Going west, Virginia? An unhealthy position

Bad blood over London hospital closures may end her cabinet career, report Stephen Castle and Nicholas Timmins

AT 3pm a week last Thursday four Conservative MPs filed into Virginia Bottomley's ministerial office. It was one of Whitehall's pointless rituals. They were there to protest about the likely closure of Edgware Hospital in north London. For the leader of the delegation, Sir John Gorst, MP for Hendon North, it was the 25th meeting about the subject with the Secretary of State for Health in just over a year. The minister, close to a final decision, was willing to hear representations, but not to hold a discussion. This explained what one MP later noted as the "glassiness in her response", as if she was listening "but not really receiving us in intellectual terms".

Four days later came a second meeting which may prove to have been a turning point in Mrs Bottomley's six years at the Department of Health. In the lobby of the House of Commons the minister spoke to Peter Brooke, a former Cabinet minister. She was intending, she said, to announce the closure of the 900-year-old St Bartholemew's Hospital in London. She would do so by written answer and Mr Brooke, as the most senior MP with a constituency involvement, might like to put the question down, she suggested.

Mr Brooke, a defender of the hospital, firmly declined. The question was put down by another MP from outside London; Mr Brooke, instead, put down a private notice question which forced Mrs Bottomley to put in a Commons appearance to defend her decision. He followed it up with an attack on her "moral cowardice" in not doing so in the first place. Sir John Gorst and his allies weighed in. The hour-long debate developed into the most vicious roasting of a minister by Tory colleagues since Michael Heseltine's coal fiasco.

The usually mild-mannered Mr Brooke was in the vanguard. As one veteran parliamentarian put it: "To the extent that there is an ancestral voice in the Conservative Party, it's Peter Brooke. It was a bit like the High Priest at the door of the Temple crying: `You're doomed'."

GIVEN the job, perhaps Mrs Bottomley was always doomed. The problem of London's hospitals dates back at least 50 years. All were originally voluntary foundations, set up to treat the poor. Before the Second World War, several were permanently on the verge of bankruptcy. The arrival of the National Health Service saved them.

But since 1945 London's population has been shrinking while the hospitals themselves have struggled with cramped and outdated premises. The obvious solution was to move them to new buildings out of London. An attempt to do so in the 1950s ran up against the power of the medical establishment and the attractions of Harley Street. Instead of Charing Cross being moved to, say, Reading, it travelled a few miles down the road to Hammersmith. Instead of the Royal Free being shifted to Luton or Leicester, it went to Hampstead. St George's on Hyde Park Corner moved not to Southampton but to Tooting. Almost every other hospital stayed put, rebuilding on its existing site.

After 1976, the London hospitals lost their preferential treatment. Spending per head of population was to be equalised and that shifted money out of London. Patients, however, were still being pulled in from the Home Counties and further afield because the London teaching hospitals still had the consultants, the facilities and the reputations. What the hospitals lacked was the money to provide a proper service. Beds started to close. London needed about 10 properly-resourced teaching hospitals, able to organise themselves so that the long waits for treatment and the awful hours on trolleys in casualty departments ended. Instead it had 13 or so big hospitals that became increasingly inefficient.

Then came the NHS internal market, designed to expose precisely such inefficiencies. "What the new system will do," said William Waldegrave, Secretary of State, on the eve of the NHS reforms in 1991, "is force some decisions out of us cowardly politicians who for 20 years have put them off." Within six months, the truth of his words was apparent. Health authorities outside London and on its fringes were not prepared to send their routine cases to Guy's and Bart's and to pay higher London prices to have their patients treated. The great teaching hospitals were facing financial meltdown. Yet Mr Waldegrave put off the decisions again. With a general election approaching, he appointed Professor Bernard Tomlinson to recommend a rationalisation programme.

Tomlinson reported in 1992: the proposals included several closures (including Bart's) and mergers. The Government then issued a response, which largely accepted Tomlinson, and invited consultation. Fierce campaigns were fought for several hospitals, particularly Bart's. Last week's 15-page written answer from Mrs Bottomley was confirmation of the campaigners' worst fears: Bart's would close, so would Guy's, after a gradual rundown, so would the hospitals in Greenwich and (though it was not earmarked by Tomlinson) Edgware. Almost every hospital in the capital has been affected and, according to some estimates, 1,000 out of 16,000 hospital beds will go.

SO a row was inevitable. The alternative to a planned closure programme was to allow the market blindly to destroy great chunks of the teaching hospitals. Different hospitals might have been chosen but the protests would probably have been as great.

Mrs Bottomley's personality and record, however, probably made last week's row worse. This is not the first time that she has been accused of moral cowardice for announcing controversial policy decisions by written answer. Twice, she has announced rises in prescription charges through written answers, once earning a rebuke from the Speaker.

Yet, paradoxically, one of the main reasons for Mrs Bottomley's problems is her thirst for publicity. As one colleague put it, both Mrs Bottomley and her husband, Peter, the MP for Eltham, "have a rather obsessive interest in press and radio". James Naughtie, presenter of Radio 4's Today programme, identified her last year as one of those constantly pressing to be interviewed on the breakfast slot.

All that effort is probably counter-productive because the Bottomley technique, backed by apparent belief in her message, tends to grate. "Her only interview tactic," said one Tory MP last week, "is rattling off facts and figures about the health service and eventually that started to become a negative." This may well explain why one Gallup poll rated her as the "most insincere" member of the Cabinet.

Worries about presentation have been reflected in an attempt to reorganise the department's press office, and the greater role in drafting press releases given to the trusted special adviser, Richard Marsh.

There is, however, a limit to the help that public relations can provide; "Mother Teresa would get a bad press in this job," said one official last week. Nurse, nanny or head girl are the epithets which crop up consistently at Westminster, and, with responsibilities which include the health of the nation - complete with advice and targets on drinking, eating and smoking - the tags have stuck. One ally says: "She is a person who evokes strong emotions - like another female Tory politician. Maybe that is something women politicians have to live with."

Mrs Bottomley is not much more popular with her fellow Tory MPs than she is with the public. Even with fellow MPs of a liberal leftish outlook, Mrs Bottomley has failed to cement strong ties, partly because women politicians can find it difficult to build up a power-base in the male- dominated environs of Westminster where the Smoking Room is as important as the Chamber. One friend said: "Unfortunately she does not have a lot of political supporters in the House. That became clear on Wednesday because a number of her critics might have expressed themselves in a slightly different way if she had been warmer in the past, or attempted to cultivate them. She is not a naturally clubbable person, although I concede that it is harder for women.

"The venom with which people like Hugh Dykes [Harrow East] spoke was very striking considering that, as a leftish pro-European, he ought to be a political supporter of hers."

While last week's row concerned London, MPs outside the capital are slow to defend her. One Tory MP for a northern seat added: "You can meet her in the lobby and she won't even look you in the eye. At divisions she is invariably on her own."

Mrs Bottomley's family connections do not help. Peter Bottomley remarked on radio last week that "if you come from a family tradition of great uncles who, when the whistle blew, walked towards the guns and got shot dead, you have a degree of toughness". Many fellow MPs regard that kind of self-satisfied personal publicity as typical of the couple. (The Daily Mail pointed out yesterday that none of the great uncles who fought in the 1914-18 war exactly fitted this description: one was felled by a sniper's bullet, another was wounded while firing guns, a third was killed in an air crash during trials on Salisbury Plain.) And the Tory right is deeply suspicious of the Bottomley background. Virginia's father, John Garnett, ran the Industrial Society and her mother sat on the Inner London Education Authority. The family is related to the Jays with whom they holiday each Easter on the Isle of Wight. As if that were not enough, the young Virginia was a researcher for the Child Poverty Action Group and a psychiatric social worker in the 1970s. She is, said one MP, seen by the Thatcherites as "a closet pinko".

Whether or not this is a view shared by John Redwood, the right-wing Secretary of State for Wales, is not documented. But the tension between Mr Redwood and Mrs Bottomley goes back more than a year. Mr Redwood's right-wing populism has led him to a series of attacks on the bureaucracy of the modern-day NHS and the need for resources to go to doctors and nurses rather than pen-pushers. It may have been by accident that he last week added to Mrs Bottomley's discomfort by arguing - on the day of the Bart's closure row - that it is a "myth" that closing hospitals saves money. Mr Redwood's speech had been sent to the Department of Health which, it is claimed, failed to mention the London hospitals announcement and hence the sensitivity of the issue. But Mrs Bottomley never saw the speech and her department was reluctant to warn others about the decision because of the quasi-judicial nature of the decision-making. Many MPs still suspect Mr Redwood of being after Mrs Bottomley's job.

LAST week's dbcle was a long way from the glittering future that seemed to await Mrs Bottomley on her promotion to the Cabinet in 1992. She had been an MP for only one year before she became a parliamentary private secretary, only four years before she became a minister. Some talked of her as a future premier.

By most standards she has not been a bad minister. If anything, she has had fewer disasters than predecessors such as Mr Waldegrave and John Moore. Ministers who have worked with her praise her ability to delegate and her application to the job. In recent public spending rounds, she has got good settlements for health out of the Treasury, albeit with Downing Street's backing. She has a reputation for entering Cabinet battles very well prepared. One colleague tells of being rung by Mrs Bottomley on a point of detail at midnight on a Sunday when they were due to breakfast together a few hours later. Such zeal has led some commentators to hint, without any evidence, that she has become unbalanced.

She is the inheritor rather than the creator of many of the health policies that cause the Government problems. Kenneth Clarke started the NHS market reforms; Mrs Bottomley is suspected of having doubts about them but, if so, she has never dropped her guard. She inherited Tomlinson, and the unresolved problem of the London hospitals, from Mr Waldegrave. Both Tomlinson and the King's Fund, the influential health think-tank, which also reported in 1992, concluded that wholesale closures were needed. Only now is the inadequacy of some of their data emerging. The King's Fund was in thrall to the theory that health care was about to undergo a technological revolution which would allow GPs to do far more without patients needing long and expensive hospital stays. It now admits that it may well have got its sums wrong. Across London, the total of closures is beginning to look too extensive and too fast, the rundown of hospital beds too great, the closure of specialist units overdone. But at least Mrs Bottomley has acted. For years, the conventional wisdom among health policy thinkers has been that a really effective health minister should do two things: ban tobacco advertising and a close a couple of London teaching hospitals. She will not do the first, but she has done the second and some doctors still believe this will allow the other hospitals to deliver the quantity and quality of care that Londoners deserve.

CAN Mrs Bottomley stand the pressure? Will she survive? Because her progress in politics has until now been so effortless she has never needed, said one MP, to develop a tough skin. But she is determined to hang on and will very probably do so. At the Cabinet meeting on Thursday she received the backing of her colleagues as Mr Waldegrave proposed three cheers for the Secretary of State for Health. Her fervent backing for Mr Major should stand her in good stead; In Penny Junor's book The Major Enigma, Mrs Bottomley described her boss thus: "He is courteous, he does listen, but there is also a steeliness behind that." The Prime Minister's instinct is usually to stand by his ministers. In a year when his leadership is under increasing pressure, Mr Major is unlikely to want to dilute his cabinet support unless it is really necessary. But whether the Tories will go into an election with the same health secretary is a different matter.

Last year Mrs Bottomley was said to want a move. A friend said last week this was "logical. Eighteen months ago it would have been upwards. Now, I'm afraid, it's sideways."