STRUCTURE: Two hospital trusts are exploring closer working in a move which could eventually see a full merger.

HSJ understands a memorandum of understanding has been signed between Princess Alexandra Hospital Trust and East and North Hertfordshire Trust to explore opportunities in working together.

In April last year Princess Alexandra admitted that it would not be viable as a standalone foundation trust.

It said it would be exploring “vertical and horizontal” integration options, including with community providers.

The £177m-turnover had a range of performance problems when it made its announcement last year and A&E performance for 2015-16 against the type-one four-hour target was 82 per cent, five percentage points lower than at the end of 2014-15.

East and North Hertfordshire Trust, which has a turnover of £376m, also has significant performance problems in A&E, recording a type-one performance of 78 per cent.