That said, the basic policy is both sensible and worthwhile. The issue of dispersed specialities and the inheritance of an arguable excess of hospitals (and a compensating shortfall in primary health care) are problems worth tackling, and Mrs Bottomley deserves credit for tackling them. The target of a concentration of medical expertise adjacent to places of high academic scientific standing is a good one, and chimes well with the University of London's own strategy.
Of course, it was not going to be achieved without ructions. The apprehensions of civil servants and, presumably, ministers about the reaction of consultants which had prompted the prior two decades of inertia were a vivid index of what lay in store (though to the credit of Bart's they had spoken to me as early as 1977 about the desirability of rationalisation). Local apprehensions are also understandably strong. Once the plough had been grasped, however, resolution in completing the furrow was desirable. In all this I support the Secretary of State.
The strategy called for a disproportionate attention to tactical handling. Apologists for the process may say that, until decisions are taken, the defence of territory is all and one cannot expect high-minded leadership on the ground. Others might say that the absence of high-minded leadership ensures that eyes will not be raised to the sunlit uplands that could lie ahead. All I would say, now that the decisions have been taken, is that there is no excuse for some of the pettiness we have seen so far (including from the Trust executives vested with the management of the process), and high-minded leadership should take over.
My concerns from here are twofold. The local one, exemplified by millions of petition signatures, is that if you have hospitals in which their constituencies believe, you must, once you have decided to alter the status quo, make sure that what comes next is not only worthy of the past but also creates something greater than the sum of the parts. The national concern is that for this country, Bart's, in a post-industrial society, is an international asset and it must continue to reflect its great reputation to the world. If that means sophisticated medical investment in that hallowed ground beside the Priory at Smithfield, then that would not be a bad epitaph on nine centuries. I would posit that this would hugely enhance the chances of the new merged Bart's at Whitechapel being the success that its past history should command.
The writer is MP for City of London and Westminster South and former Secretary of State for Northern Ireland (1989-92).