We're onto the final topic before a short break, with Matt Hancock being asked about systems for monitoring the deaths of health and care workers during the pandemic.

Hancock says there was no individual department ready to monitor this at first, but suggests that he went on to establish one.

Hancock is then pressed on whether he was aware of issues around under-reporting deaths of health workers and says he is "not surprised" before adding that statistical reports were largely wrong at the start of the pandemic.

There's then some discussion of statistical techniques that were used by Public Health England, and Hancock denies "quibbling" with them.

But, he stresses that the figures that were found were only a guide to the underlying truth of how many people were dying from Covid.

With that, the inquiry takes another short break.

Asked now about mandatory vaccinations in health and social care settings, Hancock describes the moral case for this as - "if you are employed to care for others then you should take reasonable steps to ensure you are not harming those in your care".

He calls a clinically proven vaccine a "reasonable step".

During the pandemic, he was persuaded to do this for social care first and then for health - but the latter did not happen.

He says this was a "regret" and he should have done both at the same time.

Speaking about the possibility of hesitancy from ethnic minority groups, Hancock looks to the wider vaccine programme in which the government sought to ensure that those organising and administering the vaccines were also from those communities.

Looking forward - he said he would push for mandatory vaccines for health and social care employees "right from the start".

The inquiry is continuing to probe the impact of Covid on people from ethnic minority backgrounds, as the hearing is shown WhatsApp messages between Hancock and Helen Whately - the minister for social care in June 2020.

In the first text, Whately says there is "systemic racism within the NHS" and that now would be a good moment to tackle it - Hancock agreed to both parts.

In another text - a year later - the pair discuss how to tackle the problem, criticising the NHS' decision to bring out a glossary of terms that included critical race theory ideology.

"My strong view is that racism was a problem and is best tackled by treating each individual as a person," he tells the inquiry, adding that he didn't want to start singling out people by their communities.

The former health secretary says that racism affected who was promoted to senior roles in the NHS and whistleblowing by these groups was not taken as seriously.

Hancock suggests that this is a problem that needs to be resolved whether during a pandemic or otherwise.

The inquiry shifts to discussing the disproportionate impact of Covid on those from ethnic minority backgrounds.

Jacqueline Carey KC first asks about masks not fitting a range of face types.

Hancock says he raised this with the NHS. Asked whether a more diverse range was available by the time he left office, he says he "think[s] so" but that he wouldn't be able to say whether it was "fully adequate".

He is then asked about the risks from the disease itself.

The former health secretary says the first four doctors to die in the pandemic were all from ethnic minority backgrounds - adding that he was aware of the disproportionality before official reports came through.

As to steps he took to mitigate, the "single biggest thing" in his role was to make the lockdown "strong enough", he says.

Jim Reed
Reporting from the inquiry

The numbers we just heard in testimony were particularly stark.

Jacqueline Carey KC, the lead counsel, brought up data on screen showing that there were more than 30,000 cases of hospital acquired – or nosocomial in health speak – Covid in the pandemic.

To be clear – these are patients who went into hospital in England for another reason and caught the virus while inside.

Around a third of those patients, some 9,850 people, then died, although we don’t know whether that was directly as a result of Covid.

Matt Hancock described hospital-acquired infection as a “very serious problem” in health systems everywhere but said the NHS had a “particular problem with it.”

The inquiry turns to address how differences between hospitals prevented them from complying with Infection Prevention Control measures.

Watford Hospital is given as an example. Inquiry counsel Jacqueline Carey KC describes how the hospital couldn’t maintain two-metre gaps between beds and lacked adequate ward ventilation because of its layout.

Hancock stresses that he did everything he could within his remit, for instance by commissioning a new hospital for Watford.

He says these questions are very important ones to ask the then-chief executive of NHS England and explains that he was not accountable for decisions on ventilation within hospitals.

"I say none of this to criticise Simon Stevens who did an absolutely brilliant job", he notes, before saying that individual hospital managers would also accept that they are responsible for these decisions.

"It doesn't mean I didn't feel it," Hancock adds, accepting that the buck stopped with him as the secretary of state. "I felt it deeply."

Still on the theme of PPE, Hancock is pushed on his earlier comment that there were individual shortages, but at no stage a national shortage.

Carey puts it to him that "nationally available" PPE does not help individual workers facing shortages in their areas.

She asks Hancock if he is trying to present a "rosier" picture of the PPE situation.

He denies this, saying he is being clear about what happened and underlines that the inquiry is about lessons for the future - nurses on the ground now care that there will be enough PPE in the future, he says.

He is next asked about hospital acquired infections - saying he was aware this could be an issue as soon as he heard of a new infectious disease - "it's obvious".

Asked what he did to mitigate the risk, Hancock references hospital PPE guidance as well as introducing testing in hospitals.

However, he adds that some hospitals "did not want to test staff" for risk they may find too many with Covid.

The NHS has a "cultural problem" with not doing enough in relation to nosocomial infections - those acquired in hospital settings - he tells the inquiry.

We're into quite granular detail now on PPE supplies, with the inquiry being shown a graphic that displays how close specific items came to a "stock out".

"We were working incredibly hard to make sure that we didn't have a stock out and we nearly did," Hancock observes.

Hancock is then asked about guidance for re-using PPE - which he signed off on - and admits this caused upset at the Royal College of Nursing, which brought in refusal to treat guidance in response.

"I didn't want to see that guidance in place either," he says, but notes that the objective was to save as many lives as possible and in certain circumstances the advice he received concluded that reuse of PPE is better than none.

"It's perfectly reasonable for a trade union to take a different view but that doesn't mean they're necessarily right," he adds.

The inquiry is continuing to discuss PPE stockpiles that were available at the start of the pandemic.

An audit conducted at the start of 2020 showed that some kit was past its sell by date and also that it did not contain a single gown despite a previous recommendation to buy them.

Hancock says procurement was the responsibility of Public Health England although one of his roles was to "fight for their budget".

He speaks of how "slowly" the government buys things, saying it has gone back to being "incredibly slow" since the pandemic.

Did England ever run out of PPE, he is asked.

"As a whole, no, but individual locations did," he replies.

He adds that England came "extremely close" - to within "small numbers of items on a regular basis" - during April and May 2020.

The inquiry resumes as Jacqueline Carey KC asks Matt Hancock about personal protective equipment (PPE).

It's quickfire questions to begin, and Hancock accepts immediately that some medical staff went to work wearing ineffective PPE.

Hancock explains that the "central balancing" with PPE involved comparing supply against precautionary healthcare considerations.

The former health secretary says he regarded this an essentially clinical decision taking into account stock – and didn't "interfere" with IPC action on this.

Still, Hancock says that he was deeply involved in pushing to purchase more PPE, and suggests that this was not an academic exercise, but one concerned with saving lives.

"The practical reality is that there is a certain amount of PPE and you have to use it as effectively as you can while buying as much as possible," he says. "That is the real world reality here."

The inquiry has filed back in for the restart, and Matt Hancock is sat waiting for the afternoon’s questioning to begin.

The former health secretary will continue to give his account of his response to the Covid pandemic until around 16:30 this afternoon.

Adam Goldsmith
Live reporter

Image source, PA Media

Before the afternoon session begins, let’s take you through what former Health Secretary Matt Hancock told the inquiry this morning:

• Hancock stressed that despite the pressure it faced, the NHS did not collapse during the coronavirus pandemic, and that the ‘Stay Home, Save Lives, Protect the NHS’ mantra “struck the right balance”
• There was considerable time spent on whether there should be national guidance on who went to intensive care - Hancock insisted that he wanted “individual doctors” making those decisions
• Cancelling non-urgent care appointments - for instance those involving cancer - was the “least bad decision” - and Hancock stressed it was down to NHS England when these treatments restarted
• Hancock said that emergency Nightingale hospitals- temporary hospitals to treat Covid patients - were “entirely justified”, even though one in Birmingham treated no patients in either the first or second waves of infections
• There was also a lengthy discussion on improving the 111 non-emergency NHS phone service, as well as suggestions from the former health secretary that ambulances should have reserve staff in a similar way to the Territorial Army

We’re expecting the inquiry to restart at about 13:40 GMT.

Jim Reed
Reporting from the inquiry

Just before the break we heard about the use of DNACPRs – or “Do not attempt cardiopulmonary resuscitation” orders.

This was a highly controversial subject during the pandemic.

If a patient goes into cardiac arrest or stops breathing, it means they should not be given chest compressions or defibrillation to try to save their life.

That order should only be added to medical notes after consulting with the patient or their family.

But there were reports in the pandemic of under-pressure hospitals applying it either without consent or in a blanket fashion – i.e. based on either age or disability.

Hancock said he was made aware of those concerns through another MP and via press reports.

“I thought this was totally appalling,” he said. “The principle of healthcare has to be based on consent.”

He said he used news conferences to remind NHS staff that this should not be happening.

Ambiguity over accountability may prove a key issue for the inquirypublished at 13:00 Greenwich Mean Time 21 November 2024

13:00 GMT 21 November 2024

Hugh Pym
Health editor, reporting from the inquiry

A thread running through many of the exchanges so far has been the issue of who was in charge of the NHS pandemic response.

Matt Hancock as health secretary had overall responsibility for policy and was answerable to Parliament.

But at the time, and has since changed, NHS England was independent and at arms length from the government.

For much of the worst of the pandemic it was run by Sir Simon Stevens. So there was confusion in the unprecedented pressures of the pandemic over who was responsible for what.

Hancock told the inquiry he had pushed for hospital capacity to be expanded though this would have meant staff in intensive care being overstretched with more patients.

Concerns were raised by NHS England but the changes were made.

Intensive care nurses then had to look after six patients each. Hancock said that had been decided by Sir Simon Stevens.

On the question of the speed of returning the NHS to normal levels of planned treatment after the first wave, Hancock said he pushed for a faster response but, again, the implementation was down to NHS England.

Stevens, now Lord Stevens, is not appearing as a witness at this stage and may well have different recollections. The ambiguity over decision making and accountability may prove to be a key issue for the inquiry.

In the final question before lunch, Matt Hancock is asked about Do Not Resuscitate (DNR) orders, external where a doctor or patient can decide not to give or receive cardiopulmonary resuscitation.

Hancock says he was made aware of concerns they were being used inappropriately - calling this "appalling".

He emphasises healthcare "has to be based on consent" and that any DNR notice without appropriate consent is "wrong" and "potentially illegal".

As for steps he took in this regard, he says he "reiterated" and "made clearer" guidance to medics.

The hearing is now taking a break for lunch so we'll catch you up on what's been said and get analysis from Hugh Pym and Jim Reed at the inquiry.

The inquiry now moves on to ambulances, and is shown testimony from one pregnant person, who complained of huge difficulty and delay after phoning for help.

Hancock says he was aware of the problems with delays, adding that a person in charge of co-ordinating ambulances "burst into tears" when he spoke to them because of how difficult the task was.

He then suggests that the UK should have people trained as ambulance drivers on standby, similar to the Territorial Army.

Image source, PA Media

During the second Covid wave, Hancock says, the ambulance service improved as the peak was not as bad.

Hancock then responds to evidence of patients being held in ambulances for six to 12 hours outside hospitals.

He says he was aware of this and that having ambulances stacked outside A&E units made existing problems worse.

The former health secretary is also pressed on regional differences in ambulance waiting times.

He answers by saying this is partly down to the fact that Covid affected different parts of the country more significantly than others, as well as different standards of care more generally.

Inquiry counsel Jacqueline Carey KC spends some time on the number of calls to 111 - the NHS non-emergency number - that were abandoned in the initial stage of the pandemic.

The public were asked to call 111 as a first port of call, but there were issues with call-handling capacity in early March 2020.

At its peak 40% of calls were not answered, Carey says.

Hancock replies saying the system of ringing 111 before going to A&E "should be our national system" – and underlines "difficult decisions" have to be made in a pandemic.

Carey then pivots slightly asking whether there was "sufficient action" to ensure those who needed healthcare still came forward.

It was a “difficult balance”, Hancock says, calling it a "two-part message" of "Stay at home unless you really need the NHS, in which case please do go".

In any similar future situation, Hancock says this needs to be a clear part of the communications.

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.