THE ONGOING integration of London's undergraduate and postgraduate medical schools within four multi-faculty University of London colleges represents a "remarkable achievement" that should safeguard the capital's position as a world-class research and education centre, according to a new report.
But the report, the second by the King's Fund London Commission assessing the state of health care in the city, says significant capital investment, through the Private Finance Initiative, is still needed to complete their physical transfer.
"It remains to be seen whether - and when - this will become available," the report states.
"It would be a serious mistake to permit the current commitment to wane because of a failure to provide capital investment."
Five years after the first King's Fund London Commission report was published, Transforming Health in London takes a fresh look at aspects of health care in the capital.
It describes the ongoing regrouping of all but two of London's 17 former medical schools and postgraduate institutes as "the outstanding achievement of the last five years".
The report adds that detailed planning to bring curricula in line is under way, and notes that "integration on this scale and with this speed is unprecedented in the capital".
Proposed by both the King's Fund in 1992 and a Government report the same year, the amalgamation of medical schools and their integration into, and closer relationship with, biological and social science faculties of existing London University colleges was seen as necessary for strengthening the base of medical education and research in London.
"The proposals for integration went with the grain of thinking within the University of London and the medical schools," the report says.
"Medical academics and researchers were alive to the risks that continuing fragmentation would bring within the increasingly competitive world of international biomedical research."
Linked to the mergers of medical schools, the rationalisation of acute hospital beds was also deemed necessary because London faced unique problems of large numbers of beds in centrally located crumbling teaching hospitals, combined with a declining inner city population.
The introduction of an internal market with the 1990 NHS and Community Care Act was seen as a threat to London's expensive teaching hospitals.
They relied on flows of patients from outer London whom it was feared would now go to cheaper hospitals locally.
Acute services rationalisation linked to mergers would, it was hoped, release funds for primary care and modernisation of hospital stock.
But the report notes that difficulties with PFI have caused a number of rationalisation schemes to stall.
In addition, rising costs mean projected savings promised by site rationalisation may be threatened.
Hopes of rationalising specialities, such as cancer care, to help concentrate treatments in a limited number of centres to support high- calibre research have also been dashed, says the report.
The plans have been frustrated by the political manoeuvrings of institutions to which the changes pose a threat.