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

The health service has learned a lot from the first wave of the pandemic, including just how hard things are going to be in the second wave. Trusts will have to care for the rising tide of covid patients plus the elective recovery work with exhausted staff and all the myriad other winter pressures.

One chief executive of a trust group in the Midlands told our Digital Strategy Summit this week that this would make the second wave “10 times harder” than the first. The health and care system will need to use technology to get a grip on performance to cope.

The NHS has transformed how it uses technology and digital services, with patients routinely accessing care remotely and clinicians and administrators working from home securely. But the second wave will require a second step-change.

Trusts will need almost to-the-hour intelligence on performance across their hospitals, giving as clear a picture as possible of patient flows, where there is excess capacity and how it can be utilised.

The general pressure is continuing to dial up around the country, with Nottingham University Hospitals Trust the latest to report expected disruption to their elective programme, ward closures and rising covid cases, according to an internal memo.

Winter is never a good time for NUH – is it for anyone? – as in recent years the trust and the wider system have declared black alerts amid increasing pressures on beds and rising attendances. And there is now covid to add to the mix.

Sources close to the trust have also told HSJ there are expectations cases will be “significantly higher than last time”, but in context of a county that was not hit as badly as the surrounding areas.

The contents of the memo and conversations with those close to the trust jar with the enduring national narrative of the NHS needing to go back to business as usual. On the ground it is anything but.