Reflections on politics of the week
A few issues which crossed my mind on health, new peers and power dynamics in Whitehall
Once again, there have been a few items in the news which have caught my eye and on which I want to make a brief comment but don’t qualify for a full-blown essay. So I’ve corralled them and will set out a few thoughts, and I hope this format is of some interest or use to readers: as much as anything else, you never know when an issue is going to resurface in a different and more significant form.
A doctor’s mandate
There are questions being asked about the involvement of former health secretary Alan Milburn in advising the current incumbent Wes Streeting, and the opposition has tabled parliamentary questions to seek clarification on Milburn’s role. The official response is that he is neither a ministerial nor departmental adviser, yet we know that he has held meetings with civil servants at the Department of Health and Social Care and has been given sight of sensitive information (though, slightly amusingly, only in printed hard-copy form as he does not have a departmental email address or access to internal IT systems).
Milburn’s former special adviser Paul Corrigan has been given a paid role at £350 a day “to work on emerging policy and delivery issues” at the DHSC, beginning on 11 July 2024 and lasting for 12 months with the possibility of extension. It is explicitly not a civil service appointment but a “direct ministerial appointment” to assist Streeting in “bringing in additional experience to support the government to turn visions for better health services into successful delivery”. It was described in a written answer by Karyn Smith, minister of state for health (secondary care), as “Senior Strategy Advisor for the 10-Year Health Plan”.
This sense of nostalgia in the Department of Health reinforces the recent role of former Gordon Brown-era health minister Lord Darzi of Denham in conducting an investigation into the state of NHS England, which was published last week. Darzi was parliamentary under-secretary of state for health from 2007 to 2009, responsible for a major health review which culminated in High Quality Care For All: NHS Next Stage Review Final Report, a command paper issued in June 2008. Before he was made a minister, however, he had been commissioned by NHS London to develop a five- to 10-year healthcare strategy for the capital, Healthcare for London: A Framework for Action (July 2007); he was national advisor on surgery for the DHSC from 2002 to 2007; and he had served on the board of the NHS Modernisation Agency, an executive agency of the DHSC (2001-07) responsible for overseeing the modernising of the health service and the improvement of patient care and outcomes.
There are some on the Left who regard the Blair era as one of incipient betrayal of the founding principles of the NHS during which there was a dangerous flirtation with the private sector, and the involvement of Milburn, Corrigan and Darzi with private healthcare providers and advisers only entrenches this hostility. Let me be quite clear that I do not even remotely share that antipathy. When I wrote about NHS reform yesterday, I said that I regarded Milburn as “by the far the most effective and capable health secretary of the last 30 years”, and I have enormous respect and esteem for Ara Darzi, with whom I worked years ago when I was second clerk of the Health Committee in the House of Commons. Corrigan equally has a formidable reputation and is well-regarded by many people whose opinion I trust.
I am not, therefore, arguing that these healthcare veterans should not be involved in the current government’s plans to transform the NHS. Indeed, to be frank, if I were Sir Keir Starmer I would offer Milburn the post of secretary of state, something I floated more than three years ago in The Daily Telegraph, of all publications, at the expense of Wes Streeting, whom I have never found particularly impressive (though I am aware he has a substantial following in some quarters). I am at best sceptical of the Starmer government’s ability to effect long-term and lasting changes in the NHS, but input from people like Milburn, Corrigan and Darzi can only improve their chances.
What I do think is potentially problematic, however, and this may be my inner bureaucrat speaking, is the sometimes ill-defined nature of their involvement. Darzi at least was commissioned to conduct a short investigation and given clear terms of reference, though it was noticed that he was not asked to make recommendations, merely to report his findings. Corrigan’s position as “senior strategy advisor” is—to me, anyway—slightly opaque: the minister told Parliament on 4 September that “further details on the terms of reference for the role will be released shortly on the GOV.UK website”, but these still leave me and, I suspect, other habitual Whitehall watchers, with a number of questions as to his precise status and authority.
It is Milburn’s position which is most anomalous. I appreciate that the government has yet to mark 12 weeks in office and so is still very much in its initial phase, though I would temper that by pointing out that Starmer was leader of the opposition for more than four years, with generous time to think about the prospect of government, and had put his shadow cabinet in place by September last year. But it simply isn’t satisfactory to have Milburn hanging around the Department of Health on an informal basis. Either it drastically limits his authority and influence, which would be a wasted resource, or it will lead to uncertainty about his powers, responsibilities and, perhaps most importantly, accountability. One lesson which has emerged from government over the last 30 years, from Sir Tony Blair’s “sofa government” to Boris Johnson’s over-reliance on WhatsApp, is that lax record-keeping and excessive informality are damaging to efficient and transparent administration.
None of this is unrecoverable. When Parliament returns after the party conferences, however, it would be beneficial for everyone if Wes Streeting could decide whom he wants available on a formal basis to advise him on creating his 10-year plan for the NHS, set out those roles and responsibilities clearly and make them public. It may not seem important now, and I quite accept that it is not something which exercises the vast majority of voters, but these things do matter. Given the controversy the government has already encountered over some appointments—especially that of donor and labour supporter Ian Corfield, who was given a civil service role as a director in HM Treasury without the Civil Service Commission being fully aware of his party links and consequently withdrew from the post to be an unpaid “International Investment Summit Adviser” instead—this is an area on which ministers should not fall down.
Old faces, new names
A list of 19 new peers included in the Dissolution Honours was announced on 4 July 2024. Casual observers of politics can sometimes become confused when familiar faces take on new nomenclature on joining the House of Lords, so I thought it might be helpful for some people to list the titles which the lucky newcomers to the upper house have chosen as they have been introduced. Many are self-explanatory but some may fox the unwary.
Minette Batters: Baroness Batters
Dame Margaret Beckett: Baroness Beckett
Liam Booth-Smith: Lord Booth-Smith
Sir Graham Brady: Lord Brady of Altrincham
Dr Hilary Cass: Baroness Cass
John Cryer: Lord Cryer
Tom Elliott: Lord Elliott of Ballinamallard
Chris Grayling: Lord Grayling
Harriet Harman: Baroness Harman
Dame Margaret Hodge: Baroness Hodge of Barking
Kevan Jones: Lord Beamish
Barbara Keeley: Baroness Keeley
Dame Eleanor Laing: Baroness Laing of Elderslie
Craig Mackinlay: Lord Mackinlay of Richborough
Theresa May: Baroness May of Maidenhead
Caroline Pidgeon: Baroness Pidgeon
Sir Alok Sharma: Lord Sharma
John Spellar: Lord Spellar
Dame Rosie Winterton: Baroness Winterton of Doncaster
It should be noted that Theresa May was already formally Lady May since her husband, Sir Philip, was knighted in 2020. Lord Cryer’s ennoblement technically makes Ellie Reeves, minister without portfolio in the Cabinet Office and chair of the Labour Party, Lady Cryer.
Factions and cliques
There is no doubt that the government’s critics are seeking to paint a picture of factionalism within Labour ranks even at this early stage, and I accept both that some of this leads to the exaggeration and distortion of facts but also that it is not only part of the job description for opposition parties but entirely fair game for the administration’s critics more broadly. It has always been thus and I can guarantee that the Labour Party will have acted in just as tendentious and superficial a manner in their 14 years in opposition, as the Conservatives will have done before that. (Remember one of the laws of politics: there never was a “Golden Age” when public figures were universally honest, upright, competent and respected.)
Two of the most prominent targets of this have been the deputy prime minister, Angela Rayner, and Sir Keir Starmer’s chief of staff, Sue Gray: the former is portrayed as being frozen out or diminished in authority, while the other is painted as a controlling, power-hungry figure who is alienating those around her. These are caricatures, of course, though I think the sheer weight of anonymous attacks on Gray from within government and the Labour Party indicates that something is awry. She may not fulfil every stereotype her detractors lay out, but it is implausible to pretend that every single story is a fabrication or a distortion of the truth.
My current view is that Gray seems at least to lack the kind of political judgement which her role needs to be carried out well, and that failing is at the root of many of her travails. I would note a few facts which may be entirely incidental or could, when we look back in a few months’ or years’ time, turn out to have been significant markers.
The first concerns Dorneywood, the 18th-century country house in Buckinghamshire which since 1947 has been a grace-and-favour residence for a senior government minister. Its usage is in the gift of the prime minister, and it has previously been used by the foreign secretary, the home secretary and the deputy prime minister, though most typically it has been the residence of the chancellor of the Exchequer. It was occupied by William Whitelaw (1979-88) and Sir Geoffrey Howe (1989-90) when they were informal deputies to Margaret Thatcher, and John Prescott had use of it during most of his tenure as deputy prime minister under Sir Tony Blair (1997-2007), giving it up in 2006. Alistair Darling took up residence when he became chancellor of the Exchequer in 2007, and it was subsequently used by his successors George Osborne, Philip Hammond, Sajid Javid, Rishi Sunak and Jeremy Hunt. Its new occupant is Rachel Reeves, the chancellor, which is in one way a continuation of previous practice, but The Times suggested, perhaps mischievously, that Angela Rayner had been “pipped” to it, leaving her with no official residence.
We should not read too much into this. Rayner does not strike me as someone who would have craved the use of a large country house, and when she said during the election campaign of Dorneywood, “I haven’t even thought about that, I love my little flat in London”, it sounded honest. However, it should be noted alongside this that there were indications before the election that Rayner, as well as her departmental portfolio, would have an Office of the Deputy Prime Minister in the Cabinet Office, as predecessors Nick Clegg and John Prescott had maintained. This, it was expected, would give her a base at the centre of government and support her in roles not strictly within her remit at the Ministry of Housing, Communities and Local Government, such as employment rights and the future of work. One Whitehall source told The Times “She spends quite a lot of time on her DPM role but she doesn’t really have the civil service infrastructure to back her up”. Rayner does have a room in the Cabinet Office but there is, as yet, no wider supporting administrative infrastructure for her.
There was also some surprise among observers that Rayner is not currently a regular member of the National Security Council, which meets every Tuesday lunchtime. Ministers not in its core membership can be invited to attend when necessary, but Sir Oliver Dowden was a full member as deputy prime minister and chaired its sub-committees on resilience and economic security. Equally, Pat McFadden, chancellor of the Duchy of Lancaster and minister for the Cabinet Office, is a member, and Sue Gray attends as Downing Street chief of staff. There is no evidence this is a calculated snub or an attempt to marginalise Rayner, who has no background in foreign affairs or defence and a substantial domestic portfolio to manage, but it is one of several pieces of evidence which could be used to construct a narrative. It was also noted that, while Gray was expected to accompany the prime minister on his visit to the White House last week, it was more surprising that she also joined his meeting with the Italian prime minister Giorgia Meloni at the weekend.
These are just straws in the wind at the moment and may signify nothing. Angela Rayner is part of the “Quad” of ministers—with Starmer, Reeves and McFadden—who initially make central strategic decisions and has a substantial power base within the Labour Party, of which she is the elected deputy leader, in her own right. But it is worth noting and absorbing these things, in case they become important in the future.