The battle for Bart's came to typify patients' fears and managers' frustrations about the changes to the NHS everywhere. Mark Gould reports

For Ray Pett, the war is over. The last 'Bart's is saved' headline has been written. Now his job is to win the peace, says the chief executive of the Royal Hospitals trust.

But that still involves closing two well-loved century-old hospitals, signing the biggest private finance initiative deal in the country, and creating a national centre of excellence for cancer and cardiac care at Bart's, while also reshaping it to deliver part of the trust's general and teaching remit.

And while work goes on to build a totally new hospital behind the grade II* Georgian facade of the Royal London Hospital's Whitechapel site, Bart's will still be expected to provide a full range of district general hospital services.

All this has to be achieved with the goodwill of 6,000 staff who watched the 250-year-old Whitechapel site crumble as politicians, clinicians, pressure groups and activists engaged in a very public and bloody battle over Bart's.

'The war is over. Morale is starting to stabilise. There is a positive sense of enthusiasm among staff,' Mr Pett says with the confident air of someone who knows where he is going. His first job is to make sure the staff all know where they fit into the jigsaw.

'There is nothing worse for morale than protracted uncertainty. People have been working hard in the middle of all this uncertainty and now that is over,' he says. 'Feedback from meetings with staff is that they are now quite positive. I have not just been meeting nurses and doctors. I have been down in the basement with the porters and the technicians.'

Outside the hospitals, Mr Pett has engaged East London and the City health authority - the major purchaser - and the fledgling primary care groups, other local acute and community trusts and North Thames regional office.

'We have very good links with GPs, community health councils, mosques, churches and voluntary groups,' Mr Pett adds.

Nearly 40,000 Bangladeshis live within a three-mile radius of Whitechapel. Seventy languages are spoken in east London schools. Informing local residents about NHS reprovision is a tough job.

'I spoke at the East London mosque about what we are trying to do and asked people there what we should be doing. As a result we are changing a number of things. We want to make the Muslim community think of the hospital as a place where they can feel comfortable - not just in terms of language or food but having a place for prayer.'

The London Chest Hospital, a handsome red-brick sanatorium built as a TB hospital in the 1850s, will close when the Whitechapel rebuild nears completion. The Queen Elizabeth Children's Hospital closes at the end of September when services move to Whitechapel.

Mr Pett says staff are sorry to see both hospitals close but does not think another 'save Bart's' onslaught is on the cards.

'Although all the staff love both hospitals they can see the logic of the way forward. The London Chest will have a longer-term part to play in decanting services when building starts at Whitechapel.

'Staff at QEH recognise the modern way to treat children is in the middle of a high-tech hospital with all the other specialisms that it can provide. Now that staff know what the future holds for them, morale is turning around.'

The Queen will give the official seal of approval and raise public awareness when she formally opens the new children's unit in October.

Health secretary Frank Dobson has committed regional funding to pay for whatever the Turnberg review of London acute services recommends for Bart's.

Early next year, the trust will have developed a full business case for the Bart's reconfiguration and the small print of the division of cancer and cardiac services, endocrinology and AIDS services. Ballpark figures suggest the region will face a 30m-a-year bill.

'We know we are not going to get a blank cheque from the region but they have pledged to deliver a two-site option,' Mr Pett says. 'We are not going to create a new Christie or Brompton. Our cardiac and cancer centre will be part of the trust. It will provide a complete national tertiary referral service while also playing a part in local cardiac and cancer care. I think that is unique. Where movement between sites is required it will be the consultant, not the patient, who has to move.'

The final division of services at Bart's will inform the specification of the PFI for Whitechapel, which will be advertised in the Official Journal of the European Community early in 1999.

'We already know that there is very strong interest from the business world in our scheme as it will be the largest PFI in the country at around 250m. We know we have got priority as we are on the list of schemes that have been given the government go-ahead.'

Mr Pett estimates that the 'first bulldozer' will not go to work until 2001, as part of a five-year building plan. While the listed neo-classical facade will stay, the new PFI building stretching behind it will be state- of-the-art.

'We want to use those things that have a demonstrable benefit to patients and incorporate them in our design. There will be lots of telemedicine.

'We also want to make the new hospital a centre of excellence in teaching and research. The medical school for Bart's and the Royal London will be based here. We love the East End. It is not just about a hospital - it has so much more to offer, and we want young doctors and nurses to know that.'