Within the EU, the talk is now of a periphery and a core. Peripheral countries that the international bond market no longer loves – Greece, Ireland and now Portugal – have to borrow large sums of money from the core merely to stay afloat. 

The core calls this a “bailout”, but the terms are uncharitable. By taking the loan, states cede much of their sovereignty to the International Monetary Fund and the European Central Bank. Taxes will rise; public spending will fall. Resistance, as the Daleks used to say, is useless.

Joining the EU periphery is simple, and doesn’t require an Atlantic or Mediterranean coastline. Just allow artificially low interest rates to fuel a property boom, wait for the bubble to burst, and you’re in. It’s leaving that’s tricky.

The NHS has created its own periphery of organisations with unaffordable property deals.

Twenty-two English trusts have private finance initiative commitments that make foundation trust status by 2014 a pipe dream. The problem lies in long term contracts for support services.

Ireland’s property boom legacy is a swathe of ghost housing estates outside Dublin. Portugal’s building legacy lines the Algarve. The NHS’s PFI legacy is bondage to a hospital configuration that’s no longer sustainable or even necessary. Those two weary apologies for PFI – “it was the only game in town” and “look at the lovely new hospital” – mirror the blandishments of the loan shark and the gullibility of the amateur property speculator.

Consultants are being engaged to explore each trust’s options, including “transitional relief”, “major service changes” and “restructuring asset utilisation”. IMF options would include local pay cuts and higher local charges, but “localism” doesn’t stretch that far.

But will a consultant’s experience with PFI schemes be a benefit or an automatic disqualification when bidding for this work? And is Monitor or the Department of Health more likely to assume the role of the IMF?