by Gordon Brown
CHAPTER 8
RENEWING THE NHS
When, in summer 2001, Sarah announced she was pregnant and expecting our first child the next spring, we were overjoyed.
We had married in August 2000, when we had tried to avoid all publicity. This proved difficult. In Scotland, you have to publish your ‘marriage banns’, giving the names of the couple intending to marry, displaying them for fourteen days in a public place. Fortunately, a very helpful registrar of marriages, births and deaths in our local office in Inverkeithing positioned the banns in as inconspicuous a place as possible. So, for days, no one noticed. Our stay-low strategy worked, in fact, until the night before the wedding. Presumably news of the impending marriage made its way to more and more officials up the line, and from there, predictably, the story leaked to the Daily Record. As a result, just as we were holding a small dinner for family and friends in Edinburgh, I found myself dealing with what became a media frenzy. Friends I had not yet told about our marriage – and who we were planning to phone the next day – had to be informed that night and statements issued confirming the event. Eventually, I was able to tell everyone we would invite them to a party later in the year and none had been forgotten.
There followed a rush of TV crews to our local church. Fortunately, a helpful local policeman had placed traffic cones on the road outside the church reinforcing the impression that an event was about to take place. Few people realise that in Scotland, as long as your church minister agrees, it is possible to get married in a religious ceremony at home. I had the idea to do this when I saw a photograph of the wedding of my grandmother and grandfather almost a century before, which showed the ceremony taking place in one of their parents’ home. Sarah and I planned to get married in the dining room of my home in North Queensferry, courtesy of our local minister, Sheila Munro.
We had another small diversion that would help keep publicity to a minimum: getting married on the eve of the Queen Mother’s one hundredth birthday. We assumed the interest in us would quickly subside, overtaken by the more compelling and telegenic birthday celebration occurring in London. And we were right: we had about thirty-six hours of intense media interest after the leaked story, but once we had flown out of Edinburgh that evening we were able to enjoy our honeymoon in Cape Cod – with only a few snappers in attendance.
I was, however, taught one salutary lesson in my dealings with the press. Feeling sorry for the numerous cameramen and journalists camped for hours outside our home while we celebrated inside, I asked my older brother to pour them glasses of champagne. This backfired: one of the bottles was from Sainsbury’s. So the event quickly became dubbed a wedding on the cheap with run-of-the-mill supermarket champagne.
Sarah’s first pregnancy came almost a year later, and for the next few months we continued our lives as normal: spending weekdays in London and then flying up to Scotland for weekends in Fife. Suddenly, just after Christmas, when Sarah went to our local maternity hospital – Forth Park in Kirkcaldy – the routine twenty-six-week scan indicated a high heartbeat and low levels of amniotic fluid that could inhibit growth in the final seven weeks of pregnancy. That was the Thursday. On the Friday, Sarah and I drove back to the hospital, and after a thirty-minute Caesarean section, which seemed to go well, Jennifer was born at 12.16 p.m. on 28 December. Our consultant obstetrician, Dr Tahir Mahmood, who carried out the delivery, said the baby was ‘crying healthily’.
Naturally there were some problems with a baby born seven weeks prematurely: Jennifer weighed only 2 lb 4 oz. The doctors told us she was doing well. Yes, she looked incredibly small and fragile in her incubator, but we were surrounded in the children’s unit by other small babies in incubators. I assumed everything would work out fine, though I was concerned that Sarah herself was unwell. Outside Forth Park, the cameras had gathered and I gave an interview saying just how happy I was. Politics, I said, suddenly seemed less important, and, not normally prone to such statements, I declared Jennifer ‘the most beautiful baby in the world’. Congratulations, toys and clothes were all arriving. It is difficult to describe the joy that comes from seeing your first child, even in fraught circumstances.
It took some days before I realised that there was something wrong. First, we were told that Jennifer would be treated with phototherapy lamps for jaundice, which is common in premature babies, and fed through an intravenous drip. Nevertheless, we still believed that, though very tiny, she would grow – and grow up. Sarah was producing milk for her. Even when we were told that Jennifer would need to stay in the incubator unit for six weeks until mid-February, and even though six days later Sarah came home without our baby, we still did not fear the worst.
Then doctors and nurses told us that she was not responding properly, and that she had to be moved from the hospital in Kirkcaldy to the Royal Infirmary in Edinburgh to be treated by specialists. She still seemed able to respond when we held her and talked to her.
But by the Friday night, exactly a week after her birth, I started to draw my own conclusion that there was little hope – and not because of anything anyone said. I just began to realise she was not responding to treatment. Finding yourself looking at your beautiful baby, who looks untouched by illness but with whom something is so fundamentally wrong that nothing can be done, is almost impossible to bear. That was the most terrible, terrible moment.
I called my friend Dr Colin Currie and asked for his advice. His medical expertise was a great source of wisdom, while his writing skills proved invaluable when I arrived in No. 10 and he took time off from his important medical research to work with me. He said I would have to talk to the consultant the next day, but warned me that I might have to face up to the worst. So, that Saturday we had a private meeting with Dr Ian Laing, who had come in specially to see us. An ultrasound scan, he explained, had shown that our beautiful daughter had suffered a cerebral haemorrhage. He told us gently that there was absolutely no hope whatsoever; all we could do was sit with her – which we did for twenty-four hours a day, sleeping at the hospital – as gradually the life support she had was withdrawn. Even then we did not realise how short the time we would have with her was. Although we knew that she would not live, we hoped that maybe she had more days.
She was baptised on the Sunday at her cot in the Royal Infirmary ward. Sheila Munro came in to perform the baptism and I held Jennifer in my arms – her beautiful face still unaffected, untouched by the scale of the tragedy that had befallen her. Sarah and I took our vows as parents to do everything to bring her up ‘in the nurture and admonition of the Lord’. The baptism was not for us just a comfort or a ritual: it was a recognition that every single life, even the shortest one, had a purpose and every person is irreplaceable. The Saturday, Sunday and Monday were essentially a vigil. We spent Jennifer’s last nights taking it in turns to be at her bedside and sleeping next door in a room set aside for the parents of critically ill children. There was nursing help to ensure Jennifer had no pain or suffering. We were with her all Monday afternoon as her life ebbed away. We held her in our arms as she died at 5 p.m.
It was unspeakable to come home without her. We actually did not want to leave the hospital. We could not bear to be away from her. But we had to leave. Some photographers snapped a photograph of us right after we got in the car.
I had to call my mother – she never saw our baby alive – who was now frail. My older brother John and his wife Angela had visited regularly. But my younger brother Andrew, who had come to visit, sadly arrived just too late. Sarah’s parents, Pauline and Patrick, were – as they always have been – towers of strength and support, both then and in the months and years to come.
There was, perhaps understandably, huge press interest. We were personally grateful to Paul Dacre, the editor of the Daily Mail, and his wife Kathy, and Piers Morgan, then editor of the Mirror, who came to the aid of Sarah and me in the days when Jennifer was critically ill and dying. Following some intrusive and unfair reporting of her condition, they helped secure a
period of restraint when it came to reporting on her death. For that we remain grateful to this day.
In the past when a baby died at ten days old, there was usually no funeral, but we thought it right to have one. And I wanted something to be said about her life. My brother John agreed to speak, but I spent hours writing the notes for his remarks: that was one way I grieved. John spoke about the ten days we had with Jennifer and how they had changed our lives – that ‘never to see our baby grow up, take her first steps, talk her first words, have her first day at school, carve out her first friendships, was almost too much to bear … Jennifer brought great joy: joy so deep, a love so immediate and intense, that the anxiety, the loss that followed, are almost unbearable. So for Sarah and Gordon, their lives were transformed twice over: first as they wept tears of happiness and then of sorrow.’ To this day, I draw strength as well as solace from rereading these words spoken in the Kirkcaldy church where my father was the minister.
Jennifer had died on 7 January and her funeral took place on 11 January. After this, I could not think of returning to London. Sarah was not well and I wanted to be with her. Life seemed empty. Westminster was the last place I wanted to be.
Sarah and I resolved that we had to do something that gave meaning to our loss. In Jennifer’s memory, we would create a charity to find treatments that would prevent what we had suffered. The Jennifer Brown Research Laboratory at Edinburgh University has in its first fifteen years facilitated breakthroughs in a number of areas, such as the level of oxygen that is needed in an incubator if a premature baby is to survive and flourish. At the time of writing it is conducting a major new longitudinal study that will track some of the most serious problems that arise in pregnancy, including brain damage.
To raise money for the charity, I spent some of the next year writing a book of essays, entitled Courage. It featured the lives of men and women who had the courage of their convictions and also the willpower to stand up for them whatever the odds. I was grateful to a long-time family friend of ours, Lord Swarj Paul, who, in memory of his own daughter who had also died too young, distributed copies to every school in the country.
But just as Jennifer’s birth and my becoming a father gave a sense of completeness to my life, so the sense of emptiness that came with her loss would not leave me. I was brought up to keep private emotions to myself – that was called for at all times. Never talk about your sorrows, I was taught, nor your innermost feelings. But even at the time, I noticed how it changed me. The day-to-day things that occupy so much of our lives seemed trivial and irrelevant. I had been accused of hardly ever smiling anyway, but I doubt if I smiled even once for months after Jennifer’s death. I could not listen to music for more than a year.
Having returned to work in February, with great reluctance I had to travel to Canada for a G20 finance ministers’ meeting. Despite the comradeship of fellow finance ministers who were so kind to me, I was reluctant to throw myself into the debates. In the weeks that followed, however, I found there was one task that I could wholeheartedly embrace. It comforted me to think that I could help all those who would need the NHS as much as Sarah and I had.
And so I immersed myself in writing the Budget of 2002, which was delayed by a month because of the death of our daughter. Its purpose would be to increase funding for the NHS. My personal commitment to the NHS, deepened by what happened to Jennifer, was long-standing. After all, I owed my eyesight to it, and as a son, I was grateful for the care it provided for my elderly parents. But Sarah and I were not alone. Millions of British citizens owe their lives, their health and, in Aneurin Bevan’s phrase, their serenity to the existence of the NHS. It is our best-loved national institution. Any government which neglects or ignores it pays a heavy price. But while the performance of the NHS is a make-or-break issue for every government, the expectations faced by Labour governments are always especially high. This is not just because Labour created the NHS in 1948. It is because throughout the last seventy years we have always claimed that it is safer in our hands. When we fought the last day of the 1997 general election on the slogan ‘24 hours to save the NHS’, we knew we were raising expectations even higher and I was determined to meet them.
The year of our election, 1997, had not been a good one to be sick and dependent on the NHS. The Major government’s modest increase in spending was never going to be enough to prevent a winter crisis in the health service or satisfy heightened expectations. And because we had pledged not to exceed already announced expenditure targets, we had to be content initially with the most modest of promises: that we would reduce the numbers on waiting lists by 100,000. But after we came into power, I decided to announce an extra £1 billion for the NHS in my first Budget and then later that autumn I announced an additional £250 million to relieve winter pressures.
It is to the great credit of our first Health Secretary, Frank Dobson, that he not only accepted the economic logic of sorting out the public finances first but also persuaded nurses, doctors and patients that we had to do so. Frank was one of the best leaders of the NHS because nobody doubted his commitment to a free universal health service and to meeting the needs of the poor. His diplomatic and leadership skills, which should have won him the election for mayor of London, were critical in holding the government together in our first years. It was thanks to his patience that while the government started with a narrow aim – to avoid a winter crisis – we were later able to deliver the best-financed health service in our nation’s history.
The historic significance of what we legislated in 2002 lay in the fact that the NHS had been recurrently underfunded and would finally be given the resources it actually needed. It would at last be able to prove that it was not a relic of the 1940s, ‘created by fools to be run by saints’, but was able to satisfy twenty-first-century demands for individualised treatment and higher standards of personal care. NHS spending rose from £60 billion in 2001–2 to £102 billion in 2007–8 and £118 billion in 2010 when we left office. To achieve this, we would have to take on those who wanted to privatise the NHS or introduce a system of charges and fees, and we would have to win public support for the biggest single tax rise for the NHS in its history: a National Insurance increase of 1 per cent in both employer and employee contributions, and an additional 1 per cent paid by top earners.
We had actually been working on these plans for some time – since the winter of 1999, in fact. In a series of discussions with Ed Balls, Ed Miliband, Spencer Livermore and Bob Shrum in Washington, we had agreed on a basic strategy. We would have to convince people anew of the uniqueness and value of the NHS as a free service – and also make a further argument about the risks families would face under a system of private insurance, which could not guarantee them access to the wide array of advances being made in medical technology and treatments. To do this, we would publish the costs of heart transplants, statins and cancer care in a way that allowed people to understand that the NHS was not there merely for minor ailments but as the best insurance policy in the world against catastrophe.
Persuading the public to let us raise taxes would be an uphill struggle, and we were all too aware of our manifesto promises that ruled out increases in the basic rate and top rates of income tax. So, over the next two and a half years, a group of officials and advisers within the Treasury worked on an intricate plan to refinance the NHS. First, I planned to announce in the 2000 Budget a five-year plan for the NHS with an unprecedented 7 per cent annual increase in spending. This, we said, we were doing in preference to the tax cuts the Tories were now proposing.
Our programme of research and public education was set back only once, when Tony – who knew our thinking and was keen to signal a fresh start in 2000 – announced in his New Year interview with David Frost that he planned to raise NHS spending to the average European level of 8.5 per cent of GDP. I knew immediately the problem we now had: as with John Smith’s shadow Budget, the focus would be on the resultant tax rise, before we had had a chance to ex
plain the logic of a National Insurance increase as ‘something for something’. Tony had announced the gain – the spending increase – without explaining the pain – the tax rise, despite my insistence that the two had to be announced together. For the next few weeks the focus on tax and spending threw the very carefully organised sequencing of our campaign into disarray.
The public rollout of the strategy we had devised in Washington stepped up in the March 2001 Budget, delivered three months before the general election of that year. It was a sensitive juncture, with the Tories looking to pin us to the wall on tax rises. In the Budget, I announced the next stage of our strategy by inviting Derek Wanless, the former head of NatWest Bank, to prepare a report on future funding of the NHS. I found him to be a great colleague. I also discovered we had had similar experiences growing up. I told Derek that my father had told me story after story of the panic of families in the 1930s as they faced up to the crippling costs of treatment for loved ones. I shared with Derek my father’s view that the NHS was a ‘deliverance from evil’. Derek responded that he could remember his own parents telling him similar stories about the days before the NHS in the north-east of England.
Because of the foot-and-mouth outbreak, the general election of 2001 was moved from May to June. We fought it on the final line of my Budget speech from that spring: ‘Schools and hospitals first.’ Tony had started the year with a modest claim: ‘A lot done and a lot still to do.’ Some of my colleagues wanted to move on from that to a broader ‘One Nation’ appeal to Conservative voters, but we found this had no traction when we tested it. As chairman of the Election Strategy Group, I made our focus schools and hospitals. When, in the last days of the election, Tony and I campaigned from a battlebus festooned with the banner ‘SCHOOLS AND HOSPITALS FIRST’, we were working from a script that had been years in the making.