of state, I attended cabinet under Cameron, which was incredibly helpful. I attended as the number two in the business department and the energy department, which was two minister of state jobs joined together. Both of those departments were run by Lib Dems, Vince and Ed Davey [secretary of state for energy and climate change, 2012–15], and so David Cameron asked me to attend cabinet so that there was a Conservative view on those two important subjects around the cabinet table. And then I attended cabinet as paymaster general when I was effectively number two to Oliver Letwin [minister of state for government policy, 2010–16] in the centre and running the Government Digital Service, doing digital transformation of government. And so I knew what cabinet felt like; I’d spoken in cabinet; people were used to me saying things – albeit from right at the end of the table – and therefore, you know, you try to make a crisp and a clear point; understanding your place in the dynamic of that institution. So I had had training, if you like, in being a cabinet minister.

Going from being a junior minister to a cabinet minister, I found incredibly liberating. I really enjoyed it. Going into government is like getting into a Mercedes and going into cabinet is like you’re in a Ferrari – not that I’ve actually ever driven a Ferrari. You touch the accelerator and it shoots off. As in, the civil service becomes ultra responsive. And you’ve actually got to also be slightly careful of that because you can say things that will then get interpreted and four weeks later, something comes up to you – a meeting goes in the diary or something comes in the box. “Well, this is what we thought you wanted.” And you are like, “well, that was just noises off or a note of exasperation.” And so your whole demeanour becomes part of the policy direction and leadership of the department and the civil service are super sensitive to that.

"Going into government is like getting into a Mercedes and going into cabinet is like you’re in a Ferrari – not that I’ve actually ever driven a Ferrari. You touch the accelerator and it shoots off."

I mean, what I’d say on that is that my experience of being a secretary of state is that if you understand that your role is to provide direction, communication and upward management – i.e., handling the centre and the Treasury – and then to choose between options put to you for how to get from A to B, you will achieve far, far more than when you spend your time in the weeds of how to get from A to B and what the options are. Your role is an unusual mix of exec and non-exec. And we can come on to Chris Wormald [permanent secretary, Department of Health and Social Care, 2016–24], who has just been made cabinet secretary this week – what he was a past master of was understanding what I wanted to achieve and advising on how to get there, and if the route that we had come to, either because it was my presumption that would be the route or because that was the initial advice on the route, if that route was blocked – for practical reasons, for political reasons, because we couldn’t get the money out the Treasury, whatever reason – what he’s brilliant at is helping you find another route to the essential direction or destination that you're looking for. And that is an A1 skill set – the best in the civil service.

There’s been a debate in recent years about ministers being blocked by the civil service. My experience is that this literally never happened to me when something was physically achievable. And I observed in coalition in particular – because it was brought out into the light by the nature of coalition – that usually when a junior minister can’t achieve something, it’s because the secretary of state doesn’t want it to happen, but doesn’t want to tell them directly, and so it just goes into the grinder. If, as a secretary of state, you can’t achieve something, it’s either because it’s not possible, or because it’s not legal and you don’t have the time, bandwidth or wherewithal to change the law, or because the prime minister doesn’t want it and he or she doesn’t want to tell you that they don’t want it. And then the civil service get the blame.

So I saw it as a top level part of my job to ‘upward manage’, as I call it. You have to be able to know that the prime minister and the chancellor are at the minimum acquiescent to what you want to achieve and preferably favourable to it, and then you need to work the machine to ensure that the machine between them and you accepts that decision. Because often, and this was particularly the case under Boris [Johnson], the machine layer between Boris and me would not like something that he had agreed to. And it was partly his nature – he’s not famous for always giving the clearest of steers or always giving the same steer to two different people if asked – but nevertheless I would have to have the meeting with him in order, in front of people, for it to get minuted that the prime minister agreed with my proposal and can we please therefore bloody well get on with it. And so upward management is a critical part of the job.

"[Boris Johnson's] not famous for always giving the clearest of steers or always giving the same steer to two different people if asked"

And so to any new minister, I would say the civil service are not your blockers, but sometimes they are the messengers either of real world impossibility – and you can push at that because sometimes they’re too cautious and that’s fine, but if you’ve pushed three times and you’re still getting a no, there is a real world blocker. So there are undoubtedly areas where the civil service are unkeen. They might have seen it before and think that it’s a disaster or they might think it’s unwise and therefore make it harder for you. But my rule of thumb was if you push something three times and it won’t move, you’ve got to work out what the real world blocker is.

And if you find out the real world blocker is that the prime minister is dead set against this, then you drop it, right? Because they’re the prime minister! Or you might find that there’s an adviser in No.10 who absolutely hates it and then you’ve got to work it out. Then it’s you versus that adviser to persuade the prime minister, and the prime minister of the day will choose: it will go one way or the other. And there’s a whole art to getting that piece of paper into the prime minister’s box and sometimes you could be quite Machiavellian about that. Knowing how to unblock that blockage is an art form but those who blame the civil service are not leading in an effective way – that’s my strong view.

Emma Norris (EN): You became health secretary in 2018 – one of the biggest spending departments in Whitehall. How well-prepared did you feel to take on the role and how did you go about getting to grips with it?

MH: Well, nobody’s fully prepared to become health secretary and I’m not a trained clinician. But there are a couple of things that were really helpful. The first is that as an MP, I’d spent a lot of time with my local health system – both what was then the CCG [clinical commissioning group – the body responsible for planning and commissioning local health services] and the local hospital and my local GP surgeries. I knew them really well and had very good relations with the leadership and so I understood how the system worked.

And one of the big strengths of the UK system is that as an MP, you may not be an expert in an area but you have an understanding of what it looks like from the point of view of the public. And I defend the fact that we don’t have experts in the top jobs in the UK system because your job is not to be the representatives of doctors, or train drivers in the transport job. Your job is to be the representative of the public and to take advice from the experts. That’s how the system works and I think it’s, by the way, the best way of doing it. You only have to look at the Americans to rapidly discount alternatives. So the first thing was that I had an understanding of the system, although not an expertise in the system.

The second thing is that I had an understanding of really big numbers. And this is important because of the impostor syndrome that you inevitably get in those really big jobs. I’d worked at the Bank of England for five years and I’d been in the engine room there, if you like, on 9/11, when the financial system came closer to collapse than anybody now remembers. And I was a 22-year-old private secretary and I was personally involved in negotiating a $25 billion swap facility with the New York Fed because my boss gave me the authority to and then had to go off for a meeting on something else because there was a crisis going on. He gave me a negotiating umbrella of up to $35 billion and I secured $25 [billion] from the Americans and I literally wrote the contract out and faxed it to them and then they edited it and faxed it back. And one of the banks was going to go bust if we didn’t get this sorted by the end of the business day. That was when I was phased by big numbers.

Fast forward 20 years and I’d dealt with very large numbers. But nevertheless, when you’re made responsible for a £150 billion budget, that is a lot of other people’s money and so the sense of deep responsibility is immediate. But that experience had helped and I’d been involved in crisis management both at the Bank and when we were in opposition. And, you know, I remember Chris Wormald on day one saying to me, “when it comes to the presentational stuff, the question is not ‘are we in the news?’ It’s ‘do any of these news stories matter?’”. And of course, in the pandemic, there were days when nine of the top ten stories on the BBC app were our responsibility as a department. And that was extreme crisis management, of course.

And the other defence of generalists in cabinet jobs is that actually half the skill set is transferable. It’s communication, it’s leadership, knowing how the government machine works at the top, high politics. And I had, by 2018, six years of ministerial experience, which was enough to feel comfortable in that element of the job.

The other thing that I decided within hours was that I would set out early priorities. I think I was appointed two weeks before the summer recess and I said that I wanted to give a speech just before the summer recess, setting out early priorities. And I remember saying “setting out my priorities” and Chris saying “I would recommend calling them your early priorities in case you want to change them on reflection”. And that was very good advice and in fact we added one to it – this was all pre-pandemic. And so I set out my priorities of workforce, technology and prevention – and I’ve enjoyed seeing that they’re Wes Streeting’s [appointed health secretary in 2024] three priorities now. 

"the other defence of generalists in cabinet jobs is that actually half the skill set is transferable. It’s communication, it’s leadership, knowing how the government machine works at the top, high politics"

And the reason for that – and this I got from reading Nigel Lawson’s [chancellor of the exchequer, 1983–89] memoirs – is that you’ve got to remember, especially as a secretary of state, that your speeches and public communications are as important for telling your own team what matters to you as they are for telling the public what matters to you. And throughout the pandemic, I used the platform in No.10 – the daily press conferences – often to speak directly to the health and social care workers on the front line, as well as, of course, to the broader public. And there is no internal comms function in the NHS as a whole: there is only the media, because it’s too big. I actually tried to set one up and it didn’t happen, partly because it’s such an enormous beast that you can’t.

So a long answer to your question, but there were pieces of my experience that came to bear straight away and that I brought with me. But my big fear was not being able to understand and articulate the substance of the clinical side, not the organisational side, which I knew I’d be able to get my head around, or the policy conundrums, which is the sort of meat and drink and what I love, but the clinical side. In the end, other than the specific pathogen of Covid-19, I didn’t need to do that because that’s what you lean on your CMO [chief medical officer] for.

EN: You talked about your three priorities – workforce, tech and prevention. How did you actually come up with those priorities? As you say, you alighted on them quite quickly into your time as secretary of state.

MH: In a way, it was obvious. And in the end, I only added one more, which was infrastructure and that was because when Boris came in as prime minister, he was particularly keen on it – 40 hospitals – so that became the fourth. But the three each have a story behind them.

The tech, because that’s why I was appointed as health secretary. That’s what Theresa May said to me. Boris had resigned as foreign secretary, Jeremy Hunt [health secretary, 2012–18] was being promoted to be foreign secretary. I went into Downing Street. I wasn’t expecting to be promoted at that point. I had only been culture secretary for six months. I was slightly hoping not to because I was really loving it. And Boris resigned. I was at a reception in the House of Commons speaking and as I came off, my private secretary said, “I think you need to take a call”. The call was “will you come over to Downing Street?” Obviously, the answer is yes.

On my way over to Downing Street, I didn’t know what job I was going to get. I was sure I wasn’t going to become foreign secretary – that would have been a ridiculous promotion – and therefore I knew that the prime minister was going to promote somebody between me, in the most junior job in the cabinet, and all the way up to anywhere below the great offices of the state, essentially, or maybe even just anybody below chancellor. I was like, ‘is she going to put Gove [then environment secretary] in the job and then I’ll do environment?’, or – I can’t remember who the various options were – but I could have ended up in any of the mid-ranking cabinet jobs and I didn’t know which one.

And when you get promoted or appointed, you’re taken in and often in a full blown reshuffle, you’re put in a room and other people are put in other rooms around Downing Street and everybody’s kettled in individual room so nobody knows who’s where, because if somebody turns down a job then they’ve got to have people on hand to be able to slot into different jobs. The Institute for Government’s done lots of work on the joy and chaos of reshuffles. 

"rather sweetly [Jeremy Hunt] unpinned his NHS badge that he always wore and pinned it on my lapel in this sort of ceremonial handover of the responsibility for the NHS"

In this simpler reshuffle, they didn’t bother doing that. They must have been absolutely certain I would take the job, and they must have been absolutely certain the other person was going to take the job and so it was just straightforward. I walked into the White Drawing Room on the first floor of Downing Street, with the picture drawn by Churchill on the left hand side as you go in the door and the two chairs where the prime minister receives foreign dignitaries overlooking the Downing Street garden. And standing there in the window was Jeremy Hunt, and that was the moment that I knew I was going to be the health secretary. And rather sweetly he unpinned his NHS badge that he always wore and pinned it on my lapel in this sort of ceremonial handover of the responsibility for the NHS. So I had about half an hour during which the first thought that crossed my mind was about all these long words. But obviously I knew I had to keep schtum because I didn’t want to jinx it.

When Theresa May appointed me she said, “we need to digitise the NHS. You’re a digital chap. Please could you go and do that.” So a bit like Cameron saying “go and push apprenticeships”, all I got was just a high-level steer and I remember, because I’d had half an hour or so, I then asked her a series of policy questions: “what about this? What about that?” She was like, “I’m appointing you because I trust you to make these judgements, but the reason I’m appointing you is to do digital.” So that was why technology, and it was my background anyway.

I then walk into the department and after Chris Wormald had talked to me, the next person to come and see me was Sally Davies, who was CMO, and she literally sat opposite my desk – as you’re sitting opposite me now – and she hit the desk and she said, “if we don’t do better at prevention, the NHS will not survive.” I was like, “OK. I buy that argument.” I’d done some work with Jeremy Hunt on this agenda as culture secretary anyway, in terms of exercise and sport, so I was open to this argument. So that’s prevention.

And then workforce, because the junior doctor strike – still technically ongoing – was like the Korean War. It was a frozen conflict. And I wanted to resolve that and so workforce was the third peg. So that’s why those three.

EN: And so you have a sense of what you want to do but not so long after you’ve become health secretary, the pandemic begins. At what point did you realise just how consequential a crisis Covid-19 would be? And how did you go about getting to grips with having to make such enormous decisions about people’s lives?

MH: I knew that it was deeply problematic in the third week of January [2020] when Chris Whitty [England’s chief medical officer, 2019–] said he thought there was a 50/50 chance of this escaping China, and if it escaped China it would go global. And from 23 January, Chris Wormald delegated all of his non-Covid responsibilities – so his entire job as of 1 January – to David Williams [second permanent secretary in DHSC, 2020–21], who’s absolutely brilliant and now perm sec at the MoD, and I started the daily coronavirus meeting. And the series of meetings that we had in late January essentially set out all of the things that we eventually did. It’s when we first pushed on the vaccine; it’s when we first started buying PPE [personal protective equipment] from abroad; it’s when we got going on testing, albeit not early enough. And so from late January we were absolutely full on at it. And it was surreal because this team knew there was a massive problem because I took a 50/50 chance of a disaster as requiring everything to be thrown at it. And the rest of the world was just cheerfully going on its business.

So when you look at what happened from the health department down through the NHS and PHE [Public Health England] as well, in particular, they got going at that point. And you have mentioned testing, PHE was responsible for testing at that stage and they were brilliant at doing the early tests – when it was scientific – but they couldn’t get the scale and it took until March when we took responsibility of them and put it into a separate organisation to build the testing system. But whatever the criticisms you can make, and of course we were getting them right from the start, which is totally reasonable – there were things we could do better and that’s what the inquiry is about – all of the subject areas if you like, were all there from that late January set of meetings. And looking back at the notes of those meetings now, it’s quite extraordinary because you can see the traces back to these huge programmes that started in those discussions.

EN: As a secretary of state, you’re always going to have to make big decisions but being the secretary of state for health at the outset of a global pandemic means a different scale of decision making than you were anywhere close to anticipating. How did you go about getting to grips on a human level with that to make those kinds of decisions?

"In a pandemic, no decision is a decision."

MH: The decisions were of different scale and also of a different nature because – and I think this is what made it all doable at a human level – most of the time, [taking] no decision is a perfectly plausible option. And the view I learned of how the machine operates is that if you take no interest in an area as a minister or as a secretary of state and there’s no ministerial level leadership given to a particular area, it carries on. The ship of state sails on just gradually getting more encrusted with barnacles – slower and will be overtaken by others – until somebody shines a spotlight on it. And part of the job is to spot where the barnacles are growing and get them off before there’s queues at the passport office or whatever else it might be.

In a pandemic, no decision is a decision. And of course it is in normal times, but in normal times it’s an essentially inconsequential decision mostly. In a pandemic, no decision is an active decision not to do anything. For instance, when it comes to lockdowns, no decision has life and death consequences. No decision on the vaccine would have prolonged the lockdown in 2021.

In a way, that then psychologically made it easier to take really big decisions, because I remember the out of body experience I had sitting in the cabinet room – I remember exactly which seat I was sitting in – when Chris Whitty and I had decided going into the meeting that we had to tell Boris that we had to stop all unnecessary social contact and ask everybody to do that. And I remember sitting there saying, “prime minister, we are going to have to tell everybody to stop all unnecessary social contact”. And that felt deeply strange and completely unprecedented. I almost had a physical reaction to saying it.

But most of the decisions were necessary decisions and it’s simply a matter of ‘make the best decision you possibly can with the information that you have’. By the way, information was much poorer than normal, but you never have perfect information. So that was a degree of magnitude harder, but not conceptually harder: information is always imperfect. But normally you can say “let’s delay by a month and go get more information”. You couldn’t do that in these circumstances. It comes back to this point that no decision was an active decision, but that made it easier then to make really big decisions because you knew that at that moment, in that meeting, you had the decisions on the table in front of you and you had no decision, but I saw no decision as one of the outcomes of the meeting, not just a non-answer, if you like. 

A case in point is when we brought in the start of the lockdown a week before the legal lockdown. In the COBR room [Cabinet Office Briefing Rooms – shorthand for the government’s Civil Contingencies Committee], Simon Stevens [chief executive of NHS England, 2014–21] said – and I talked about this at the inquiry – “we need 24 to 48 hours to get the 111 system [the NHS non-emergency helpline] up and running with new scripts ready for the calls that inevitably going to come”. We announced this and Sadiq Khan [mayor of London, 2016–] said, “I think we should just take the risk on 111 because this is a major problem, we need to do it now”. And Boris decided in favour of Sadiq over Simon, but you couldn’t have not made a decision. If we’d said, “we’ll have a think about that and have a COBR tomorrow”, that would have been a decision. Boris sided with Sadiq but irrespective of which way he sided, he had to take a view. So that made it in a way easier because, I mean, these decisions weren’t easy but there was no alternative.

EN: And lots of the policies that you were having to grapple with during a pandemic, like support bubbles, for instance, affect different people in different ways depending on their family structure, their living situation. How did you go about understanding the different impacts things might have on different people?

MH: I have found my political philosophy training from the PPE [politics, philosophy and economics] degree at Oxford more useful than I would have possibly have imagined at the time. Because when you’re facing a novel situation, you need something to fall back on. In DCMS [the Department for Digital, Culture, Media and Sport], I’d brought in what became the Online Safety Act and we had just started that process with, I think a green paper – I mean, it was very tentative: it started with a speech. That was bringing political philosophy to a novel situation. And the argument was the online space needs to be liberal, as in, according to the harm principle – straightforward JS Mill [the nineteenth-century political philosopher and author of On Liberty]; straight out of second year PPE tutorials – as opposed to a libertarian approach, which had been the government’s position and was Ed Vaizey’s [a DCMS minister, 2010–16] position beforehand. I spoke to political philosophers about this at the time, to try to give an intellectual framework to something that was completely novel.

So that was in DCMS pre-pandemic. And when you’re faced with these huge and novel decisions, you’ve got to come back to your political philosophy. And again the harm principle is important. And I wish I had talked about this in public earlier than I did, even though this wouldn’t have been for mass communication necessarily, it might have helped explain what we were doing to other decision makers and to the commentariat better, which is to say if you’re a liberal, then you believe that people should be as free as possible as long as they’re not harming others. And the problem with a pandemic is that you can harm others without even knowing it. And therefore there is a stronger justification for state action than in normal times, even without changing your political principles. You have to be a libertarian, not liberal, and not take the harm principle as gospel, if you don’t believe in lockdowns. And I see that as a distinctly different political philosophy. And, of course, there were some libertarians in the Conservative ranks – Liz Truss [secretary of state for international trade at the start of the pandemic] chief amongst them, and she agitated on this basis throughout – and Boris has a streak of libertarianism as well, although his is a very complicated political makeup. But taking a first principles approach to novel problems was important.

And then I found my economics was important because epidemiology is actually based on the same maths as economics, because it’s all about the interaction of the real world and human behaviour, and it’s therefore on the boundary of art and science – they are both behavioural sciences, if you like. And the maths is all about the exponential in both economics and epidemiology. So I found epidemiology natural – I found I had a natural understanding and affinity for it, especially with the best tutor in the world, Chris Whitty. And my early conversations with him on some of these things like, you know, the definition of the R number [the reproduction number, which measures how fast a virus is spreading] were, again, like Oxford tutorials: it was a one-on-one from the best tutors in the world. So I found I relied on that a lot.

EN: And you mentioned Chris Whitty – you were often not just having to make decisions at speed, but when there wasn’t, for instance, scientific consensus: you were getting different advice, different views, or when the information was just changing all the time. How did you go about making decisions in that context?

MH: Synthesise as much information as you can and make a decision in the time frame that you need to. I mean, that’s it.

It comes back, actually, to your earlier question, which is “how did you feel about making these big decisions?” And the same answer, which is a decision not to decide was a decision, and therefore you have to make the best decision that you can. One of the things I felt very, very strongly throughout was that I was making the best decisions I could in the circumstances. And I quite early on decided this was highly likely to be – going to be – the biggest thing that I did in public life. And Rishi [Sunak, then chancellor of the exchequer] and I talked about this actually: even if either of us became prime minister, it was likely to be the biggest thing either of us was going to do in public life and therefore I stopped caring about the partisan politics of it right at the start – that really didn’t matter. It came to matter for parliamentary handling purposes later, but I knew that this is it: when a million people might die, you drop all of that.

"I quite early on decided this was highly likely to be – going to be – the biggest thing that I did in public life."

And in a way that made it easier as well because then you’ve got your political philosophy, you know what you’re about, you’ve got as much information as you can, you’ve got the best advice you can, you try to take lots of voices into account, you’ve got to upward manage – and obviously with some of Boris’s aides that made life much more difficult – and then you’ve got to run a massive machine and you’ve got to get enough sleep. We actively talked about getting enough sleep and making sure that we ate well. We all stopped drinking – I banned the department from drinking. So the two Chrises [Chris Wormald and Chris Whitty] and I, as the leadership team, effectively, of the department had active discussions about “this is going to be a marathon. How are we going to get through?” So I thought about taking a flat next to the department and moving in, like leaders often do in the election campaigns, that sort of thing. We decided that it was actually going to be too long a period for that. And so we thought about the logistics of it and keeping ourselves fighting fit.

And then a bit later, when the military came in to support on the logistical front in the department, that really helped that whole area as well because they actively think about this far more than politicians do, and so that was a part of it in the sense that you can give logistical advice to new ministers about handling the timetable and the Finkelstein law [after Daniel Finkelstein, Conservative peer and Times columnist], which is “never accept a meeting in six months’ time that you wouldn’t want to do tomorrow”, because it’ll be tomorrow eventually. But that’s normal times: that’s easy compared to in a crisis.

EN: The Department of Health and Social Care was the lead department during the early days of the pandemic. That meant that you were having to oversee decisions that didn’t sit really within your department: school closures, things like that. How did it feel to operate across departments?

MH: By the time we got to school closures, it had become prime ministerial-led, but obviously we had a huge interest in all these cross-government decisions. Early on we found it frustrating working across government. The Cabinet Office actively blocked things that we thought needed happening, on process grounds. It’s a matter of record that I struggled to get the first COBR meeting going and I knew I needed a COBR meeting because COBR is the mechanism for a non-prime minister to secure cross-government decisions. The utterances of the chair of COBR become government policy automatically, because it is formally a cabinet sub-committee. And so if you’re given the chair of COBR, you effectively have that right to act across government. Of course, it still might not happen if the secretary state doesn’t want it to happen, but you need to have the secretary of state in the room and effectively agree it with the secretary of state. So at first it was frustrating, but then they came in with gusto, and that was very impactful.

"[Dominic] Cummings took the view that his view was more important than the prime minister’s and we now know that he also thought the prime minister was an idiot"

That was good for a while, but it was also chaotic and it was chaotic specifically because of the attitude of Dominic Cummings [chief adviser to the prime minister, 2019–20], because his view was that he did not have to represent the view of his boss, and in those senior No.10 aide jobs that is unconstitutional and obviously wrong. And it’s wrong for a reason: it’s because it’s totally impractical. You’d never get a Jonathan Powell or an Ed Llewellyn [Downing Street chiefs of staff, 1997–2007 and 2010–16 respectively] – who are the two pre-eminent chiefs of staff that I know of – differing in any way from their boss. Now, they may use constructive ambiguity to not tell you whether they’ve actually spoken to the boss about it or not, but they would know their boss’s mind well enough to know if they could make a decision on the boss’s behalf or have to refer it. And having been a chief of staff myself, albeit in opposition, to George Osborne [shadow chancellor of the exchequer, 2005–10], I understood that role and how to play it. And, of course Charles Powell [private secretary for foreign affairs to the prime minister, 1983–91] actually, not that I was around during that period, but from his descriptions of not needing to talk to Margaret Thatcher because she was so clear in her views and that being one of her strengths and how she managed to get so much stuff done. 

Cummings took the view that his view was more important than the prime minister’s and we now know that he also thought the prime minister was an idiot, although he didn’t make that clear at time. And therefore he held meetings that clashed with mine, whether intentionally or not, and caused chaos in accountability. But once Mark Sedwill [cabinet secretary, 2018–20] got a grip of that and put in place proper structures, and Cummings focused only on testing, that all sorted itself out. Testing was a total nightmare for exactly the reasons of poor accountability, but at least it was constrained largely to that area. One of the reasons the vaccine project was such a success is because we kept it out of No.10 and the Cabinet Office.

In terms of the question about impacting on other people’s departments: frankly, the rest of the cabinet were brilliantly collegiate and the key people really lent into the whole thing – Ben Wallace [defence secretary, 2019–23] at Defence. Gavin Williamson [education secretary, 2019–21] and I disagreed on some of the school closure measures but they were decisions properly taken in a process sort of way. And I was just a voice in the room for those once the centre had taken over and then ultimately if there was a disagreement in the classic sense then the prime minister would decide. So once we got the structures organised, it was fine, but it wasn’t easy with Cummings around.

The final piece of that puzzle, when it really worked well, was when Gove [by then chancellor of the Duchy of Lancaster] was essentially given what should be recognised as deputy prime ministerial powers to chair Covid-O [the Covid-19 Operations Committee], which sounds very technical but because it was a cabinet sub-committee could make decisions across government, and he and I were in strong alignment on the substance. And as you’ve seen from some of the text messages, you can see the raw way in which we sometimes exercised that power.

TD: One of the challenges, particularly early on but throughout, was about what was happening in social care. Sitting in DHSC, what were you doing to try to understand what was happening in the social care system and the knock-on effect of your decisions for social care?

MH: So social care seriously needs reform because the accountability and lines of authority are misaligned. That’s the fundamental problem. Social care is 90% delivered by the private sector: that isn’t the problem because the problems in social care bedevil the public and the private elements of it. The problem is that formal accountability of social care is with local government but that’s not how anybody feels it. It comes back to a core challenge of devolution within England, which is the hard part of devolution is devolving the accountability. The easy bit is devolving the powers, but devolving powers, if you don’t successfully devolve the accountability, is counterproductive and won’t last.

"social care seriously needs reform because the accountability and lines of authority are misaligned."

The 1946 settlement [the act that established the NHS] was that the NHS would be nationalised in terms of powers and accountability but social care will not. And short of ripping that up and creating a nationalised system of accountability for social care, we will always be muddling through – that is my view. And we got to the best possible solution without ripping up the 1946 settlement with the social care white paper that I was involved in the formation of, and then Sajid Javid [health secretary, 2021–22] published in September 2021, that then fell by the wayside due to internal Tory politics about the tax rise needed to pay for it.

In terms of the pandemic, the NHS had a very strong voice in the room in the person of Simon Stevens and a very strong resonance with the public and that meant that they had their say. So, for instance, on one of the most controversial measures, of course, which is the discharge of people from hospital into care homes, that was a policy very strongly pushed by Simon Stevens on two grounds. The first is to ensure there was hospital capacity, because people would die if there wasn’t enough. And secondly for the protection of those who otherwise were highly likely to catch Covid in hospital and will be highly vulnerable to it because hospitals are very dangerous places in pandemics. So he had good policy grounds to push that and pushed it very hard. I have looked over the decision to do that over and over again and I can’t see a better alternative because leaving people in hospital would have led to more people dying – that’s my view with hindsight and it was why I went along with this decision. In a way it’s just one of the most extreme examples of government choosing between different and unpalatable options.

So the NHS did have a very strong voice in the room and I therefore spoke up for social care and we had to balance these two things. But fundamentally, I can’t see a better way of doing it in that moment. There is a better way of doing it in the future which is to have better isolation facilities within care homes and obviously it’s something that should be worked on in preparation for the next pandemic. But there has to be an answer to the question, what do you do with people who are medically fit to leave hospital for whom clinical assessment is that they’re more likely to catch Covid, and these are people very vulnerable, in this case, to this disease, and how do you deal with that?

Now second time round, we did better because we put a lot of effort over the summer into making sure that all care homes had facilities for the isolation of people coming out of hospital. And there’s debates around this like, “why didn’t we test them?” – well, the answer is we didn’t have enough tests. So there is a public debate here which is separate from the debate based on the facts at the time. But that doesn’t take away from the fundamental problem with social care being this point about devolution versus accountability.

TD: You’ve mentioned Chris Wormald a couple of times: I was wondering if you could tell us your reaction to the news that he is going to be the new cabinet secretary?

MH: Genuinely, Chris is one of the finest public servants of our generation. And all four reported candidates [Dame Antonia Romeo, Tamara Finkelstein and Sir Olly Robbins] would have done a brilliant job. I’ve worked with all four of them and all four of them could have done the job. So in a way, there’s always a public debate about the calibre of the civil service, but the top four options are all brilliant.

I think Chris is deeply experienced. He’s got experience both of the court mandarin aspect of the job, which – whether you like it or not – is an important part of the job. Having been the director general in Nick Clegg’s office when Nick Clegg was the deputy prime minister and, a long time before that, a private secretary, he understands those dynamics that are necessary to manage at the top of government. And he has deep experience of the operational running of major budgets and major departments, especially in Health and Education.

His performance during the Covid pandemic was exemplary and at one point he and I worked out that we had eight times as much on as in normal times, and the health department is a big department and the job of permanent secretary or secretary of state is heavy going in normal times and we worked out it was eight times bigger. He handled that and learned from it.

And the other thing is that he is deeply modest, which will serve him well, handling the inevitable egos around the cabinet table and the Wednesday morning meeting [of permanent secretaries]. So he’s as well placed as anybody possibly can be to do what is an almost impossible task.

TD: Tell us what you are most proud of from your time in government and what impact you had in achieving it.

MH: Undoubtedly the thing I’m most proud of is the vaccination programme during Covid. It was one of the most effective and largest programmes of government in civilian times. And we went from the advice that it would take, in normal times, five to ten years to develop a vaccine to delivering one before anybody else in the world, in 11 months.

There were amazing people involved in making that happen. It was a huge team effort, but it was also about galvanising people to anticipate that we might actually come out in the best-case scenario. In a time when things kept going along the worst-case scenario, the challenge in the vaccination programme towards the end was getting the roll out ready in case the science and the amazing regulatory work by the MHRA [Medicines and Healthcare products Regulatory Agency] came out quicker than anticipated because we knew that there’d be huge pressure the moment one was validated.

So at the start, it was largely Oxford University and then it was the Vaccine Task Force doing their purchasing and then it was the MHRA – all three of these led by brilliant women – and then the roll out in the NHS, also run by a brilliant woman, Emily Lawson [head of the NHS Covid vaccination programme from November 2020 and previously NHS chief commercial officer]. And so those four parts all happened about as quickly as they possibly could, but the biggest challenge towards the end was saying to millions of people who are going to help make this happen: “this might all happen at the start of December”. And I remember when I first put that date out there, people were incredulous. And so I described it as the reasonable best case scenario, to contrast with the reasonable worst case scenario, and that’s what came off.

TD: Looking back, is there anything if you could have your time again, you would have done differently?

MH: Well, yes, lots of things, of course. It was an unprecedented time. The number one thing is when the next pandemic hits – and it is a when – we need to be ready to scale a whole part of the response that simply didn’t exist last time around: the testing operation is the single most important in the early days, the contact tracing, the protective equipment, the NHS response. Getting that up and running fast is vital. There’s now work on to have a vaccine within 100 days. I think that’s a good stretching target now to bring it down to essentially four months rather than the eleven that we pulled off under Covid and that’s important.

"The number one thing is when the next pandemic hits – and it is a when – we need to be ready to scale a whole part of the response that simply didn’t exist last time around"

But the single most important thing that we learn is what I call the ‘doctrine’ we need to apply. That’s normally a military term, but it means how you engage in a battle at a strategic level. And it is that as soon as you deem a lockdown to be necessary, you need to get on and lock down. There is no benefit from waiting. You may assess that you don’t need to do it – and obviously it’s great if you don’t have to and we have communicable pathogens that come into the country all the time that we don’t take such drastic action in response to – but as soon as you do assess that it’s going to be necessary, you should get on with it straight away, because you’re either then going to have a lockdown at a low level of prevalence or a lockdown at a high level of prevalence that will probably therefore go on for longer. So that doctrine is actually the single most important thing we need to learn.

TD: And what advice would you give a new minister about how to make the most impact and be as effective as possible?

MH: If a new minister asked me for advice, the number one thing I would say is to work out your priorities early and set them out clearly, but also to know what your job is. Your job is to set the direction and get clearance from your seniors, whether that’s your secretary of state, the prime minister, the chancellor – anybody who could block your plans – and then choose amongst the options for how to get from A to B, not to get down into the weeds of how to get from A to B. That is what the civil service is brilliant at and you need to use them because if you don’t sort out the upward management, you’re not going to get anything done.