Bristol, Alder Hey, Mid Staffordshire; some hospital trusts are forever synonymous with failures which shone a light on problems found throughout the NHS. Could South London Healthcare Trust and Heatherwood and Wexham Park Hospitals Foundation Trust be about to join them?

South London is likely to close the emergency care and maternity units at its Queen Mary’s Hospital over quality concerns. Heatherwood had to seek a loan of £18m from the government, a move the Department of Health protested a little too loudly was “not a bailout”.

‘A health system cannot maintain an oversupply of hospitals - eventually, the quality or the money go south’

Both trusts have the kind of complex and extensive back story which always underpins failures like these. South London’s move appears to be connected to the tortuous and politicised debate over the shape of the capital’s health services. Heatherwood has a history of deficit, as well as disputes with commissioners and regulators. But behind the individual tales are factors that will loom large across the NHS for, at least, the next five years.

The most telling message is that a health system cannot maintain an oversupply of hospitals - eventually, the quality or the money go south. This is true during a period of plenty, which, it is worth remembering, we are still theoretically enjoying. When the money gets tight, the rivets start to pop. Rationalisation of services must be delivered in a planned way - a rash of emergency measures will produce a system as unbalanced as the one we have now. The big test will be the credibility of the savings plans being prepared by primary care trusts as part of the quality, innovation, productivity and prevention programme and due for publication in October. These projections must be very specific about, for example, reductions in bed numbers.

The other - related - signature issue raised by the events of the last week, is the speed with which the foundation trust model, as currently configured, is looking less and less aligned with policy. Can South London really be ready for full independence by March 2014 and if not, which FT would be prepared to take it on? More damaging still is Heatherwood’s loan - at highly attractive rates - which at a stroke kicks away one of the founding principles of the foundation trust movement that the government has pledged to take to fruition.

Of course, Heatherwood’s loan is not “a bailout”, just as the closures at Queen Mary’s are only “temporary” to deal with winter pressures. HSJ’s readers, however, may be forgiven for concluding that “if it walks like a duck and talks like a duck…”

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