Matt Hancock wanted to decide ‘who should live and who should die’ if the NHS became overwhelmed during the pandemic, the Covid Inquiry sensationally heard today.
Lord Simon Stevens, former chief executive of the health service, said the comments were made during a February 2020 planning meeting.
In his witness statement, he revealed the ex-Health Secretary ‘took the position’ that he — rather than medics or the public — ‘should ultimately decide’ which patients should be cared for.
While noting that this situation ‘never crystalised’ during the Covid crisis, he said he would ‘discourage the idea’ that any individual should make this decision.
In a witness statement, Lord Simon Stevens, the former chief executive officer, said the comments were made during a February 2020 planning meeting
Lord Stevens’s witness statement said: ‘The secretary of state for health and social care took the position that in this situation he – rather than, say, the medical profession or the public – should ultimately decide who should live and who should die’
In his written submission to the inquiry, Lord Stevens shared details about a planning exercise — called operation Nimbus — on February 12, 2020
In his written submission to the inquiry, Lord Stevens shared details about a planning exercise — called operation Nimbus — on February 12, 2020.
Led by the Cabinet Office, the purpose was to set out how the Government would respond to a ‘reasonable worst case scenario’ in which there are 1.6million new cases per week — of which 1.25 per cent are fatal — and 860,000 deaths are forecast in the coming months.
Inquiry counsel Andrew O’Connor said that the exercise ‘provoked a discussion’ about who should be responsible for making decisions about prioritising and allocating stretched NHS resources in this situation.
In a witness statement to the inquiry, Lord Stevens wrote: ‘My sense at the time was that it [the planning exercise] helpfully sensitised a wider range of Government departments (beyond the health sector) to the type of pressures the UK might experience.
‘It did result in – to my mind at least – an unresolved but fundamental ethical debate about a scenario in which a rising number of Covid patients overwhelmed the ability of hospitals to look after them and other non-Covid patients.
‘The Secretary of State for Health and Social Care took the position that in this situation he – rather than, say the medical profession or the public – should ultimately decide who should live and who should die.
‘Fortunately this horrible dilemma never crystalised.’
Mr O’Connor noted that Chancellor Jeremy Hunt, a former Health Secretary, ‘took a different view’ during Exercise Cygnus — a 2016 Government simulation of a flu outbreak.
Mr Hunt told the Covid inquiry in June that, at that time of the exercise, there was a protocol requiring the Health Secretary to ‘flick a switch’ and decide who should be cared for.
But he said ministers should not be asked to ‘play God’ and deprive people of a hospital bed, so ordered that the policy be changed, concluding that it was ‘inappropriate’ for this decision to be taken ‘away from the frontline’.
Mr O’Connor told Lord Stevens that Mr Hancock ‘took a very different view’ and asked whether his stance was ‘an appropriate line to take’ or ‘desirable’.
In response, Lord Stevens told the inquiry: ‘I thought it would be highly undesirable except in the most extreme circumstances.’
He said the Department of Health created an ethical and moral advisory panel to look into how to limit care ‘in a way that would be fairest and be the most defensible under this horrible situation’.
Lord Stevens added: ‘I certainly wanted to discourage the idea that an individual Secretary of State, other than in the most exceptional circumstances, should be deciding how care will be provided.
Lord Stevens (right, in December 2020 at a Downing Street briefing), 57, has been friends with former PM Boris Johnson (centre) since their time together at Oxford University, where he helped secure Mr Johnson’s election as president of the Oxford Union
‘I felt that we are well served by the medical profession in consultation with patients, to the greatest extent possible making those kind of decisions.’
Asked whether this was an example of operation Nimbus ‘doing its job’ by highlighting issues while there was still time to think about how to deal with it, Lord Stevens said: ‘I actually don’t think this was a question that was resolved.’
Lord Stevens, 57, has been friends with former PM Boris Johnson since their time together at Oxford University, where he helped secure Mr Johnson’s election as president of the Oxford Union.
From 1997 to 2004 Lord Stevens acted as an adviser to Tony Blair’s government, including three years in the No10 policy unit.
David Cameron said he recruited him to run the health service because he ‘knows more about NHS problems and market solutions than any man alive’.
Lord Stevens, whose salary was around £200,000, stepped down from NHS England in July 2021 after seven years at the helm, and became a peer in the House of Lords.
He was the eighth person to run NHS England since it was created in 1948.
In his resignation letter, he described being in charge of the NHS through ‘some of the toughest challenges in its history’ as a privilege.
In another blow to Mr Hancock, Lord Stevens told the inquiry that senior ministers sometimes avoided Cobra meetings chaired by the former Health Secretary in the early days of the pandemic.
Cobra meetings ‘usefully brought together a cross-section of departments, agencies and the devolved administrations’, according to his witness statement.
‘However, these meetings were arguably not optimally effective.
‘They were very large, and when Cobra meetings were chaired by the health and social care secretary other secretaries of state sometimes avoided attending and delegated to their junior ministers instead.’
Asked by Mr O’Connor if that was a reflection on Mr Hancock, Lord Stevens said: ‘I am not saying that was cause and effect, but that was the fact of the matter.
‘I just observed that those two coincided.’
He also denied that he was forced out of his job by Mr Hancock or Mr Johnson’s former chief of staff Dominic Cummings.
Lord Stevens was shown messages between the pair from January and February 2020 that discussed moving him from his NHS post.
In one WhatsApp, Mr Hancock tells Mr Cummings that he is ‘getting [Lord] Ara Darzi to persuade him it’s in his best interests to go now’.
In another message, the former Health Secretary said Lord Stevens plans to ‘go at Christmas’, to which Mr Cumming replied ‘we must get on with it now’.
But Lord Stevens told the inquiry today that Mr Hancock did not encourage him to quit during Covid and that there was no sense he was ‘defying’ Downing Street by staying on.
He said he planned to stay in the job for five years but that in 2019 there was a ‘degree of political chaos’, which was followed by Covid — so he did not feel able to leave until July 2021.
Asked if Mr Johnson and Mr Cummings trusted him, Lord Stevens said he could not speak for the latter but added that his regular interactions in the autumn with the PM ‘did not give me a different sense of that’.
Lord Stevens was also asked whether Mr Hancock was ‘untruthful’.
He said: ‘There were occasional moments of tension and flashpoints, which are probably inevitable during the course of a 15-month pandemic.
‘But I was brought up always to look to the best in people.’
Pushed on whether Mr Hancock was truthful, he said ‘various people’ have made ‘quite strong accusations’ against Mr Hancock but he doesn’t know that he’s seen the evidence to back those up. Asked whether he trusted Mr Hancock during the pandemic, he said: ‘For the most part, yes.’
The inquiry was also shown a section of Mr Johnson’s witness statement, in which he described the lead up to the first lockdown on March 23, 2020.
He said the Government was between a ‘rock and a hard place’ when deciding whether to plunge the nation into shutdown.
Mr Johnson denied that he was ‘manipulated or pushed into the first lockdown’ or that he was ‘gamed on the numbers’.
He wrote: ‘It is true that I have reflected (no doubt out loud and no doubt many times) about whether the lockdowns would do (and did do) more harm than good.
‘I believe that it was the duty of any pragmatic and responsible leader to have such a debate, both with himself and with colleagues. We were between a rock and a hard place, the devil and deep blue sea.
‘I was very worried about the economic harm caused by the action we took against Covid and whether it would do more damage to the country than the virus itself. But I always attached the highest priority to human life and public health.’
