What reaching the peak means for the NHS: We're increasingly confident we have hit *a* peak and hopefully *the* peak of the second wave of coronavirus infections. Hospital admissions lag behind and will carry on rising for another week or so, but this is still a key moment… 1/10

I have talked before about how and why the healthcare the NHS provides right now is simply not as good as usual. We have protected emergency care but routine care for cancer, cardiac disease and so many other illnesses has been badly affected. Especially surgical treatments. 2/10

The surge in COVID patient admissions has a huge impact on other parts of the NHS. We see this pattern often in the winter flu season but it is far worse right now. The shortage of normal hospital beds and ICU beds makes in-patient work very difficult. 3/10

But the key issue is planning. The NHS was not designed to handle huge fluctuations in patient numbers over short periods. We need spare capacity to admit patients into. When the hospital is full, patients must wait to come in, creating serious problems in Emergency Depts. 4/10

Creating spare hospital capacity for a workload we cant predict is difficult. Solutions for small/medium/large patient numbers are all different. If we under-prepare, we cannot admit every COVID patient. If we over-prepare, we ring-fence beds we could use for other patients. 5/10