Bart's may still close as inquiry makes it Dobson's choice

An inquiry into the future of London's health care has decided that St Bartholomew's hospital should close, but has been unable to agree whether this is realistic. The conclusion is, nevertheless, likely to seal the fate of the capital's oldest hospital, says our Health Editor.

Bitter disagreements have blighted the London Review panel, set up last May by Frank Dobson, in one of his first acts as Secretary of State for Health, to examine the future of health- care in the capital.

The five-member panel, chaired by Sir Leslie Turnberg, former president of the Royal College of Physicians, has been unable to agree whether closing St Bartholomew's hospital and transferring its departments to the Royal London is practical, and has made no recommendations about proposed changes at Guy's and St Thomas's hospital.

However, it has concluded that London no longer has too many hospital beds.

The review panel's report has been with ministers since November and publication was expected before Christmas. A health department spokesman said it would now appear "in the coming months".

The delay reflects the political sensitivity of the decisions facing ministers. The review was promised before the election by Chris Smith, then Labour health spokesman and an Islington MP, as a means of staving off unpopular decisions. St Bartholomew's hospital, which has stood on its Smithfield site over the border from Islington for 870 years, was earmarked for closure by Virginia Bottomley, the then Tory health secretary, and has been the subject of an emotive five-year campaign to save it.

The review panel's report says the best answer to the problem of Bart's would be to transfer its remaining departments (the accident and emergency department closed three years ago) to the Royal London in Whitechapel, in line with the former Tory policy, where there are plans for redevelopment to provide 1,200 beds at a cost of pounds 250m, funded through the private finance initiative. The plans would also involve the closure of the London Chest Hospital and the Queen Elizabeth Hospital for Children, merging all four hospitals on a single site.

The plans are backed by the Royal Hospitals NHS Trust, encompassing the four hospitals, which says keeping Bart's open would cost an extra pounds 26m a year, and by the consultant staff of the trust who voted overwhelmingly in favour of the single-site solution in a ballot before Christmas.

However, a minority on the review panel argued that closure of Bart's would result in an unacceptable loss of beds that would be unlikely to be re-provided at the Royal London. They also questioned its affordability, pointing out that the Chelsea and Westminster Hospital in west London, which opened in 1993, cost more than pounds 200m to provide only 600 beds.

The panel's report, agreed after its final meeting on 6 November, sets out the pros and cons of closing Bart's put forward by the two sides, leaving the final decision to ministers. It is understood that health ministers have reluctantly accepted that the Tories' closure plan should go ahead but that any final decision would only be taken with the agreement of the Prime Minister and the Treasury.

The review report says that London now has fewer hospital beds than the rest of the country, when account is taken of patients coming into the capital from outside for treatment.

The report makes no recommendations on the plans for Guy's and St Thomas's, Britain's largest National Health Service trust. However, it raises questions about the proposals to close Guy's accident and emergency department in 1999 and to build a 232-bed women and children's hospital costing more than pounds 100m on the St Thomas's site while mothballing an 11-storey tower three-quarters of a mile away on the Guy's site.