Policy responses for United Kingdom - HSRM

United Kingdom

Policy responses for United Kingdom

1.2 Physical distancing

Update 22nd September, 2020

There was an announcement in early September, followed by the passing of new legislation to mandate that people in England can only socialise in groups of 6 from any number of households (indoors and outdoors) across the country unless these meetings are for educational activities, childcare, support groups, weddings, organised sport outdoors, communal prayer, funerals and other activities considered to be essential. Weddings were initially limited to 30 people but this has now been reduced to 15. While sites for communal prayer have no upper limit as long as distancing is maintained (https://www.gov.uk/government/publications/coronavirus-outbreak-faqs-what-you-can-and-cant-do/coronavirus-outbreak-faqs-what-you-can-and-cant-do).

As areas in the North East of England started to see exponential growth in incidence, restrictive measures were introduced, to prevent households mixing at all, either at home or in public spaces (https://www.gov.uk/government/news/stronger-measures-introduced-in-parts-of-the-north-east-to-tackle-rising-infection-rates).

As the incidence is now rising and following on from similar restrictions in the North East, the government announced on September 22nd that individuals should return to work from home unless it is necessary for them to go to work. Pubs and restaurants in England, Scotland and Wales have also now been banned from having customers after 10pm, with all customers also required to be seated at tables and to wear a face covering when not at a table. In Wales, off-licences and supermarkets will also be prevented from serving alcohol after 10pm and hospitality businesses will only be able to provide table service. All pub, restaurant and shop staff are also now required to wear a face covering, although it is unclear whether this will still include a visor in place of a mask as before. Spectators for sporting activities are also to be ended.

In Wales, the rule of 6 was not adopted outdoors and individuals were allowed to mix in groups of no larger than 30 people outdoors, while indoor groups were restricted to 6 people aged over 11 from an ‘extended household’. Some local areas (Bridgend, Blaenau Gwent, Caerphilly, Merthyr Tydfil, Newport and Rhondda Cynon Taf People) with a concerning rise in COVID-19 cases have been placed under local lockdowns, with people unable to leave or enter these areas without a reasonable excuse.

In Scotland, mixing between households was initially limited to 6 people from 2 households, (excluding children aged over 11), but this has now been restricted and all inter-household mixing has now been banned, except for those living alone, alone with children or who form extended households.

Both Scotland and Wales have maintained 2 metre distancing rules in comparison to the 1m rule in England and Northern Ireland.

People in Scotland and Wales have been advised against making all but essential travel.

Update 4th August, 2020

Following a recent rise in cases detected by the ONS and after a prolonged lockdown in Leicester when incidence rose, the government has delayed reopening nationally so that casinos  and bowling alleys can no longer open as expected in August and wedding receptions have been postponed. In the North East and in Yorkshire, test positivity has also risen and these areas are now under enhanced surveillance by DHSC, PHE and local authorities.

This has led to some restrictions, including individuals from different households being asked not to meet and also to increased testing. The NHS Test and Trace data shows that around half of people (50.6%) tested under pillar 2 received the result within 24 hours of taking a test, 81.4% of cases were reached, of which 81.3% provided one or more contact, of which 75.1% were reached and asked to self-isolate, and only 54.7% were contacted within 24 hours of being identified by the positive case. 

Update July 28th 2020

From July 24th, the use of face coverings was mandated in shops, including banks and post offices. Of note, these are not required in hair dressers or beauty salons, where visors are advised, but not face coverings.

Update 14th July 2020

On the 9th July the government announced measures that would allow outdoor pools to reopen from 11 July and indoor gyms, swimming pools and sports facilities to reopen from 25 July. Guidance has been published by the Department for Digital, Culture, Media and Sport, has been compiled with input from the trade body ukactive, the Sport and Recreation Alliance, Sport England and other sports bodies, and in consultation with Public Health England and the Health and Safety Executive, which includes advice for providers of pool, gym and leisure facilities on cleaning, social distancing, and protection for staff to help venues get back up and running safely. The government has also announced that facemasks will soon be mandatory from July 24th inside shops and crowded areas, rather than only on public transport. At the same time, beauticians and nail bars were also granted approval to open from July 13th using measures such as screens, social distancing and standard infection prevention and control measures. https://www.gov.uk/government/news/beauty-salons-set-to-reopen-for-some-services-next-week-under-new-government-guidelines.

Update 5th July 2020

As of the 4th July, pubs, restaurants, hairdressers, outdoor gyms, children’s playgrounds museums, galleries, social clubs, and places of worship have all now been re-authorised to open, provided they adhere to strict guidance to implement measures to physically distance within these settings. Working safely guidance has been published to guide businesses to implement these measures. People have also been told that they may also stay the night away from home with campsites and hotels reopening. This also includes staying the night at another household, if congregations are limited to only 2 households. Outdoor meetings are still limited to six people from any number of households or an unlimited number if from 2 households. Physical distancing has now been reduced to 1 metre where 2 meters is not feasible.

Measures in Scotland and Wales have not reduced the physical distance from 2m to 1m and Scotland limit all outdoor meetings to 3 households and Wales to 2 households. Indoor meetings in Wales are similarly limited to 2 households, whereas Scotland allows 3 households to meet. 

Update 12th June 2020

The government has announced that non-essential retail shops and zoos can open from Monday 15th June but that pubs, restaurants, nail bars, hairdressers and beauty salons cannot open until July. Despite initial plans for primary schools to return in June, these have been pushed back till September after concerns were raised by the National Teaching Association that it was not feasible to limit classes to 15 children and maintain social distancing. People who live alone are now also allowed to meet with one other family, who would form part of their ‘bubble’.

Update 7th June 2020

On 4th June 2020, the Transport Minister announced that wearing a face covering on public transport in England would be compulsory from 15th June, with people failing to comply potentially subject to a fine. Exemptions will be made for young children, disabled people and those with breathing difficulties. Travel operators will be allowed to refuse travel to passengers not wearing face coverings, with British Transport Police helping to enforce the policy. It was emphasised that masks should not be those meant for clinical settings to avoid contributing to PPE shortages, and should instead be home-made. The British Medical Association and opposition MPs have criticised the policy for being introduced too late in the outbreak (https://www.bbc.co.uk/news/uk-52927089).

In addition, from 15th June, all hospital visitors and outpatients will be required to wear face coverings, while all hospital staff must wear surgical masks at all times.  It is unclear whether the supply chain is sufficiently resilient to meet this demand for PPE. The decision was announced without prior consultation with NHS leaders and has faced criticism, with the chief executive officer of NHS Providers suggesting the decision was ‘rushed’ and ‘overly influenced by politics and the need to fill the space at the Downing Street press conferences’ (https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-news-face-masks-uk-deaths-lockdown-latest-nhs/).

Update 15th May 2020

The UK government has set out five key criteria, which must be met for the lockdown to be lifted. They had indicated that lockdown would be lifted in a phased way, to enable children to return to school and low risk individuals to return to work first. The government committed to outlining a roadmap to exit lockdown on May 10th (See 1.1 Health Communication, Transition measures). The key principles required to lift lockdown in England are:
  1. Making sure the NHS can deal with the number of people needing treatment
  2. Sustained and consistent fall in daily deaths
  3. Reliable data that infection is decreasing
  4. Ensuring there is enough PPE and testing capacity
  5. No risk a second peak of infections

In terms of lifting strict social distancing measures, the Scottish government has also published a ‘Framework for Decision Making’ in which they outline their plans for monitoring the number of new cases, to ensure that Rt is maintained below 1 and balancing other health, economic and social harms (https://www.gov.scot/publications/coronavirus-covid-19-framework-decision-making/pages/1/). The plan acknowledges that there may be a need to re-impose lockdown measures if the Rt rises sharply and also recognises that measures may vary by geography. It acknowledges the following key measures:
  • Innovative approaches to maintain and enhance physical distancing
  • Continued focus on strong hygiene practices
  • High public community awareness of symptoms and prompt action in response
  • Active surveillance
  • Case finding, contact tracing and quarantining
  • Shielding of clinically at risk groups

On May 9th, ahead of the publication of the recovery plans, the government announced that local authorities had been asked to increase access to active travel by widening pavements for pedestrians and increasing cycle access to avoid potential overcrowding on public transport. On May 11th, after the announcement of the government’s recovery strategy (See 1.1 Health Communication, Transition measures), guidance was published on staying alert and safe and also on staying safe outside the home (https://www.gov.uk/government/publications/staying-safe-outside-your-home/staying-safe-outside-your-home) and (https://www.gov.uk/government/news/new-guidance-on-spending-time-outdoors?utm_source=f3fc1c2a-9679-494b-9830-6451ea9e84de&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate), which stated that:
  - People should go back to work if they could not work from home
  - Other than leaving the house for work, people should only go out to exercise, to shop for essentials or to seek medical care and when they do go out, they should take regular precautions like hand washing and social distancing
  - People who are vulnerable or shielding should continue as much as possible to stay home and should not go out unless necessary
  - Critical workers can still take their children to school
  - Religious ministers can now attend places of worship but the public may not
  - People may drive wherever they wish in England (but not for example in Wales) as long as social distancing is observed
  - Sectors of the economy that are allowed to be open should be open – such as food production, construction, manufacturing, logistics, distribution and scientific research
  - Some outdoor sporting facilities, food markets and garden centres may now open as long as physical distancing is observed
  - Hotels, parks, shops, pubs, cinemas and other public settings are to remain closed
  - People going outside should wear non-medical face coverings to protect others in enclosed spaces, although this is optional and not mandated

Tougher controls were also announced for the police who could now issue a fixed penalty notice of £100, doubling with each repeated offence to people who break the physical distancing rules. Local authorities, particularly Environmental Health Officers will also now regulate businesses to ensure that they uphold the social distancing guidance.

Educational Settings:

After considerable consternation among the teachers who have been anxious for clear guidance ahead of any school re-opening, the government published guidance on May11th setting out plans to welcome back children in Nursery, Reception, year 1 and year 6, alongside priority groups, including childcare and special schools and alternative settings. This is currently planned for June 1st, although keyworker children remain at school until then (https://www.gov.uk/government/publications/actions-for-educational-and-childcare-settings-to-prepare-for-wider-opening-from-1-june-2020/actions-for-education-and-childcare-settings-to-prepare-for-wider-opening-from-1-june-2020).

Protective measures include reducing pinch points, when many people might otherwise gather at the same time (such as parent drop-off), social distancing, reduced class sizes and increased utilisation of outdoor space (https://www.gov.uk/government/publications/coronavirus-covid-19-implementing-protective-measures-in-education-and-childcare-settings). Measures also include increased cleaning, use of PPE and testing, which will also be made available to students and teachers and their households from June 1st. Accompanying this will be a test, trace isolate system, managed by local Health Protection teams in the case of any outbreaks in schools. The government has stated an intention to slowly bring other children back to school with an ambition to bring all primary year groups back to school before the summer holidays, for a month if feasible and funding has been announced by the government to cover additional costs. This decision is based on the rationale that children are less likely to become unwell with COVID-19 but this has not necessarily satisfied teachers or parents, many of whom are still extremely concerned about the feasibility of implementing social distancing among young children.

Transport and Workplace Guidance:

The transport sector has been given guidance about the need to promote social distancing among travellers, by staggering departure times, minimising face to face seating, providing sanitiser, improving communication through the use of posters and announcements and using screens or barriers for example (https://www.gov.uk/government/publications/coronavirus-covid-19-safer-transport-guidance-for-operators?utm_source=945feea5-f72a-4e58-b6a4-2c8237392139&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate
). Workplaces have also been suggested to stagger arrival and break times, minimise meetings, increasing ventilation and providing more storage for workers to keep clothes and bags away. It is unclear how this will be operationalised in such a short timeframe as these announcements were made after the initial recovery plan was announced. Transport for London has responded to these ambitions rapidly and has published their own intention to increase Streetspace in London by working with local Boroughs to identify areas where more support is needed for people to walk and cycle whilst maintaining physical distance. There has been much debate and discomfort about how the return to work may exacerbate inequalities as the lowest paid professions are also the least likely to be able to work from home. This is compounded by recent evidence by the Office for National Statistics showing that some of the lowest paid jobs were at the greatest risk of dying from COVID-19 (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/coronaviruscovid19relateddeathsbyoccupationenglandandwales/deathsregistereduptoandincluding20april2020).

Initially, during the ‘containment’ phase, physical (or social) distancing was advised only for those who were isolating, either because they were cases or contacts of confirmed cases or had returned from a high-risk area but remained asymptomatic. The start of the delay phase was announced on March 12th, and involved stricter measures, with the government asking people to physically distance at home where possible. This was announced in news briefings and the government website but was not publicised elsewhere. Initially, all physical distancing was recommended rather than mandatory, except for quarantine measures (see next section). By this stage in the UK it had been 15 days since the 100th case had been confirmed. For comparison, the same measures were implemented some 9 days after the 100th case in Germany and around 14 days after the 100th case in the US.

On Monday 16th March 2020, there was a blanket recommendation for the public to stay at home and avoid mass gatherings, public transport and close contact with persons, particularly individuals who were considered vulnerable, (which was defined as those eligible for a seasonal influenza vaccine i.e. those over 70 years of age, those with chronic conditions, pregnant women), who were also requested to stay at home in isolation for the foreseeable future and restrict non-essential visits (https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19). Although restrictions on mass gatherings were not formally implemented at this time, sports bodies and entertainment venues unilaterally decided to suspend such events anyway. On 20th March 2020 all pubs restaurants and cafés were asked to close for all but takeaway food sales. 

Schools, colleges and nurseries in the UK were asked to close from 23rd March 2020, but cover was provided for children whose parents are keyworkers (to enable functioning of the health and social care services, transport and utilities as well as food supply), children with disabilities (to ensure continuity of care) and those children considered to be vulnerable such as those who are eligible for free school meals. 

From 24th March 2020, non-essential retail outlets were closed (excluding supermarkets and pharmacists etc) and physical distancing became mandatory for everyone with people required to stay at home, except for very limited purposes such as one form of exercise per day, essential work that cannot be done at home and shopping for food or collecting medicines. Gatherings of more than two people were banned in public for a minimum period of three weeks. Relevant authorities, including the police, were granted powers to enforce these measures through fines and dispersing gatherings.

Following the deaths of several bus drivers, the Transport for London is now trialling implementing screens for buses and limiting all front door use on all buses.