Doctors accept need for change

DOCTORS' leaders yesterday accepted the urgent need for radical structural changes in London's health services which are likely to bring about the closure of some leading hospitals and the loss of up to 700 consultants' jobs and many more among junior staff.

But the British Medical Association emphasised that it was not writing a 'blank cheque' for the wholesale implementation of the Tomlinson Report, to be passed to the Government next month, if it appeared that patients would be worse off. It also maintained it was vital that the changes, widely recognised as essential to prevent indiscriminate closures under the pressures of the internal market, were carefully managed.

However, John Chawner, chairman of the BMA's consultants' committee, said that discussions earlier this week with Brian Mawhinney, the Minister for Health, indicated that the changes recommended by the inquiry would be implemented 'fairly rapidly', not over a period of many years. It was crucial that doctors who were made redundant were treated fairly and that suitable programmes for redeployment were introduced, he said.

The inquiry, set up under Sir Bernard Tomlinson in January, was established as the health service reforms began to bite in the capital and leading hospitals faced mounting financial crises.

A number of the large teaching hospitals, like the Middlesex and University College Hospital, have only small local populations so that block contracts from their district health authorities which pay for their services cover only a proportion of their workload.

Before the changes many patients came from outside the hospitals' areas. But with the financial strictures of the market, health authorities are increasingly reluctant to refer patients elsewhere, particularly to London where costs are greater.

The effect has already meant redundancies at the UCH and Middlesex, Charing Cross, Guy's, and the Royal London, with more rumoured to be on the cards at St Bartholomew's and King's.

'In setting up the Tomlinson inquiry the Government acknowledged that the problem of over-provision in London is a long-standing one, and the Secretary of State (Virginia Bottomley) has stated publicly that she will grasp the nettle,' Mr Chawner said.

However, even the establishment of the inquiry had caused 'planning blight', with patients reluctant to join waiting lists and health authorities unwilling to place contracts with hospitals that may turn out to be doomed.

If closures were managed carefully it would go some way to easing the pain of the transition, allowing patients and staff to plan for the future, Mr Chawner said.