The government has warned heart and lung transplant units that they will close unless they meet new national service standards.

It follows the damning Commission for Health Improvement investigation into services at St George's Healthcare trust, London, where 10 patients died.

Health minister John Hutton has launched a discussion paper which aims to establish new commissioning arrangements and common framework standards, which cardiothoracic units will have to meet.

Mr Hutton said: 'We will not hesitate to take the necessary action at any point in the future if, on the basis of CHI's independent advice, those standards are not being met or if patient safety is being compromised in any way, shape or form.'

CHI will be given the role of examining the national service as a whole, putting it 'under constant scrutiny', according to Mr Hutton.

Mr Hutton has rejected proposals to cut the number of cardiothoracic units from six to four, arguing there was no evidence the move would improve outcomes.

If the paper gets the green light, the role of the National Specialist Commissioning Agency Group will be strengthened from next April, taking over responsibility for commissioning as well as funding for heart and lung transplantation.

The consultation document states: 'This commissioning will be based on a framework of common standards covering staffing levels and qualifications, retrieval arrangements, and outcomes such as survival and rejection rates.'

CHI chief executive Dr Peter Homa welcomed the proposals, adding: 'Our investigation into heart and lung transplant operations at St George's Healthcare trust revealed how services for transplant patients can be improved. 'This new document from the Department of Health means that patients should be able to expect the same high standards of care from the service wherever they live.'