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Am I missing something? The notion of Trust viability is in accordance with an artificial construct created by the NHS and DH through Monitor (CCP and OFT as well) – Tariff, rules for competition, risk rating of Trusts etc. So following the market rules, consolidation, franchising and break up are necessary – almost self fulfilling prophesies, once the rules have been set. It seems clear that with this proportion of Trusts not viable, the model is aimed at reducing the number of hospitals, or the tests are wrong. This outcome however might be right; healthcare has to change its profile of supply. I would question, albeit some might argue the logic and objectivity of the approach, whether this is how policy towards healthcare supply should be made. Whilst there are numerous quality indicators, it does seem (again, maybe rightly) that finance trumps all – should the NHS not be measured as a socio-economic good than a pure economic good? It seems to me that all the current approach is doing is masking the real discussion that should be taking place – which is how does the NHS best provide the service the public wants? For what it’s worth I think there must be a significant core service free at the point of need, but beyond that, co-payment (means tested, as with opticians and dentists now) is possibly the only way to sustain the variety and size of service currently available. The current frippery around “To be or not to be FT?” simply masks that debate.