Minister

Lord O’Shaughnessy

“You've got these wonderfully informed experts in the House of Lords who...you can genuinely debate"

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Lord O’Shaughnessy discusses the benefits of working in policy before becoming a minister, the particular nature of being a Lords minister and the impact of Brexit on the work of the Department of Health and Social Care.

TD: So, if we start with when you entered government, you worked at Number 10 and then you entered the Lords in 2015. What brought you to the Lords and what was it like becoming a minister at that point in time?

LO’S: Yes, as you say, I had experience in government as a special adviser in Number 10. I left at the end of 2011 and then was involved in setting up an academy trust and a free school, so I suppose, if you like, what brought me back is a combination of the political experience plus the expertise, both in policy terms and then practically in setting up free schools. It was David Cameron, obviously, who asked me back immediately after the election in 2015. At some point before the 2010 election, we had had a discussion about whether I might become the Lords minister for education, which didn’t happen for a variety of reasons; I think he wanted to keep me at Number 10. Michael Gove [then secretary of state for education] was quite keen on me doing it, but then he found [Lord] Jonathan Hill and he was absolutely fantastic at it. So, it sort of all worked out. Although David never said it explicitly when he asked me to join the Lords, I think certainly in his mind he had an idea that that’s the kind of job that James could do at some point.

I spent most of Christmas nervously reading everything I could about healthcare and then landed on Tuesday 3 January in the middle of a winter crisis

So, going into the Lords, I guess my main policy experience – I mean, obviously, as director of policy I had read widely, but it was mostly around education – was when I went in October 2015 and did a fair amount of education stuff. I was still working in education at that time with the schools and various other things, and then, as these things tend to, I was asked to become a health minister, because it was a job that came up, and John Nash was education minister and still enjoying it in the Lords. It was a complete handbrake turn; obviously, I knew something about it, but not anything like the degree of depth that I had in education.

I spoke to the leader of the Lords, Natalie Evans, in December and it all escalated quite quickly. David Prior wanted to move on to do the business job in the Lords from health, and so in the space of three weeks my team had prepared my mega briefing packs. I spent most of Christmas nervously reading everything I could about healthcare and then landed on Tuesday 3 January in the middle of a winter crisis, a proper full-blown one. I don’t know if you remember that far back, but it was a big one that year, in the winter of 2016–17. I remember very distinctly going in, because Jeremy Hunt was secretary of state [for health] at the time and he used to have his comms meetings at 8:30 on a Monday, but it was a Tuesday then because of a bank holiday. And it was like someone had just opened Pandora’s box, filled with stuff you don’t usually see [laughs]. You know, the kind of fingertip data flow of what was happening in individual hospitals and on individual days and A&E waits and all the rest of it. So, it was a proper ‘in at the deep end’ job. We had four working days that week, and on the fourth I went on a visit up to Oxford to see a mental health hospital. And then, on the Monday, there was a statement on the winter crisis and mental health funding – one of the PM’s big mental health announcements – where I had to stand up for about 45 minutes in the Lords and take questions from all comers on health, which I was five days into.

TD: It was a baptism of fire.

LO’S: Yeah [laughs].

TD: So, if we go back to your Policy Unit days, as you said, you were looking across the breadth of government policy when you were there. Was that useful preparation for the experience of becoming a minister?

LO’S: Yes, I think there were two things which made it a lot easier for me to be able to hit the ground running. One is having worked for David Cameron for four years. I mean, he was just fantastic as a leader, he was a brilliant performer, he was steeped in it, and I had the opportunity to learn from him. And George Osborne, I worked with him too. So that was very important; not so much in policy terms, although it helped a bit, but more in just being exposed to frontline politics.

But the second thing was that I’d had just over a year as a backbencher in the Lords. During the coalition period [2010–15], unusually the government had a majority in the Lords. The Commons doesn’t think about the Lords very much anyway, but it really didn’t have to think about it at all then. It could get anything through, apart from when it all blew up. If it was a big thing – like [Andrew] Lansley’s Health Bill [the Health and Social Care Act 2012] or the electoral reform stuff [the Parliamentary Voting System and Constituencies Act 2011] – then it all blew up. But you didn’t have to think about it during the coalition. So, I don’t think I’d ever set foot in the place before being introduced as a peer, never really thought about how it worked, but I had a year of getting used to it. And of course, all these institutions have their own cultures, and it’s actually incredibly helpful to know, particularly when you begin, that impressions are quite important.

So, knowing about the culture, knowing simple things like how you address people, some of the formalities, really helps make an impression. And then, as I say, the experience of having worked with people and knowing a bit about what it was like, seeing some absolute pros on the frontbench, and then, as far as possible, just trying to make your own mark – that’s the other thing, you can’t be a facsimile of other people, you’ve got to do something genuine. And actually, I was lucky with the mental health stuff, because a lot of what I’d worked on in schools was around wellbeing in education and so on. So I was able to draw, in that first outing, a bit of experience from what I’d done hands-on at school level, and I think that helps. In some ways it was bits of good fortune that came together to make that first outing OK.

TD: You talked about working with David Cameron. As a minister were you exposed at all to Theresa May and the way she ran Number 10? Did you get any sense of how they each of them did things differently?

LO’S: Not really. I mean, as a junior minister you’re several rungs below. But obviously when I first joined it was pre-the 2017 election, and Nick Timothy and, to a lesser extent, Fiona Hill [then joint chiefs of staff to Theresa May] were sort of old friends. So I had exposure in the sense that I knew them and I could speak to them, and I went a couple of times to see them. But after they had gone [after the 2017 General Election], not particularly, no.

TD: You became a minister in the middle of a winter crisis. What priorities did you have in your first few days?

LO’S: The interesting thing is – and this ranges a bit more widely but – I don’t know how well it’s appreciated just how much parliamentary stuff the Lords ministers have to do because you’re on your own. You do have a whip, but you share them with two or three departments at least. The expectation is that you will do the vast bulk of your own parliamentary work, and in health, I remember, we had a little competition with my counterpart Baroness Williams, Susan Williams [minister of state for countering extremism at the Home Office], about who had to do the most stuff. We got our offices to tot them up, and the Home Office just pipped [the Department of] Health. But basically, you can pretty much guarantee two or three outings a week for questions or debates. In actual fact, the Home Office has much more legislation than Health, so you get off a bit lightly on that, but in terms of oral questions, debates, UQs [urgent questions], statements and that kind of stuff, it’s the heaviest.

So there’s a lot of parliamentary stuff. And the thing that I very much felt – I mean, there are many differences coming from the back to the front of the House – but it’s that your words have meaning. It’s not to say that people pay as much attention to the Lords as they do the Commons, and no-one pretends that that’s the case, but equally it’s very obvious when you’re standing up that if you say something that you either don’t mean or isn’t true, or you make a promise you can’t deliver, that you’re going to regret that. You also don’t want to be just kind of banal, you want to say things that are interesting and engage people. You’ve got these wonderfully informed experts in the House of Lords who, if you can get into the right mode, you can genuinely debate rather than the usual ding-dong.

So that’s how you tread that line between engaging but not saying stuff that you regret, particularly when you don’t know your subject yet. That is the really interesting thing, because I remember someone saying: “In a judicial review, for example, if a minister has said something as a statement of intent about policy, that has legal force.” Bloody hell! You know? And then, in the Lords of course, what you’re doing, because you’re on your own, is you’re not just talking to your own policy brief, you’re talking to everybody’s policy brief. So, I wasn’t minister for mental health and social care and mental capacity when we did the Act or whatever, but you have to deal with all that stuff regardless.

TD: Did you get support from the civil servants to help you with that?

LO’S: Oh yeah, there was never any problem with that. Just to circle back to your original question, I spent a lot of time in those first few weeks trying to immerse myself in the subject, meeting colleagues, getting lots of briefings about all areas, because of the parliamentary stuff, and then trying to get into my own areas, which at that stage had broadened out. There was Brexit, but there wasn’t much going on about that at the time. Life sciences was big, medicines policy, a bit of land and estates stuff because we’d had the Naylor Review [a review into how efficiently the NHS uses its land and property] and I was also doing – and subsequently handed off – the [Contaminated] Blood Inquiry. In fact, Jeremy [Hunt, then health secretary] and I wrote a paper to the PM to say we thought we needed an inquiry, and she happily took that suggestion. Oh, and then the procurement stuff, which actually Philip Dunne [MP, former minister of state for health] was very happy to do because he likes doing procurement, whereas it leaves me cold! So, yeah, it was a mixture of trying to get into my subjects and be able to form an opinion, a view on them, as well as just to make sure I had some sort of panoptic view of everything that was going on.

I was very lucky in that I’d worked with Jeremy for 10 years in one way or another and so he totally trusted me, and I trusted him. It just meant that if I wanted something, the civil service knew that Jeremy would support me getting it or finding it. Not that I would have anticipated any problems, and I never experienced any problems. Funnily enough, I also knew Chris Wormald [permanent secretary at the Department of Health] from my education days and when he ran the deputy PM’s office for [Nick] Clegg [deputy prime minister in the Conservative–Liberal Democrat coalition government]. So again, Chris and I had a nice relationship already. These things really help. If you’re new to something, a brief to know the principle people is a massive help, and God knows, if I’d landed with someone I didn’t know or like or respect, that would have made life a hell of a lot more difficult.

DD: When you were getting to grips with the role, did you speak to any other Lords ministers about what the experience was going to be like?

LO’S: Yeah. I spoke to David Prior a bit, who was my immediate predecessor, Ara Darzi, who had done the job for Labour, and Freddie Howe, who had done it for about five years for the coalition. And as they say, it’s quite an interesting thing in the Lords. While in the Commons you’re on the defensive to the other side and you can wheel out political lines, you can’t do that sort of stuff in the Lords; you just look like an idiot and people don’t respect you for it. So you have to try and work out who is serious and who is not serious, and engage with the ones who are serious, and take the heat out of the other ones, generally speaking. And luckily I’d seen it in action as well, people who had done it well in that year before I became a minister. So it was as much learning from watching people rather than necessarily their advice, unless you can see them do it in action. Freddie Howe was very good, for example, very respectful but smooth and authoritative, and that’s a good start, I think, rather than getting too over-excited, which they don’t really appreciate in the Lords.

TD: In terms of the actual breadth of your brief, you said you had some ways in through the mental health route, but there were an awful lot of issues that you were responsible for. How did you find getting up to speed on all of those areas?

LO’S: Well, luckily I like that kind of thing; I have a mind that likes to hop between subjects, if you see what I mean, and try and find connections with them. So one of the lovely things, if you are so inclined, about being a Lords minister is that other than the secretary of state, no other minister probably has broader knowledge about what’s going on in the department. Particularly if you’re a parliamentary under secretary in the Commons, you’ve got your brief, which is probably relatively narrow, and you have no reason to go and talk to anyone else’s brief. I mean, you talk to your colleagues, but if you’re focusing on public health you wouldn’t go to the minister of state for care to talk about, you know, care homes. So you actually have a really nice opportunity to see a lot of it, and personally I enjoyed it: I liked that, it keeps you on your toes.

TD: You spoke about knowing Jeremy Hunt before you joined the department. Could you reflect a bit on how he ran the department and how that compared with when Matt Hancock came in?

LO’S: Yes. I was warned in advance that Jeremy ran it like a business in a way. He was famous, or infamous, for having all his big meetings on a Monday, so Mondays would just be the senior leadership of the NHS and other bodies to-ing and fro-ing. His theory was that because health is always in the news and there’s always something going on, you can’t guarantee that your Tuesdays, Wednesdays and Thursdays won’t get blown out by these emergency debates, UQs and all the rest of it. So if you left stuff until later in the week, and you want to have a more fingertip control approach, which he did, then you would just lose your time and you would lose your opportunity. It was really interesting. Monday was a full-on day of big “accountability meetings”, as he liked to call them, and then throughout the week he would go off and maybe do a trip, go to a hospital or GP surgery or whatever it was. Towards the back end of the week it was obviously constituency work.

Matt [Hancock] was not perfectly like that, obviously, but that was what they both tried to do: fit as much of that kind of accountability stuff in the early week, use time during the week to do more policy-orientated, longer-term, strategic stuff, along with visits and that kind of thing, as well as any parliamentary stuff. However, Matt keeps it more fluid; he has a different style to Jeremy. On the one hand, he’s a bit more removed, but on the other hand he likes to be involved in everything. So, Jeremy would have a set of things which were his big things, patient safety for example, or the NHS app; they would often be quite particular, and he would be really into them. Anything else, he basically gave to a junior minister and you’d report to him, and unless you were in trouble he basically left you to it. Matt wants to know everything that’s going on much more, having bits of influence everywhere. He’s more across everything, in a way, but actually at a slightly greater distance. So, very different styles for two people who are broadly similar in their outlook.

DD: Going back to your roles in the Lords. As a whip, do you feel like the role of the whip in the Lords is significantly different from the Commons, or are they approximately the same?

LO’S: Completely different, yeah. I mean, for a start, what’s your punishment? “Hello, do you mind coming to vote for us tomorrow, we’d be terribly glad if you could?” “I can’t.” “Oh, that’s a shame”, you know? [laughs]. I actually never had to do any whipping, it was only because there’s a fixed number of salaries for ministers and they didn’t have any when I became a minister, so they gave me a whip’s salary. I never actually did any, but obviously I spent lots of time with them. And of course, the other significant difference is that they do frontbench duties, like Lord Young, former leader of the House. He’s just brilliant, an absolute pro, watch and learn every time. He’s been a minister off and on for 30 plus years, maybe even 40 years now, and he’s still in the Whip’s Office. He does a lot of stuff because he’s Cabinet Office and others will do a bit less, but yeah, you do frontbench duties, bills and stuff, which you don’t do from the dispatch box if you’re in the Commons. And of course, if you’re in the Commons you really are a whip in the truest sense. You’re kind of a hybrid in the Lords.

DD: You’ve mentioned a few of the policies that you were involved in. How did you find the quality of policy making? As well as the advice that you’ve touched on already, in the department? Any frustrations with it?

LO’S: Variable, in all honesty. You would come across tremendous teams with a superb director or deputy director and good people under them, and others who just didn’t seem that engaged. I mean, it’s the classic thing you get in any organisation, I guess, there’s no particular difference. As I said, because I was meeting all these policy teams for all sorts of things, all sorts of subject areas, because of parliamentary questions and stuff, it was really noticeable. Sometimes you would think, “Great, I know these people, I’ll get a good briefing and they’ll understand”, and all the rest of it. Other times, you would just think, “Oh God”. You’d spend an hour with them and learn nothing.

DD: How different was the policy-making experience in the Department of Health compared to the Policy Unit? And are there any lessons that you’d take back to the Policy Unit now you’ve seen both sides?

LO’S: Not really, I mean, it’s very different. The Policy Unit, when I was there, was very small, it was only spads [special advisers] in Number 10. The policy-making department [in the Department of Health] is obviously a massive function, and all civil servants really, so I couldn’t make any sort of comparison.

DD: What policy do you feel like you had the most success with?

LO’S: I suppose there are three things that I look back on and think I’m particularly proud of. The first was one of those things you only really find out about when you’re dealing with it directly. It was an incredibly important framework agreement that we had with the pharmaceutical industry called the Voluntary Scheme for Branded Medicines, Pricing and Access, although it used to be called the PPRS [Pharmaceutical Pricing Regulation Scheme]. Basically, for about 50 years there have been agreements between the pharmaceutical industry and the government in order to try and control prices and price inflation, so you can plan for the long term. And we had one of those PPRSs that finished at the end of 2018, and it had to be re-negotiated halfway through because the pricing was all out of whack and there were various problems with it. It was just something I got my teeth into very early on, and actually spent quite a lot of the 2017 election campaign, when I wasn’t really allowed to work because of purdah [the pre-election period when there are restrictions on the use of public resources and announcements that can be made by the government], just reading up on how these schemes work and so on. And so, helping to design a new scheme, spending a lot of time on that, actually provided a lot of opportunities for partnerships between government and pharma, around innovative new drugs and stuff, and pricing models, and that landed at the end of last year. So, I think that went quite well.

The second would be the Life Sciences Industrial Strategy, which I think is one of the best industrial strategies that we’ve got. It has actually helped stabilise that industry through a lot of difficult times with Brexit, but was really challenging, with lots of ways around the people side of things, and trade and regulation. We’ve managed to keep that industry in a reasonable place, and I think the industrial strategy has had a part to play in that.

And then the third would be Brexit preparation. I was in charge of that for the Department of Health and Social Care and, tell me if I am wrong, but I think it was one of the best prepared departments in government for all eventualities. What I realised fairly early on is that whilst we had less Brexit stuff to do than in some departments – the Home Office and Defra [Department for the Environment, Food and Rural Affairs], for example – the key vulnerability of us as a nation, particularly in a no-deal scenario, but even in a deal scenario, is around the availability of medicines. That is probably the number one risk. And so, making sure that we had everything in place – we were working with the stockpiling plans, thinking about our trade routes in the event of a no deal, our regulatory framework, all those kinds of things – became, over time, towards the end of my time as minister, an almost all-enveloping activity. And I think we got ourselves into a reasonable place, and we would have been alright if we’d gone through [with a no-deal Brexit]. But who knows, time will tell.

TD: Could you talk a bit more about your relationship with industry and how that worked in the context of no-deal planning?

LO’S: Yeah, well, it was actually one of my predecessors, George Freeman [MP, former Parliamentary Under Secretary of State for Life Sciences], who had set up this working group immediately after the [2016] referendum, when he was Life Sciences Minister, which is a position which doesn’t exist now but is sort of what I became. He set up the group immediately in the summer of 2016, and then that became a forum between government and industry. It was called the EURG (the European Union Reference Group), a sort of nothing name, but it enabled us, particularly with the trade associations – the ABPI [Association of the British Pharmaceutical Industry] and BIA [Bio-Industry Association] – to just have an honest dialogue, which was co-chaired with me by a guy called Phil Thompson at GSK [Glaxo Smith Kline].

There were one or two other representatives from different bits of industry and the [medical] devices side as well, and the NHS, basically to discuss what is going on here, what are the risks, what should we do about them, how should we think about policy, how should we think about ameliorations and mitigations in the event of a no deal, and so on. We probably met every couple of months for that whole time, and I have to say, they were tremendous. I mean, none of them wanted that outcome, they were all institutionally and individually pro-Remain, I think, but they totally committed themselves to doing what was right for patients. I was seriously impressed by their attitude and their capabilities – they really helped us.

It’s interesting to reflect on, particularly in the Conservative Party, that kind of wing of conservatism which has a very laissez faire attitude to business, which is to let them do their thing and the government do its thing, and anything that’s committees and corporatism is just wrong somehow. What this experience exemplified to me was that here you have an unbelievably thorny problem, not insoluble but really challenging, and nobody has the monopoly on wisdom. So, unless you get all the key people in the room and they can find a forum in which they can be frank but constructive with one another, then you can’t solve these problems because no-one can solve them alone. So, I have to say, actually, without them, we just wouldn’t have been prepared.

TD: No deal was obviously a big focus, particularly towards the end of last year and the beginning of this year. Were there other bits of Brexit that fell under your patch, such as thinking about the future relationship [between the UK and the EU]?

LO’S: Oh God, yeah, very much so. A very good example would be this concept which we developed for the Political Declaration [on the future UK–EU relationship] which is associate membership of the EMA [European Medicines Agency]. I also led on all the [ongoing] European work, so I would go to the [European] Councils and those kinds of meetings with all my European counterparts. I spent a lot of time speaking to them about Brexit and what we wanted and hoped to achieve out of the deal and the future relationship and all the rest of it.

And out of that came this sense that, actually, there is this interesting regulatory category. If you think about it, there’s the economic partnership and there’s the security partnership, but there is something which sits in-between which is about safety. It applies to chemicals, it applies to airlines and it applies to medicines: it isn’t a security issue but it’s not a pure economic issue either, it’s something in-between. So, when they realised this, the argument was that, actually, there needs to be a kind of special recognition that for issues of safety there was a case for the EU to operate differently, by looking at associate membership type roles. Now, of course, these are all speculative in the sense that they are in the Political Declaration and not in the [legally-binding] Withdrawal Agreement, but we were able to get that message through, that that could be something to be explored.

I would go to the [European] Councils and those kinds of meetings with all my European counterparts. I spent a lot of time speaking to them about Brexit

Think about it by analogy: if you think about airlines and security, you wouldn’t hesitate to share information about suspects who might be getting on a plane with a weapon or something. The economic side would be, “Well, we want this airline HQ with us”, but that is a bit of a zero sub-game, so you are going to have a fight about that. But for safety, you would obviously share information about which planes were in the sky and which ones were safe, even if you weren’t part of an economic partnership.

So, that was the kind of metaphor and it’s the same with medicine. We’re not saying you need to have a single market, as it were, for buying them, but actually given that they are going to cross these barriers – and they do big time, not just end products but actually in the multiple stages of manufacturing – why would you not share safety information? There’s no downside in doing it, because it’s not a zero-sum game. So, yeah, that would be a good example of how the experience of going into it deeply and thinking about the future not only got us to a good proposal in the Political Declaration, but also helped us conceive of something, a category of things and functions, that you can imagine in a kind of hybrid relationship with the EU in the future.

DD: You announced quite a few policies during your time as a minister. Did you consider about how they might be put into practice, and did you have any meetings with civil servants to follow up on their implementation?

LO’S: Well, yes, of course, because the civil service are good at stopping you saying anything just because you feel like it and without thinking it through [laughs]. Particularly if you’re a junior minister, because the bar of being able to actually announce anything is that much higher than if you’re a secretary of state, who can generally decide and do what they want unless it’s completely bananas! I am relatively cautious in that sense; I don’t particularly just like throwing stuff out, but of course you think about it. I mean, leaving the Brexit stuff aside, there is a whole team in the Office for Life Sciences which is now largely focused on implementing the sector deals and any other area such as the tech and digital data front. While now it falls into NHS X [a recently created body overseeing the digital transformation of the NHS], at the time that didn’t exist, so instead there was a mixture of the DHSC [Department of Health and Social Care] team, NHS Digital and others. We had a data strategy and a gathering of all the heads of the organisations to think about the programme and implementation.

If you look at that first 18 months in particular, I think, of the coalition government, it was phenomenally effective in getting stuff done

DD: When you were writing the 2010 manifesto, were you thinking about having the conversation about implementation at that point, or was it much more focused on the overall policies?

LO’S: Well, we had a whole function then, with Francis Maude [Lord Maude of Horsham], Nick Boles [MP], Kris Murrin and the implementation team, and I think we were genuinely really well prepared. There was the policy side of things, which was mainly Oliver Letwin and myself, and then there was the implementation side, led by Francis and Nick Boles, and we worked very closely together. You may also remember that each team had a business plan, as they were called, and that was a mixture of the policies that they wanted to do plus the implementation of plans, timeframes, resources and so on. Most of that was in place pre-2010, from the beginning of the access talks [the period when the civil service is authorised to discuss potential policy changes with the official opposition], so a lot of that was being mainstreamed down to the civil service anyway. Even with having to form a coalition and that being an expected, or rather [a] low-probability event, I don’t think it took long for both the coalition and the civil service underneath it to re-orientate. We created the Programme for Government, obviously, and then to turn that into a business plan and then into implementation, I think that all happened really efficiently. If you look at that first 18 months in particular, I think, of the coalition government, it was phenomenally effective in getting stuff done. I mean, even things like tuition fees, which obviously had long-term political consequences for the Lib Dems, that was done pretty swiftly.

DD: On that topic, do you think that going from a coalition to single party and then minority government made any difference to your job specifically in the wider dynamics of policy making?

LO’S: It’s hard to compare it, because I never saw the Lords in action, as it were, during the coalition days. People said it was relatively straightforward because, unusually, they had a majority. To be honest, I think the biggest change was going from a majority to minority after the 2017 election. It wasn’t just the numbers, it was also the kind of degree of confidence that the government had in itself. Obviously, it took a bit of a pounding after losing the majority, and the PM herself, there was a period of adjustment for her, I think, as well. So, that’s when I think things generally became more difficult, and then as we moved towards the second half of 2018, I think you did start to see – and certainly in the first half of this year – a crowding out effect. I actually think the government managed to mainly carry on with its domestic agenda fairly effectively until the middle of 2018. It was from that summer onwards that you actually started getting civil service numbers being redeployed into Brexit prep functions, and that’s when you started to see a bit of a crowding out effect. But it happened later than most people assume that it was happening.

TD: You mentioned visits both to NHS organisations around the country as well as foreign trips. I wonder if you could talk a bit about your travel as a minister? How useful did you find it and how important was it for your role?

LO’S: I think the trips fall into three categories. First is the kind of domestic visits, and they are without doubt always the best thing you can do, because you get on the ground, you talk to clinicians or researchers or, even better, patients, and you see wonderful, hopeful, hope-giving stories of people. I remember going on a visit up to the Oxford Biomedical Research Centre, and meeting a patient there who was literally the first woman in the world to be given this combination of therapies for her cancer. In the words of her clinician, it had “gone to sleep”, and all of a sudden, this was somebody who’d been given hope of life; it was really powerful stuff. So, that is always the best thing to do in these kinds of jobs, and I remember thinking when I was in Number 10 that I didn’t get out enough, because it’s harder when you’re an adviser. I did try and get out as much as I could as a minister, but again, particularly in the Lords, it’s difficult. You’ve got such a heavy parliamentary load and it can be quite unpredictable since you haven’t just got questions every five weeks, something can come up almost every day. It is hard, but it’s important.

The second would be the EU stuff; that was interesting and it was fascinating to see from up close how the Commission and the Council works. They had their set piece topics, but largely it was about having bilaterals with my colleagues and trying to find out how they were feeling about the UK and Brexit, trying to get a few key messages across. Thirdly, there was a couple of trade mission type trips, one to Arab Health, a big health conference in Dubai, and another one out in Philadelphia for a big medical technology conference. It was really about banging the drum for British businesses and trade missions.

I have no idea how effective those are, because you don’t really see the aftermath as it’s mainly dealt with by DIT [Department for International Trade]. Although I think the European trips were relatively useful and we certainly got good information out of them, whether we changed anyone’s mind, I don’t know.

TD: You mentioned DIT there. In your role, were there other departments across Whitehall, or ministers in other departments, that you had to work with, or was it very much within DHSC?

LO’S: So, I worked with BEIS [Department for Business, Energy and Industrial Strategy] through the life science strategy, which was split across both departments. The DIT, through the Life Sciences Organisation, which is actually part of DIT, and Healthcare UK, which is a kind of export body [part of both DIT and DHSC]. A bit of Treasury, inevitably, and then also as required for different topics; for example, we worked with Lord Richard Keen of Elie [Ministry of Justice spokesperson in the House of Lords] on clinical negligence reform. But no, I would have thought the vast bulk of it was spent in the Department [of Health and Social Care].EALTHC uk

DD: What advice would you give to a new Lords minister on how to be most effective in office?

LO’S: I think there are two big features that are different about being a Lords minister. The first is the breadth that you have to cover, because you have to cover a whole department. So, actually immersing yourself not just in your own policy areas, but actually meeting teams and stakeholders and others in all the areas you’re likely to have to talk about is really important. And critical to that is actually meeting the key peers with an interest [in those polices]. Somebody said, “The thing is, when you stand up as a Lords minister, you have to remember that the person who is asking the question has probably written a book on the topic!” So, it’s quite important to engage with them up front and make sure that you have established the trust. And the second is, actually, to just learn the ways of the [House of] Lords. It has its peculiarities in how you address people and all the rest of it, and some people are quite fussy about following form.

TD: And is there anything else you think would be useful to mention?

LO’S: I think I’ve got across the peculiar nature of being a Lords minister, it’s quite different. You’re slightly more isolated, in a way, because a lot of what goes on in the Commons is quite ‘clubby’ around intakes and cohorts and dining clubs and with your ministerial team, if you’re in a ministerial team or a ministerial whip or whatever. Whereas, in the Lords, you’re a bit more of a lone wolf to some extent. You’ve got your ministerial team who you sit with on the frontbench and have your weekly meetings with, but it’s not quite the same. So, you have to be comfortable with that. Anyway, I think I got some of that across, as well as the breadth of it and the focus on the parliamentary work. We’ve covered most bases.