Vitriolic press coverage, union battles and professional plaudits - Andrew Cole asked the NHS's only female health secretaries to recall their time in power

We have had two woman health secretaries in the 53-year history of the NHS. But apart from their gender it is difficult to find much in common between Barbara Castle, the left-wing Labour firebrand, and Virginia Bottomley, the quintessentially 'wet' Conservative who succeeded her almost 20 years later.

Baroness Castle, as she now is, comes from a northern, nonconformist background that did much to forge her radicalism. She held a number of high-powered Cabinet posts before being appointed secretary of state for health and social security in 1974. When she was sacked two years later it was to be her last ministerial post.

For Virginia Bottomley, on the other hand, upper middle-class, home counties and part of an extraordinary dynasty that takes in several Labour ministers and the BBC's Peter Jay, her move to the Department of Health in 1989 was both the start and near-finish of a meteoric ministerial career. Three years later she was promoted to health secretary and three years after that moved to the lesser position of heritage minister. By 1997 her ministerial career was over - much to her relief, it now seems.

It is true that both faced fierce battles with the health unions and the doctors during their time in power - Lady Castle over nurses' pay and her drive to end pay beds within the NHS, Mrs Bottomley over the internal market reforms and her attempts to close some of London's best-known hospitals.

It is also true that both were forced to leave office, not at a time of their choosing, because they had made too many enemies in influential parts of the service and had lost support among colleagues and the wider public.

But there the similarities end. Barbara Castle's two years in charge are characterised in her diaries and other writings by tears, tantrums and almost constant confrontation. But she was also responsible for some notable achievements - not least the linking of pensions to earnings and a radical overhaul of child benefits.

The legacy of Mrs Bottomley's three-year reign is much thinner - partly, of course, because so many of her government's reforms were overturned by Labour. But the lasting images from that period relate not to big causes but to bureaucratic and structural change - and a seemingly endless stream of statistics.

The manner of the two women's departure from office only underscores the difference. For Barbara Castle, being given the boot by the incoming prime minister Jim Callaghan in 1976 was one of the lowest moments of her political career.

In her autobiography, Fighting All The Way , she talks of the humiliation of returning to the backbenches 'and feeling that all eyes were upon me, either sympathetically or patronisingly'.

'What interests me is the stubbornness of my sense of power and authority, ' she wrote in her diary. 'I find it inconceivable that I shall not be at Tuesday's Cabinet, not fighting for a proper rate of child benefit, not introducing the pay beds bill on Monday. . .

'I know that I am one of the best ministers in this government and certainly the toughest fighter for our party's policies. And I am at the peak of my powers. To turn me out for Ennals [the new secretary of state] - really!'

By contrast, Virginia Bottomley describes her sense of liberation and freedom at leaving ministerial office.

Even her move from health to heritage in 1995 was dictated by a desire to retreat from being a fulltime politician. Indeed, she claims, she was offered a much bigger department but turned it down because it didn't interest her. 'I felt I needed to spend a bit longer with my family. '

Which was why two years later she made it clear to the then prime minister John Major that this was it - regardless of what happened in the election. 'I wanted to become a human being again, ' she explains. Her father was dying, her older daughter was getting married, her son was moving into a new house and her younger daughter was in the middle of A-levels.

One thing both women missed when they left office was the ministerial car and their devoted drivers. For Lady Castle this was Edna, whose support went well beyond the call of duty and included driving her back to her flat after she had been sacked and cooking her a consoling meal of bacon and eggs.

For Virginia Bottomley one of the saddest aspects of her departure in 1997 was that it spelt the end of her 10-year relationship with her driver Miss King, who had by that time become 'like a family friend'.

Although neither has ever returned to the hub of power since leaving health, the contrast in their ensuing careers is instructive. Barbara Castle insisted on being elected to the standing committee to ensure the health legislation she had initiated got on to the statute books intact. She stepped down as an MP in 1979, but only in order to become one of the first MEPs, a post she held for the next 10 years, finally calling it a day at the age of 78.

Even this was not the end of her political career.

She accepted a peerage in 1990 and used her position to attack not only Conservative but Labour governments. At the age of 90 she still remains a thorn in prime minister Tony Blair's flesh, particularly in her battle to restore the earnings link with pensions.

Since 1997 Virginia Bottomley's political profile, on the other hand, has been virtually non-existent.

Her ambitions after the last election, she told The Independent, amounted to getting (former transport secretary) Paul Channon's old office at the Commons, a particular spot on the backbenches and the vice-chairmanship of the British Council. She achieved them all.

In addition, she says now, she wanted to be a good constituency MP, something she found difficult to balance with being a minister. She also holds several governorships and still 'mentors' health service managers and chairs when asked.

Interestingly, Mrs Bottomley reveals she was offered another big Cabinet post in 1994 but turned it down because she didn't feel her work was completed at health. 'Many of my friends advised me to leave earlier than I did because they said health is a job where as time goes by the secretary of state becomes increasingly the recipient of people's frustrations. '

However, there was a lot of unfinished business in 1994. Alan Langlands had only recently been appointed NHS chief executive and she was concerned to protect and consolidate his authority.

'It was also a time of change in the regions and I felt that with [health minister in the Lords] Baroness Cumberlege we were the custodians of the corporate culture and to abandon the project there and then would be damaging. '

Asked about her proudest achievements while in charge, there is a long pause - so long you worry that she can't think of any. But there then follows a long list, including cutting the one-year waiting list from 200,000 to 4,000, reducing junior doctors' hours and improving the lot of both women and ethnic minorities within the NHS.

These last two are clearly especially dear to Mrs Bottomley's heart. Her department was the first government body to sign up to Opportunity 2000, and she was appalled by what she heard from black staff about job discrimination and racism.

'Unlike many other employers, there are huge numbers of professional black and ethnicminority staff in the NHS. So there is no excuse for having all of the top tier being white blokes, ' she says.

One of her best moments, she says, was being given a standing ovation by the junior doctors at a British Medical Association conference when she had been expecting a hard time. Conversely, one of her worst was when she was heckled at a Royal College of Nursing congress. She has always seen herself as a champion of nurses, she says, and hadn't expected to be treated as a caricature Tory.

Barbara Castle also had a few confrontations with nurses while at the Department of Health and Social Security, mainly in the shape of the health unions. But perhaps surprisingly, given her exploits on the pensions and child benefit fronts, her proudest achievement was setting up the 1974 Halsbury inquiry, which led to an unprecedented 30 per cent pay rise for nurses. Nurses were ecstatic when the award was announced and it set a new benchmark for their pay, she recalls. 'When the surgeons stop carving It is nursing the patient back to health that really matters. Nurses are not sisters of mercy, they are tough, highly skilled professional people. '

Perhaps predictably, one of the few things both Lady Castle and Mrs Bottomley experienced equally was vitriolic and sometimes openly misogynistic treatment by the media.

At the time of her departure, Barbara Castle was said by the Sunday Mirror to have 'aroused more venom than any other British woman politician, past or present'. And in a strikingly similar phrase, Mrs Bottomley was dubbed 'the most hated woman in Britain'. It is clear that at least some of the press criticism was purely directed at the fact they were female.

However, the reactions to it speak volumes about the different characters of the two women. The pre-feminist Lady Castle is brusquely dismissive of suggestions that she was in any way disadvantaged or treated differently because of her gender.

'You wouldn't go into a field like that unless you were prepared to accept the tough talk and rough treatment, whether you were a man or a woman, ' she states bluntly. 'It was not because I was a woman that I got attacked, it was because I was standing up for firm treatment in the interests of the health service.

'I treated men as equals and they treated me in the same way. I was very advanced. '

Conversely, Virginia Bottomley has no doubt she got a different press because she was a woman, pointing for a start to the column inches devoted to her hair and clothes. But during her time as secretary of state much of the coverage took on a nastier tone.

'Initially my coverage was all of the peaches and cream and English rose variety. Usually it made me sound trivial and then it made me sound as though I wasn't somebody who cared deeply about the NHS. '

She says her father, who was chair of St Thomas' trust at the time, was outraged by the triviality and sometimes cattiness of the press coverage because they were such a distortion of her ethics.

She claims to have an aversion to publicity anyway. 'If you tell some MPs There is something about them in the paper they'll smile and rush to see it - no matter whether It is good or bad. If There is something about me in the paper I'll instantly cringe. I am frank to people I know, but I do not like publicity of the general sort. '

She even confesses to avoiding prime minister's question time whenever possible because she finds it too confrontational. But is not confrontation a necessary part of any politician's armoury? 'It may be; it probably is, ' she says, leaving the obvious conclusion unspoken.

Yet despite this carefully cultivated unworldliness, she is quick enough to attack the present government's health policies and to draw a distinction between their 'politicisation' and centralisation of the service and her attempt to set up a devolved NHS with 'greater autonomy and independence from political fashion, whim and point scoring'.

She has been particularly shocked, she says, by a stream of complaints from her constituents about the decline in local services, and believes the time has come for politicians to accept the inevitability of rationing. 'That is not something I would have said 10 years ago. But I think the health service is going to have to set limits. Otherwise the articulate and greedy will deprive the inarticulate and needy of services. '

She is also scathing about health secretary Alan Milburn's treatment of NHS managers, saying she was 'really shocked' at the recent enforced resignation of Bedford Hospital trust's chief executive over the bodies in the chapel scandal.

'That was unforgivable. I would never have done that as secretary of state. What I find very worrying is that trust chief executives are dispirited and demoralised and feel cowed. There was a time when more of them felt liberated and exhilarated because within their resources they really could make changes and feel more in control. '

Barbara Castle is rather more circumspect in her criticisms of her own government so close to an expected general election. But she has made little secret in the past of her dislike of its control freakery tendencies, and has of course had several high-profile run-ins with Tony Blair on pensions. She was also critical in HSJ of the government's 'mechanistic' emphasis on cutting the numbers on waiting lists and expressed suspicions about the private finance initiative.

1'Ithink there are grave dangers in allowing private finance in too much. . .

I think it undermines the ethos of the NHS, ' she said. What Lady Castle makes of her only female successor is unknown, but Mrs Bottomley is generous about her political opponent. 'Magnificent, ' she says.

'She's in the top league of amazing women politicians like Mrs Thatcher.

I am not in that league. '

Yet although she sought advice from a number of former ministers when she was appointed health secretary, Barbara Castle was not one. This was partly, no doubt, because of the chasm in their politics, but it also reflects the relative significance of the health portfolio to the two women.

'Health was very important to Barbara Castle, I am sure, ' says Mrs Bottomley, 'but I think there were many other jobs that were important. ' It was clearly different for Mrs Bottomley.

There is something almost satisfying in the way the two women's political careers diverge at nearly every turn. Attempting to draw a contrast between her 'healing' regime and Alan Milburn's regime, Mrs Bottomley talks of health secretaries falling into two camps: the window breakers (bad and clearly inhabited by among others Mr Milburn) and the glaziers (good and obviously Mrs Bottomley's natural home).

So where does her much-praised predecessor Barbara Castle fit in this landscape? There is an eloquent pause. Clearly she doesn't want to give Mr Milburn any reflected glory by bracketing him with Labour's very own Queen Mother. But there can be no doubt: if Virginia Bottomley was a glazier, then Barbara Castle was a window breaker. The sound of breaking glass has, metaphorically, always seemed to accompany Lady Castle's career - and many would say thank goodness for that.