Last summer, thousands of people took to the streets in the Cornish town of Hayle to protest against suggestions that their local hospital may be closed.
The trust only meets 13 of 44 core standards, the commission says
It never happened, but for the board of the beleaguered Royal Cornwall Hospitals NHS Trust, it was one option on the table to tackle its massive deficit.
One year on, and there are still major concerns about the trust, which comprises the Royal Cornwall Hospital in Truro, West Cornwall Hospital in Penzance and St Michael's Hospital in Hayle.
Both its ability to handle its finances and the quality of services on offer have been deemed "weak" by the Healthcare Commission, which found it to be the worst performing trust of the 395 it examined in its latest check on England's health services.
It failed to comply with 31 of the 44 government-set core standards, which cover a range of fields - from infection control to clinical training. The trust had, among others, been unable to meet crucial standards on hygiene, treating patients with dignity and helping with feeding.
The commission is now to start probing these apparent shortcomings, in co-operation, it stresses, with the trust itself.
"It's about 10 years too late," says Joe McKenna of the Health Initiative for Cornwall lobby group. "These problems have been around for years."
"The bottom line is that you've got a tiny trust trying to serve a large rural population, and the money it's given just isn't enough. Local managers may not have managed the budget particularly well, but they've been asked to do an incredibly difficult job."
Change has been afoot in recent months. In January, a new chief executive, John Watkinson, joined.
He believes that in some cases, failure to comply simply reflected the inability to provide evidence of compliance - while stressing that the way the trust performed was nonetheless "unacceptable".
He has managed to significantly reduce a year-on-year deficit of £36m by what the hospital describes as "new ways of working", including offering more procedures in day surgeries, meaning that fewer and fewer patients are staying overnight, and stopping the use of agency staff.
However, the historic £51m deficit remains.
Nonetheless he feels the trust is back on track - and should be able to comply with all 44 standards by spring next year.
If the commission finds that action is not taken to this end, a formal investigation will be launched, while Health Secretary Alan Johnson has already warned it could be taken over by a well-performing trust if need be.
Joan Tanner, chairwoman of Penwith District Council, whose area includes St Michael's Hospital, says all these threats are unnecessary. The trust, she says, "has moved on".
"There's a real feeling on the ground that things are changing. The new leadership is genuinely interested in what the locals want - there has been a string of open meetings.
"People are coming out of hospital with good stories. Friends I know who've had hip replacements at St Michael's say it's like a hotel - it's like it used to be."