Hospital closures 'should await further research': The author of a report on health services in London is recommending a cautious approach. Judy Jones reports

MINISTERS should forestall any moves to close London teaching hospitals until the financial implications have been better researched, the Government's chief adviser on the capital's health services said yesterday.

Sir Bernard Tomlinson, a former chairman of the Northern Regional Health Authority, last month recommended that 10 hospitals should close or merge to counter an 'over-provision' of acute beds in London. However, at a conference of NHS managers and health policy analysts in London yesterday, he acknowledged that wide disparities had emerged in the costing of the various options being considered.

Ernst and Young, the management consultants, were commissioned by the Royal Marsden and Royal Brompton hospitals to examine the cost of implementing Sir Bernard's recommendation that they should vacate their present buildings and move to the site of the Charing Cross Hospital.

The consultants concluded that it would cost up to pounds 62m to decant the two specialist hospitals on to the Charing Cross site, it was disclosed yesterday. The North West Thames Regional Health Authority had calculated that the closures would be pounds 10.6m cheaper than alternative options for rationalising the hospitals' services.

Sir Bernard acknowledged yesterday he was worried the Government might sanction closures before there had been a comprehensive analysis of the finances of hospitals threatened with closure.

'The problem of differing estimates have to be ironed out. I would be very disturbed if movements were approved on the basis of back-of-envelope calculations. There has to be an agreed basis for what will move under particular circumstances.'

Making his first major speech since publishing his report, Sir Bernard told the conference that waiting lists would rise if the Government failed to tackle the historical anomalies that distorted the allocation of health care resources. About half a dozen inner London hospitals were not viable under the split of the NHS into purchasers and providers.

However, closures should be phased 'over several years,' he said. Although it would cost pounds 140m to bring the standard of family doctors' premises in the capital up to an acceptable standard, a great deal more money was needed to improve primary health care to the point where acute hospital beds could be shut for good, he said.

It was unrealistic to expect the inquiry team to put a global figure on the amounts needed. 'Our report would have been placed on the first available shelf, only to gather dust, if we had treated this as a political opportunity,' he said.

A sizeable minority of the senior NHS managers attending the conference applauded vehement criticism of the Tomlinson recommendations from health service union leaders. Many doctors feared that the Tomlinson report could simply be a prelude to a cost-cutting exercise.

Pete Marshall, the London secretary of Cohse, told the conference: 'The reason why some hospitals are not viable is not because patients aren't waiting to use them, but because of the introduction of market forces in the NHS.'

Virginia Beardshaw, a health policy analyst and director of the King's Fund London Initiative, warned ministers that hostility towards the notion of hospital closures had deepened in recent weeks among patients and health service professionals. 'The people of London are digging in. The twin feelings of impending loss and of powerlessness that are around at the moment are especially conducive to producing anger.'

The survey carried out by the King's Fund, a health policy think- tank, showed that Londoners wanted an expansion of primary health care to include facilities for minor surgery, specialist clinics and community support.

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