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Only six out of 18 hospital trusts in London trying to gain Foundation Trust status would be "financially viable" in three years, an found.

The 18 acute trusts would need to make "unprecedented" £1.2bn savings to sustain services, the report said.

Despite the cuts 12 would not be viable in the long-term in their current form and face deficits of £233m, it said.

The report said London has "too many acute hospitals" and £421m in nursing cuts was needed to offset the deficit.

The study, referred to as the "Sustainable and Financially Effective" (Safe) report, analyses the financial viability and clinical sustainability of each of the 18 trusts.

'Spending too much'

Up to 59% of the funding for London is spent on acute care, which eats into the investment needed to improve services such as accident and emergency, maternity and primary care, the report said.

Royal Free Hampstead Hospital, St George's Healthcare Trust, Croydon Health Services, Kingston Hospital, Lewisham Hospital and Barnet and Chase Farm Hospitals would be financially viable by 2014-15.

Imperial College Healthcare Trust, St Barts and the London NHS Trust, Whittington NHS Trust and Ealing Hospital trusts would need more than three years to be viable, according to the study.

Hospitals categorised as "not financially viable", despite the savings, were West Middlesex Hospital, North Middlesex University Hospital, Barking, Havering and Redbridge Hospitals, South London Healthcare, Newham Hospital, Whipps Cross University Hospital, North West London Hospitals and Epsom and St Helier Hospital.

But when the study took 1% inflation into consideration 16 of the 18 trusts were projected to face a £358m deficit and only Royal Free Hampstead and St George's Hospital were found to be financially viable.

Dame Ruth Carnall, chief executive of NHS London, said: "London's health services are improving, but not all patients receive the highest standards of service all of the time.

"With trusts spending too much money to maintain the status quo, many will be unable to afford the costs of meeting the minimum standards for 24/7 emergency care and anaesthetic consultant cover."

The study recommended some trusts may need to merge, some with an existing foundation trust, but said this may not be sufficient.

"Trusts are currently trying to sustain services over too many sites", which "needs to be addressed", Safe added.

The report said to achieve £1.2bn efficiency savings by 2015 the hospitals could look to save £421m from nursing, £184m from theatres and outpatient services, £187m from scientific and technical staff, £177m from non-clinical staff and £45m from laundry and catering.

NHS London said any changes to services or site closures would only go ahead if patient care would be improved.