‘AIIMS’ for East Delhi: Why Delhi is merging three major hospitals into one super unit

At Rajiv Gandhi Super Speciality Hospital (RGSSH) barely two kilometres away, the scene is starkly different. The sprawling hospital at Tahirpur in Northeast Delhi is essentially empty — entire sections of the gastroenterology ward lie vacant. Beds are unoccupied, corridors unhurried.

As a semi-paid tertiary care facility in a city where vast numbers rely on free government treatment, the RGSSH struggles to draw patients — even as GTB buckles under the weight of approximately 6,000 OPD visitors and 250 admissions per day, and an average bed occupancy rate of 104%, according to figures on the hospital website.

This is the paradox at the heart of East Delhi’s public health system: one hospital is overwhelmed, another is underused, and a third — the Delhi State Cancer Institute (DSCI) — is situated somewhere between these two, but stretched in its own way.

The Delhi government has now proposed a solution to resolve this imbalance: merging these three hospitals into a single, autonomous medicine super-institution modelled on the All India Institute of Medical Sciences (AIIMS).

The sprawling Rajiv Gandhi Super Speciality Hospital at Tahirpur. (Express photo by Amit Mehra)

Integrating 3 hospitals into 1

Last month, Chief Minister Rekha Gupta announced a proposal to integrate GTB Hospital, DSCI, and RGSSH under a unified autonomous institute, with GTB as the lead institution. The three hospitals are located in close proximity — within a kilometre or two of each other — that makes their physical integration feasible.

Officials say the integration plan presents a 360-degree solution that is intended simultaneously to decongest GTB, increase utilisation of idle capacity at RGSSH, rationalise duplication of services, optimise high-end equipment that is currently sitting underused, and expand the number of seats available to students of medicine.

IHBAS, which sits on a large tract of land in Shahdara, will provide 75 acres for future construction for the new, integrated institute. The government also plans to develop IHBAS separately into an institution for mental health equivalent to NIMHANS, Bengaluru, the country’s premier specialty institute of its kind.

The scale of the problem the merger seeks to address — and the case for restructuring — is reflected in the numbers.

According to government figures, GTB Hospital records more than 14 lakh outpatient visits annually, and provides inpatient care to almost 95,000 patients. With 1,400 beds, it is operating well beyond its capacity. DSCI handles around 1.27 lakh OPD patients, and RGSSH records almost 2.87 lakh — and yet, of RGSSH’s 650 beds, roughly 400 remain unused.

“Among the three hospitals, GTB is the biggest and sees over 10,000 patients every day,” a senior health department official said. “The merger will help in rationalising the distribution of patients to the dedicated hospitals, specialty wise.”

The case for consolidation

The three hospitals currently operate in their own administrative silos, duplicating services, and scattering scarce resources. They all have departments in cardiology, pulmonology, nephrology, urology, anaesthesia, orthopaedics, internal medicine, ENT, and general surgery. Overlapping specialties mean parallel infrastructure and dispersed faculty — as well as equipment that goes underused in one facility while patients wait months for it in another.

Under the proposed integration, services would be redistributed by specialty.

So RGSSH, with its relatively modern infrastructure and 650-bed capacity, would be dedicated largely to super-specialty services. All oncology-related services would be consolidated at DSCI. Pulmonary medicine could shift to RGSSH, while endocrinology would be strengthened at GTB. Preclinical and para-clinical departments — pathology, microbiology, biochemistry — would be consolidated at the University College of Medical Sciences (UCMS) and GTB for effective teaching.

This model draws explicitly on AIIMS, where dedicated centres such as the Dr BRA Institute Rotary Cancer Hospital and the Dr RP Centre for Ophthalmic Sciences function under a central directorship.

What’s in the merger for patients?

The most immediate benefit would be in referrals. Currently, a cancer patient referred from GTB to DSCI must start from scratch — a new file, a new OPD registration — a process that invariably delays treatment. Under a shared system, documentation would travel with the patient.

Integration can solve the constraints of land. The main building at GTB is around 40 years old and in need of renovation. A new trauma block and ICU building are planned, and the existing emergency, OPD, and casualty wings need major upgrades. But there is no room to build while maintaining services. IHBAS’s substantial landholding — the campus sprawls over 111.69 acres, of which hospital buildings cover only about 20 acres — offers the space that GTB does not have on its own land.

More seats, better training

Beyond patient care, the merger is being positioned as a major reform in medical education. Since postgraduate seats are tied to faculty strength, integration will allow faculty to be pooled rather than fragmented across institutions.

Both RGSSH and DSCI have senior teaching faculty — assistant professors, associate professors, and full professors — but limited postgraduate (PG) or Diplomate of National Board (DNB) seats because they are not formally linked to a teaching medical college.

GTB Hospital caters to around 6,000 OPD visitors and 250 admissions every day. (Express photo by Amit Mehra)

Integration with UCMS-GTB would change that. Under existing Medical Council of India norms, an associate professor can support two PG seats and a professor can support three. Combining faculty across institutions would generate new seats without requiring new appointments.

Officials project some specific gains.Seats in radiology, currently extremely limited, could increase to around 22. Pathology seats may increase to 26. Anaesthesia seats could jump to around 48.

At DSCI alone, 26 new PG seats are projected in radiation oncology, nuclear medicine, cancer research, and intensive care. RGSSH could add about 14 new seats in super-specialty areas such as cardiology and cardiac surgery. Filling the existing faculty vacancies would add further capacity.

A broader benefit would be clinical exposure. Medical trainees at GTB currently have limited access to super-specialty departments concentrated at other institutions. A merged system would allow rotations across hospitals, giving residents experience in areas not currently available to them.

The absence of an academic environment at RGSSH — no MBBS students, no postgraduate trainees — has itself been identified as a factor in the hospital’s low patient turnout and difficulty attracting senior faculty.

Where integration could falter

Doctors and officials broadly welcome the plan, but say it could be undermined if a cluster of structural problems are not satisfactorily resolved.

A complex and politically fraught challenge is the difference in service conditions across the three institutions.

GTB is a Delhi government-run hospital whose staff belong to the Central Health Services cadre, alongside some from the Delhi government’s Non-Teaching Specialist cadre. RGSSH and DSCI, by contrast, are society-run institutions where the entire staff is employed on a contractual basis.

At RGSSH, employees work on consolidated pay with limited job security. At DSCI, a promised regularisation of staff has not materialised, leaving workers in a state of prolonged uncertainty.

“This (idea of merger) creates fear. People have financial commitments, home loans, family responsibilities. If salaries or job conditions change, it becomes a major concern,” a senior health department official said.

Without clear and legally binding assurances of uniform service conditions, the merger risks triggering staff resistance that could paralyse its implementation.

Infrastructure deficits are another problem. GTB lacks a Magnetic Resonance Imaging (MRI) machine and has only one computed tomography (CT) scanner, so patients are referred elsewhere, and waiting times can stretch from months to years. RGSSH also lacks MRI facilities, limiting its effectiveness as a tertiary care centre. And at DSCI, only one of four modular operation theatres is functional, and the absence of ICU facilities and radiologists forces referrals for critical cases.

The health department official put it starkly: “AIIMS has multiple MRI machines. If we combine these hospitals, we barely have one.”

Manpower shortages add another layer of difficulty.

GTB has a significant deficit of consultants and professors, particularly in surgery. Simply merging institutions without filling vacancies or at least a credible plan for doing so, would mean integration on paper without changes on the ground. Doctors at RGSSH emphasise that building infrastructure alone is not the answer: “You can build infrastructure, but without skilled doctors and faculty, patient care will not improve.”

Seasonal and administrative pressures also bear consideration.

During the dengue season or the monsoon, GTB’s wards overflow; at other times, beds may be available. Integration will need to account for this variability in patient load.

Even basic administrative functions such as vehicle security within hospital premises currently suffer from inadequate staffing.

Three conditions for success

Integration on the ground will require a clear sequence of actions.

Once the cabinet approves the proposal, it will go to the Lieutenant Governor for formal orders. The societies governing DSCI and RGSSH will have to be legally dissolved. Decisions on cadre unification, faculty integration, and administrative consolidation will begin after that. This process could take 9-10 months to implement, officials said.

Experts and officials converged on three conditions that would determine whether the merger delivers on its promise.

First, service conditions must be harmonised. Staff across all three institutions must receive uniform pay, job security, and career progression guarantees before integration begins. Without this, the merger could face organised resistance from the very people who will be required to carry it out

Second, infrastructure gaps must be addressed concurrently, not sequentially. The plan to build on IHBAS land is a medium-term solution; in the near term, basic diagnostic equipment — starting with MRI machines — must be funded and installed. A super-specialty hub must be able to offer comprehensive diagnostics in-house.

Third, human resources must be treated as the central variable. Faculty recruitment must be accelerated, vacancies must be filled, and the pooling of existing faculty across institutions must be operationalised without delays.

“If these issues are resolved, this can be a win-win for patients, doctors, and students. But without that, integration on paper alone will not change the reality on the ground,” a senior health department official said.

The government’s vision of a medical complex in East Delhi that can match the reach, training quality, and specialist depth of AIIMS is not unreasonable given the geography and the existing asset base.

Three hospitals, 1-2 kilometres apart, with complementary strengths and overlapping weaknesses, are promising candidates for integration. But the distance between the announcement and the outcome will be measured not in kilometres but in the pace and process of execution: whether service conditions are equalised, machines are procured, and competent doctors are given a reason to stay.

For poor patients like Parbati Devi and Daani Ram, that distance will be the only one that will matter.