Tunnel vision

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In contrast to most people, Andrew Lansley appears to be at his happiest in a hospital. Sleeves rolled up and smiling, the health secretary looks more at home here than in his nominal place of work, Westminster. But then, in contrast to most politicians, Andrew Lansley seems less interested in politics than in his own particular policies, ones which he has spent nearly a decade crafting.

Despite the lengthy gestation, those policies saw. Lansley booed at the Royal College of Nursing, mocked in a well-watched YouTube video, turned on by Lib Dem and Labour opponents, and then ordered by the prime minister to announce a pause in his plans to reform the National Health Service following accusations of Tory privatisation by stealth. For a while, he looked in need of urgent medical attention, but today, after an invigorating tour of Stevenage Hospital’s A&E department, Lansley appears to have recovered.

“I have been around a very long time, and the political and the personal are very difficult to separate,” he suggests. But while he sounds relaxed, the plans he spent so long preparing have come under sustained attack.

In a recent article John McTernan, a former adviser to Tony Blair, suggests that Lansley’s mistake, in contrast to the former Labour health secretary Alan Milburn, was a failure to spend time “understanding the dynamics of professions and creating a coalition of the willing”.

Lansley is unimpressed, arguing that Milburn’s attempted reforms failed – “and that’s the difference”. But while he dismisses Milburn’s approach as “piecemeal” and lacking strategy, Lansley admits that his own coalitionbuilding attempts still left “organisations and people with which I haven’t had that relationship, and they don’t understand that this is all about supporting the NHS”.

So if not a failure to build a coalition, then perhaps a failure to adequately talk through his plans? “Yes, a bit,” Lansley admits. “What I hadn’t understood was the extent to which people would agree with the principles but have some quite aggressive complaints about the details. There was not sufficient anticipation, on my part, of how rapidly we had to get beyond the agreement in principle to people understanding how it would work in practice. Just because we knew it wasn’t about privatisation, cherry-picking and charging, people out there [still] needed to be told.”

So why weren’t they? “We were moving at pace and it is sometimes difficult to get messages across in a short period of time,” Lansley replies, insisting that “we needed a pause to get those messages across and give ourselves more time to make that happen”.

Listening to Lansley, it seems that his belief in his reforms, as first published, has not wavered, and he gives the impression that they remain more or less in their original form– despite the pause, and Lib Dem crowing over their role in the re-writing.

“They’re in government so, absolutely, they can claim victory,” says Lansley – an answer unlikely to please some fellow Tories. “We’re doing it together – it’s not about one party winning or losing, it’s about the coalition succeeding.”

If that sounds like the approach of a technocratic policy man, then his critics would say that is precisely what Lansley, a former civil servant, is. “Getting the policy right is enormously important; it’s pejorative to describe that as technocratic,” Lansley argues. “There are people in politics who don’t do policy. I do, but I have also done politics.”

His own politics took time to settle. Lansley describes his upbringing as “not overtly political” – he thinks his Manchester Guardian-reading parents drifted away from Labour during the 1970s – but by his teens he was attending political meetings, with the guest speaker at his first visit the then Labour leader Harold Wilson. At university, however, Lansley joined the Tory Reform Group and was elected – supported by Labour, Conservative and Liberal students in a bloc vote against the Socialist Worker Party – as the Student Union president. He then veered left, joining the newly formed Social Democratic Party in the early 1980s. “There’s a founder member certificate lurking around,” he admits, bashfully. “I was technically a member, but I wasn’t an active one – I was a civil servant at the time.”

Once promoted to private secretary grade, Lansley gave up any political affiliations, but as he worked closely with Norman Tebbit up to the 1987 election, his political philosophy began to take shape.

“I began to take the view that I couldn’t have served under Labour in exactly the same way, so I thought I ought to leave,” he admits, explaining that this “seminal moment” was shaped by his support for the Conservative Party’s economic policies, its belief in “people’s responsibility towards each other”, and – critics of his NHS reforms may flinch – the “benefit in what has been tried and tested”.

Recruited to head the Conservative Research Department in 1990, Lansley turned the CRD into a Downing Street finishing school, as he employed the likes of David Cameron, Steve Hilton and Ed Llewellyn. Two decades on, the hierarchy is reversed. “Sometimes I have to slightly pinch myself,” he admits, with a wry smile, before quickly adding: “But it’s great – and it’s quite important that people who do important and stressful things have longterm relationships with one another.”

Elected to Parliament in 1997, Lansley’s increasingly political brain – he describes undergoing the “interesting shift” from “what line to take to what does the party think” – led him to work on William Hague’s 2001 election campaign, with accounts of the time describing an MP now firmly on the Tory right. Lansley dismisses the charge.

“It’s a complete travesty to describe what we were doing [in 2001] as a core vote strategy,” he argues, before admitting: “As we moved into the later stages, did the public think it was all about tax andEurope? Well, yes. We could have remembered what we were trying to achieve strategically.”

Lansley then sat out Iain Duncan Smith’s often strategically baffling leadership – “Given the nature of the campaign, I wasn’t expecting to, and didn’t, form part of his team” – and returned to the back benches, but in 2003 IDS’ successor Michael Howard “asked me what I wanted to do”.

Lansley chose health, a subject he had first encountered on the health select committee in 1997. There was strategy in his thinking too. “If we were to change the public’s view [of the Conservatives], then the NHS was one of the key routes – it was vital to get that right,” he explains, noting that he helped move the party “to a place where more people trusted the Conservative Party with the NHS than Labour – a major achievement”.

So when his reforms stuttered so publicly, Lansley was baffled as much as troubled. “What disappoints me is that there are clearly people who somehow imagine that I don’t understand the NHS or appreciate it. I thought I demonstrated that absolutely, and you just have to keep on demonstrating that – and I will.”

So is it fair to say that he is in the same position as his now cabinet colleague Iain Duncan Smith, a minister so wedded to his policy brief that he has declared himself uninterested in any other government position? “It’s fair to say that it is,” Lansley agrees, before attempting, again, to demonstrate his determination. “I have seen ministers who have a clear strategy and as a consequence achieve, and I have seen ministers who don’t try to do anything except manage tomorrow’s headlines.

That might be successful, but it’s like eating a meal with no nutrition. We’re in government to change things, and we’re trying to look at a major shift in responsibility towards frontline service. We’re not in politics just to win elections, and I am not in politics to be in politics, in power, or famous. I’m not interested in any of that stuff. I am committed to the policy and the philosophy that underlies that.”

With Liberal Democrat dissenters already promising further revolts over the NHS reforms, there will also be plenty of politics for Andrew Lansley to deal with. For now, however, he appears in good spirits. Or perhaps that’s just the effect of spending a day in a hospital.

Sam Macrory is political editor of The House Magazine