Whose money is it anyway, Virginia?: They gave millions and now want it back: a donors' revolt at Guy's may start a landslide, says John Torode

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GUY'S and St Thomas's are two of Britain's most respected teaching hospitals. Historic rivals, they stand within a couple of miles of each other. Guy's is a chaotic jumble of patched-up Victorian buildings and a brutal Sixties tower near London Bridge station; St Thomas's is a couple of miles up river, opposite the Palace of Westminster.

Under Virginia Bottomley's reorganisation programmme, the two hospitals are being forcibly merged to form a single trust. Guy's is the loser. Its facilities will be downgraded and most of its patient care shifted to St Thomas's.

The result has been an explosion of anger from the friends of Guy's. Sir Philip Harris, former chief executive of Harris Queensway and the biggest private donor to the hospital, has written to the new trust saying he wants his recent donations back and will not be honouring further pledges. As the sums involved were pounds 2m, which has already been spent, with another pounds 4m to follow, his decision has caused consternation among the trust's governors.

Sir Philip thought he had been shelling out for a custom-built, state-of-the-art, integrated treatment and research centre for cancer and kidney patients at Guy's. The building is nearing completion and is (for the present) named after him. Sir Philip Harris House is a large yet user-friendly, five-storey, Post-Modernist brick block, conveniently sited next to London Bridge station. Now it stands empty and boarded- up while its fate is decided. If Mrs Bottomley has her way, it will house only some residual functions.

The reclusive multi-millionaire's action has sparked off something of a funding strike among Guy's other major donors. Kay Glendinning, administrator of the Dunhill Medical Trust - which has given pounds 10m to Guy's in the past six years - confirmed to the Independent that her trust would make no further grants for the present. 'Uncertainty is undermining morale and destroying the institution,' she said. 'It is the kiss of death - illogical, unfair and not in best interests of anybody. I feel very bitter, as do a lot of other people.'

The donors' revolt at Guy's has encouraged calls for similar action by supporters of other hospitals. 'I am led to believe that donors are saying no to the NHS generally,' says Cyril Chantler, dean of the combined Guy's and Thomas's medical school.

The resistance he describes has the support of the influential Institute of Charity Fund Raising Managers. 'I would be very, very hesitant about advising anyone to give a substantial sum to an NHS trust for a particular purpose,' says ICFRM director Stephen Lee. 'It (the attempt to divert Sir Philip's donation) raises substantial problems and calls into question the whole business of charitable giving for medical purposes.' In any case, he adds: 'Whatever I say, if donors do not feel absolutely secure, they will vote with their feet.'

The strike by donors to Guy's has the support of many senior medical staff. Cyril Chantler says: 'I am not here to take the side of one hospital or the other, but I do know that the days of separate research, clinical treatment and surgery are over.'

Chisolm Ogg is the director of the joint kidney unit which was to have operated out of Sir Philip Harris House. 'Some years ago I went to them (the Guy's Association of Kidney Patients), told them about planned rebuilding and asked for their help in raising funds through small individual donations . . . I would have a lot of difficulty about going back to them now . . . Frankly, they would be better off putting it in the bank for a rainy day.'

Dr Ogg has found a ready listener in Alec Schwardz, chairman of the kidney patients' association. The reason for his involvement in fund-raising is, typically, personal. His late wife 'received wonderful treatment at Guy's and I am very grateful'. Since her death in 1980, Mr Schwardz has been raising money for Guy's. He says: 'My general feeling is that if Guy's ceases to have a renal unit as planned, it will not have the pounds 1m we have collected.'

Bob Knight, chairman of the Guy's consultants' committee sympathises. 'Sir Philip Harris House was planned over many years. Groups of patients have stood in cold stations with buckets collecting for it. Now they fear for what they had been promised. It will be nothing like they had planned. I can understand their refusal to pay up. It is responsible and sensible.'

It is not merely consultants and individual donors who are in a state of near-rebellion. So are outside academics, who seek efficiency rather than emotional satisfaction. Take Nick Wright, director of clinical research for the Imperial Cancer Research Fund, which had promised pounds 1.7m to Sir Philip Harris House for breast cancer research.

Professor Wright's need, he says, is for an integrated research and treatment unit, because his scientists require access to very large numbers of patients. Now they will be denied such access, because the laboratories are to be at Guy's but the out- patients at St Thomas's.

'No mucking about,' he says. 'If we are not going to get our money's worth, we want back the pounds 400,000 they have already spent. And we are not going to pay the further pounds 1.3m the ICRF has pledged.'

According to Stephen Lee, of the Institute of Charity Fund Raising Managers, the donors' revolt has raised a further nightmare scenario. If the courts rule that the authorities at Guy's had not acted 'in good faith' when allocating donors' money, members of other NHS hospital trust boards, or other charitable trustees, could be personally liable to repay the many millions of pounds which are being spent in defiance of donors' stated intentions. This is in spite of the fact that any misuse would have been at the direction of the Secretary of State.

This uncertainty explains why Mr Lee hopes that The Case of Sir Philip's Missing Millions ends up in court. 'Quite simply, my members want the situation clarified. They are asking who will in future be disposing of their charity, and under whose direction.'

So, if the Harris case does come to court, an important general principle will be aired. But the debate would revolve round a local area of uncertainty: is the provision to be offered at St Thomas's adequate?

The point is that, as long as the projected new facilities at St Thomas's are of as high a quality as those once planned for Guy's, the change of plan is probably lawful, however distressing for the donors. But most donors and experts at Guy's believe that the proposed new deal will be less efficient.

For Professor Wright of the ICRF, the crucial issue is the physical integration of research and patient care, which is not going to happen.

Dr Ogg says simply: 'I don't think what is being offered at St Thomas's is acceptable. It is less convenient for the patients and will inevitably be a lower quality unit. The choice of St Thomas's is wrong.'

Bob Knight agrees. 'The move is unnecessary and will cost a huge amount of money. It will prove a disaster for Guy's and Thomas's. Guy's facilities won't fit on the (Thomas's) site so there will have to be some reduction in provisions. For a lot of patients there will be considerable inconvenience, for some there will be deprivation of a first-rate service.'

As for Mr Schwardz, he visited the St Thomas's site recently. 'I saw pleasant and helpful chaps, but I have to say that their site was unsuitable. I am not prepared to see my members' pennies go down the Swanee.'

Of course, the case may not come to court. Recently Mrs Bottomley wrote to a local patients' group claiming that no final decision had been made about Sir Philip Harris House. This is taken as a tactical retreat in face of the revolt at Guy's. But, until the issue is resolved, donors will be increasingly wary about supporting hospitals, and NHS governors and special trustees will walk in fear of financially crippling legal proceedings from irate donors.