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

Various recent media reports and analyses have pointed to London as being worst affected by coronavirus, but new research suggests it has been overtaken by three other regions in the last month.

According to analysis of official data by HSJ, the West Midlands, North West and North East have now seen the highest number of deaths from all causes, on a per-head-of-population basis, compared to expected levels.

In March and April, London was recording significantly higher rates of excess deaths.

But over the course of May and early June, the rate of excess deaths in the West Midlands – driven mainly by Birmingham and the Black Country – has risen to 120 per 100,000 population. The North West – driven mainly by Merseyside – has risen to 118 per 100,000, while the North East increased to 113 excess deaths per 100,000. London rose to 109 deaths per 100,000, before flatlining.

Experts said age profiles, deprivation levels, and care home populations were among the likely factors in this development.

This is important because of measures needed to protect communities from any second wave of the virus, and future decisions over resources.

Justin Varney, director of public health for Birmingham, said: “Clearly there has been a tragic loss of life, to a varying extent around the country. The value of looking at these regional differences could be about the economic injection that’s going to be needed in each area.

“If there have been a lot of excess deaths in care homes for example, then those homes will have lost a lot of residents and income, so will be facing a massive financial black hole. Clearly these areas will need more support, and so far Birmingham has not even got half of the funding we need.”

The Serco buy-out

Of all the public-private partnerships put together by Guy’s and St Thomas’ Foundation Trust, the pathology joint venture was the biggest.

A 10-year contract saw the south London trust go in with its neighbour King’s College Hospital and outsourcing firm Serco to run the two organisations’ labs, and potentially go after other work.

There are differing views on how successful it has been but the manner of its replacement exposed some difficulties in governance.

It always looked odd that the £2bn+ procurement process for pathology across South East London (apart from Lewisham and Greenwich Trust, which opted out) was being run by two of the providers that owned one of the bidders.

HSJ understands the process was too messy with a non-NHS body as part of the mix and that Serco had to be bought out of their third of the company.

Although this amount has not been disclosed because of “commercial confidentiality” it surely can’t be for a company worth all that much. With its two main contracts (worth around £90m a year in total) gone as of September there won’t be much of Viapath left.