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Anon 4.43 - It depends how you define successful. These trusts have great doctors and rightly attract patients. Financially they benefit from: high levels of SIFT and dental SIFT (generally accepted to be bunce); high MFFs; high margin off tariff treatments; and high levels of donations from captive charities.

Financially they make surpluses, but these surpluses are more down to serendipity as described above than good management.

The accountants always assume that merging will reduce non clinical costs, but often this leads to diseconomies of scale and large unresponsive support services.

Does anyone in the NHS really have a clue how to manage a >£2bn organisation effectively.