Returning to a regional tiered approach

On 23 November, the Prime Minister set out our COVID-19 Winter Plan in Parliament. Our COVID-19 Winter Plan puts forward the UK Government’s programme for suppressing the virus, protecting the NHS and the vulnerable, keeping education and the economy going, and providing a route back to normality.

Thanks to the shared sacrifice of everyone in recent weeks, in following the national restrictions, we have been able to start to bring the virus back under control and slow its growth, easing some of the pressure on the NHS.

We will do this by returning to a regional tiered approach, saving the toughest measures for the parts of the country where prevalence remains too high.

The tiering approach provides a framework that, if used firmly, should prevent the need to introduce stricter national measures.
On 2 December we will lift the national restrictions across all of England and the following restrictions will be eased:

  • the stay-at-home requirement will end
  • non-essential retail, gyms, personal care will reopen. The wider leisure and entertainment sectors will also reopen, although to varying degrees
  • communal worship, weddings and outdoor sports can resume
  • people will no longer be limited to seeing one other person in outdoor public spaces, where the rule of 6 will now apply

The new regulations set out the restrictions applicable in each tier. We have taken into account advice from SAGE on the impact of the previous tiers to strengthen the measures in the tiers, and help enable areas to move more swiftly into lower tiers.

The changes to the tiers are as follows:

  • in tier 1, the government will reinforce the importance that, where people can work from home, they should do so
  • in tier 2, hospitality settings that serve alcohol must close, unless operating as restaurants. Hospitality venues can only serve alcohol with substantial meals
  • in tier 3, hospitality will close except for delivery, drive-through and takeaway, hotels and other accommodation providers must close (except for specific exemptions, such as people staying for work purposes, where people are attending a funeral, or where they cannot return home) and indoor entertainment venues such as cinemas, theatres and bowling allies must also close. Elite sport will be played without spectators. Organised outdoor sport can resume, but the Government will advise against higher risk contact sports

These are not easy decisions, but they have been made according to the best clinical advice, and the criteria that we set out in the COVID-19 Winter Plan.

These are:

  1. case detection rates in all age groups
  2. case detection rates in the over 60s
  3. the rate at which cases are rising or falling
  4. positivity rate (the number of positive cases detected as a percentage of tests taken)
  5. pressure on the NHS

The indicators have been designed to give the government a picture of what is happening with the virus in any area so that suitable action can be taken. These key indicators need to be viewed in the context of how they interact with each other as well as the wider context but provide an important framework for decision making – assessing the underlying prevalence in addition to how the spread of the disease is changing in areas. Given these sensitivities, it is not possible to set rigid thresholds for these indicators.

The regulations will require the government to review the allocations every 14 days, with the first review complete by the end of 16 December.

We have been able to announce UK-wide arrangements for Christmas, allowing friends and loved ones to reunite, and form a Christmas bubble of 3 households for 5 days over the Christmas period.

We have increased funding through our Contain Outbreak Management Fund, which will provide monthly payments to local authorities facing higher restrictions.

We are also launching a major community testing programme, honing in on the areas with the greatest rate of infection.

This programme is open to local authorities in tier 3 areas and offers help to get out of the toughest restrictions as fast as possible.

The following areas will be in each tier from the 2 December. This list will also be published on GOV.UK and a postcode tracker will be available for the public to check what rules apply in their local area.

Table of how areas have been allocated

North WestGreater ManchesterVery high (tier 3)While there has been continued improvement in Greater Manchester, weekly case rates remain very high, especially amongst those aged over 60, at around 260 per 100,000 people. The pressure on the local NHS is decreasing in some areas but remains a concern; Manchester University hospital and Pennine Acute Trust remain under significant pressure.
Lancashire, Blackpool, and Blackburn with DarwenVery high (tier 3)While there have been improvements in some areas, case rates and the proportion of tests which are positive for COVID-19 remain high. Case rates in over 60s are very high (over 200 per 100,000) in 6 lower tier local authorities. There is still pressure on the NHS in this region.
Liverpool City RegionHigh (tier 2)There is continued improvement across the Liverpool city region. Case rates (including for the over 60s) are decreasing rapidly with some notable improvements in Liverpool, Knowsley and Sefton. Cases have fallen by 69% over 6 weeks. However, despite improvements, case rates in over 60s remain high at 150+ per 100,000 people in all lower tier local authorities.
Cheshire (including Warrington)High (tier 2)Case rates are continuing to decline across Warrington and Cheshire, with a 27.4% fall to 209 people per 100,000, in line with Liverpool City Region. However, case rates in those over 60 remain high (175/100,000) though falling. Positivity is 8.1%. Warrington and Halton Teaching Hospitals NHS foundation Trust has 150 inpatients with COVID-19.
CumbriaHigh (tier 2)The picture in Cumbria is broadly improving although case rates in Carlisle and South Lakeland are increasing – with increases likely due to a large school outbreak. Case rates in over 60s are above 100 per 100,000 in Carlisle and Barrow-in-Furness. These case rates are too high for allocation to tier 1 but Cumbria’s trajectory does currently not warrant inclusion in tier 3.
North EastTees Valley Combined AuthorityVery high (tier 3)While case rates are now decreasing in all lower tier local authorities, they remain very high at 390 people per 100,000 across the region, with positivity also very high at 13.3%. The case rate in over 60s remains very high at 292 per 100,000. NHS admissions in the area have remained high in November.
North East Combined AuthorityVery high (tier 3)The region continues to see very high case rates, overall 318 people per 100,000, although this figure is either stable or falling in all parts of the region. Case rate in over 60s remains very high at 256 per 100,000. NHS admissions in the area have remained high in November.
Yorkshire and The HumberThe HumberVery high (tier 3)The picture in Humber is improving with case rates now falling in 3 of the 4 lower tier local authorities. However, case rates in all ages and in over 60s remain very high (431/100,000 and 344/100,000 respectively). Positivity is 12.6%. There is ongoing pressure on the local NHS.
West YorkshireVery high (tier 3)This area is improving with case rates falling in all 5 lower tier local authorities. However, case rates in all ages and rates in over 60s remain very high (389/100,000 and 312/100,000 respectively). Positivity is 13.9%.
South YorkshireVery high (tier 3)This area is improving with case rates falling in all 4 lower tier local authorities. However, case rates in all ages and rates in those over 60 remain very high (274/100,000 and 223/100,000 respectively). Positivity is 11.0%. There is pressure on local NHS Trusts.
York and North YorkshireHigh (tier 2)Overall case rates (including for those over 60) in this region are improving in 7 of the 8 local authorities and lower than other parts of Yorkshire and The Humber but remain high overall (202/100,000 in all age groups and 145/100,000 for those aged over 60). Positivity is 8.5%. Rates in Scarborough are significantly higher than the rest of the region (334/100,000 in all age groups and 247/100,000 in those aged over 60) but falling rapidly.
East MidlandsLeicester and LeicestershireVery high (tier 3)Improvements have been seen in overall case rates in all but one lower tier local authority, but remain very high at 355 per 100,000, including in over 60s at 250 per 100k. The pressure on the local NHS remains very high.
Derby and DerbyshireVery high (tier 3)There has been improvement in this area, but case rates remain very high at 275 per 100,000, and in those over 60 it is 220 per 100,000. The pressure on the local NHS remains high.
LincolnshireVery high (tier 3)There has been an overall improvement, but case rates remain high throughout the county, at 307 per 100,000 and in the over 60s it is 281 per 100,000. NHS pressures in Lincolnshire remain high and show signs of increasing, particularly for the units treating the more serious cases
Nottingham and NottinghamshireVery high (tier 3)There has been an improvement, but case rates remain very high in the over 60s at 211 per 100,000. The overall case rate is 244 per 100,000 and positivity is 10%. The proportion of hospital beds taken up by COVID-19 patients is high but appears to be falling.
NorthamptonshireHigh (tier 2)Although improvements in the overall case rates have been seen recently, there is a continued rise in rates of COVID-19 in the over 60s. Over 60s case rate is 154 per 100,000. There is some evidence that the local NHS is seeing the proportion of people with COVID-19 being admitted and subsequently occupying beds stabilising, however COVID and non-COVID patients occupying beds in units treating more serious cases is high.
RutlandHigh (tier 2)This area is improving with a case rate of 125 per 100,000 and 118 per 100,000 for the over 60s, which while elevated is different from the surrounding areas. Positivity is 6.4%.
West MidlandsBirmingham and Black CountryVery high (tier 3)While case rates are improving (down 8.3%) they remain very high (390/100,000). There is a similar trend for positivity. Pressure on the NHS remains high.
Staffordshire and Stoke-on-TrentVery high (tier 3)While the situation is improving with case rates down 13.4%, case rates and test positivity are both very high across this area (391/100,000 and 11.1% respectively). The pressure on the local NHS remains very high, including in units treating the more serious cases.
Warwickshire, Coventry and SolihullVery high (tier 3)The case rate remains very high (though falling) across this area at 236/100,000. The case rate in over 60s remains very high at 182/100,000. There is a clear upward trend in case rates in over 60s in 3 of the 7 local authority areas. Positivity is 9.0%. The pressure on the local NHS remains high.
Shropshire and Telford & WrekinHigh (tier 2)The case rate remains high (though falling) at 200/100,000. The case rate in over 60s remains high at 139/100.000 and is falling. Positivity is 7.2%.
HerefordshireHigh (tier 2)Herefordshire has a high case rate at 160.3/100,000. These rates are too high for allocation to tier 1 but the slight downward trajectory – a fall of 1.9% – does currently not warrant inclusion in tier 3.
WorcestershireHigh (tier 2)While there has been a decline in case rates in all lower tier local authorities they do remain high (201/100,000),including in the over 60s (141/100,000), These case rates are too high for allocation to tier 1 but the downward trajectory – with a fall of 18.3% – does currently not warrant inclusion in tier 3. Hospital admissions of patients with COVID-19 have started to stabilise
LondonLondonHigh (tier 2)The trajectory of key indicators of COVID-19 in an area (including all age case rates, over 60s case rates and positivity) have been increasing until very recently. The situation in London is not uniform throughout the city. 13 of the 33 boroughs have case rates which are 10% or more higher than a week ago and ten boroughs where case rates for over 60s are above 150 per 100,000. Hospital admissions continue to increase in the East and North London in particular, although they are still well below the spring peak. Taken as a whole, the situation in London has stabilised at a similar case rate and positivity to other parts of the country in tier 2.
East of EnglandBedfordshire and Milton KeynesHigh (tier 2)The overall case rate is still increasing in two of the 3 lower tier local authorities. The overall case rate is high at 178/100,000 and it is 113/100,000 in the over 60s although this rises to 185/100,000 in Luton. Positivity 6.9%. There is pressure on the local NHS.
Essex, Thurrock and Southend on SeaHigh (tier 2)Overall the rate is 159/100,000 and rising. The rate in over 60s is 100/100,000 and falling. Positivity is 6.4%.
NorfolkHigh (tier 2)The majority of Norfolk is improving. Case rates are 123/100,000 and positivity is 5.0%. Case rates for over 60s remain over 100 per 100,000 in Great Yarmouth, Norwich and South Norfolk (with increasing trajectories in the last two areas).
Cambridgeshire and PeterboroughHigh (tier 2)An improving picture with decreasing case rates across 5 of the 6 local authorities although the case rate is still high at 123/100,000 overall). Case rates in over 60s are also decreasing (58/100,000). Positivity has dropped to 5.2%.
HertfordshireHigh (tier 2)There is an improving picture across the majority of Hertfordshire – the case rate has fallen to 147/100,000 overall with drops in rates in 9 of the 10 local authorities. Case rates in over 60s are falling also (102/100,000) but they are greater than 100/100,000 in 6 local authorities. Positivity is 6.3% falling.
SuffolkHigh (tier 2)There is an improving picture across the majority of Suffolk. The case rate has fallen to 82/100,000 with drops in rate in 4 of the 5 local authorities. There has been a >40% increase in weekly case rate to 128/100,000 in Ipswich compared to the previous week. Across Suffolk, case rates in over 60s are also falling (72/100,000). Positivity is 3.7%.
South EastHampshire, Portsmouth and Southampton.High (tier 2)There is a mixed picture across this area although the overall case rate is now 152/100,000 and falling in almost all areas. NHS admissions were increasing rapidly until mid-November and are now stable.
Isle of WightMedium (tier 1)The case rate is low and decreasing at 71 per 100,000 and lower in over 60s at 44 per 100,000. COVID-19 pressure on the NHS is low.
East and West Sussex, and Brighton and HoveHigh (tier 2)Case rates in Sussex are at 120 per 100,000 with a total positivity of 4.5%. However, the trend is increasing in several areas. NHS admissions have been fairly stable in the last month but there is increasing occupancy in units treating more serious cases.
SurreyHigh (tier 2)Case rates are stable or improving in all areas with the overall rate at 139 per 100,000. The most concerning lower tier local authorities are those that neighbour London (Spelthorne and Runnymede) with case rates over 200 per 100,000, and high case rates in the over 60s are observed in neighbouring Surrey Heath and Woking. Surrey Heartlands Health & Care Partnership (STP) report admissions to hospital from COVID-19 patients were fairly stable in the last month.
Reading, Wokingham, Bracknell Forest, Windsor and Maidenhead, West BerkshireHigh (tier 2)An improving picture across the area with the exception of Slough and Reading. Slough has high case rates (326 per 100,000 overall and 219 per 100,000 for the over 60s) and relatively high positivity of 12%. The case rate and positivity away from Slough do not justify inclusion at tier 3.
SloughVery high (tier 3)The weekly case rate in Slough is much higher than surrounding areas at over 320 per 100,000 people compared with 155 per 100,000 in the rest of Berkshire and 138 in Buckinghamshire. Test positivity is also much higher at 12%.
BuckinghamshireHigh (tier 2)A broadly stable or improving picture across Buckinghamshire with a case rate at 138 per 100,000 and positivity at 6.4%. These case rates remain too high for allocation to tier 1.
OxfordshireHigh (tier 2)Positive improvements across key indicators across all areas in Oxfordshire, but case rates still too high for tier 1. Buckinghamshire, Oxfordshire And Berkshire West STP hospital admissions have been fairly stable in recent months.
Kent & MedwayVery high (tier 3)Case rates are high and continuing to rise with large increases in case rates in almost all areas in the last 7 days. Some of the highest case rates in the country are currently seen in Kent. Rising case rates in people aged over 60 are a particular concern. Positivity is also increasing in 10 of the 13 lower tier local authorities. Kent And Medway STP are reporting hospital admissions are increasing and mutual aid necessary across the county.
South WestBristol, South Gloucestershire, North SomersetVery high (tier 3)The overall picture remains concerning with very high case rates overall (325/100,000) and in the over 60s (208/100,000). Positivity is 10.4%. Bristol, South Gloucestershire, and North Somerset are part of a wider travel to work area and thus form a natural geographic grouping, separate to the surrounding area.
Somerset and Bath and North East SomersetHigh (tier 2)There are very small increases in the case rates in this area, however overall case rates and those in over 60s remain high (154/100,000 and 102/100,000 respectively). Positivity is stable at 5.5%.
Dorset, Bournemouth, Christchurch and PooleHigh (tier 2)Case rates are falling across the area (131/100,000 in all cases and 99/100,000 in the over 60s). However the over 60 case rate is still high at 151/100,000 in Bournemouth, Christchurch and Poole. Positivity is 5.2%. In addition, the Dorset STP reports daily admissions to hospitals are increasing.
GloucestershireHigh (tier 2)Case rates in Gloucestershire remain high at 162/100,000. While a decline has been seen in the case rate in the over 60s, this remains at 92/100,000. Positivity is 6.3%.
Wiltshire and SwindonHigh (tier 2)Case rates continue to fall in Swindon but are increasing in Wiltshire. Overall case rates are 143/100,000 and 93/100,000 in the over 60s. Positivity is 6.2%. Swindon and Wiltshire STP are reporting increasing admissions to hospital.
DevonHigh (tier 2)Case rates are 121/100,000 overall though there are higher rates in Plymouth, Torbay and Exeter. The case rate in the over 60s is 85/100,000 though significantly higher in Exeter (155.9/100,000). Positivity is 4.2%. There is pressure at the Royal Devon and Exeter Hospital.
Cornwall and Isles of ScillyMedium (tier 1)There are low case rates and test positivity in Cornwall and the case rates in all age groups are stable or declining. There have been no cases in the Isles of Scilly in the last 7 days meaning there is strong evidence to make an allocation to tier 1.

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