The must read stories and debate in health policy

Mackey targets capital and PFI

The squeeze on NHS capital funding has been well documented, with STP leaders being told not to hold their breath over their requests for capital investment.

The Department of Health’s capital budget has been frozen in cash terms over the course of this parliament, and it has also been repeatedly raided in recent years to prop up the revenue account. Another £1.2bn transfer is expected in 2016-17, making the situation even tighter.

But now NHS Improvement is working on a plan get hold of that much needed capital investment for NHS trust estates.

Jim Mackey, chief executive of NHSI, told the HSJ Summit the regulator is seeking greater flexibility around capital spending and is looking to create an “NHSI bond”.

This could be a mechanism for providers that want to sell assets to get some of the capital before the sale goes through. Sales can often take years to complete, so the bond would help accelerate investment.

Discussions are still at a very early stage, so the source of the accelerated funds is unclear.

Last month HSJ revealed a huge spike in backlog maintenance problems at NHS trusts, which are struggling to access capital funds to deal with the issues.

Mr Mackey said: “There are examples where you’ve got really terrible fabric of buildings that needs sorting out. It’s not acceptable to have our patients in that sort of environment.”

He also revealed NHSI has established a working group looking at the possibility of buying out some providers’ PFI schemes.

Mr Mackey said the borrowing levels and profit margins within some private finance initiative deals are “absolutely ridiculous”. He was involved in the only PFI buyout to have happened to date when he was chief executive of Northumbria Healthcare Foundation Trust.

Long waiters continue to rise

A London teaching hospital has more than 100 patients waiting over a year for treatment.

Imperial College Healthcare Trust has 102 patients whose waiting time has breached the 52 week target for treatment, its latest board papers reveal.

The trust had agreed with NHS England that it would start hitting the target by April 2017 but admitted it might not be able to do this without sending some patients to independent sector providers.

The trust reported a 47 year-plus waiters in March, while in July, board papers said the total had hit 80.