Andrew Lansley stands on the concourse of Euston station cracking jokes with a gaggle of civil servants. Lansley, who must be at least 6ft3, towers over the group. He looks relaxed. The contrast with how he looked a few months ago could not be sharper. Then, the Health Secretary seemed to be carrying all the troubles of the coalition’s NHS reforms on his shoulders. He had developed a stoop and he would talk to you with his arms crossed. But now his controversial, much revised bill is almost through parliament. What he calls his period in ‘purgatory’ is nearly over.
For a Cabinet minister, Lansley is surprisingly free from ego. As we get on the train, he expresses surprise that I don’t mind making a journey just for the sake of interviewing him. Most of his colleagues would consider this standard procedure.
Once we get moving, I ask him whether, despite the ramifications of the autumn statement, the NHS budget will still be immune from cuts. His reply is unequivocal: ‘We have been very clear that the NHS is going to have real terms increases year on year. I mean clearly what we’ve said in terms of the coalition agreement is an agreement for a parliament. From our point of view, I would say yes is the answer to that because exactly the same principles apply. We have a profile of rising demographics and demand and cost pressures and technology in the NHS, so it is inconceivable that we can sustain the quality of services that we are looking for without the basis of real terms increases.’
Does this mean that spending on the NHS will have to rise in real terms every year from now until kingdom come? ‘I believe so.’
Downing Street agrees. One senior figure at No. 10 tells me that ‘Dave, George and Steve’, the holy trinity of Cameron, Osborne and Hilton, ‘all believe that the pressures on the Health Service are such that you are always going to have to increase spending on it’. Lansley is keen to stress that when the economy starts growing at a reasonable rate, you’ll be able to put more money into the Health Service without increasing the share of GDP that it swallows up. For this reason, he thinks that the commitment to ever-rising spending is sustainable.
No piece of coalition business has proved more controversial than Lansley’s Health Bill. Lansley himself was humiliated when the bill was ‘paused’ halfway through its legislative process, then substantively amended. When the subject comes up, he grimaces involuntarily. The biggest thorn in the bill’s side has not been a Labour MP but the 81-year-old Liberal Democrat peer Shirley Williams. She forced her leader, previously an enthusiast for the reforms, to demand changes. When asked what he makes of her, the Health Secretary is lost for words. ‘She is...’ he splutters. ‘How can I say, she is... a high maintenance date.’
‘We have had lots of meetings,’ he continues. ‘In a sense, to give her her due, even if I felt we had to devote an enormous amount of time simply to get to the point where we were clear about what it is she wanted, I think that allowed her to realise that we were not dealing with the bill as she imagined it was.’
Lansley is confident that Labour will come to accept the bill, too. ‘Andy Burnham says drop the bill,’ he says. ‘But in truth if you start to disaggregate the bill and say are you in favour of this, this, this and this, his position is pretty much to be in favour of most of it. In three years’ time he is going to say, well of course we’re not going to go back to the old system. Fine, they shouldn’t and it is in nobody’s interests, not in the NHS’s interest for him to say that.’
What frustrates many of Lansley’s colleagues, however, is that he felt the need to pass a bill in the first place. Many whisper that he could have got to much the same place at far less political cost by just quietly carrying on with the Blairite reform plan. Lansley, though, is not convinced. He says that ‘Labour politicians tried to do that and they failed because actually they ended up with completely half-baked reforms.’ To his mind if the reforms are not comprehensive, ‘the bureaucratic system generally takes them on board, twists them and rejects them. Then it goes back to where it was.’
An interest in health runs in the Lansley family. His father was one of the first NHS scientists. He died last year having spent months in hospital. Lansley recalls, ‘There was one moment when I was sitting with him talking and a staff nurse came up and said “Tom, we’re going to have to take your blood now” — oh right. “We’re taking your blood because what we do is send it off to the laboratories and they will look to see if there is any infection” and she went on like this explaining it and I was thinking, we’re not going to disturb her with the fact that a) the Secretary of State is sitting here and b) the person you’re talking to used to be the chairman of the Institute of Biomedical Sciences.’
During his illness, his father discharged himself from hospital, having decided that there was nothing more they could do for him. Lansley, with a catch in his voice, reflects that ‘going home was the best thing for him because we managed to sort it all out at home. It’s tough though, when you actually go through it… you do have crises… and the ambulance comes and you get whisked off to hospital, there’s no way back. That happens all the time.’ For a brief moment, I sense the man behind the politician.
But it doesn’t take long for Lansley to revert to NHS-speak. He is comfortable saying ‘in the outcomes framework, domain four is patient’s experience of their own care’. In the current climate, though, he sees an advantage in his bureaucratic tone: ‘It does have the ancillary benefit that if things get really difficult and everybody demands a technocratic government, I might get to keep my job!’
Interestingly, Lansley believes that he has become more Eurosceptic in office. ‘You tend to go in one of two directions — either you keep going to Brussels and you like it, or you keep thinking, why are they interfering with our ability to do this thing?’
It is European influence, or the lack of it, which partly explains why Lansley wouldn’t want to work in any other department. ‘In a sense, I was trained for the Department of Trade and Industry because that’s where I was a civil servant, but I pretty much gave up that idea when I thought that actually Europe tells us what to do in the Department of Trade and Industry most of the time. In the Department of Health we’re still in charge and we can still make things happen.’
I ask Lansley what he’s planning to do for Christmas and his face lights up. ‘If you can picture the scene, it is pretty idyllic because my sister-in-law has restored a wrecked Georgian farmhouse on Anglesey.’ He’ll walk on the beach with his wife, two younger children, his in-laws and his sister-in-law.
But for all his evident enthusiasm for Christmas with his family, one gets the impression that the gift he is really waiting for is his bill becoming law.