Jeremy Laurance: Much-needed restructuring thwarted by vested interests


Almost 20 years ago, a government inquiry into London's health service, chaired by Sir Bernard Tomlinson, recommended the closure of four hospitals – Barts, Guy's or St Thomas's (he could not decide which), Charing Cross and the Middlesex – and that the money saved be used to improve GP and community services.

London's palaces of disease, presided over by powerful consultants with lucrative private practices in Harley Street, were £50m in the red. University College Hospital alone was losing £1m a month.

Sir Bernard said: "If this change is not managed firmly, and in certain cases urgently, the result will be serious and haphazard deterioration in health services in London."

That was in 1992. Today only the Middlesex has gone. Barts, Guy's and Charing Cross remain open (though the first two have lost their A&E departments). London still has too many hospitals that are sinking ever deeper into debt.

Sir Bernard observed that for more than a century it had been recognised that London had too many hospitals draining a disproportionate share of the nation's health budget. But, because of the power of vested interests, it had proved impossible to change that. So it remains today.

In 2007, after a review by the surgeon Ara Darzi, the Labour government initiated the concentration of specialist services in fewer hospitals to raise standards, and the building of polyclinics to provide care at a new level between that of GPs and hospitals. But that innovation was halted after the 2010 election when Andrew Lansley announced a moratorium on "top-down" reorganisations.

Closing hospitals has proved politically impossible for politicans. At the last election, MPs from all parties queued up to be photographed with campaigners battling to save maternity or accident and emergency departments. Yet evidence shows that closing hospitals is essential to guarantee good care in those that remain.

More than £600m has been spent bailing out a score of failing NHS trusts in the past six years. In London, five primary care trusts have received £153 million from NHS London's Challenged Trust Board to tide them over.

As the NHS faces the toughest financial settlement since its inception, Lord Crisp, its chief executive under Tony Blair, said last week: "whole hospitals will have to close" to release resources for community care.

But, he added, "historical baggage" and "vested interests" conspire to prevent it.