Andrew Lansley: How the Health Secretary learnt to junk the jargon (he only said 'referral pathway' once...)

In one of those twists that happen in politics, health is out of the headlines and the minister's job looks almost safe, says Oliver Wright

It would be fair to say that the Secretary of State for Health is probably not much looking forward to this morning. At around 11.45, in the normally genteel town of Harrogate, Andrew Lansley will stand up and face more than a thousand of his most ardent critics: the massed ranks of Britain's nurses.

They may be the caring profession but for any Health Secretary such an encounter is fraught with difficulty. The political career of one of his Labour predecessors, Patricia Hewitt, never really recovered after she was heckled and booed at the Royal College of Nursing Congress in 2006. What hope then for a Tory health minister, whose Bill to reform the NHS has made him a hate figure for large parts of the profession for whom he has responsibility?

So the question, as we meet a few days before his speech and Q&A sessions, is why does Lansley look so chipper? Gone is the slightly hunted look and grey pallor of earlier this year when his health Bill was finishing its tortuous progress through Parliament. In its place he is smiling, joking and, most remarkably of all, has cut back on the unintelligible jargon. He uses the phrase "referral pathway" only once.

In fact, Lansley seems almost cheerful about the prospect of a beasting from the nurses. "I see nurses all the time," he says, and muses later: "I normally expect a rough ride."

Lansley's new found cheerfulness is largely a consequence of the strange and unpredictable shifting sands of politics at the moment. Two months ago, the conventional wisdom was that he was for the sack. The damage done to relations with the profession during the bruising passage of the Bill meant the Government had to press the "reset" button and Lansley would be a casualty in a summer reshuffle.

But then the Budget happened, and a string of crises have changed the political landscape. Suddenly health has disappeared from the headlines.

It is perhaps a sign of his new-found confidence in his job prospects that Lansley confides that he has sent his wife Sally off to the Government Art Collection to "refresh" the paintings in his fourth-floor office. He also has a new set of media advisers and appears to have lost some of the jargon which characterised his previous efforts to explain his health reforms.

"The politics of it is dead simple," he says. "If we don't do these things now, by 2015 and the next election the NHS will be in crisis [because of a lack of money]. That's what we talked about at Cabinet in 2010 when we decided to go ahead.

"I could show you the graphs. Each year the NHS has seen an increase in the number of people going to A&E departments, an increase in the number of people being referred to hospital by GPs, an increase in the number of people who arrive in hospital as an emergency admission, and an increase in people going for planned operations – all by as much as 3 or 4 per cent a year.

"This year the figures suggest that the number of planned operations have gone up, but each of the other three areas are flat or have gone down. That is because we are now treating people more effectively in the community. My predecessors have been trying to do this for years, but now it happening."

And that helps reduce the cost of the NHS on the taxpayer? "Yes," he says.

But despite the rosy picture he paints, very significant problems remain. The NHS has to save £20bn over the next four years and his critics point out that many of the changes he wanted to bring about could have been done without the time-consuming and distracting legislation he was so keen on. It was madness, they say, to dismantle the architecture of the NHS and rebuild it when the focus of the organisation needed to be concentrated solely on making what was there work better.

Part of the problem is Lansley's background. Before becoming Health Secretary, he shadowed the brief in opposition for almost six years. Many of the plans he legislated for and is now implementing had their genesis in the good times: when money was not a problem and the NHS was benefiting from massive budget increases.

It is almost as if, when he got handed the train set, he couldn't resist going ahead and rebuilding it – even though times had changed and the squeeze on public sector spending meant it was pragmatically and politically a bad idea.

Lansley, not surprisingly, rejects this. He believes it is possible to enact his changes while making savings and improving patient care.

"Actually the service is doing very well," he says. "One of the key things people said from the outset was that every time you get change you get a risk of disturbance to business as usual. That's inevitable. So the focus across the service of delivering high performance has been really important.

"We are in a place at the moment when we've got waiting times at exactly the same level where they were two years ago before the election. The proportion of people waiting more than a year has gone down by two thirds. We are doing hundreds of thousands more diagnostic tests – with the same average wait as before the election.

"We have increased access to NHS dentistry. We have cut mixed-sex accommodation by 95 per cent. The service has brought hospital-acquired infections down to their lowest-ever levels. We have got improvement in patient-reported outcomes."

The list maybe impressive but the huge difficulty will be sustaining it as the cuts get more difficult – especially with a recalcitrant and demoralised staff who are angry about pay freezes and pension changes, not to mention the divisions caused by what was widely seen as an ideological health bill.

It is partly because of this that Mr Lansley is making the trip to Harrogate – to try to show the nurses some love, even if they choose to boo him.

His message: we are on the same side. He even suggests in the wake of nursing scandals at Mid Staffs and elsewhere that there are some similarities between his position and theirs.

"Over the last year or so nurses have felt that they and the care they provide have come in for a lot of stick and I can sympathise. As a politician I know perfectly well that things can go right 99 times and nobody says a thing about it. It can go wrong once and it is a front-page story. That is very true of nursing. When things go wrong it can be a very bad thing. The cases we have seen have been the exception – not typical of nursing quality."

There is something thick-skinned – almost wilfully stubborn – about Lansley and you suspect he's not quite aware of the antipathy that he can generate.

Ask him about the personal – and sometimes nasty – attacks that he sustained over the past two years and he suggests that it is "just politics".

"I don't pay them much mind. They were doing the same thing to people who popped up and said they agreed with anything we were doing," he says.

"They're clearly ideological. They had a big go at Shirley Williams when she said they've made big changes to the Bill and now I agree with it. It was basically a pretty extreme ideological response."

He said he took some advice from Ken Clarke who, as Health Secretary in the 1980s, was the subject of similar attacks. "Sometimes he'd say in Cabinet, 'blimey, you're getting it pretty easy. The doctors put my picture on billboards saying what do you call a man who doesn't take medical advice'."

So does he feel any sense of schadenfreude now that others in his party are feeling the heat of the media spotlight.

He laughs and, not entirely convincingly, says: "I would have no such feeling whatsoever."

So what of the future? How does he want to leave the NHS and be remembered? "I would like people to say: we now have not only an NHS that everybody has access to, but one which clearly delivers some of the best healthcare anywhere in the world."

A lofty aspiration. But the jury is very much still out.

The CV: Andrew Lansley

Born: 1956 in Hornchurch, Essex.

Schooling: Brentwood School, Essex, then Exeter University, where he studied politics.

Career: Ran the Conservatives' successful 1992 election campaign, which won him a CBE, but suffered a minor stroke the same year. Won seat of South Cambridgeshire in 1997 and joined Commons health select committee. Granted health brief by Michael Howard in 2004 and named Health Secretary in Coalition Government six years later.

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