Hospital closures delayed: One in five of London's acute NHS beds will go as funding is switched to GPs

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Main points of the Bottomley package

Bart's options: closure; merger with the Royal London and London Chest hospitals; or retention as small specialist hospital

Proposal to resite the Royal Brompton and Royal Marsden hospitals at the Charing Cross Hospital rejected

Merger plans between St Thomas's and Guy's, and University College Hospital and the Middlesex to go for consultation

No final decisions until review of specialist services: cardiac, cancer, neurosciences, renal, plastic surgery, and paediatrics

An extra pounds 170m capital funding for primary services over 6 years - pounds 30m more than minimum Tomlinson deemed necessary

About pounds 43.5m to improve GP and primary healthcare centres, particularly in the most deprived areas, will be spent next year

ONE in five of London's acute NHS beds is set to close in the next five years because of a major shift of resources away from hospitals towards family doctors and community health services.

However, the Government yesterday put off naming the hospitals that must close or merge in the overhaul until the autumn.

Virginia Bottomley, Secretary of State for Health, had been widely expected to spell out to MPs precisely where the axe would fall in her response to Sir Bernard Tomlinson's proposals to concentrate London's fragmented hospital services on fewer sites.

Instead, Mrs Bottomley set in train a process that looks certain to see St Bartholomew's and the Charing Cross closed or greatly curtailed early next year, with Guy's and St Thomas's merged, and with a whole swathe of further speciality closures and rationalisations to come.

Lord Hayhoe, a former Tory health minister, will be appointed chairman-designate of a joint Guy's and St Thomas's NHS Trust over the next few weeks.

Mrs Bottomley's repeated line that the Government was 'grasping the nettle' and making 'a decisive break' with the past, was seen by Conservative MPs expecting firm closure announcements as a 'fudge' - although one former health minister dubbed it 'rather good fudge' given the longer-term implications.

But Bart's and the Charing Cross accident and emergency departments seem likely to close, with firm decisions in the autumn on whether either should stay open or remain as limited specialist centres. A consultation exercise by the North-East Thames regional health authority last month on the idea of abandoning Bart's transition to NHS trust status in April produced responses from 2,000 individuals and organisations. Some 91 per cent opposed dissolution.

With Mrs Bottomley expecting, on a 'cautious' estimate, that 2,500 more beds will go over the next four to five years, six speciality groups have been set up to report by the end of May on how and where specialist services, from cancer and cardiac to renal and paediatrics, should be provided.

That raises questions about hospital departments, including St George's in south-west London, Queen Mary's, Roehampton, and others, which had escaped unscathed in the Tomlinson review.

The 'radical programme of change' and all it implies 'will start now, work quickly and keep to a strict timetable,' Mrs Bottomley said, with 'significant implications' for manpower.

She combined the widening of the London review with an announcement that pounds 170m in capital will go into primary care over the next six years aimed at providing a 'first class' primary service to the capital. David Blunkett, Labour's health spokesman, described the announcement as 'a damp squib with a long fuse attached to a powder keg of cuts and closures'. It provided the worst of all worlds, he said, allowing 'existing hospitals to wither on the vine' while not providing the resources needed. There would be 'a further period of confusion and uncertainty while the internal market continues to damage the NHS in the capital'.

Professor Michael Besser, chief executive of Bart's, said the hospital was the victim of 'stitch-ups, and disinformation campaigns' at the hands of ministers and regional health managers. 'I remain confident that Bart's specialist services will survive, but to propose closing its accident and emergency department is a disgrace, and anti-democratic.'

The British Medical Association praised Mrs Bottomley for deferring vital decisions until it had more information. But the King's Fund, a leading health policy think-tank, criticised the Government for its 'fudge' over Bart's and Charing Cross.

Robert Maxwell, chief executive of the fund, expressed alarm over the tight timetable for the completion of the specialty reviews.

Conservative MPs produced widely differing reactions, from those outside London who wanted faster decisions, to praise from David Mellor, a former health minister, at the retention of the Royal Brompton and Royal Marsden on their existing sites - which looks likely to spell the end for the Charing Cross.

(Photograph omitted)