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

Coronavirus update

The photos and footage keep coming of the Nightingale hospital at the Excel centre in London — a “giant critical care barn” as it has been described — and the UK epicentre of covid-19 infection remains in the capital.

Yet away from England’s biggest urban centres — Birmingham and Manchester as well as London — there is concern other regions are in danger of missing out on such additional surge resource; and having less robust planning in place for if/when they are hit.

On top of this, hospitals in more remote areas — normally with older populations more susceptible to serious illness from covid-19 — are already struggling, so may be vulnerable to meltdown when the virus arrives in earnest.

The regional issues raise strategic tensions about how the service should respond too — are huge field hospitals in urban centres the wisest first move, or should resource flow out to smaller hospitals? Can kit be ferried around the country, or does it need to be divided out equally? Can patients even be shunted around England to where hospitals have capacity?

HSJ’s deputy editor explores these issues in a new analysis piece.

On Tuesday afternoon, HSJ analysis showed deaths in the East of England — a region with plenty of rural and coastal patches — are higher than London was at the same point since its 10th recorded death. It is not possible to read much into the whys and wherefores of that yet; but it may be one more reason to consider the options.

Moving further up north, an example of how health service configuration is being shaped by the virus:

The fragility of the emergency department at Chorley and South Ribble Hospital has been well documented for several years.

Lancashire Teaching Hospitals was forced to temporarily downgrade the department in 2016 after national caps on agency spending made staffing the unit more difficult.

Although it later reopened as a 12-hour service, there is general consensus among medical experts that even the reduced service is unviable in the medium to longer term.

Preparatory work to consult on a major reconfiguration was underway before the coronavirus outbreak, but the trust has now moved to close it temporarily amid the current pressures.

Staff will be transferred to the main hospital in Preston, 11 miles north, to boost its services during the covid-19 outbreak.

Stretching a depleted workforce across the two sites would “put lives at risk”, said Karen Partington, the trust’s chief executive, as she pleaded for “understanding of the measures we are taking and the reasons behind them”.

The case for retaining an accident and emergency department at Chorley has always been more political than clinical, and with accident and emergency attendance numbers dropping dramatically in recent weeks, the move appears the logical step.

Depressingly, understanding is not what the trust has received from influential local MPs, Sir Lindsay Hoyle — now the Commons speaker — and Katherine Fletcher, who have been heavily critical of the decision in the local media.