In the first of a package of announcements aimed at sorting out central London hospitals, Mrs Bottomley's bitter Christmas present to Bart's was that its accident and emergency department is to close as expected, probably by next October. The hospital said it was too soon to spell out job implications.
Specialised services including cancer, day surgery and Aids treatment will continue there 'for some years to come', Mrs Bottomley said, along with a minor injuries unit. But the 'phased concentration' of services from Bart's and the London Chest Hospital on to the Royal London hospital site in Whitechapel effectively means St Bartholomew's is being run down to merge with the Royal London, a process that may take until the next century.
The University College London hospitals were promised 'a secure future'. Mrs Bottomley has in effect told Camden and Islington Health Authority that it cannot carry out the full extent of its threat to switch contracts away from the UCLH to the cheaper Royal Free and Whittington hospitals.
UCL hospitals are to be given 'transitional funding' to enable them to provide prices its purchasing authorities can afford while they cut costs further through concentrating services at either site - University College or the Middlesex. They are to be the key cardiac and cancer centre for central north London at the expense of the Royal Free, which has won its fight to keep its kidney transplant programme.
Challenged that she was bucking the market by protecting UCLH and stopping purchasers hunting out the cheapest buy, Mrs Bottomley said: 'A managed market has always been the intention of the NHS changes.' While purchasers had priority, she said there would be occasions where 'it is necessary to intervene for particular reasons'. In the case of UCLH, there had been a clear need to do so to safeguard its world-class teaching and research base. The purchasing authorities are thus being told they must maintain the 'necessary core' of local services to protect UCLH's accident and emergency service.
Yesterday's announcements leave a string of crucial decisons still to come, including the likely transfer of the Hammersmith to Charing Cross, a clear possibility that plans by Guy's and St Thomas's to keep both sites open will be overturned, and a difficult decison on the Royal Marsden hospital's home. David Blunkett, Labour's health spokesman, said Mrs Bottomley's decision on UCLH 'is an admission that her structural changes to the NHS have failed', while the continued lack of other key decisions a year on from the Tomlinson report will 'perpetuate the shambolic and piecemeal approach to London,' with great teaching hospitals 'withering on the vine'.
The A & E closure at Bart's is accompanied by a pounds 25m redevelopment at the Homerton Hospital, a new 28-bed ward at the Royal London A & E department and 120 new ambulances for the capital.