Nine hospitals in London targeted for closure: Government advisers publish plans for reorganising health services but Bottomley avoids commitment to action. Judy Jones reports

NINE London hospitals, including the world-famous Harefield heart centre and the Royal Marsden cancer hospital, could close under plans to reorganise the capital's fragmented specialist health services.

The blueprints for reorganisation, published yesterday by six teams of independent government advisers, would virtually halve the number of specialist units operating in the capital and expand services at some of the bigger centres.

Amid Opposition protests in the Commons, Virginia Bottomley, Secretary of State for Health, gave a broad welcome to the reports of the reviews but would not commit the Government to implementing specific recommendations.

However, she left the door ajar for a reprieve for the pioneering Harefield Hospital in north-west London, the internationally-renowned transplant centre, earmarked under the proposals to move into the nearby Northwick Park Hospital.

Challenged by Michael Shersby, the local Conservative MP, the minister said that while no holder of her office could rule out change for ever, she saw 'no prospect of Harefield moving from its present site in the near future'.

The review teams examined the spread of services in six specialist areas: cancer, heart, children, plastic surgery and burns, neurosciences and kidney disorders. The nine hospitals unlikely to survive on their present sites if all six reports are implemented are St Thomas's, Southwark; St Bartholomew's, Smithfield; Harefield, Uxbridge; the Brook, Greenwich; Oldchurch, Romford; the Royal Marsden, Fulham; Queen Elizabeth's Hospital for Children, Hackney; the London Chest Hospital in east London, and Atkinson Morley's Hospital in Wimbledon.

Many of the recommendations are in tune with the inquiry concluded by Sir Bernard Tomlinson last autumn. In particular, they redoubled the gloom into which St Bartholomew's Hospital was plunged by the Tomlinson report when it urged the transfer of all six of Bart's principal specialties to the Royal London Hospital a mile away in Whitechapel.

However, yesterday's report gave fresh hope to the Charing Cross Hospital - doomed under the Tomlinson report, but recommended for retention as a centre of excellence at the end of the specialist inquiry teams' three-month review.

The piecemeal fashion of the Government's review of London's health service, which will bring no final decisions at least until this autumn, has caused consternation at many hospitals. Several of the reports placed question marks over the cost-effectiveness of the Government's streamlining exercise, and the data used.

The team examining children's health services reported that members had found it impossible to take the condition of hospital buildings into account in the time given. It was also unable to draw any conclusions about 'contract prices, or make statements about manpower issues'.

The kidney team admitted that it had been forced to use 'crude and imprecise' hospital workload figures in its calculations. Members of the cancer team noted the 'imperfect' data available on costs, cancer statistics, outcomes and work volumes. Most of the team leaders said at a press conference that their plans would require more NHS staff. Mrs Bottomley said no change was not an option.

But she emphasised that the process was one of evolution, not imposition. 'Most importantly, proposals and decisions must be guided by patient needs, reflected through the powerful mechanism of the internal health market.' David Blunkett, Labour's health spokesman, said the Government could not be trusted to improve London's health services when its overall agenda was one of spending cuts. 'The latest reports show no costings, no investment but every likelihood of closure.'

Doctors at several hospitals earmarked for closure expressed bitterness and anger at the likely break-up of medical teams that had taken years to create. Professor Michael Baum, head of surgery at Royal Marsden, said: 'Our hospital is a national resource. It is brilliantly managed . . . and judged academically excellent.'

Professor Michael Besser, chief executive of Bart's, said the plans were senseless and expensive. The changes affecting Bart's alone would cost up to pounds 300m to implement. 'Services can only be damaged by moving them to inferior conditions.'

The Royal College of Nursing and the Association of London Authorities also condemned the proposals.

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