Letter: Community care and teaching hospitals

Sir: There is a danger the debate on the future of London's teaching hospitals (Letters, 12 October) will become emotive and polemicised. There have been tremendous changes in these hospitals since I first encountered them in the late Sixties and early Seventies. Then they were very much larger, more arrogant and certainly much more inward-looking than now. Indeed, there has been a remarkable change for the better.

Their bed populations have been reduced by a third to a half. Management has improved greatly, with many consultants functioning as budget-holding directors of their own departments. This has led to greater all-round efficiency and more relevance to the needs of local populations. This trend is likely to continue under the influence of internal and external audit and the internal market, as well as by complying with the directives in 'Caring for Patients' and 'Care in the Community', even if the Tomlinson Committee had never existed.

It is not then a case of promoting community care at the expense of teaching hospitals, or vice versa, but of facilitating the evolution of both to achieve comprehensive health care. Tomlinson can best contribute to this process, and accelerate it, by concentrating more on rationalisation of services between hospitals, and less on their closures.

There are no empirical data to support the view that London could sustain a massive loss of beds even within a five-year time-scale without great hardship to patients. Also, we lack evidence that local social and primary health care infrastructures could be in situ within such a time-scale. Hasty and ill-advised closures could well necessitate costly new buildings before the end of the century.

Yours faithfully,

EAMONN FOTTRELL

Consultant Psychogeriatrician

Medical Administrator

Tooting Bec Hospital

London, SWI7