Hospital closure rethink follows pit ruling

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THE GOVERNMENT has been forced to rethink its strategy over the closure or merger of up to 10 London hospitals after ministers' plans to rationalise the coal industry were ruled illegal in the High Court.

Lawyers at the Department of Health advised ministers last summer that they would need to tread carefully to ensure any programme for implementing Sir Bernard Tomlinson's blueprint for rationalising the capital's health services did not become entrenched in legal battles.

Their warnings took on a more urgent note when Lord Justice Glidewell last week ordered independent scrutiny of the Government's decision to shut 10 pits, landing British Coal with a multi-million pound bill.

Health ministers have been left in no doubt that their plans for rationalising services in London could be thrown into disarray by legal challenges from leaders of anti-closure campaigns.

Earlier this month, more than 150 London GPs demanded an 18-month moratorium on any government programme to implement the closures and mergers recommended by the Tomlinson inquiry. They argue that massive investments in family doctor and community health care facilities, costing several hundred million pounds, must be made before any hospital bed closures can be contemplated.

Virginia Bottomley, Secretary of State for Health, was widely expected towards the end of next month to announce final decisions on implementation of Sir Bernard's report, commissioned to tackle the perceived overprovision of acute hospital beds in London. But it has emerged that much of her statement to the Commons early in the new year will consist of further proposals, as distinct from firm decisions.

The announcement will come after nearly three months of discussions with executives and staff at vulnerable hospitals mentioned in Tomlinson. Crucially, however, lawyers have pointed out there must also be periods of statutory consultation after the Secretary of State has made clear the Government's intentions.

Implementing some of the Tomlinson recommendations, such as closure of St Bartholomew's, one of the world's best known and oldest teaching hospitals, could prove to be political timebombs.

If consultations go beyond April, when Bart's will be launched as a self-governing NHS trust, attempts to dismantle it so soon afterwards would be an embarrassment for ministers, and could be deemed unlawful.

Like their counterparts at St Thomas's, the Royal Brompton and Marsden hospitals, Bart's executives have fiercely contested the financial assumptions and estimated volumes of patient treatments cited by Sir Bernard to justify his recommended closures and mergers.

Brian Mawhinney interview, page 2