Staff whose views are rarely made public speak out on the meaning of the NHS's 50th anniversary in a new book, Other Voices. Author Patrick Butler explains

Other Voices was born out of the cynical assumption that much NHS 50th anniversary coverage would be dominated by the views of top doctors, top managers and top politicians: in other words, it would tell only half the story.

We wanted to get a sense of what half a century of change in the NHS looked like from the perspective of staff of whom nobody had ever asked: 'The NHS: how was it for you?'

We interviewed 21 Unison members: cleaners, a chef, an estates engineer, nurses, ambulance workers, a porter, a student nurse - and even a trust executive director who started her career as a student nurse.

A recurring theme was change and alienation. Many of the older interviewees referred to the NHS as a 'big happy family'; or rather, said it used to be a big happy family but had long since been torn apart through rows over money and petty rivalries.

Experience of change was more positive the more of a stake one had in the outcome. On the whole, anyone who had had even a sniff of operational responsibility tended to be more optimistic about the future of the NHS.

Is there a lesson here? The trauma of market reforms and competitive tendering is still marked. The pristine accounting logic of contracting takes on a brutal, Kafkaesque hue in the eyes of people who have experienced the signing away of their job and NHS pension for 'service benefits' that remain unclear.

Fear inculcated in the years of officially sanctioned gagging and secrecy still persists. One prospective interviewee pulled out because of fears - real or imagined - that she would be blacklisted simply for talking to a journalist.

So why do people put up with low wages and tough jobs? The sustaining myths of the professions - vocation or 'public service' - were not much in evidence. No one did it for the money. Many joined because it was 'just a job' (and it was once a steady job) or because it was a family tradition.

So why is working in the NHS at this humble level mysteriously satisfying? As Liz Austin, with 50 years' NHS service, says: 'We all moan but I can't say I haven't really liked it. I wouldn't have stayed, would I?'

Or George Brown, a chef, who tells his staff: 'You won't get a job outside as good as you get here. That's it about the NHS - people like it.'

Other Voices from 50 years of the NHS 194898, by Patrick Butler and Joelle Depont.

Available from Unison, 20 Grand Depot Road, London SE18 6SF.£2.50.