The head of the NHS in England has said that the guidance on wearing masks in healthcare settings is “clear”.

Amanda Pritchard said that “people should wear masks in healthcare settings”.

Asked what she thought when she saw images of Prime Minister Boris Johnson without a mask in hospital, NHS England chief executive Ms Pritchard said: “The guidance is clear: people should wear masks in healthcare settings.

“I wasn’t on the visit. So I’m afraid I don’t know the ins and outs of exactly what happened there.”

The guidance is clear: people should wear masks in healthcare settings

Pressed on whether she would have told Mr Johnson to put a mask back on, she added: “I’m sure my colleagues did encourage everybody there to follow the appropriate guidance.”

Mr Johnson visited Hexham General Hospital in Northumberland last week, and photographs showed him meeting masked nurses at the hospital, talking to them and bumping elbows with them, despite not having his face covered.

Soon after that photo opportunity, the Prime Minister put on a mask, which had been handed to him by an aide.

Northumbria Healthcare NHS Foundation Trust said the Prime Minister “did wear a mask for the majority of the visit”.

But “after the Prime Minister left a welcome meeting, he walked along a mezzanine corridor, for a very short period of time, without a mask”.

“As soon as this was identified he was given a mask and he put it on,” the trust said.

Mr Johnson’s mask-less appearance at the Cop26 climate change summit also raised eyebrows as he sat next to 95-year-old environmentalist Sir David Attenborough, who was wearing a face covering.

At a Downing Street press briefing on Monday Mr Johnson insisted that he takes a “responsible” approach to wearing a mask.

“I wear a mask wherever the rules say that I should, and I urge everybody else to do the same,” he said.

“People have actually seen me wearing face coverings quite a bit more regularly as we have seen the numbers ticking up in the UK.

“I think that is the responsible thing to do and I am going to continue to do it.”

Mr Johnson said the Government would “continue with our approach, which is to rely on people’s common sense – on people’s sense of personal responsibility to themselves and to others”.

“But clearly in confined spaces, where you are meeting people that you don’t normally meet, you should wear a face covering.”