Is Bart's saved?

Our oldest hospital may finally be taken off the critical list by its friends in the City - to start a new life as a charity

When Virginia Bottomley, then Secretary of State for Health, announced in 1992 that St Bartholomew's Hospital in London was likely to close by the year 2000, I immediately wondered whether it would really happen. Of course a cabinet minister has immense power and is bound to have the backing of the Treasury when seeking to save money. And I well understood, too, the argument that inner London had accumulated too many hospitals.

My doubts were based upon observing the behaviour of institutions. Institutions have life. I found it difficult to believe that Bart's would simply roll over and die - by ministerial fiat. For the outstanding feature of the Royal Hospital of Saint Bartholomew is its immense age. It was founded in 1123 as a hostel or hospital alongside the Priory of St Bartholomew in Smithfield, where it still stands today. It is likely that some of those first admitted were born before the Norman Conquest. Bart's is pre- Magna Carta. It is more than 100 years older than Parliament. No Oxbridge college rivals it for antiquity. The Inns of Court appeared 200 years or so later. Only the monarchy and the Church of England are older. This still vigorous, well-equipped hospital has survived many turbulent periods in English history and threats to its existence. Could it really pass away now in just another reorganisation of the health service?

If Bart's is saved, as now seems probable, its historic strengths will have played an important role. In the first place, Bart's was created specifically to minister to the sick poor. As well as hospital it was hospice and almshouse. It cared for orphans and foundlings and babies from nearby Newgate Prison. It maintained a night shelter for pilgrims and wandering people. When Henry VIII granted its new letters patent in 1546, it was "hereafter to be called the House of the Poor in West Smithfield in the suburbs of the City of London, of Henry VIII's foundation". Remarkably, this social mission has survived intact to the present day. Perhaps uniquely, Bart's has neither private wing nor private beds.

This is, I believe, why the Save Bart's campaign has been so popular. Appearing quickly after Mrs Bottomley's announcement, the organisation, run from outside the hospital by former patients, gathered 500,000 signatures to a petition within six weeks and then pushed the total to 1 million. The petitions came from every part of the country and from all over the world. While it is unlikely that more than a handful of the signatories, former patients, visitors, staff and supporters, actually knew the hospital's history, they had somehow absorbed its ethos.

Bart's second historic strength, so far as saving itself from oblivion is concerned, is utterly different from the first. This hospital with a mission to the poor is part of the fabric of the richest square mile in the country, the City of London. The letters patent of 1546 was in effect part of a re-financing following the closure of St Bartholomew's Priory, in turn a result of the dissolution of the monasteries. The king insisted that the City share the cost and assume responsibility for the hospital's administration and maintenance. While Bart's increasingly asserted its independence in the centuries that followed, it remained within the ambit of the City fathers until 1948, when it became part of the National Health Service.

Now the common councillors, aldermen, members of livery companies, masters of this and that who comprise the City of London's government do know their history. To this day, on ceremonial occasions they wear gowns trimmed with fur; they pass round loving-cups at their feasts and give toasts in quaint wording - to the so and so Company "with its Maids, Wives and Widows", coupled with the name of the Master. The historic Bart's is part of their world. Indeed, the current Lord Mayor is a consultant surgeon at the hospital. Thus on a very cold January day earlier this year, 800 City supporters marched from Guildhall to Downing Street, some in their gowns of office, to deliver a petition for the preservation of the hospital. More to the point, the City has money. The City government is rich; the institutions comprising the financial markets are some of the wealthiest in the world. This is crucial. A plausible plan for securing the independent existence of Bart's can be financed.

Where Bart's differs from other historical institutions, faced as they often are with defending themselves, is that it took no steps to prepare for an adverse diagnosis. The threat had been in evidence for some time. But whereas the Oxbridge colleges always keep half an eye on political risks, Bart's did nothing. The City Corporation has recently scored a great political triumph by persuading the Labour Party that the Lord Mayor, with all his pomp and circumstance, should be maintained even when London has a new elected authority. Nothing similar has been attempted by Bart's itself. Partly this is because the hospital ceased to manage its own affairs when its own board of governors was abolished in 1974. Doctors, too, are unpolitical to a fault. And unbusinesslike, judging by last week's report by the Audit Commission into doctors as purchasers of health services.

Nonetheless it now looks as if Bart's can be saved. A new charity, The Royal Hospital of St Bartholomew Charitable Foundation, is being formed. Its board, or "governors" as the trustees will be called, will comprise City figures with fund-raising ability. It already has sufficient finance to commission management consultants to prepare a business plan. This will describe how new services are to be built up and a new graduate medical school established as certain existing operations are transferred to the Royal London Hospital. Given the ever-growing shortage of hospital beds, there can be few fears of a failure of demand for the new facilities.

But the big idea is that the working capital, in effect the flywheel of the undertaking, should be supplied by charitable donations. City institutions would be prominent among those asked to subscribe in this manner rather than by the usual means of an investment in shares. The notion is that the new Bart's would pioneer a model for financing and delivering medical care complementary to the health service. While its patients would have their bills paid by the NHS or by their companies or by insurance schemes or out of their own pockets, the spirit is intended to be neither that of the cost-cutting NHS trust hospital nor of a profit-maximising, American- style operation.

My only regret, in looking through the proposals, is that the creation of a private wing is suggested - with the result that one of the key traditions of the hospital would disappear. Indeed, I would like to see Bart's remain even closer to its origins and provide, alongside its super-sophisticated facilities and graduate school, a shelter for the homeless, as in mediaeval times.

There is just one snag. The Secretary of State for Health, Stephen Dorrell, must be persuaded to pass, or sell, ownership of the hospital and its site to the new trust. To agree would be at once popular and daring, a prospect not often given to a Tory politician these days. And so, after 400 years as a church institution, 400 years under civil tutelage and 50 years under state control, Bart's would find a new status - one appropriate, it is hoped, to the 21st century.