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

There are 70 per cent more people in hospital now than when England was approaching its spring covid-19 peak, and twice as many non-covid patients, according to official figures leaked to HSJ.

In some regions, the contrast is even sharper. In the North East and Yorkshire, where covid-19 hospitalisations are still mounting rapidly, there are now twice as many patients in acute hospitals than there were in early April.

The information also shows that there are now 13 per cent more patients than there were on 3 April in mechanical ventilation beds – which are reserved for the most seriously ill patients. These include more than double the number of non-covid patients than there were in the spring.

The information — shared with HSJ and the Independent by NHS sources — also reveals that one in 10 hospital beds are now occupied by confirmed covid patients – up from about 6 per cent two weeks ago.

Overall occupancy is now around 85 per cent – lower than usual for the time of year – but of course we are not normally climbing the second peak of a lethal pandemic.

One hospital director said covid infection control measures – such as splitting out covid positive, negative and unknown patients – “means that we just can’t operate at the occupancy levels that we did previously”. To maintain emergency department flow they now need to keep occupancy to around 75 per cent, that source said, rather than 95 per cent previously.

Late March saw a national cancellation of most planned care, large reductions in emergency admissions, and a huge programme to discharge patients home or to care homes.

The NHS is now trying to maintain planned care where possible. There are also indications that it has become harder to discharge patients from hospital than it was in April.

Emergency activity has so far not significantly dipped this time, and winter will keep it higher.

For optimists, there was a possible winter scenario where covid investment bolstered health and care capacity; covid remained largely dormant; and other infections were more contained than usual due to distancing. Unfortunately that looks unlikely at this stage; instead there is the prospect of widespread and quite severe operational pressures, and care failures, if the covid peak cannot be turned quickly.