The 2010 Liberating the NHS white paper promised an end to “central or regional support” for providers. “Hidden bailouts will end,” it declared.

Four years on we reveal that central bailouts remain widespread with some trusts highly dependent.

Dave West

‘Public opposition to the policy has been intense’

They are a little more transparent: our analysis is based on information published (posted quietly on the government website) for the first time because of the Health Act 2012.

The white paper envisaged that instead of being bailed out, unsustainable trusts would enter a “rules-based special administration regime”.

More pragmatic future

This barely got off the ground. At Mid Staffordshire Foundation Trust an expensive administration process is ongoing and has not so far solved its problems.

A revision to the regime for trusts is in process following a successful legal challenge to its use on South London Healthcare Trust.

Public opposition to the policy, dubbed a “hospital closure clause” by campaigners, has been intense.

Future attempts to create a fairer financial system and bolster provider freedom will need to be more pragmatic.