Challenge to accident department closure fails in court

BMJ 1994; 308 doi: (Published 30 April 1994) Cite this as: BMJ 1994;308:1124
  1. Clare Dyer
  1. Legal Correspondent, BMJ.

    An 80 year old woman and two London boroughs failed this week in an attempt to stop the health secretary, Virginia Bottomley, going ahead with plans to close the accident and emergency department at one of London's oldest and most famous hospitals.

    Monica Willan, a former housekeeper at Harrods department store, and the London Boroughs of Hackney and Islington sought judicial review of the decision to close the accident and emergency unit at St Bartholomew's Hospital, which they claimed was “irrational and perverse.” Their QC, Lord Lester, had argued that the consultation process leading up to the closure decision was a sham and that Mrs Bottomley had prejudged the outcome and based her decision on irrelevant information.

    But Lord Justice Leggatt, sitting with Mr Justice Buxton, rejected their application, saying that the secretary of state had not made up her mind in advance. The judge said that Mrs Bottomley continued to believe that the closure was “safe and sensible in all the circumstances” and ruled that her decision was not open to legal challenge.

    He said “no one London born, or a lover of London” could learn without sadness or deep emotions of the decision to close any part of one of the capital's great teaching hospitals. But it was to parliament and the electorate, not the courts, that the secretary of state was answerable for an unpopular decision.

    Lord Lester had submitted that Mrs Bottomley had taken her decision before the consultation process had even started and had failed to give “conscientious consideration” to the views of the public.

    The decision to axe the department had its roots in the 1992 Tomlinson report, which proposed that the hospital should be merged with the Royal London Hospital at its White-chapel site in east London. The report said that accident and emergency services for the City of London could be adequately provided by other London hospitals. The government intends to close the unit by the end of the year. Other services at the 800 year old hospital will be moved from its Smithfield site to the Royal London Hospital except services for AIDS, oncology, and endocrinology and some services for cardiology.

    Among the opponents of the move are the City of London police, whose acting commissioner wrote to Mrs Bottomley last year: “The thought of transporting casualties to the Royal London Hospital in the almost permanent traffic chaos existing between Aldgate and that hospital is too horrendous to contemplate. Apart from the logistics of dealing with the needs of persons who are taken to that hospital, I fear lives may be lost and suffering prolonged and worsened by the inability to reach with reasonable speed that or any other alternative hospital remaining after the government's plans are put into effect.” The police also later expressed dismay after Mrs Bottomley announced closure plans for Guy's Hospital.

    Mrs Willan, who lives near the hospital in Clerkenwell, said: “I am devastated that the battle is lost, but the war is still on. This is the thin end of the wedge and the whole hospital will be closed unless we fight on.” The judges, who refused leave to appeal, ordered Mrs Willan and the two councils to pay the government's legal costs.

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