Earlier this year, a report from the independent King's Fund analysed the problems of health care in London. Their conclusions were crystal clear. London has far too many expensive teaching hospitals, which have sucked precious resources away from primary care, leading to a poor range of community and GP services.
The major contemporary health problems in London will not be solved by monolithic hospitals. The problems of mental illness, the care of old people and of people facing life with HIV/Aids-related problems, of people with addictions and of deprived children, can only be challenged in local communities by robust community health provision and by first-class general practice.
Some of your correspondents (Letters, 6 and 9 October) suggest that the Tomlinson report may lead to a loss of excellence. This is nonsense. The teaching hospitals that will remain in London will be more than capable of maintaining excellence.
I would also suggest that rationalising specialist services on to fewer sites in London's hospitals will not only save money, but could improve excellence. It will also be perfectly possible to protect one-off, highly specialist units by planned transfer to the sites that will remain after Tomlinson.
Readers outside London must also be aware that cities like Cardiff, Newcastle and Southampton are able to deliver excellence in their own teaching hospitals.
As the Tomlinson findings become public, we can expect a flurry of elitist vested interests, desperate to convince us that the world cannot revolve without them or their hospitals.
Sir Bernard Tomlinson will hopefully have the courage to challenge those interests and do what should have been done decades ago.
I am not a Tory supporter, but this government's NHS reforms are leading to a more honest and rational public debate about how we get the best use of precious and finite resources.
I, and many like me in the front line of primary care, hope and pray that ministers will show the same courage as Sir Bernard Tomlinson in acting speedily on his recommendations. Those who want no change in London's hospital provision are not living in a real world.
West Lambeth Community Care Trust
Tooting Bec Hospital