The hearing moves onto how Hancock balanced the decision to open Nightingale temporary hospitals, but a call from NHS England for 10,000 more beds ahead of an expected second wave was not delivered on.

"Hold your horses" the KC smiles, as Hancock jumps in to stress he was "very involved" in attempts to get more beds.

Hancock says he got funding for the expansion of A&E departments across England and he also wanted to expand bed capacity, but accepts he "didn't win" on getting 10,000 more beds in the summer of 2020.

Despite this, the former health secretary says he was still worried about a second wave in the winter, and concerned about political opposition if one came, which he says he expected to be stronger than the first.

Hancock is now being quizzed on the Nightingale temporary hospitals which were commissioned to increase hospital capacity during the pandemic.

He explains these were needed to both provide care for those that used them and were "entirely justified" as an insurance policy, given the information they had at the time, adding that hundreds of patients did receive care through them.

Hancock is given an example in Birmingham where inquiry counsel Jacqueline Carey KC says the Nightingale hospital there had no patients in either the first or second Covid waves and was not used as a vaccine centre, either.

Hancock refers to "frustration" he felt that they weren't being used for other purposes, but underlines operational matters are for the NHS.

We move on to address the decisions taken by Matt Hancock to increase capacity within the NHS, and the impact this had on care not related to Covid.

Hancock affirms that he agreed with the principle of expedited discharges - that's releasing people from hospital quickly even when still in need of care - to free-up space.

On suspending non-urgent elective care, he says he did so "reluctantly", but it was the "least bad" decision he could take.

Inquiry counsel Jacqueline Carey KC presses Hancock on how he made the decision about when non-Covid related care was able to resume. He says he sought advice from the boss of NHS England, Sir Simon Stevens (now Lord Stevens), on this.

To highlight the impact of these delays, the inquiry is shown a letter sent to Hancock which relates to a patient desperate to have their cancer care resume.

Then, Hancock is asked how he followed up on checking for confirmation when non-Covid care could start again, and he explains how he met Stevens for discussions on this, but stresses that resumption was ultimately for the head of NHS England.

The inquiry has resumed after the morning break with questions for Hancock around national guidance and a "tool" for situations where ICUs become overwhelmed.

Evidence submitted to the inquiry by former NHS England boss Simon Stevens said that Hancock wanted to decide "who should live and who should die" if hospitals became overwhelmed by coronavirus patients during the pandemic.

Hancock underlines multiple times that he believed those decisions - on which patients should get ICU treatment - should be taken locally.

He adds it would be "very hard" to write something that would "improve on an individual clinician making a decision... on how to save lives".

He tells the inquiry he had not really considered the "wider controversy" that such England-wide guidance might provoke.

Image source, PA Media

Former Health Secretary Matt Hancock spoke for just over an hour this morning. This is what he said:

• He defended the government's 'Stay Home, Save Lives, Protect the NHS' mantra during the pandemic, saying it "struck the right balance"
• He acknowledged it was "extremely difficult" to keep health workers safe and visited hospitals to experience conditions for himself
• He accepted the NHS was under immense pressure but stressed his aim was to ensure the system did not "collapse"
• Hancock reflected on his relationships with the UK's nations and singled out former Scottish First Minister Nicola Sturgeon for causing "all sorts of difficulties"
• On cancer care delays, Hancock suggested it simply was not safe for these treatments to go ahead due to patients' vulnerability

More to come now as the hearing resumes after the morning break. You can stream the second session of evidence by clicking Watch live above.

Matt Hancock is challenged about his belief that the NHS was not overwhelmed.

The inquiry plays Dr Kevin Fong’s evidence about the number of deaths that NHS staff experienced, and how overwhelmed they were - including one time when they ran out of body bags

Hancock says he "agrees with everything that was said" and the system "had to cope with more than it had to cope with at any other time in modern history".

He tells the inquiry it was his "duty that the public felt that the NHS was there for them".

Although Hancock says there was no national shortage of PPE he admits this doesn't mean there weren't shortages in individual hospitals.

But he maintains he was "right to use that language" because his responsibility "was for the system as a whole".

He explains the best way to solve the problem "was to have measures in place at a national level to stop the spread of the disease."

The inquiry is taking a short break and will return at 11:30 GMT.

Stay with us - we'll have a recap of this first session of evidence with you shortly.

Image source, PA Media

Jacqueline Carey KC, counsel to the inquiry, tells Hancock now about a specific case the inquiry has previously heard - that of Susan Sullivan who had Down's syndrome and was admitted to intensive care but was refused admission to the ICU.

On her notes it said she had cardiac comorbidities and Down's syndrome.

Hancock tells the inquiry he did get reports that people were being denied ICU care, as well as the misuse of so-called Do Not Resuscitate (DNR) notices, and he was "fighting" on behalf of those to whom it was happening.

Carey underlines Sullivan's hospital was over capacity at the time.

Hancock says clinicians make decisions like that in normal times and more so in a pandemic.

He adds that he passed on material like this to cabinet colleagues.

Matt Hancock is talking about the strain of the pandemic on intensive care units (ICUs) in England's hospitals and the task of having to increase hospital capacity while controlling the spread of the virus.

Listing the challenges, he tells the inquiry there were four reasons more people were dying during the pandemic:

• The direct impact of Covid itself
• Unavailability of healthcare
• Impact of measures to control the spread, such as lockdowns
• Higher hospital admittance

Although he says “the system as a whole withstood the pressure”, he talks about a visit he made to St Bartholomew's Hospital ICU in London where there were “far more beds than there was space for, I saw it for myself”.

Jim Reed
Reporting from the inquiry

There’s a lot of talk now about the pressure on intensive care units (ICU) in the pandemic.

The inquiry has already heard evidence that, at the peak of the second wave in January 2021, 6,099 ICU beds were filled across the UK, well above the pre-pandemic capacity of 3,848.

The vast majority of those were Covid patients on ventilators at the time.

Hospitals could only stretch capacity in that way by cramming in more beds or opening new overflow units in corridors, operating theatres and other spaces.

The problem is they only had a limited number of highly trained staff so staffing ratios were then stretched to the limit.

In normal times you would have one critical care nurse for each patient. Hancock said at times that was stretched to one nurse to every six patients.

And he accepted that did have an impact – not just on those staff but also on the care some of those patients received.

“I was acutely aware of this, and it weighed heavily on our decision-making at the time,” he said.

The inquiry now turns to staff-patient ratios that were stretched in a bid to increase capacity in the NHS.

Hancock tells the inquiry he wanted to stretch them "as much as clinically possible" at the same time as building new hospitals - the temporary Nightingale hospitals which were created in existing buildings like conference centres.

He explains that as well as the pressure stemming from the sheer numbers needing care, it was also concentrated in the sense that there would be very large numbers "presenting with the same condition".

Asked about the decision to stretch ratios to one nurse to six ICU patients, he says he thinks that would have been an NHS decision.

As for whether he accepts that in intensive care that could lead to a "different level of care", he responds that he doesn't only "appreciate" it - he saw it himself.

He underlines that as to the specific ratio, he had to rely on clinical advisors and NHS England advice.

His role, he adds, was "strategic".

Matt Hancock is talking about how stretched the NHS became as Covid spread in the spring of 2020.

He tells the inquiry that in normal times one nurse would care for one patient in ICU, but during the pandemic he says "we stretched that so that one nurse cared for six people, it was a deeply challenging situation".

Hancock goes on to talk about the need to protect the NHS while encouraging patients to come forward if they need it, saying "it was always in my mind".

The former health secretary admits that some cancer treatments were delayed but says it was not clinically safe to continue them when they could affect a patient's immune system.

He says that "whilst individual parts were under pressure the overall point is we did not have a collapse in the system".

Image source, PA Media

Jacqueline Carey KC Counsel now asks Hancock about asymptomatic transmission of Covid-19 and its effect on hospitals and staff.

Hancock describes the challenge here as the "system as a whole" and the "clinical advice to the system".

He says asymptomatic transmission was not considered a "material factor" initially - something that only changed in April 2020.

He adds that his failure was his "inability" to override that global consensus.

However, in early March he did take the decision to increase PPE requirements. He explains one of the reasons for the "sharp increase" in demand was the increase in the recommended use.

He agrees with the inquiry counsel that World Health Organization guidance is not "binding" but adds that it does influence public health views and that of Public Health England.

It was not something he could overrule "with the stroke of a pen", he tells the inquiry.

When asked about his relationship collaborating with the four UK nations, Matt Hancock explains how important it was to bring the health ministers from each nation together.

He says it was “incredibly helpful for understanding and discussing decisions we were making".

However, counsel to the inquiry Jacqueline Carey KC reads out some quotes from one of their meetings where Hancock spoke about Nicola Sturgeon - the former First Minister of Scotland - “causing all types of difficulties”.

Hancock says there was excellent collaboration between the four health ministers of the UK.

Hancock hit with quickfire round of questionspublished at 10:26 Greenwich Mean Time

10:26 GMT

Jim Reed
Reporting from the inquiry

Rather unusually counsel to the inquiry Jacqueline Carey KC has started with a series of quickfire questions covering major topics.

Matt Hancock was asked about the message to "Stay at home and protect the NHS" repeated by ministers in the pandemic.

Did it strike the right balance? "Yes," he replied, “because it was literally true that if we didn’t stop the spread of the virus, then the NHS would be overwhelmed".

He also said the government did “everything it could” to keep NHS staff safe though that was “extremely difficult”.

He said hospital visiting restriction means balancing “difficult considerations” on both sides but felt the balance was “broadly right”.

He agreed that the NHS started 2020 with a high proportion of hospital beds already full and that placed it under “more strain” when Covid hit. And he said the decision to suspend all non-urgent planned care in the pandemic was the right one.

All these subjects are going to be explored in much more detail over the next day and a half.

Emotions are running high here among members of the public watching his testimony.

Baroness Hallett has already had to ask people in the public sitting area to lower pictures of relatives who lost their lives to Covid which were being held up in the inquiry room.

Hancock is now asked about the insight he gained by way of visits during the pandemic to health facilities such as GPs and hospitals.

He gives an example he has provided before - of a night he spent in Basildon Hospital helping to turn over patients on ventilators.

He describes being in an intensive care unit where a patient was "lucid" and "talking" but whose oxygen levels were low and falling.

The doctor decided, with consent, to anaesthetize and intubate the patient telling Hancock afterwards that the patient had a 50-50 chance of waking up.

Pushed on what insight this visit gave him, Hancock says it "stiffened" his "resolve" to not lift measures preventing the spread of the virus too soon.

When asked if healthcare workers were kept safe, Matt Hancock says he visited hospitals and saw for himself what healthcare workers were facing.

Under the circumstances he believes that he and his team did "everything we possibly could"

He goes on to say "does that mean every decision was perfect, of course it wasn’t".

Hancock admits they got the funeral guidance wrong, but emphasised that they did what they did to stop the NHS being overwhelmed like it was in Italy.

Matt Hancock has begun addressing the inquiry - he is sworn in and responds to some background questions initially.

He is first asked about the message to "Stay at home, protect the NHS and save lives".

He agrees the message "struck the right balance" - citing reasons including that support for the NHS is one of the "strongest things" that holds this country together.

The chair of the inquiry intervenes briefly to ask those in the hearing who are holding pictures of Covid victims to lower them to avoid distraction.

Image source, UK Covid-19 Inquiry

Matt Hancock has just been sworn in and is beginning his evidence.

We're poised here on the news desk to bring you the key lines and further analysis - or you can follow along yourself by clicking Watch Liveabove.

As well as bringing you the key lines in text we are streaming the Covid-19 inquiry.

You can view by clicking the Watch live button at the top of the page.

Hancock is due to start his evidence shortly.