It may be little consolation to the 100 or more managers who lost their jobs in the sinking of Anglian Harbours trust, but its closure last year helped demonstrate how an influential economic theory works in the NHS.
Unfortunately, says the Office of Health Economics, it appears that the theory of 'contestability' - the threat that a new provider could enter the market - is hardly more effective than 'competition' in improving patient care.
And, it argues in a report published this week, even when contestability is used as the final 'nuclear option', the lengthy process which leads up to it diminishes its short or medium-term effectiveness.
The idea of contestability was first put forward by economists in 1982, and entered the NHS 12 years later in the NHS Executive guidance paper on the internal market, Local Freedoms, National Responsibilities .
Its appeal for the NHS was that, in a service where there were often natural monopoly providers - usually large acute trusts with no nearby competitors - it offered the benefits without the costs of setting up a rival hospital.
In the OHE's words: 'With contestability, it is the threat of competition which incentivises providers rather than the fact of competition.' The more credible the threat, the stronger the incentive for good performance.
Not surprisingly, the idea has been seized on by the government and touted in The New NHS white paper as the final sanction to be used by primary care groups against failing trusts.
But the report points out that contestability in terms of building and equipping from scratch a new hospital to take over from a failing trust is clearly not practical: the costs and the timespan are too great. 'In the context of the NHS, a hospital's managers and staff might. . . rest safe in the knowledge that these kinds of entry by a new provider. . . will not happen, however inefficient or poor quality the existing service, ' it says.
Anglian Harbours trust stands as a unique example of contestability put into practice in the NHS, and even then, while so many managers lost their jobs, frontline staff have 'been left alone'.
'Over time, ' warns the OHE, 'the credibility of a threat that is never carried out inevitably diminishes. The NHS internal market has been in operation for several years, but there is still little evidence of bluffs being called.'
Where such a threat is no longer credible, it says, 'an appeal to professional standards and pride through peer group benchmarking' might achieve the ends expected of contestability more effectively.
But benchmarking, with its threat of 'naming and shaming' poor performers in front of their peers, will itself only work if it is recognised as valid by those peer groups, relates to what they do, is up to date, and is widely disseminated.
'Contestability may be of limited help for some services in some areas, but the challenge is to incorporate the quality and cost benchmarking of existing acute hospital services into the clinical and managerial culture of the NHS.
'Only in that way, ' says the OHE, 'may performance be improved without recourse, in most cases, to the upheaval of avoidable and publicly unpopular service relocations.'
Competition and Contestability Between Acute Hospitals. Office of Health Economics, 12 Whitehall, London SW1A 2DY.£10.
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