Whatever the future holds for Bart's, it seems destined for controversy. Kaye McIntosh reports

Some arguments never die. And rows about shutting hospitals ignite such fury they can burn for years. In east London, the row over the future of St Bartholomew's Hospital is still as live as it was when the 'Save Bart's' protesters were hitting the headlines.

The latest instalments include claims that experts are recanting their views and pressure groups demanding the government step in, take over Bart's and run it directly from Downing Street.

It's hard not to blame the politicians.

Former health secretary Frank Dobson took the credit for 'saving' Bart's. He bowed to public pressure and decided to turn the hospital, based in the City of London, into a cardiac and cancer centre - a stance that may come back to haunt his dreams of becoming mayor of London when it comes to East End votes.

His successors could be forgiven for hoping they had doused the flames of opposition back in February.

Health minister John Denham launched the final version of plans, approved by London regional office, to spend£150m developing a specialist centre at Bart's. This was matched by approval for a£462m project to build a new hospital on the trust's other site, the Royal London Hospital in Whitechapel.

But the decision provoked as much outrage from east London as the original proposals had sparked among those in the City.

Senior doctors at the Royal London describe the plans as 'dangerous'.

Gastroenterologist Professor David Wingate claims there is a 'serious risk' to patients because cardiology services are on a separate site from neurology and other major acute specialties. 'I know of one or two patients who have died when we think it would not have happened had they been at one site, ' he says.

The doctors claim two high-profile converts to their cause - both of whom were involved in drawing up the 1998 report which 'saved' Bart's by linking it to the Royal London to form the trust now known as Barts and the London. The doctors say the man who led the review, Professor Sir Leslie (now Lord) Turnberg, and panellist Professor Sir Brian Jarman, have changed their minds.

Lord Turnberg was quoted on a local television programme as saying that if there is a plan that is 'well resourced' enough to provide all the services on one site, 'then I would think a one-site option is right'.

Sir Brian denies any change of heart. He told HSJ: 'I think that Bart's should be kept.' But he also says it would be 'best' if the two-hospital trust was dissolved.

'It doesn't seem very workable', largely because of 'antipathy between consultants'. Sir Brian suggests that Bart's should re-join its neighbours at the Homerton Hospital trust: 'It did work well, I gather, when Bart's was with the Homerton.'

Professor Wingate blames the present stand-off on politicians who, he says, made the decisions based on high-profile lobbying by influential people at Bart's and in the City. His case is partly supported by a confidential report from expert advisers on splitting services between the sites. The report, for the regional office, says: 'The panel recognises that the trust management and politicians have had to produce a compromise solution to a difficult problem set within a highly political context.'

The trust's plans were changed as a result of the report, including moving 26 cancer surgery beds to the Royal London.

In the wake of the report, Bart's and the London trust director of planning Steve Saunders said that putting the recommendations into place would provide 'a safe way to organise the services'.

But the opposition has not been placated. East London voluntary organisations are so concerned they are threatening to send in their own inspectors to make sure other hospitals in the area don't suffer as a result of money going to Bart's.

The East London Communities Organisation says that 'unless Bart's is 'taken out of' the East London and the City HA financial pool and made 'a national resource with funding direct from government', local hospitals such as Newham Hospital will be left as 'Cinderella' services. Unlike Cinderella, Barts and the London's tale is unlikely to have a happy ending. l Making a proposal: ten year strategy for east London An 850-bed development at the Royal London Hospital, Whitechapel.

l A 350-bed cancer and cardiac centre at St Bartholomew's Hospital in the City.

l 90 intermediate care beds across East London.

l£24m improvements at Newham General Hospital to provide new wards, outpatient and day care facilities.

l£30m for new wards, a new A&E department, children's centre and outpatient facilities at the Homerton Hospital.

l£44m to build a new medical school at the Royal London site in Whitechapel, including£17m NHS investment.