THE decision by Jeremy Hunt, the health secretary, to dismember the South London Healthcare Trust is a sound one, even if the local response has hardly been enthusiastic. The trust, which oversaw several south London hospitals, had a history of mismanagement, compounded by onerous debts incurred through the Private Finance Initiative to fund building projects. Aside from these avoidable errors, the case for hospital and departmental reorganisations in the capital is strong and getting stronger. As things stand, the constituent hospitals run by the trust will be taken over by neighbouring institutions. That does however pose the question as to whether merely handing failed hospitals over to the managements of slightly stronger ones is more than short-term palliative care.

Reasons for optimism on this score are few. The NHS now has better systems for dealing with outright failures, clinical and financial. The publication next week of the report into the appalling mismanagement and neglect at the mid-Staffordshire trust from 2005-2008 will focus minds on how the health service can avoid such disastrous failure, with better warning signals of malfunctions on the wards and greater accountability of senior managers.

Even without these unwelcome dramas however, too many hospitals are struggling. Some of this is the result of a fierce spending squeeze. Just as much trouble stems from a failure to face up to the changing nature of health services. London, for instance, has too many hospitals replicating basic provision like accident and emergency and maternity, rather than honing specialisms and concentrating expertise. Also, many long-term conditions can now be dealt with better at home with monitoring and guidance, than on a hospital ward.

As unpopular as the idea may be with the people who live near them, many more hospitals will need to change functions in the years ahead and a lot of them will lose departments (at least) as a result. This time, Mr Hunt, split the difference by over-ruling a recommendation that Lewisham hospital have its entire accident and emergency provision transferred to neighbouring Greenwich (Lewisham’s hospital was not part of the failed trust, but a reconfiguration plan for the area suggested that providing the same service in a number of locations close to one another was inefficient.)