Michael Matheson

Akash Paun (AP): In May 2011, you were appointed as minister for public health. What do you remember of the conversation you had with Alex Salmond, the first minister, when he asked you to take on that role?  What was your first day as a minister like?

Michael Matheson (MMa): I can remember it very distinctly. I remember going into the cabinet room. Alex Salmond was sitting there. At that point, I had no idea what the ministerial appointment was going to be. He sat with a list in front of him. If I recall correctly, I think I was one of the first ministers in that day, him having appointed his cabinet the day before. He sat me down. He said, “Look, Michael, I want you to be minister for public health.”

I'd previously been sitting on the health committee in parliament. I was leading on a lot of the media stuff around things like minimum pricing [of alcohol] for us as a back-bencher. I had built up quite a bit of a rapport with the media, dealing with issues around healthcare for us on the committee. I was a lead member on the committee at that particular point, when we were dealing with what was quite controversial legislation at the time. So I’d built a bit of knowledge around health.

After he appointed me, I remember leaving the cabinet room. The very first person you are introduced to is your private secretary. I remember very distinctly my private secretary saying, “We'll now go to St Andrew's House,” and going to St Andrew’s House [the headquarters of the Scottish Government]. Then it was just a day of actually being introduced to folk and starting to work out how you can manage your constituency diary and your ministerial diary. That's when you realise that you lose control of a very considerable chunk of your life in some ways. You have to set some really clear ground rules on how you're going to manage your diary and how you’re going to prioritise family stuff. 

Very quickly after I left St Andrew’s House, I got a call from Nicola Sturgeon, who was the cabinet secretary for health at the time – so I’d become her junior minister. I got a call from her to congratulate me, saying she was pleased I'd been appointed to the role and organising to have a catch up with her on how things work in the portfolio. You get a schedule of all the things that you are responsible for in your portfolio. I remember having a discussion with Nicola and on my list was long-term conditions. I remember, saying to her, “So which long-term conditions do you want me to cover?” She said, “Them all.” What happens on a regular basis is that a lot of long-term condition organisations and healthcare-based organisations have members debates in parliament. They have events in parliament. They are often having various conferences. As minister for public health, you find yourself in the chamber doing more debates very often than any other minister and constantly dealing with events for different healthcare organisations.

AP: How did you establish your own priorities? Did you still have some agency in setting those priorities and deciding what to focus on?

MMa: I came to it quite naturally because I had a healthcare background. Prior to being in politics, I was an occupational therapist, so I had trained in the NHS. My family have a nursing background as well. So healthcare was quite natural to me. One of the things that very often people find difficult when you go into a healthcare brief is the acronyms and language used around long-term conditions – “What the heck is that?” A lot of that just came to me quite naturally, so I could sit down with officials and at times tell them, “That's nonsense. That’s not how the system works.” With things like long-term conditions, it was quite easy for me. For example, if you've not got a healthcare background and the next minute you’re going to do a debate on, say, multiple sclerosis, then you might know a bit about it and that it can be quite disabling to someone, but do you know more about the wider context and the aetiology of the condition? I had that benefit. I could manage that. I was quite natural at being able to fit into the role because of my healthcare background. But what I found very quickly was that officials very often had less knowledge about it than I had myself. I found myself quite quickly in a position where I was starting to challenge officials around, “I don't think that's right. I don't think that's the right approach.”

When I was in healthcare, there were a couple of things that I prioritised. It was not just dealing with the long-term conditions issue. We were doing a lot of stuff around smoking. We'd already introduced the ban on smoking in public places. We were in a court battle around minimum unit pricing [of alcohol], but there was no legislation to bring in around smoking.

I was very clear about the need to make sure that policies were much more focused on tackling health inequalities. For example, we wanted our health boards to introduce smoking cessation programmes across the board. So if you want to give up smoking, you should be able to go along and they'll take you through a smoking cessation programme. They'd been doing that for a couple of years. What I did was change their target to not just be running smoking cessation programmes, but that 40% of those who participated in them had to come from the lowest income households. It was a very deliberate shift in public health policy to be targeted towards those who were from the most deprived communities. The reason I saw that as being important was because the broad-based approach we'd taken – in my view – was exacerbating inequalities. What was happening was that folk in smoking cessation programmes were largely coming from more affluent households, where they were making an active choice and had more confidence in accessing services. I was very deliberate in wanting our policy to be much more focused on targeting health inequalities.

I introduced further legislation around smoking, which was banning the displays in shops. Scotland was the first place to do that. We were going to introduce plain packaging. The UK government was refusing to do so. We had developed a link with Australia who were ahead of us on this matter. We were about to do that and then the UK government backed down and decided they were going to do it.

A key part for me when I was public health minister was not just doing long-term conditions, but making sure policy was directed much more towards tackling health inequalities. And I changed the narrative around it, because a lot of what we had in our healthcare policy was that the health services or the NHS will respond to these matters and that we will run a scheme in order to help to treat people with these particular conditions. My view was – and the narrative changed too – we need to stop talking about health inequalities in themselves and start talking about social inequality, because social inequality drives health inequality. The answers to this are very often outwith healthcare.

At that point, drugs policy was a justice-led policy. I can remember having a discussion with Nicola saying, “Why do we not have drugs policy in the health portfolio? It's a health issue. It's not a justice issue.” So there was much more focus towards tackling inequalities and also changing the narrative around policy from one which was based on just talking about the healthcare system’s response, to one which was much more about social inequality, how that drives health inequalities and how that then has an impact on our health service. In order to address these issues, we need to take a much more joined-up approach on how we deliver public health policy and how that links into our social policy.

AP: You mentioned minimum alcohol unit pricing – is that another example of the same approach to tackling public health problems?

MMa: Yeah, it was. If you look at the evidence base around minimum unit pricing, it has had a particularly beneficial impact on those on lower incomes who were buying high-strength, low-cost alcohol, which was having a very significant impact on their health. With the very cheap high-strength ciders. I don't know if you still get them to the same extent, but you used to get the supermarket own-brand spirits, particularly white spirits. It was quite clear that what supermarkets were doing was using these products as ‘loss leaders’ to get people to come into their shops. You'll go to the supermarket to get your food but also because you know there's good deals in there and you would get some alcohol as well, whether it be wine or white spirit or something else. They were using it as a loss leader and it was very deliberately and cynically targeted particularly at those they knew were on low incomes.

That again was driving our health inequalities, because people were buying cheaper alcohol on the basis of its cost, even though it was a higher strength. What minimum unit pricing does is it helps to close that down. It reduces that and we can see from the evidence base we've now got the impact that it has actually had in reducing alcohol deaths.

AP: What was your experience of taking that legislation through parliament and getting it implemented?

MMa: I didn't take the legislation through. The legislation was taken through by my predecessor, Shona Robison. I was the minister then overseeing the regulations and everything… but we were still in court at this point. I had been on the health committee that dealt with it and witnessed what happened. It became really quite a divisive argument, because you were either for it or against it. Despite the fact the evidence basis had been presented by academics from Sheffield University and the modelling they carried out showed the impact that this would have – they're the same experts who provided the modelling for the Blair government bringing in the minimum wage and they have great expertise in this area – it became a very, very divisive debate.

Then, once it was in place, you had the Scotch Whisky Association taking it to court. If we were to try and pursue that legislation today, I suspect it would be caught by the [United Kingdom] Internal Market Act [2020]. I don’t think we’d be able to get it through. But it became very divisive. I would say – and I was challenged by the alcohol industry at the time – that the tactics they used were reminiscent of the type of tactics that were used by the tobacco industry: draw it out, try to discredit those who are presenting the evidence base to you, and then try and delay things for as long as you could. I'm not comparing the two of them directly, but the tactics were not dissimilar to the behaviour that we saw from the tobacco industry historically. So it was very divisive and very difficult, despite the fact that the evidence base for it was very clear. And now we've got very clear clinical evidence that demonstrates its impact.

AP: This was the period when the independence referendum campaign was going on, running up until September 2014. What was it like to be in government during the campaign and how, if at all, did it affect your role as a minister?

MMa: It was a hugely exciting time. When we knew the referendum was going to take place, there was a huge amount of excitement in government. What you were then experiencing was a huge amount of international interest. I think probably for political reasons, very often wider policy interest was used to try and get into the constitutional debate stuff. You would get interest from ministers from overseas in what you were doing on smoking or alcohol or other issues around tackling health inequalities, but it always led into where things were going with the referendum and what you thought the outcome was going to be. I suspect for a lot of governments diplomatically it was probably a little more difficult to go over and engage directly on the constitution. I remember having a whole series of meetings – including with health ministers from Russia – all about smoking and alcohol, but it always got round to the constitution. From the point when we knew there was going to be a referendum through to when we set the date, there was a huge amount of energy and excitement around government and a huge amount of international interest.
It almost became a bit of a distraction, though, from some parts of normal government work, because it became the dominating factor running through what government was doing. It was dominating political debate. You were also extremely conscious that anything you said in any public forum that would normally not be that much of an interest to anybody could be very quickly manipulated. The public health minister speaking at a conference, answering a question and saying something jokingly, wouldn't usually really gather any interest. But you were very conscious that we were in a much more heightened state and there was a real risk that anything you say could be used against you. You knew the stakes were so high.

The other part of it outwith government was that you were under huge amounts of pressure politically, from a campaign point of view, to be getting out there and spreading the message as well. You were under pressure not only in your ministerial role. There was a huge amount of energy and excitement, but also you were under a lot of pressure to make sure that you were campaigning and out pushing for a ‘Yes’ vote as well. It was an exciting but also quite challenging time because of the pressure put on you in a range of different ways.

AP: Were you involved in the preparation that the government was doing for if there had been a ‘Yes’ result? Were there things within the health portfolio you were thinking about?

MMa: There were. At that time, it was led by my cabinet secretary Nicola [Sturgeon], who was also deputy first minister along with being health secretary. There was planning around things like the MHRA [Medicines and Healthcare products Regulatory Agency], so if we were to become independent, how we would access that, how we would make utilisation of that, and different control of drugs issues as well. We have highly specialised cross-border services, so there were issues about making sure that would continue. (I remember we looked at Ireland – who make use of those cross-border services.) Usually, sadly, very often for children who have got very rare conditions, maybe going to somewhere like Great Ormond Street. At that point, I think lung transplants took place in Newcastle, so we had patients moving across there. So we were looking at how you would deal with some of these types of issues.

We were also trying to head off questions as well. For example, around things like organ donations. The reality is that organ donations actually work on a pan-European basis, by and large, not just on a domestic basis. We were trying to head off some of these things. Officials were looking at trying to head off potential questions, but also making sure that we had a clear idea of how we would go about trying to manage joint UK programmes if Scotland became independent.

There was a tension within some of that. There were those who would argue that you should just do it on your own. Or do you go into a shared agreement with the UK government? It's not a health example, but I remember the discussion around DVLA. Should we set up a new DVLA-style system here in Scotland? Or do you just go into a contract with the DVLA in the UK and say, “Well, can you provide that service to us?” Say you do it for five years and then we will build the capacity to run our own organisation. So there was a tension between those who would say “You should just set it up right away” and those who would say “We’ll do something in partnership in the UK government and do it on a gradual basis.” Some of those debates were taking place internally in government at that time.

Millie Mitchell (MMi): After the referendum, Alex Salmond stepped down and Nicola Sturgeon became first minister. You became cabinet secretary for justice. What was that conversation like with Nicola Sturgeon, and what was it like to make the step up to being a cabinet minister for the first time?

MMa: I remember meeting her in Bute House – upstairs in her office, not in the cabinet room. She said, “Look, I want you to become the cabinet secretary for justice.” I said to her, “Justice or social justice?” and she said “Justice.” I had thought social justice, maybe with health and the type of stuff I was doing. I was a bit surprised at that. However, having said that, looking back, there was some logic to it, because when we were in opposition, when Nicola was the shadow cabinet secretary for justice, I was her deputy. I was on the justice committee for almost two parliaments – I think it was nearly one and half sessions – so I had spent a long time on the parliament’s justice committee. I was surprised. I thought she would be much more inclined to put me into something like social justice as opposed to justice itself.

But it was a portfolio I really enjoyed despite the challenges that we had during the time I was in office. I was able to use quite a bit of my experience from public health in justice. In my view, there was quite a significant read across between the two of them, which I was able to make use of in the portfolio. 

MMi: Are there any examples of ways you did that?

MMa: In the public health portfolio, because you were dealing with healthcare professionals and clinicians, it was quite data-driven. “We can see the data shows positive outcomes if you do x, y, z.” Reducing smoking is shown to reduce cardiovascular disease, cardiac disease, lung disease, all the other things that go along with it. Justice wasn't quite like that. Justice was a bit more general. It didn't have that same evidence-based approach to it. 

When I came in – I’ll be quite frank with you – it was a portfolio which had a lot of heat around it. There were a lot of fires that had to be dampened down in various areas. For example, we had just gone through the merger of our eight police forces to create one police force and the same with our fire service as well. They were struggling. There were real difficulties there. There were real tensions playing out publicly within our policing system as a result of the merger. It also resulted in a significant reduction in their budget because it was a cost-saving initiative. There were a lot of real fires and real difficulties in our police service. 

In our justice portfolio, there are three big areas I would say. You've got the policing aspect of it, you've then got your court aspect of it and then you've got the prison service aspect of it. There were a lot of fires burning in there. Courts were fine. They were where they would normally be. There were a lot of real problems in our prison system. Our prison system continued to have one of the highest prison populations in Western Europe. We were still locking up folk for very short term sentences, which were really ineffective.

I set out and tried to take a public health approach to justice. We published our justice strategy – the first in quite a considerable period of time – which tried to set a completely different tone to what we were trying to do in justice. It was about evidence-based justice decision-making and getting away from the false dichotomy that it's either ‘tough justice’ or ‘soft justice’. What I would say is it’s not tough or soft, it’s being smart. It is making smart choices in justice. Short-term sentences are rubbish. They don’t reduce reoffending, we know they disrupt households, all of that sort of stuff.

By that time, it was an example of exactly what government should be doing – trying to join up how the system has to play a part in reducing the potential risks of people ending up in our justice system from early-years education right through into adulthood, and what the different parts of government can do as well. I remember John Swinney – the DFM [deputy first minister] and education secretary at that point – was very keen on pushing that out right across government as much as he could. 

I'll give you some practical examples of how we went about doing it. We created Community Justice Scotland, which was a new body to look at how our criminal justice social work departments across the country were operating. We had 32 of them and they were all working at different standards and in different ways. I wanted to get greater consistency. The idea behind that was to get greater assurance around the services they would provide and the outcomes we would achieve from them. I headhunted the head of our violence reduction unit – Karyn McCluskey. I was reading an article in The Scotsman yesterday about how we could get much more into being evidence-based. I brought her in specifically to take that forward.

I then went through the process of looking at how we could reduce our prison population. The previous cabinet secretary for justice had a prisons commission, who had recommended that we should reduce our short-term prison sentences so that nobody should get a short-term prison sentence of less than six months. I decided to double that – nobody should get a prison sentence of less than a year – because the evidence shows it’s a pointless exercise. It’s really disruptive. 

I remember having a conversation with Henry McLeish – the former first minister. Prior to devolution, when he was a Scotland Office minister, he was responsible for justice and home affairs issues in Scotland. He had heard that I was looking into this and he came to meet with me. I remember him saying to me, “That's a really bold thing to think to do.” He was on the commission that looked at these things. I said, “Look, my view is that we need to disrupt the system. We need to demonstrate that we're trying to do things differently. Incremental change will no longer deliver the reductions in our prison population. As a country we aspire to be socially democratic. We say that we want to be a liberal open society, but we have got one of the highest prison populations in Western Europe. We are getting this wrong and we need to send this signal to the system.” So I said it would move to a year. I got agreement from the first minister in doing that. We had plans for a new prison to be built in Greenock in Inverclyde. I cancelled the prison on the basis that I wanted to see our prison population being reduced. 

And also at that time we had a real problem with our female prison population at Cornton Vale in Stirling, where it was overcrowded. It was described by the chief inspector of prisons as being like a casualty clearing ward as opposed to a reception unit for female prisoners. We were locking up women who had experienced sexual violence, domestic violence, alcohol misuse, drug misuse and were living in really difficult circumstances. We were taking a criminal justice response to it. In my view, we actually needed to take a different response, so I commissioned a piece of work to look at redeveloping and redesigning our female custodial estate. One of the last acts I did before I finished up as justice secretary was I quite literally started the digger to knock down Cornton Vale Prison.

We've got two female custodial units up and running – the first of their type in Europe that are now drawing huge international interest – where the women cook for themselves. They order their food in from the supermarket. It comes in and gets delivered, etc. It is about a much more trauma-informed approach. They are much more focused on trying to make sure that they're ready to live back in the community. They're based in local communities. They're not stuck all the way out somewhere. When you go past them, you wouldn’t know that they're prisons as such. They are very different and smaller units as well. 

It is a completely different approach to take – a much more public health approach to justice using data. The evidence shows this is a much more effective way to deal with offending behaviour, particularly for females. I reduced the amount of short-term prisoners because that’s not a good way to do it. Along with trying to settle things down in the police service as best we could with the issues we had in there, the other part I did in the justice system was to make sure that drugs moved from my portfolio into health. At that time, Shona Robison had moved to become cabinet secretary for health and we agreed to transfer drugs policy into the health portfolio, which is where it's been ever since.

That's a couple of practical examples of trying to use my previous ministerial experience in my approach to justice. Some of the things that we took forward were reflective of trying to take a much more evidence-based approach to our policies in justice – I’m not trying to be disrespectful to Kenny MacAskill [cabinet secretary for justice, 2007–14] and others – than what at times had seemed quite punitive.

However, the consequence was that the Daily Mail hated me – ‘Soft justice Matheson will let everybody out’ and everything. My argument was that the approach we’re taking makes our communities less safe, because we know short-term prison sentences are really ineffective. Folk go back out and re-offend again. The idea is to disrupt that. We know community-based sentencing is a more effective way to do it and I wanted to embed that on a national scale much more effectively.

MMi: Interesting and I think it is a very current issue in the UK at the moment with prison overcrowding…

MMa: I would say one of the biggest public policy failures in Scotland in the post-devolution era is our inability to reduce our prison population to be in line with the average for the rest of Europe. We continue to have one of the highest prison populations in Western Europe. England's the same. It is one of the biggest areas of public policy failure I think there has been the last 25 years.

The other wee bit so you’re aware in justice is that it has got a bigger reach than I had in public health, where it went into UK stuff. Because as justice secretary you deal with security issues as well, I had much more engagement with the UK ministers than I'd probably had in the public health side. Of the home secretaries I dealt with, probably the most engaging – and I would say probably the most respectful of the devolved settlement – was Theresa May [2010–16]. She was very engaging. She would just ask “can I give you a quick call about something?” She would engage with you. She was like, “Do you want to do that in Scotland? No? That's fine.” She was very engaging, very open to having a discussion about matters and I actually quite enjoyed the discussions we used to have with her. I found her very, very approachable.

AP: Who was the worst?

MMa: Who was the worst home secretary that I dealt with during my time? Well, the worst justice secretary I dealt with was Michael Gove [2015–16], because he appeared to have no interest in the portfolio whatsoever and just saw it as being part of his own political career. He didn't appear to have that much interest in it. 

Amber Rudd [home secretary, 2016–18] was much more party political. She wanted to play political games. Ben Wallace was the security minister at the same time [2016–19]. He was really helpful and used to try and deal with things. Amber Rudd was just trying to play political games, but Theresa May was very good.

AP: In 2018, there was a reshuffle and you became cabinet secretary for transport, infrastructure and connectivity – later changing to net zero, energy and transport. What's striking about all those sets of issues is they're all inherently long-term policy challenges. What did you learn about the role of being a minister in making progress on tackling long term challenges?

MMa: Going into transport, infrastructure and connectivity was quite a difficult transition for me, because it wasn't as people-based in the way in which I had been in public health and justice. There was a level of continuity in the approach that I took in public health and justice around tackling inequalities and the overarching strategic approach we took to policy development. I couldn't do that in the same way in transport, infrastructure and connectivity. That was actually the discussion when I was appointed by Nicola Sturgeon. She said, “I want you to do something that's completely different. This is going to be a completely different area to you.” I then found myself engaging with the Chambers of Commerce, CBI [Confederation of British Industry], Institute of Directors, construction companies – organisations that I hadn't really been engaging with previously. It was a very different space for me in that way.

Also budgetary-wise, it was a completely different space. It was a much, much greater budget. Transport has a huge budget and also the infrastructure budget. It took me into, probably, quite an uncomfortable space, where I was out of my natural territory to some extent. In that way, at times, I was a bit disappointed when I went into that portfolio, to be honest with you. It didn't feel natural to me. However, I can now see from the experience I got, it was a really good way of stretching me and taking me into a different area. 

I found myself being much more focused on economic issues. I found myself being much more focused on the technical aspects of things, so my knowledge of why certain things happen or don't happen in a rail network just went like that [gestures upwards]. From having absolutely no interest in them or no knowledge of them previously. I had an overarching role for infrastructure and strategic planning in government. Whether it be from a school building programme to a hospital building programme, I had to bring that all together to a central point in government so there was a coherence to our infrastructure policy – an area I had no knowledge of or experience of. But what you found was there were lots of different organisations out there who were keen to influence how government would go about spending its capital budget. I learned a lot from that and engaged with a lot of different stakeholders. 

The connectivity side was quite distinctive because that was very much about digital connectivity, which was about expanding broadband capacity. We had two contractors to provide that in Scotland so we went through a wee bidding process around that as well. So there was plenty of procurement, infrastructure, construction, franchising for trains, railway network, our ferry network, airlines, etc.

I was in that portfolio at the time when we went into COVID, which meant that I was then dealing with a lot of the issues that arose from, for example, major infrastructure programmes quite literally coming to a halt, the costs that were then associated with those, having to bring in transport restrictions across the whole of our network, having to bail out airlines in order to make sure we were keeping enough airline connectivity to allow us to support the health service, providing levels of public transport to allow healthcare workers to get to work. 

During that time, I was dealing with international travel with Grant Shapps [secretary of state for transport 2019–22]. In Scotland, we brought in managed quarantine hotels first. We tried to deal with airports that obviously had no passengers, who were getting really angry that we were putting in further restrictions. Bus companies and transport companies were quite literally going under, because there were no passengers and no footfall. 

It was quite a challenging time, but it was an area where I learnt a lot, getting into different policy areas with different stakeholders. It was much more economic focused. And then also dealing with the pandemic, which took me into a different space again. There was a lot of engagement with the UK government around dealing with international travel.

AP: What was your experience with that?

MMa: Grant was okay, actually. But we used to have these inter-ministerial groups. I can remember participating in these meetings where the chancellor [Rishi Sunak, 2020–22] would be trying to minimise the negative impact of a policy on the economy. Grant Shapps was very much in that space – talking about how if we restrict airports more and travel more, then the more the impact on our airports and airlines, etc. And you would have Matt Hancock [secretary of state for health and social care, 2018–21] on the other side arguing that “We need to do this from a health perspective as well.” And then you would have ourselves and the Welsh government, who would be largely taking a health approach rather than an economic approach. The dynamics were often about a battle between economic policy and economic impact and healthcare and health impact. You saw these tensions playing out all the time. The devolved governments were very often brought in at the end of these meetings to give our views. The [Welsh] health minister at the time, Vaughan Gething, would usually take a health approach to it. But you could see these real tensions in the UK government.

Sometimes you would get the information at the last minute. We would find that when it came to receiving reports from the UK Health Security Agency, we were getting them an hour or two before the meeting, whereas [the UK government] had them the night before. They were able to analyse them and go through them. You were quite literally getting text messages from your chief medical officer trying to say, “Look, this is what we’re finding from this report. You need to be aware of this before you go into the meeting.” It was really, really difficult and it became a real battleground at times. I felt that they were trying to restrict the information being given to us as a government to make decisions, because they wanted control over that decision making and they wanted us to follow their decision making process instead.

AP: Do you think it would have been good if there was more closely coordinated decision making between the governments on COVID? Was there a difference between earlier and later in the pandemic?

MMa: In my experience, the divergence started when the economic arguments against taking particular public health approaches during the pandemic started to clash. There was more pressure on UK government, I think, to look at the economic impact that some of these measures were having. You could see this in meetings and I would message the chief medical officer, who would be on the call as well, saying “The economy ministers are winning this meeting. They are going to get their way on us not doing this because they think that the economic impact is too great and the health benefits are not justified given the economic impact that it will have.” 

The evidence for managed quarantine hotels was clear that you should do them. We saw from the first summer the importation of the virus from Spain and Greece when people went holiday and all of the impact that then had. The new variants were starting to emerge as well. But they delayed and they delayed and they delayed. And then we just took a step and said we were going to do it. The clinical advice we were getting was that you should do this.

When it became more of an economic/healthcare debate, that's when the divergence started and that's when you started getting briefings in the papers. These meetings often took place on Friday. On a Thursday night you would get a leak on what they were going to be discussing the next day. It would very often be about health and it would usually be the economic side briefing that we didn’t need to do this. You’d have the UK Health Security Agency report and the findings from it, and you could see that they were already heading it off. The games were being played out. Whereas, we were taking a clinical-based approach on the basis of what the clinical advisors were recommending to us. Not necessarily an approach of what they said you should do, but on the basis of what they were saying was happening as well. That's when things started to become much more marked and there was a divergence of approach.

AP: After the 2021 election, there was the Bute House Agreement and the two Green ministers – Lorna Slater and Patrick Harvie – joined the government. They both worked closely with you as net zero secretary. What was your experience of working with them as ministers from a different party?

MMa: I remember being involved in a discussion with Nicola Sturgeon about the possibility of doing a partnership with the Greens. In Bute House, there was Nicola along with Liz Lloyd [then strategic advisor and chief of staff to the first minister] and myself. She was asking my opinion around the issue. My portfolio was a new portfolio that had been created of net zero, energy and transport. Connectivity and infrastructure had been taken out. The only bit that was left was transport. We were bringing our climate change portfolio and the natural environment portfolio in with transport. The idea was that they are all inter-related and we also had COP26 coming up. The first minister wanted someone to be lead minister for COP26, which was me. 

I was in favour of the Bute House Agreement. I thought it was an opportunity to set a new direction in politics. I thought it would also help to create a bit of a renewal, because the 2021 election had been a good election for us but I felt people were waning on us as a government. I thought it would freshen up the approach. The vast majority of what ended up in the Bute House Agreement sat within my portfolio. I was very conscious of that when having that discussion with Nicola. She was saying, “A lot of this is going to fall to you and the working relationship you can get with the Greens.” Both of those ministers were part of my portfolio, so it was also about bringing them into government. 

I was involved in hours and days of negotiations around the Bute House agreement for my portfolio. In the end I thought we got the right balance on it without causing too much undue political difficulty for ourselves. Then it was a case of managing that while I was in government, bringing in two Green ministers – which was completely new – and introducing them into government. What would often happen was that there might be a write-around within our portfolio or policy. Because Green ministers, rightly so, would take a slightly different perspective on it from what we would necessary take as our priorities, at the end of it I would often try to smooth that process out so that there was enough for the Greens but it didn't create any undue difficulties for us as a party and as a government. Sometimes it was taking the edge off proposals to allow us just to say, “well that's much more manageable.” 

It became a different role again. At times I felt as though my role was also managing some aspects of the Bute House Agreement and the personalities around it to try and make sure that we didn't get into political difficulty around some of the policy options that could have ended up coming through.

AP: Were there any disputes between you and the Green ministers that were difficult to reconcile?

MMa: During the Bute House Agreement, there were real difficulties around road building programmes. They had a couple of what were almost red lines for them, which were the dualling of the A9 to Inverness and the dualling of the A96 from Aberdeen to Inverness. But they were big political commitments that we had previously made as a party and as a government, and we had spent a significant amount of political capital on them. They weren’t deal-breakers, but the DFM [deputy first minister, then John Swinney] was doing a lot of negotiating in between us. They've got their red lines. But that means we’ve got to be able to say “we're not doing a dual road on the A9,” if we're not doing it. Which would have caused us major political difficulty in our group. As a party it would have caused us real difficulty. So it was a different type of dynamic. It was trying to think about the fact that actually not necessarily our government but our parliamentary group are just not going to wash this. And our members are not going to wash this. So it was a slightly different dynamic. 

I got on well with both of them but they would potentially push things all the way out to their limit very quickly. Whereas I instinctively do things much more incrementally. We do it in stages. That might be where we want to get to, but if you try to go there too quickly, my experience in government was that you'll scare the horses and actually won't get anywhere near it. That might be where you want to get in the long-term, but you have got to realise it's going to take a bit of time to get there and you work back from that. So I think they were quite impatient and keen to be seen to be getting things done now. Sometimes my role was reigning some of that in to try and do it in a much more manageable way. And to do it in a way that didn't cause undue difficulty for the government and for us as a party with our backbenches.

MMi: After the 2023 leadership election, in your fifth role, you were back in the health brief as cabinet secretary for NHS recovery, health and social care. How did you use your previous experience as a junior minister in this brief, as well as in different portfolios, to inform your approach? 

MMa: The thing that struck me most when I went back into health was how many things had not changed. Many of the problems that I saw in our healthcare system when I was public health minister remained the case. I don't say that as a criticism of previous health secretaries, but some of the systemic problems that our health service faced were still there. We still had too many people waiting. We still had tensions between primary and secondary care. We still had a social care system that felt completely undervalued. We also had a situation where we had new modern healthcare technology putting more and more pressure on our healthcare system because of the costs associated with individual drug treatment programmes, which can cost £1 million per patient. I was struck by how many of the same things were still there and the challenges that were still there.

Before I resigned, I commissioned a piece of work to start looking at where we want our healthcare system to be in the next 10 to 20 years. When I was asking officials, “What’s the plan? Where are we going to be in 10 years’ time?”, in my view, there wasn't a clear vision of what we were trying to create and what we needed to do in order to get there. What I viewed as being a key priority for me was to create a vision of what it would look like in the next 10 to 15 years. We needed to start a process that would allow that engagement and create the space to have that dialogue. I commissioned the chief medical officer to start engaging with the royal colleges and the royal societies to start developing a space to get their input and views. As a government we started to look at what an engagement strategy would look like. 

The challenge in the health service, though, is that – compared to any other portfolio – folks are really, really precious about it. If I was to say, “I am going to fundamentally change the health service and how the health service or NHS works”, folks would go “Hold on a minute. What exactly are you going to do here? What does this mean?” Taking forward fundamental change in how our healthcare system is going to operate is really, really difficult, because the system is wired back-to-front. The way resource goes in the healthcare system is that it goes largely to the acute sector, then you get a bit for primary care, and then you get a bit for social care. It should be the complete opposite. You should go in from social care, primary care and then it should be acute care. But to do that would mean that I as a health minister would have to say, “I'm taking money away from the acute hospitals and I’m put it into primary and social care.” And the response would be, “We can't do that, because then there's less money for the hospitals to operate.” But people would say to me that's the right thing to do.

In my view, the difficulty is the lack of a clear vision of where we want to be in the next 10 to 20 years and the process of how we're going to create that vision and create that opportunity in the future. Then to have that open debate about how there needs to be fundamental reform, because more of the same means that people will not get the services that they expect. If you look at the demographics we're facing, we will end up in this vicious circle of declining capacity and capability because people are now… Look at our hospitals. Are people sicker? Yes. Acuity levels are greater. People are spending longer in hospital. That's just going to continue with the ageing population, so it needs fundamental change. That process has started, but it's a debate that will need to take place over the next couple of years otherwise the system won't work in the future to meet people's needs. 

And that draws my ministerial life to an end!

AP: During your time in government, you worked under three different first ministers. How would you compare the differences between their leadership styles, how they ran cabinet and how they engaged with you as a minister within the administration?

MMa: I wasn't a cabinet secretary under Alex, but I was obviously a minister. He was less interested in what you were doing. When I was in health, I think it wasn’t an area he found natural. It wasn’t an area of political interest to him. If you look at his political background and the things that he would do in the [House of] Commons, health wouldn’t really feature in it to a great degree.

Maybe I'm wrong, but that is certainly the impression I got. Also because Nicola was the cabinet secretary and the DFM, it was pretty hands off in terms of just leaving us to get on with. I probably had a bit of cover there because of that. Whereas Nicola was always interested in what was going on and what you were doing, I always felt he was a bit more distant. He didn't appear to be that interested in it. The only thing was that I created a new agency called Food Standards Scotland and he wasn't happy about the way I took it forward and made that clear to me. My experience was that he wasn't directly interested in the portfolio when I was dealing with it at that particular point. 

Nicola was much more interested in the detail of exactly what was going on and how you were going to do it. She wasn't always looking over your shoulder. It was very much a case of like, “Bring things to me if you want a bit of guidance on that,” so she could be quite distant from me as well. But when she did engage in something, she would be interested. And when something went wrong, she became, “Well, what are you going to do about it? How are you going to resolve it? You need to fix it.”

At the point in time when one week after the next there was another thing about the police, with leaks about folks’ behaviour and stuff like that. I can remember her saying, “You need to get on top of these things.” The problem was that it was like whack-a-mole. Every time I got on top of one, another problem popped up. But you had no idea about it because it was in the police service. It was really difficult. She was much more sensitive to adverse issues and getting on top of them quickly. She was very keen to make sure we were doing that. At cabinet, she was quite focused in getting on with it. Alex liked to hold court a wee bit sometimes, when I was covering for the cabinet secretary. Nicola was less like that. She was quite focused, so sometimes cabinet meetings were much quicker and sharper.

And then I would say Humza [Yousaf] was the most collective of the first ministers that I experienced. He was very much about working together. If there were issues, we needed to talk about them. He would say, “You make sure you take time for your family as well”. He was very concerned about people's welfare. He was very supportive and open to you going to him for advice as well as leaving you to go on with it. He was always up for giving suggestions. His cabinet meetings could take a couple of hours because he would like everybody to say their bit. 

Alex would be very much more restricted. Nicola was very much a case of “just get on with what you need to do.” My gauge was sometimes you would just say, “I'm not going to offer this up because I don’t feel as though it’s going to go down well this morning.” Whereas Humza was much more keen on getting people to open up, say their view, express their view. Quite a collective-type leader, of the three that I served under. So all three of them were quite different.

MMi: Turning to the end of your ministerial career, are there any lessons you think other ministers could learn from the events that led up to your resignation?

MMa: If I look back, the lesson I would say is recognising how unforgiving the political space is that you’re operating in. In the end, it was my desire to try and avoid the press knowing about what my son had done. It was completely unforgiving, despite the fact that when you offer it up, then they say you’re using it as a cover. Actually, no, I'm not, but I'm telling you that's what's happened. So I think what I would say to ministers is that it is quite unforgiving at times when something like that happens, despite what your background is and how long you've been in government and how you've always tried to avoid getting the government into any difficult positions. A lot of people can also see through some of the things that are happening, so I was struck by the number of people who reached out to me and offered me support and encouragement and recognised what was going on. I think my advice would be to be aware that it is a very unforgiving environment which you operate in at times. There is no space for error sometimes. When you’re a backbencher, if you do make an error, it's not the same. But when you're a minister and you're a senior minister, you're going to get chased down and you quite literally get chased down.

What you shouldn't underestimate is the impact that these things can have on your family as well. Because they do have quite a significant impact on your family, particularly my children who were teenagers. For example, it's in the public record that our house got broken into. Doing all of this: taking the children out of school; my wife becoming unwell with stress; having to go out your house, drive away and then come back to pick up your kids to get photographers to go away; folk hanging about your house; climbing over the back wall to get out because the kids had football shirts on and the press would take photographs of them; pictures of your children ending up on social media. All of that was constant.

I think the thing that you need to realise is that when you become a minister, if you do make a mistake, you can end up in the eye of a political storm. The thing that acted as a big catalyst for me was that, as soon as the general election was called, everything was put on steroids. It became a massive issue because folk saw a political advantage they could get from it. It just got completely blown out of all proportion in my view.

MMi: What achievement would you say you’re most proud of from your time in office?

MMa: Probably the biggest achievement… I would like to think my legacy will be the reform of the female custodial estate, which I hope, in the long term, will prove to be successful and will demonstrate – not just here in Scotland but in other parts of the world– that you can do things in quite a fundamentally different way. I know there's a lot of international interest in them. I suspect that is the one thing in terms of social policy that is the biggest legacy I will leave. Although, every time I go into a shop and their cigarette displays are all covered up, I think “I did that” as well.

MMi: What advice would you give to someone becoming a minister for the first time about how to be effective?

MMa: Protect your family time, because it's very easy to get overtaken by events. Also, don't take criticism too personally, because sometimes you will get criticised as a minister. The other thing I would say is that the biggest downside as a minister is sometimes you just don't get enough time to think about policy issues in a way that you would like to, in order to come to a considered view. Because I was always under pressure to deal with issues, particularly as all of my portfolios have been operational portfolios. Things go wrong, the trains go wrong, the ferries go wrong, the health service goes wrong, the police and justice system goes wrong. Things happen and you just have to deal with them. Some people find that a bit difficult to deal with and you'll be criticised when things are going wrong, but you just deal with it as best you can. Don't take it personally. Try and find a time when you can to think before you make decisions. Know and be aware that civil servants are great, but they've got their own agenda as well, and you need to assert your views and your approach over them to make sure they follow what you're looking for.