The must-read stories and debate in health policy and leadership. 

The January monthly performance data brought the customary truckload of doom.

Two-year elective breaches jumped 15 per cent to 18,585 patients, a record number of category 1 ambulance calls, 12-hour accident and emergency breaches and a jump in the number of medically fit for discharge patients in hospitals.

However, in a refreshing twist, this month’s statistical extravaganza brought what on the face of it looked like some good news.  

As HSJ reported, the NHS’ overall waiting list size appeared to stabilise between October and November at just under six million patients, while the number of 52-week breaches dropped, albeit just a tad from 312,665 to 306,996.

What is driving this appears to be non-admitted clock stops running at a higher level – roughly halving the gap between the recent rate and pre-covid.

However, as leading waiting expert Rob Findlay told HSJ, what we can’t tell yet is how many of these non-admitted clock stops reflect discharges and how many reflect patient pathways being removed administratively from waiting lists following validation.

Of course, both types of clock stop are valid and welcome. But there are only so many of the low-hanging fruit administrative errors to pluck, so it is unclear what this actually means for the longer-term trend. Next month’s data could make intriguing reading. 

Money upfront

A scenario in which NHS England pays independent providers around £225m between now and March – as it has guaranteed – to reserve capacity in case of a covid admissions surge could lead the NHS financially exposed, its chief executive has warned. The figure could rise to up to £525m if the capacity needs to be fully utilised.

The monthly payments under the new national deal, detailed in a letter published late on Wednesday, will be between £75m and £90m each month until April to reserve the capacity. But if a major surge occurs and the capacity has to be released, the payments are likely to double to £175m a month.

Both scenarios would leave the NHS “exposed financially”, NHSE chief executive Amanda Pritchard has warned, and the arrangement creates “a material risk that the NHS pays for activity that is not performed”.

The national deal was announced on Monday but the financial details of the contract were only revealed in a letter from Ms Pritchard to health and social care secretary Sajid Javid late on Wednesday. Ms Pritchard explained in the letter that the deal had been agreed in a response to ministers’ request to “maximise the use of independent sector bed capacity across England”. Read our full story here.

Also on today

Our deputy editor Dave West looks at the discharge debacle in The Integrator, and Marie Curie’s
chief executive Matthew Reed argues that ICS leaders must prioritise care for the dying.