Who said commissioners won’t have their say about the proposed reconfiguration of specialist cardiac services to shift patients from central University College London Hospital to Barts Hospital, near St Paul’s?

The plans have been under development for at least two-and-a-half years and at their most ambitious involved a typically bombastic takeover bid by cash-rich, space-poor UCLH foundation trust of its deficit-ridden neighbour to the east.

‘Even in this era of enlightened self-interest, UCLH will be looking for something in return’

Since then wings have been clipped and the latest plans involve UCLH ceasing to provide specialist cardiac care with patients and clinicians instead being transferred to Barts, whose expensive − and otherwise likely to be underused − new private finance initiative-funded Cardiac Centre for Excellence is scheduled to open towards the end of 2014.

As cardiology has been particularly profitable for UCLH, the move would knock around £10m off its impressive £63m (8.3%) annual earnings before interest, tax, depreciation and amortisation.

So even in this era of enlightened self-interest, UCLH will be looking for something in return. Part of that something will include a favourable outcome to separate but now crucially parallel reconfiguration plans for the capital’s cancer services.

PFI and bailouts

But there is no straightforward quid pro quo here for UCLH: the foundation trust wants to expand its specialist cancer services, but it will only have the space to do so if it can first relocate the patients occupying the 80 beds of its heart hospital to Barts.

‘If a hospital is to be paid to make a £10m surplus on the capital’s cardiac patients, far better those patients be at Barts’

Far from having been given the metaphorical finger by two of the capital’s largest hospitals, London’s commissioners − at least at the strategic level − have been involved in these discussions from the start. At the forefront of their mind has been Barts and the Royal London’s £1.2bn PFI scheme.

Last year the trust reported a £2.6m surplus after costs that included an £84m PFI payment. By 2014-15, that PFI payment is scheduled to increase to £127m. Short of a dramatic increase in efficiency, Barts is a hospital whose future currently depends on bailouts.

From a commissioner’s view point, if a hospital is to be paid to make a £10m surplus on the capital’s cardiac patients, far better those patients − and the surplus − be at Barts.

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