There have been problems of late for acute providers in the East, with two of its foundation trusts in trouble with the Care Quality Commission and another being scrutinised by the strategic health authority.

The CQC had only just removed conditions relating to quality of care at Basildon and Thurrock University Hospitals Foundation Trust when it warned of yet more problems. Inspectors were concerned about nursing care planning and assessment and discharge practices and warned “further improvement needed or enforcement will follow”.

The watchdog has also found shortcomings in mental health provision at Southend University Hospital. It found psychiatric support in accident and emergency was only available from 2pm-10pm, meaning “waiting times can be prolonged to the point that a patient walks out”.

A report to NHS East of England’s board on West Hertfordshire Hospitals Trust said there were “quality concerns including: a high number of open and unresolved serious incidents; five open ‘never events’; and an upward HSMR [mortality rate] trajectory”.

Others have financial problems.

Bedford Hospital Trust’s January board meeting heard that it had to go to the primary care trust for help. It has told the commissioner it may not make its savings target if the 30 per cent marginal tariff on emergency admissions is applied.

Financial concerns are affecting plans for a freestanding midwife-led birthing unit at Queen Elizabeth Hospital, part of East and North Hertfordshire Trust. A review of maternity arrangements concluded: “In the main, senior clinicians, managers and GPs were against [and] only 13 per cent of women said they would use an FMU”.

And anyway, said the report: “It is not affordable.”.