NHS and council leaders have warned Stoke-on-Trent and Staffordshire will be plunged into Tier 4 - if we fail to follow coronavirus rules this Christmas.

They say mixing with other households and people outside bubbles is the biggest risk to cases rising.

It comes as hundreds of coronavirus patients continue to be treated at the Royal Stoke University Hospital and infection rates remain too high.

And there is a warning that routine treatments will have to be stopped if the NHS becomes overwhelmed with Covid-19 this winter.

The first cases of the new Covid-19 mutant strain - which spreads more quickly - have already been reported in Staffordshire.

The plea has been backed by a number of community leaders, including Royal Stoke chief executive Tracy Bullock and Stoke-on-Trent City Council leader Abi Brown.

In their joint message, they said: "As leaders of NHS and social care services across Staffordshire and Stoke-on-Trent, we are urging people to support us by following Covid-19 guidelines and using the most appropriate services this Christmas and New Year.

"The best gift we could get is the start of our Covid vaccination programme. But vaccinations are still in the very early stages and no-one will receive full protection until some time after they receive their second vaccine dose. That means no-one will be protected until mid January.

"We also have a new strain of the virus to contend with which seems to spread more quickly.

"That means we have to continue to make every effort to stop the spread of the disease by abiding strictly to Tier 3 guidelines. The inevitable consequence of not doing this is that we shall become a Tier 4 area.

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"Hospitals across the area have seen an increasing number of staff having to self-isolate, and at the same time there are growing numbers of patients. GP practices, mental health and community services are similarly impacted, as are care homes and social care.

"Hospitals remain busy and the redeployment of staff to deal with rising Covid cases will mean other essential services suffering and routine operations suspended.

"This is a very different winter for the NHS, with patients staying in hospital for longer lengths of time, while they recover from this deadly virus.

"We would like to thank everyone who is following the rules as we know it is tough mentally, financially, and physically. However, in these crucial weeks we must ask people to do everything they can to follow the lockdown measures.

"This virus can only spread by too many people mixing with other households and people outside their bubble. Are you doing everything you can to reduce the spread of this virus?

"Only by limiting social contact, can you help protect yourself, your family and our health and care staff from contracting the virus. Importantly, the quicker we control the virus the quicker we can return back to the new normal and treat people who are waiting for routine treatment.

"Everyone can help by first of all complying with Tier 3 guidance and protecting themselves, their families and their work colleagues from contracting the virus. We need people to act now.

"Increased cases lead to increased admissions and sadly deaths. Health and care will be in a difficult place in the coming weeks, if people do not limit their social contact and follow the rules now.

"This will unfortunately mean we have to take difficult decisions to stop routine treatment, in order to save lives from Covid-19. In the long-term this will have a greater impact on people’s health, which we all want to avoid.

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"This holiday period we’re reminding people to use the most appropriate service for their needs, which may include pharmacies, out of hours GP services or even self-care. We remind everyone that A&E and 999 is for genuine life-or-limb emergencies.

"Your NHS is here for you and we’re working differently to stay safe. If you do need us for urgent care, or you are worried you have early symptoms of cancer then don’t delay, however please help us by phoning NHS 111 or your GP first.

"Help and advice for anyone with an urgent need is available online from NHS.111.uk or by dialling NHS111. If you have Covid symptoms you should book a test by dialling 119."

And here's reminder of the Tier 3 rules:

Social contact: You cannot meet anyone socially, unless they are from your household or support bubble, either indoors or in outdoor spaces like private gardens, beer gardens, hospitality or ticketed venues.. However, rule of six limits still apply in outdoor open spaces, such as a park, forest, or beach.

Bubbles: Two households can form a 'support bubble' if one of them only has one adult; or a 'childcare bubble' if one of them has a child under 13. There's also now a new exemption which allows a multi-adult household to form a support bubble no matter what, if that household has a child under one, or a child with care needs under five. If you're in a bubble, you can behave as though you're all in one household.

Shielding: 'Clinically extremely vulnerable' people who shielded in Spring can return to school and work. There will be specific guidance for each tier.

Sex: Indoor recreational gatherings are banned unless you live together or are in the same bubble. The same applies to outdoor spaces like gardens or beer gardens. Gatherings are still technically allowed in parks, but you're supposed to socially distance. And, er, there's a little thing called public indecency law.

Pubs and restaurants: Hospitality venues must shut and can only remain open as "click and collect" or takeaway services. This includes hotels. Drive-throughs can stay open.

Travel and holidays: You should limit any journeys made outside your local Tier 3 area - except for work and school run journeys. This is guidance, rather than the law. People are advised against overnight stays outside the area or having visitors to stay from elsewhere. This means no holidays.

Work: The advice is to work from home if you can.

Weddings and funerals: 15 guests can attend marriage ceremonies but receptions are banned. Funerals can have up to 30 mourners, with only 15 people allowed at the wake.

Shops: All retail - including non-essential shops - can stay open.

Gyms, pools, hairdressers, and 'personal care' (e.g. nail salons): These can stay open.

Cinemas, bingo, bowling, soft play and other indoor entertainment: These must shut in Tier 3.

Sports: Organised indoor sport and exercise classes can continue to take place outdoors, but not indoors unless it's just one household or bubble.

Spectator sports: Not allowed in Tier 3, indoors or outdoors.

Mass events, theatres, gigs and conferences: Not allowed.

Religious services: Can go ahead as long as the sub-group you're in the venue with is consistent with social gathering rules for your tier.