Christmas plans for millions of families were in the balance last night as ministers and devolved leaders held talks on curtailing freedoms over the festive period amid warnings that the NHS would be overwhelmed. Boris Johnson is likely to face down calls to change course, though the government may issue new advice urging extreme caution. A government source said it was possible the four nations may diverge after no agreement was reached at a crisis meeting with devolved administrations on Tuesday chaired by Michael Gove. Leaders discussed cutting the number of days families can meet from five to three; reducing the number of households mixing from three to two; and introducing travel restrictions – or a combination of measures. The four nations will meet again on Wednesday in the hope of agreeing a joint approach. The decision – described as “incredibly difficult” and “heart-rending” – comes after many families have spent months unable to see or hug one another during the coronavirus pandemic, and just a week before the reunions are due to start. Hours before the talks, the British Medical Journal and Health Service Journal published a rare joint editorial saying the government could no longer claim to be protecting the NHS if it went ahead with rash plans to let households mix indoors, without social distancing, and travel across the country over Christmas. Health service managers said hospitals could become dangerously full, with operations cancelled, unless ministers rethink the planned relaxation of rules from 23 to 27 December. Just a fortnight after a four-week national lockdown, Covid-19 case rates are rising in more than three-quarters of all local areas in England, latest data shows. This includes every borough of London, 42 of the 45 local areas in eastern England and 66 of the 67 local areas in south-east England – where a new strain of the virus was this week revealed to be spreading quickly. On Tuesday, 506 people were confirmed to have died with Covid UK-wide, with 17,329 people in hospital. Arlene Foster, the Northern Irish first minister, said ministers would discuss the current situation with medical and scientific advisers and a final decision would be announced on Thursday. A No 10 source said the prime minister was not in favour of changing advice for England, given the rules had been introduced and promoted just a short while ago and were now well understood by the public. In Tuesday’s meeting, concerns are understood to have been raised about the risk of a lack of compliance among the public should leaders go back on the offer they made in late November for a chance to meet at Christmas. Leaders discussed a change of messaging akin to the strategy used in Scotland by Nicola Sturgeon, who has been emphasising that people should not gather unless absolutely necessary. It is understood that one option discussed had been to cut the number of days where household mingling is permitted but concerns were raised about ferry capacity for those travelling to and from Northern Ireland. Limited train services and the potential for gridlock on the roads would also have to be factored in. Other measures discussed included limiting the total number of people allowed to gather in one home. A government source said the situation merited further consideration. “It would be irresponsible not to assess where things are, given the circumstances,” they said. Another Whitehall source said the decision was challenging, with more than public health considerations at stake. “It’s a really difficult decision. From a public health perspective, the implications are maybe clear, but there are a lot more things to consider,” the source said. On Tuesday afternoon, Sturgeon advised the Holyrood parliament that her government was now considering whether changes to the Christmas rules were necessary as she delivered her weekly review of Scotland’s five-level system of Covid controls. She told MSPs that she had been advised that, through genomic sequencing, nine cases of the new Covid variant had been identified in Scotland, all in the Greater Glasgow and Clyde area. “We are considering whether any additional precautions are necessary in light of what we know so far – including whether there should be any change over the Christmas period because of this or the wider context.” Mark Drakeford, first minister for Wales, said before the meeting: “The choice is a grim one. I have read in my own email account heart-rending pleas from people not to reverse what we have agreed for Christmas. People who live entirely alone who have made arrangements to be with people for the first time in months and who say to me this is the only thing they have been able to look forward to. “Yet we know that if people do not use the modest amount of additional freedom responsibly then we will see an impact on our already hugely hard-pressed health service.” Labour piled on pressure for a change in the rules, saying the consequences of a poor decision could be unthinkable. In a letter to Johnson, the Labour leader, Keir Starmer, wrote: “This is a critical moment for our country. The failure of your tiered system to control the virus leaves us with precious little headroom … Put simply, if you take the wrong decision now, the ramifications for our NHS and our economy in the new year could be severe.” Jeremy Hunt, the former health secretary who chairs the Commons health committee, also urged ministers to consider changing the plans for Christmas, saying it would be “a very, very dangerous and precarious situation” for the NHS to enter January with very high levels of bed occupancy from Covid. Countries across Europe have announced strict lockdowns over the festive period, including Germany, the Netherlands and the Czech Republic. In its joint editorial, the British Medical Journal and Health Service Journal said if current trends continue, there will be 19,000 Covid patients in English hospitals by New Year’s Eve – the same as at the peak of the first wave on 12 April. Those numbers do not factor in the impact of Christmas households mixing and travelling. The editorial says the extra caseload of Covid-19 patients is likely to be 40 times higher than at the beginning of the second wave. NHS Providers, which represents hospitals, said trust leaders were “seriously worried about the combination of 10,000 fewer beds than last year due to the need for rigorous infection control, and 13,000 of the remaining beds currently occupied by Covid-19 patients”. Chris Hopson, the organisation’s chief executive, said: “We recognise the government has a difficult judgment to make about whether to amend the proposed Christmas restrictions or not.” Polling suggests that half the public think Covid rules over Christmas are not strict enough, including a clear majority of those over 65, the most at-risk age group. An Ipsos Mori survey of 1,027 people for the Evening Standard found that only 39% of the public believes the Christmas rules are “about right” and 49% said they were “not strict enough”, rising to 56% among the over-65s.