Andrew Lansley and his big gambleBMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d491 (Published 26 January 2011) Cite this as: BMJ 2011;342:d491
- Peter Davies, freelance journalist, London
UK health secretary Andrew Lansley was once prime minister David Cameron’s boss—a little remarked fact that may partly account for the fearlessness with which Mr Lansley felt able to spring upon cabinet colleagues his controversial plans for the NHS. When he was head of the Conservative research department in the early 1990s, Mr Lansley gave Mr Cameron and George Osborne, now chancellor, their first jobs in politics.
“That explains why he and David Cameron have a good relationship and why Andrew is trusted on health,” says Andrew Jones, formerly a Conservative policy adviser and now group medical director of Nuffield Health. Indeed Mr Lansley distinguished himself at the research department, playing a significant backroom role in the Tories’ unexpected 1992 election victory, for which he was awarded the CBE.
So if he behaves like someone with credit in the bank, it may be with justification. Mr Cameron confirmed Mr Lansley would be health secretary in a Tory government as long ago as 2008, a public guarantee extended to no other opposition frontbencher apart from Mr Osborne.1 Before the election, he was able with impunity to initiate cross-party talks on social care without telling Mr Cameron.2 He remains immune to the more swingeing budget cuts imposed on his colleagues.
Yet one sceptical policy expert thinks Mr Lansley would be well advised not to push his luck and made a serious political mistake in not ensuring the prime minister was fully briefed on the radical nature of the NHS reorganisation. “History suggests that relying on the personal loyalty of politicians is a very quick way to the backbenches. It probably helped him make the sale. But you can only use it once, and he probably has used it now.”
However, Mr Lansley is not trading solely on 20 year old friendships: during his six year apprenticeship as shadow health secretary, the public’s view of whether it could trust the Conservatives with the NHS was transformed, despite Labour’s massive investment in the service. “I consider that a major, major achievement,” says Dr Jones, pointing out that health, often toxic for the Tories during election campaigns, was a neutral issue in 2010. During those long years in opposition Mr Lansley toured the NHS assiduously, meeting anyone and everyone. “He was probably better prepared than any previous health secretary,” says King’s Fund chief executive Chris Ham.
He had taken an interest in health since becoming an MP in 1997, immediately joining the health select committee. He may have had strong personal motives for doing so. In 1992, though in apparent good health and aged 36, he suffered a stroke misdiagnosed by his GP as an ear infection.3 His first wife (they divorced in 2001) was a doctor. His father worked in the NHS from 1948, running the pathology lab at East Ham Memorial Hospital for 30 years, becoming chair of the Institute of Medical Laboratory Scientists and co-founder of the Council for Professions Supplementary to Medicine.
Mr Lansley’s own career, after a politics degree at Exeter University, took him into the civil service. He was principal private secretary to Norman Tebbit for three years at the Department of Trade and Industry, where he worked on privatising British Telecom. Some claim this experience was crucial to his political outlook and personal style. Though now a Tory “moderniser” rather than a right-winger, he still believes in the free market.3 Critics argue he cannot see the political wood for the policy trees.
“He’s a civil servant and policy wonk. He’s not a politician, and I’m surprised by his lack of political dexterity,” says one, citing Mr Lansley’s inability to create a narrative to convince the public of the need for his reforms. “He has no constituency of support on the backbenches and no identifiable allies.”
Another says: “He’s not a good communicator of the ideas he’s spent so long thinking through. He doesn’t win hearts and minds. He often comes over as critical of people in the system, not realising you need them on board to achieve your plans.”
At times Mr Lansley can seem gaffe prone. His 2008 claim that “recession can be good for us” was swiftly retracted.4 He accepted a £21 000 donation from Care UK for his personal office, apparently unaware of any potential for what the Liberal Democrats called “a staggering conflict of interest.”5 His directorship of marketing company Profero, whose clients included GlaxoSmithKline, Pizza Hut, and Pepsi, attracted similar criticism.6 The agency helps mount government health drives, such as anti-drug campaigns. And he infuriated celebrity chef Jamie Oliver by suggesting his school meals initiative had made children’s diets worse, later apologising.7
Others are more positive about Mr Lansley’s civil service background. “He has a very good idea of how sound policy development should be done,” says Dr Jones. “He went into the Department of Health with a very clear plan and he’s exceeded expectations in getting a very positive response out of the DH. Everyone thought [NHS chief executive] David Nicholson wouldn’t stay five minutes, but the reverse is true.”
Professor Ham has doubts about that plan. “He developed a lot of these ideas when the NHS budget was still growing significantly. They would have been much easier to apply in 2007-8. If he’s vulnerable to criticism, it’s that he’s not been flexible to change.”
Some who have met Mr Lansley since he launched his reforms report him unsettled by the reaction. “He’s had a long, dark night of the soul,” says one. The result of the next election may decide whether his NHS reorganisation proves his biggest gaffe of all.
Cite this as: BMJ 2011;342:d491
Competing interests: None declared
Provenance and peer review: Commissioned, not externally peer reviewed.