Health secretary Matt Hancock has given the strongest hint yet that a new national lockdown may be needed after warning the current tier system is "no longer strong enough” to tackle the new strain of Covid-19.
He refused to rule out putting the entire country under much tougher measures as he warned the public we have some “very difficult weeks ahead” with rising pressures on the NHS.
Latest NHS data shows that there are 23,823 people in UK hospitals with Covid-19, higher than the peak in April.
Speaking to BBC Radio 4's Today programme, he said: "There are tier-3 areas of the country where the virus is clearly spreading and increasing, and in fact some of those areas are where it is increasing the fastest.
"And we have moved incredibly fast to take action when necessary, including on Boxing Day, so we don't shy away from those decisions, difficult as they are, because they can be necessary for the control of the virus.”
Asked if they will go beyond tier 4 into a new lockdown, Hancock replied: "We have shown that we are prepared to move incredibly quickly, within 24 hours if we think that is necessary, and we keep these things under review all the time.
"We look at the data on a daily basis and we can see at the moment that there are significant rises, especially, as I say, in the areas that are still in tier 3."
Earlier he had told Sky News: "We don't rule anything out, and we've shown repeatedly that we will look at the public health advice and we will take the public health advice in terms of what is needed to control the spread of the disease."
Asked whether tier 4 restrictions work, the cabinet minister said: "It is down to people's behaviour, frankly. What matters is, yes of course, the rules that we put in place, but it is also about how people act.
"And frankly what I would say is this: it is critical that everybody in the country does all that they can to reduce the spread of the virus."
This was echoed by Professor Stephen Powis, director of NHS England, who warned the coronavirus measures “may have to be extended” because infection rates are still so high and hospitals are filling up.
Asked whether non-urgent operations would be cancelled again as doctors deal with Covid patients, he said: "We're really determined to keep routine services going as much as possible, but the way to avoid any disruption, as I say, is for everybody to stick to those social distancing guidelines.
"The more you do that, the less likely it is somebody will get the virus and end up in hospital, and the less pressure there will be and the less the risk that other services will be disrupted.”
He was speaking after 82-year-old dialysis patient Brian Pinker became the first person to get the new Oxford/AstraZeneca vaccine this morning.
Professor Powis told BBC Breakfast: "It's a remarkable scientific achievement. Who would have thought that, within a year of this virus first becoming apparent, that we would have not just one vaccine but two vaccines that we are able to use?"
He said the jab will be delivered in around 100 hospital hubs and 700 centres in GP practices and in the community by the end of the week.
After reports the NHS will not confirm it will be able to provide two million vaccines per week, the NHS boss said: "I would hope within the next few... certainly this month we'll be able to get up to that sort of number but as I said this is dependent upon supply.
"This is the new vaccine, supplies are coming in as we speak but they come in batch by batch, but we'll be delivering it as soon as we get it."
Hancock was also asked if two million doses can be delivered per week, and told BBC Breakfast the NHS would be able to if it receives enough supplies.
"If the NHS needs to go faster, then it will go faster,” he added.
“If there were two million doses a week being delivered, then the NHS would deliver at that speed.
"That's the critical question, but that supply isn't there yet, and we are working very closely with the manufacturers."