The NHS in England is returning to its highest state of alert amid warnings that hospitals will continue filling up with Covid-19 patients for at least another two weeks.
The service will go back to level 4 alert status at midnight on Wednesday to coincide with the start of the second lockdown.
The switch to level 4 means the NHS’s response to the resurgence of the pandemic is being handled nationally rather than regionally and that NHS England’s national incident coordination centre – comprising the organisation’s senior team – has become operational again, having been stood down in July.
It will monitor which hospitals are coming under the most pressure and decide what steps need to be taken to respond, for example by diverting patients with spare capacity and managing non-Covid care.
The number of people seriously ill with Covid who are being treated in hospitals in England has risen from 2,000 at the end of September to almost 11,000.
That is more than half of the 19,000 Covid patients whom hospitals were treating at the peak of the pandemic in April, Prof Stephen Powis, NHS England’s national medical director, said on Wednesday.
New national restrictions are due to come into effect in England on Thursday, after MPs vote on them, and remain in place at least until 2 December.
What can I leave home for?
- For childcare or education, where it is not provided online.
- To go to work unless it can be done from home.
- Outdoor exercise either with household members or with one person from another household.
- For all medical reasons and appointments.
- To escape injury or harm, such as domestic abuse.
- To provide care for vulnerable people or volunteer.
- To shop for food and essentials.
- To see people in your support bubble.
- Children will still be able to move between homes if their parents are separated.
Government say the list is not exhaustive, and other permitted reasons for leaving home may be set out later. People could face fines from police for leaving their home without a legally permitted excuse.
Can different households mix indoors?
No, not unless they are part of an “exclusive” support bubble, which allows a single-person household to meet and socialise with another household.
Parents are allowed to form a childcare bubble with another household for the purposes of informal childcare, where the child is 13 or under.
Can different households mix outdoors?
People are allowed to meet one person from another household socially and for exercise in outdoor public spaces, which does not include private gardens.
Can I attend funerals, weddings or religious services?
Up to 30 people will still be allowed to attend funerals, while stone settings and ash scatterings can continue with up to 15 guests.
Weddings and civil partnership ceremonies are not permitted except in “exceptional circumstances”. Places of worship must remain closed except for voluntary services, individual prayer and other exempt activities.
Can I travel in the UK or abroad for a holiday?
Most outbound international travel will be banned. There is no exemption for staying away from home for a holiday. This means people cannot travel internationally or within the UK, unless for work, education or other legally permitted exemptions.
Which businesses will close?
Everything except essential shops and education settings, which include nurseries, schools and universities, will close.
Entertainment venues will also have to close. Pubs, restaurants and indoor and outdoor leisure facilities will have to close their doors once more.
However, takeaway and delivery services will still be allowed, while construction and manufacturing will stay open.
Parents will still be able to access registered childcare and other childcare activities where reasonably necessary to enable parents to work. Some youth services may be able to continue, such as one-to-one youth work, but most youth clubs will need to close their doors.
Public services, such as jobcentres, courts, and civil registration offices will remain open.
There is no exemption for grassroots organised team sports. Elite sports will be allowed to continue behind closed doors as currently, including Premier League football matches.
Powis said the number of people being infected with coronavirus was rising across the country. The influx is not confined to places in the north such as Liverpool and Manchester, and hospitals in the south of England are starting to fill up.
“The north-west is particularly under pressure; the highest infection rates are in the north-west. That translates into the highest number of admissions [being] in the north-west,” Powis said at a press conference. “But … infection rates are now rising and rising faster in the south, [and] hospital admissions are beginning to rise in the south of the country too. Therefore our hospitals are beginning to fill in the south with coronavirus patients.”
Sir Simon Stevens, the NHS England chief executive, admitted that the pressure on hospitals from Covid-19 was increasing so sharply that the health service could have to abandon its ambition that patients seeking normal, non-Covid care during the second wave of the pandemic should be able to get it.
“The truth, unfortunately, is that if coronavirus takes off again, that will disrupt services. We’re seeing that in parts of the country where already hospitals are dealing with more coronavirus patients now than they were back in April,” he said, citing Leeds as one place where hospitals have already had to cancel routine surgery.
Hospitals in Liverpool, Nottingham, Yorkshire and Plymouth in Devon have done the same in recent weeks.
“We’ve seen, for example, that in the north-west of England a quarter of patients who would otherwise be having their routine operations, those beds, services and facilities are instead being having to [be] repurposed for coronavirus,” said Stevens.
He pleaded with the public to help protect the NHS by following the new rules that come into force on Thursday morning, as well as the government’s “hands, face, space” infection control advice. “The reality, I think, is that there is no health service in the world that by itself can cope with coronavirus on the rampage,” he said.
What he called “three lines of defence – the actions we take as individuals and families, [and] the efforts of the test-and-trace programme” were vital to ensure the NHS was not overwhelmed, Stevens said.
NHS Providers, which represents hospital trusts, said the return to the highest level of emergency preparedness confirmed that “the health service is once again facing one of the most challenging periods in its history”.
Saffron Cordery, the organisation’s deputy chief executive, said: “Despite months of preparation for the second wave, this is going to be an extremely difficult winter for the NHS and will place a further burden on staff who have worked relentlessly since the start of the pandemic to care for patients.”
Planned surgery and cancer care may have to be scaled back to ensure hospitals can focus on Covid patients, she said. “Alongside treating more Covid-19 patients than at the height of the first wave, trusts are also providing above-average levels of cancer care and planned surgery. But this is now under threat.”
