Mergers that make sense

May 5, 1995

The Labour Party has this week catalogued the 245 English hospitals which have closed since the National Health Service reforms began, obviously expecting to make political capital from the public's concern and alarm.

But, unlike the rows over hospitals, there had been little outcry over the continuing plans to merge eight of London University's nine medical schools into larger institutions, until the recent Commons debate on the Bill to merge St Bartholomew's and the Royal London Hospital Medical Colleges with Queen Mary and Westfield College.

Labour MP Brian Sedgemore claimed the move would destroy Bart's medical college, following the Government decision to destroy Bart's hospital. But medical schools and hospitals are two separate entities, and Mr Sedgemore is mistaken in conflating the two. Far from being wiped out, the new school will be called the St Bartholomew's and Royal London Hospital School of Medicine and Dentistry, and the three college councils predict a rosy future. The current NHS changes have merely given a final prod to an academic initiative, which dates from the 1960s and owes nothing to ideological debate about the number of hospital beds.

The Todd commission 30 years ago warned that the quality of London's medical education was threatened by having 12 medical schools, each with an independent teaching hospital, which had no direct contact with multi-faculty institutions. But institutional loyalties torpedoed both its proposals and similar ones in the 1980 Flowers report, although mergers went ahead of St Mary's Hospital medical school with Imperial College, King's College Hospital medical school with King's College, and between Guy's and St Thomas's Hospitals medical schools.

Institutional loyalties undoubtedly remain, but there is a new pragmatism, largely due to financial pressures, partly due to educational ones. Free standing medical schools, facing demands for strategic plans from the Higher Education Funding Council, see value in being anchored to larger, more flexible institutions. Merger leads to critical mass: uniting strengths can create something bigger than the sum of the parts, particularly valuable when confronting the continuing pressure of the research assessment exercise.

Mergers will bring London into line with the rest of the country, since only the capital, by historical accident, provides medical education through separate institutions. Bringing medicine into multi-faculty colleges will help to implement curriculum reforms demanded by the General Medical Council, broadening students' access to basic science.

There have been hiccups: the prospective merger of Guy's, St Thomas's and King's almost foundered when its combined intake was thought to be under threat from a potential cut in medical student numbers which will not now be imposed. But the jigsaw is gradually taking shape, the latest piece being the National Heart and Lung Institute's merger with Imperial College in August, and each announcement is resolutely upbeat.

The mergers do not entail academic job losses - there is, after all, no drop in student numbers - although hospital closures will have some impact on academics' clinical work. HEFCE and London's healthcare reorganisers are still thrashing out responsibility for transitional funding, but the university is optimistic that this will be sensibly resolved.

Mr Sedgemore's leap to the barricades was not necessary.

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