By now everyone in London’s heard of the SaFE review. NHS London commissioned consultants McKinsey to put together the Safe and Financially Effective paper and it has sat on desks for a few weeks at Southside. It’s explosive.

On today’s tariff it shows nine of the 18 non-FT acutes aren’t viable. Perhaps more scarily, in the downside scenario of an extra 1 per cent tariff deflator, all but two of the 18 would fall over. Ergo, 1 per cent difference in tariff renders an extra seven London acute trusts unviable.

The chatter around the 2012-13 operating framework says there could be an extra 1.5 per cent deflator on the way.

It’s worth considering which of the nine of 18 are in scenario one, under today’s tariff, and which are the two left standing in bleaker scenario two, (the one with an additional 1 per cent off tariff).

Trusts on the scenario one casualty list have already been more-or-less identified. They would be: North West London Hospitals, West Middlesex University Hospital, North Middlesex University Hospital, Barnet and Chase Farm Hospitals, Ealing Hospital, Whipps Cross University Hospital, Barking, Havering and Redbridge Hospitals, Newham University Hospital and Epsom and St Helier Hospitals.

The usual suspects, then. The more interesting list is who that leaves. It is: Croydon Health Services, Imperial College Healthcare, Kingston Hospital, Barts and the London, Lewisham Hospital, Royal Free Hampstead, South London Healthcare, St George’s Healthcare and  Whittington Hospital trusts.

Who do you think survives under the second scenario of a 1 per cent tariff cut?

The answer was: only the Royal Free and St George’s. Both large, single-site, no PFI trusts with a healthy amount of specialist work and some efficiency left to drive through.

Imperial’s survival plan is sure to include some reconfiguration and swallowing West Middlesex while Barts bid for the future is a large scale merger with two trusts from list one.

Take these off the second list and you’re left with Croydon, Lewisham, South London, Kingston and the Whittington.

The last two on this list have been identified for downgrading before, in the Healthcare for London plan Ara Darzi came up with and Andrew Lansley halted.

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