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.

The inquiry has been holding hearings since July 2022 which have been broken into modules.

It is now on Module three, which started in September this year.

This section looks at the governmental and societal response to Covid-19 as well as dissecting the impact that the pandemic had on healthcare systems, patients and healthcare workers.

This will include healthcare governance, primary care, NHS backlogs, the effects on healthcare provision by vaccination programmes as well as long Covid diagnosis and support.

Module three will finish in a week's time on 28 November.

A Covid Inquiry spokesperson has called projections by the TaxPayers' Alliance (TPA) that the cost of the hearings could reach "almost £208 million", external inquiry as "flawed".

The TPA said its estimate would make it "the most expensive statutory inquiry by total cost and on a per day basis".

But an inquiry spokesperson called this a "flawed analysis".

They say: "These are figures based on hypothetical future expenditure and an imaginary Inquiry end date, and the UK Covid-19 Inquiry does not recognise them."

The spokesperson refers to the "broad scope" of the inquiry and says the chair has made clear the inquiry "will take time and have a significant cost".

"The Inquiry continues to be thoroughly transparent, publishing financial reports on a quarterly basis for anyone to see," they add.

The inquiry's latest financial report, external dates to 30 September 2024. It indicates the total expenditure to that date sits at just under £124.2m.

Elliot Keck, head of campaigns at the TaxPayers' Alliance, said that while the inquiry was right to question its data - it believes the figure could be an underestimate.

"On all three occasions that we have produced an estimate the total cost has increased, due to accelerating daily spending," Keck tells the BBC. "If the inquiry's chiefs are as concerned as we are, then they should be urgently seeking ways to bring down costs."

Image source, PA Media

Former Health Secretary Matt Hancock is due to answer questions at the UK Covid inquiry today.

The Conservative ex-MP for West Suffolk has faced criticism of his decision-making during the pandemic.

During his previous appearances at the inquiry, he has said he was "profoundly sorry" for each Covid-related death – and admitted that entering the first lockdown earlier would have saved many lives.

Hancock’s Commons career was dogged by controversy.

His stint as health secretary was no exception - he resigned from the role in June 2021 after breaching social distancing guidance by kissing a colleague.

Fast forward a year and he was appearing on screens as a contestant in the ITV reality show I'm A Celebrity... Get Me Out Of Here! – for which he had the Tory whip removed - and Channel 4’s Celebrity SAS.

He would later work alongside journalist Isabel Oakeshott on his book, Pandemic Diaries.

However he accused Oakeshott of a "massive betrayal and breach of trust" after she released 100,000 WhatsApp messages linked to his time as health secretary to the Telegraph newspaper.

Jim Reed
Reporting from the inquiry

We're expecting to hear from Matt Hancock around 10:00 this morning.

A well-known face in the pandemic, he stood down as an MP at the last general election.

He served as health secretary for England from 2018 until he stepped down in June 2021 after security footage was leaked to the press showing him kissing an aide in his office.

This will be his third appearance at the inquiry. For the next day and a half he'll be asked just about the impact of Covid on the NHS and healthcare.

Expect a wide range of issues to come up - from the availability of PPE for doctors and nurses, to the impact of visiting restrictions in hospitals to the use of so-called "Do Not Resuscitate" orders.

There's also likely to be a focus on the longer term effects of Covid on waiting lists for other planned treatment - from hip replacements to heart surgery.

His testimony this week follows appearances by other former health ministers from Wales, Scotland and Northern Ireland.

Image source, PA Media

The Covid inquiry's latest round of public hearings begin in September, to consider how coronavirus affected healthcare systems across the UK.

In July, the inquiry's first report said the UK's flawed pandemic preparations led to more deaths and greater economic damage than there should have been.

Just under 227,000 people died in the UK with Covid between March 2020 and May 2023, when the World Health Organization (WHO) said the "global health emergency" was over.

The Covid inquiry was launched by former Prime Minister Boris Johnson in June 2022 and the first public hearings took place a year later.

The inquiry is chaired by former judge and crossbench peer Baroness Hallett, who previously led the inquests into the 7 July 2005 London bombings.

Rob Corp
Live editor

Image source, PA Media

Morning - we're back at the Covid Inquiry in central London which is examining the UK's response to the coronavirus pandemic.

Former Health Secretary Matt Hancock is in the witness chair for the third time as the inquiry looks at how the healthcare systems across the UK nations coped with the first global pandemic in living memory.

It's examining not just how the NHS and government responded - but how we as a society met the challenge of a virus that would cause the deaths of more than 200,000 people across Britain and Northern Ireland.

Hancock of course was in charge of the Covid response for England and drew up the rules we were supposed to follow - until he had to quit the post in 2021 for breaking his own social-distancing guidelines.

We'll be here with text updates from our health editor Hugh Pym and health correspondent Jim Reed who are the inquiry and you can watch proceedings live when the hearing gets under way at 10:00 GMT.