22 November 2024

(10.00 am)

Mr Matt Hancock

MR MATT HANCOCK (continued).

Lady Hallett: We’re going to try and get through all the questions, Mr Hancock, so we can finish your evidence this morning in one go.

The Witness: Terrific, thank you.

Lady Hallett: Mr Jacobs, I think.

Questions From Mr Jacobs

Mr Jacobs: Good morning, Mr Hancock.

Mr Matt Hancock: Good morning.

Mr Jacobs: Some questions on behalf of the Trades Union Congress. Firstly, on vaccination as a condition of employment.

You were asked questions on this topic yesterday in connection with ethnic minority groups. You described some groups feeling less connected to authorities as you put it and you described the importance of developing trust, using trusted voices and so on.

Does imposing vaccination as a condition of employment not actually work against those factors, so, in relation to groups feeling connected to authorities, you have a mandatory direction from authority with a severe sanction of loss of employment, and it also really abandons attempts at trust and persuasion?

Mr Matt Hancock: Actually the experience that we had with vaccination as a condition of deployment in social care led to the – exactly the opposite conclusion: vaccination rates increased. And I think most people in employment in care settings understood and understand that part of their responsibility, I suppose, is not to infect the people they’re caring for with a potentially deadly disease.

So obviously I understand those concerns, and anybody introducing a vaccination as a condition of deployment should be sensitive to those concerns, but ultimately the imperative of saving lives is more important.

Mr Jacobs: But going back to the focus of my question, Mr Hancock, if you’re right to say that there’s a problem of some groups feeling less connected to authority, that authority saying, “Take the vaccine or lose your job”, the reality is that’s going to be a problem, isn’t it?

Mr Matt Hancock: Well, the reality is best understood by looking at what happened when we introduced this in social care and exactly the opposite happened. So there were those concerns raised and there were the concerns raised that tens of thousands of people would leave employment. That isn’t what happened. And I think it isn’t what happened because vaccines – clinically proven vaccines are safe and effective and I think the moral obligation to save lives is more important.

You often get this in government, when, you know, where there is a – when you’re looking at the best interests of society as a whole, there are some strong voices who are opposed to something. You know, there’s not just people who are hesitant at taking the vaccine but there’s some anti-vaxxers who spread misinformation, and there’s some people who get very upset at things even though they’re the right thing to do.

So I understand the argument but it isn’t borne out by evidence.

Mr Jacobs: Well, in terms of evidence and experience, we’ve heard evidence, for example, from Professor Ball, from a trust in Birmingham, who described vaccination as a condition of employment in healthcare having a very significant impact both on unvaccinated staff but also vaccinated staff who were worried what was going to happen to their colleagues. So do you accept that as a reality of the impact of this sort of measure?

Mr Matt Hancock: Well, this measure wasn’t brought in in healthcare. So I understand that some people make those arguments in advance, and say that’s what’s going to happen, but as I say, when we brought this in in social care, exactly those arguments were advanced and turned out not to be accurate.

But even if they were accurate, even if there were concerns, the lifesaving imperative has, in my view, an overriding moral value that requires and demands that this policy is the right one. So, of course I understand those concerns and we discussed them and considered them ahead of bringing this in in social care, but they are not borne out by reality, as you put it, and even if there were – even if they were, you would – you have to consider the fact that if you don’t have this, then you have people who are going into work with a higher chance of, entirely unintentionally, giving somebody in their care a disease that leads to their death. And it is as stark as that. So, for me, this is a – it’s a cut and dried issue, and I’m very, very pleased with how it went in social care, because it went very well.

Mr Jacobs: In terms of the moral imperative that you describe to take the vaccine, do you at least recognise that there may be a moral imperative that points the other way which is with healthcare workers who have been putting their lives on the line through the earliest, most dangerous stages of a pandemic, to say to them, “You are now out of a job unless you take the vaccine” there’s also a moral imperative against doing that? It may be something that points both ways?

Mr Matt Hancock: As I say, you have to consider all of these things, absolutely. There is a counterargument, but the lifesaving moral imperative absolutely overrides that, not least because vaccinating people who are in these dangerous settings, like working in a hospital, it’s good for them as well as good for their patients. So even if you’re not – even if you take away, as you seem to want to, the moral imperative in terms of protecting the lives of people who go into hospital, it’s good for staff themselves as well.

So, to say there’s a balance is accurate, but in this case the scales of that imperative are very heavily weighed in favour of using science to save people’s lives.

Mr Jacobs: And certainly my clients agreed with that in the sense of promoting use of vaccine, seeking to assist the NHS in achieving high levels of vaccination within staff. But do you think there might be a case for saying that because of the downsides, persuasion and using trust is actually more effective in the round than applying the sanction which you invite the Inquiry to suggest?

Mr Matt Hancock: No. I think that if somebody doesn’t want to use the science that’s available in order to protect the people they care for, then it’s entirely appropriate that they should seek employment elsewhere.

Mr Jacobs: Is there a lack of balance in your view, Mr Hancock?

Mr Matt Hancock: Churchill once said, “I am partial as between the fire brigade and the fire”, and that applies in this, I’ve considered it very deeply and I think the clarity of what is right this issue is absolutely clear.

Mr Jacobs: Next topic, please. Nightingale hospitals and staffing. You describe yesterday that the Nightingales were to operate within the auspices of the relevant trust and the trust would be responsible for staffing, if I understand your evidence correctly, and also that Nightingales would be used when the capacity of existing hospitals could stretch no further; is that right?

Mr Matt Hancock: Broadly, yeah.

Mr Jacobs: If they are to be used in circumstances that existing capacity could really stretch no further, was it ever really realistic to think that at that point the trusts could then provide thousands of staff for thousands of extra beds in additional hospitals?

Mr Matt Hancock: Yes, and that is what was planned, and of course it would be difficult, of course it would be challenging, but a combination of bringing more people back into service, for instance those who’d retired, or were working in private healthcare, and also stretching ratios, as we discussed yesterday, the combination of those two things made this doable. I’m not saying it was easy, but it was doable, and it was – it would have been critical had we not managed to stem the spread of the virus when we did.

Mr Jacobs: You say, boldly, yes, Mr Hancock, but we’ve heard about these being used when staffing ratios in intensive care was already 1:6.

Mr Matt Hancock: Yeah.

Mr Jacobs: So where do these intensive care specialists appear from?

Mr Matt Hancock: Well, the combination, as I said, of bringing people in who, immediately prior to the pandemic, weren’t working in healthcare, for instance qualified nurses who had recently retired, plus the –

Mr Jacobs: Just to pause you there, Mr Hancock, had they not been brought in already to assist with existing hospital capacity?

Mr Matt Hancock: Yes, the combination of bringing those in, them in, and stretching ratios meant that we were able to service more physical capacity. So, as you know, to deliver an effective hospital bed and an effective hospital treatment, you need the staff and you need the physical equipment, and by building the physical hospital and by stretching staff ratios and bringing in more staff, you could therefore enhance the number of beds. So yeah.

But my point is, my central point is, I know this was an enormous challenge, but it was doable and to the degree that it was needed in those hospitals which did take patients we did it.

Mr Jacobs: I think I’m at my time. Thank you, my Lady.

Thank you, Mr Hancock.

Lady Hallett: Thank you, Mr Jacobs.

Mr Stanton.

Mr Stanton is behind you as well, I’m afraid, Mr Hancock.

Questions From Mr Stanton

Mr Stanton: Good morning, Mr Hancock. I ask questions on behalf of the British Medical Association. I’d like to ask you about staff burnout and the trauma they experienced.

Mr Matt Hancock: Yes.

Mr Stanton: The context is the circumstances we heard described yesterday by Professor Fong, and with regard to the fact that survey responses to Professor Fong and his team reported symptoms of serious mental illness, including severe depression, severe anxiety and PTSD among ICU staff at a level of approximately 50%.

I recognise from your evidence that you have personally witnessed and experienced those circumstances as well, but I’d like to ask you, were you aware that the levels of trauma experienced by healthcare workers were of that magnitude?

Mr Matt Hancock: Yes, I was. And, you know, you acknowledge that I witnessed and, to a degree, experienced this, and of course – and I worked incredibly hard but not nearly in the same way as those who were experiencing this and the death directly, day in, day out, in intensive care. So I’m grateful for your acknowledging that I spent as much time as I could on the wards but it was nothing like those who worked full-time in intensive care.

I am aware of the figures that you quote. It was something that we were worried about from the start. It is a consequence of the enormous pressures and the deadly nature of the virus, absolutely.

Mr Stanton: Thank you. Can I ask you about the general points at which you became aware that this was such a significant issue, and can I ask how that factored into some of your strategic decision-making, and also engagement with your senior colleagues, and thinking about the period between the first and second waves when healthcare workers, and the NHS generally, desperately needed to recover, and also, from your evidence yesterday, when you described speaking to a doctor in distress, who told you that there must not be a third wave.

Mr Matt Hancock: So at that point we were worried about a third wave, because it had taken us so long to win the argument for the necessary lockdown the second time around. And thankfully, because of the vaccine, that wasn’t – that didn’t happen. And that was – well, thank goodness for that.

The – we put in place measures as much as we could, and as early as we could. This included, for instance, introducing well-being and recovery areas where possible, supporting hospitals to do that. That was really a hospital-by-hospital decision rather than one that we implemented directly.

I spoke to the BMA and other unions regularly throughout this, throughout this period, in order to understand these pressures and see what we could do. There were contractual changes in some places in order to try to make sure that the problems were mitigated but it was very much mitigation because of, you know, what was effectively a wartime attitude in the intensive care and other settings across the NHS.

Mr Stanton: Thank you.

Could I ask you about the sort of – type of support and the strategic way in which that support was put in place. And just taking an extreme example, obviously where you had a single individual who would be experiencing mental health issues –

Mr Matt Hancock: Yes.

Mr Stanton: – that is absolutely for the employer to deal with, and deal with at that level. When you have issues at this level, reports of approximately 50% of staff experiencing severe anxiety, et cetera, do you think a more central role and leadership was required, not necessarily from you, but NHS England, for example?

Mr Matt Hancock: Yes, so there’s absolutely a need for national measures when – as well as local measures when there’s something of this scale. For instance, NHS England put in place a first port of call phone line, essentially, you know, an emergency mental health phone line for NHS staff, and it was something that the chief people officer in NHS England was engaged on and very concerned about.

You’re right to say that the formal accountability was with NHS England rather than the department, because NHS England – but the individual employer is, of course, the trust, the GP surgery, or the local NHS institution.

So, there was a need for national and local measures, and if there’s further things that can be put in place earlier in the future then I think that the BMA is very well placed to recommend them.

Mr Stanton: Thank you.

Final question, Mr Hancock. How can we avoid this level of trauma in future pandemics, future health emergencies?

Mr Matt Hancock: The absolute number one thing that we can do to avoid this sort of trauma for NHS staff is to bring in lockdown measures early in response to a pandemic level pathogen. And I think that those who understand the consequence of waiting before bringing in measures that are going to be necessary, need to unite to win that argument.

There are still people making the argument that lockdown wasn’t necessary or in future we should try to do without it. I think that is false, wrong and dangerous and we should – and the case needs to continue to be made so that should a pandemic potential pathogen hit, which could happen at any time, we’re ready.

And I come back to the doctrine that I set out in the first module, which I think is – has yet to be challenged, there needs to be a national debate in my view about how we respond immediately, and, again, the BMA will play an important role in that.

Mr Stanton: Thank you, Mr Hancock.

Thank you, my Lady.

Lady Hallett: Mr Wagner.

Mr Wagner’s over there.

Questions From Mr Wagner

Mr Wagner: Good morning, Mr Hancock. I ask questions on behalf of Clinically Vulnerable Families.

I have two areas to ask you about. The first is shielding. You say in your statement that you in your view shielding saved many hundreds of thousands of lives; is that fair?

Mr Matt Hancock: Yes, it’s very, very difficult to estimate, but it was a huge programme and I think it’s likely to be in that order of magnitude.

Mr Wagner: Is that based on any scientific study or is it –

Mr Matt Hancock: Yes, it’s based on – it’s my best estimate based on the number of people who were in the shielding programme, the risks that they face should they catch Covid, which, of course, by its nature was much higher than the general population, and the likely reduction in the – in transmission amongst those who were shielding. But it’s very hard to know for sure.

Mr Wagner: So is that your estimate or is it – is it somebody has given you that estimate?

Mr Matt Hancock: There was some internal work done before I left office, but the – because the – the statistical challenge is, because there isn’t a control group because we chose to support everybody rather than have a control group, is not possible to get an estimate that the government is happy to put its imprimatur to because there’s – because these statistics are very hard, actually, to assess.

Mr Wagner: I want to ask you about what might have been done differently to improve the shielding programme. Just picking up on some evidence you gave yesterday, would you agree that by definition the clinically extremely vulnerable group who were involved in the shielding programme would also have to access healthcare settings, particularly hospitals quite a bit more than your average member of the population?

Mr Matt Hancock: Yes, absolutely, that is – by the nature of the group, that is likely to be true.

Mr Wagner: And you said in evidence yesterday that hospitals are dangerous places in pandemics, the estimate is that more people caught Covid in hospitals than almost any other setting and that’s often forgotten.

Mr Matt Hancock: Yes.

Mr Wagner: I just want to ask you about the combination of those factors. Wasn’t there a problem with shielding that you were protecting people at home –

Mr Matt Hancock: Yes.

Mr Wagner: – but they were also the people who were having to go to hospitals, and wasn’t it the case that, in a sense, that you were protecting people from the frying pan at home but sending them into the fire in hospitals and therefore not really giving protection at all?

Mr Matt Hancock: No, that’s – I think – I was agreeing with you until the last bit. When a pandemic hits you don’t have a choice between no pandemic and the actions that you take. You have a choice between how to minimise the impact of a pandemic. So, in a way, it comes back to the last answer that I gave to the BMA which is we need to make sure that we have a doctrine that brings in lockdown as early – as soon as you know that you’re going to have to do it, you should bring it in. And that is a hard judgment to know that you’re going to need NPIs but as soon as you do, there is no benefit and no tradeoff from not bringing them in immediately.

This is particularly important and acute for those who are clinically extremely vulnerable to whatever pathogen has come along.

But to argue that shielding didn’t work because the people who were shielded needed hospital treatment, they were going to need hospital treatment anyway. So what shielding did was protect them as much as possible from infection in the community, but the best thing to do to protect them from – in hospital is reduce nosocomial infection and reduce the overall level of infection across the country.

So it absolutely doesn’t follow logically that because people who are shielding have to go to hospital therefore you shouldn’t do shielding; that’s not true.

Mr Wagner: Well, that wasn’t what I was putting; it was more about how to improve the programme.

Mr Matt Hancock: Okay.

Mr Wagner: And when you get into hospitals, if you can’t improve things like ventilation, you know, testing, those sorts of things in the early days, doesn’t it make the shielding programme much less effective for that group, taken overall?

Mr Matt Hancock: No, because you have to protect people who are clinically extremely vulnerable from community-acquired infection and from hospital-acquired infection and to say that shielding is only a partial solution is reasonable, but to say that it is no solution because it can’t be the whole solution is false.

Mr Wagner: So you’ll agree it’s only part of a picture which has to include protecting people in healthcare settings as well?

Mr Matt Hancock: Absolutely.

Mr Wagner: Just in relation to shielding from the perspective of the shielded. Dr Catherine Finnis of CVF gave evidence to this Inquiry that many of those advised to shield felt that the messaging was frightening and the effect was in one sense to disempower people by impressing on them the need to shield without providing them with sufficient information about the risks of Covid-19 and the steps that could be taken to manage them.

Would you agree, Mr Hancock, with the evidence of Professor McBride, the CMO for Northern Ireland, and I’m quoting, that “The approach that was taken in good faith initially did not fully think through the loss of agency and the loss of control that people would experience”?

Mr Matt Hancock: So I take that evidence seriously but I also have to counterbalance it with the strong evidence we got of the support for the communications that we put out to those who were shielding, directly communicating with them. I wrote a number of times to the shielding population and their GPs were encouraged to follow up.

So there were very strong voices on the other side as well, and when you’re dealing with a group of up to 2 million people who are clinically extremely vulnerable, the virus itself is extremely frightening. The – it’s the virus that’s frightening because it’s killing people. Being able to communicate effectively is incredibly important and, hence, writing directly and I took personal trouble to make sure those letters were as empathetic as possible, understanding these concerns.

However, the question you’ve always got to ask is: what is the alternative? And I understand the point about agency, and we didn’t make any of the shielding measures required, they were advice, and we were clear that it was advice, and therefore agency was retained but I understand the impact of being told by the Secretary of State or the Chief Medical Officer that this is what you are recommended to do. So we always sought to strike that balance.

With respect to improving the shielding programme, I absolutely think that we should go over it and discuss it and be prepared to make it better next time round, as we did throughout – we reiterated many times during the pandemic to try to improve this. But I think it would be wrong just to take the view of one side of this debate when, in fact, amongst those who are clinically vulnerable there was, essentially, a spectrum of views all the way through from “Tell me exactly what I ought to do” to “Don’t tell me what to do, I’ll work it out for myself”, and there’s every view in between.

Mr Wagner: Do you agree, just going back to that question, that one area that could be improved was empowering people more with information. So, for example, giving them good information about what kind of mask they could wear in – to go out into the community, ventilation, that sort of thing, to make it just a bit more empowering for people who didn’t want to just stay in their homes if they could avoid it?

Mr Matt Hancock: We tried to do that as much as possible, yes. But you’ve got to remember, again, that the responsibility that I had towards the shielding population was not only to ensure that we got that population right – and Jenny Harries did a huge amount of high quality work to do that and we expanded it over time – but also to take into account the response from all those who are shielding not just those who were vocal and in campaign groups.

And – you know, my – I was always focused on the fact that my responsibility was to society as a whole, and in particular to those who are most vulnerable, and therefore tried to get as broad a range of feedback as possible.

Mr Wagner: Finally, on DNACPRs (do not attempt CPR) orders.

CVF is concerned that there remain people to this day who may not be aware that a DNACPR notice was issued for them during the pandemic. For that reason, and to restore trust and confidence in the advance care planning process more widely, CVF has been advocating for a systemic review of all DNACPRs put in place in early 2020 and that the notes of all the formerly shielded people from 2020 be reviewed.

Do you recall any consideration being given to that kind of review and would you support that going forward?

Mr Matt Hancock: I certainly think a review like that should be looked at, because it’s obvious that there were cases when DNR notices were wrongly applied and I think the issue of consent is so important here.

To answer your question specifically about whether we looked at this, I can’t recall us looking at a review like that, because our absolutely prime motivation was to stop that from happening in the first instance, and I’d left office by the time we were in a position then to do the review and look-back. But now, of course, we’re no longer in a pandemic and so now would be an appropriate moment to consider doing that.

Mr Wagner: Thank you. Those are my questions.

Lady Hallett: Thank you, Mr Wagner.

Ms Polaschek, who is sitting beside Mr Wagner.

Questions From Ms Polaschek

Ms Polaschek: Thank you.

I ask questions on behalf of 13 Pregnancy, Baby and Parent Organisations, and I have one topic of questions, on one of their key concerns, the visiting restrictions which impacted women and pregnant people but also new mothers, the newly bereaved and their families when having support and healthcare.

Is it right that you were made aware, including for example in a meeting with the charity Bliss on 7 September 2020, that a core concern amongst these groups was that many hospitals were implementing the visiting restrictions very differently and therefore creating, in effect, a postcode lottery and, in turn, anxiety amongst many women and pregnant people about what support they would be allowed?

Mr Matt Hancock: Yes. And more so than that, my first meeting on this subject that I can recall and have found the evidence from was in June 2020 and I was concerned to get the balance right from the start.

There is a balance here between protecting people from infection and the very, very strong need for companionship in birth or bereavement, but this was a concern, I remember the meeting with Bliss and, I think, Alicia Kearns MP.

Ms Polaschek: Thank you. And it’s right that initial drafts of nationwide visiting guidance, which were later published in December 2020, were shared with your private secretary, and that visiting guidance would have imposed obligations on NHS trusts to implement with immediate effect women having access to a support person at all times during the maternity journey. Were you supportive of that policy direction?

Mr Matt Hancock: Yes, I was, and one of my advisers in particular I asked to stay close to this to make sure that it – that I was continued to be properly advised on it.

Ms Polaschek: Were you made aware that there was resistance from the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists to those initial drafts and that, consequently, amendments to the draft guidance resulted in those directions to NHS trusts being toned down?

Mr Matt Hancock: Yes. As I say, there was a balance in this argument and we had to take into account the balance and the need to mitigate the spread of the disease.

I come back to the point that hospitals are dangerous places in pandemics but nevertheless I was very keen that we get a set of guidance out that was appropriate and supported by those like the groups that you represent.

Ms Polaschek: But just to be clear, did you then understand as a result that that NHS visiting guidance continued to allow for localised variation and therefore maintained, in effect, the postcode lottery?

Mr Matt Hancock: Yes, the argument in favour of that was that during the autumn of 2020, the level of disease was very different in different parts of the country, and there may be areas, for instance, that were in the higher tiers of what was then the tiering system, where a lack of visitors altogether was appropriate in extremis.

I understand there’s some groups who think that that should never be the case, but this was the debate and we had to take all considerations into account, but I was broadly on the side of ensure there’s a – and ensure a companion – a single companion can make a huge difference, and that was the side of the debate I was on.

Ms Polaschek: And just coming to that balance, Mr Hancock, the Inquiry has heard evidence from Gill Walton of The Royal College of Midwives, who was frank that one of the reasons her union did not endorse even the toned down version of that guidance was because of the perceived risk to staff from Covid-19 infection. And her evidence specifically was that testing and greater access to PPE earlier, for both support partners and staff, absolutely and, she said, definitely would have facilitated further visiting.

We’ve talked generally about PPE shortages and you’ve given evidence on that, but were you aware of those specific concerns about PPE shortages in maternity care?

Mr Matt Hancock: I wasn’t at the time but I am now. I would say, with respect both to PPE and especially with testing, there are many, many examples of things that can be done better if you can expand your testing fast enough. That’s why I was – had my shoulder to the wheel on that in a very public way, to try to make the expansion of testing happen as early as possible. And this is just one heart-rending example of why it’s important.

Ms Polaschek: I think you’ve said that you weren’t aware of those at the time, so – those concerns about PPE and maternity care, so does it follow that you didn’t discuss any specific steps that the NHS could have taken at the time to allay those concerns of midwives and other maternity staff in order to try to open up visiting for the impacted women you’ve identified?

Mr Matt Hancock: Well, the truth is that we went into this without a testing system, right, and so it simply wasn’t an available choice. There was a clinical ordering of prioritisation for tests. My job was not to effect that clinical prioritisation, which companions for women giving birth would have been one example of, my job was to expand the number of tests available so we could get as far down that list as possible.

The first – so the first time I engaged on this subject was in June 2020, as that testing became more widely available and as we came out of the first stage of lockdown. But engaging on it any earlier, without the testing to be able to expand that and without – and with severe shortages in PPE, wouldn’t have – I don’t think – even with hindsight, wouldn’t have made much difference.

Ms Polaschek: Thank you, Mr Hancock.

My Lady, those are my questions.

Lady Hallett: Thank you.

Mr Burton.

Mr Burton is over there.

Questions From Mr Burton KC

Mr Burton: Good morning, Mr Hancock, I ask questions on behalf of the Disability Charities Consortium who speak on behalf of some 17 million disabled people in the UK.

In October 2020, the Chancellor of the Duchy of Lancaster, Sir Right Honourable Michael Gove MP, wrote to you and other secretaries of state asking on behalf of the Prime Minister for greater ambition in tackling the terrible disparities highlighted by the pandemic. In that letter Michael Gove said this:

[As read] “I want to draw your attention to the Prime Minister’s request to departments to consider options from proving outcomes for those with disabilities ahead of a future Covid-O discussion. This is also extremely important work. I expect Secretary of State to work with their departments to bring much more ambitious and far-reaching proposals to that discussion as per the Prime Minister’s steer. The Prime Minister has clearly directed his ministers to engage with this issue fully and develop a strong package of interventions. If we do, then I have complete confidence that this committee and our government can move the dial and prevent a replication of disproportionate impacts in the second wave.”

Mr Hancock, what did you do by way of bringing much more ambitious and far-reaching proposals to prevent a replication of disproportionate impacts on disabled people in the second wave?

Mr Matt Hancock: Thank you. So this was obviously an incredibly important subject. I agree with the sentiments expressed by Michael in that letter. And the answer is the shielding programme was the core to the response from the health department. We anticipated from January 2020 that people with disabilities may be more likely to be clinically extremely vulnerable to Covid and more likely to be badly affected and the evidence, sadly, bore that out. There was a disproportionate impact in the first wave.

In the summer and autumn of 2020 we expanded the clinically extremely vulnerable list and the shielding list as a consequence, in order that a wider range of people got more of that – the support that came with that package.

The other thing that I did personally was ensure that people living with disabilities were higher up the prioritisation by – for vaccines, by accepting the JCVI advice, clinical advice, on the prioritisation of vaccines. So that was another important action that happened that autumn.

Mr Burton KC: Mr Hancock, just on the first of those, is it not correct that in relation to the CEV list, it’s correct that people with Down’s syndrome were added to that list in Autumn 2020, but no other disabled people were added to that list, were they?

Mr Matt Hancock: More disabled people were, not by group but by identification of more individuals. So the – you’re right to say that the criteria didn’t expand but the data work to find more people who needed to be within the existing criteria meant that the list as a whole grew quite considerably over the autumn.

Mr Burton KC: Do you mean the CV list rather than the CEV list?

Mr Matt Hancock: I mean the shielding list.

Mr Burton KC: I’m grateful. My next question is about mortality rates. In October 2020, the ONS established that 6 in 10 deaths that occurred between March and July 2020, ie the first wave, were of disabled people. That rate of disparity remained for the second wave, even when controlled for matters such as residence type, geography, socioeconomic and demographic factors, healthcare characteristics, and indeed vaccination status, and disabled people therefore remained at a greater risk, a much greater risk of death than non-disabled people.

In light of that, do you believe your department did enough to reduce disproportionate impacts on disabled people ahead of the second wave?

Mr Matt Hancock: We did everything we could, and the challenge is that the virus itself was more aggressive against people living with disabilities. And that is a sad fact –

Mr Burton KC: Mr Hancock –

Mr Matt Hancock: – in the same way that it was more aggressive against people who were older. So, absolutely, we took action to reduce the total number of people affected and the disparities, but the disparities were a result of the nature of the virus.

Mr Burton KC: So you’re saying disabled people were clinically more likely to die from Covid-19 than non-disabled people?

Mr Matt Hancock: That is the clear evidence from the data, yes.

Mr Burton KC: Would you be able to assist us with what evidence you’re referring to, Mr Hancock?

Mr Matt Hancock: Yes, I’m very happy to write afterwards with it. I haven’t got it to hand.

Mr Burton: I’m most grateful.

Thank you very much, my Lady.

Lady Hallett: Thank you, Mr Burton.

Mr Pezzani.

He’s over there, just along from Mr Burton.

Questions From Mr Pezzani

Mr Pezzani: Thank you, my Lady.

Mr Hancock, I ask questions on behalf of Mind, the mental health charity.

The context of my question is this. Firstly, at paragraph 4 of your fifth witness statement you say, the single most important fact about the NHS in the pandemic is that it was never overwhelmed, although of course you do qualify that by saying that demand never exceeded capacity across the UK as a whole.

Mr Matt Hancock: As a whole, absolutely.

Mr Pezzani: The second part of the context to my question is the witness statement of Saffron Cordery, who is the deputy chief executive of the NHS Providers organisation, in which she says at paragraph 206:

“Throughout the course of the relevant period, trust leaders highlighted to us that mental health services for children and young people faced a significant treatment gap prior to the pandemic in addition to demand stemming from the pandemic.”

Mr Matt Hancock: Yes.

Mr Pezzani: And at paragraph 209 of the same statement she describes how in May 2021 NHS providers conducted a survey of chairs and chief executives of mental health and learning disability trusts that provide mental health services for children and young people. The findings of that survey include that 85% of respondents said they could not meet demand for children and young people’s eating disorder services, and two-thirds said they were not able to meet demand for community services and inpatient services.

Mr Matt Hancock: Yes.

Mr Pezzani: So my question is, in specific relation to children and young people’s mental health inpatient capacity, do you maintain that the NHS was never overwhelmed during the relevant period?

Mr Matt Hancock: Well, what I’d say to that is that this was a problem well before the pandemic and in the 2018 long-term plan we increased the budget for mental health services faster than the NHS budget as a whole and, within that, for children and young people’s services the fastest still. So this is a clear and significant problem in the NHS. It remains so today irrespective of Covid.

So I would say that these services were not overwhelmed by Covid, they were already under very significant pressure before the pandemic.

Mr Pezzani: I’m grateful, thank you.

Thank you, my Lady.

Lady Hallett: Thank you, Mr Pezzani.

Ms Hannett.

Ms Hannett is behind Mr Pezzani.

Questions From Ms Hannett KC

Ms Hannett: Mr Hancock, I ask questions on behalf of the Long Covid groups. We’re very grateful to Counsel to the Inquiry who has already raised most of the issues with you that we wished to raise already.

I have one remaining question. We know that healthcare workers are disproportionately affected by Covid-19 and so are also likely to be disproportionately impacted by Long Covid. As you’ve already confirmed with Counsel to the Inquiry, even now there’s no data being collected on the prevalence of Long Covid amongst healthcare workers.

You’ve already stated there should be data collected on the incidence of healthcare workers with Long Covid. Do you agree that collecting data on staff absence due to Long Covid would have been helpful in order to understand the overall capacity of the healthcare system?

Mr Matt Hancock: Yes, I do, yes.

Ms Hannett KC: And do you agree that that would also have been helpful to have that data for all staff with Long Covid, whether they’re agency staff, privately employed staff, casual workers, non-clinical staff, ie even those not directly employed by the NHS?

Mr Matt Hancock: Yes, and collecting the data in these circumstances for those not, as you say, not directly employed by the NHS is always more challenging, for instance we discussed private pharmacy services yesterday in a slightly different context, but I strongly agree.

Ms Hannett: Thank you.

Thank you, my Lady.

Lady Hallett: Thank you, Ms Hannett.

Mr Simblet, who is just there.

Questions From Mr Simblet KC

Mr Simblet: Good morning, Mr Hancock. These questions are on behalf of the Covid Airborne Transmission Alliance, or CATA, which has been referred to already in the questioning yesterday. It’s an organisation of healthcare workers and others who came together during the pandemic because they were concerned about the need to protect healthcare workers from Covid’s airborne nature and they therefore had concerns also about appropriate protective equipment.

And I’ve got three questions on the types of masks provided to healthcare workers.

Mr Matt Hancock: Okay.

Mr Simblet KC: Now, my first question is about the feedback that you sought from healthcare workers in the context of paragraph 137 of your fifth witness statement where you mention the National Social Partnership Forum, which you say is the established mechanism for the department to discuss issues affecting staff, brings together the department, main healthcare trade unions, NHS employers arm’s length body partners, and you say:

“The forum discussed issues relating to PPE regularly and particularly how staff concerns could be addressed.”

So, what were the outcomes of those deliberations on PPE, how were the staff concerns over the level of protection dealt with, and were those concerns adequately addressed in the forum?

Mr Matt Hancock: Well, it’s a good question whether they were adequately addressed, but they were addressed. The amount of IPC – sorry, the amount of PPE was effectively determined by the IPC process which I took as read, as clinical advice. Of course, the availability of the higher-end masks was extremely tight at the start of the pandemic and had we, for instance, specified FFP3 masks right from the get-go, there would have been a risk that in extremely high-risk settings there would not have been the availability of those masks had they been used across the board when the lower-grade masks were available more widely.

So those sorts of tradeoffs do need to be considered but I think that – but that was the formal process.

I think I also say in my witness statement, there was also, obviously, informal and other advice that we took. The formal process was only – the formal forum was only part of the way that we understood feedback on this basis.

Mr Simblet KC: Right. Well, I’ll move on to the next question which is about the data you were provided with. And, again, in the same witness statement, paragraphs 115 to 116, you state that data on nosocomial infections was consistently used to inform policy –

Mr Matt Hancock: Yeah.

Mr Simblet KC: – identifying outliers and implementing best practice.

Mr Matt Hancock: Yeah.

Mr Simblet KC: And you say that you discussed nosocomial infections frequently with Sir Simon Stevens and Dame Ruth May.

Mr Matt Hancock: Yes.

Mr Simblet KC: And that in June 2020 you “pushed for us to look at data on the impact of use of masks in hospitals on infections”?

Mr Matt Hancock: Yes.

Mr Simblet KC: Now, you’ve given in your statement two examples of that. One, a meeting on 11 June, of which in fact the minutes, which we don’t need to go into, say – it’s headlined the “SOS nosocomial infections meeting on 11 June”.

Mr Matt Hancock: Right.

Mr Simblet KC: And then in November 2020, so five months or so later, there was a discussion with Amanda Pritchard and Ruth May. And so my question is this: from your evidence yesterday, ie your understanding was that FFP3 masks provide a higher degree of protection than FRSMs, this would appear to be particularly important as an issue. Can you say what data you were provided with about masks and their impacts and how did that data affect what you did?

Mr Matt Hancock: Yes, there was regular updates of data on those matters. You quote two meetings. There were many other discussions in between that, both formally and informally, and I think the reason that the June meeting is quoted is because around that time I pushed hard for, and succeeded in getting, the agreement of the NHS to insists on masks for everybody in hospital in all settings where there might be a risk to patients.

So that was a – there was a strengthening of that advice which I worked on with Ruth May, as you say.

So in the paperwork there’s – there are the examples. I don’t have them to hand today.

Mr Simblet KC: Yes, all right. And then thirdly, and this goes back to a question you were asked in Module 2 by Mr Stanton who has asked you questions this morning for the British Medical Association, and it’s this. Given that FFP3 masks are, in your view, the best protection against an airborne virus and there being evidence that Covid was airborne, there was a stop order placed on the purchase of such masks in June 2020. And you were asked why that was. You didn’t know the answer at that point. Do you know the answer now?

Mr Matt Hancock: No, I don’t. I would bring – I would bring one other thing to your attention. FFP3 masks are not the best protection against Covid. The best protection against Covid is to stop the virus in its tracks by bringing in lockdown measures –

Mr Simblet KC: Well –

Lady Hallett: We understand that argument, Mr Hancock, we’re talking about protection –

(Unclear: multiple speakers)

Mr Simblet: Within masks, within the field of masks.

Mr Matt Hancock: Within the field of masks FFP3 masks aren’t the most effective, there are stronger masks as well. So this isn’t a binary question. I have no idea why – if or why a stop notice was put in place and if I had seen it I doubt I would have approved it, but I haven’t seen the paperwork.

Mr Simblet KC: Well, you’ve answered the question. Thank you very much.

Lady Hallett: Did you say yesterday, Mr Hancock, that you understood the IPC guidance took into account the factor of supply? Because that is not consistent with the evidence I heard from people who were on the IPC committee.

Mr Matt Hancock: Well, my understanding is it took into account the real-world situation that we were in. So for instance –

Lady Hallett: Well, where did you get that impression?

Mr Matt Hancock: That’s my recollection from the discussions I had at the time, my Lady.

Lady Hallett: With whom? Can you remember?

Mr Matt Hancock: Well, I discussed these matters primarily with Ruth May, Simon Stevens and Chris Whitty and Donna Kinnair, they were the four people I would have relied on for this – on this sort of issue.

Lady Hallett: So it wouldn’t have been the people directly providing the IPC guidance?

Mr Matt Hancock: No, because that guidance was provided to me through – in particular through Ruth May.

Lady Hallett: So your impression was – I am not using the term pejoratively, but it was second-hand?

Mr Matt Hancock: It was indirect, yes.

But an apposite example is the point about FFP3 masks. If there’s only a certain number, then that sort of guidance would take into account the places where they were most in need and could save most lives. That was my understanding of it. If that understanding is incorrect, that was the impression that I had.

And there may be a difference between what was considered formally and what was broadly taken into account in these decisions. The paperwork will only show part of the – part of that.

Lady Hallett: Thank you.

Who is next? Ms Sen Gupta.

Over there.

Questions From Ms Sen Gupta KC

Ms Sen Gupta: Thank you, my Lady.

Mr Hancock, I represent the Frontline Migrant Health Workers Group. Our client’s members include outsourced non-clinical workers, not directly employed by the NHS.

Mr Matt Hancock: Yeah.

Ms Sen KC: And largely from ethnic minority and migrant backgrounds, such as hospital cleaners, porters, security guards and medical couriers, and clinical nursing and healthcare assistant staff, all of whom are from a migrant background.

Mr Hancock, my clients and their members have numerous questions for you in relation to your conduct during the pandemic. However, in deference to her Ladyship and the Inquiry team, we restrict our questions today to those we’ve been given permission to ask you, updated to reflect your oral evidence so far.

From your answers yesterday, it appears clear that, at least from the spring of 2020, you were aware that migrant healthcare workers were suffering disproportionately high infection and mortality rates; is that right?

Mr Matt Hancock: Yeah, that’s right, and I cared a huge amount for it. I think that the non-clinical employees working in NHS settings are often overlooked in these debates, and those who you represent deserve a stronger voice. And so I was very worried about it, yes.

Ms Sen KC: Thank you, Mr Hancock. You were worried about it. What practical steps did you take to address your worry?

Mr Matt Hancock: Well, the most important thing we could do was bring down infection rates in hospitals. Hence, for instance, the IPC measures that we’ve discussed, that first came in in March 2020, took into account the risk of asymptomatic transmission in the way that they didn’t amongst wider society. That’s one example but there were others.

Ms Sen KC: That’s not specific to migrant healthcare workers though, is it, Mr Hancock? What specific steps did you take focused on that group?

Mr Matt Hancock: I took steps focused on all those who worked in the NHS, especially in those roles where the voice may not be as strong because they may not have the same representation. And my – as with the discussion yesterday on issues of ethnicity in the NHS, my attitude was not to try to prioritise one group or community over another, it was to try to support all those in those roles, no matter and irrespective of the colour of their skin or where they were born.

Ms Sen KC: Thank you, Mr Hancock. You’ve referred to steps, and I’ll ask again, what specific steps did you take in that regard?

Mr Matt Hancock: Absolutely central to this was bringing in lockdown measures. I know that I keep repeating it but it is absolutely core to how you can respond to a problem like this.

The second is bringing in PPE measures that took into account the risk of asymptomatic transmission within hospitals that I’ve just mentioned.

The third was supporting research into how the disease spread. So this was critical and in fact goes to the questions we’ve just been discussing from the Covid-19 Airborne Transmission Alliance, because in the early days we did not understand how it was transmitted and there was a presumption that transmission was more based on touch than on aerosol. And when the research came to light to show the importance of aerosol transmission, we again took steps related to that.

So this was a core part of trying to reduce nosocomial infection but it’s a very difficult problem to crack.

Ms Sen KC: Mr Hancock, do you accept that migrant healthcare workers, who had precarious immigration status, were more vulnerable to employer pressure to work in higher-risk environments than their non-migrant colleagues?

Mr Matt Hancock: I can absolutely see how that could be the case, yes.

Ms Sen KC: As the Minister for Health, what practical steps did you take to address that?

Mr Matt Hancock: Well, as I say, even before the pandemic I was worried about this, and I had taken steps to highlight it to the NHS as employers, including publicly describing what I wanted to see and in introducing, encouraging the NHS to introduce, a chief people officer for the first time, who, as it happened, herself was from a migrant background, but that’s less important than the fact she took action within the NHS to try to tackle this problem.

But I’m afraid to say, I have to tell you in all honesty, there is still a huge amount to do on this agenda.

Ms Sen KC: Mr Hancock, when the pandemic hit in early 2020, around half the UK’s hospital sites had outsourced ancillary services, including for cleaners, caterers, security staff. And those workers invariably worked for minimum wage and, as outsourced workers, did not have the employment protections of NHS employed staff.

As the Minister for Health, what practical steps did you take to protect these particularly vulnerable workers?

Mr Matt Hancock: Well, one step, for instance, was to support the increase in the minimum wage and the introduction of the national living wage, which I campaigned for again before the pandemic. That’s one example.

The second is that in discussing people issues within the NHS, I was always at pains to take into account those not directly employed. This wasn’t always the natural inclination of employers within the NHS, and in fact yesterday’s discussion around pharmacists not employed directly by the NHS is one example: where I said pharmacists should get support as a whole, and then the system turned that into pharmacists directly employed should get support, and within three days I’d managed to change that back again to my original instruction. This is – you know, that’s one granular example I reiterate because it’s front of mind, but there’s endless things like that that you have to do if you want to support people who are themselves supported by the organisation that you represent.

Ms Sen KC: Mr Hancock, PPE. You told her Ladyship yesterday “our responsibility was to make sure that there was as much PPE available as possible”?

Mr Matt Hancock: Yes.

Ms Sen KC: You also said “preventing nosocomial infection is a key responsibility [for] the NHS”?

Mr Matt Hancock: Yes.

Ms Sen KC: Outsourced workers dealing with NHS patients, both in NHS and private hospitals, reported that they were not provided with adequate PPE. As the Minister for Health, what efforts did you make to ensure that outsourced workers in hospitals were provided with appropriate or indeed any PPE?

Mr Matt Hancock: Well, again, my responsibility was to ensure that there was PPE broadly available and that, as a nation, we didn’t run out. The – of course the distribution of that matters, and ensuring the policy supports and allows for the distribution of PPE to all those who are vulnerable and need it was important.

One example of this is that we set up PPE supply chains from the government to organisations, including many of those who employ those you represent, who before the pandemic would have bought their PPE entirely privately.

So, you know, in normal times, most organisations buy PPE as a normal purchase with no intervention from the government whatsoever. And before the pandemic the NHS Supply Chain supplied only the state-owned NHS hospitals, about 250 of them.

We expanded that to include around 60-70,000 organisations to which the state supplied PPE. So that’s one of many examples.

Ms Sen Gupta: Thank you, Mr Hancock.

Thank you, my Lady.

Lady Hallett: Thank you, Ms Sen Gupta.

Ms Woodward, who is at the back there.

Questions From Ms Woodward

Ms Woodward: Thank you, Mr Hancock, I ask questions on behalf of Covid-19 Bereaved Families for Justice Cymru, and my question is about communications with the devolved nations and it relates to evidence that Frank Atherton, the CMO for Wales, gave to the Inquiry during this module.

The transcript of Dr Atherton’s evidence can be found at tab 62 of your bundle, Mr Hancock, and for others’ reference it’s PHT000000108.

I’m afraid I’m going to have to read out a length of Dr Atherton’s evidence to you to give my question context.

When asked about instances where the approach in Wales diverged from the approach in England, Dr Atherton said this:

“Testing was a bit of an issue, the testing strategies generally … Although information on the public health basis flowed very smoothly, I think, between the chief medical officers, sometimes … because the work was being undertaken so rapidly … policy leads at UK level in England, let’s say, didn’t communicate as rapidly as I would have liked with colleagues who were working on similar issues in Wales and that did lead, I think, to some divergence and some difficulties in keeping up with what everybody was doing.”

When he was asked about a solution to that communication issue, Dr Atherton said:

“I think in the same way that chief medical officers met and continued to meet regularly, there needs to be more communication between policy officials, policy leads, between the four nations. I think to some degree that is already happening but that would make far more sense.

“It’s very difficult in the heat of a pandemic … because work was often being directed by, say, the Secretary of State at UK level and it was very difficult, I think, for policy officials there to always remember to link up as closely as they might with policy leads in the other devolved nations. It’s something we need to continually work at as civil servants …”

We can see from this passage that, in relation to testing, Dr Atherton appears to suggest that there were delays in information being communicated from policy leads at the UK level in England, including the Secretary of State, to those working on similar issues in Wales, and that this led to divergence and difficulties in testing policy between the nations.

My question is this, Mr Hancock.

Do you agree that these communication difficulties were as a result of delays from the UK Government, including yourself?

Mr Matt Hancock: Well, I agree with precisely with the statement as read out from the CMO for Wales. Your interpretation isn’t quite right, because it’s true that there could be decisions that I had to make very rapidly as the UK Secretary of State, some of which would involve – have an impact on devolved issues because my role was both as the Secretary of State across the UK and directly responsible for the operation of – the strategic operation of the NHS in England rather than across the UK as a whole, but what he said, and I think is right, is that there was good quality communication with CMO – between the CMOs.

There was also high quality communication amongst ministers. We had a – exactly as he set out and recommended, we had a weekly Zoom meeting. I personally went, at the start of the pandemic, in anticipation of this problem, to go and visit each of the other three ministers, and we had an excellent rapport, which can be seen on the WhatsApp channel that we communicated on very, very frequently.

The point that he’s making is that at – it’s amongst policy officials, maybe that needs to be strengthened too. Personally I can’t – I’m not sure what communications there were at that level. I – you know, we had policy officials sit in on those weekly calls as well, but I’m sure that it can be improved. The point he was making about decisions by the Secretary of State, sometimes I had to make very rapid decisions and that, therefore, inevitably makes this sort of communication harder, and that is absolutely true.

Ms Woodward: Mr Hancock, from your perspective, what were the challenges that you faced, personally, or that you were aware of from your team, in communicating effectively and quickly with the Welsh Government, if we set aside the fact that of course some decisions were being made by yourself very quickly?

Mr Matt Hancock: Yes, so personally I didn’t find difficulties at the – when decisions and discussions were happening at the ministerial level. I had an excellent relationship with Vaughan Gething, who was the health minister for almost all of the time, and we would speak or message directly if we needed to or we’d communicate in more formal settings, including the weekly meeting.

And I would say that we supported each other through – both going through similarly extremely challenging circumstances and having to make enormous decisions in – between unpalatable options.

Whether there could then, at the next level down, be better communication, if that is the evidence of the CMO in Wales then I wouldn’t dispute it.

To give an example of that in substance, one of the particular challenges between England and Wales was the provision of testing at the border because, for many people, their closest testing site might be on the other side of the border, for instance the data integrations between the NHS in England and Wales are – were poor and need to be radically improved because if you live in, say, Chester and work in Wrexham, your data needs to move from one to the other.

As it happens, I had a flu jab in Wrexham earlier this week and I’m a patient in England and who knows whether that data will make it on to my medical record, my English medical record.

So – but those are – that’s a highly technical specific example but that is the level of detail that we’d get into.

Ms Woodward: Thank you, Mr Hancock.

Thank you, my Lady, those are my questions.

Lady Hallett: Thank you.

Mr Weatherby.

Questions From Mr Weatherby KC

Mr Weatherby: Good morning, Mr Hancock. I ask questions on behalf of the Covid-19 Bereaved Families for Justice UK.

The first topic was covered by Ms Carey yesterday, asymptomatic transmission, and I think you agreed that decision and policy-making in that respect should have proceeded on a precautionary basis. Have I understood that right?

Mr Matt Hancock: Yes, and should in future.

Mr Weatherby KC: And should in future. What I wasn’t so clear about is whether you accepted that as Secretary of State, looking back on it, you should have ensured that in fact that is what happened?

Mr Matt Hancock: My challenge, looking back on it, is that I was facing a global consensus to the contrary. I pushed hard. One of the challenges you have as Secretary of State is that you have to work out where you can push and how far you can go. Reflecting on it, of course it would have been far better –

Mr Weatherby KC: Yes.

Mr Matt Hancock: – if we’d had that presumption.

Mr Weatherby KC: You were acting on an absence of evidence or what was being told to you there was an absence of evidence?

Mr Matt Hancock: But I know looking back, if I really searched for what I really felt and knew at the time, I had a strong instinct that this was the problem.

Mr Weatherby KC: Yes.

Mr Matt Hancock: The problem is, looking back, if I had simply said there was asymptomatic transmission, clinicians, right up to the World Health Organisation, would have said you don’t have the evidence for that, Secretary of State.

Mr Weatherby KC: Yes, but that’s the point, Mr Hancock, isn’t it? We’re talking about an absence of evidence –

Mr Matt Hancock: Absolutely.

Mr Weatherby KC: – rather than evidence of absence.

Mr Matt Hancock: And generally –

Mr Weatherby KC: And that was your role as Secretary of State to push back and say that?

Mr Matt Hancock: And generally my approach was to take the reasonable worst-case scenario.

Mr Weatherby KC: Yes.

Mr Matt Hancock: And the reasonable worst-case scenario should have included the possibility of –

Mr Weatherby KC: It should.

Mr Matt Hancock: – asymptomatic transmission.

Mr Weatherby KC: Let me take this one step further. In terms of aerosol or airborne transmission, would you also agree, going forward, that the learning point is that with a newly emerging respiratory disease, the same should apply?

Mr Matt Hancock: Yes, absolutely, for a respiratory disease, yes.

Mr Weatherby KC: Thank you. Topic 2, capacity, and again you’ve been asked a lot of questions about this so I can deal with this quickly, and about the need to increase capacity and the evidence you’ve already given about Nightingale hospitals.

In Module 1 the Inquiry heard from Professor Sally Davies, the CMO until shortly before the pandemic, who told us that, and I’m quoting:

“Compared to similar countries, per 100,000 population we were at the bottom of the table on numbers of doctors, numbers of nurses, number of beds, number of ITUs, number of respirators and ventilators.”

Do you agree that those were all key factors in the capacity problem in the NHS and why you needed to increase NHS capacity after the pandemic struck?

Mr Matt Hancock: Yes. My response to that is that that is absolutely true, it’s one of the reasons I campaigned for the 10,000 extra beds in the summer of 2020 ahead of the second wave and –

Mr Weatherby KC: Can we focus on the position effectively at 1 January 2020 –

Mr Matt Hancock: Okay.

Mr Weatherby KC: – and what happened then?

Mr Matt Hancock: Yes, I was going on to say we were in the middle of expanding those numbers very radically from the time when Sally left office. For instance, I’d committed, in 2019, to 50,000 more nurses. That has now been delivered but I’m strongly on the record in favour of exactly that argument, yes.

Mr Weatherby KC: Thank you. And if we hadn’t been bottom of the table in respect to those matters, the need for the extra capacity that you then applied your mind to would at the very least have been mitigated, wouldn’t it?

Mr Matt Hancock: I think “mitigated” is a good word because I would still argue in favour of it as an insurance policy.

Mr Weatherby KC: Yes, so again the answer is “yes”?

Mr Matt Hancock: Yes, it is, yes. Very much so.

Mr Weatherby KC: Third topic. Visiting arrangements. And again, a lot of this, a lot of the points I was going to ask you about have already been dealt with so I shan’t repeat those, but really one specific point.

The Inquiry has heard quite a bit of evidence about the problems of restrictions on support and visiting for those with learning disabilities and that includes the individual referred to by Ms Carey in the questioning she asked you about Susie Sullivan who had Down’s syndrome and whose family I represent.

Mr Matt Hancock: Yes.

Mr Weatherby KC: Do you agree that, from the outset, guidance on visiting arrangements during the pandemic should have contained specific provision for people who needed additional support, including those with Down’s, those with learning disabilities, those with dementia, in order to ensure their safety and well-being so far as was possible?

Mr Matt Hancock: Yes, what I’d say is that these rules were drafted very rapidly and one of the important pieces of work that could be done ahead of the next pandemic is to draft such rules so they’re on the shelf, so to speak, so much more nuanced rules can be put into place very rapidly with appropriate consultation whilst we’ve got time to do it.

Mr Weatherby KC: Yes, well, no doubt that’s a very sensible suggestion, Mr Hancock. But why wasn’t that done prior to this pandemic?

Mr Matt Hancock: Because the anticipation of a pandemic – we’ve been through that in Module 1. There wasn’t – there were huge amounts of areas where there wasn’t work done.

Mr Weatherby KC: Were you aware of the problems created by the restrictions on visitation for those needing support or those with learning disabilities? Did you become aware of that during the pandemic?

Mr Matt Hancock: I did and I’d worked hard on the question of support for those with learning difficulties and inpatient settings, in particular, ahead of the pandemic so it was an area that I was well versed in.

Mr Weatherby KC: Okay, but once the pandemic was on us and these problems arose, did you become aware that the visiting restrictions were having such a deleterious effect on people who needed this kind of support? Did you become aware of that?

Mr Matt Hancock: I can’t remember being presented with specific evidence of individual cases and the debate was more at a higher level about the balance between the spread of the virus and the need for visiting, much as in the case of maternity.

Mr Weatherby KC: I don’t want to be unfair and you had an awful lot on your plate, but do you think you should have been aware of it?

Mr Matt Hancock: Well, this would have been brought to me as a policy issue rather than individual cases which would have, rightly, been the responsibility of those on the ground.

Mr Weatherby KC: Yes, and do you think the policy problems should have been brought to you?

Mr Matt Hancock: Well, at that time, the team had a very difficult task to do to work out which issues needed to be brought to my attention because I was – if you’re working an 18-hour day there was still a massive limitation on bandwidth, so these decisions did have to be taken and probably appropriate to be taken at a junior ministerial level.

Mr Weatherby KC: Is the real answer yes, this was a real problem, a problem that we’ve heard really affects the welfare and mortality rates of people with learning disabilities? Is the answer yes, it should have been brought to your attention?

Mr Matt Hancock: The easy answer for me to sit here and say would be “yes”. What I’ve been at pains to do during this Inquiry is to try to explain what it’s really like and, in this instance, I think if a civil servant had made a decision that this sort of matter would go to the minister of care, I think that would have been an appropriate decision.

Mr Weatherby KC: So it should have gone to somebody else?

Mr Matt Hancock: There’s a ministerial team for a reason. If you try to put every decision through the Secretary of State, decisions just don’t get made.

Mr Weatherby KC: I’ll move on. Topic 4 and back to 111 services. I think that you’ve already confirmed that part of the reassurance to the public underlying the Stay at Home messaging was that those who needed NHS care could continue to access the NHS, including online and through first point of contact 111. And the devolved services, similar services. Is that correct?

Mr Matt Hancock: Yes.

Mr Weatherby KC: And by way of example, and it’s just one example, one of the families that I represent, her father followed the guidance, attempted many times to call 111, each time it took several hours to get through, his health deteriorated, each time he was told to remain at home. And that’s quite a typical report from family members.

Mr Matt Hancock: Yeah.

Mr Weatherby KC: Now plainly the plan relied on 111 being able to cope with the increased levels of demand. I’m not going to take you to that because Ms Carey did yesterday, but the plan – the messaging and the reassurance for Stay at Home relied on 111 being able to cope with the increased level of demand –

Mr Matt Hancock: But not only on 111. So this brings to the point about the NHS as a whole being there. So 111 is, of course, a vital service and was –

Mr Weatherby KC: First point of contact, your words.

Mr Matt Hancock: And weighed upon heavily. However 999 remained available and didn’t have the same outages. So people who were facing an acute problem could switch from calling 111 to calling 999 if necessary.

Mr Weatherby KC: Right. Well, let’s focus on the first point of contact, the service that you were advising the public to use as the first point of contact unless they had, for example, serious immediate life-threatening problems, in which case they would phone 999. Okay? So let’s focus on 111.

And I think you’re agreeing with me, I’ll put it again, that the plan relied on 111 being able to cope with the increased level of demand?

Mr Matt Hancock: No, I repeat my previous answer that 111 was one service within a range of services, and your request to focus only on 111 is not appropriate in the question that you give because you have to look at the services provided by the NHS as a whole.

Mr Weatherby KC: Right. Well, I’m not going to ask the question yet again but I am concentrating –

Mr Matt Hancock: You can, but I’ll give you the same answer. The point is you’re concentrating on 111. My point is that if you have a life-threatening condition and you can’t get through on 111, you call 999, and that is very broadly known.

Mr Weatherby KC: Noted. We’ve been through that.

Is it correct there was no emergency pandemic planning around the use of 111, including no planning for increasing the capacity of 111 services?

Mr Matt Hancock: I don’t know that for sure but I wouldn’t be surprised if that was true because 111 was brought in after the pandemic plan was written in 2011.

Mr Weatherby KC: Yesterday you gave evidence regarding some consideration of delaying the Stay at Home message by 24 to 48 hours to allow more time for the 111 system, and no doubt the 999 system as well, to get more ready, yes?

Mr Matt Hancock: Yes, that’s right.

Mr Weatherby KC: Can you help what could have been done in 24 hours or 48 hours to cope with the surge that Ms Carey took you through yesterday?

Mr Matt Hancock: Well, again, this is an operational question for Sir Simon Stevens. He, in the COBR meeting, suggested that delay for these operational reasons and it was taken into account.

To give examples of what could have been done: firstly, there would have been more time to draft scripts, because 111 relies on scripts for call handlers to follow, to give them guidance of how to answer questions. In the end there was a matter of hours and those scripts were put together overnight as opposed to having 24 to 48 hours to write them.

The second thing is that the operation to expand 111 and bring in more call centres –

Mr Weatherby KC: Yes.

Mr Matt Hancock: – could have been – would have had 24 to 48 hours more notice to put in place. So those two examples.

Mr Weatherby KC: Okay. But you’re not sensibly suggesting that 24 hours or even 48 hours would have made a material difference to getting robust and appropriate scripts together, never mind call centres and further staff; you’re not sensibly suggesting that, are you?

Mr Matt Hancock: Well, the question implies an easy world of being able to do what you fancy. That isn’t what happens in a pandemic. The reality is that everything – nothing is done perfectly, everything is done to people’s best ability.

And as I say anyway, the Prime Minister then made the judgment not to wait that period, understanding and taking into mind the operational improvements that could have been made. It wouldn’t have been perfect, even after 24 or 48 hours, as you imply, but it would have been easier operationally, but we decided not to do that and, with hindsight, I think that was the right decision.

Mr Weatherby KC: Well, so far as we can see from the disclosed material it wasn’t until May that you considered whether the 111 service had been able to cope with the demand that was immediately put on it by this policy, and it was in the middle of May that you caused to be conducted a deep dive regarding 111 capacity, and that appears to have come out of a Quad discussion on 18 May. Does that sound right to you in terms of the timing?

Mr Matt Hancock: No. The work to enhance and support 111 was immediate from the middle of March, when that COBR discussion took place and, before that, in anticipation that there be a huge surge of questions, and there was immediate work to support 111 during that period, that again was led by the NHS, by NHS England. That work was successful. By May we were able to then look back to understand what had happened as opposed to the hand-to-mouth immediate response.

Mr Weatherby KC: I follow. In fact, it was a result of that deep dive that you ended up being informed on, I think 22 May, of the 40% of 111 calls that had gone unanswered in March 2020, as we heard yesterday. Does that accord with your recollection?

Mr Matt Hancock: I have no reason to doubt that.

Mr Weatherby KC: Yes. Sticking with 111 for a moment. My next point. The quality of the service. Again, you were referred to the Healthcare Safety Investigation Branch investigation published in September of 2022. And you referred to it yesterday in evidence with regard to the strong messaging which may have discouraged some people from seeking treatment. But it’s not that point I want to ask you about.

The same report made a number of critical findings in relation to the 111 service, including that the Covid Response Service, which was an add-on, if you like, to the 111 service –

Mr Matt Hancock: Yes.

Mr Weatherby KC: – it didn’t function as intended –

Mr Matt Hancock: Yes.

Mr Weatherby KC: – and that there were basic deficiencies in the advice and that callers were not asked about comorbidities and there was comment about the needs of specific groups such as those with learning disabilities or whose first language wasn’t English. Are you aware of those criticisms of the 111 service by the HSIB?

Mr Matt Hancock: Yes. I think you have to set them against the fact that, thank God we had 111 in the first place, and it did an amazing amount of work. The correct thing to do is to thank those who worked in 111 for their service and be grateful that we had it and then to seek to improve the response in the future.

Mr Weatherby KC: Yes.

Mr Matt Hancock: I think the point that you make specifically about the pandemic response line is an important one that I haven’t seen drawn out yet in any of the discussion, which was that there was a PHE contract for a pandemic response line in anticipation of the need for a phone line, and it did not integrate well, and one of the lessons should be to be ready to expand 111 with draft scripts that could draw from the learnings from the pandemic.

Mr Weatherby KC: I’ve no doubt you are right that’s a lesson that can be drawn, but before we get to that, can you help us that during your time as Secretary of State what quality assurance mechanisms were put in place so that you could be satisfied, as Secretary of State, of the quality and functioning of the 111 service?

Mr Matt Hancock: Well the 111 service was contracted by NHS England so it would be their responsibility to do that. What I say, though, is that, again, this was put in place very rapidly, in short order, and just as we were earlier discussing, you’ve got to take 111 in its context with the 999 and, of course, physical services and being able to call your GP, and the other side, there’s also now much more widespread online availability of information, and for many people not being able to reach 111 would lead them to search on the NHS website. We saw that journey many times as well.

So you’ve got to see the information provision in the round rather than simply looking at one sentence.

Mr Weatherby KC: Can I ask you to focus on the question. The question was that this is a big part of your policy of Stay at Home. It’s one of the mechanisms to underpin that policy. I entirely understand that it’s been rolled out very rapidly. But you need to roll out quality assurance rapidly as well, don’t you, because otherwise you may roll out something which doesn’t work as, in fact, to some extent, seems to have been what happened here?

Mr Matt Hancock: I repeat my previous answer which is that the question implies a world of time and easy consideration which is simply not the world that anybody inhabits when they’re trying to respond to a pandemic. This was a deadly pathogen and we were bringing in measures from January 2020 with enormous rapidity, and I’m very grateful for those who did that work and did it so well.

Can it be improved? Of course it can, as anything done in a massive hurry can be improved, as it was during the pandemic.

Mr Weatherby KC: So the lesson is to have a plan for services like 111 including a surge capacity plan –

Mr Matt Hancock: Precisely, yes.

Mr Weatherby KC: – but also a plan to quality assure it so that you know that you’re actually not wasting your time?

Mr Matt Hancock: Well, that implies that there’s a binary between putting up stuff that is useful and putting up nothing at all. Actually, putting together scripts very rapidly, putting things on the internet, on the website very rapidly, and then improving them iteratively is in practice what you do in these circumstances. There isn’t – there may be time for somebody like the CMO or another qualified clinician to look over prepared documents that are prepared in a very, very short window of time, of course you can do a formal quality assurance later, but in many cases we had to do things far, far faster than we would do in normal circumstances, and if you don’t take that into account then the point you’re making doesn’t really make sense.

Mr Weatherby KC: Well, the question was actually aimed at how you optimise the services that you were able to provide, even given the lack of planning and the lack of capacity.

Mr Matt Hancock: Yes.

Mr Weatherby KC: So having no assurance meant that you simply didn’t know whether these services were working properly or optimally in the circumstances.

Mr Matt Hancock: Well, firstly, there was not no assurance, because senior clinicians looked at these materials before they went out. And secondly, the way that the world works in practice is that you get the best information you can out, if you have to move very rapidly, and then you improve it over time. It is not a sequential process with the benefit of time.

Now is the moment to do the work that requires time and use time to consult with bodies. Now is the moment to –

Mr Weatherby KC: As you correctly said, we discussed that in Module 1.

The next topic, DNACPRs. Again, you were asked a number of questions yesterday about this. And you stated that you were aware from early April 2020 that there were concerns being raised about the inappropriate imposition of DNACPRs, and potentially blanket orders, and this is something that chimes with well over 400 of the family members that I represent, who have raised such concerns.

This was an issue, wasn’t it, that was on your radar long before April of 2020 because in May of 2019 –

Mr Matt Hancock: Yeah.

Mr Weatherby KC: – there was the NHS learning disability mortality review, sometimes referred to as the LeDeR, and that had identified a whole host, about 19, instances where learning disabilities or Down’s syndrome were given as a rationale for a DNACPR order.

Mr Matt Hancock: Yes.

Mr Weatherby KC: And you knew about that, didn’t you, because in fact –

Mr Matt Hancock: Not only did I know about it, I acted on it at the time absolutely and –

Mr Weatherby KC: I’m coming to that.

Mr Matt Hancock: Right.

Mr Weatherby KC: So on 12 February of 2020 the government, your department, issued a response to that report, and in that report – I’ll give the reference just for the record. It’s INQ000474478. And in that report, at paragraph 2.47, your department describes the problem that I’ve just raised as being “completely unacceptable”?

Mr Matt Hancock: Yes, that was my view.

Mr Weatherby KC: And that will be your view?

Mr Matt Hancock: Very strongly held, yeah.

Mr Weatherby KC: Yes. And as a result of that, the action that was taken, so far as I understand it, was that the department wrote to trusts to say that this needed to be addressed?

Mr Matt Hancock: Yes, I think that was done again by my – by the junior minister, but it was something that I was –

Mr Weatherby KC: Sighted on?

Mr Matt Hancock: Yes.

Mr Weatherby KC: Indeed. Now we come to April, literally two months later.

Mr Matt Hancock: Yeah.

Mr Weatherby KC: And other problems, but similar problems in some cases, materialised in respect of Covid patients.

Mr Matt Hancock: Yes.

Mr Weatherby KC: And so yesterday you told us that you’d acted again in April and you made a number of public statements. But in fact, apart from that, nothing else was done until October, when the CQC started to investigate and report on the DNACPR issues. That’s the reality, isn’t it?

Mr Matt Hancock: No.

Mr Weatherby KC: No?

Mr Matt Hancock: No.

Mr Weatherby KC: Okay. Well –

Mr Matt Hancock: The reality is that as soon as I heard about this being a potential problem and these concerns being raised with me, I immediately acted because I feel so strongly about this, and I went public on it, including using the platform of the daily press conference to reiterate the total unacceptability of this. And I discussed it with the NHS leadership, whose responsibility it was to stop it from happening.

Mr Weatherby KC: Sir Simon Stevens?

Mr Matt Hancock: Yes.

Mr Weatherby KC: Well, I can help you with this because what in actual fact happens in early September or by early September, David Davis MP raises a question about a number of allegedly inappropriate DNACPRs, and that prompted an email discussion which refers to you having a meeting with Sir Simon about this issue.

And in that email correspondence, which was at tab 61 of your evidence bundle, INQ000478907 for the record, it’s clear that there was still no data available to assess the scale of the problem or to monitor any progress held by either the DHSC or NHS England.

So, yes, you’d written in February to the NHS trusts, yes, you’d used your public platform to recognise the issue, but then nothing had been done apparently to monitor or collect data or again assurance about whether the problem is continuing or how it had been dealt with. That’s the reality, isn’t it?

Mr Matt Hancock: No. The reality is that when this issue was highlighted I didn’t use my public platform to discuss the issue, whatever the word was. I used my public platform to instruct that this was entirely unacceptable. There is no reason that the department would have data on this because it’s a question within the NHS, and I took it up with the NHS.

I’m afraid we come to the division of responsibilities between the NHS and the department. The departmental position was extremely and vocally clear, and then when it was again brought to my attention I took further action. So the – that’s what I did and that was what I was accountable for. I absolutely – looking back, I took the action that I ought to have taken and there is no – there is absolutely no reason why anybody should put in place one of these measures without a properly consented process.

Mr Weatherby KC: Well, I’ve put the point to you. The Inquiry has the documents. But no monitoring, no data, no assurance, and that’s what happens in early September and that’s what triggers the CQC having a look at the issue. That’s the reality, isn’t it?

Mr Matt Hancock: The reality is that I raised this matter with those who were properly appropriate for ensuring that it didn’t happen.

Mr Weatherby: I’m out of time.

Lady Hallett: Thank you very much, Mr Weatherby.

Ms Carey, any further questions from you?

Ms Carey: No, my Lady, I have had an opportunity to look at the transcript overnight and there’s nothing I need to clarify, thank you.

Lady Hallett: Thank you very much.

Mr Hancock, that completes the questions we have for you in this module although I’m afraid I do know that we are going to be asking you questions in another. Thank you for your help so far.

The Witness: Thank you very much.

(The witness withdrew)

Lady Hallett: Very well, noon on Monday.

(11.40 am)

(The hearing adjourned until 12.00 noon on Monday, 25 November 2024)