I think it was on my first outing at the despatch box as Secretary of State for Health that Andrew Lansley threw me a copy of his draft NHS Bill, suggesting I read it as part of my induction. It struck me as the work of a man who knew a lot about the NHS but understood nothing about politics.
Geoffrey Howe once described an economist as a man who knew 100 sexual positions but had never actually met a woman. Lansley is a man who knows 100 clinical procedures but has never carried out an operation. The fact is, a health secretary needs no such information. It has nothing to do with his role in the health service. Andrew is a technocrat. I do not use the term pejoratively; it's a statement of fact. He would make a good permanent secretary at the Department of Health. Having coveted the job of secretary of state for six years, it took him six months to make a complete hash of it.
This isn't because he's hostile to the NHS: he is genuine in his admiration for it. Anyone who read the obituaries of his father, Thomas Lansley, a distinguished biomedical scientist present at the birth of the NHS, can see that Andrew's affection for the service was imbibed with his free NHS orange juice. He also came to the Tories through the unconventional route of the SDP, which must have made Lord Owen's call for his resignation (upon the publication of his excellent critique of the NHS reforms) particularly hard to take.
The problem is that in all those years as Opposition spokesman on health, Andrew developed a superiority complex. He was convinced he had nothing to learn. His disastrous plan therefore entered Richmond House with him, fully formed. It was an edict, not an idea. With it he brought the very worse combination of characteristics – a technocratic secretary of state, smug in his self-belief, hawking a half-baked blueprint which had only been partially aired, deluded in his belief that the NHS admired him as much as his leader did.
The first warning sign was when Lansley opposed Labour's efforts to open GP surgeries into the evenings and on Saturday mornings. Andrew said GPs should have total control and if they wanted to inconvenience their patients so be it. Then came his opposition to GP-led health centres open from 8am to 8pm, 365 days a year, offering care not just to those who were registered but also those who worked in the vicinity and found it more convenient to use than their registered practice.
He is enthralled by the notion that only GPs knew what is best for the NHS: the consequence of this is the abolition of primary care trusts in favour of GP commissioning. This turns our evolutionary "practice-based commissioning" approach into the revolutionary top-down re-organisation that the Government promised to avoid.
But the third warning sign is perhaps the most revealing. In 2007/08, a couple of Conservative-supporting newspapers were (rightly) campaigning to end the practice whereby a cancer patient's purchase of a drug unavailable on the NHS had all NHS treatment withdrawn. This cruel and unnecessary "rule" had always operated, but it was clearly wrong.
I was amazed that the Conservative opposition never supported this campaign and that Andrew Lansley and his front bench team never once raised it in the House. Andrew said the issue was complex and the problem might be solved by creating a worse one. But only a technocrat would have stuck with this inherited "rule" against the interests of vulnerable patients. When we got rid of it Andrew belatedly announced that he would have done the same thing.
The Royal College of Nursing is not known for its militancy or its propensity for carrying motions of no confidence in a secretary of state. A politician would have marched towards the sound of gunfire and addressed the conference. A technocrat would talk to a small gathering and truly believe it was an acceptable alternative.
If Andrew Lansley ever had political antennae, he's obviously had them surgically removed.