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Intro: [00:00:00] You are listening to Parliament Matters, a Hansard Society production supported by the Joseph Rowntree Charitable Trust. Learn more at hansardsociety.org.uk/pm.

Ruth Fox: Welcome to Parliament Matters, the podcast about the institution at the heart of our democracy, Parliament itself. I'm Ruth Fox.

Mark D'Arcy: And I'm Mark D'Arcy, and welcome to a slightly different edition of this podcast. We are joined in the Parliament Matters studio today by two fellow podcasters and former MPs and health policy experts, Dr. Sarah Wollaston and Steve Brine.

Ruth Fox: Both used to chair the Commons Health Select Committee. In her previous career, Sarah was a doctor and Steve served as a health minister. Now they collaborate on a health and politics podcast, 'Prevention is the New Cure'.

Mark D'Arcy: And Sarah and Steve, I wanted to start by looking at how health issues, how NHS issues, feed into the lives of parliamentarians. Sarah, you went from being a GP to being an [00:01:00] MP and from a GP surgery to an MP surgery. Were you surprised at the kind of NHS issues that were brought to you as a parliamentarian?

Sarah Wollaston: I thought it was extraordinary how similar my surgeries were. I guess you could say that except for nobody took their clothes off.

But, uh, the kind of issues that people would bring was very often health and social care related and a bit like being a GP. You are there trying to listen to see how you can have a constructive input and help, but that of course, changing your initials from GP to MP by one letter also means your popularity falls off a cliff.

So you notice that pretty smartish.

Mark D'Arcy: And Steve, did you immediately learn, as a new Member of Parliament, that the NHS had a very special place in voters' minds and woe betide the MP who got the politics of the NHS wrong?

Steve Brine: No. Well before that, because obviously I won my seat in Winchester and I'd had a strategy of what we call priority NHS, so I never [00:02:00] produced a leaflet, I never wrote a column for the local paper, I never did anything with the association that didn't mention the local NHS. Usually the local hospital, the Royal Hampshire and Winchester. And so that was at the centre of everything I did. So when I became an MP, I always had an interest, because I'd lost my mother to breast cancer just before I got married in 2003.

So seven years before I got elected. So I had an interest in that subject and I'd chair the all party group on breast cancer. So I had that interest personally and a massive constituency interest, because I knew health was so important to the people of Winchester. So I used to raise it every chance I could locally and every opportunity when I got into Parliament.

Mark D'Arcy: Yeah, but did that lead to a situation where health issues were the third rail of British politics? Almost didn't dare say anything controversial. No MP could possibly survive supporting the closure of their local hospital, even if it was a logical thing to do. Do you remember a guy called, um

Ruth Fox: Dr. Richard Taylor, I think.

Mark D'Arcy: Dr. Richard Taylor, who was an independent MP for two terms in Kidderminster on the [00:03:00] basis that he'd successfully campaigned to prevent the closure of their local hospital.

Steve Brine: Well, I think, you know, yes, you, you are there to represent your constituents. Did the people of Winchester want to see the local hospital downgraded and lose its obstetric and its consultant ed?

No. 100% they didn't. So I was representing their opinion in saying that, but you know, there were other services that were moved, you know, so acute orthopaedics were moved and I supported that, but that wasn't popular locally. But I think you come to recognise that yes, health is sacrosanct in some regards and that the public massively support the principle that underpin the NHS, but they're also exasperated by it.

They're exasperated by it now, and they were back when we got elected in 2010. And so if you just pretended that everything was okay in the health service, per se, then you looked a bit off the pace to be honest.

Ruth Fox: But isn't that sort of then part of the problem for you with your ministerial hat on, that it is so difficult to bring forward a reorganisation of the NHS and get it to stick?

Mm-hmm. We're seeing Wes Streeting now on sort of undoing the reforms of the Lansley era in the period of the coalition government [00:04:00] that you end up with so many MPs in each party defending their patch, that becomes very difficult to move things forward and, and for people to actually say, you know what, no, this isn't the best way to structure services.

Steve Brine: Well, of course they're two different things. So people standing up against reconfiguration of their local hospital, which if you're gonna have a new hospitals program that's worthy of the name, and I think there's a big question mark around that, then the health secretary is gonna run into battles with his back benches.

And for a health secretary that's ambitious to move maybe on up the ladder, that could be a problem. The reorganisation of the NHS, which I know you want to come on and talk to, that's a different matter and I think, MPs probably separate that in a way from stuff that's going on with local services in their local constituency around which they're representing the constituency opinions. One's almost a global issue and one stays a very local issue.

Ruth Fox: But doesn't it sometimes though lead to MPs looking a bit like hypocrites because at the one hand, a constituency level, [00:05:00] you're defending your patch. At a ministerial level, you are sort of imposing these changes and you might have said, as a constituency MP, I really don't want that.

But then once MPs get into ministerial office, they're taking a different attitude.

Steve Brine: Well, of course as a minister, you would recuse yourself from any decisions that were about your own local constituencies. You'd never take those decisions and I wasn't the hospital's minister, so that never came up.

But yeah, you can be in that situation. And you know, the tabloids are often full of stories where health minister's campaigned against something and then has to do it. But ultimately that's leadership, isn't it? I mean, I was the pharmacy minister and I had to carry through the austerity measures from the original George Osborne spending review, which then reduced the money that went to pharmacies.

I can tell you, the pharmacies in my constituency were not thrilled with me about that. But I still had to do it because that was government policy.

Mark D'Arcy: Now Sarah, you have form on the health service reorganisation issue, not least because you shot to prominence really during the 2010 2015 Parliament when the Andrew [00:06:00] Lansley Health and Social Care bill came up and you very patriotically volunteered to be on the bill committee because you knew a thing or two about the health service and had some suggestions you could make.

Sarah Wollaston: Yes, indeed. I thought that legislation might benefit from having somebody who'd actually worked in the job and understood how these things pan out, and I used to teach junior doctors and medical students and I gave up teaching them about the structure of the health service because it would always have changed by the time they qualified.

So I could see I had experience of just how disruptive these kind of major reforms are that they deliver less than you think, and they cost more than you think, and really just takes everybody's attention away from their day to day, really important business. And everyone's just redesigning the chairs on the deck.

So that kind of thing. I thought they might benefit from some practical understanding of how it works on the ground. What an exotic notion. Oh, I know, I know how naive. And I was told, because I had said to them I was [00:07:00] going to vote against it at second reading and they said to me, well, you can be on the bill committee and be helpful on the bill committee, but you have to vote for it at second reading.

So I thought, well, I held my nose, voted for it at second reading, understanding that I would then be able to put forward amendments. And guess what? I wasn't on the bill committee, they left me off. So there we are.

Steve Brine: And then I was

Sarah Wollaston: Live and learn.

Mark D'Arcy: But at the same time, there must be a weird sort of sense of nostalgia for you about the way that the structures that were set up then, like NHS England, uh, were created in the Andrew Lansley bill all those years ago and now being unwound by the new Health Secretary Wes Streeting and it's all come about really very, very rapidly with a sense of almost down the torpedoes, I'm gonna make this change.

Sarah Wollaston: Well, I think it was always going to happen at the end of the day because you have a Secretary of State, I know that they took back powers of direction at the end of the last Parliament for the Secretary of State, but [00:08:00] really I think that whole notion around you had sense that we wanted to get rid of quango as well.

The biggest quango of them all was NHS England. So I think that it didn't make sense to have these two parallel organisations, Department of Health and NHS England both making decisions, slowing each other down. So I don't object to that because I always felt it was going to end badly. But I think that the trouble is that there are organisations as well, I should say, I used to chair one of them, an Integrated Care Board, NHS Devon, and, they have a job to do, but they're being cut back so much now that it's hard to see how they're going to be able to fulfill their statutory obligations. So that worries me. The things that are happening around it, so we know we're expecting the 10 year plan, for example, sometime in the next couple of weeks.

But in that, the Health Secretary has said that he wants to move towards prevention. The trouble is integrated care boards just don't have any money for prevention, particularly those that are strapped for cash. So [00:09:00] I'll be interested to see in practice how they're going to make sure that that can happen, particularly in the context of those integrated care boards that are really overspent.

Steve Brine: We always used to say at the department that after the Lansley bill and the Health and Care Act of 2012, and I didn't join the department until 2017, but people used to say, you know, everyone wants a health bill like a bout of the clap, because it was just, I mean, it was such trench warfare, you know, the bill committee went on for so long and then we had the Nick Clegg pause, if you remember when it had to go then be recommitted.

It was a total nightmare. And I think the problem they've got with this health bill that's gonna have to happen is that they're almost reverse engineering it. Because I think that the abolition of NHS England happened by mistake. I don't think it was part of a strategy and part of a plan, and it certainly isn't part of the 10 year plan.

It's become so and so they're now gonna have to try and fit the legislation to the announcement instead of the other way round. And that's a problem. So however long they think the health bill's gonna take, it'll take longer. However many amendments they think that there will be, there will be a lot more.

The Christmas tree analogy is gonna [00:10:00] be literally as big as the one outside Downing Street. And however many times they think they're gonna have problems with MPs on this bill, you can double that. So it's gonna go on and it's gonna take a lot longer than they thought would be my prediction.

Mark D'Arcy: So what would your advice be between you, to, if you like a modern Sarah Wollaston figure sitting on the government benches, wanting to improve the government's legislation,

Sarah Wollaston: I think it's difficult because those decisions are often made by special advisors, think tanks, and your ability in practice to push something through that's an amendment is limited. So you can never do that on your own. The answer is you have to work with others and try and really focus your attention. My view was, you know, you can't stop the Supertanker, at least try and nudge its course in a less harmful direction.

Steve Brine: But remember the 2012 bill, became the act, was in a coalition situation. So [00:11:00] you know, we had Paul Burstow and Simon Burns who were the ministers from the two parties doing the health bill.

Whereas now it's a single party with the Labour Party in government with a massive majority. And of course, that will be then reflected in the bill committee. And I suspect what they will do as they did in 2010, and I wrote down this morning some of the names that were on there, so Dan Biles, Steve Crabb was the whip, Nick Debois, Margo James, Jeremy Lefroy, Nicki Morgan, Dr. Dan Porter, Anna Soubry Julian Sturdy, we were all new MPs and there was no coincidence I think in that. And what will happen this time is they will pick keen, ambitious, new Labour MPs to be on the bill committee in the hope that they won't ruffle any feathers and they won't ask any difficult questions.

And the trick will be to go on and make sure that you do do that because as Sarah and I were discussing earlier before we came to talk to you both, you know, the decisions in parliament that you mostly regret are the ones where you didn't rebel, and as two people who have a fair share of rebelling, I was thrown out the Tory Party for doing so, then I think, you know, you just [00:12:00] ultimately have to look yourself in the mirror at the end of the day.

And so my advice to the MPs that are put on that bill committee is remember how this will feel in 15 years time.

Ruth Fox: Should just perhaps explain Mark for listeners who may not be familiar with this Health Act that we are talking about, particularly some of our international listeners. So we're talking about a bill that was brought forward in the coalition government of David Cameron and Nick Clegg you mentioned was the Liberal Democrat leader as Deputy Prime Minister in the coalition.

They brought forward reforms in the hands of the Health Secretary Andrew Land. That bill got into real deep trouble and had to be paused. I mean, the story is that David Cameron hadn't really looked at it and when he did look at it, realized that nobody seemed to understand exactly what the reforms were going to do and it was paused.

And when we talk about recommit, it basically, it had to go back into public bill committee because they made changes to it. And when we talk about it being a Christmas tree bill, what we're talking about is bills with lots of policy, baubals on lots of things that are sort of stuck on and it becomes like a Christmas tree all lit up.

Steve Brine: [00:13:00] Yes. So what will happen is that the government's 10 year plan for health and care, which Sarah rightly referred to, which will come out shortly. It will underwhelm, it'll be quite top line, it'll talk about the three shifts the Secretary of State wants to achieve. It'll focus on 18 week recovery, which the Prime Minister has put all his chips on.

And it won't be able to go into the detail that people want and therefore it will disappoint. And what will happen is that every campaign group, every charity, every back bench MP who feels that they've got this issue, maybe something in their constituency they want to then tie nationally, they will try and bring that forward.

Maybe not on the bill committee, because obviously there can only be so many people on that. But every bill has to then come back to the floor of the house for report stage and third reading. And that's another opportunity for people to input with things that they think are the most important thing ever that no one's ever thought of.

And so that's why I say it will take longer than you ever imagined to do it. And the reason why they've got themselves into this pickle is, as I say, I think it happened by accident. I don't think they need it to achieve a lot of the changes that they want to make, but they are gonna have to bring forward primary legislation in [00:14:00] order to abolish the body that's called NHS England. And what they'll find, as we found in 2012 Act, is there are competencies and there are disciplines that currently exist within NHS England, which they haven't yet thought about. So I'll be honest and say to you that in 2012 there were things that the NHS and the department did, which the government thought, oh, crikey, uh, where are we gonna safely land that?

And then, then they created another small quango that went in, like NHS Improvement was created to safety check, and to quality check failing hospitals, and they will find stuff like that. I know that a conversation was had between the Department and NHS England, where somebody said, could you just tell us all the things that you actually do.

Um, which I think really quite an interesting question to ask at that stage. I know exactly and they are gonna find that is gonna come back to haunt them in the bill committee would be my guess.

Mark D'Arcy: So let's take a look at some of the kind of current issues floating around in health policy. First of all. Wes Streeting is very keen to shift the NHS much more to preventive medicine, and I know if only from the title of your podcast that you're both extremely in [00:15:00] favor of that. And speaking as someone who's had any number of NHS routine screenings for health conditions recently, I'm very grateful that it seems to be happening a bit.

But is this Bill going to deliver a step change of the kind that you think is needed?

Steve Brine: No, and that's because you don't need a bill to do that. What you need to do is to, what I would describe as population level muscular interventionism on public health. So to give you an example, I had bought in the sugar tax when I was the minister, or the soft drinks industry levy, which basically forced soft drinks producers to reformulate their drinks and take the sugar out. Coke Zero would be an example and I would like to see them go much further on that kind of interventionism. So I'd like to see a salt reduction strategy, which would reduce the instance of stroke, which one of the big five killers. But the government are terrified of that because the left have as many problems as the right in the so-called nanny state problem.

Remember the left years ago had a huge problem bringing in the smoking ban in public places. And you know, on the right there were all sorts of problems with the sugar tax, and I used to get roughed up in the tea room about it all the time, but [00:16:00] you don't need legislation to do a lot of that stuff.

What you need is political guts and political will, and we'll see how much this Secretary of State means a sickness to prevention because a lot of the stuff he could get on with and enable people like NHS Devon to be able to actually intervene in people's lives and to catch people upstream. As somebody said to us in on our podcast the other day, when we talk about alcohol harm, we spend so much time hoing people out of the river after they've floated downstream instead of stopping and falling in the first place.

Sarah Wollaston: And you look at something like minimum unit pricing, there's really good evidence that that is working in Scotland and more recently in Wales. And it's such a clear evidence-based policy that would make a difference. They just need to get on with it and they need to get on with it early because what you often find is this huge panic about people won't like it.

You look at something like preventing smoking in public places and pubs, everyone said it would be a disaster, you know, within a few months everyone just got on with it and actually felt quite happy that they were going to the pub and not having to wash their clothes when they got home. [00:17:00] Same with seatbelt legislation.

So I would say really, if there isn't a lot of money around, which clearly there isn't, let's get on with the stuff that will really make a difference upstream. So that's what I really hope they'll do. And also extend, of course the sugary drinks industry levy, which again, it was huge panic about, you know, nanny state.

All it did was lead to reformulation and it was the perfect policy because it's a tax that you don't end up having to collect because people just reformulate it.

Steve Brine: They've got two choices. I mean, look, you've got 205 billion pound budget now for the NHS, and as the Secretary of State has said, we don't want to be a health service with a country attached to it.

And we are heading in that direction. So in my opinion, this is a, I think a conservative answer as well actually, is that if you believe in a smaller state and a more efficient state, then you must believe in prevention. Because as long as we continue to catch illness and disease late, then you have a bigger state in order to pick up the pieces.

And so if you believe in a health service free at the point of need as I do, and both the [00:18:00] main parties do rightly, then you have to believe in prevention, because otherwise the health service is not sustainable on its current trajectory. That's just simple economics.

Mark D'Arcy: I mean to me it seems almost a no-brainer, this argument, I mean, it's the nanny state right up to the moment someone rocks up into an NHS consulting room requiring lifelong care to keep them going because of something that's the result of a lifestyle choice. So why is it that that argument seems to have such resonance and all the words nanny state just have to be uttered and large chunks of the press immediately.

Sarah Wollaston: There are some very, very big, powerful lobbyists who are feeding into that debate. I can remember we were on the cusp of having minimum unit pricing. I was walking across the atrium in Portcullis House and the minister came up to me and said, oh, by the way, we're just about to drop it. And you know, we've got it almost across the line.

But the power of industry lobbying against it just killed it.

Steve Brine: And treasury. Because of course there's so-called double running where you have to spend now alongside the day [00:19:00] spend in order to achieve that shift. The left shift, they call it, to prevention. But that requires a kind of spend to save, doesn't it?

And the Treasury hate to spend to save because you know, they don't believe in it. Well, don't believe in it because these smart ministers come and go, oh, this a brilliant idea that's gonna save you all this money. And okay, yeah, tell me. Yeah, but you're gonna have to actually spend in order to achieve it.

And Treasury hate that. They hate that dynamic. And so ultimately, you know, you never then get to that.

Ruth Fox: Interesting. Steve, this week, Parliament, the House of Commons, is gonna be asked to look at the estimates. The spending for government departments and health is one of the few departments that's obviously got an increase, as you say, 200 billion plus.

There is a debate going on today actually as we speak, as we are recording, on the health departments spending plans as part of this estimates process. But ultimately, MPs have got very little access to information, very little role in being able to change anything. They can't really change the estimates.

I mean, there's provision for them to amend downwards a little bit here and there, but very difficult to do [00:20:00] on the basis of the information that's presented to the House of Commons. Do you think really MPs understand enough about the detail and are really equipped to do that through the estimates process?

And if so, what do they need? What would a better process look like to actually be able to hold departments and ministers like you to account?

Steve Brine: No, they don't at all for the spending. I mean, unless you're the select committee chair or a Health Minister or you know, you lead a big all party group, where you've got a constituency point to make.

I think MPs see estimates day as the day to get on with their inboxes, and then make sure that they're there at 7:00 PM to vote when you've gotta vote through the estimates. And of course, without the 10 year plan being published, you don't know whether the money that they've been given through the spending review is actually gonna move the dial.

And what you want to know, surely as a good MP, is well, is the money that my constituents are spending on these tax rises gonna move the dial on the big five killers. So, you know, cardiovascular disease, stroke, heart disease, and you can't really answer that question based on this. So today's debate is a procedural necessity, but it certainly doesn't lift the bar.

Sarah Wollaston: When I was [00:21:00] chair of the Health and Social Care Select Committee, we spent a lot of time talking about the smoke and mirrors of health spending because they would say, oh, we're increasing health spending. But what they meant was they were increasing spending on NHS England, but they were taking it out of public health budgets.

They were taking it out of education budgets, and so they were just shifting and capital budgets, which now means that we have an absolutely eye watering backlog of critical repairs across the NHS that are really hampering NHS efficiency. But it all stems back from that process, which happened over the whole decade really of these shifts. And so standing up and talking about increasing health spending. Yes, but... was my point.

Mark D'Arcy: And Steve, you mentioned the idea of spend to save initiatives and the mother of all spend to save initiatives would be sorting out social care. For the NHS, if you could only stop people who didn't really need to be in hospital beds being in hospital beds because you had a [00:22:00] better social care system that could look after them outside of a hospital, an awful lot of improvement could be made in hospitals, but the treasury will know that umpteen billions would be needed to pump prime the creation of some kind of national care service.

And so it never happens. Is this an issue that is forever going to be consigned to the too difficult box? This is where ministers dare not go.

Steve Brine: Probably we were talking about this morning, weren't we? Sarah? I think the thing is is that they've commissioned Baroness Casey, she, of busy fame, in recent days to do the Casey review into social care.

And this is because Andrew Dilnot who your listeners will know had produced the Commission on social care, had actually produced a very good, coherent piece of work, but he'd never rolled the pitch with Treasury. And it really annoyed the Treasury because it came with a big number and it came to them and they were like.

What do you mean? And so every Chancellor since has kicked it into the long grass, including Rachel Reeves. So what they've now done is ask Casey to come up with this review. And really what it's about, I think, is providing an answer to the question, what did they mean by a national care service in their manifesto, which I don't think they know.

And [00:23:00] also to provide a figure that the Treasury can live with. And this will then go into the next manifesto because Casey won't actually properly report until probably 28, until we're in the foothills of a general election campaign. And no sensible politician would launch a social care policy in a general election campaign, would they?

Ruth Fox: Bringing back bad memories there, Steve.

Steve Brine: Yeah. Post traumatic memories. So it's, the problem for them is, you know, they'll get that into the manifesto, but there won't actually be a solution until the next parliament. And if you've got an ambition to move from hospital to community, if you don't fix social care, you don't fix the NHS.

Sarah Wollaston: Absolutely. And you see it when you are working in the health service when you're chairing an integrated care board that people ask me, why have we got so many ambulances queuing outside the hospital? It's because of the issues mostly at the back door where we cannot discharge people safely from hospitals because of the lack of social care.

So we keep putting more money into the NHS to the acute side, but the acute side [00:24:00] cannot function efficiently, when the hospital is running at a bed occupancy over 90% and they're running sometimes 98% bed occupancy or more, the mattresses never get cold, because it's so much pressure, and of course it means it ties up all your staff in your emergency department looking after very sick people who should have been moving through the system.

So that causes, it's like glue throughout the entire system. So they talk a lot about NHS productivity. I'm afraid they need to sort out social care, but I doubt they will because if it happens near a general election, it won't happen.

Mark D'Arcy: Do you think the members of parliament in general get that? Do they understand that this is perhaps the key issue that has to be resolved at some point?

Sarah Wollaston: I think the trouble is that when it comes to popularity stakes, if you say to people, we are putting money into prevention, we're putting money into social care, we're putting money into the NHS, where do you think the [00:25:00] public want their money to go? They always say they wanted in the NHS, and it would be nice to see more MPs speak with genuine understanding about, putting money into social care is in effect, putting it into the NHS because it allows the NHS to function, but you really don't hear people championing that.

Ruth Fox: We know what a lot of these big issues are. Obviously there's a lot of blobbing going on. There's a lot of advice being sent through to parliamentarians, to ministers and so on.

Ultimately, in terms of the House of Commons and the select committee reports and so on, a lot of resource, a lot of intensive work is done, but I mean, how much notice really being taken of it by ministers, by government departments, because we talk about Parliament and the Commons holding ministers to account.

But it often feels a sort of a one way street that you're telling ministers what these issues are, you're sending the information and the evidence off to them, but successive governments ignore it.

Steve Brine: It's very important, I [00:26:00] should be careful what I say here because the select committee chair when I was minister is sitting right next to me.

Dr. Wollaston. I always took select committee incredibly seriously on two levels. One appearing before it. Well, I took the House very seriously, so I would never, the night before, we would do orals or we were due before the select committee, you know, I would be in early, early to bed, going through my topical folder because the minute you're flippant, it bites you where it hurts.

So I took the Select committee incredibly serious in being before it because it's much harder than being at the box. The dispatch box is easy in a way because you can only ever answer a shortly. The Speaker's hurrying you along and if you're really, really stuck, you say I'll write to the Honorable Lady or Honorable Gentlemen. The select committee, if they're smart and most of them are, will come back at you and back at you and back at you.

And then in terms of the reports they produce, and I remember this when I was producing them as select committee chair. I saw it as a brilliant resource. I thought it as an informed, considered resource that would give me ideas because ultimately, you know, my private office were busy. The civil [00:27:00] servants had lots of priorities, some of which were coming from NHS England, some of which were coming from me.

And then I had the select committee that was producing this work they'd really thought through, and I would often turn to it for advice, and I hope I said the right thing there. So it's true. Thank you.

Sarah Wollaston: I think select committees can be impactful and they can be helpful to government. I think of the work that we did around childhood obesity and helping to support the sugary drinks industry levy, for example.

But they're also very specific examples where you can really change things. So I'm thinking of an occasion when there was a memorandum of understanding just popped up between the Home Office and NHS digital. A proposal that for people who had overstayed their visas, that the NHS was just going to hand over personal details like their address.

And I just thought that was egregious. I mean, it was outrageous and it was just sort of, kind of sneaking its way through. So I decided that we would hold some hearings with NHS [00:28:00] Digital because there would be far reaching implications and they were very sniffy about being called, but in fact, just by doggedly returning to the subject and asking questions, it was dropped.

So I think there are some times where there are little things that crop up where a select committee can absolutely, change a policy, but you just have to be watching out for what's happening.

Ruth Fox: And Steve, you said you took inspiration and ideas from select committee reports, so you're obviously reading them, but to what extent do the civil servants do that?

Do they have a different attitude and you have to push them?

Steve Brine: No, they read them and then they produce a submission that would come to you usually just to say, so that you then sign off the response to said select committee and you know, you would then be able to read the whole thing, which would be attached to the sub if you wanted to, which I usually always did because there was always some nuggets in there that were important.

I mean, I loved being a back bencher. I loved being a whip. I loved being a health minister. It was the only job I wanted in government. But I actually loved being a select committee [00:29:00] chair more than anything because it was so much freedom. And you would go on the media as a minister and they would be trying to cut your legs off.

You'd go on a select committee chair and they'd say, Mr. Brine, what interesting things would you like to say today? Um, other than Mark D'Arcy who used to put me to the sword every

It was a bit like that, and it was just so much fun. And you did feel that you could influence the debate and it would support you in things. So Sarah's mentioned the sugar tax, but I mean, just before we recorded this, we were speaking at a big medical cannabis conference. We're doing a live edition of our podcast there, you know, and I changed the regulation. So I rescheduled cannabis in the Misuse of Drugs Act so that we could explore further research into medical use of cannabis.

And the select committee then did an inquiry on it. And what that did is it gave me the confidence to go on with that policy. You know, I'm sure you've discussed this on your podcast many times, but, the good work goes on in select committee corridor, not really down in the chamber half the time. And of course the attention's all on the latter, but the real good stuff is the former.

Sarah Wollaston: Best job in politics.

Mark D'Arcy: When we [00:30:00] interviewed your latest successor, Layla Moran, who's chairing the Health Select Committee in this parliament, she talked about how she wanted to really drive sorting out social care. And I just wonder how possible you think it is for a select committee to keep the pressure up and actually alter the course of the government super tank?

Sarah Wollaston: Well, I think they just have to keep at it and keep up with the evidence base. I mean, I set up the first ever Citizens Assembly because I just felt that we just needed to demonstrate where public opinion was on this. And it was really interesting and it's just such a shame that all of these reports over the years have just been sidelined.

And, as I said, the use of evidence in Parliament really is pretty poor.

Ruth Fox: Should explain this is the first ever Citizen's Assembly for a select committee in the House of Commons.

Sarah Wollaston: We held a citizen's assembly. It was fascinating. Just as an aside, the thing that I think really most surprised me was even those people who didn't stand to benefit [00:31:00] necessarily from an inheritance, that concept of your home is your castle, people do not like inheritance tax, but clearly they don't also like being charged extra through their national insurance, and everybody thinks it should happen, but thinks somebody else should pay for it.

Ruth Fox: Yeah.

Just sort an interesting thing that you don't think parliament's very good with evidence.

Sarah Wollaston: Yeah, no, I think it's shocking. I mean, you sit there in the chamber on a health debate and you hear people spouting all sorts of stuff with absolutely no evidence attached to it whatsoever. Early on, I got sent a, all MPs were sent a book on evidence and statistics because do you think MPs use statistics well?

Ruth Fox: Well, no, and I don't think the Office of National Statistics thinks they do either. And also Ministers, I mean, this is one of the things, you also find the ONS taking up ministers for their spin, shall we say,

Sarah Wollaston: Shocking. It's shocking. I mean, it's one of the things that most surprised me coming into parliament from the health service because you know, when you are a clinician, you are expected [00:32:00] to follow the evidence.

You can't prescribe things such are like snake oil, um, because you have to have evidence. Whereas in politics, it is an evidence free zone largely, I'd say.

Ruth Fox: But doesn't that go back then to your experience on the Health Act that we were talking about earlier, the health bill where you had expertise and knowledge and didn't get onto the public bill committee?

You did get onto other committees about which you knew nothing.

Sarah Wollaston: Well, I'll come onto secondary legislation here.

Ruth Fox: Yes, my favorite subject.

Sarah Wollaston: So, so much of what happens in legislation is actually happening in the, the secondary legislation. I remember as a new MP, finding myself in one of these secondary legislation, delegated legislation committees, and it was on double taxation in Oman, and I thought there must have been some horrible mistake because I noticed that next door there was a committee looking at some health policy, which I could have actually made a meaningful impact to. So I scuttled up to the whip and said, that might have been a mistake. I think I'm probably supposed to be next door. [00:33:00] He said, don't be ridiculous. He said, why would we want anyone who knows anything about health in that committee?

He said, and I was constantly being told as an MP that if I waited 10 years, it would all make perfect sense and sadly, I left after nine and a half years. We never quite got there, but there we are.

Mark D'Arcy: Can I do a little bit of a hand break, turn into a select committee related issue that both of you will have encountered from both sides of the fence there is a thing called the Osmotherly rules, which govern what civil servants should properly be asked when they appear before select committees. And ECB Osmotherly, the author of those rules died recently, but his legacy still remains in terms of the amount that civil servants are allowed to say in front of select committees like your own. What's your experience of those rules.

Sarah Wollaston: Well, I was like you, I was, uh, his name leapt out from the obituary pages of the Times, last week. And what I felt was that those rules, I can understand why they were set up [00:34:00] because as they say, advisors advise, ministers decide. And so setting out that principle that you are not there to share the advice that you give to ministers, you are there to answer very specific questions about things like implementation and so forth. But the difficulty is there's no right to call civil servants. They only appear if the minister says they can appear, and I know, for example, there were occasions when that would be very frustrating.

I mean, I was also chair of the Liaison Committee for a while, and then we were having huge rows about Dominic Cummings and whether he should appear before select committees or not. And of course, the rules have since been extended to include special advisors, so they now covered by the Osmotherly rules.

And I think that's a shame in a way.

Mark D'Arcy: It used to be said that the Official Secrets Act wasn't there to protect secrets, it was there to protect officials. Is that also true of the Osmotherly rules? That this is a very convenient shield that allows civil [00:35:00] servants to dodge accountability in front of committees like ones you chair?

Steve Brine: I take a slightly different view in that when the Secretary of State used to come before us, or usually the Secretary of State, but other ministers, the message would come through from the clerks, oh chair, they've asked if they can bring X and Y from the department or NHS England with them. And I used to say, well, why do they need to come as well?

And you know, okay, sometimes I'd say yes, but the truth is that the questions would all go to the minister or the secretary of state, even if it was the perm sec sitting next to them. And so,

Sarah Wollaston: Perm Sec would be passing little notes.

Steve Brine: Yeah, maybe. But they, you know, the questions all went to the minister. And so the officials, sometimes the minister will be on the hook with the, a member would be giving them a grilling or something and they'll say, well, I'm gonna bring in my official here.

And, often the chair would say, no, you're not, uh, because you'll carry on strike here and answering the questions. So I know why the rule was there. But in practice, in reality, they often didn't actually get to say that much. They were [00:36:00] probably quite happy about that.

Ruth Fox: Another bit of a hand break turn Mark. I just want to go back to something that you said, Steve, about being in the chamber, that it's easier as a minister than in a select committee. Is that true of all types of business? Because it strikes me that one area where it's perhaps not quite so true is the day when you're called to answer an urgent question, something's happened, might be an emergency, might be a disaster, might be a crisis of some kind. The Speaker says wants the health minister to appear to answer questions on whatever it is, or, you know, something's been announced in the media, leaked to the media, and the Speaker wants a minister in front of them to wrap them over the knuckles for having leaked it to the press rather than to the House of Commons first.

What's that experience like? For example, how do ministers decide who's gonna take one for the team. Get to answer the question. Yeah.

Steve Brine: They're a nightmare.

Ruth Fox: It's rarely the Secretary of State, I notice.

Steve Brine: UQs are a nightmare. They are somewhat harder, but even then still, you can [00:37:00] only give, you know, a one sentence answer before you move on to the next person.

Whereas what I mean is in select committee, they can come back at you and back at you for quite some time. I'd written down here, my brain dump 1130 on a Monday, nine o'clock on Tuesday, Wednesday, eight 15 on Thursday, Friday. And what that was was I'd set on my phone the times by which you had to submit a UQ each day when I was a minister, and the day after I left office and I resigned as you remember, over Brexit disagreement with my own party, I actually slept like a log because the fear of a UQ bid is real. And my first week as a health minister, the social care minister got stuck on the tube. And if you remember previously, our previous conversation had been a slight ruckus around social care during the 2017 election.

And, uh, Labour opposition had put down a UQ on social care, something like, you know, what on earth are the government up to on social care? I paraphrase and um, because the minister was stuck on the tube, the Secretary of State said to me, Jeremy Hunt, one for you, mate. And so I was absolutely thrilled and it was terrifying.

But you know, often with a [00:38:00] UQ by the time it's then granted, and of course that's at the gift of the speaker. I mean I can remember sitting in the family room, which is just off the lower waiting hall in the House of Commons, which is where I used to meet officials when I needed to do something very quickly with them, and I sometimes would meet them 45 minutes before I'd be at the box to answer a uq, and that's mega stressful.

And UQs are really stressful, but they are a tool whereby the opposition and Parliament can hold ministers to account. And I don't actually know, maybe I'm ignorant, but I don't actually know whether there would be many health UQs from the opposition front bench during this parliament. But there certainly should be because they were used a lot by Wes Streeting in opposition.

So, you know, the karma would, the karma would be for the return leg.

Mark D'Arcy: I also wanted to ask you, because you are both people who have a bit of a track record of Commons rebellion on your CV. We are looking at what may well be the first mega rebellion of the Starmer era. More than a hundred of his back [00:39:00] benches have signed a reasoned amendment to the second reading debate for the legislation that's supposed to cut personal independence payments, and hopefully from the government's point of view, save it 5 billion pounds.

Now looking at those numbers. And looking at the cast of characters who've assembled and whose names are down on the order paper at the moment, what do you both make of that there?

Sarah Wollaston: Well, I think the first job of a chief whip is to be able to count and uh, so if they think they are definitely going to lose, they'd be better to pull it for now and see what's possible, but I can understand why this has come up completely because I think it's a very surprising thing for a Labour government to be doing, and I think there will be really very severe consequences for some of those who are affected

Steve Brine: As a whip, with my whips hat on, I would look at that list and I'd want to know, is there a whipping operation within the rebellion?

So, you know, does the rebel cause have a whipping operation that actually is one to be reckoned with because [00:40:00] it's all very easy to sign an amendment. I mean, it doesn't get you popular with the whips, but I remember when I was on the back benches a whip saying to me, I don't care what you sign, I don't care what you say, I care how you vote.

And ultimately, will they all vote against the government? I doubt it very much. So if you then drop it or pull it or backtrack, then what you're saying, aren't you, to your detractors, is well the chancellor or the prime minister or the government, they're for turning. Come back at us on the next thing that you've got a problem with.

And so, you know, if a government less than a year in with a majority of this size can't get through its welfare reform, then you know, it needs to have a long, hard look. And I think the reason it's in this position is because this is not welfare reform. This is welfare cuts, in order to make the budget balance, that's why they've got a problem.

And there are MPs, yes, they've got a big majority, but lots of their MPs have got small majorities in their constituencies. And Sarah and I will remember when we were first elected, when the government tried to privatize the forests, how many colleagues said to [00:41:00] us, I've already had five times as many emails as my majority.

And that's what will be happening with this. And that's what spooked them. But will they go through the opposition lobbies and vote against their prime minister? Because they're all desperately hopeful of a job. I would be surprised.

Mark D'Arcy: So what sort of calls might people be getting? Would it be, don't you dare do this, or your career will be over before it's even started? Exactly that. Or would it be, would you mind going on this parliamentary trip to the Seychelles islands, that week, and unfortunately you wouldn't be able to vote, but nevermind. Or something in between.

Sarah Wollaston: I do remember the calls early on to myself to, hey Sarah, we think you've got an absolutely marvelous future ahead of you.

But of course none of that will happen if you vote in that lobby. So those calls certainly do happen. But yes, all sorts of things people will be promised if they're helpful on this occasion, but I'm afraid the government has already shown its for turning on the winter fuel allowance. So I think they're gonna have many more of these ahead of them.

Steve Brine: And they could have a massive rebellion and still carry the day because the Tory [00:42:00] party may save them.

And even if they don't, they've still got a big enough majority to withstand quite a big rebellion. I mean, they could have a rebellion of 50 actually vote in the opposition lobbies and they could still survive it. And so I think ultimately for them, their problem is, what does this say about the future trajectory?

If they're going to backtrack on these PIP changes, as they've said, 5% on defense at NATO Summit this week, where's this all coming from? Because all eyes and Paul Johnson, the IFS, has said, well, all eyes on the budget in the Autumn.

Mark D'Arcy: And what's the psychological legacy for people who rebel and for people who perhaps back off from rebelling?

Steve Brine: Well, I mean, as somebody, I voted for the Benn Act, which of course said that we shouldn't leave without a deal in the Brexit days and Boris, to be fair, he was consistent for once. It happens, sometimes. Even a stopped clock. He said, if you do this, then I'll throw you out. I'll take the whip away for you. And me and 20 others were the Benn Act rebels and we had the whip taken away from us.

Yeah, it was difficult. You know, I had young children and a mortgage to pay and that was not long before the 2019 general election. But looking [00:43:00] back on my career, you know, I don't think there were any votes where I look in the mirror the day after the vote and I don't give myself a nod and think you did the right thing.

And that's all you can do. It's all you can do is look back and think you did the right thing.

Mark D'Arcy: And sarah, perhaps we can end with your advice to budding rebels. What do you think they should do? How should they approach the dreadful moment when they might have to vote against their own government?

Sarah Wollaston: I would say when they look back on their career, they will probably spend more time regretting the times they didn't rebel than the times they did.

Mark D'Arcy: Steve Brine, Sarah Wollaston, presenters, co-presenters, I should say, of Prevention Is The New Cure. Been an absolute delight talking to you about the politics of health in Parliament. We'll be back again next week, Ruth.

Ruth Fox: We will be. Thanks, Mark, and thank you Steve and Sarah for joining us. As Mark says, it's been a pleasure, really interesting, and I hope listeners enjoyed it.

Just before we go, a message to all our listeners. I'm very conscious that we've had quite a few questions from you. We haven't had time to get to them this week, but we will next. So [00:44:00] that's also an invitation to any listeners who have got a question and you've not yet submitted them. There's an opportunity to do so for next week.

Send them to hansardsociety.org.uk/pmuq and we've got a little form there. Or you can send them to us on social media at Hansard Society and we'll get to those next week. And of course, listeners, don't forget to fill in, complete our listeners survey, it'll really help us to learn more about what you're enjoying about the podcast, what you'd like to see more of, and also of course helps us with those pesky advertisers.

So with that, Mark, thanks very much. We'll see you next week.

Mark D'Arcy: Bye-bye.

Outro: Parliament Matters is produced by the Hansard Society and supported by the Joseph Rowntree Charitable Trust. For more information, visit hansardsociety.org.uk/pm or find us on social media @HansardSociety.

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