Three major teaching hospitals have unveiled a ground breaking service reorganisation under which they will exchange responsibility for providing key specialised services.

The plans were put forward this week by University College London Hospitals, Royal Free London foundation trusts and Barts Health Trust. They shared details with HSJ.

The scheme would see specialist cardiac services move from UCLH to Barts. Specialist urological cancer surgery will transfer to University College London Hospitals and the Royal Free.

The plans were made by UCL Partners, the academic health science centre partnership covering north and east London, of which all three organisations are members.

UCL Partners described the move as a “once-in-a-lifetime opportunity” to remodel cancer and cardiac care, on scale similar to the reconfiguration in recent years of stroke care across London.

Those leading the changes said the move pointed to a change in the scope of what allteaching hospitals would provide in future.

UCL Partners managing director Professor David Fish told HSJ: “The days of every large teaching hospital trying to do everything very well are possibly behind us.”

He said it reflected international approaches to research and industry. Professor Fish said: “Most clinical academic institutions would try to deliver a service which could compete internationally and the life sciences [industry] respects a degree of focus.”

Professor Fish said he hadbeen impressed by managementat each trust, who had co-operatedeven when their organisationstood to lose activity.

University College London Hospitals chief executive Sir Robert Naylor told HSJ: “When I came to UCLH 12 years ago we were trying to do everything.

“Over time we have decided there are only two things we can be world-class at, neuroscience and cancer. It’s not possible anymore for everyone to do everything.”

He said the concentration of expertise would allow Barts to compete with international cardiac centres, such as the Cleveland Clinic, while UCLH competed with the equivalents for cancer, for example the Memorial Sloan-Kettering cancer centre in the US.

UCL Partners said their proposals for a single cardiac care system were intended to overcome “the [current] fragmentation of clinical and academic activities”.

A combined cardiac centre at St Bartholomew’s Hospital will be one of the biggest cardiac surgical units in the UK, with more than 2,200 procedures a year.

For cancer, the proposals will see all prostate and bladder specialist surgery move to UCLH and renal surgery to the Royal Free. Routine cancer services will continue to be delivered by UCL Partners’ 12 member trusts.

UCLH and the Royal Free will between them provide about 400 additional cancer procedures each a year.

The changes will be introduced over the next three years.

One senior figure working on a different clinical service change plan, commenting on UCL Partners’ plans, told HSJ it was very difficult to develop the trust between senior clinicians to allow such a major change.

The source said the proposalal so reflected the fact that “commissioners just don’t have the clout [to lead service change] any more, they just say to the big providers ‘get on with it’”.