Former health secretary Matt Hancock told officials that he – rather than the medical profession – “should ultimately decide who should live or die” if the NHS was overwhelmed during the pandemic, the Covid inquiry heard.
“Fortunately this horrible dilemma never crystalised,” the former head of the NHS, Lord Simon Stevens, said in his evidence to the inquiry on Thursday.
Stevens, who led NHS England until 2021, said he stressed at the time that no individual secretary of state should be able to decide how care was provided, “other than in the most exceptional circumstances”.
Hancock’s position, which materialised during a planning exercise at the Cabinet Office in February 2020, was a different one from his predecessor, Jeremy Hunt, who had wanted such decisions to be reserved for clinical staff.
Stevens told the inquiry that this ethical question was never resolved and cropped up again during the pandemic when “rationing” of NHS services was discussed.
The former NHS chief was largely uncritical of Hancock, unlike other figures who appeared before Heather Hallett’s inquiry this week, including former No 10 senior adviser Dominic Cummings and ex-civil servant Helen MacNamara.
Stevens’ witness statement referred to the “Operation Nimbus” planning exercise, which he said was helpful in terms of outlining the pressures government departments might have faced.
“It did however result in – to my mind at least – an unresolved but fundamental ethical debate about a scenario in which a rising number of Covid-19 patients overwhelmed the ability of hospitals to look after them and other non-Covid-19 patients,” 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.”
On the final day of evidence this week, the inquiry saw new details of Johnson’s witness statement, in which he expressed his frustrations with the NHS, blaming the health service for the first lockdown.
The former prime minister blamed “bedblocking” in the NHS for locking down the country as Covid took hold.
He said: “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 bedblocking.
“Before the pandemic began I was doing regular tours of hospitals and finding that about 30% of patients did not strictly need to be in acute sector beds.”
Stevens rejected Johnson’s claims, noting the sheer number of coronavirus patients needing a hospital bed was far higher than the number of beds that could have been freed up.
“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,” Stevens told the inquiry.
“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,” he added.
While Stevens declined to criticise Hancock when giving evidence, the inquiry heard that Cummings had repeatedly pushed Johnson to sack his health secretary because he had “lied his way through this and killed people and dozens and dozens of people have seen it”.
In one message, Cummings complained about Stevens and Hancock “bullshitting again”.
Stevens was shown messages, but said: “There were occasional moments of tension and flashpoints, which are probably inevitable during the course of a 15-month pandemic, but I was brought up always to look to the best in people.”
Appearing later, the top civil servant in the Department of Health, Sir Christopher Wormald, said that Hancock would probably be surprised by how “widespread” the perception was regarding his frequency of alleged “untruths”.
Wormald was also questioned at the inquiry over why he and the UK’s most powerful official, Mark Sedwill, were discussing how the virus was like chickenpox as late as mid-March 2020.
Wormald, who remains the permanent secretary in the department, believed Johnson “did not understand difference between minimising mortality and minimising overall spread”.
Lord Sedwill messaged Wormald weeks before the first lockdown, saying: “Indeed presumably like chickenpox we want people to get it and develop herd immunity before the next wave. We just want them not to get it all at once and preferably when it’s warn (sic) and dry etc.”
This message exchange came on the same day that Cummings had complained in a WhatsApp message that Sedwill had been “babbling about chickenpox”, adding “god fucking help us”.
Giving evidence to the inquiry this week, Cummings claimed that Sedwill had told Johnson: “PM, you should go on TV and should explain that this is like the old days with chickenpox and people are going to have chickenpox parties. And the sooner a lot of people get this and get it over with the better sort of thing.”
Stevens also told the inquiry that senior ministers “sometimes avoided” Cobra meetings chaired by Hancock in the early days of the pandemic.
In his witness statement, he said the meetings “usefully brought together a cross-section of departments, agencies and the devolved administrations”.
“However, these meetings were arguably not optimally effective. They were very large, and when Cobra meetings were chaired by the health and social care secretary other secretaries of state sometimes avoided attending and delegated to their junior ministers instead,” he added.
This phase of the Covid inquiry assessed government decision making, with more witnesses scheduled to appear next week.
These include Sedwill, former No 10 special adviser Dr Ben Warner and former home secretary Priti Patel.
