Cain is still discussing the expert committee SPI-B. He says it isn't fair of the inquiry lawyer to suggest he cut off official scientific advice that was readily available to them.

He says nobody had approached him with the advice or feedback.

"I was hosting numerous messages and the evidence that was presented to me... was at odds with the research that we were doing," he says.

And he adds he stands by his campaigns as "being incredibly effective".

Andrew O'Connor KC now asks if Cain considered it his role to think about communications across the UK, not just England.

Cain says he would broadly look across the UK, but that the challenges "become more about politics than communication".

Cain is now being asked about SPI-B - an independent, expert committee which provided advice to Sage (the government's Scientific Advisory Group for Emergencies) during the pandemic.

The inquiry lawyer says Professor Yardley from the committee claimed SPI-B was not consulted about the messaging coming out of No 10, including the "Stay at home, protect the NHS, save lives" campaign, its successor "stay alert, control the virus, save lives", "eat out to help out", and the "freedom day" slogan.

Cain says he did not agree with some of the slogans and was not consulted.

He says in the future advice should be sought "wherever we can get it".

Cain stands by 'Protect the NHS, save lives' campaignpublished at 11:16 Greenwich Mean Time 31 October 2023

11:16 GMT 31 October 2023

Jim Reed
Health reporter

Image source, Department of Health

It will probably go down as one of the most memorable public health slogans of all time: "Stay at home, protect the NHS, save lives".

Cain told the inquiry he was responsible for drawing this up alongside a small number of colleagues in Downing Street and an outside agency.

He was just asked about whether he properly consulted the NHS, amid concerns by some health leaders that it may have deterred people from coming forward who needed help for other non-Covid problems.

Asked if he was telling people "not to go to hospital", Cain said he would "strongly stand by" the campaign, which had a goal of "protecting as many lives as possible".

The waiting list for planned treatment on the NHS spiked over the pandemic and has continued to rise ever since, to 7.75 million people in England.

It's impossible to say how much - if any - of that can be blamed on patients who are sicker now than they would have been having not coming forward for treatment in 2020 and 2021.

NHS leadership did criticise this "stay at home" campaign, the inquiry lawyer says, because the concept of protecting the NHS created a risk that people would delay seeking medical treatment for other urgent non-Covid medical issues.

Lee Cain says says he "strongly stands" by the campaign and that the messaging worked with No 10's goal of saving as many lives as possible.

He disagrees that the reason people were not going to hospital for non-Covid issues was because of the campaign.

"We were clear in interviews and other messaging that obviously people with serious health concerns should seek help and go to emergency care as they would previously do," Cain says.

Moving on, inquiry lawyer Andrew O'Connor KC is looking at communication strategies during the pandemic.

In his statement, Cain talks about the "stay at home, save the NHS and save lives" campaign, which he believes was successful.

Highlighting the need to stop the NHS being overwhelmed, O'Connor says during the early stages of the pandemic, it was clear certain groups of society were at a heightened risk from Covid.

"Wouldn't it have been better, instead of saying 'protect the NHS', to come up with some language to protect those people who were at the greatest risk from Covid?" he asks Cain.

"No," Cain says. He says they focused on maximum compliance, which was "the best way to protect everybody."

Lee Cain turns to a press conference where Boris Johnson announced they would "turn the tide within 12 weeks" on the pandemic, describing this as "unhelpful" and "frustrating".

But the lawyer for the inquiry Andrew O'Connor KC again goes back to Dominic Cummings' texts calling the cabinet office "terrifyingly [expletive]" and asks Cain whether he agrees that the ex-PM was not up to the job.

"It was the wrong crisis for this prime minister's skill set," Cain replies, at which point Baroness Heather Hallett asks him to use "straight-forward English".

"I felt it was the wrong challenge for him mostly," Cain says.

Cain is asked about the meaning of a reference in a WhatsApp message between him and Dominic Cummings, where Cummings says the prime minister is back to "Jaws mode".

Cain says Johnson would refer to the shark film Jaws and the mayor who wanted to keep the beaches open. The prime minister had a routine where he would use that as a joke in his after dinner speeches.

Johnson would say the mayor was right all along to keep the beaches open, because it would have been of long term harm to the community, Cain recalls.

Image source, Covid inquiry

Back to Cain's witness statement now. A theme, the lawyer for the inquiry says, is that a cause of the lockdown delay was the prime minister's "indecision".

"These moments of indecision significantly impacted the pace and clarity of decision-making across government," Cain writes.

He's asked what Boris Johnson's main concerns were around that time. Cain says it was whether the government was overreacting, and "will the cure be worse than the disease".

He adds it's easy to look back and say what should have been done, but "this was one of the biggest peacetime decisions in recent years" - and it "clearly weighed heavily" on Johnson.

"Indecision probably was a theme of Covid that people did struggle with inside No 10," Cain says.

The chair of the inquiry, Baroness Hallet, interrupts. She asks if Cain defends the 10-day gap between the decision that there had to be a lockdown and its implementation.

"I think it is longer than you would like," he responds, but emphasises how much organisation went into it behind the scenes.

Nick Eardley
Political correspondent

Lee Cain was one of the people speaking to Boris Johnson on a daily basis in March 2020, when Covid was becoming a crisis in the UK.

We're getting a picture here that lockdown was seen as inevitable more than a week before it was announced.

Cain writes that on 14 March, it was seen as "the only strategy which could supress the spread".

Lockdown was announced - but not until 23 March. Cain says that was longer than many would like, but the government machine took time.

Image source, Covid inquiry

Cain says the lack of data was absolutely staggering in March 2020: there was no dashboard, no live information flow, he recalls.

"We'd basically have a meeting where the amount of bed capacity in hospitals would be jotted down on a whiteboard," he adds.

On 13 March, when he was warned that the NHS was going to be overwhelmed, Cain confirms that was "news to him" at that point.

The following day, a meeting was held between the ex-PM, Dominic Cummings and No 10 private office staff (including Cain), in which they agreed that a lockdown was needed - but it was not announced for another 10 days.

Questioned about this period, Cain says it took longer than anticipated but for justifiable reasons - "it's quite a big undertaking locking down an entire country," he argues.

Jim Reed
Health reporter

We have heard a lot in the inquiry so far about two different government strategies to deal with Covid in the spring of 2020: mitigation versus lockdowns.

The mitigation strategy gained traction around the start of March that year. The idea was to "squash the sombrero", as Boris Johnson put it, of cases on a graph - so the UK could avoid a dramatic peak which would overwhelm the NHS.

Instead, younger, healthier people would be expected to catch the virus over time and build up some immunity in the population ahead of the winter - while the more vulnerable would be protected. This is where the much-derided idea of 'herd immunity' comes from.

Ministers thought they could achieve this with voluntary measures - asking people to work from home and wash their hands, for example.

What Cain, and others, have said is that by 13 March it became increasingly clear that this strategy was not gong to work and the NHS could be overwhelmed within weeks.

Cain explained to the inquiry that he was told it could be worse than the scenes in Lombardy, northern Italy, where hospitals were being completely overrun by Covid patients.

On the weekend of 14 March, a meeting was called to discuss a switch to a more dramatic strategy - a mandated national lockdown.

The question is why did it take another nine days before that lockdown was announced by Boris Johnson on 23 March?

The lawyer for the inquiry asks if Cain agrees there was a general lack of leadership, to which Cain says yes.

Moving on to the decision to implement the first lockdown, Andrew O'Connor KC notes the change from a mitigation to a lockdown strategy.

He references a point Cain made about warnings that the NHS wouldn't cope if the country didn't go into a lockdown, and asks Cain if it was his impression something had changed in the numbers.

Cain says they had been told "a suppression strategy wouldn't work" and that they could "only undergo 12 weeks of hard measures".

"If we did suppress, as soon as we unlocked we would then see a second spike, NHS overwhelmed," he says.

The new modelling Cain references showed that tens of thousands of people would die if they stuck to the plan they had in place, meaning a new one was needed.

Cain says he was aware of Dominic Cummings "kicking the tyres quite robustly" in an effort to see the government's plans to deal with Covid, stressing that he was perhaps the only one doing so.

The lawyer for the inquiry brings up a WhatsApp message sent by Cummings to Boris Johnson on 12 March 2020.

"We've got big problems coming," it says. "Cab off [cabinet office] terrifyingly [expletive], no plans, totally behind on pace."

Questioned whether he endorses what Cummings is saying and who was therefore failing within the cabinet office, Cain responds: "The point was nobody quite knew who was the point person who should be driving this machine.

"If you asked me now who was supposed to be doing that... I couldn't tell you."

Nick Eardley
Political correspondent

Lee Cain is painting a picture of what was going on in Downing Street in early March 2020.

He says the media message, to flatten the curve, was being used as the government's plan.

That, he says, led to concern in No 10.

He argues in his witness statement: "The fact that many senior figures kept referring to the document as the plan shows that in reality the government had no plan to deal with a pandemic."

We've also been shown a Dominic Cummings message sent to Lee Cain from 3 March 2020, where he refers to then PM Boris Johnson's view of Covid: "He doesn't think it's a big deal and he doesn't think anything can be done and his focus is elsewhere, he thinks it'll be like swine flu and he thinks his main danger is talking economy into a slump."

Cain is speaking now about the government's confusion over how to handle the Covid pandemic.

A WhatsApp message from Dominic Cummings to Cain in March 2020 is shown, saying the PM "still doesn't think it's a big deal...he thinks his main danger is talking the economy into a slump".

Cain responds that the PM was not alone in not doing as much as he should have given the scale of evidence at the time.

But he says yes, the prime minister should have done more - but so should those around him.

He says he isn't an epidemiologist, continuing: "I don't think there was any clarity of purpose, any really serious outlined plan to deal with Covid at that particular point and I think that was the core failure, what were we supposed to do?"

The lawyer for the inquiry moves on to an action plan published on 3 March 2020, in which he says Cain is "quite dismissive".

In his witness statement, Cain refers to the document as "swiftly prepared", but that many in government referred to it as an actual plan for handling Covid.

He wrote he was surprised by this as it wasn't detailed and was for communications purposes.

Cain replies, saying it's clear this document is not a plan to deal with Covid but instead a "thin overview".

He adds he can't fully remember his involvement in the plan.

The lawyer for the inquiry asks Lee Cain whether it is correct that he didn't criticise Boris Johnson's two-week holiday during early 2020.

In response, the former director of communications says it is because he was receiving assurances the UK was well-prepared and that it was not irrational to focus on other "large-scale issues at the time".

The lawyer then quotes Cain who said that at the time Johnson was stressing the importance of not overreacting in the response.

Cain says: "He was worried about the government being swept up in a media hysteria and overreacting and causing more harm than good."

What this inquiry has already heard about Covid preparednesspublished at 10:32 Greenwich Mean Time 31 October 2023

10:32 GMT 31 October 2023

Jim Reed
Health reporter

The inquiry starts today by asking Lee Cain about the planning for a pandemic.

He says he was assured by the Department of Health that the UK was among the best prepared countries in the world.

And in 2019 - just a year before Covid spread around the world - the UK and the US were ranked second and first respectively in the Global Health Security , externalindex for pandemic security, put together by the US' John Hopkins University.

The first module of this inquiry looked at that subject in a lot of detail.

It heard that much of the government's planning was based on a potential flu pandemic - not the emergence of an entirely new virus such as coronavirus.

That appeared to heavily influence the early government response, with scientists assuming the virus could not be stopped and would spread across the country regardless.

Other places - such as South Korea and Taiwan - took a different approach and clamped down quickly on early cases, using contact tracing and isolation.

When the action plan was launched in March 2020, Cain says the government was still well prepared - and that was the view of officials at the time.

The lawyer for the inquiry highlights a conversation Cain had with a senior adviser to Matt Hancock, the health secretary at the time.

This conversation, lawyer Andrew O'Connor KC says, suggests the plans weren't as well prepared as they thought.

Cain says this was the first time someone raised concerns about preparedness, and supply chains in particular.

"It wasn't a sort of panic," he says, but just someone flagging that plans needed more attention.

And asked if he did something about this warning, Cain replies that he started to host a meeting on the issue. Soon after this, he says Dominic Cummings started a senior team meeting.

Image source, Crown copyright

Lee Cain is asked if there was concern about the priority being given to Covid in January and February 2020.

"In January, it felt like we were getting the balance right at the time. As we moved into early January and early February, I think it became clear we didn’t particularly have that balance," he says.

"The question of whether No 10 should have been kicking the tyres more… I think is a valid one."

He also says Health Secretary Matt Hancock was confident on the pre-preparedness and there was the assurance they were ''well set'' to deal with whatever came their way.

Andrew O'Connor KC asks about Lee Cain's personal relationship with former Prime Minister Boris Johnson.

Cain says he developed a good understanding of how the ex-PM would react to information, having worked with him for a long time: "You get a sort of simpatico almost relationship between a special adviser and a principal."

The lawyer for the inquiry goes on to question where Covid was in a hierarchy of concern in January and February of 2020, and Cain says he started from a "low base".

Cain says that when the government was first informed about Covid, there had been "a decade of pre-preparedness" and it was being monitored "closely" by officials in the Department of Health.

He says he believes it was quite rational for the Covid response to be led by the Department of Health, with the expectation that it would inform the government as and when the issue needed more attention.

"Clearly we got that assessment wrong," he says.