Ginny knows best: When John Major entrusted the Health Service to Virginia Bottomley in 1992, he expected the public to warm to her angelic manner. So why is she now Britain's most detested politician?

THE CONSULTANT cancer surgeon poked his head round the door: 'D'you know the

anagram of Virginia Bottomley?' he asked, scowling. 'Main vile Tory bigot.' And then he went back to cancel some more admissions, because all the operating theatres in his London teaching hospital are now closed one week in every six.

'She's like gossamer when she talks, isn't she?' grumbled the woman in Edgware General Hospital's outpatients department. 'She comes on television and makes those long speeches full of figures, and you think: 'What's she saying? How can there be too many beds when there are people waiting on trolleys? And why does it all sound so meaningless?' '

Few politicians engender so much passion, rouse so much ire, as the Secretary of State for Health - which is odd, because she is herself curiously passionless: driven by no great ideology, possessed by no coherent, controlling set of ideas about free-market economics, libertarianism or collectivism. She is 'an essentially practical person, who at university was less interested in sitting around analysing than in trying to make the bookshop work', according to her father; 'a glazier, or a window cleaner, rather than a window breaker', says her husband.

Mrs Bottomley occupies an essentially managerial job, implementing health reforms dreamt up by previous secretaries of state. It is a role that should be suited to such pragmatic talents. And yet she is loathed. In a recent Daily Telegraph poll, she was judged Britain's most insincere politician. In a Guardian poll of reactions to alternative Conservative leaders, she was less popular than Heseltine, Hurd, Clarke or Portillo, all of whom were thought to be less attractive than the present prime minister.

John Major must have congratulated himself on making a smart move when he promoted Virginia Bottomley in 1992. Not only was he making good his previous gruesome error of failing to include a woman in his cabinet; he had found one who looked admirably equipped for the job. She came from a famously liberal-lefty family, many of whom were doctors. She had once worked for the Child Poverty Action Group, and then for 10 years in the NHS as a psychiatric social worker. She was unquestionably on the left of the Tory party, and she and her family (her husband is the only Tory MP to wear a Transport and General Workers Union tie) had always used the NHS. She didn't look remotely, conceivably, like a woman with a mission to privatise.

And, of course, she is a woman, with all the caring connotations that implies, and much beauty besides. The wide, lipsticked mouth engulfs people in smiles, the eyes are wide and concerned-looking, the skin is clear, the shoes sensible; she is an ideal of a certain kind of modest, intelligent womanhood. She even, unlike Margaret Thatcher, has a lovely voice - melodious, bell-like and unstrident.

So what has gone wrong? Mrs Bottomley herself would say that nothing has - that, on the contrary, she has won round the profession, so that doctors are no longer opposed to change. But ideas which are now received wisdom in medical circles - that we will soon need fewer hospitals, concentrating on complex, hi-tech cases, while much of their old work is done out in the community at Super Health Centres - have failed to percolate through into public discussion. So, as Mrs Bottomley goes about her business - biting the bullet, as she sees it, of the overprovision of hospital beds in London - she upsets patients, who see hospitals closing, and don't understand why; who fear that the health service is being smashed at its very roots and then feel doubly betrayed by the womanly caring demeanour, the repeated assurances that she knows what's she's doing because she's been there, worked there, loves it.

It is, of course, somewhat difficult for her to explain the role of primary care before there is any. The hospitals are closing way before the GPs' surgeries have got their district nurses, their physiotherapists, their counsellors and their visiting consultants. And it is also difficult to explain if you refuse to engage with the issues. Interviewing Virginia is like throwing bean bags at a plate-glass window: questions seem to slither away in front of you, flopping on to the floor.

The issues are complex and endlessly debatable: how are we to decide whether heart transplants or hip replacements should take priority when the capacity to spend effectively on health care far exceeds the resources to pay for it? Why is there a belief that hospitals are becoming a thing of the past when emergency admissions are actually rising? How has this doublethink come about, whereby doctors are now rebuked for being too efficient? Britain has one of the cheapest health services in Europe: might that be because, historically, there wasn't a price on everything, and staff worked long hours in the name of something more nebulous than value for money?

Ken Clarke, architect of the health reforms, would, one suspects, have thwacked the bean bags back with some enthusiasm. Virginia sits comfortably in her vast office, in a green tartan skirt (which might, possibly, have come from Marks & Spencer, where she once shopped before opening-time to escape her admirers), a classy acid-green jacket and navy tights. She is of the Mary Archer type: controlled, ladylike, and beautiful; the type whose composure men frequently long to disturb (one Labour MP has called her 'staggeringly sexy'). She listens carefully, replying in her caressing, delightfully lulling voice, in little speeches larded with statistics and achievements, eschewing the broad sweep. On the rationing issue, for example, she says: 'As long as there's been a health service, choices have had to be made. When I was in my twenties, I campaigned to get mentally handicapped children out of those desperate long- stay hospitals. The reason they were there was that there was no money in the community. When we had the first heart transplant, the first kidney transplant, and only one special- care baby cot, there were terrible decisions that had to be made. So I've got little sympathy for this new discovery from the chattering classes that resources are finite and decisions have to be made. What is new, and this is right, is that there is greater discussion and debate about the running of the health service, and that's part of the role of the health authority, with local GPs.'

This is a typical Virginia response: Teflon- coated. It's hard to tell exactly what it means. But then why should the secretary of state run the risk of getting herself into trouble by engaging with the issues? Better to say something bland, but with any luck still politically effective: note the side-swipe at the chattering classes, aimed at ingratiating herself with the right, and the reference to her campaigning past, designed to reaffirm her caring credentials. Unfortunately, in the absence of any willingness, or ability, to do more than manage competently and massage the PR, Virginia Bottomley is left looking like one of those hi-tech buildings with the lifts and pipes on the outside. There is a disconcerting sense that you can see the politics working.

PETER Bottomley, the mildly eccentric MP for Eltham, is trying to explain his wife. 'She is like her great-uncle Ronald who played rugby for England before the First World War: when the whistle blew, he got up and walked towards the guns. Or her uncle Kenneth, who rowed for Cambridge, who did the same, walked towards the guns.'

'Er . . . sorry?'

'All I'm trying to say,' Mr Bottomley mutters exasperatedly, 'is that for her, politics was never a lifelong ambition. Other people suggested she went into politics. She isn't interested in personal aggrandisement, not at all. In her family, they are dedicated to public service and total lack of self-interest.'

Other members of what Virginia calls her 'great tribe' tell a similar story, of a woman with a calling, marching towards the guns. 'Virginia sees herself as a sort of vehicle,' says her aunt, Peggy Jay, a former Labour GLC councillor. John Garnett, her father, believes that 'all her life - and that's what the family is all about - she has been concerned with answers. What's the best you can do? She gets immense happiness from doing good. That's the way we were brought up.'

Virginia Hilda Brunette Maxwell Garnett was born into this tribe 45 years ago, in Dunoon, Scotland, the second of four children. Her father ran the Industrial Society; her mother was a teacher who had joined the Jarrow marchers. A public-service, paternalist tradition courses through the family, 40 members of which still meet (as family members have since 1904) for an Easter walk on the Isle of Wight - 'a bit like the Kennedys at Hyannis Port,' as her cousin Peter Jay has said grandiosely. On this walk, the oldest male Garnett traditionally tells tales of derring-do: Scott of the Antarctic, the sinking of the Titanic, and how Virginia's grandfather James Maxwell Garnett, secretary of the League of Nations Union, lost his fountain pen when he was writing Education and World Citizenship.

Douglas Jay, Harold Wilson's economic adviser, was married to Virginia's aunt; Peter Jay, former ambassador to Washington and now the BBC's economics editor, is one of her cousins; the deputy governor of the Bank of England is married to another. A great uncle invented the long-range weather forecast.

Virginia has spent every August of her life on the Isle of Wight, mucking about in boats, eating ice-creams and building sandcastles. 'The great message of the sea is that the tide turns and you get used to the turbulence and the calmness. And that's quite a good metaphor for life,' she has said, in one of her yukkier reflections on these interludes. At other times she has talked about singing round the piano and the resilience that the family has given her along with the sense of service. Photographs of the MP for Surrey South-west on holiday in a sun hat, a long-limbed golden girl, swimming and playing tennis, bring to mind images of Joan Hunter Dunn: 'furnish'd and burnish'd by Aldershot sun,/ What strenuous singles we played after tea,/ We in the tournament - you against me.' Perhaps it really was like this for Peter Bottomley, who arrived to camp in their garden when he was 16 and she was 12 and, emotionally, never really left. ('Oh] full Surrey twilight] importunate band]/ Oh] strongly adorable tennis-girl's hand]')

John Garnett remembers his elder daughter as 'a very difficult little girl: a big person in a little skin, an unhappy child, who hated going to bed and doing the things one tries to get children to do'. She went to Putney High School for Girls, where they unaccountably omitted to make her head girl, an oversight for which she once said she had been trying to compensate ever since; she also failed, much to her disappointment, to get into Oxford. She went to Essex instead, where her politics began to shift. At school she was the Labour candidate in mock elections, and canvassed in Battersea for her aunt Peggy, who admits she was 'frankly surprised' when Virginia became a Tory. 'I think she might have had a fairly horrible time at Essex in some ways: there was a lot of sort-of class war. And she was associated with Peter at a very young age, and I think he always had it in mind to go into Parliament.' (Her association with Peter, it was later revealed, extended to having his baby while she was still a student: their first child, Joshua, was born three months before they married.)

Virginia herself has said that she was exasperated by endless socialist talk, when the Tory students were getting on with the Meals on Wheels. Her moral tutor at Essex, Peter Townsend, thinks however that 'it is highly unlikely she was a Tory then'. Professor Townsend and Mrs Bottomley recently exchanged bitter letters in the British Medical Journal, after she apparently rubbished her education as 'defeatist talk' in Parliament. Professor Townsend believes she was trying 'to wriggle out of the contradictions between the person she was then and what she is now supposed to be. It seems to me tragic - a denial of what she stood for personally'.

On other occasions, Virginia has attributed her rightwards shift to suspicion of trade union domination of Labour. 'I believed in helping those who couldn't help themselves, and almost by definition those people were unlikely to be trade union members,' she has said, meaning, presumably, that trade unions concentrated on looking after their own - but somehow suggesting that the pesky trade unions upset the proper order of things, which is that poor people must be helped, and Virginia Bottomley is jolly well going to do it. (Her uncle, Douglas Jay, once said: 'In the case of nutrition and health, just as in the case of education, the gentleman in Whitehall really does know better what is good for people than the people know themselves.') The obverse of the kind of noblesse oblige do-gooding in which Virginia and her family specialise is a sort of condescension, an assumption of superiority.

'I often think of the opening scene in Howards End, when a young man is looking through a window into a lighted room at a family. I think that family is us,' Peggy Jay has said. This is a family which is mightily pleased with itself - which doesn't, of course, invalidate its good works. At the Child Poverty Action Group, Virginia succeeded in getting a number of wretchedly poor families to keep diaries of their expenditure, and wrote a report that was crucial in blocking moves to get child benefit paid to fathers through the tax system, instead of direct to mothers. She invited one of the families for Christmas; and, when the Ugandan Asians were expelled, gave house room to a Mr and Mrs Jetta for 18 months. 'Her house is constantly packed with broken people,' her father says. 'And she said to me recently, did I realise my nephew's wife was in difficulties? - and packed me off to see her.'

But however beneficial the effects of Virginia's Lady Bountiful activities, they require an acceptance by the people she is sorting out that they are suitable material for sorting. And these days that's a bit more difficult, because she's trying to sort out the entire country.

GINNY the Sorter-Out, rather like an Enid Blyton heroine, has only to solve one mystery to come across another. 'I can't think of a moment when I ever sit back and think 'Isn't this an achievement?' ' she tells me. 'I'm always thinking about the next battle, the next campaign.' And there have been few battles bigger than The Case of The Health Service.

Before entering Parliament, Virginia spent 10 years as a psychiatric social worker in south London, becoming a JP at the age of 27 and chair of the Lambeth juvenile bench at 32, at the time of the Brixton riots. It was Mrs Thatcher - who told Virginia, with typical restraint, 'You'd make a better MP than your husband' - who, according to her father, decided her on a career in politics. She fought the Isle of Wight in 1983, where the sitting Liberal Democrat, Stephen Ross (later Lord Ross of Newport), claimed: 'She played the line, 'I have friends in high places. I can make this island work.' ' (Someone who knows her socially says: 'She is certainly never chary of using her connections. She will bring her children to parties if she knows there will be influential people there.') She lost by 3,000 votes, but only months later beat 300 other candidates to fight the Surrey South-west by-election, following the death of Maurice Macmillan. It is one of the safest seats in the country.

'The day she was adopted for the Isle of Wight, she found out she was pregnant with her third child,' Peggy Jay remembers. (Joshua, now 25, works in the City and Cecilia - Lil - 24, is a doctor.) 'She made a very sensible decision, that she would see Adela (now 12) had continuity of care with a sort of deputy mum.' To this end, she employed Frances Riordan, a nanny-housekeeper (who died last year), 'which was quite difficult for Virginia, because she had to share authority with Frances, but it meant that the child had total security.' Virginia, who works from 6am to midnight, says the most important thing is that Adela should know that she is utterly reliable.

Within a year of entering Parliament in 1984, Virginia became a parliamentary private secretary to Chris Patten, and then to Geoffrey Howe. By 1988 she was a junior minister at the Department of Environment; by 1989 she was a health minister under William Waldegrave. She joined the Cabinet just eight years after arriving at the Commons.

Her admirers contrast her handling of the hospitals with the fiasco over pit closures, and insist that she is a good tactician. But the truth is that while the Labour Party may have accepted several key elements of the government's reforms, the public remain largely ignorant of what is going on and continue to feel that changes are being made to their health service over their heads. 'For her, it's like a game of draughts,' says Frances Hirst, a cancer patient waiting in the Barts radiotherapy suite; 'but those draughts are people. She insists the health service is treating more patients, but how do we know? They've changed the way they collect the figures: they're about as reliable now as the unemployment statistics.'

One reason for Ginny's failure to get the message across may be that there's no clear message. As Chris Ham, professor of health management and policy at Birmingham University, points out: 'What is curious about these reforms is the way that one agenda has been overlaid on another. For Margaret Thatcher they were all about efficiency, for Ken Clarke primary care, for William Waldegrave the Health of the Nation, for Virginia Bottomley community care.' With so many conflicting messages, patients can be forgiven for thinking that what they're really about is saving money. Except, that is, when it comes to administrators: one recent Health Department advertisement for a human resources manager offered pounds 90,000 plus bonuses.

So what does Virginia think is the point of the health service reforms? 'Well,' she says, after a characteristic pause to establish and direct her answer, 'the health service reforms are about ensuring that we focus on the needs of patients, that we achieve better value for money, and that we improve the organisation, devolving responsibility as much as possible. There continue to be areas where a strategic overview is necessary: we need to ensure there is a comprehensive health service. There will always be that tension between the strategic overview and the need to devolve.'

London was undoubtedly her hottest potato: conventional wisdom has it that there are too many hospital beds in the capital, where 20 per cent of NHS resources are being squandered on 15 per cent of the population. Barts and Guy's are unlikely to survive in anything like their present form; other hospitals which will suffer cuts and amalgamations include Charing Cross, Hammersmith, the Royal Marsden and Queen Charlotte's.

To Londoners, who take a fierce pride in their great hospitals, this looks like death by a thousand cuts - and for what? The primary care which is supposed to replace them is still largely invisible. And the argument that there are too many beds is by no means won: London has little more than half the number of per head of population than New York and, at 28.5 per 10,000 people, is way behind Paris (with 38.9 per 10,000). It simply may not be possible to treat London as another English region: 1 million Londoners live on income support, and there is a high incidence of homelessness, Aids and mental illness. The population swells by half as many people again every weekday.

The specialist teams at London hospitals may, meanwhile, be unwilling to transfer to Southend or Harrow. David Bihari, the physician in charge of intensive care at Guy's, believes that the closure of his hospital's accident and emergency department 'is all about balls, not brains. Virginia Bottomley has psyched herself up to close a teaching hospital, and she's determined to prove she's got the balls to do it.' He is planning to move to Australia.

The situation is not so different in other British cities. In Birmingham, acute admissions to hospital rose by 14 per cent last year, and 6 per cent for each of the two preceding years, partly due to an ageing population. 'There is a feeling that every straw is being grasped at to cut hospitals,' says Ken Taylor, a consultant physician and co-ordinator of the Birmingham Doctors' Emergency Admissions Group. 'Meanwhile, we are hot-bedding patients, as if they were products in a factory. The NHS is heading towards an acute service, with less and less room for non-urgent work. Affluent patients will increasingly get their non-urgent work done privately.'

Ginny the Sorter-Out has many fears to allay. And if she succeeds . . . well, she has already been talked of as a possible future home secretary, even Tory party leader. Peter thinks she may go into business: 'What other 45-year- old,' he asks, 'has managed bigger budgets, given as many press conferences, employed as many people?' Her father says her aim will simply be to go on doing good: 'She says her prayers, and wouldn't miss a Sunday in church: that's the key to it all.' Her belief in an idea of service is not in doubt, nor is her commitment, personally and politically, to live up to it. But right now what she has to do is persuade the nation that she is not, as one consultant described her to me, the Minister For Pretending The Health Service Is Safe In Tory Hands. Whether she has the clarity of purpose, the ability to produce the soundbites, or the tone to do this is an open question. On Desert Island Discs recently, she requested 'piped Today programme' as her luxury, adding: 'I'll want to ring up and say: 'Now, Today programme, you may be a very good programme, but the balance isn't quite right.' ' This is the authentic Ginny note: intrusive, goody-goody, and very off-putting. -

(Photographs omitted)