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

The second wave of the pandemic has been concentrated on the North West, around Greater Manchester and Merseyside, but is clearly spreading south into the Midlands and east into the North East and into Yorkshire.

Trusts in Leeds, Doncaster, Bassetlaw, Bradford, Rotherham and elsewhere in Yorkshire have cancelled varying degrees of elective work to make space for covid patients.

And on 3 November, Barnsley Hospital Foundation Trust became the first acute to have more than a third of its general and acute beds occupied by covid patients, according to NHS hospital activity data.

This made it the trust with the highest occupancy rate in England after a surge of patients that saw its covid occupancy grow from a seven-day rolling average of less than 1 per cent at the start of September, to 3 per cent at the start of October, and pushing above 36 per cent by the start of November.

Meanwhile health systems in the Midlands are seeing increasing occupancy rates, with the Nottingham and Nottinghamshire system seeing its covid occupancy rate grow from a seven-day average of 13.2 per cent on 27 October to 18.7 per cent on 3 November.

This was the largest rate of growth over that period and made it the third most occupied system behind the South Yorkshire and Bassetlaw and the Lancashire and South Cumbria systems.

Great expectations

HSJ editor Alastair McLellan’s leader column homes in on this week’s round of media appearances by NHS England chief executive Sir Simon Stevens, which had a lot to do with expectation management.

This most politically savvy of public service leaders is aware that there is considerable expectation by politicians and media that “routine” services will be restored and maintained in those parts of the country less affected by the second wave, which effectively means most places south of Birmingham.

Sir Simon has, long before the pandemic, stressed the importance of the NHS building and maintaining credibility with government stakeholders, especially Number 10 and the Treasury. Trust chief executives whose organisation’s under-performance is not justified by covid can expect some difficult conversations.

The NHS England chief is likely to be just as robust with government about the need to not only meet the continuing extra costs created by covid, but also to provide the investment in diagnostics and other extra capacity needed to stop waiting lists ballooning beyond control. Read Alastair McLellan’s full leader column here.