Covid UK: Chief medical officers say NHS risks being ‘overwhelmed’

The UK’s chief medical officers have warned of a ‘material risk of the NHS being overwhelmed’ in the next 21 days as the mutant Covid strain wreaks havoc across the country.

Parts of the health service are under ‘immense pressure’, the chief medical officers for England, Scotland, Wales and Northern Ireland said in a joint statement on Monday.

Their letter saw Britain’s Covid alert level raised to five – its highest – for the first time since the pandemic began, meaning ‘transmission is high or rising exponentially’ and ‘there is a material risk of healthcare services being overwhelmed’.  

Boris Johnson warned that hospitals are 40 per cent busier than the first peak of the virus in April 2020 – as doctors liken working for in the NHS to being in a warzone.

Analysis has suggested that the UK could be facing 100,000 fatalities as early as February – while the number of people in hospital beds in London and the east have soared by 68 per cent since December 25.

The British Medical Association (BMA) welcomed the lockdown announced on Monday evening as it warned that hospitals are ‘stretched to breaking point’. 

In his address to the nation, Mr Johnson said: ‘Our hospitals are under more pressure from Covid than at any time since the start of the pandemic.

‘In England alone, the number of Covid patients has increased by nearly a third in the last week to almost 27,000.

‘That number is 40 per cent higher than the first peak in April.’

He said that across the UK, a record number of people tested positive for coronavirus on December 29 – around 80,000 people.  

Mr Johnson said that the number of deaths was up 20 per cent in the last seven days – and ‘will sadly rise further’. 

Meanwhile, there are currently 26,626 Covid patients in hospital in England, a 30 per cent rise on the week before.

The peak of admissions in the first wave of Coronavirus was 18,974 on April 12, 2020. 

The patients taking up more than a fifth of all beds – compared to a sixth in 2020. Staffing shortages caused by the latest wave have meant that hospitals could hit capacity sooner than they did previously. 

The 3,145 people admitted yesterday is 40 per cent more than the 3,099 admitted on April 1. 

The scale of the problem was underlined as the latest grim daily tally was released, with 58,784 new cases on Monday – a 42 per cent rise on the same day one week prior. 

It means the UK has passed the milestone of 50,000 infections every day for a week, suggesting that the easing of restrictions at Christmas helped fuel the outbreak.

Department of Health chiefs also posted 407 more deaths, up 14 per cent on the figure recorded last week. 

But it can take infected patients several weeks to fall severely ill and succumb to the illness, meaning fatalities have yet to reach their peak and will continue to rise. 

The UK recorded almost 1,000 deaths twice last week, in grisly tolls not seen since the darkest days of the spring.

A letter – written by the UK’s four CMOs and NHS England’s national medical director Professor Stephen Powis – ahead of Mr Johnson’s address – said: ‘Following advice from the Joint Biosecurity Centre and in the light of the most recent data, the four UK chief medical officers and NHS England medical director recommend that the UK alert level should move from Level 4 to Level 5.

‘Many parts of the health systems in the four nations are already under immense pressure. There are currently very high rates of community transmission, with substantial numbers of Covid patients in hospitals and in intensive care.

‘Cases are rising almost everywhere, in much of the country driven by the new more transmissible variant. We are not confident that the NHS can handle a further sustained rise in cases and without further action there is a material risk of the NHS in several areas being overwhelmed over the next 21 days.

‘Although the NHS is under immense pressure, significant changes have been made so people can still receive lifesaving treatment. 

‘It is absolutely critical that people still come forward for emergency care. If you require non-urgent medical attention, please contact your GP or call NHS 111.’ 

The medical officers are Professor Whitty (England), Dr Frank Atherton (Wales), Dr Gregor Smith (Scotland) and Dr Michael McBride (Northern Ireland). 

Level five indicates a risk of healthcare services being overwhelmed within 21 days without urgent action.

It does not mean the NHS will be overwhelmed in three weeks, but there is a risk of that happening if no action was taken. 

Senior doctors yesterday warned the NHS could soon ‘max out’ as infections continue to soar.

Dr Yvonne Doyle, Medical Director for Public Health England, said: ‘The continuous rise in cases and deaths should be a bitter warning for us all.’

NHS chiefs said the pressure on hospitals will keep increasing throughout January because infection rates are so high.

Intensive care nurses say they are already ‘stretched beyond breaking’, with the usual ratio of one nurse per patient relaxed so that nurses are caring for up to three patients.

The shortage of nurses also means that in some hospitals, including the Royal London, NHS consultants have stepped in to work shifts as ICU nurses.

Danny Mortimer, Chief Executive of the NHS Confederation which represents hospitals, said staff were making ‘compromises’ to standards of care due to the ‘relentless’ pressure.

He told the Mail: ‘[Hospitals] are taking their staff and spreading them more thinly. There will be two or three nurses looking after a ward of patients when normally there would be five or six.

‘There is probably not a critical care unit in the country that has a one-to-one ICU nurse to patient ratio. We have had to change that to cope with extra beds. Staff are making compromises.’

Thousands of non-urgent operations, such as knee or hip surgery, have been cancelled to free up space for virus patients.

Mr Mortimer added: ‘The level of pressure is impacting on other services as we have to protect the sickest and most urgent cases.

‘The elective work is cancelled first. It has stopped in London because the physical space is needed for Covid patients.

‘We’ve now had six days [in a row] at more than 50,000 confirmed infections. Our members are very very worried.

‘They know that rising infections leads to rising admissions, which leads to death and harm for patients.

‘They have to ask things of staff and make compromises to the standards of service the NHS can provide.

‘We expect it to keep getting worse through January and February, the current experience in London is going to be felt in rest of the country.

‘The NHS will cope, but we won’t be able to meet the standards of service that we would want to have in normal times.

‘There will be fewer staff, people waiting far longer and ambulance crews significantly delayed. Our teams will not allow the NHS to collapse but we need the help of the public.’

Dave Carr, an ICU nurse in London, said there were ‘scenes of real chaos and confusion and pressure inside hospitals’.

He added: ‘At the moment in the NHS in the ITUs, certainly in London, we’re over capacity.

‘Our intensive care units are stretched beyond breaking. In ITU’s across London, these nurses are looking after three patients on ventilators. It’s absolutely harrowing, it’s breaking us.’

Dr Nick Scriven, president of the Society for Acute Medicine, said: ‘Covid patients are requiring more and longer hospital care, not necessarily in intensive care units, so beds will fill up and stay filled for longer than in the spring/summer and if you add in even just a fraction of the ‘normal’ winter pressures, things could get dire quickly.

‘Also, when you factor in that any “surge” due to Christmas mixing might only just have started to happen, it could get extremely difficult over the next 10 to 21 days as the effects of people catching Covid over Christmas/New Year become apparent.

‘Additionally it feels that Covid sweeps up and down the country in waves – first spring wave in London or the Midlands, autumn second wave North and now the third wave again in London and the south east.

‘The new variant seems to be creeping up the country week-by-week and it is a race against time to get the vulnerable (and staff) vaccinated before the rolling waves hit up in the North again.

‘While I think the NHS could well reach a “maxed ou” stage, that will really manifest itself in the cancellation of all non-acute work (operations/clinics) causing further chaos to those waiting for treatment.

‘I hope and think the acute care will be delivered but it can and is going to be like April and May again all over before, hopefully, the vaccine starts to attenuate this by Easter.’ 

Following Mr Johnson’s earlier address, Professor Whitty tweeted: ‘Covid cases are rising rapidly across the UK in large part due to the new variant.

‘The NHS is treating many more Covid patients and vaccinating vulnerable citizens. NHS staff deserve our profound thanks. But we must act now or the NHS will come under even greater pressure.’

Dr Chaand Nagpaul, BMA council chair, said: ‘It’s clear that we need a major intervention to bring down the spread of this virus, especially the new more aggressive variant, given that the NHS in on the brink – currently facing exponential demand for care beyond what can be supplied in many places.

‘Hospitals are stretched to breaking point, with doctors reporting unbearable workloads as they take on more Covid-19 admissions alongside the growing backlog of people who need other, non-Covid care.

‘Doctors are desperate, with some even comparing their working environment to a warzone as wards overflow, waiting lists grow, and ambulances queue outside hospitals because there are now so many people with Covid-19.

‘As a result, the NHS is currently facing a perfect storm of immense workload and staff burnout and more cases expected as we see the impact of Christmas on infection rates.

‘The vaccination of healthcare workers needs to be significantly sped up so that health and care staff across the country are prioritised to receive both the first and second doses of the Covid-19 vaccine to help keep them free of the virus, so they can continue to provide the care so vitally needed by so many.’ 

Chief executive of the hospitals’ group NHS Providers Chris Hopson told The Times yesterday: ‘Hospitals are filling up with Covid patients at a deeply alarming rate.’

He said figures are now ‘equivalent to 18 hospitals full of new Covid patients in just ten days’.

He added: ‘Speaking to NHS trust leaders across the country today, and looking at today’s statistics on the number of beds occupied by Covid-19 patients, it’s clear we have reached a critical point where immediate and decisive action is now needed to stem the rapidly rising rate of infections, hospital admissions and deaths.’

NHS figures yesterday revealed that a record number of very-sick patients waited on trolleys in A&E during December.

The data, seen by the Health Service Journal, shows that more than 2,930 people spent at least 12 hours in A&E departments. Nearly half of these were in London.

The previous highest number of 12-hour trolley waits – the time between arriving at A&E and receiving a bed – was 2,847 in January 2020. The wait is usually down to staff shortages on top of a lack of space.

On Sunday, it was revealed that trusts in London and the south-east at the centre of the UK’s epidemic are preparing to transfer patients to hospitals in the south-west while patients in the east of England will be moved to the Midlands.

The massive Nightingale hospital at the London Excel Centre, which was created in record-time early in the pandemic only to be swiftly mothballed, is also expected to reopen within a fortnight, the Times reports.

National pairing arrangements have been put in place amid warnings from doctors that hospitals in the South have come under ‘immense pressure’ due to a surge in cases of ‘mutant’ Covid, with hospitals across the UK being told prepare to face the same Covid pressures as the NHS in the capital.

Chris Hopson, chief executive of NHS Providers, said just a small number of patients from London would be transferred to the south-west and Midlands when space in neighbouring hospitals was exhausted.

He said: ‘Hospitals are doing a great job creating extra surge capacity in London and the south-east to treat the critically ill. If it gets more difficult, we will find other ways to treat people within the region but we know there are some patients that can be moved to where the pressure is slightly less, for example the south-west and Midlands.’

Dr Alison Pittard, the dean of the Faculty of Intensive Care Medicine, hinted the NHS could collapse because ‘very, very tired staff’ may not have the energy to handle the deluge in ‘mutant’ virus cases.

Speaking on the BBC’s Andrew Marr Show, she also claimed that she had heard of cases of people as young as 30 suffering from coronavirus in ICU wards and claimed that ‘younger people will die from Covid’. 

Although ICU capacity has been increased, three intensive care units were full every day last week: the Walton Centre in north-west England, and Maidstone and Tunbridge Wells and Portsmouth University hospitals in the south-east.

Fourteen intensive care units were at least 95 per cent full throughout Christmas week, five of them in London, according to the Times.

Doctors who spoke on condition of anonymity told the newspaper how consultants were choosing who to admit to intensive care by assessing which patient ‘has the best chance of surviving’.

One GP working in a west London hospital claimed: ‘We could be like Lombardy [northern Italy] by next week. There is a high likelihood we’re going to see a disaster.’

Dr Megan Smith, a consultant anaesthetist at Guy’s and St Thomas’ NHS Foundation Trust, said medics faced ‘horrifying’ decisions with patients ‘in competition’ for ventilators.

She told ITN: ‘It’s not a position any of us ever want to be in, and we’re used to making difficult decisions as doctors, but deciding the outcome of, effectively a competition for a ventilator, is just not what anyone signed up for.

‘In terms of the emotional trauma for those individuals, it’s horrifying. We shouldn’t be having to do it, but we are.’

Asked about the hospitals crisis in London and the surrounding areas, Dr Pittard said the trusts are ‘under immense pressure’.

‘It’s really difficult for staff because obviously we want to make sure everyone is cared for, but also need to look after the staff as well,’ she said. ‘So it’s really difficult for everyone working in NHS hospitals at the moment, particularly in my area of intensive care.’

She also admitted that the NHS would have to postpone ‘some of the more non-urgent stuff’, adding: ‘obviously that is one of the ways the NHS managed in the first wave, was to reduce the normal activity so that we could focus on Covid patients.

‘One of the things that we have done now during the second wave is to continue normal activity alongside other Covid-related activity. And we want to continue that at all costs… but of course some of the more non-urgent stuff will need to be postponed’.

Dr Pittard also revealed that NHS hospitals are seeing greater numbers of younger people being admitted for treatment than during the first wave of the epidemic last spring.

‘The age group is a lot lower than it was during the first wave, and I think that’s probably because more people are getting Covid and it is affecting younger people, perhaps younger people are realising how serious it is and they need to seek input as well,’ she told the Andrew Marr Show.

‘It does affect younger people, so just because you’re not in the older age bracket doesn’t mean you’re immune.’

She went on: ‘One of the downsides is that because we have been through it all before staff are very, very tired and that is the thing that concerns me.

‘We can’t just create staff overnight. We can get more drugs. We can get more beds and equipment but we can’t just get more staff, so that is the real concern this time around.’

Having dealt with the first wave of the virus, staff are now better prepared in terms of how they manage patients when they come into hospital and how their treatment in intensive care, she said.

‘It is almost like we know what is coming our way so we know how to deal with it.’

And hospitals across the country are being told they should be prepared to face the same pressure as the NHS in London and south-east England.

Professor Andrew Goddard, president of the Royal College of Physicians, said the virus’s highly infectious new variant was spreading nationwide. 

He said the 50,000-per-day figures are ‘mild’ compared compared to what he thinks will come next week and warned that doctors are ‘really worried’ about the coming months. 

‘There’s no doubt that Christmas is going to have a big impact, the new variant is also going to have a big impact, we know that is more infectious, more transmissible, so I think the large numbers that we’re seeing in the South East, in London, in South Wales, is now going to be reflected over the next month, two months even, over the rest of the country,’ he told BBC Breakfast yesterday.

Prof Goddard added: ‘All hospitals that haven’t had the big pressures that they’ve had in the South East, and London and South Wales, should expect that it’s going to come their way.

‘This new variant is definitely more infectious and is spreading across the whole of the country. It seems very likely that we are going to see more and more cases, wherever people work in the UK, and we need to be prepared for that.’ 

What you can and cannot do during the national lockdown: The government guidelines in full

You must stay at home. The single most important action we can all take is to stay at home to protect the NHS and save lives.

You should follow this guidance immediately. The law will be updated to reflect these new rules.

Leaving home

You must not leave, or be outside of your home except where necessary. You may leave the home to:

• shop for basic necessities, for you or a vulnerable person
• go to work, or provide voluntary or charitable services, if you cannot reasonably do so from home
• exercise with your household (or support bubble) or one other person, this should be limited to once per day, and you should not travel outside your local area.
• meet your support bubble or childcare bubble where necessary, but only if you are legally permitted to form one
• seek medical assistance or avoid injury, illness or risk of harm (including domestic abuse)
• attend education or childcare – for those eligible

Colleges, primary and secondary schools will remain open only for vulnerable children and the children of critical workers. All other children will learn remotely until February half term. Early Years settings remain open.

Higher Education provision will remain online until mid February for all except future critical worker courses.

If you do leave home for a permitted reason, you should always stay local in the village, town, or part of the city where you live. You may leave your local area for a legally permitted reason, such as for work.

If you are clinically extremely vulnerable you should only go out for medical appointments, exercise or if it is essential. You should not attend work

Meeting others

You cannot leave your home to meet socially with anyone you do not live with or are not in a support bubble with (if you are legally permitted to form one).

You may exercise on your own, with one other person, or with your household or support bubble.

You should not meet other people you do not live with, or have formed a support bubble with, unless for a permitted reason.

Stay 2 metres apart from anyone not in your household.

Detailed guidance on the national lockdown

Who this guidance is for

This guidance is for people who are fit and well. There is additional advice for people who are clinically extremely vulnerable to coronavirus and households with a possible or confirmed coronavirus infection. If you are clinically extremely vulnerable you should not attend work, school, college or university, and limit the time you spend outside the home. You should only go out for medical appointments, exercise or if it is essential.

Hands. Face. Space.

Approximately 1 in 3 people who have coronavirus have no symptoms and could be spreading it without realising it.

Remember – ‘Hands. Face. Space.’

• hands – wash your hands regularly and for at least 20 seconds
• face – wear a face covering in indoor settings where social distancing may be difficult, and where you will come into contact with people you do not normally meet
• space – stay 2 metres apart from people you do not live with where possible, or 1 metre with extra precautions in place (such as wearing face coverings)

In all circumstances, you should follow the guidance on meeting others safely.

When you can leave home

You must not leave or be outside of your home except where you have a ‘reasonable excuse’. This will be put in law. The police can take action against you if you leave home without a ‘reasonable excuse’, and issue you with a fine (Fixed Penalty Notice).

You can be given a Fixed Penalty Notice of £200 for the first offence, doubling for further offences up to a maximum of £6,400.

A ‘reasonable excuse’ includes:

• Work – you can only leave home for work purposes where it is unreasonable for you to do your job from home, including but not limited to people who work within critical national infrastructure, construction or manufacturing that require in-person attendance
• Volunteering – you can also leave home to provide voluntary or charitable services.
• Essential activities – you can leave home to buy things at shops or obtain services. You may also leave your home to do these things on behalf of a disabled or vulnerable person or someone self-isolating.
• Education and childcare – You can only leave home for education, registered childcare, and supervised activities for children where they are eligible to attend. Access to education and children’s activities for school-aged pupils is restricted. See further information on education and childcare. People can continue existing arrangements for contact between parents and children where they live apart. This includes childcare bubbles.
• Meeting others and care – You can leave home to visit people in your support bubble ( if you are legally permitted to form one), to provide informal childcare for children under 14 as part of a childcare bubble (for example, to enable parents to work, and not to enable social contact between adults), to provide care for disabled or vulnerable people, to provide emergency assistance, to attend a support group (of up to 15 people), or for respite care where that care is being provided to a vulnerable person or a person with a disability, or is a short break in respect of a looked-after child.
• Exercise – You can continue to exercise alone, with one other person or with your household or support bubble. This should be limited to once per day, and you should not travel outside your local area.You should maintain social distancing. See exercising and meeting other people.
• Medical reasons – You can leave home for a medical reason, including to get a COVID-19 test, for medical appointments and emergencies.
• Harm and compassionate visits – you can leave home to be with someone who is giving birth, to avoid injury or illness or to escape risk of harm (such as domestic abuse). You can also leave home to visit someone who is dying or someone in a care home (if permitted under care home guidance), hospice, or hospital, or to accompany them to a medical appointment.
• Animal welfare reasons – you can leave home for animal welfare reasons, such as to attend veterinary services for advice or treatment.
• Communal worship and life events – You can leave home to attend or visit a place of worship for communal worship, a funeral or event related to a death, a burial ground or a remembrance garden, or to attend a wedding ceremony. You should follow the guidance on the safe use of places of worship and must not mingle with anyone outside of your household or support bubble when attending a place of worship.Weddings, funerals and religious, belief-based or commemorative events linked to someone’s death are all subject to limits on the numbers that can attend, and weddings and civil ceremonies may only take place in exceptional circumstances.

There are further reasonable excuses. For example, you may leave home to fulfil legal obligations or to carry out activities related to buying, selling, letting or renting a residential property, or where it is reasonably necessary for voting in an election or referendum.

Exercising and meeting other people

You should minimise time spent outside your home.

It is against the law to meet socially with family or friends unless they are part of your household or support bubble. You can only leave your home to exercise, and not for the purpose of recreation or leisure (e.g. a picnic or a social meeting). This should be limited to once per day, and you should not travel outside your local area.

You can exercise in a public outdoor place:

• by yourself
• with the people you live with
• with your support bubble (if you are legally permitted to form one)
• in a childcare bubble where providing childcare
• or, when on your own, with 1 person from another household
• Public outdoor places include:
• parks, beaches, countryside accessible to the public, forests
• public gardens (whether or not you pay to enter them)
• the grounds of a heritage site
• playgrounds

Outdoor sports venues, including tennis courts, golf courses and swimming pools, must close.

When around other people, stay 2 metres apart from anyone not in your household – meaning the people you live with – or your support bubble. Where this is not possible, stay 1 metre apart with extra precautions (e.g. wearing a face covering).

You must wear a face covering in many indoor settings, such as shops or places of worship where these remain open, and on public transport, unless you are exempt. This is the law. Read guidance on face coverings.

Support and childcare bubbles

You have to meet certain eligibility rules to form a support or childcare bubble. This means not everyone will be able to form a bubble.

A support bubble is a support network which links two households. You can form a support bubble with another household of any size only if you meet the eligibility rules.

It is against the law to form a support bubble if you do not follow these rules.

You are permitted to leave your home to visit your support bubble (and to stay overnight with them). However, if you form a support bubble, it is best if this is with a household who live locally. This will help prevent the virus spreading from an area where more people are infected.

If you live in a household with anyone aged under 14, you can form a childcare bubble. This allows friends or family from one other household to provide informal childcare.

You must not meet socially with your childcare bubble, and must avoid seeing members of your childcare and support bubbles at the same time.

There is separate guidance for support bubbles and childcare bubbles.

Where and when you can meet in larger groups

There are still circumstances in which you are allowed to meet others from outside your household, childcare or support bubble in larger groups, but this should not be for socialising and only for permitted purposes. A full list of these circumstances will be included in the regulations, and includes:

• for work, or providing voluntary or charitable services, where it is unreasonable to do so from home. This can include work in other people’s homes where necessary – for example, for nannies, cleaners, social care workers providing support to children and families, or tradespeople. See guidance on working safely in other people’s homes). Where a work meeting does not need to take place in a private home or garden, it should not – for example, although you can meet a personal trainer, you should do so in a public outdoor place.
• in a childcare bubble (for the purposes of childcare only)
• Where eligible to use these services, for education, registered childcare, and supervised activities for children. Access to education and childcare facilities is restricted. See further information on education and childcare.
• for arrangements where children do not live in the same household as both their parents or guardians
• to allow contact between birth parents and children in care, as well as between siblings in care
• for prospective adopting parents to meet a child or children who may be placed with them
• to place or facilitate the placing of a child or children in the care of another by social services
• for birth partners
• to provide emergency assistance, and to avoid injury or illness, or to escape a risk of harm (including domestic abuse)
• to see someone who is dying
• to fulfil a legal obligation, such as attending court or jury service
• for gatherings within criminal justice accommodation or immigration detention centres
• to provide care or assistance to someone vulnerable, or to provide respite for a carer
• for a wedding or equivalent ceremony in exceptional circumstances and only for up to 6 people
• for funerals – up to a maximum of 30 people. Wakes and other linked ceremonial events can continue in a group of up to 6 people.
• to visit someone at home who is dying, or to visit someone receiving treatment in a hospital, hospice or care home, or to accompany a family member or friend to a medical appointment
• for elite sportspeople (and their coaches if necessary, or parents/guardians if they are under 18) – or those on an official elite sports pathway – to compete and train
• to facilitate a house move

Support groups that have to be delivered in person can continue with up to 15 participants where formally organised to provide mutual aid, therapy or any other form of support – but they must take place at a premises other than a private home.

Where a group includes someone covered by an exception (for example, someone who is working or volunteering), they are not generally counted as part of the gatherings limit. This means, for example, a tradesperson can go into a household without breaching the limit, if they are there for work, and the officiant at a wedding would not count towards the limit.

If you break the rules

The police can take action against you if you meet in larger groups. This includes breaking up illegal gatherings and issuing fines (fixed penalty notices).

You can be given a Fixed Penalty Notice of £200 for the first offence, doubling for further offences up to a maximum of £6,400. If you hold, or are involved in holding, an illegal gathering of over 30 people, the police can issue fines of £10,000.

Protecting people more at risk from coronavirus

If you are clinically vulnerable, you could be at higher risk of severe illness from coronavirus. There is additional advice for people who are clinically extremely vulnerable to coronavirus. Those who are clinically extremely vulnerable should not attend work, school, college or university, and limit the time you spend outside the home. You should only go out for medical appointments, exercise or if it is essential.

Travel

You must not leave your home unless you have a reasonable excuse (for example, for work or education purposes). If you need to travel you should stay local – meaning avoiding travelling outside of your village, town or the part of a city where you live – and look to reduce the number of journeys you make overall. The list of reasons you can leave your home and area include, but are not limited to:

• work, where you cannot reasonably work from home
• accessing education and for caring responsibilities
• visiting those in your support bubble – or your childcare bubble for childcare
• visiting hospital, GP and other medical appointments or visits where you have had an accident or are concerned about your health
• buying goods or services that you need, but this should be within your local area wherever possible
• outdoor exercise. This should be done locally wherever possible, but you can travel a short distance within your area to do so if necessary (for example, to access an open space)
• attending the care and exercise of an animal, or veterinary services

If you need to travel, walk or cycle where possible, and plan ahead and avoid busy times and routes on public transport. This will allow you to practice social distancing while you travel.

Avoid car sharing with anyone from outside your household or your support bubble. See the guidance on car sharing.

If you need to use public transport, you should follow the safer travel guidance.

International travel

You can only travel internationally – or within the UK – where you first have a legally permitted reason to leave home. In addition, you should consider the public health advice in the country you are visiting.

If you do need to travel overseas (and are legally permitted to do so, for example, because it is for work), even if you are returning to a place you’ve visited before, you should look at the rules in place at your destination and the Foreign, Commonwealth and Development Office (FCDO) travel advice.

UK residents currently abroad do not need to return home immediately. However, you should check with your airline or travel operator on arrangements for returning.

Foreign nationals are subject to the ‘Stay at Home’ regulations. You should not travel abroad unless it is permitted. This means you must not go on holiday.

If you are visiting the UK, you may return home. You should check whether there are any restrictions in place at your destination.

Staying away from home overnight

You cannot leave your home or the place where you are living for holidays or overnight stays unless you have a reasonable excuse for doing so. This means that holidays in the UK and abroad are not allowed.

This includes staying in a second home or caravan, if that is not your primary residence. This also includes staying with anyone who you don’t live with unless they’re in your support bubble.

You are allowed to stay overnight away from your home if you:

• are visiting your support bubble
• are unable to return to your main residence
• need accommodation while moving house
• need accommodation to attend a funeral or related commemorative event
• require accommodation for work purposes or to provide voluntary services
• are a child requiring accommodation for school or care
• are homeless, seeking asylum, a vulnerable person seeking refuge, or if escaping harm (including domestic abuse)
• are an elite athlete or their support staff or parent, if the athlete is under 18 and it is necessary to be outside of the home for training or competition

If you are already on holiday, you should return to your home as soon as practical.

Guest accommodation providers such as hotels, B&Bs and caravan parks may remain open for the specific reasons set out in law, including where guests are unable to return to their main residence, use that guest accommodation as their main residence, need accommodation while moving house, are self-isolating as required by law, or would otherwise be made homeless as a result of the accommodation closing. A full list of reasons can be found in the guidance on closing certain businesses and venues in England.

Accommodation providers are also encouraged to work cooperatively with local authorities to provide accommodation to vulnerable groups, including the homeless.

Going to work

You may only leave your home for work if you cannot reasonably work from home.

Where people cannot work from home – including, but not limited to, people who work in critical national infrastructure, construction, or manufacturing – they should continue to travel to their workplace. This is essential to keeping the country operating and supporting sectors and employers.

Public sector employees working in essential services, including childcare or education, should continue to go into work.

Where it is necessary for you to work in other people’s homes – for example, for nannies, cleaners or tradespeople – you can do so. Otherwise, you should avoid meeting for work in a private home or garden, where COVID-19 Secure measures may not be in place.

Employers and employees should discuss their working arrangements, and employers should take every possible step to facilitate their employees working from home, including providing suitable IT and equipment to enable remote working.

The risk of transmission can be substantially reduced if COVID-19 secure guidelines are followed closely. Extra consideration should be given to those people at higher risk.

Going to school, college and university

Colleges, primary (reception onwards) and secondary schools will remain open for vulnerable children and the children of critical workers. All other children will learn remotely until February half term.

In the circumstances, we do not think it is possible for all exams in the summer to go ahead as planned. We will accordingly be working with Ofqual to consult rapidly to put in place alternative arrangements that will allow students to progress fairly.

Public exams and vocational assessments scheduled to take place in January will go ahead as planned.

Universities

Those students who are undertaking training and study for the following courses should return to face to face learning as planned and be tested twice, upon arrival or self-isolate for ten days:

• Medicine & dentistry
• Subjects allied to medicine/health
• Veterinary science
• Education (initial teacher training)
• Social work
• Courses which require Professional, Statutory and Regulatory Body (PSRB) assessments and or mandatory activity which is scheduled for January and which cannot be rescheduled (your university will notify you if this applies to you).

Students who do not study these courses should remain where they are wherever possible, and start their term online, as facilitated by their university until at least Mid-February. This includes students on other practical courses not on the list above.

We have previously published guidance to universities and students on how students can return safely to higher education in the spring term. This guidance sets out how we will support higher education providers to enable students that need to return to do so as safely as possible following the winter break.

If you live at university, you should not move back and forward between your permanent home and student home during term time.

For those students who are eligible for face to face teaching, you can meet in groups of more than your household as part of your formal education or training, where necessary. Students should expect to follow the guidance and restrictions. You should socially distance from anyone you do not live with wherever possible.

Childcare

There are several ways that parents and carers can continue to access childcare:

• Early Years settings (including nurseries and childminders) remain open
• Vulnerable children and children of critical workers can continue to use registered childcare, childminders and other childcare activities (including wraparound care)
• parents are able to form a childcare bubble with one other household for the purposes of informal childcare, where the child is under 14. This is mainly to enable parents to work, and must not be used to enable social contact between adults
• some households will also be able to benefit from being in a support bubble
• nannies will be able to continue to provide services, including in the home

Care home visits

Visits to care homes can take place with arrangements such as substantial screens, visiting pods, or behind windows. Close-contact indoor visits are not allowed. No visits will be permitted in the event of an outbreak.

You should check the guidance on visiting care homes during COVID-19 to find out how visits should be conducted. Residents cannot meet people indoors on a visit out (for example, to visit their relatives in the family home). There is separate guidance for those in supported living.

Weddings, civil partnerships, religious services and funerals

Weddings, civil partnership ceremonies and funerals are allowed with strict limits on attendance, and must only take place in COVID-19 secure venues or in public outdoor spaces unless in exceptional circumstances.

Funerals can be attended by a maximum of 30 people. Linked religious, belief-based or commemorative events, such as stone settings and ash scatterings can also continue with up to 6 people in attendance. Anyone working is not counted in these limits. Social distancing should be maintained between people who do not live together or share a support bubble.

Weddings and civil partnership ceremonies must only take place with up to 6 people. Anyone working is not included. These should only take place in exceptional circumstances, for example, an urgent marriage where one of those getting married is seriously ill and not expected to recover, or is to undergo debilitating treatment or life-changing surgery.

Places of worship

You can attend places of worship for a service. However, you must not mingle with anyone outside of your household or support bubble. You should maintain strict social distancing at all times.

You should follow the national guidance on the safe use of places of worship.

Sports and physical activity

Indoor gyms and sports facilities will remain closed. Outdoor sports courts, outdoor gyms, golf courses, outdoor swimming pools, archery/driving/shooting ranges and riding arenas must also close. Organised outdoor sport for disabled people is allowed to continue.

Moving home

You can still move home. People outside your household or support bubble should not help with moving house unless absolutely necessary.

Estate and letting agents and removals firms can continue to work. If you are looking to move, you can go to property viewings.

Follow the national guidance on moving home safely, which includes advice on social distancing, letting fresh air in, and wearing a face covering.

Financial support

Wherever you live, you may be able to get financial help  

Businesses and venues

Businesses and venues which must close

To reduce social contact, the regulations require some businesses to close and impose restrictions on how some businesses provide goods and services. The full list of businesses required to close can be found in the guidance on closing certain businesses and venues in England, but includes:

• non-essential retail, such as clothing and homeware stores, vehicle showrooms (other than for rental), betting shops, tailors, tobacco and vape shops, electronic goods and mobile phone shops, auction houses (except for auctions of livestock or agricultural equipment) and market stalls selling non-essential goods. These venues can continue to be able to operate click-and-collect (where goods are pre-ordered and collected off the premises) and delivery services.
• hospitality venues such as cafes, restaurants, pubs, bars and social clubs; with the exception of providing food and non-alcoholic drinks for takeaway (until 11pm), click-and-collect and drive-through. All food and drink (including alcohol) can continue to be provided by delivery.
• accommodation such as hotels, hostels, guest houses and campsites, except for specific circumstances, such as where these act as someone’s main residence, where the person cannot return home, for providing accommodation or support to the homeless, or where it is essential to stay there for work purposes
• leisure and sports facilities such as leisure centres and gyms, swimming pools, sports courts,fitness and dance studios, riding arenas at riding centres, climbing walls, and golf courses.
• entertainment venues such as theatres, concert halls, cinemas, museums and galleries, casinos, amusement arcades, bingo halls, bowling alleys, skating rinks, go-karting venues, indoor play and soft play centres and areas (including inflatable parks and trampolining centres), circuses, fairgrounds, funfairs, water parks and theme parks
• animal attractions (such as zoos, safari parks, aquariums, and wildlife reserves)
• indoor attractions at venues such as botanical gardens, heritage homes and landmarks must also close, though outdoor grounds of these premises can stay open for outdoor exercise.
• personal care facilities such as hair, beauty, tanning and nail salons. Tattoo parlours, spas, massage parlours, body and skin piercing services must also close. These services should not be provided in other people’s homes
• community centres and halls must close except for a limited number of exempt activities, as set out below. Libraries can also remain open to provide access to IT and digital services – for example for people who do not have it at home – and for click-and-collect services

Some of these businesses and places will also be permitted to be open for a small number of exempt activities. A full list of exemptions can be found in the guidance on closing certain businesses and venues in England, but includes:

• education and training – for schools to use sports, leisure and community facilities where that is part of their normal provision
• childcare purposes and supervised activities for those children eligible to attend
• hosting blood donation sessions and food banks
• to provide medical treatment
• for elite sports persons to train and compete (in indoor and outdoor sports facilities), and professional dancers and choreographers to work (in fitness and dance studios)
• for training and rehearsal without an audience (in theatres and concert halls)
• for the purposes of film and TV filming

Businesses and venues which can remain open

Other businesses and venues are permitted to stay open, following COVID-19 secure guidelines. Businesses providing essential goods and services can stay open. The full list of these businesses can be found in the guidance on closing certain businesses and venues in England, but includes:

• essential retail such as food shops, supermarkets, pharmacies, garden centres, building merchants and suppliers of building products and off-licences
• market stalls selling essential retail may also stay open
• businesses providing repair services may also stay open, where they primarily offer repair services
• petrol stations, automatic (but not manual) car washes, vehicle repair and MOT services, bicycle shops, and taxi and vehicle hire businesses
• banks, building societies, post offices, short-term loan providers and money transfer businesses
• funeral directors
• laundrettes and dry cleaners
• medical and dental services
• vets and retailers of products and food for the upkeep and welfare of animals
• animal rescue centres, boarding facilities and animal groomers (may continue to be used for animal welfare, rather than aesthetic purposes)
• agricultural supplies shops
• mobility and disability support shops
• storage and distribution facilities
• car parks, public toilets and motorway service areas
• outdoor playgrounds
• outdoor parts of botanical gardens and heritage sites for exercise
• places of worship
• crematoriums and burial grounds

Public services

The majority of public services will continue and you will be able to leave home to visit them. These include:

• the NHS and medical services like GPs and dentists. We are supporting the NHS to carry out urgent and non-urgent services safely, and it is vital anyone who thinks they need any kind of medical care comes forward and seeks help
• Jobcentre Plus sites
• courts and probation services
• civil registrations offices
• passport and visa services
• services provided to victims
• waste or recycling centres
• getting an MOT, if you need to drive when lawfully leaving home