Services would be focused on fewer sites

THE OVERHAUL proposed by six independent review groups would concentrate specialist health services for London and the area within the M25 on fewer sites. The main recommendations are:

CANCER: Cut treatment centres from 15 to 8. The Royal London would take the work done at St Bartholomew's in Smithfield and Oldchurch in Romford. In south-east London, services provided by St Thomas's and King's probably go to Guy's. Further west, the Royal Marsden would pull out of its cramped Fulham Road buildings and move to its 30-acre Sutton, Surrey, site. Charing Cross would be the main centre serving the west, backed up by the Hammersmith.

St Mary's, Paddington, is among the losers. The Royal Free would be merged into the University College Hospital/Middlesex complex. The Mount Vernon centre in north-west London, the largest in south-east England, should be retained.

HEART: Cut 14 centres to 9. The Royal London unit is to expand. The London Chest, in the short term, and the Middlesex would take Bart's heart work. The London Chest would then close with services relocated to Chelmsford. Harefield would close and have its services decanted to Northwick Park, north-west London. Hammersmith loses its services to the Royal Brompton. St George's, Tooting, will go on serving the south-west. In the south-east, Guy's is favoured over St Thomas's. King's would be the second regional centre, taking services from the Brook.

CHILDREN: The Great Ormond Street hospital should remain a major centre, and either Guy's or St Thomas's should become one. The Queen Elizabeth Hospital to close and services to move into the Royal London. Outpatient and day-care services to be provided locally.

BRAIN, NERVE DISORDERS: Work at 11 centres should be redistributed among 6 hospitals. The Royal London keeps its services and takes those from Bart's and Oldchurch. Royal Free work to be merged into Queen's Square complex of Great Ormond Street and the National Hospital for Nervous Diseases. In the south-east, Guy's would absorb the work of the Brook and the Maudsley. The Atkinson Morley in Wimbledon would relocate to one of Guildford's district hospitals within five years. For west London, services would remain at the Charing Cross or move to the Hammersmith.

PLASTIC SURGERY, BURNS: Services at 14 centres should be concentrated on 4 main sites: the Royal Free, Royal London, Guy's or St Thomas's, and St George's. But Charing Cross could become a plastic surgery specialist centre. Those losing plastic surgery facilities include King's and Queen Mary's Roehampton, leaving only day surgery and outpatients.

KIDNEY DISORDERS: Just five transplant centres at Guy's or St Thomas's, Royal London, Hammersmith and Charing Cross, St George's, and UCH/Middlesex are recommended. In addition dialysis and other specialist renal services would continue at St Helier, St Mary's, Bart's, Royal Free and Charing Cross.

Reports of independent reviews of specialist services in London; Health Publications Unit, Heywood Stores, No 2 Site, Manchester Road, Heywood, Lancashire OL10 2P2.