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

The number of covid positive hospital patients has increased on the previous week, marking a 7 per cent fall, 8 per cent less than the 15 per cent reduction recorded on 24 September.

The slowing of the decline comes at a time when the NHS is waiting to see if the return of children to school and greater social mixing at work and elsewhere will start to drive hospitalisations ahead of autumn and winter pressures.

On 24 September, there were 5,036 covid positive hospital patients but on Tuesday the number had increased to 5,126, a 7 per cent weekly fall.

The slowing of the decline is apparent across the country, apart from the East region and, to a lesser extent, the Midlands. The total in the North West has now plateaued.

Read our full analysis with maps here.

Inverse, perverse and due for a change

HSJ editor Alastair McLellan’s editorial begins by recapping on the the idea of the inverse care law, whose creator Julian Tudor Hart stated: “The availability of good medical care tends to vary inversely with the need for it in the population served.” 

Alastair argues that there is another “inverse” relationship that has proved almost as pernicious in its impact on the NHS.

The inverse leadership rule (there are and have been exceptions, so ‘rule’ is a better suffix than law) states that the quality of leadership is likely to be highest in NHS organisations which are already the most successful, and poorest in the least.

After citing various reasons why this might be, Alastair says the NHS has a new opportunity to break the inverse leadership rule with the appointment of the chief executives and chairs of the 42 integrated care systems.

“The NHS leadership community is waiting with bated breath to see who will put themselves forward for the roles. If the most respected figures do so, ICSs will be off to a good start. If not, their credibility and permanence will be under question from the start.”

He adds that the NHS Executive leadership appears to face a stiff task in convincing the service’s top leaders to take up the ICS CEO roles. Read his full piece here.