Welcome to HSJ’s new Performance Watch expert briefing. Our new fortnightly newsletter will delve into the most pressing performance matters troubling system leaders and provide unrivalled insight into what they plan to do about them.

An unprecedented warning from senior clinicians that patients are dying in corridors, NHS Providers’ “watershed moment” declaration, and the worst December four hour waiting time figures on record all dropped this week. So, what happens next?

The harsh reality is system leaders have precious little in the way of levers to pull at this stage in winter. Workforce shortages mean there simply aren’t enough staff even if the Treasury did suddenly produce some cash and extra beds are no use without the staff.

Besides, the prime minister’s uninspiring response to questions about the NHS on Thursday morning did not give the impression any help would be on offer any time soon (“She brushed aside calls for an increase in NHS funding, saying the NHS had already received extra money,” reported The Guardian)

HSJ understands that Sir Bruce Keogh’s national emergency pressures panel is due to meet on Monday.

But I also understand that tightly guarded internal performance data suggests pressure has eased in January following the severe problems over new year, and this could mean the panel resists any further intervention next week.

That is not to suggest that senior figures are not worried about the prognosis for the system.

Leaders are only too aware that a surge in flu (levels are currently high but not unprecedented according to Public Health England monitoring), a cold snap, and other hard to control variables like norovirus could push the system into even deeper strife and place even more lives at risk.

The limitations on further central action is possible at this stage, coupled with a cognisance that reallocating resource to A&E will further destabilise other parts of the system, makes non-intervention the most likely outcome of next week’s meeting.

Besides, the response from trust chiefs to the NEPP’s first intervention (an invitation to suspend operations, outpatient appointments during January and relax mixed sex rules) was pretty mixed.

Some welcomed it, but many trusts have declined to cancel appointments or relax separate sex standards, calculating that any short term gains were not worth the loss of such hard fought gains. Some chiefs expressed frustration to HSJ, saying the national message had confused patients and frontline staff.

NHS Providers concurred that there was little left in terms of help over the coming weeks. Director of policy and strategy Saffron Cordery told HSJ the best short term outcome would be “a commitment [from ministers] on a long term solution for the NHS and recognition that this must never happen again”.

This would at least provide a morale boost and a sense of hope. She added: “The position is very challenging because the well publicised workforce shortage means there are no more staff to bring in even if more money was made instantly available.

“Trusts are however using their staff more innovatively and we would encourage that. For example, there are community trusts deploying their staff in acute trusts to help speed up discharges.”

Despite today’s furore, the message to the system is: “Keep on doing what you’re doing (because there are no other options).”

Leaders will cling to the hope that the system might be through of it. But, for four out of the last five years, January has proved tougher than December.