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Saved by a digit

The December emergency department four hour wait performance was spared from being the worst ever recorded only by rounding off figures. At one decimal place, the all department score equalled last January’s of 85.1 per cent – the previous all time low. At two decimal points, however, only 85.07 per cent were seen within four hours last month; last January it was 85.14 per cent.

Looking at performance in only type one (“major”) departments paints an even rougher picture. This was worse than in last January. Examining trusts’ individual performance, 18 achieved 90 per cent or above on type one attendees – down from 31 in the previous December. The shining examples of those able to defy gravity are dwindling.

Things don’t seem to be getting rosier. Early January has by all accounts seen very bad performance – down to 80 per cent across whole regions.

Recent data shows flu admissions still on the rise.

And HSJ has revealed a remarkable letter to the prime minister, signed by clinical directors of more than 60 UK emergency departments. It includes accounts from recent weeks of four hour performance as low as 45 per cent; and patient safety compromises including patients dying prematurely in corridors.

Private inquiries

Jim Mackey might have stepped down from his national role, but that isn’t going to stop him from trying to solve the NHS’s capital funding problems.

The chief executive of Northumbria Healthcare Foundation Trust has told HSJ he’s in discussions with a number of other providers to establish an “NHS alternative to PFI”, which would aim to deliver “off balance sheet” capital projects.

He reckons there is potential for NHS owned special purpose vehicles to be set up by trusts to secure private investment for significant estates projects, rather than profits being creamed off by a private PFI firm.

During his two years at NHSI, Mr Mackey frequently expressed his frustration at the NHS’s inability to take advantage of low interest rates by securing private investment for capital projects.

The off balance sheet aspect is likely to prove both tricky and contentious, as accountancy rules have tightened up on this sort of thing in the last few years.

But if it’s possible to do, many will see it as a necessary evil given the severe constraints on traditional public capital at a time when the NHS desperately needs investment.