Robert Maxwell, chief executive of the influential King's Fund, an independent health research organisation, says there is 'every reason to listen to the mounting concern' generated by the changes to London health services over the past two years.
He says that the Government has to 'think again, particularly about the pace of change and its leadership. There is intense pressure on acute beds, and on A & E departments, a serious loss of morale and a sense that deals are being done behind closed doors which are not communicated to those (patients and staff) principally affected by them.'
The report, What Next for London's Health Care? says that however necessary the changes, there are 'grave problems in London's hospitals about admitting emergency patients, long waits on trolleys and rising waiting lists for elective (non-urgent) patients.'
Referring to the failure last Friday of an appeal against the closure of the accident and emergency department at St Bartholomew's Hospital - signalling the hospital's closure in five years - he says that 'great care' must be taken before such steps are implemented.
He says: 'Undoubtedly there are arguments for rationalising facilities to keep pace with medical advances, reduce overheads and enhance quality but these are not easy messages to put across. It is difficult for the public to accept a need for major changes at well- loved institutions . . '
The report points to the widespread increase in emergency admissions both inside and outside London, the reasons for which are still unclear. Two years ago, the Tomlinson report proposed major improvements in GP services and premises, this year costing pounds 84m, and rationalisation of the London hospitals. But. while the Government anticipated a loss of 2,000 to 2,500 acute service beds, designed to save pounds 50m, it has been estimated that 2,500 beds have already been closed.
He condemns the 'piecemeal' closures of beds, more often brought about by financial pressures in the reformed NHS rather than properly managed hospital planning.
'The effect within institutions has often been devastating. While bricks and mortar are not everything, they enshrine institutional tradition and identity. Closing beds by itself simply restricts services with relatively little saving and a disproportionate effect on service levels. This is precisely the opposite of an intelligent response.'
While Mr Maxwell applauds improvements in primary care, he warns that the 'family oriented model of British general practice' will not work for the homeless, commuters, tourists and mobile young people.
But primary care must be much wider than improved GP services. More community provision might include more nursing and residential homes, 24-hour GP surgeries and community-style hospitals.
Mr Maxwell says that ministers should maintain special funding for the capital over the next three years in return for agreement from London health authorities about the changes they will make.
This was essential as in several areas the 'financial situation is one that threatens to go out of control and to drive damaging cutbacks in services.'
He suggests the growth of the NHS market in London should be held in check while the health services are reorganised.