Thirty years after filing his first column, HSJ political commentator Michael White looks back at how the landscape has changed
I never really clocked John Lennon's line that 'life is what happens when you're making other plans' until I heard it fall from the lips of David Mellor. At the time the former health minister had just left John Major's cabinet in disgrace and was making the best of an undignified Commons resignation speech.
My relationship with HSJ has been a bit like Lennon's line, without the actress and the Chelsea football shirt. It just happened. We first got together 30 years ago when Peter Cole, my Guardian colleague in the Commons press gallery, left to join the Evening Standard. He bequeathed me the paper's parliamentary sketch and his ¬¨¬£10-a-week freelance column in what was still called the Health and Social Services Journal.
Jim Callaghan was prime minister, presiding over what was becoming a Labour minority government in which David Ennals (obviously aping this magazine) was secretary of state for health and social services.
Callaghan would stagger on through the storm - inflation, OPEC oil shocks, shop floor militancy, terrorism - until he lost a Commons no-confidence motion by one vote on 28 March 1979.
It ushered in the most radical government since Attlee created the welfare state. The question then became 'Would Margaret Thatcher dismantle the NHS along with so much else?' With hindsight, the answer was 'Probably, if she could.' But it was one of the few institutions tough enough and cherished enough to resist her formidable will. As secretary of state, Norman Fowler checked out the health insurance option and quietly buried it.
My column was shorter in those days, probably 350 words, and on Thursday mornings I used to take my typed copy to the old Macmillan office off the Strand. Since then it has peaked at 900 words and currently sits at 720, plus my photo.
The Emap magazine empire now owns what has become a very glossy and professional title and I e-mail my column to the editor in NW1 on Monday mornings, much closer to press day. Everything is faster in the age of 24/7 rolling news, so media waiting times have come down too.
In rude health
In 1984 I went to work in the US for four years. I learned a lot about the strengths of a marketised healthcare system there, but more about its weaknesses. The federal government spends far more taxes on healthcare than we do, but it is not spent well. Despite consuming nearly 15 per cent of GNP, there is much injustice and anxiety. Worse, there is more bad health. Neither Labour nor Tory reformers want to copy it.
In that interval I bequeathed the column to my then boss, Ian Aitken, whose wife, Catherine, was a GP. Ian, who is now almost 80, gave it back on retirement in 1992. As for Peter Cole, having become a Fleet Street editor he is now a professor of journalism at Sheffield University.
Six weeks younger than me - we are now 61 - I expect he is starting to get his tax money back from the NHS too. In 1998 I had kidney stones zapped, later something nasty cut from my leg and am now dosed to keep my blood pressure low (by White family standards).
My wife has had small ops and the daughter-in-law produced a grandson at Queen Charlotte's where our three children were born. Am I surprised by it all? Of course, and grateful too. It has not let us down. We are all alive and I have already lived 20 years longer than my mother.
Enough about me. What about the NHS? In May 1977 David Ennals had been in charge for a year since Callaghan, on taking over Gordon Brown-like from Harold Wilson, had sacked his old rival, Barbara Castle. Her deputy, David Owen, who was almost as charismatic, was promoted to be foreign secretary at 38 soon afterwards. Barbara was unlucky. She, not Mrs T, could have been PM.
Echoes of the future
Re-reading the history books and memoirs it is useful to remember what an ungovernable nightmare the 1970s were. In 1974 Castle had reluctantly accepted Sir Keith Joseph's three-tier restructuring of the NHS, the first of many. But she faced militant junior doctors, consultants working to rule (deeply shocking to many) in a gentlemen v players, London v the rest medical world which is still visible in the current MTAS recruitment dispute.
As for the ancillaries, whatever action they take on pay in 2007 it will not match the campaign to get rid of private 'pay beds' in the NHS.
Remember Ma Brookstone, the militant NUPE-now-Unison shop steward at Charing Cross? Ministers compromised, but the net effect was counter-productive. As with the attack on grammar schools, the private sector got a huge boost.
But Labour did good things too - money was shifted to poorer regions and spending increased by 1 per cent of GNP to 6 per cent. That process goes on. But patients - should I say customers? -are more impatient, more demanding, less loyal to the post-war collective ethos that the NHS embodies.
Loyalty was enough to save the NHS from Maggie's handbag and her attempts to use tax breaks to subsidise private insurance against the advice of chancellor Nigel Lawson. He once said (or was it that reforming bruiser Ken Clarke?) that the NHS is the nearest thing the godless British have to a religion.
That remains true and the service is staffed, equipped, managed and housed in circumstances far better than in 1977. 'Golden Age' talk is usually nostalgia. We should remind ourselves and the tabloids of that.
Remember too that MPs work harder. There was no health select committee in 1977, only a handful of women MPs and no minorities. I really do think we are better, if more boringly, governed. But there are always more challenges and New Labour's failure to make the extra NHS billions work as they might again makes the future uncertain.
Despite the mistakes. Gordon Brown will be unwise to unpick Blair's choice and contestability agenda and wise to meddle less.
There is much to do. On to 2037. I hope not to be there. The service can't afford me.
Michael White is assistant editor (politics) of The Guardian.