A recession, rising unemployment, escalating demand for health services and the tricky issue of how to improve the NHS with little or no new cash.

Sound familiar? These are the issues set out in secret cabinet papers from 1978, only released to the National Archives at the end of December last year. They show how little has changed, in politics at least, in 30 years.

The papers reveal how the beleaguered James Callaghan government struggled to produce an election manifesto that made the best of what his chief adviser Bernard Donoughue termed the “political sex” of the health service, without putting any new cash into it.

The Cabinet wanted to launch a public “great debate” to inspire the nation. The NHS was thought to be the safest focus, although the feeling was “it is not enough to continue to increase the scale, [it must] become more humane in response”.

The rallying cry for a government stuck for cash was “quality as well as quantity”.

Secret fears

The Labour prime minister’s handwritten notes during one Cabinet meeting could be mistaken for ones made today. Commenting on a presentation by the then secretary of state for health and social security David Ennals, Mr Callaghan scrawled “we have made gains but have taken little credit”.

He also jotted: “Have to close NHS hospitals” - although the concern at the time was that new technologically advanced district general hospitals were supplanting the need for popular local community hospitals.

He also wrote: “NHS [is] designed for those who administer in it [rather] than for the patients.”

The answer for a government with so little cash was to refocus the debate on public health.

In one of the few differences from today, road safety and seat belts were listed alongside diet, smoking and alcohol as prime challenges. In 1971 8,302 people died in road accidents in the UK. By 1998 this had fallen to 3,501.

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