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What would make you feel better after a gruelling six months of organisational restructuring and a pandemic? A Caribbean holiday? A substantial pay rise? Or a commemorative badge from your employers?

The first two are not on offer to staff at Kent and Medway Clinical Commissioning Group. But the third is one of a number of options they are being asked to vote on: alternatives include a thank you letter from senior management, a “Graze-type” box of nibbles or an extra day’s leave.

As the CCG is understood to be considering some redundancies, morale is obviously a concern for managers, who say a “large number” of staff have responded positively to the survey. And it is harder for CCGs to allocate cash to initiatives that boost morale than it is for trusts – which often have charitable funds donated for staff welfare.

However, the reaction from HSJ readers in our comments section and on Twitter suggest that this particular offer – however well meaning – may not hit the spot and may even – perish the thought! – be subject to a little bit of ridicule. Food – or maybe nibbles – for thought for the CCG.

Going south

Every week the Intensive Care National Audit and Research Centre – more commonly known as ICNARC – publishes a report analysing the data on covid patients in critical care in UK hospitals.

Of late, ICNARC’s analysis has been subdivided into all covid cases in critical care up to 31 August, or the first wave, and all from 1 September, the second wave. They have published a couple of handy maps that show how the number of admissions to critical care have been distributed across NHS regions in England, Wales and Northern Ireland in the first and second waves.

There were 10,900 admission in the first wave to 31 August and there have been 1,233 total across England, Wales and Northern Ireland up to 16 October in the second wave. The distribution of patients across the different NHS regions is already clearly different in the second wave when compared with the first.

In the first wave, 28 per cent of critical care admissions were in London while 12 per cent were in the North East and Yorkshire. The second wave has nearly flipped this: NEY has had 23 per cent of the admissions, London has had 13 per cent.

This is unsurprising when considering the rate of community transmission across the North West and North East over the past few months. But the region with the second largest admissions to critical care in the first wave, the Midlands, is increasingly looking like a cause for concern.

So far in the second wave it has had 233 critical care admissions – 18.9 per cent of the total. That’s already surpassed the proportion in the first wave (1,683 admissions or 15.4 per cent).

Data published by NHS England shows both general admissions to trusts in the Midlands as well as deaths in hospitals in the region have gone up sharply in the past week. It seems the second wave is starting to head south.

Trusts in the North have already had to cancel electives. As one expert observer asked this week, how long before the West Midlands follows suit?