The remaining national covid restrictions may have been lifted in England, but cases of covid-19 are very much still on the rise, with daily increases now close to those we saw when the last lockdown was imposed in January. On 16 July 2021, there were 51,870 cases, just a few days before “Freedom Day.” To put that in context, on 9 January 2021, there were 59,937.

There is now greater emphasis on personal responsibility in deciding how cautious to be about maintaining practices like mask wearing and social distancing, and people have shown they are willing to make sacrifices. But this is a risky strategy. Attitudes are changing, and if we are not careful, there could be increased illness and further strain on the NHS.

Already, because of soaring demand for non-covid care, a number of NHS trusts have had to declare OPEL level 4, or “black alert.” This is almost unheard of at this time of year.

Thanks to the incredible efforts of NHS teams across the country, the number of people waiting longer than a year for non-urgent treatment has fallen significantly in recent months. But they still face a huge challenge, with 5.3 million patients waiting to start treatment in England. 

There are also more than 76,000 staff vacancies across the health service, including nearly 35,000 nursing posts, and more than 6,600 medical vacancies. The NHS and its workforce are under extreme, and increasing, pressure, to the point that it now feels like winter in summer—not just in hospitals, but across primary care, mental health services, ambulances and community services—and the challenge is only likely to grow into the end of the year. 

Our members have also told us they have faced resistance from some areas of the public about the need to continue using face coverings in healthcare settings, and we made a strong call for a definitive position from NHS England and NHS Improvement on this. Our members welcomed the reminder from Ruth May to the public earlier in July that everyone attending healthcare settings must continue to wear a face covering and follow social distancing rules.

But now that the government mandate is no longer there, it will be crucial to help the public feel empowered to make simple choices on a personal level, to protect themselves and others, and in turn, ease some of the pressure on the NHS. 

To support this, the NHS Confederation has launched the #NotTooMuchToMask campaign, alongside a host of other organisations, including the Academy of Royal Medical Colleges, NHS Providers, the British Medical Association, the Patients Association, the Richmond Group of Charities, UNISON, the Local Government Association, and other membership bodies and patient groups. 

The campaign aims to support informed decision-making, and encourages the public to commit to five pledges: 

• Wearing a face mask or covering, including where not wearing one could make someone feel unsafe.
• Keeping indoor spaces well-ventilated and opting for meeting outdoors, where possible.
• Maintaining hand hygiene, including before and after social contact outside their household.
• Getting tested, supporting contact-tracing measures and self-isolating, when required.
• Making sure they get both doses of the vaccine and encouraging others to do the same.

Some people may be happy to see the end of covid-19 related restrictions; that is their choice to make. This is not about piety or coercion. We are all human. It is not more condemnation we need, but more consideration. The campaign is about helping communities to take a moment to consider how individual actions can contribute to the “greater good.” 

For many, the relaxation of restrictions does not signify freedom. For those with medical vulnerabilities for example, it means greater anxiety and isolation. 

Against this backdrop, freedom is a difficult concept. Freedom from government-mandated curbs on social activity, yes. But not freedom from risk, not freedom from pressures across all areas of the NHS as a result of huge treatment backlogs—and not freedom from the pandemic. 

The government has taken a gamble, so it makes sense to try to improve the odds, not just for ourselves, but for those at greatest risk.

It is not just personal choice that will replace the law, but a sense of mutual benefit. If I do my best to protect you, I hope you will do the same for me. The public need to know what is expected of them, but beyond that, they need to know they are not acting alone—that everyone is, as has so often been said, still in this together. 

There is a clear need for vigilance, particularly when so many adults have not had two jabs, and that is what is at the heart of this campaign. Once the risk of a further covid-19 wave has receded, we hope it won’t be necessary. Until then, we should err on the side of caution. 

Matthew Taylor, chief executive, NHS Confederation. 

Competing interests: none declared.