Bart's: will the City come to its rescue?: Commuters and East Enders are joining forces

THE TRAMP was eating breakfast in his usual alcove at St Bartholomew's Hospital in the City of London last week when he ran out of milk. After pausing to button and belt his filthy raincoat, he shuffled into the hospital shop nearby. The girl was sharp but not unkind: 'I'll get it for you now, just wait a minute.' She was attending to a middle-aged gent in a pin- striped suit, talking loudly into a mobile phone as he paid for his FT: 'Tell them I'm on my way. Just a strain. No squash for a month but no damage done.'

Bart's, the world-renowned teaching hospital due to close by the year 2000 following the Government's re-organisation of the capital's healthcare, serves both the wealth of the Square Mile, and the poverty of east London. As the battle for the hospital enters a new phase, supporters hope that one will be the saviour of the other; that the influence of the City is now crucial to the continued provision of medical care to some of the most under-privileged people in Europe, as well as more than 500,000 daily commuters and tourists.

Doctors will demonstrate outside the casualty department today against Government plans to close Bart's. On Friday, it was the turn of the city of London to back Bart's. The Save Bart's Campaign received a substantial boost when the Court of Common Council of the Corporation of London voted unanimously to oppose the accelerated closure of Bart's now being proposed. More than 150 people, from consultants to hospital cleaners and patients past and present, filled the public gallery and overflowed into the aisles as Professor Chris Hudson, chairman of the hospital's medical council, strode up and down hissing loudly, 'Stand up, stand up so they can see you.'

Common Council members accepted criticism that they had come to the campaign a little late. It was two years ago that the hospital, founded in 1123 by Rahere, an Augustinian monk, received its death notice, following the Tomlinson inquiry which tackled the acknowledged problem of too many expensive London hospitals serving too few people. Bart's was an unexpected casualty. There is speculation that certain high-ranking members of the Corporation were reluctant to put their knighthoods at stake by becoming embroiled in this hot political issue. Virginia Bottomley, Secretary of State for Health, is committed to implementing Tomlinson. However, the City's wholehearted but late intervention has refocused attention on what many perceived to be a dying institution, whose survival campaign had been a valiant failure.

A condition check last week found the patient 'satisfactory' - although somewhat stressed. The hospital ended the financial year 1993/1994 in profit of around pounds 500,000 - two years ago a projected deficit of pounds 7m- pounds 10m was given as one of the reasons for closure. In April, Bart's joined the newly created Royal Hospitals NHS Trust, comprising the Royal London Hospital at Whitechapel and the London Chest Hospital, with all historic debts cleared. Cost-cutting measures put in place by Professor Michael Besser, chief executive until April this year, led to hundreds of redundancies, but has restored the finances. The hospital is full, with 1,300-1,500 admissions a month, up on all previous figures. And contrary to some reports, vital medical staff are not deserting in droves: two professors have left.

Final year students at the hospital's medical college have finished in the top three of London medical colleges for the past five years, and Bart's is still second only to Oxford University in attracting research money - some pounds 12m at last count. 'Either people are stupid or giving their cash to something that is worthwhile,' Professor Lesley Rees, Dean of the medical college, said.

Within the hospital there is some fear for the future, paranoia - and a lot of loathing. Loathing for the Government and for the Trust board, headed by a retired general Sir Derek Boorman, widely believed to be a Tory placeman with a brief to close the hospital come what may. 'You don't get to be a general by asking questions. You do what you are told,' said one senior surgeon last week. But there is also a fierce commitment to Bart's survival and a belief that it can pay its way in the new NHS internal market - with or without an Accident and Emergency Unit. This will close in February 1995. A political lobbying firm has offered its services free of charge and will work the party conferences over the next few months. The Save Bart's campaign is expanding with a second office opening in the City, away from the hospital and the intimidating watch of the Trust board. Francis, a cancer patient and one of the founders of the campaign said: 'We are not giving up.'

Bart's staff have not given up either. They are anxious to talk but on a strict 'no names' basis. One doctor who is prepared to speak is Dr Barbara Bonner-Morgan, a freelance opthalmologist who helped found the Save Bart's Campaign. Bart's, she said, was the finest hospital in the country. 'to close it would be the scandal of the century'. Yet the fear of speaking out is palpable. At one clandestine meeting with six professors and senior consultants, all refused to give their names.

They are keen to talk because they feel cheated. They knew the future of the Smithfield site was far from certain, but they say they were assured by Trust and Government figures that it would continue to provide wide-ranging medical care for at least 10 years, and there would be continual reappraisal of the position. There was still hope.

Then on 30 July, the Court of Appeal refused to allow campaigners to launch a judicial challenge to Mrs Bottomley's decision at the end of last year to close Bart's A&E Unit. This had become inextricably linked to the hospital's identity and survival.

Immediately, the Royal Hospitals NHS Trust and the Royal London published plans, agreed at a board meeting three days earlier, for the accelerated closure of the hospital. If approved by the Department of Health, all the Trust's services would be provided from Whitechapel - which was to undergo a redevelopment - after 2000. Estimates of the cost vary widely: from pounds 70m to pounds 300m. The Bart's site, valued at pounds 10m- pounds 60m and housing a new pounds 15m operating suite and the most modern day-care surgery unit in Europe, would be sold off. Prospective buyers would be constrained by its ancient monument status - part of the hospital is built on Roman ruins - and a number of Grade I and II listed buildings, but an adjacent GPO office is now vacant, and the combination is believed to be commercially attractive.

What prompted the board's decision is not known. It followed a consultation procedure, but just two weeks earlier the chief executive had assured members of the City Corporation that Bart's was safe well into the next decade.

The decision left many bewildered. In May 1992, Tony Pinching, a leading figure in world Aids and HIV research, had arrived at Bart's to take up a new chair of clinical immunology. He has since overseen the development of a pounds 5m new lab and ward complex. He was aware that Tomlinson was under way, but 'didn't think that anyone sane who came here and asked the important questions could possibly see it other than as a place to keep'. He was a key figure in drawing up plans for the merger to transfer eight specialities away from the Royal London in Whitechapel and to Bart's. This will still go ahead but now it is clear they will be transferred back to Whitechapel within six years. There is no guarantee of adequate funding or space there.

Professor Pinching argues that decisions are being made with no information other than what the NHS calls 'purchaser intention ' - what health authorities and fundholding GPs predict they will need to buy for their patients from the Trust in the future. 'This is operating at a very crude level. Purchasers can't cope with what they need today, let alone in the future.'

Another professor, who declined to be named, said that the announcement of the accelerated closure had been the final straw for many. 'We've been steam-rollered. These decisions are being taken without any thought for the staff at Bart's, its history and clinical excellence and facilities.'

'Big Lee', a porter and union official - 'you can use my name because someone has got to put their head on the block' - believes Bart's history is crucial. 'It was for the sick and the poor and it was a promise honoured by Henry VIII that this hospital provides them with free care. We've taken people from every major disaster: Moorgate, Cannon Street, Bishopsgate . . . No one else could do it.'

(Photograph omitted)