NHS Providers has written to the prime minister ahead of a review of COVID-19 restrictions on 16 December, urging extreme caution over relaxing the rules, and asking for areas that should be in the highest Tier 3 category to be moved into that tier without delay. The letter also calls for the prime minister to personally lead a more informed debate about the risks of social mixing over Christmas.

In a letter to Boris Johnson, the organisation which represents every hospital, community, mental health and ambulance trust in England, draws on the latest evidence and conversations with trust leaders from this week. It highlights a "worrying increase" in infections across a wide range of areas, with the overall trajectory over the last fortnight "at the bottom end of hopes and expectations".

Trust leaders are worried that the high infection rates in the north of England during the autumn may now be spreading to the south.

   

Trust leaders are worried that the high infection rates in the north of England during the autumn may now be spreading to the south. They are also concerned that, unless these rates come right down, the spread of the virus will quickly gather pace as soon as restrictions are relaxed, triggering a third wave of COVID-19 patients coming into hospitals just as the NHS enters its traditional busiest period.

In particular, the letter points to trust leaders' concerns about current pressures on hospital beds. The reduction in the number of COVID-19 patients in hospital, post peak, is significantly slower than in the first wave and, in some areas, the number of COVID-19 inpatients is increasing. As of Thursday 10 December, there are 13,000 hospitalised COVID-19 patients compared to 500 at the beginning of September. This is at a time when enhanced infection control measures mean the NHS has 10,000 fewer beds in operation.

In particular, the letter points to trust leaders' concerns about current pressures on hospital beds.

   

The letter says that the NHS has been short of beds for each of the last five winters. Trust leaders are therefore very worried about the task they face between late December and February as they try to balance:

• large numbers of COVID-19 patients
• the impact of increasing winter emergency pressures
• planned care that can not be delayed any longer
• the new demands of the COVID-19 vaccination programme.

NHS Providers' conversations with trust leaders this week indicate that trusts are now expecting operational pressures to be greater, and to arrive earlier, than they were planning a month, or even a fortnight, ago.

Although the letter stops short of arguing for a review of the proposed temporary relaxation of social contact rules over Christmas, it urges the prime minister to take a personal lead in ensuring a better public debate about the risks inherent in the guidance for 23 – 27 December.

Citing the recent surge in COVID-19 cases in the USA following Thanksgiving celebrations, it says a relaxation of restrictions on social contact, combined with the natural desire to come together for a traditional festival, will inevitably increase the spread of the virus. The letter says it's vital the public understands that any extra social contact, particularly with those who are vulnerable, even within the rules, is risky. It says people should think very carefully before finalising their Christmas plans.