Hospital fiscal problems

In my humble opinion a NHS trust is likely to run into financial difficulty because of one of three reasons - not enough patients , uncontrollable costs or debt (historic ). Large cities like London ,Manchseter and Glasgow simply has too many hospitals compiting for patients , the mix of patients is also a crucial factore ,A & E patients are a greater cost factor to an NHS trust than the run of the mill patients like knee replacements etc . Obviously a high volume of A & E patients is an uncontrollable cost which is totally beyond the control of the trust . Not enough patients tends to be a curse of the more rural trusts . Historic debt is a major factor to be taken into account , resulting in unsustainable high interest payments