News that Portsmouth Hospitals Trust is one of 22 predicted to struggle to gain foundation trust status because of a hefty private finance deal would have come as little surprise to the local health economy.

NHS organisations in the area drew up the Portsmouth and South East Hampshire sustainability plan last year to tackle disproportionately high activity at the trust’s £256m, shiny new 1,400 bed Queen Alexandra Hospital.

Opened in 2009 and commissioned before the zeitgeist became firmly fixed on moving care into the community, the hospital’s emergency department attracts 100,000 patients every year – significantly more than A&Es in comparable areas.

However, a progress update presented to NHS Portsmouth’s board last week revealed that six months into the sustainability plan, A&E activity remains high despite initiatives such as introducing an out of hours GP service to the site.

The plan, which has nine workstreams, including one around estate configuration, anticipates the hospital could end up around 15-20 per cent smaller by 2014.

Estate rationalisation is also cited as a “key action” in the tripartite formal agreement for the trust to achieve foundation trust status, which was signed by the Department of Health on 6 April.

Given that, it is perhaps not surprising that local commissioners have agreed to take on the unitary payments for any parts of the estate that can be found alternative non-acute uses.

They are also encouraging the trust to form a “strategic partnership” with the “asset poor” Southampton University Hospitals Trust.