Virginia Bottomley, Secretary of State for Health, accepted the thrust of a report recommending the closure or merger of 10 inner London hospitals, the concentration of medical training and research on to fewer sites and measures to bring health services closer to the people who use them.
'We should grasp the nettle, and take decisions that will bring an end to the uncertainty for NHS staff,' she told the Commons after publication of the report on the future of London health services from the team led by Sir Bernard Tomlinson. 'The Government accepts the view that London has too many hospitals and too many beds.'
Mrs Bottomley refused to make an explicit commitment to fund the expansion of primary health services demanded by the Tomlinson report to compensate for the projected run-down of acute hospital beds.
The inquiry team estimated that at least an extra pounds 140m would be needed just to bring existing GP premises up to an acceptable standard. Last summer's inquiry by the King's Fund, a prominent health service think-tank, suggested pounds 250m should be injected into family and community health services to ensure an all-round improvement in London health services.
The Government hopes to announce its decisions on the report early in the New Year after consultations with the affected hospitals and staff organisations. Several health organisations, including the Royal College of Nursing, criticised the failure to include patient and consumer representatives in the consultation process.
Opposition MPs and health unions seized upon the Secretary of State's failure to guarantee specific funding as evidence that the Government was embarking on a programme of massive cuts that would leave Londoners with the worst of both worlds: ever-lengthening waiting lists and deteriorating community health services.
The capital's inner city areas already have fewer group GP practices and district nurses than elsewhere in the UK, and proportionately more elderly GPs. The physical condition of many family doctors' premises is poor and nearly half fail to meet minimum recommended standards.
Some GPs are under such pressure that they are often forced to advise patients to ring 999 if their condition worsens. GPs and nurse practitioners should be employed at hospital accident and emergency departments to help train junior doctors and reduce the burdens on them, Sir Bernard recommends.
David Blunkett, Labour's health spokesman, accused the Secretary of State of having capitulated to Treasury demands to claw back millions of pounds worth of savings from hospital closures. The savings yielded must be ploughed back into the health services for Londoners, and new money had to be guaranteed to ensure a smooth transition of services into the primary sector, he said.
However, Marion Roe, Tory chairman of the Commons health select committee, pointed out that more patients outside the capital would benefit by being treated in hospitals closer to their homes, instead of being sent to London.
The ad hoc development of specialist medical services has meant that there are 13 cancer centres, 14 cardiac, 11 kidney, and 13 neuroscience centres around inner London. Despite a population drift into the suburbs and beyond, central London hospitals continued to suck in resources, creating a mismatch between health needs and service delivery.
Sir Bernard said his inquiry team had found that about 1,700 acute hospital beds in the capital - nearly 10 per cent of the total - were not being used because the present configuration of services had failed to keep paces with advances in medical technology and shifting population trends. 'If change is not managed firmly, and in some cases urgently, the result will be a serious and haphazard deterioration in health services in London,' his report states.
The report suggests a further 2,500 acute beds could close, provided compensating improvements in the primary sector were in place. A cut of up to 680 consultants may be necessary to bring down the present 'top heavy' medical staffing structure to more cost-effective levels. Regional health authorities employ about 3,000 consultants in inner London, although the current total may be closer to 4,000 once those employed by universities are counted. That represents twice as many consultants per head of population as elsewhere in the UK.
The British Medical Association is seeking an early meeting with health ministers to draw up redeployment programmes for doctors in the hospitals recommended for closure who wish to continue working in the NHS, and to negotiate early retirement deals for the rest.
Mrs Bottomley said that a special committee of health experts, the London Implementation Group, would be constituted as soon as possible to explore options arising out of the report. However, the report was still 'Government advice, not Government policy'.
Report of the Inquiry into London's Health Service, Medical Education and Research; HMSO pounds 6.95.
Leading article, page 12