The publication of the Todd report in 1968, with its support for twinned medical schools and amalgamation with multi-faculty institutions, outlined an agenda that shaped debates on medical education into the mid-1990s. The report was essentially utopian, however. If a consensus was reached over the need for rationalisation and reform, how these were to be achieved created conflict. As issues had to be discussed at college, university and state level, planning was slow. It was only after the 1980 Flowers report, designed to solve the deadlock over amalgamation and the structure of medical education in London, that pressure on teaching hospitals to merge with multi-faculty institutions increased, encouraged by changes in the NHS and higher education. Debates over NHS reform and funding cuts forced the pace and resulted in a series of unhappy marriages between medical schools. St Bartholomew’s inevitably became caught up in these debates and felt keenly pressures exerted on the NHS and university sector. The result was a blurring of the relationship between the hospital and College, and an often circular, drawn-out debate over a merger with The London Hospital in Whitechapel and Queen Mary College (QMC) – later Queen Mary and Westfield College (QMW) – in Mile End.

The history of the events surrounding the collaboration and the eventual creation of a confederation between St Bartholomew’s, The London and QMC in 1986 is a complicated, often unhappy one, compounded as it was by the intervention of the University of London, University Grants Committee (UGC) and NHS. St Bartholomew’s periodically felt bullied, not least by a UGC that was determined to push ahead with the ideas expressed in the Todd report. Whereas the UGC had originally worked to preserve university autonomy and minimise its intervention in how funds were allocated, it had evolved into a powerful body that expected to shape university development. Having lost control over a number of financial issues, the UGC was determined to become more ‘dirigiste’. However, the College was unprepared to accept the UGC’s model. Conflict with the UGC, and the fluctuating debates over amalgamation, resulted in a planning blight that limited development in the College. Throughout, despite internal divisions, a united front was presented, and the need to discuss issues fully slowed decisions, engendering frustration outside St Bartholomew’s.