Stevens says Hancock thought, if NHS overwhelmed, he should decide who would live or die, not doctorsO’Connor is now asking about discussions about what might need to happen if the NHS was overwhelmed, and care had to be rationed.
In his witness statement Stevens said Matt Hancock thought that, if decisions had to be taken about who would live and who would die, that should be a ministerial matter. He said:
The secretary of state for health and social care took the position that in this situation he – rather than, say, the medical profession or the public – should ultimately decide who should live and who should die. Fortunately this horrible dilemma never crystallised.
Stevens tells the hearing:
I certainly wanted to discourage the idea that an individual secretary of state, other than in the most exceptional circumstances, should be deciding how care would be provided.
I felt that we are well served by the medical profession, in consultation with patients to the greatest extent possible, in making those kinds of decisions.
Simon Stevens giving evidence to Covid inquiry. Photograph: Covid inquiryKey events
Wormald starts by repeating what he said when he gave evidence to the inquiry during module one; he says he wants to express his regret to everyone who suffered, directly or indirectly, during Covid. And he expresses his thanks to NHS staff.
Asked to explain his role as permanent secretary at the Department of Health and Social Care, Wormald says it has three parts. He is chief executive at the department; chief adviser to the secretary of state, who holds the legal powers of the department; and accounting officer for the department, in charge of resources voted by parliament.
Keith asks about the chief medical officer’s role. Prof Sir Chris Whitty is the CMO.
Wormald says the CMO is an integral part of the department. He has permanent secretary rank. He is the chief clinical adviser to the secretary of state on matters relating to England. But he is also an adviser to the PM, and to cabinet, on clinical matters relating to the UK.
Chris Wormald, permanent secretary at the Department of Health, gives evidence to Covid inquiryThe next witness is Sir Chris Wormald, permanent secretary at the Department of Health and Social Care.
Hugo Keith KC, lead counsel for the inquiry, is doing the questioning.
He says Wormald has submitted four statements to the inquiry running to hundreds of pages.
Rishi Sunak welcoming Kamala Harris, the US vice-president, to the AI safety summit at Bletchley Park. Photograph: Toby Melville/ReutersPhilip Dayle is now asking questions on behalf of the Federation of Ethnic Minority Healthcare Organisations (FEMHO).
Q: When did it become clear that black, Asian and ethnic minority communities were disproportionately being affected by Covid?
Stevens says by early spring. He recalls a meeting in April where the issue was raised.
Q: Was that fast enough?
Stevens says he acted immediately concerns were raised with him.
Stevens has now finished his evidence.
Anthony Metzer KC is now asking questions on behalf of groups representing people with long Covid.
Q: Was the NHS concerned about long Covid by July 2020?
Yes, says Stevens.
Q: Would public health messaging have helped?
Q: Was the NHS worried by August 2020 that long Covid would create significant long-term costs for the NHS?
Yes, says Stevens.
Q: How did decision-makers respond?
Stevens says the Department of Health and Social Care was concerned about this. Ministers were looking at this.
Bethan Harris, counsel for Covid Bereaved Families for Justice Cymru, is asking questions now about hospital discharges.
Stevens says Matt Hancock decided on 11 March that people being discharged from hospitals into care homes would not be prioritised for testing. He says Hancock took this decision on the basis of clinical advice.
At the time, he says, there was a recognition that people could have Covid without being symptomatic. But he says there was “uncertainty” around the extent to which that happened.
He says the courts have looked at this issue. He says the courts decided that it was reasonable for ministers to prioritise testing in the way that they did, but that better guidance should have been offered to care homes about isolating people being admitted from hospital.
O’Connor is asking about PPE. He says PPE will be covered properly in another module, but he raises something Helen MacNamara said in her witness statement about whether PPE was suitable for women.
Extract from Helen MacNamara’s witness statement Photograph: Covid inquiryStevens says MacNamara was right to raise this. He says the NHS was already looking at this issue at this point.
O’Connor asks if, as the inquiry heard yesterday, it is true that Stevens told Boris Johhson when Johnson asked about this that there was not a problem.
Stevens says that is not what he said at the meeting. He says minutes of that meeting are available, and he quotes from them. They record Stevens telling the PM that work on this was ongoing and that testing was under way to make sure PPE was suitable for women.
Rishi Sunak welcoming the president of the European Commission, Ursula von der Leyen, to the AI safety summit today. Photograph: ReutersStevens says Boris Johnson wrong to argue lockdown might not have been needed if NHS had addressed bedblocking problemO’Connor shows Stevens an extract from Boris Johnson’s witness statement in which Johnson seems to imply that he was forced into a lockdown because the NHS had not dealt with its capacity problem, and bedblocking (patients taking up space because adult social care provision outside hospital was not available).
In it Johnson says:
It was very frustrating to think that we were being forced to extreme measures to lock down the country and protect the NHS – because the NHS and social services had failed to grip the decades old problem of delayed discharges, commonly known as bed blocking. Before the pandemic began I was doing regular tours of hospitals and finding that about 30 per cent of patients did not strictly need to be in acute sector beds.
Extract from Boris Johnson’s witness statement. Photograph: Covid inquiryStevens says Johnson was right to say there were longstanding problems with social care, that led to patients being stuck in hospital when they could be at home. But he goes on:
We and indeed he were being told that if action was not taken on reducing the spread of coronavirus, there wouldn’t be 30,000 hospital inpatients, there would be maybe 200,000 or 800,000 hospital inpatients.
So you can’t say that you would be able to deal with 200,000 or 800,000 inpatients by reference to 30,000 blocked beds.
Even if all of those 30,000 beds were freed up – for every one coronavirus patient who was then admitted to that bed, there would be another five patients who needed that care but weren’t able to get it. So no, I don’t think that is a fair statement in describing the decision calculus for the first wave.
Stevens says Hancock thought, if NHS overwhelmed, he should decide who would live or die, not doctorsO’Connor is now asking about discussions about what might need to happen if the NHS was overwhelmed, and care had to be rationed.
In his witness statement Stevens said Matt Hancock thought that, if decisions had to be taken about who would live and who would die, that should be a ministerial matter. He said:
The secretary of state for health and social care took the position that in this situation he – rather than, say, the medical profession or the public – should ultimately decide who should live and who should die. Fortunately this horrible dilemma never crystallised.
Stevens tells the hearing:
I certainly wanted to discourage the idea that an individual secretary of state, other than in the most exceptional circumstances, should be deciding how care would be provided.
I felt that we are well served by the medical profession, in consultation with patients to the greatest extent possible, in making those kinds of decisions.
Simon Stevens giving evidence to Covid inquiry. Photograph: Covid inquiryStevens says ‘for the most part’ he found Matt Hancock truthfulO’Connor says the inquiry has heard claims that Matt Hancock was dishonest. (See 10.01am.)
Q: Did you find Hancock truthful?
Stevens replies:
All I would say is strong accusations need strong evidence to back them up. And I don’t think I’ve seen that evidence.
O’Connor says he does not think Stevens is “engaging” with the question. He tries again.
Q: Was Hancock someone who you found you personally could trust?
Stevens replies: “Yes. For the most part, yes.”
Asked what he meant by that, Stevens goes on:
I’m not denying that there were a small, handful of occasions during the course of the year, year and a half, when there were tensions. But that I don’t think is particularly surprising given the circumstances under which everybody was working.
UPDATE: Ben Quinn has posted on X the extract on this from Stevens’ statement.
From the #CovidInquiry ..
Matt Hancock told officials that he – rather than the medical profession – “should ultimately decide who should live or die,” if the NHS was overwhelmed, the Covid-19 Inquiry has been told by the former head of NHS England, Simon Stevens pic.twitter.com/Z2W8uwEghf
— Ben Quinn (@BenQuinn75) November 2, 2023