Relaxing Covid restrictions could trigger a third wave of the virus during the busiest time of year for hospitals, NHS bosses have warned.
In a letter to the PM, NHS Providers, which represents hospital trusts in England, urged “extreme caution” in moving any area to a lower tier.
England’s three-tier system is due to be reviewed on 16 December.
The government said it “will not hesitate to take necessary actions to protect local communities”.
Decisions on tiers are made by ministers, based on the latest available data and advice from public health experts, a spokesperson added.
On Saturday the UK reported a further 519 deaths within 28 days of a positive Covid test and 21,502 new cases.
Chris Hopson, chief executive of NHS Providers, told the BBC: “We’re about to hit our busiest time of year so people are really worried that if we relax the restrictions now the NHS simply won’t be able to cope with all of the work that it needs to do in late December, January and February.”
He told BBC Breakfast that the NHS currently has 10,000 fewer beds than last winter, because of Covid rules meaning beds must be socially distanced.
“At the same time you’ve got rising infections in places like London, Essex, parts of Kent, parts of Lincolnshire,” he said.
‘Move areas to Tier 3’
In its letter to Prime Minister Boris Johnson, NHS Providers called for areas to be moved into tier three – the highest level of restrictions – “as soon as this is needed, without any delay”.
Earlier this week, some health experts called for the capital to be placed in tier three “now” after official figures showed Outer London had a higher infection rate than some areas already in the top tier.
NHS Providers added that “the evidence of the second wave suggests that unless infection rates fall to a very low level, as they did in London after the first wave, the virus will spread again quickly as soon as restrictions on social contact are relaxed”.
“Trust leaders are worried that if infection rates remain as high as they are at the moment, relaxing the restrictions will trigger a third wave,” it said.
The letter warned of “significant pressure” on hospital beds, with 13,000 patients in hospital with Covid-19 on Thursday, compared with 500 at the beginning of September.
“Over each of the last five winters, demand for NHS beds has significantly outstripped capacity,” it said.
“Yet we are now facing the extremely concerning prospect of the NHS having 10,000 fewer beds (9%) in operation than last year, due to infection control measures, and many thousands of the remaining beds occupied by Covid-19 patients.”
A government spokesperson said: “We have introduced strengthened local restrictions to protect the progress gained during national restrictions, reduce pressure on the NHS and ultimately save lives.
“On top of our record NHS investment, this winter we are providing an extra £3bn to maintain independent sector and Nightingale hospital surge capacity and a further £450m to upgrade and expand A&Es.”
Although the letter stopped short of arguing for a review of the temporary relaxation of restrictions over Christmas, Mr Hopson called for a “different debate” about the risks involved.
“I don’t want to be the Grinch who stole Christmas, I really don’t, but I think everybody needs to think really, really carefully what are they going to do over Christmas,” said Mr Hopson.
Rather than people asking themselves what they can do within the rules, they should be thinking about the risk they are causing to others, he added.
Between 23 and 27 December, three households will be able to form a “bubble”, allowing them to mix indoors and stay overnight.
The rise in infections in the US after the Thanksgiving holiday has also been highlighted by experts, who have warned the same could happen in the UK after Christmas.
“If we have that kind of thing happening over the Christmas holidays in this country – with very high transmission rates then possible in January – it’s going to take so much longer to get things back to normal, because partly all the vaccination clinics will be disrupted,” said Prof Sarah Gilbert, the architect of the Oxford University vaccine.
She told the BBC’s Andrew Marr show: “Hopefully we can be more or less back to normal by the summer but that’s not going to be possible if we’re starting from a very bad position in January.”
NHS Providers warned: “The prevailing public perception is: ‘Thank goodness we can celebrate Christmas.’ We believe it is vital for the public to understand that any extra social contact, particularly with those who are vulnerable to the effects of the virus, is risky and that they need to think very carefully before initiating such contact over the Christmas period.”
A government spokesperson said: “We know that Christmas cannot be normal this year, but we have worked closely with devolved administrations to reach agreement on a single set of UK-wide measures to help people come together with their loved ones in a way that is as safe as possible.”
