Working to make government more effective


Norman Lamb

Norman Lamb reflects on not being offered a ministerial role after the 2010 general election, coalition politics and mental health care reforms.

Norman Lamb
Norman Lamb, former minister for care and support

Sir Norman Lamb was a minister between 2012 and 2015, serving as parliamentary under-secretary of state for employment relations and postal affairs in 2012 and minister of state for care and support from 2012 to 2015). He was also parliamentary private secretary to Nick Clegg (2010–12) and the Liberal Democrat MP for North Norfolk (2001–19).

Catherine Haddon (CH): Could we start by going back the beginning of the coalition government – were you expecting a ministerial role?

Norman Lamb (NL): Yes. The start was a very difficult period, absolutely. In our rather grand terminology, I had been shadow secretary of state for health prior to the election. I remember as the coalition was being formed there was lots of speculation in the press about whether I would become secretary of state for health, and all sorts of stuff like that. Then we went through this extraordinary process, everybody, of course, is waiting by their phones, waiting for a call, and in some cases it never happens. It hadn’t happened by Thursday (a week after the election), so I went back to Norwich. I was then at home on Thursday afternoon and the phone went, and it was the No.10 switchboard and they put me through to Nick [Clegg, deputy prime minister 2010—15], and he basically said “first the bad news – we thought it was going to be minister of state but in fact we’ve miscalculated on the numbers and it will be parliamentary under secretary, but would you accept a role at DfID [the Department for International Development]?” So… I thought undervalued, but I thought it would be a very interesting job, so I said yes. He said “you’ll get a call from the prime minister in due course.”

We then went out for pizza and I got a call from the Lib Dem chief whip to say “don’t worry, things have been delayed, you’ll get the call tomorrow morning, but arrange to meet with the permanent secretary”. I called the permanent secretary at DfID on Friday morning. It should have rung alarm bells – she hadn’t heard of my appointment, but we agreed a time to meet up that afternoon. Then I had a call from Nick, not through the switchboard but from his mobile direct, just to say “Norman, there’s been an almighty cock-up, we’ve miscalculated the numbers and I can’t offer you the job I offered you last night.” So I was left with nothing. I was quite a strong supporter of Nick, so I felt pretty shafted. I talked to David Laws [chief secretary to the Treasury at the beginning of the coalition government], who was a close ally, and he said “I don’t understand this because you were on a list of five people for minister of state, which I saw yesterday.”

I still to this day don’t know exactly what happened, but the bottom line was I was left with nothing. Then there was this mad scrambling around over the next few days to sort something out. I ended up as an assistant government whip, and with this title chief parliamentary and political adviser to Nick, attending the cabinet. It was a sort of consolation prize, and with the benefit of hindsight, it’s much better to start bad and end good than the other way around, which is what happened to some people. It meant that for two years, I witnessed everything in the cabinet, which was fascinating, but ultimately observing rather than doing was intensely frustrating. The Chris Huhne [then secretary of state for energy and climate change] fall from grace in February 2012 was the moment which gave me my opportunity in BIS [the Department for Business, Innovation and Skills] to start with.

CH: We’ll come on to that. Had you had discussions about whether or not it would be the best strategy for the Lib Dems to take a whole department rather than spread yourselves across different ones, or was that all taken with Nick?

NL: In the wider group, both the shadow cabinet – again, rather grand – but also the parliamentary party, all of the discussion was full coalition or supply arrangements. There was some discussion of this choice between taking on whole departments and spreading across, but I don’t have a recollection of any proper consideration of that choice.

CH: Once you’d found yourself there, did you talk about what your role with Nick Clegg would involve? Obviously there are a lot of PPSs [parliamentary private secretaries] across Whitehall. But this was a very unusual situation as he was deputy prime minister of a different party, and he lacked resource at the centre as well. Did that put pressure on you?

NL: Well, it was all a bit shambolic in that opening period because of the lack of resource. The fact that suddenly we were in government and most people had not expected it or thought about it enough. I’m sure Nick and Danny [Alexander, chief secretary to the Treasury 2010–15] had a bit, but the rest of us hadn’t expected this to be happening. So, there wasn’t any great discussion about job description or purpose or role – in fact, I found it to be a fairly hollow role. I was involved in central discussions and I became part of the core team around Nick, but I was also conscious that the power lay with Nick and Danny – Nick primarily went to Danny and not anyone else – which caused, I think, some frustration amongst many people. A lot of people felt that Danny wasn’t necessarily the best influence on Nick, and I still feel that strongly.

"A lot of people felt that Danny wasn’t necessarily the best influence on Nick, and I still feel that strongly"

CH: In what way? Were there some early decisions that could have been done differently?

NL: I think that Danny was hopeless on the health reforms, he passed it all and didn’t really understand the issues, in my view. In my view, the great sadness was David Laws falling early as the chief secretary [Laws was chief secretary for a little over two weeks at the beginning of the coalition]. The caricature of David was as right wing, as a sort of Tory in disguise, but actually, internally, he wasn’t. He was the one who was fighting against ending the indexing of benefits, he was fighting for a real terms increase in education spend and a real value to the pupil premium. His fall from the Treasury meant that we lost an intellectually coherent Liberal in the Treasury. We ended up with someone who was trying to convince Tories that he could be trusted doing this vital role of chief secretary to the Treasury. It was a case of overcompensating, which you quite often see. David and I were close allies, so we talked a lot. Later in the coalition, the quad [the main decision-making body in the 2010–15 coalition government, comprising David Cameron, Nick Clegg, George Osborne and Danny Alexander] expanded to include David and Oliver Letwin [minister of state for government policy 2010–15] and it became clear that Danny’s contributions were unhelpful in many respects.

There was one famous occasion, which I think David deals with in his book, where within the quad on a critical issue Nick was wanting to negotiate with the Tories – Nick found himself isolated against Danny, Cameron and Osborne. Danny would tend to take the Treasury perspective or would have discussions with George. I think that we lost a Liberal influence in the Treasury. Danny demonstrated tight control over departmental spend. Of course, you had to have a disciplined operation there, but I think we lost that Liberal influence, which was fatal in Liberal terms, in terms of our prospects, but most importantly in terms of ensuring fairness in respect of the impact of austerity.

CH: Your role was at the heart of the government. Were you engaging with Conservatives there, or did it all go through the party structures?

NL: Yes, I was attending cabinet every week and it meant that various Tories [would engage with me]. One example would be Philip Hammond [secretary of state for transport 2010–11] coming to me to complain bitterly about Norman Baker [parliamentary under secretary for transport 2010–13] being difficult to work with and not complying with protocols and going to the press and so forth. Norman, who I’ve got a lot of time for, was a press junkie who was just going off and actually doing what he ought to be doing, I think getting the message out there about what a Lib Dem minister was achieving. The interesting thing was that the two of them ended up getting on quite well in transport and having a degree of mutual respect, I think because they were both assiduous – I think the dynamic ended up working quite well. But he came to me to try to mediate some sort of solution. And Michael Fallon [who held various ministerial roles during the coalition], I’m trying to remember in what role it was that he engaged with me, but we had discussions about internal issues within the coalition and it was during the period when Michael Fallon was rising through the ranks. I was involved in core discussions. I remember Nick’s inner team went off to have dinner together, and Nick asked the question “do you think that we will be fatally wounded by the tuition fees issue?” and most people around the table reassuring him that we wouldn’t be, that it would be passing… I think it was probably a miscalculation!

CH: What was the learning curve like for Nick himself? It’s a massive role, it’s a lot of pressure and the Lib Dems were relatively new into government. What did it look like from your perspective?

NL: It was an extraordinary pressure on him because all of the big decisions of government were having to be approved by him. He was having to think in the national interest, but also “what does this do to our party, can I get it through my party?” He was having to make massive judgement calls without the resource to support him. I mean, to start with, that office was ridiculous. It was subsequently enhanced significantly with the increase in the number of SpAds [special advisers] and so on. But I think he had a massively challenging start to the whole thing. So big mistakes were made, but you can understand it because of the intensity and the speed at which things were happening.  There was that early decision in June 2010 about a steelworks in Sheffield that was shafted. It was just things coming at you at such a speed, and we were making just really unpopular decisions.

This government now is confronted by coronavirus, of course, but your normal situation is that a government just comes in and there is a long honeymoon period. It was so different, we were having to make really unpopular decisions from day one, and of course knowing or feeling that we were all involved in this big experiment. Can a small party survive a coalition under this electoral system, particularly in those sorts of circumstances where we were having to take the rap for getting the public finances under control? It was an extraordinary challenge, but I think we all grew in confidence to a degree, as we did the job, and I think that was very much the case with Nick.

Colm Britchfield (CB): Your got your first ministerial role in BIS in February 2012 when Chris Huhne stepped aside. Can you talk us through what the appointment process was like?

NL: We were all at a parliamentary awayday, at some godforsaken hotel in Eastbourne, which was populated by very elderly people and the Lib Dem parliamentary crew. Then, on the morning of the Friday – we’d all arrived there on the Thursday evening – dramatic news appeared online. You looked around the room and people were looking at their phones, and this was the news breaking that Chris Huhne had resigned. Nick, of course, disappeared upstairs with advisers. Meanwhile, Stephen Lloyd, the local MP, had wanted to tell us all about this local initiative where he had this giant-sized … I don’t know, bumble bee or something. I can’t begin to remember what this thing was, but it was a man dressed as this enormous bumble bee or something. We had camera crews all over the place, this bloody bumble bee, and making massive decisions about government and trying to avoid having cameras with this enormous thing. Then, at some stage during the day, Ed Davey [then parliamentary under secretary for employment relations] got pulled upstairs and offered the role of secretary of state for energy and climate change. Then I got called up to be offered the role that Ed had vacated. And then I left in a car to travel to London to meet the team and the new department, so that was the appointment.

CB: It was immediately the next day you got into dealing with that?

NL: Yeah, I went off that evening with the first load of stuff.

CB: You weren’t at BIS for a huge amount of time, but what were the major issues that came across your desk in that role?

NL: I was there for eight months or less, and it was intense to say the least. I took the Enterprise and Regulatory Reform Bill, which is a very substantial bill, through parliament in that time. I was on three European Councils, so I was constantly back and forth to Brussels. I was responsible, in that very junior role in the department, for an extraordinary array of issues: trade policy, competition, consumer affairs, employment, the Post Office, Royal Mail, and, of course, we were just running up to the privatisation of Royal Mail, and a host of other bits and pieces. It was a big portfolio and it involved intense work. I was working on my red box [of ministerial papers] every night at one in the morning, and that was the sort of normal routine and it was seven days a week pretty much.

Then, by September, it was all over. It was very hard work, but I loved it and we did some really good stuff. Apart from taking the bill through parliament, I commissioned a review of policy on mutuals and worker share ownership by a guy called Graham Nuttall, which led to Treasury changes, which makes it easier for employee-owned businesses to be established and converted and so forth. To be fair to Danny Alexander, he did secure those reforms in the Treasury. My big involvement in the Royal Mail thing, was that I had taken the policy through the Lib Dems to privatise, which was massively controversial at the time. But critical for me was for the workforce to have a share of the ownership of Royal Mail – and it was that, that led to that happening as part of the final deal. Michael Fallon, I think, took over from me as minister responsible for Royal Mail. Unfortunately, the Tories did it in a way that just offered shares to individual employees rather than having a trust owning shares for employees. So, it was not in any way embedded, it was a quick deal to satisfy us and give something to employees without really, in my view, accepting the philosophy of it in a meaningful way.

"My mindset was that as a junior minister you can’t really change things. Then you realise, actually, you can, and so you start asserting yourself and you find the most effective ways to achieve change."

CB: When you came into that with a pretty wide portfolio, were you given much guidance from within the department as you arrived to get up to speed?

NL: I had a very good private office and very helpful team that were brilliantly supportive to me, but beyond that, no. I mean, [there were] lots and lots of briefings, and I’ve got a very positive view of my time there, but you really were learning on the job. I feel overall very much that I gradually became increasingly effective at doing the job, of being a minister, because you start to understand the extent of your power. To start with – other people’s mindsets may be different – but my mindset was that as a junior minister you can’t really change things. Then you realise, actually, you can, and so you start asserting yourself and you find the most effective ways to achieve change.

CB: You were also there at the same time as Vince Cable [secretary of state for business, innovation and skills 201015, what was your working relationship with him like?

NL: It was fine, he just left me to get on with it really. He did not interfere. He’s quite a private man, Vince, and quite shy I think, bizarrely. We had discussions, but I don’t think we had any fallouts at all, we were on the same page and he seemed to be very happy with what I was doing. But there wasn’t an enormous amount of interaction because he just let me get on with it.

CB: So, to compare your time working with Vince Cable with previously working with Nick Clegg – the two major figures in the party really – what comparison would you draw between them based on your time there?

NL: Well, philosophically, I was closer to Nick than I was to Vince, I guess. Although actually, when Vince became leader, I felt comfortable when he made speeches because they were substantial and they were largely saying things that I agreed with. That’s not always been the case with some other leaders. In reality, when he became leader, I was comfortable with it, but in the coalition context, the running theme was allegations of Vince undermining Nick Clegg.

CH: Let’s discuss your move to minister for care and support at the Department of Health in September 2012. You had been Lib Dem shadow secretary of state for health before the coalition, so it was an area you knew about. Was this a move that you pushed for?

NL: No – I think it’s not in my character to lobby and I think probably, I don’t know what others were doing, but it’s pretty clear that, at the start, many others were lobbying hard for positions and I was just doing nothing at all. That was probably my undoing at the start. But I hadn’t been going to Nick to say I want this job, I hadn’t at all. I was just too busy getting on with the job in BIS. I clearly had an ally in David Laws, even though by that stage he was out of government, he was still in touch with Nick. I don’t know, but he may have lobbied for me. Despite this very difficult start, when Nick rang me to tell me that he was taking away the job he’d offered the night before. We naturally get on, so we got over it very quickly. The bigger picture was that health was a big problem for the coalition at that stage, the whole aftermath of this nightmare Health and Social Care Act [of 2012].

In my first two years I had this role of assistant whip, which I hated, I’m not a natural disciplinarian – it constrained me in policy areas that I was interested in and so on. I was being lobbied by all sorts of people about these health reforms. I thought they were pretty nonsensical myself, and if you remember the pause that happened in those reforms, as assistant government whip I’d gone on to the BBC and said that I felt that they were flawed and that they needed a re-think – which is not a normal thing for a whip to be doing. This was the extraordinary reality of the coalition, everything that was normal was just thrown out of the window. I’d been quite vocal but by speaking out I got a bit of a role in making some adjustments during the pause, adjustments which weren’t nearly significant or useful enough to change the substance of it. But I think Nick and [David] Cameron felt that because health was such a problem for the coalition and [Andrew] Lansley [secretary of state for health 2010–12] was so tainted by that stage, there had to be a clear out and a fresh start. Politically, for the government, for the Tories and the Lib Dems, there had to be an effort from there on to neutralise health as an issue. But getting a new team in, I think, was essential to do that, so that’s also part of the reason.

"Politically for the government, for the Tories and the Lib Dems, there had to be an effort from there on to neutralise health as an issue"

CH: What was the department like then, at that time? It had been trying to drive through this massive reform, was it struggling with that? How did it feel?

NL: I came in with Jeremy Hunt [secretary of state for health 2012–18], he was determined to make a mark there. I was going into the department where I knew something about the issues, I had a very strong view about the need to start to integrate health care with social care. I’d made that very clear to Jeremy Hunt on the first day there. I was on such a mission on the things that I wanted to try to achieve in the time that I knew I had, and it didn’t feel at all like a department in crisis. I think people clearly saw a new secretary of state who was assiduous and serious about it and consensual. He’s a smart former businessman and he knew that having me on-side and getting on well with me was a necessary pre-condition for his success. So from the very start, there was quite a close collaboration, much closer than actually Vince Cable. I was the No.2, I suppose, and we worked very closely together. I think Jeremy saw me as a closer ally than his own Tory junior ministers. There felt like a momentum from the word go, and I think Jeremy Hunt, not necessarily in substance but in media terms, was very successful at shifting the narrative. Looking back, I think that period, which was where we got a lot of quite positive, good press over a two-and-a-half-year period, probably ended up helping to neutralise health for the Tories without actually helping the Lib Dems much at all.

CB: You mentioned social care, what was your experience working on that issue at the time? It’s still very prominent in people’s minds.

NL: I helped persuade Jeremy Hunt to back Dilnot [the recommendations of the Dilnot review into social care provision]. I am sure there were other people seeking to influence him as well, but he became convinced of that. It was part of the big negotiations and part of the coalition phase two, halfway through – the Lib Dems wanted certain wins and the Tories wanted certain wins, and one of the Lib Dem wins was to secure Dilnot. We secured it, so we got the Care Act [2014] amended during its passage through parliament to add in the Dilnot reforms and the department was united behind it. There was no battle in the department over Dilnot at all.

CB: How do you reflect on the Dilnot process now?

NL: Well, with a degree of bitterness, because I think we did policy in the right way there. We commissioned an outside expert to come in to advise government, he did that, it was pretty well received by the sector when we consulted. We then legislated following the consultation. It was a weaker form of Dilnot because [George] Osborne [chancellor of the exchequer 2010–16] was never really on side, and he may have known that would undermine its popularity. The sector, I think, in my view, stupidly, was negative about it because the cap was not low enough. Which meant that it didn’t go through with a great fanfare which made it easier for the Tories to dump when they got rid of us, which is what happened.

CB: Do you think within that process it might have taken root more effectively, had it been done differently?

NL: I think the fatal problem was that we collapsed in the ’15 election and however popular it had been when it was implemented, let’s say there’d been a lower cap and the sector were all on side. I think, fundamentally, once the Tories got rid of us, they didn’t have their heart in it, and they would dump it. There was cost attached to it and they didn’t see it as a priority to spend that billion quid in the early stages of it. I think whatever we’d done, the Tories (particularly in the Treasury) would have got rid of it, once we were out of government.

CH: You talked earlier on about your time in BIS and how busy it was. Was it similarly busy at health and was it easier knowing the area very well in advance?

NL: I suppose I’m one of the lucky people who had two jobs in government where I knew something about at least part of them. I was an employment lawyer. I had various responsibilities in BIS, but part of my role was as employment minister. I had also developed policy on Royal Mail within the Lib Dems. On all of that agenda, I knew the territory pretty well and was interested in it as well. Loads that I didn’t know much about, competition policy and trade and so forth, but it was all interesting stuff and so I either knew about or I was interested in it, which meant that it was stimulating. In health, an absolutely similar workload, but to a degree the workload was heavy because I was wanting to be proactive. If I’d been passive and allowed the civil servants to run things, then it wouldn’t have been nearly as heavy as it was in practice.

CH: How was the civil service in the various jobs that you held there, were there differences?

NL: In BIS, I found them all to be very professional and supportive. There was one interesting moment in BIS, because I am the slightly unusual person in the Lib Dems in that I have always had a frustration with the EU. I was a Remainer, but I was deeply critical of the way the EU had developed. There was a European court decision on employment law which had ridiculous implications for employment law in this country. I went out and said we shouldn’t rush to implement this because it actually doesn’t make sense, it’s ridiculous. I was under loads of pressure from the comms people not to say anything that was out of turn, but I just went out and said it. And of course, the roof doesn’t cave in and things carry on as they were before.

But I was conscious both in BIS and in [the Department of] Health of this sort of institutional pressure to defend the department against criticism, to toe the line, rather than ever to challenge. I wasn’t interested in following that advice, I didn’t think it was appropriate. In the Department of Health (DH), you’re buffeted constantly by freedom of information surveys showing dreadful waiting times in mental health or dreadful conditions in care homes, whatever it was it was constant. The institutional view was, always try to say it’s not as bad as it really is or as it’s claimed to be, everything is improving. That was the standard press release for every circumstance. That was what we were encouraged to say. I always felt this is not credible. This survey might well be exposing something that is genuinely awful, and our job ought to be to accept that and to challenge the system to improve. I saw myself as an advocate for mental health in government rather than the government advocate dealing with mental health. Having said that, there were excellent comms people in DH and the civil servants were very supportive. I had an outstanding private office.

"I was conscious both in BIS and in Health of this sort of institutional pressure to defend the department against criticism, to toe the line, rather than ever to challenge."

CH: Were there any crises that you had to deal with?

NL: We had the run up to the winter before the ’15 election, which was a very tense period because everyone was focused on avoiding ambulances stacked up outside A&E departments and long waits and so forth. There was a lot of tension around that period, it never felt like there was a crisis. We were also dealing with the impact of the Lansley legislation, and that shifted power substantially from ministers to this independent NHS England. Jeremy Hunt was doing his best in a way to undermine the purpose of the Act because he was, in many ways, micro-managing a lot of stuff from the department. Which is precisely not supposed to be his role. Simon Stevens [Chief Executive of NHS England] was doing the sort of big visionary stuff, Jeremy Hunt was getting his hands dirty with A&E waiting times and so forth, precisely the opposite of what it ought to have been under the legislation, which was quite interesting.

One of the things in mental health that I was hit by was, I got a call from the Health Service Journal to ask me for my view on the decision by NHS England and Monitor (now NHS Improvement) to set a financial efficiency basis for the following financial year, which was disadvantageous to mental health compared to physical health. There was no possible justification for it. Again, I was under immediate pressure from the comms people, “don’t criticise NHS England”, and my view was that if they’re independent from us, I can criticise them. I’m not going to go along with something I fundamentally disagree with, so I went out and condemned what they had done, and I felt it should be challenged legally, and it caused a massive internal problem. I think if it had been challenged, I don’t think, on a judicial review, it would have stood up to the test. We’d legislated for parity of esteem, and here they were disadvantaging mental health against physical health, it was extraordinary. So I just went out and condemned it, and I think that was the right thing to do.

CH: You had previously been outside of government, scrutinising the government for many years. You were now in government – what was the scrutiny like from the other side? Did your view of parliament change?

NL: It was a bit odd to be at the dispatch box being condemned and attacked by Labour MPs. It was a slightly unreal thing because I was also getting on quite well with many of them away from the chamber. Liz Kendall [shadow minister for care and older people, 2011–15], for example, who I was always close to politically and we got on well, she would criticise me at the dispatch box, but I think fundamentally we agreed on most things. But you felt the turning of the tables if you were suddenly subject to the challenge. I found, on the whole, dealing with stuff from the dispatch box, [I was] more comfortable with it than I perhaps had expected. One of the things running through all of this is that, when I first arrived in the government in 2010, I was surrounded by people with enormous self-confidence from the top public schools and from Oxbridge. I was from a state school, I failed the 11+, I went to Leicester University, and I just felt an enormous inferiority complex. I just thought “what am I doing here? These people are all very, very competent.” Then, you start to realise that they’re confident, they’re not necessarily competent, and you start to realise that, actually, you can do things. And so, my confidence grew as I did the job. The gulf is much greater, for example, for a working-class lad or woman going into Oxbridge and being confronted by a wholly different culture. Nonetheless, I felt that, ludicrous as it may seem because I had a dad who was a professor, but I just felt like, my god, this is not the place for me, that was the initial feeling.

CH: Can we talk about your run up to the 2015 election? What was it like to prepare a manifesto from inside government? Was it easier? Was it harder?

NL: Well, you have no time, really, to think about the next stage because you’re so heavily involved in doing the job. But I think it was David Laws, wasn’t it, who was responsible for writing the manifesto in 2015. I didn’t feel there was an enormous burden on me to contribute time-wise substantially, and I got what I wanted really in the manifesto for health, and I think the health stuff was all fine.

There were various areas where I wanted to go much further. The most depressing moment for me, in terms of the party, was – I am a great believer in this concept of employee ownership of enterprise and of employee involvement and control in state services, and I would be radical in terms of the delivery of public services with a greater role for social enterprise and so forth. I brought in Chris Ham, who was head of The King’s Fund, to lead a review on the role of mutuals in the NHS, to adapt the foundation trust model, and to look at alternative models for delivery. I took Chris Ham along to a parliamentary party meeting to explain what we were doing, and the two of us were roundly condemned by a significant number of Lib Dem MPs because they were all petrified about the charge of privatisation and they all thought that by pursuing this we would get condemned for privatising the NHS. I just thought, my god, this is a party that from Jo Grimond [leader of the Liberal Party 1956–67] has had this view of wider stakeholders’ economy where people have a stake in their economy, and here we are, we’ve become completely reactionary, and petrified to do anything radical because of a charge from Labour that we were privatising. So, that was the low point.

CB: After leaving government, you became chair of the Science and Technology Select Committee in 2017. How useful was having had that experience in government in your role as committee chair?

NL: I think it was useful, if nothing else, in giving me the confidence to do it. By then, having been a government minister, you then think, well, now I can be chair of a select committee, that’s fine. I’ve always been interested in policy, and it was like a perfect role in many ways. When it was first suggested to me, I didn’t respond positively to it when the chief whip, Alistair Carmichael, had mentioned it. I actually had supper with Nick Clegg a few days later (after he’d been defeated in Sheffield [in the 2017 general election]) and I mentioned to him that this had been suggested to me, and I said I don’t think I will do it. He said “no, you’re mad, you’re mad, this is a fantastic opportunity and it covers all of the areas that are completely central to the future. Whether it’s automation or global warming or whatever it might be, you’ve got to go for it.” So, I did, he convinced me that it was the sensible thing to do.

CB: Jeremy Hunt is now chair of the Health and Social Care Select Committee. What are the advantages or, potential downsides to having a former secretary of state chair the committee that will be overseeing the whole department?

NL: I backed Jeremy publicly. I can see that, and I think there are negatives and positives about it. From my point of view, I wasn’t chairing a committee that reflected what I’d been doing as a minister. From Jeremy Hunt’s point of view, the risk is that he’s not going to criticise things that stem from his period of stewardship. So, that’s the negative. The positive is that he has an authority on health and if he chooses to use that authority to give a voice to health, to be challenging to government, then that’s good. But it’s too early to say whether he’s willing to do that. I was struck the other morning when he was on the Today programme talking about coronavirus, and I think doing it very effectively. But that morning, Matt Hancock [secretary of state for health and social care, 2018 – present] had refused to go on the Today programme, and the interviewer didn’t ask Jeremy Hunt about the government’s refusal, which is indefensible. Was that a deal done beforehand, or did the interviewer just fail to get around to it? I’m not sure, but overall, I don’t think ex-ministers should be barred from being committee chairs, because some of them will become, I think, very effective committee chairs.

CH: With hindsight, is there anything major that you would have done differently in your time as minister?

NL: I suppose it’s this sense that I grew in confidence as I did the job and the naivety that you have at the start begins to dissipate. But we had a big programme called ‘Transforming Care’, which was to get people with learning disability and autism out of institutions and back into the community. We agreed a concordat with the LGA [Local Government Association], with NHS England and so forth in December 2012 to halve the number of people in institutions in a two-year period. We had no data because it wasn’t collected when we started that process, so we had to rely on periodic audits in order to find out whether we were on target or not, so we couldn’t monitor through time. Two years later, when we did the audit, we discovered that nothing had changed – well, some things changed, the numbers have gone down, but nothing like what they should have done. I am left frustrated that I believed that organisations entering a concordat to commit to do something meant that they would commit to do it. I now realise that you can’t rely on that, you need a mechanism to implement.

So, I strengthened the private office through early experience. To start with, we had some really good, nice, decent and impressive people in it, but it wasn’t functioning as a powerful private office. By the end, I had a private office that was stellar, led by a brilliant woman we got in from No.10. But Jeremy Hunt’s team helped us get the right people in. There was a real close collaboration. I also got a brilliant bloke in from the Cabinet Office, responsible for implementation, and we had an absolutely ruthless focus on following everything through. We did something called the Crisis Care Concordat to improve crisis standards in mental health, and we just monitored it really closely and managed to actually, without being oppressive, to get things happening across the whole country. This focus on implementation, this idea that passing a law or announcing a position achieves nothing unless you actually change behaviour on the ground. I learnt that doing the job.

CH: Looking back at your time in government, what achievement are you most proud of?

NL: I think it was playing my part in getting mental health properly onto the map and being recognised and not ignored. When I came in, there was a real sense for me, that all of the focus was on the very politically resonant access standards in physical health – the cancer standards, the four-hour wait, the 18-week referral to treatment target. It meant that the whole system was focused on those standards, the money went there, the discussion in the department was dominated by that and no real thought or time given to mental health. I think I helped to change the discourse and got it onto the map. Particularly introducing the first ever maximum waiting time standards, has had a lasting legacy: there’s now an investment standard in the sense that clinical commission groups can’t give less money to mental health than to physical health. We’ve still got a long way to go, but there are lots of ways in which I think mental health now is less ignored than it was in the past.

"As a coalition minister, as a number two in Health, I had more power than your average junior minister in a single party government"

CH: What advice would you have for a new minister?

NL: First of all, to take offers of training and guidance, because there’s no process otherwise to get training to do the jobs that you can suddenly find yourself in. I learnt as I went along the extent of my power, and the fact that I actually had more power than I imagined to start with, and I grew in self-confidence. I think it’s fair to say that, as a coalition minister, as a number two in health, I had more power than your average junior minister in a single party government, because, in a way, Jeremy Hunt had to negotiate everything with me. But you started to realise the extent of your power, that you could achieve things. Learn the tools quickly, use the Institute for Government courses and so on to understand how you can exercise power in your role. For goodness sake, take the opportunity to actually make a difference, to achieve things, rather than just having the badge of office, which ultimately achieves nothing.

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