Government re-think may save Bart's

THE GOVERNMENT is rethinking plans to close several London hospitals, and is preparing to reprieve St Bartholomew's. The move follows a meeting last week between Virginia Bottomley, Secretary of State for Health, and the Prime Minister, who urged caution over hospital closures.

The conciliatory line on Sir Bernard Tomlinson's report - which proposed closure of up to 10 London hospitals - comes after a formidable lobbying operation by Bart's.

Final decisions have not been made, but ministers are now said to be focussing more on mergers than closures. They do not want to do anything 'irrevocable' before it is clear how the NHS internal market will affect Bart's. A further investigation of specialist medical units in London will provide more time for Bart's, which was founded in 1123, and has proposed its own survival plan.

Conservative supporters of the NHS reforms regard Bart's as a touchstone of the Government's seriousness about its internal market. The hospital has a relatively small catchment area in which to appeal for patients.

A concession could help Mrs Bottomley to introduce the remainder of her reforms. Consultations are now certain to go on beyond April when the hospital launches itself as a self-governing NHS trust. Mrs Bottomley's announcement, expected early next month, will give the go-ahead to some mergers, including that of St Thomas's and Guy's. But it will concentrate on a long-term strategy for London hospitals.

Ministers are now talking of an evolutionary approach to the transition of medical provision in London over the lifetime of the parliament. Any hospital closures would be subject to a potentially-lengthy consultation period.

At the same time ministers will stress the importance of beefing up primary health care services. They have long argued that the capital is over-endowed with hospitals but poorly served by general practices.

The Tomlinson report urged the 'systematic transfer of resources' from hospitals to family doctor and community health services and next month's announcement will list details of how this will be achieved.

The report urged the closure of Queen Charlotte's and Charing Cross hospitals in Hammersmith, the Middlesex in central London and either Guy's or St Thomas's. Other smaller hospitals recommended for closure included the Royal National Throat, Nose and Ear; St Mark's, Islington, and the Hospital for Tropical Diseases at King's Cross.