Local action is vital to our strategy of suppressing the virus, while protecting the economy, education and the NHS, until a vaccine can make us safe. Help is on its way thanks to the rollout of a safe and effective vaccine, but we are not there yet.
While we have moved to a localised approach through the tiers system, we have been clear that these must be tough, recognising that case rates are rising in many areas of the country, and our knowledge that the winter months are the most challenging for our NHS.
We have assessed each area individually, and as Monday’s decisions on Essex and today’s decisions on Waverley and parts of Hampshire show, we are prepared to move at a more localised level where the data and human geographies permit.
As set out in the COVID-19 winter plan, there are 5 indicators which guide our decisions for any given area, alongside consideration of ‘human geographies’ like travel patterns.
These are:
case detection rates in all age groups
case detection rates in the over 60s
the rate at which cases are rising or falling
positivity rate (the number of positive cases detected as a percentage of tests taken)
pressure on the NHS
While each metric is important in its own right, the interplay between each indicator for a given area is equally important, so a hard and fast numerical threshold on each metric is not appropriate. These are not easy decisions, but they have been made according to the best clinical advice, and the best possible data from the JBC.
The regulations will require the government to review the allocations at least every 14 days. We will also take urgent action when the data suggests it is required, as we did on Monday.
The first formal review took place yesterday, and the allocations and a detailed rationale is published below. I will also deposit the data packs used to inform these decisions in the libraries of both Houses.
These changes will be implemented from 00:01 on 19 December. This list will also be published on GOV.UK and a postcode checker will be available for the public to check what rules apply in their local area.
Area allocation tables
At the end of national restrictions case rates across England were falling. However, the most recent data now indicates that case rates are now stabilising or increasing across a large number of areas. Case rates in areas of northern England, which have previously been declining from very high levels are now flattening. There is a worsening and concerning epidemiological picture in London and parts of the South East and East of England.
We should not underestimate the challenge of the weeks ahead. Winter also brings additional challenges — rates are higher than they were in the summer, the colder season increases the transmission risk (people are more likely to be inside), the risk from other respiratory diseases is higher and pressures on the NHS are therefore inherently greater.
De-escalating areas now will likely lead to rising case numbers, and risks areas being rapidly re-escalated in December or in the new year. As a result a cautious public health approach has been adopted.
North West
Area Reason
Cheshire and Warrington
Tier 2 (High)
Since the end of national restrictions cases of the virus in Cheshire and Warrington have remained stable. Current case rates are broadly stable across Cheshire and Warrington though case rates in over 60s are increasing. Case rates remain greater than 100 per 100,000 in Warrington and Chester West and Chester. The epidemiology indicators remain too high for allocation to Tier 1, but do not justify inclusion at Tier 3.
COVID admissions in the Cheshire and Warrington area have reduced since the last review. The daily COVID bed occupancy is below the national acute hospital average and stable.
Cumbria
Tier 2 (High)
Since the end of national restrictions the situation in Cumbria has deteriorated from a relatively low numbers of cases. Case rates are broadly increasing across the region and have increased by more than 20% over the last 7 days in Barrow-in-Furness, South Lakeland, Carlisle and Eden. The epidemiology indicators remain too high for the area to be allocated to Tier 1, and while there is an upwards trajectory on some indicators in Barrow-in-Furness, South Lakeland, Carlisle and Eden, it does not currently justify inclusion in Tier 3.
COVID admissions, bed occupancy and critical care bed occupancy in the Cumbria and North East area are stable. In the Healthier Lancashire and South Cumbria STP there has been a slow increase in COVID admissions over the last 14 days. The daily COVID bed occupancy is above the national acute hospital average and continues to rise.
Greater Manchester
Tier 3 (Very High)
Since the end of national restrictions the situation in Greater Manchester has remained stable. Case rates remain greater than 150 per 100,000 in Bury, Manchester, Oldham, Rochdale and Wigan. Case rates in over 60s are decreasing across the majority of the area but are above 150 per 100,000 in Bolton, Bury, Manchester, Oldham and Rochdale. Case rates are lowest in Tameside, Trafford and Stockport but the most recent data indicates that case rates are now plateauing or increasing, therefore any de-escalation of these areas would likely lead to cases increasing, particularly given the interconnectedness of these areas with the rest of Greater Manchester. Positivity remains high across the area but is falling. The epidemiology indicators remain too high for de-escalation to Tier 2.
COVID admissions in the Greater Manchester declining. Bed occupancy in line with the national average and critical care bed occupancy is not rising but remains high.
Lancashire
Tier 3 (Very High)
Since the end of national restrictions there is a mixed, concerning picture across Lancashire. While case rates have now stabilised they are increasing in some areas in the most recent data that is subject to upward revision. The local authorities with the highest case rates are those located in the east of Lancashire that neighbour the north of Greater Manchester and West Yorkshire (Burnley, Blackburn with Darwen, Pendle, Rossendale, Chorley). Case rates in over 60s are increasing in several areas and remain above 150 per 100,000 in Blackburn with Darwen, Blackpool, Burnley, Chorley, Preston, Ribble Valley, South Ribble, Hyndburn and Wyre. Lancaster and Fylde have the lowest case rates in the area at 98 and 93 per 100,000, respectively. Case rates for these two local authorities have decreased but the trajectory based on the latest data indicates that case rates are now starting to stabilise or increase, therefore any de-escalation of these areas would likely lead to cases increasing. The epidemiology indicators remain too high for de-escalation to Tier 2, as it could lead to rising case numbers.
The local NHS has seen a slow increase in COVID admissions over the last 14 days. The daily COVID hospital bed occupancy is above the national average and continues to rise.
Liverpool City Region
Tier 2 (High)
Since the end of national restrictions the situation in Liverpool City Region has broadly improved. Case rates have decreased and are stable, including in the most recent data in all local authorities apart from the Wirral where a small increase is seen. Case rates remain greater than 100 per 100,000 in Halton, Knowsley and St Helens. Case rates in over 60s are increasing in Halton and Knowsley. The epidemiology indicators are too high for the area to move down to Tier 1 but the trajectory does currently not warrant inclusion in Tier 3.
COVID admissions in the Cheshire and Merseyside STP are reducing. The daily COVID bed occupancy is below the national acute hospital average and stable.
North East
Area Reason
North East 7 (LA7)
Tier 3 (Very High)
Since the end of national restrictions, the overall picture in the North East 7 has remained stable and case rates are broadly decreasing in Gateshead, Newcastle, North Tyneside and Northumberland. However, case rates are high and continuing to rise in South Tyneside which has the highest case rate in the area (272 per 100,000) and is seeing a deterioration across all epidemiology indicators. Case rates is lowest in Gateshead (94 per 100,000) however the trajectory of some neighbouring local authorities is concerning, with increasing case rates, therefore de-escalation of this area would likely lead to cases further increasing, particularly given human travel patterns across the region. De-escalating areas now could lead to further rises in case numbers, and overall, the epidemiology indicators are still too high for the area to move down to Tier 2.
COVID admissions, bed occupancy and critical care bed occupancy in the Cumbria and North East STP are stable.
Tees Valley 5 Local Authorities
Tier 3 (Very High)
Since the end of national restrictions, the situation in the majority of local authorities in the area have remained stable however the overall picture remains concerning. Case rates are broadly stable across the area though increases of over 10% have been seen in Redcar and Cleveland and Middlesbrough. Case rates in over 60s are now increasing across Hartlepool, Middlesbrough and Redcar and Cleveland and remain high. De-escalation too early poses a risk that transmission of the virus will increase rapidly and that this area is only in Tier 2 for a very short period of time before potential re-escalation is needed. The epidemiology indicators remain too high for allocation to Tier 2 and their trajectory is not consistently decreasing.
COVID admissions, bed occupancy and critical care bed occupancy in the Cumbria and North East STP are stable.
London
Area Reason
London
Tier 3 (Very High)
Since the end of national restrictions, the situation in London has deteriorated. Case rates in all ages are greater than 200 per 100,000 in 18 of the 33 local authorities. Case rates in all ages are also continuing to increase across 32 of the 33 London local authorities; the case rate is increasing by 30% or more over the last 7 days in 24 London boroughs. Case rates in those aged 60 and over are above 100 per 100,000 in 27 of the 33 local authorities and are increasing in the majority of boroughs. Positivity has increased across the majority of boroughs. The epidemiological picture continues to deteriorate especially in the most recent incomplete data (that is subject to upwards revision). The overall case rate is increasing exponentially in London.
The rate of increase of the epidemiology indicators is concerning and under emergency measures taken this week warranted immediate allocation to Tier 3 of the 32 London Boroughs and the City of London. The epidemiological indicators in London continue to deteriorate and the whole of London should remain at Tier 3.
The number of daily COVID hospital admissions continues to rise in London.
Yorkshire and Humber
Area Reason
South Yorkshire
Tier 3 (Very High)
Since the end of national restrictions South Yorkshire has improved marginally but is still of concern. Case rates are decreasing in Barnsley, Doncaster and Sheffield but remain over 150 per 100,000 in those aged over 60 in Barnsley and Doncaster. Rotherham remains of concern with case rates in all ages and in over 60s remaining over 200 per 100,000. The epidemiology indicators remain too high for de-escalation to Tier 2.
While COVID admissions, bed occupancy and critical care bed occupancy in the area are not rising, they are above the national averages.
The Humber
Tier 3 (Very High)
There is an improving picture across the majority of The Humber. Case rates are decreasing in all four local authorities and by 10% or more over the last 7 days in three of them. The case rate in Kingston upon Hull remains very high though falling. Case rates in over 60s are decreasing across the majority of the area though are increasing and remain high in Kingston upon Hull. Case rates are lowest in North East Lincolnshire and East Riding of Yorkshire, however in the most recent data, cases in the local authorities are stabilising or increasing, which is also seen in neighbouring areas, therefore any de-escalation of these local authorities would likely lead to cases increasing. Overall, the epidemiology indicators are still too high for de-escalation to Tier 2. De-escalation too early poses a risk that transmission of the virus will increase rapidly and that this area is only in Tier 2 for a very short period of time before potential re-escalation is needed.
Covid admissions in the Humber area are decreasing and bed occupancy is now below the national average.
West Yorkshire
Tier 3 (Very High)
Since the end of national restrictions the situation in West Yorkshire has improved though is still of concern. Case rates are decreasing by more than 10% in all five local authorities. Case rates in over 60s are stable or decreasing across the West Yorkshire but remain above 150 per 100,000 in Bradford and Wakefield. Positivity rates are falling across the area. The epidemiology indicators remain too high for de-escalation to Tier 2. De-escalating too early where there is still high prevalence in the community poses a risk that this area is only in Tier 2 for a very short period of time before re-escalation is needed
COVID admissions, bed occupancy and critical care occupancy in the area are falling steadily.
York and North Yorkshire
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Tier 2 (High)
Since the end of national restrictions, the picture in York and North Yorkshire has improved. Case rates are broadly stable or decreasing. The overall case rate has decreased by over 10% in the last 7 days in Craven, Richmondshire, Hambleton and York. Case rates in over 60s are stable or decreasing across the majority of the area although rising from a low base in Hambleton and Ryedale. The most concerning area is Scarborough with the case rate for all ages now above 150 per 100,000 and rising. The epidemiology indicators are too high for allocation to Tier 1 but the trajectory does currently not warrant inclusion in Tier 3.
Covid admissions in the Humber, Coast and Vale area are decreasing and bed occupancy is now below the national average. Critical care occupancy is also reducing now.
COVID admissions, bed occupancy and critical care occupancy in the West Yorkshire and Harrogate area are falling steadily.
