Thousands of NHS jobs may go in London

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THOUSANDS of doctors, nurses and other NHS staff in London face redundancy over the next five years, under radical plans from a government-appointed committee to concentrate the capital's hospital services on fewer sites.

It is now known that four leading teaching hospitals must either be closed, merged with other institutions or reduced to much smaller, specialised units.

Sir Bernard Tomlinson, who chaired the inquiry on London's health services, has told ministers that St Bartholomew's, Charing Cross and the University College/Middlesex hospitals are certain to be principal targets for rationalisation under the blueprint, formally presented yesterday to Virginia Bottomley, Secretary of State for Health. The four- strong panel of inquiry also decided that either Guy's or St Thomas' should close, and that the services they currently provide should be centred on one of the two sites.

The new internal market in the NHS has exposed the high running costs and duplication of many patient services that remained largely concealed before the health service reorganisation.

The inquiry has concluded that there must be an urgent review of the eight specialist hospitals, such as the Hospital for Sick Children, Great Ormond Street and Moorfields, to ensure an adequate supply of their services in the developing market. They are still directly-funded by the Department of Health, but will become dependent on contracts that they can negotiate from NHS purchasers within two years. Sir Bernard has concluded that they should continue to receive some direct or 'earmarked' funding even if some are eventually absorbed by larger neighbouring hospitals.

The report of the inquiry, expected to be published within 10 days, is likely to be criticised for failing to put a price on the shift in resources it demands from acute services to primary and community health care in the capital.

In its analysis of London's problems last June, the King's Fund, a health policy think-tank, suggested that the Government would need to plough an extra pounds 250m into primary health services to bring them up to acceptable levels.

Brian Mawhinney, the Minister of State for Health, is expected to spend the next two months in discussion with managers of the hospitals named in the report, and representatives of health service professionals, in preparation for the Government's response. However, some senior NHS executives are doubtful about whether the Government will risk implementing plans that will increase unemployment.