It's not often malaria and Rome can be mentioned in the same sentence. A courtier of Henry l named Rahere fell sick with malaria whilst on a pilgrimage to Rome. He attributed his recovery to a vision of St Bartholomew and by way of thanks made a vow to build a hospital for the poor.

... and so he did; in 1123, London's St Bartholomew's Hospital was born. Since then at Bart's: William Harvey discovered the circulation of the blood; Percival Pott gave us the Pott's fracture; John Athenby founded the medical school.

Today they make history of a different type. Late on Friday they announced the resignation of Bart's chair. He follows the chief exec and chief nurse. The Trust is drowning under a �93m deficit and sitting on a �1bn PFI time bomb.

If that wasn't bad enough, the CQC have 2 reports on Bart's that insiders tell me are horrific. I understand they are planning to sneak the reports out this week, on Budget Day... make what you like of that.

Is Bart's a basket case?  How much of their failure is self induced? Well, they are struggling with staffing problems that impact on quality and targets. It's rumoured they have dumped 1,000 posts. Given the choice would you work at turbulent Bart's or the comparative calm and security of UCLH just down the road? 

Money; they have a turnover of �1.25bn and an eye watering �77m savings plan that's gone kaput. Between them neither the Board nor the TDA can balance the books.

Bart's run the Royal London, St Bart's, Whipps Cross, Mile End, London Chest and Newham; the whole enterprise too big to manage. You'd be lucky to administrate it. Demand and collapsing London-wide social care is grinding their systems to a halt.

Not so much a basket-case, more a bran-tub; an unlucky dip. They have a full-house of problems. This is an internationally famous hospital run by people who are far from stupid but can't manage what your local DH has probably done; become an FT.

Solutions? Forget the FT nonsense. Bart's is a leviathan; break it up into properly manageable, responsive, accountable bits called hospitals. PFI; sort it centrally.

Funding, targets, structures, benchmarks, regulatory and just about every other method we employ to performance manage our-NHS is no longer fit for purpose. They were designed for a time when we though big hospitals were too big to fail, performance edge would come from competition and primary care came second.

None of it is now true and we face system meltdown. I'm guessing Tarzan 'gets that' but is hamstrung by politicians frozen like rabbits in the headlights; denial, zero appetite for structural change or tax-hikes thus more austerity. Tarzan's solution is to look to the service for their solutions; working around rules and organisations.

Integration is vital and urgent yet Monitor lurks in the shadows like a Victorian foot-pad, waiting to pounce on the unwary who arrange services in the way they are needed not the way market fanatics would drive them. I'd bet the farm they'll scupper some Vanguards.

Population based, capitated budgets are urgently needed to replace a tariff system that is all but redundant.

Quality? Whatever the CQC has found at Bart's has ended the careers of the Chair and senior executives (probably good people struggling with the impossible) and created more instability which will beget more problems.

The CQC won't change anything with out-of-date �300k-a-go inspection methods, special measures or a bus load of inspectors. Auditing, benchmarking and comparing whole system performance (in this case London-wide) is beyond the flat-earthers but it is where the problems and solutions are to be found.

If we are serious about shifting the fulcrum point of care, for example consultants working in primary care, we are going to need some new job-plans and contracts. If Trusts are going to take over surgeries, a device to acquire them will have to be invented.

I have little sympathy for Bart's Board; there is more than a whiff of institutional arrogance about them but I am sorry that this once great institution has been brought to its knees by the ham-fisted policies and cack-handed politicians that has combined to push solutions out of reach.

If you think this is London centric and doesn't matter to you, wake-up; the fallout from the H&SCAct and toxic austerity has produced a contagion that will infect us all. 

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What exactly does the Health Ombudsman do?

Find out - I'll be talking with the

Health Ombudsman Dame Julie Mellor - details here 

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