His plan for concentrating London's fragmented and expensive acute and specialist hospitals on fewer sites would mean thousands of NHS staff, from consultants to cleaners, losing their jobs.
Sir Bernard tells ministers in his summary: 'For the immediate future, employing authorities should scrutinise closely every consultant post that comes up for appointment. For all other staff groups, measures to facilitate the possible redeployment and relocation of staff should be explored.'
His plans would release hundreds of millions of pounds from the sale of key sites in and around central London. He recommends a 'systematic transfer of resources' from hospitals to family doctor and community health services, as well as new government money to fund the changes.
In addition, eight out of the capital's nine hospital medical schools should be merged into four medical faculties inside London University, and student numbers should be reduced, he says.
A summary of Sir Bernard's report was leaked last night to a NHS pressure group, London Health Emergency. It urges a massive programme of mergers and closures, shutting St Bartholomew's at Smithfield, Queen Charlotte's and Charing Cross hospitals in Hammersmith, the Middlesex Hospital in central London and south of the Thames either Guy's or St Thomas's.
The Royal Brompton, specialising in hearts and lungs, and the Royal Marsden, the cancer hospital, should be relocated in buildings vacated on the Charing Cross site, Sir Bernard has concluded.
Smaller hospitals recommended for closure are the Royal National Throat, Nose and Ear Hospital, Gray's Inn Road, St Mark's, Islington, which specialises in diseases of the bowel, and the Hospital for Tropical Diseases at King's Cross.
Some of the hospitals have already been earmarked for closure or merger with neighbouring institutions by health authorities struggling to balance books.
Virginia Bottomley, Secretary of State for Health, is understood to have agreed 'in principle' that St Thomas's and Guy's should merge. But there will be a hard- fought battle over which site will be preserved.
She is expected to tell the Commons today that no binding decisions will be announced without consultation. Huge anti-closure campaigns are expected to be mounted to try to save institutions such as Bart's, founded in 1123 by an Augustinian friar, and Queen Charlotte's, Britain's oldest, and arguably most fashionable, maternity hospital.
Sir Bernard outlines new ways of organising family doctor services and explores the scope for designating parts of London as 'primary care development zones'. These would concentrate community health resources in deprived inner city areas, which have higher proportions of single- handed practices.
He wants GPs to be involved in shaping health services in their areas. 'Scope of and access to general practice should be improved, accident and emergency services adapted to provide primary care where appropriate.'
Dawn Primarolo, a Labour health spokeswoman, said the proposals would butcher health care services.Reuse content