Commenting on the current government approach to restrictions on social contact, NHS Providers chief executive Chris Hopson said:

"Having spoken to a number of our NHS trust members over the last 48 hours, three things are crystal clear.

"First, there is a ring of areas around London – for example, in the home counties – where trusts are alarmed at the rise in infection rates and hospital admissions. The government has rightly put London and parts of Essex and Hertfordshire into Tier 3. It must now urgently consider adding other areas to that tier where infection rates are similarly worrying.

There is real concern in many trusts in the northern half of the country about leaving Tier 3 prematurely.

"Second, there is real concern in many trusts in the northern half of the country about leaving Tier 3 prematurely. It is good news that infection rates are dropping, in some cases significantly. But we can't afford to let up. As soon as infection rates rise, excess death rates rise too. Controlling infection rates is about limiting patient harm. At the same time, most hospitals in the north of the country still have very high levels of COVID-19 patients, just as we go into winter, the NHS' busiest period. Given this level of COVID-19 demand and the number of beds lost to ensure appropriate infection control, even a small increase in the number of COVID-19 patients will also put those hospitals under significant pressure.

We welcome the fact that the more informed debate we called for on Sunday has now materialised.

"Third, the government has clearly said it is not going to change its position on the Christmas regulations. On that basis, trust leaders want the government to think very carefully about what further advice and restrictions may be needed to minimise the risks of extra social contact between December 23 and 27. We welcome the fact that the more informed debate we called for on Sunday has now materialised. The obvious next step for the government is to set out more detailed advice on who is most at risk, given the looser regulations, and what we can all do to minimise that risk.

"It's also important to understand that these decisions are completely linked. If the government is going to stick with its current approach to the Christmas regulations, it must also ensure that its decisions on which area is in which tier are as robust as possible. That means no delay in adding any area to Tier 3 that needs to be in that tier, and no premature removal of any area from it, either."