An NHS hospital trust in England has been formally warned it could be declared broke - in the first case of its kind, the BBC has learned.
South London Healthcare, which runs three hospitals, had debts of £69m at the start of the financial year.
It has now been told by Health Secretary Andrew Lansley that an administrator could be brought in, possibly within the next few weeks.
The move could see the trust dissolved and lead to the closure of services.
The trust runs the Princess Royal University Hospital in Orpington, Queen Mary's Hospital in Sidcup, and the Queen Elizabeth Hospital in Woolwich.
When the three hospitals became one organisation they inherited a large debt - mainly from the private finance initiative that had been used for the buildings at Orpington and Woolwich.
In recent years, the yearly deficit has got worse - it reached 2012 with £69m of debt on a turnover of just over £424m.
'Deep challenges'As well as struggling financially, the trust also has some of the longest waiting times for operations, and longer than average waits in A&E. However, it does have low infection and death rates.
If a decision was made to break up the trust, another more successful NHS organisation could end up running some of the services.
But for that to happen, there would need to be a formal process of review and consultation.
Analysis
The move by Andrew Lansley to start a process which could lead to the dissolving of an NHS trust breaks new ground.
Never before has a health secretary proceeded down this path - and that in itself is a warning shot for all those NHS trusts which are struggling.
There are about 20 trusts that have long-standing problems, although for most of them the difficulties are not as acute as they are for South London Healthcare.
It is a fact that there have always been individual organisations in the health service which have struggled to break even, but in the past they have been bailed out by other parts of the NHS.
However, with money now tighter than ever, the government has signalled its intention to change that culture.
The effect will be felt across the health service - and while that may be welcomed by health economists, it will undoubtedly cause dismay to some patients.
Any decision would then need to be signed off by the health secretary and reported to Parliament.
In a letter to the trust, Mr Lansley said: "A central objective for all providers is to ensure they deliver high-quality services to patients that are clinically and financially sustainable for the long term.
"I recognise that South London Healthcare NHS Trust faces deep and longstanding challenges, some of which are not of its own making.
"Nonetheless, there must be a point when these problems, however they have arisen, are tackled. I believe we are almost at this point."
Mr Lansley also addressed employees in his letter, saying: "I appreciate that any decision to use these powers will be unsettling for staff, but I want to stress that the powers are being considered now so that patients in South East London have hospital services that have a sustainable future."
The process the trust now faces - known as an unsustainable providers regime - was established under the last Labour government as a last resort, but it has never been used.
Mike Farrar, head of the NHS Confederation, which represents trusts, said: "We welcome this decision. The NHS can't go on with short-term fixes to financial problems.
"That might mean some tough decisions, but hopefully will deliver financial sustainability in the long-term."
Consultation timetable- Under section 65 of the National Health Service Act 2006, the health secretary can appoint a special administrator to review an NHS trust
- To do so, the health secretary must first alert the trust and regional health bosses of his intention and consult with them
- This is the stage that has been reached with South London Healthcare
- When and if an order is made, the health secretary must explain to parliament why an administrator is being brought in
- The administrator is then given five working days to start
- Within 45 working days the administrator must provide the health secretary with a draft report setting out what should be done. This must be published
- There must then be a consultation period of 30 working days - which must start within five days of the report being published
- Once that is over, the administrator has 15 working days in which to produce a final report, which again must be published.
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