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Some Covid restrictions must immediately be reintroduced if England is to avoid "stumbling into a winter crisis", health leaders have warned.

The NHS Confederation said ministers' "Plan B" back-up strategy, including mandatory face coverings in crowded and enclosed spaces, should be implemented.

UK cases have been rising sharply but deaths are well below the winter peak.

The government says it has "absolutely no plan" to bring back measures but is keeping a "very close eye" on the data.

Daily cases have been above 40,000 for seven days in a row, with 43,738 new Covid cases reported on Tuesday.

Another 223 deaths were recorded, the highest since March, although daily figures are often bigger on Tuesdays.

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Under the government's winter plan, if the measures currently in place are not enough to prevent "unsustainable pressure" on the NHS, then steps like making face coverings mandatory in some settings and introducing vaccine passports could be considered as part of Plan B to control coronavirus in England.

Matthew Taylor, head of the NHS Confederation, which represents health service organisations, is urging the government to roll out these extra measures to avoid hospitals becoming overwhelmed.

"The NHS is preparing for what could be the most challenging winter on record," he said.

"It is time for the government to enact Plan B of its strategy without delay because without pre-emptive action, we risk stumbling into a winter crisis."

Ministers "should not wait for Covid infections to rocket and for NHS pressures to be sky high before the panic alarm is sounded", he added.

It is not surprising that NHS leaders are warning about a very challenging time ahead with the risk of a "winter crisis".

Some may feel it is a familiar refrain and that the health service often raises concerns ahead of winter.

But the significance of this intervention by the NHS Confederation is that it came just hours after Downing Street had ruled out Plan B at this stage and said it had not been discussed by the cabinet.

The confederation is, in effect, taking issue with ministers by suggesting the key government test for implementing Plan B in England – the likelihood of the NHS coming under unsustainable pressure – has already been met.

Concerns about the pace of the rollout of the vaccine booster programme and a steady increase in Covid cases and hospital numbers have left some amber lights flashing.

Ministers will argue more time is needed to assess data before taking big decisions on restrictions affecting everyday lives.

But they have acknowledged they will now be keeping "a very close eye" on case numbers.

The NHS Confederation has also called for a package of further measures to support frontline services – what it terms as a "Plan B plus". This could include encouraging people to get vaccinated, turn up to appointments on time and even volunteer to support the NHS.

Its demand came after Prime Minister Boris Johnson told the cabinet on Tuesday that the UK faces "a difficult winter".

His spokesman said there were "no plans" to use the Plan B contingency measures, but added: "Clearly we're keeping a very close eye on rising case rates."

The most important message for the public was "the vital importance of the booster programme and indeed for those children who are eligible to come forward and get our jab", the spokesman said.

The seven-day average of new Covid cases in the UK has risen from around 34,000 a day at the beginning of October to 44,145 cases per day.

And the number of people in hospital across the UK who have Covid has risen by 10% in a week, from 7,039 on 11 October to 7,749 on Monday.

The number of deaths within 28 days of a positive coronavirus test reported on Tuesday was the highest since 9 March, although due to reporting lags over the weekend daily figures are often higher on a Tuesday.

On Tuesday Northern Ireland announced its own autumn and winter plan, which will see face coverings remain a legal requirement in crowded indoor spaces.

The Welsh government has previously set out its plans for winter, with First Minister Mark Drakeford saying Christmas this year was likely to be more normal.

Scotland has set out a winter vaccination strategy and already has measures in place such as the requirement of proof of vaccination status at nightclubs and face masks in schools.

Meanwhile, officials say they are monitoring a new descendant of the Delta variant of Covid, which is causing a growing number of infections.

Downing Street said there was "no evidence to suggest it is more easily spread".

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