3. Mr Jeremy Hunt

MR JEREMY HUNT (sworn).

Questions From Lead Counsel to the Inquiry

Mr Keith: Would you be good enough to give your name, please.

Mr Jeremy Hunt: Jeremy Hunt.

Lead Inquiry: Chancellor, thank you very much for providing your assistance already to this Inquiry by virtue of your witness statement, which we will see at INQ000177796, dated 4 April 2023.

If we could have the last page, page 17, would you just be good enough to confirm that that is the statement of truth and declaration to which you appended your own signature?

Mr Jeremy Hunt: It is.

Lead Inquiry: For the purposes of my Lady’s Inquiry, most pertinently you were, Chancellor, weren’t you, Secretary of State for Health between 6 September 2012 and 8 January 2018, and thereafter the Secretary of State for Health and Social Care until 9 July 2018, when you became Secretary of State for Foreign and Commonwealth Affairs?

Mr Jeremy Hunt: Correct.

Lead Inquiry: You were also, although plainly not a minister, chair of the Health and Social Care Select Committee between January 2020 and October 2022, at which point, perhaps a couple of days earlier or a couple of days after, you became Chancellor of the Exchequer?

Mr Jeremy Hunt: Correct.

Lead Inquiry: In which post you continue to the present day.

Chancellor, it is obvious that, as Secretary of State for the Department of Health and then the Department of Health and Social Care, you were keenly aware of the onerous obligations placed on you as Secretary of State in relation to the provision of healthcare, including the obligations associated with the DH, and then the DHSC, being the lead government department for pandemic risk, being a health emergency?

Mr Jeremy Hunt: Correct.

Lead Inquiry: It is clear from the documents before the Inquiry the departmental risk register, the paperwork and guidance relating to the discharge by your department of its role as lead government department, the legal obligation placed on the department by virtue of being a Category 1 responder under the Civil Contingencies Act 2004, and its supervision of a number of bodies but, most importantly, the pandemic influenza preparedness board and the co-chairing of the Pandemic Flu Readiness Board, that pandemic planning lay at the heart of your department’s work?

Mr Jeremy Hunt: Correct.

Lead Inquiry: I want to ask you, please, in light of that, about Exercise Cygnus which was in October 2016. It was an exercise which took place between 18 and 20 October, and it was an exercise which was reported upon in July of 2017, the following year. You were of course Secretary of State at the time.

To what extent do you recall the significance of Exercise Cygnus or the recommendations that came from it?

Mr Jeremy Hunt: Well, I recall taking part in the exercise extremely well –

Lead Inquiry: Why was that?

Mr Jeremy Hunt: Because it was not just a significant chunk of time taken out of my diary but because something quite traumatic happened in the course of the exercise, even though it was only an exercise, which caused me to stop the exercise. I was basically asked in the course of the exercise to sanction the emptying of all the intensive care beds in the country, leading to the death of numerous people in those intensive care beds, on the grounds that the nursing requirement for those people in intensive care was so big, because each intensive care bed needed three or four nurses to look after one patient, that those nurses could spend – save more lives if they operated in the community.

So that was –

Lady Hallett: To be clear, this was a hypothetical, just in case anyone is switching on at this stage.

Mr Jeremy Hunt: Yes. And so effectively I was being asked to flick a switch which would have led to instant deaths, and I wasn’t prepared to do that.

Rightly or wrongly, you could obviously argue it lots of different directions, but, you know, in Benthamite terms, the greatest good for the greatest number, perhaps I should have been prepared to do it, but I wasn’t prepared to do it.

I think that for the people – and that was, I think, for the participants quite a controversial moment, and thankfully it was only an exercise.

But my judgement was that it was – that any pandemic scenario, if you were asking a human being – and we politicians are of course human beings – to make a decision like that, it was fraught with risk and danger, and I personally would have felt very, very difficult taking that decision. So we developed new protocols as a result of that, which meant that I think in that – if that situation would happen in real life, the Secretary of State would not be asked to take that decision.

Mr Keith: You made it plain that that was an intolerable decision to have to take for any Secretary of State and there had to be an alternative course, and you directed that protocols be drawn up to deal with at that possibility?

Mr Jeremy Hunt: Correct, and we have to be honest that you do have to take those decisions in one way or another when there is limited capacity. You know, when we saw the Covid scenes in Lombardy, there were absolutely heart wrenching scenes of Italian doctors saying that they’re being asked to play God because the people they were depriving of a bed would inevitably die.

So it isn’t that – you can’t duck those decisions, but what I felt was inappropriate was those decisions, being taken at such a long way away from the front line, and I thought those decisions, if they have to be taken, need to be taken by people who are familiar with what’s going on with individual patients and so I’m not at all suggesting that there aren’t incredibly difficult things you have to decide in any pandemic, but it’s just that it felt too clinical to me, that that should be surfaced in – almost like a regular ministerial decision – this is what you do at this point – when the human consequences were so striking.

Lead Inquiry: Although it’s not a matter for direct inquiry today, it’s outwith the scope of the areas with which we’ve asked you to assist, but in part as a result of that terrible conundrum that you were faced with, was there put in place a body called the Moral and Ethical Advisory Group to deal with the worst types of moral and ethical decisions which might confront clinical staff and administrators in the event of a pandemic?

Mr Jeremy Hunt: That may well have been what happened. I wasn’t aware that was the consequence. But what I was aware of was this dreadful euphemism that was used to describe that decision. It was described as “population triage”, which essentially was a nice way of saying making life or death decisions about large numbers of people in one go.

Lead Inquiry: There could, therefore, have been no doubt in your mind as to the significance of Exercise Cygnus, which was, I think, a cross-government exercise. It was commissioned by your department, then the Department of Health, to test the United Kingdom’s response to a serious pandemic influenza.

Do you recall what the general outcome was of Exercise Cygnus, Chancellor?

Mr Jeremy Hunt: I do, and I would say that I think there is quite a big misunderstanding about Exercise Cygnus, which is that, certainly as was described with me, it wasn’t an exercise that was to examine the UK’s preparedness for pandemic influenza, it was to establish how good the UK – how well the UK would cope in a situation in which pandemic influenza had already taken hold.

So the starting point of the operation was we had already had between 200,000 and 400,000 fatalities, and I think 1.2 million people infected with pandemic flu. So it was to see how our systems would cope in that state of extreme pressure.

I know you may well want to talk about the issue of groupthink, but I think this was the first example – looking back with the benefit of hindsight, this is not what I thought at the time, and I – you know, with retrospect, of course, I wish I had challenged it at the time, but there were no questions asked at any stage as to how do we stop it getting to the stage of 200,000 to 400,000 fatalities. It was an assumption that if there was pandemic flu it would spread, using layman’s terms, like wildfire, and you pretty much couldn’t stop it, and this was how would the system cope in that extreme situation.

So that’s why, rather ghoulishly, when you read through the report of the exercise, there was lots of talk about mortuary capacity and how you would deal with so many dead bodies, it was that kind of thing, and, as far as the NHS and care system was concerned, how would you deal with so many members of staff being off sick, even if not fatally off sick.

Lead Inquiry: We’ll come back to this later, but on the issue of groupthink, it may not have had its genesis solely in the exercises, which made assumptions of course about numbers of deaths, it may have had its genesis also in the risk assessment process, which made assumptions about huge numbers of fatalities. It may have had its genesis in the integrated management structure, IEM, for dealing with civil contingencies and emergencies, which again perhaps failed to focus sufficiently on preventing devastating consequences as opposed to dealing with them.

But Exercise Cygnus was a seminal moment, wasn’t it, because it was designed, as you say, to test the United Kingdom’s structures for dealing with a severe pandemic, and no doubt you and your department – and not least yourself, because you had had this personal involvement in the exercise – were concerned about the conclusions of Exercise Cygnus?

Do you recall prior to the report being published into Exercise Cygnus – internally, I should say, it wasn’t made publicly available – in July 2017 whether you were briefed as to the general conclusions of Exercise Cygnus?

Mr Jeremy Hunt: I don’t recall any particular briefing, but I had a very close and productive working relationship with Dame Sally Davies, and I’m sure that she would have talked to me –

Lead Inquiry: My Lady has heard that evidence.

Mr Jeremy Hunt: – and would have kept me abreast of her thinking. I mean, in some ways I worried about the fact that I was not prepared to flick the switch, I had sort of let the side down in terms of this exercise, because I think there was, I felt, a sort of expectation that they would need someone to take those kinds of decisions. So I’m sure we would have had a dialogue about it.

Lead Inquiry: In your witness statement you do say the insights from the exercise and its recommendations were made known to you. The point I want to ask you to focus on, however, is to what extent were you aware of the insights and the recommendations in advance of the formal report being made available? There was a considerable interregnum between the exercise, in October 2016, and the report becoming available in July.

Mr Jeremy Hunt: I doubt I would have been made aware. I think it would have been produced at arm’s length from me and then I would have seen it.

Lead Inquiry: All right.

You attended, Chancellor, a meeting of a committee that was then in place called the NSC – the National Security Council – (THRC), threats, hazards, resilience and contingencies ministerial committee, in February of 2017. So after Cygnus, but before the report. It was a meeting chaired by the then Prime Minister, Theresa May MP.

May we have that on the screen, INQ000006357.

There we are. Those are the minutes of that meeting held in the Cabinet room at Number 10 on Tuesday, 21 February, at 2 pm, with the then Prime Minister in the chair, and we can see your name, of course, Chancellor, in the bottom right-hand corner as Secretary of State for Health.

If we go over the page, please, we can see the remainder of those who attended. Then on page 6, the second paragraph:

“The Secretary of State for Health said that, contrary to the image presented in the media, the National Health Service was extremely good at responding to emergencies. This was in part of a reflection of the important contribution of the Chief Medical Officer [then Professor Dame Sally Davies] and colleagues who worked in public health. Exercise Cygnus had been a significant test of the country’s readiness for a severe pandemic influenza strain [hence your observation that Cygnus wasn’t concerned with a general pandemic, it was concerned with a severe pandemic influenza strain] and there were three important lessons to learn. First, the plans for responding to an influenza pandemic should reflect the need for decisions to be taken at the right level … it was not appropriate for the government to interfere with local clinical decision-making concerning access to hospital care. Second, the preparation of a Pandemic Flu Bill would help to take the various legislative measures to streamline and augment capacity in health and other services. Third, the country’s capacity to manage excess deaths needed to be improved.”

There is in that paragraph, therefore, Chancellor, references to the workstreams which continued thereafter, and my Lady has heard evidence about how the workstreams in relation to the Pandemic Flu Bill reached fruition, and the workstream in relation to excess deaths, that terrible euphemism for frankly the sheer number of deaths that would result from a severe pandemic, and how that workstream would be managed.

The conclusion from Exercise Cygnus was that the United Kingdom’s preparedness and response in terms of its plans, policies and capability were not sufficient to cope with extreme demands of a severe pandemic.

So the question, Chancellor, is this: in this paragraph you refer quite plainly to the lessons that needed to be learned and to the fact that Cygnus was a test of the country’s readiness, and to a particular number, two in fact, workstreams; to what extent was the NSC(THRC) committee made aware of the overall conclusion of Cygnus, which was that the preparedness and response in terms of the whole of the United Kingdom’s plans, policies and capability were not sufficient to cope with the demands of a severe pandemic?

Mr Jeremy Hunt: I think … so we were – this paragraph is obviously not what I would say now, with the benefit of hindsight and having gone through the pandemic. I want to answer your question exactly, so just forgive me if I take a moment to explain.

The issue – what we thought we had learned from Cygnus was that the country wasn’t very good at coping with a pandemic where hundreds of thousands of people were going to die because we didn’t have the practical arrangements in place to deal with the dead bodies, we didn’t have the decision-making structures in place that would need to do population triage, to use that euphemism, and we didn’t have the legislative requirements in place to pass a law quickly through the House of Commons. So all those things are true within the – if you asked the question as narrowly as we did in Cygnus, which is: how well prepared are we for this particular situation when 200,000 plus people have already died, a million people have already got the virus?

What we didn’t ask, and this was the mistake, was: first of all, is it only pandemic flu that we’re likely to be hit by, and could there be something with MERS-like characteristics that’s a respiratory virus that spreads almost as fast as flu but has different characteristics? We didn’t ask that question. And we didn’t ask the other question, which was: what could we do to stop it getting to that point where 200,000 to 400,000 people have died?

So I think within the narrow confines of the question we asked, we came to the right conclusions. The government accepted the 22 recommendations, from memory. They weren’t all implemented.

But unfortunately, even if we had implemented them all, I don’t think we were asking the right questions.

Lead Inquiry: And you said you promised us that you would return to the precise question after you had given that general explanation, which was: why is there a difference, seemingly, between the description of the important and significant outcome of Exercise Cygnus given in that meeting and the overall conclusion itself on the face of the report which hit the nail on the head by saying: across the united kingdoms, the plans, the capabilities and the abilities are not sufficient?

Mr Jeremy Hunt: Because what we meant by that sentence was our plans and capabilities in that very specific situation where you’ve been hit by a pandemic flu and you’ve had 2 to 400,000 fatalities, if you – what we should have done is thought much more widely about the question in the way that that sentence can be interpreted to mean, but that wasn’t how we interpreted it. We thought that we had very specifically looked at this specific scenario and we did, and we addressed the weaknesses in our provision, but we should have been asking a different question in the first place.

Lead Inquiry: Could we have, please, INQ000187694, which is a health sector security and resilience plan produced by your department, then the Department of Health, page 3.

The first paragraph says under the executive summary – and this was a document, wasn’t it, which was prepared in the general field of resilience planning for the health sector?

“Within the health sector, there are generally good levels of resilience with good preparedness and business continuity arrangements in place.”

On the face of it, that would appear to give a different impression to the conclusions, the very clear conclusions reached by Exercise Cygnus, which was that across the board there was a significant failure in the planning, the capabilities and the abilities of the United Kingdom to deal with a severe pandemic?

Mr Jeremy Hunt: Well, as I say, I think that Operation Cygnus had a very narrow focus, a too narrow focus. I think – sorry, could I just ask which date this document is?

Lead Inquiry: Chancellor, may I say – and I’m obviously not permitted to give evidence – it’s a very good question. I don’t believe that on the face of the document we’re able to give it a date, but we believe it is after Exercise Cygnus.

Mr Jeremy Hunt: Right, and presumably when I was still health secretary.

Lead Inquiry: Oh, yes, it’s at that time. It’s not a document from years later.

Mr Jeremy Hunt: Okay. I mean, that first sentence we know is wrong and, you know – but I’m afraid this was also – I’m sorry to keep going back to this but this was also part of the mistaken assumption. So alongside this assumption that it was going to be more likely to be a flu that we had to deal with than an emerging respiratory virus, which would have many fewer casualties, there was another assumption, that we were very good at dealing with pandemics, and we all thought it. And, by the way, it wasn’t just us. You know, Johns Hopkins University in America said that the UK was the second best prepared country in the world in the Global Health Security Index in 2019, and they had subcategories. One of their subcategories was which country is best prepared for preventing the spread of a virus, and scaling up treatment quickly, and we were top. We weren’t second best, we were top.

So there was, I think, a completely wrong assumption, and I think that the truth is we were very well prepared for pandemic flu because we’d been giving a lot of thinking to it – you know, Operation Cygnus, Exercise Cygnus was a huge thing – but we hadn’t given nearly enough thought to other types of pandemic that might emerge, and that was – with the benefit of hindsight that was, you know, a wholly mistaken assumption, and I think that item number 1 demonstrates that.

Lead Inquiry: But the same Johns Hopkins Center report or a report from the same Johns Hopkins Center in December of 2019 warned in the clearest terms of the dangers of focusing too much on a pandemic influenza and ignoring the significant risk of a different viral pandemic with different characteristics, including a longer incubation period, asymptomatic transmission, higher transmission, and deadlier severity. So that was probably another instance, was it not, of the groupthink blinding us to the reality?

Mr Jeremy Hunt: We should have – absolutely and that same Johns Hopkins report also said no country was well prepared, even though, you know, the US and the UK it said were the best two prepared, it was very clear that no country was well prepared.

Lady Hallett: Would that be a sensible time?

Mr Keith: Yes, thank you, my Lady.

Lady Hallett: Sorry we have to break off, Mr Hunt, but I have to think of other people, including our very hard-working stenographer. We will ensure that we get through your evidence today so that we don’t impose even more upon the burdens of government. So thank you.

(3.07 pm)

(A short break)

(3.20 pm)

Mr Keith: Chancellor, turning to a different topic, and the important question of the United Kingdom pandemic influenza strategy document 2011, there was only ever one Department of Health strategy document relating to pandemic influenza, and it was this 2011 document, and there was no analogous strategy document dealing with a non-influenza pandemic or a range of pandemic scenarios or even generically a non-influenza pandemic.

Can you recall to what extent you were briefed or informed that that strategy document of 2011 required refreshment, being refreshed, as the terminology appears to describe it, being updated?

Mr Jeremy Hunt: I don’t recall ever being advised that.

Lead Inquiry: The evidence shows that it was due to be refreshed, to use the departmental phrase, but that in 2018 and 2019 that work was paused as a result of Operation Yellowhammer, to which we’ll come later.

In the context of pandemic influenza planning, a failure to update the sole and major strategy document between 2011 and 2020 is a matter of some regret, is it not?

Mr Jeremy Hunt: I think there was a much bigger failure, which was that we were overfocused on pandemic influenza, and I would say that, notwithstanding the fact that I don’t believe I was ever advised that we should update that 2011 document – I became Health Secretary, as you know, towards the end of 2012 – we did spend a lot of time thinking about dangerous viruses, because at the end of 2014 we had the Ebola virus, which we were very directly involved in, and as a G7 Health Minister I went to a lot of summits where we discussed the global response to Ebola and, you know, we had global health security summits – I organised one in March 2018 – and we had Exercise Cygnus as well.

So there was quite a lot of thinking, but I think, looking back on it, it’s very clear that it was very deeply entrenched, almost visible in every single document relating to this that you can see, that there was an assumption that a mass fatality pandemic would be flu, and I think you’re going to come on and talk about Exercise Alice –

Lead Inquiry: Yes.

Mr Jeremy Hunt: – which I wasn’t briefed about, which itself is telling, that I was, you know, asked to take part in exercise – I don’t know if it’s Exercise Cygnus or Operation Cygnus.

Lead Inquiry: That was a mistake of mine. It is Exercise Cygnet and Exercise Cygnus and Exercise Alice.

Mr Jeremy Hunt: Right. Thank you for letting me know that. But, you know, I wasn’t briefed about Exercise Alice. I was asked to take part in Exercise Cygnus.

But I think it’s just interesting when you look at that, that that is – the report on Exercise Alice is literally the only place that I can find which really talks about the importance of quarantining. If you look at the – this assumption that you can’t stop the spread of the virus, I think that was deeply entrenched when Covid arrived, and we didn’t look at countries like South Korea and Taiwan, which had a very different assumption about the effectiveness of quarantining.

So that I think – so updating a pandemic flu document, of course all things being equal it would have been a good thing to do, but the fundamental issue is that we were – by the way, not just us but across Western Europe and North America there was a shared assumption that herd immunity was inevitably going to be the only way that you contained a virus because it spread like wildfire, it was perceived at the outbreak of the Covid as a rather heartless approach but that wasn’t really what it was. It was what scientists thought was unfortunately what was inevitable. All those assumptions would only have been challenged if we’d had a document that looked at all pandemics, not just pandemic flu.

Lead Inquiry: But, to be clear, it wasn’t a pandemic influenza strategy document, it was the only Department of Health pandemic influenza strategy document.

Mr Jeremy Hunt: Yes, and it was the only pandemic document, but it just happened to be about pandemic flu.

Lead Inquiry: The Inquiry does not exist to find fault, solely, of course. You’ve referred to the meetings that you organised. It’s right that I point out that, based on your witness statement, you took a number of very important steps when taking ministerial office. You organised meetings of international health ministers to raise the alarm concerning the risk of a severe pandemic.

Would you just tell my Lady what was done in relation to the setting up of the UKVN, the UK Vaccine Network, after the Ebola outbreak to which you’ve just made reference, which was in 2014 and 2015?

Mr Jeremy Hunt: Yes. I mean, I don’t know actually if it was my direct ministerial decision, but it was a decision of the government following the Ebola outbreak to set up the UK Vaccine Network, I think chaired by Chris Whitty.

Lead Inquiry: Yes.

Mr Jeremy Hunt: And I think, you know, that obviously was fundamentally very – turned out to be very important historically because that was the basis upon which the Oxford/AstraZeneca vaccine was developed, which saved more lives than any other vaccine in the pandemic across the world – I think about 6 million lives in total. And I think that is interesting, because although we had a blind spot about flu being the thing we needed to worry about, with flu a vaccine is very important. So if you like, the other side to that coin was that right at the start of the pandemic we were one of the first countries that really were thinking about vaccines, and charging ahead with vaccines, which we did faster than pretty much anyone else, which is why we made such a lot of progress.

But I think Professor Whitty deserves enormous credit, and certainly not under any guidance from us as politicians, because of the scientific way that he plotted the development of that vaccines network such that it was actually able to turn into something as significant as it did.

Lead Inquiry: So that my Lady can understand the position, the United Kingdom Vaccine Network provided funding, of course, for research and development into vaccine discovery and that, of course, is why the Oxford/AstraZeneca vaccine was able to benefit from the programme, because of the amount of funding that it had received at the end of the day.

Mr Jeremy Hunt: Correct.

Lead Inquiry: All right.

You’ve referred to the groupthink and the groupthink has been described variously as flaws in strategic thinking, as perhaps a failure to see things for how they were.

It may be suggested that there are a number of ways in which there was groupthink or a strategic failure. The first one, to which you’ve already made reference, is the long-standing bias, as it’s been described by, I think, Professor Dame Sally Davies and others, in favour of influenza.

So that’s the first. Would you agree?

Mr Jeremy Hunt: Yes.

Lead Inquiry: There was also, secondly, a failure to appreciate properly the risks of a non-influenza pandemic. Viral pandemics, by their nature, have variable characteristics and variable risks, and may be highly transmissible, they may have longer or shorter incubation periods, they may be more or less deadly.

Would you agree that there was a failure to appreciate properly the risks of a non-influenza pandemic?

Mr Jeremy Hunt: I think in deference to my scientific colleagues they would all have said that those risks existed, but collectively we didn’t put anything like the time and effort and energy into understanding those dangers, and I think if you look at the National Risk Register of 2017, it sort of says these were the two things: Pandemic flu that could kill up to 750,000, or an emerging respiratory virus that could kill up to 100. That was the assumption that collectively, including myself, we didn’t challenge.

Lead Inquiry: And that is why my third proposition is that there was a strategic failure to approach the risks of new and emerging respiratory viruses on the basis that it was necessary to identify multiple scenarios, not just to focus, on the one hand, on pandemic influenza with its terrible assumed consequences, and, on the other, a much more limited, generic non-influenza pandemic scenario without regard to what the specific characteristics may be?

Mr Jeremy Hunt: Yes. I mean, I think we have to be realistic. You can’t, as a government, prepare for every single scenario exhaustively, so you have to make choices as to which are the most likely scenarios that you’re going to have to deal with.

But with the benefit of hindsight – and I shall try not to use that phrase too often – you know, if you look at MERS in 2015, if you look at SARS, you can see evidence of these viruses actually taking hold, and we didn’t ask the searching questions as to whether you could have – whether we should be doing more preparations for one of those viruses becoming more contagious even than MERS turned out to be in South Korea and other places.

Lead Inquiry: But it’s not about hindsight, is it, because, Chancellor, as you accept, and if I may say so very fairly, there was a failure at the time to ask the more searching questions that were required to be asked?

Mr Jeremy Hunt: Correct.

Lead Inquiry: And the fourth strategic failure, which is more connected with the response to Covid, is that because the reasonable worst-case scenario doctrine planned for the realistic worst that could happen, and made assumptions as to the number of deaths, this tended to prevent debate and thought about what might be done to prevent those catastrophic consequences ensuing in the first place?

Mr Jeremy Hunt: Correct. That is actually linked to the kind of “we should be worrying about flu”, because –

Lead Inquiry: Yes.

Mr Jeremy Hunt: – flu has, as I understand it, a shorter incubation period, it’s much more transmissible, it’s much harder – it doesn’t have that asymptomatic period where – that is why, for example, in the whole of Operation Cygnus there is no reference to testing, to quarantining. Those are not things that we put any energy into.

I would just add one other thing, which we did touch on earlier –

Lead Inquiry: East Asia?

Mr Jeremy Hunt: I think there was a groupthink that we knew this stuff best, and there was a sense that we – with perhaps the exception of the United States, there wasn’t an enormous amount we could learn from other countries and certainly, you know, I didn’t – this is with, apologies, this is with the benefit of hindsight, but I don’t think people were really registering particularly Korea as a place that we could learn from.

I think it’s very notable that Korea did not have a lockdown in the first year of the pandemic. They avoided a lockdown at all. What I think is interesting is that the reason that they had to superb response – I mean, in the second half of the pandemic, quite a lot of East Asian countries didn’t do very well because they didn’t get their vaccines out as quickly as we did here, but in that first year I don’t think there’s any doubt that Taiwan and Korea did incredibly well. But that was actually because there was a lot of public criticism of the Korean government after the MERS epidemic in, I think, 2014/15 when their laboratory testing capacity was not up to scratch, they didn’t have a network in place, and they learnt those lessons. And there was clearly a narrowness of thinking of which, you know, I was part, which didn’t think hard enough about that kind of potential pandemic.

Lead Inquiry: That fifth, I would suggest, strategic failure is addressed at some length in your witness statement, and to focus down on what it was that East Asian countries had, because of their MERS and SARS experiences, thought about planned for and debated, what was it that they had given consideration to the funding of and the problems associated with mass testing, mass contact tracing, and mass quarantine in essence. And, as you say in your statement, those were issues which we, as a country, did not focus on.

But the Exercise Alice report, which you didn’t see at the time, was based upon an assumed MERS outbreak, was it not, and the Exercise Alice report at the time, 2016, made reference, did it not, to the need for more learning about mass testing, mass contact tracing, mass quarantine?

So it’s not a matter of hindsight, is it, Chancellor? That was something that was flagged in up respect of the East Asian learning in the context of a MERS exercise in 2016?

Mr Jeremy Hunt: Yes and no, if I may be so bold.

Lead Inquiry: Of course, if you wish.

Mr Jeremy Hunt: I think if you read Exercise Alice you can still see now – obviously I didn’t read it at the time because it wasn’t shown to me – but you can see that there was still this underlying assumption that you would be likely to be dealing with something of limited total number of fatalities –

Lead Inquiry: In a hospital setting essentially only?

Mr Jeremy Hunt: Indeed, and if you look at the recommendations, I think there were 12, and I think the Department of Health and Social Care thinks that 11 were implemented and one wasn’t, they didn’t have the urgency that you would have wanted knowing what we went through just a few years later.

So, for example, the PPE recommendation doesn’t say “We need to check that we’ve got enough PPE”, it says “Having enough” and we may not have enough PPE. It says “Having enough PPE is very important and we should do an instructional video to make sure that everyone across the whole system knows the importance of having enough PPE”.

The reason that – so I don’t believe that even if I had been shown Exercise Alice I would have necessarily asked for things to have been done differently.

What I think is, the reason it’s important, it is literally the only thing, as we mentioned earlier, that talks about quarantining and the importance of quarantining, and if there was one thing that could have slowed the progress of Covid when it actually arrived, it was to understand the importance of early quarantining to stop the disease spreading and to understand there are types of pandemic where it is worth putting a massive amount of effort into slowing the spread, and that one of the very first questions we should have been asking ourselves is: is this one of those pandemics that you can actually slow and save lives early on or not? And I don’t think we had asked those questions.

Lead Inquiry: But the reality was, wasn’t it, Chancellor, that those lessons or actions, as they were called in Exercise Alice, whether or not they were brought to your attention, and you’ve said they weren’t, and there is no evidence that Alice was ever brought to your attention, the report itself identified a number of actions which self-evidently were worthy of further exploration. They were the actions recommended by the very report itself, by the exercise, and the actions focused on, amongst other matters, port of entry screening, option plans for dealing with the cost-benefits and practicality of quarantine versus self-isolation, plan for mass community sampling, and the development of live tools or systems to collect data from infected persons in order to be able to better manage testing and contact tracing.

So regardless of whether or not ultimately that would have been of assistance when Covid struck, the fact remains that, to a large extent, those particular recommendations for whatever reason were never carried forward to fruition?

Mr Jeremy Hunt: That’s not my understanding, but I think it’s obviously something for the Inquiry to get more details from – from DHSC. My understanding is that they believe that 11 of the 12 recommendations were implemented. But I think you are right to say that here was the one bit of all our pandemic preparations where we were closest to thinking about a Covid-style pandemic, and it got very little attention in the grander scheme of things.

Lead Inquiry: I believe that the quarantine options paper in Exercise Alice was deprioritised by the DHSC on 28 September 2016. So at least in relation to that –

Mr Jeremy Hunt: Okay.

Lead Inquiry: – nothing came of that.

All right.

Lady Hallett: Or is that the one to which the Chancellor was referring that the department thinks wasn’t implemented?

Mr Jeremy Hunt: It’s not, my Lady.

Lady Hallett: It’s not?

Mr Jeremy Hunt: No, the one I was thinking about was NHS communications. So I hadn’t heard what Mr Keith just said.

Mr Keith: So may we take it that because Exercise Alice was not brought to your attention, nor brought to your attention was any of the work done following Exercise Alice or any of the ways in which the various actions recommended in Exercise Alice were not given effect to?

Mr Jeremy Hunt: Correct. I didn’t know about Exercise Alice.

Lead Inquiry: All right.

Going back to the five strategic flaws or aspects of groupthink that I’ve suggested to you, does your witness statement identify that there are steps which may sensibly be taken to challenge groupthink, whether by way of greater external challenge to challenge orthodoxy or a greater awareness of the events which have befallen other countries and how they’ve responded, but also in relation to improving the political structure in relation to how planning is prepared for?

Mr Jeremy Hunt: Yes. I mean, I think there are lots of things that we need to do to avoid that kind of groupthink, but I do think it’s important to say this was pretty much the whole western world that was thinking this way about pandemics.

But the first thing I would say is that, you know, in – we all discovered how incredibly important SAGE was at the start of Covid, and that is it’s really important within SAGE that there is contrary thinking and challenge going on, and I hope that SAGE is structured in a way to make that possible.

I think that the other thing that I would say is that, if you look at the kind of, the way government works, curiously, the kind of contrary thinking tends to come from ministers who come in with a bunch of experienced expert civil servants, highly professional, and ministers come in with their priorities and the civil servants say “We can’t do that, Secretary of State, for this reason or that reason”, and so that’s really where the most creative discourse happens.

But what failed here was that of course ministers are not scientists, so the kind of challenge to groupthink when there is a scientific consensus is never going to be done by a politician in the most effective way.

So when it comes to things like scientific consensus, you need to have structures where you are welcoming contrary thinkers, and the Civil Service tends to be a very consensus-driven body, and I know that – I believe that you’re not able to use the Health and Social Care Select Committee’s evidence as evidence for your Inquiry, but if I could just put on the record that I was extremely struck when both Dominic Cummings and Matt Hancock gave evidence to that committee that, you know, we said to them: why didn’t you challenge this idea that you could stop the growth of the pandemic, that this was somehow inevitable? And they both said it was incredibly difficult. With an enormous amount of regret, it was just really, really difficult to challenge a deeply held consensus inside the system.

So I think what I’m saying in a rather long-winded way is that you need to have contrary thinking amongst the experts. You can’t just rely on it being the elected representatives challenging the civil servants. That has its role, but within expert bodies you need to have that challenge, the RED team approach and so on.

Lady Hallett: It’s not always easy to get that, though, is it, Chancellor, because I remember in another world I used to be involved in criminal justice and the number of times I saw a theory develop within the medical profession about the cause of injuries or cause of death or something, and if the person who propounded the theory was sufficiently senior, forceful and had the personality to carry the day, then it seemed that a lot of their colleagues went along with them.

So how do you make sure you get the experts who will do the challenging?

Mr Jeremy Hunt: I completely agree and, you know, my father was in the Royal Navy and in the military you have the same thing where sometimes it’s the most junior officer who actually has worked out the solution to the problem, but if you have a rather overbearing general, they don’t feel able to speak out.

So I think you – in areas like pandemic preparedness, precisely because it’s so difficult to see round corners what might happen, I think you have to have structured challenge one way or another in the systems, and I think that’s – you know, I would say SAGE is the most obvious place where it’s important to do that, but we should think about that across government.

Lady Hallett: It’s the little boy who said the emperor’s got no clothes, isn’t it? How do we get a cadre –

Mr Jeremy Hunt: And we can make life very difficult for those little boys, that’s the truth.

Mr Keith: I hope he’ll forgive me for verballing him, I think Sir Mark Walport said at one stage that the Government Chief Scientific Adviser was a licensed dissident; but, Chancellor, from what you say no committee, it would seem – however diverse, experienced and wide-ranging in its composition – is going to be sufficient to be able to address, firstly, the mare’s nest of ministerial accountability that appears to have been developed from having a number of ministerial positions dealing with various different aspects of resilience and, secondly, the need for that challenge to orthodoxy to come from outside government so that it is listened to, and also politically it may be better enabled to take or to recommend or advise difficult funding decisions for consideration of the government of the day; and therefore is there not a case for a senior Cabinet minister with responsibility for EPRR to be appointed, who may have the ear of the Prime Minister, and also for an independent resilience body to challenge orthodoxy and to provide guidance, set strategy, organise exercises and report to Parliament?

Mr Jeremy Hunt: There is possibly some merit in that, but I would say that in my experience of the Prime Ministers I’ve worked with, the most effective ones always surround themselves with people who give them completely honest challenge to any course of action, and I would say that’s a very important characteristic of successful leadership in any field, that you are getting people who aren’t afraid to tell you that something you’re thinking of doing is a load of rubbish. That’s quite a fundamental thing, and it doesn’t always happen.

But I think there is one other thing I would say that can help: so what we do have in this country is a very open press, and very extensive and respected academia where there are lots of dissident voices, and I think that if the SAGE advice to ministers had been in the public domain earlier in the pandemic, I think there would have been lots of constructive criticism from academic organisations, universities up and down the country saying, “Have we thought about this? Have we thought about that?”, which could have informed SAGE’s thinking.

I think they did come round to thinking that actually the Korean approach to a coronavirus is worth serious consideration, but it didn’t happen until May, as far as I can glean, of 2020 and in that period transmission had increased to about 5,000 a day, and then it was inevitable that you were going to have to use a lockdown. Had we got on the case much earlier with that approach, we might have avoided that.

Lead Inquiry: Coming back to your first point about Prime Ministers in your experience having a wide range of views in front of them and of advisers not hesitating to speak truth to power and to challenge orthodoxy, isn’t the problem here that it was the system which failed to provide for a sufficient degree of challenge?

Ministers, in their exalted status, don’t know necessarily what’s going on lower down in the system. There needs to be a body that challenges orthodoxy on the part of the system itself. It’s not a Prime Ministerial issue; it’s a structural issue, is it not?

Mr Jeremy Hunt: Yes. When I was Foreign Secretary I discovered that my predecessor William Hague had instructed his officials, as Foreign Secretary, that any time there was a disagreement inside the Foreign Office about the right course of action with respect to, I don’t know, Iran or somewhere like that, he wanted to be told about the disagreement, and I think that there is a strong sense in the civil service that they need to come to a consensus view and give ministers a recommendation of a single course of action, and that makes challenging groupthink harder.

Lead Inquiry: All right.

Can I ask you, please, about a specific issue, which is – and you’ll know from the evidence of Sir Christopher Wormald – the taking place of a departmental board meeting in September of 2016 in the Department of Health.

It is, please, at INQ000057271.

We needn’t, I think, trouble you with the detail of the departmental board, because Sir Christopher has given information about what it consisted of, but these were the minutes of a particular departmental board, a very senior part of your then department, which was doing a deep dive into major infection diseases.

At page 6, please, at paragraphs 25 and 26, the view of the board, from which you were absent was:

“It was more likely than not that even a moderate pandemic would overrun the system. At the extreme, there would be significant issues if it became necessary to track or quarantine thousands of people. A decision to fund high-end quarantine facilities had already been deferred by ministers.

“All decisions in response to an outbreak or pandemic would need to be made by the Department, as a department of state, though [arm’s length bodies] would have their role to play. There were, however, concerns about how resilient the somewhat fragment system would be – especially in light of previous or future funding cuts.”

The concerns expressed there, even in the context of a moderate pandemic, about tracking, quarantining, how fragmented the system was, appear now perhaps with hindsight to have been rather prescient?

Mr Jeremy Hunt: Well, as you mentioned, I wasn’t at that board meeting and I’ve checked as to why, and it was – and if you – you will have seen from the first page you showed up that there were actually no politicians present at that board meeting because it was three days before the start of the Conservative party conference, and in fact I was making my biggest single announcement as Health Secretary on that first day of the conference, which was the increase in medical school training places by 25%, so there was a lot of work going on ahead of that.

But I have subsequently read all the minutes of that board, and indeed the presentation made by Helen Shirley-Quirk, and I think there is nothing in there that I wouldn’t have known. It was a month before operation or Exercise Cygnus, I think that’s why it was put on the agenda, and my attitude would have been – and, by the way, the same predisposition to worry about pandemic flu and to worry less about respiratory viruses I think is in the papers that were presented to the board. But my view would have been: I’m about to do Exercise Cygnus in which we will deal with these issues exhaustively.

Lead Inquiry: All right.

Could I now turn, please, to the issue of the resilience of the United Kingdom health structures, to which you’ve devoted a considerable part of your witness statement.

You make the point in your witness statement that the NHS budget was protected from some of the most difficult elements, to use your words, of the austerity period and that in real terms health funding increased on a number of occasions, not at least in November 2015 when you secured an overall increase in the NHS settlement and again in 2018.

But you make some observations about how, against the quite separate and extremely difficult issue of funding, something needs to be done about running the NHS hot all the time, because of the obvious deleterious consequences of doing so in terms of the resilience of the health structures as a whole, and ultimately our country.

How can one avoid having to run the NHS hot, whilst at the same time leaving funding questions open for future politicians?

Mr Jeremy Hunt: I think it’s a very, very important question to ask.

So I became convinced during my time as Health Secretary that the NHS needed more capacity. It wasn’t because I was thinking that – I had a crystal ball and I was thinking there could be a pandemic round the corner, it was because I was dealing with a winter crisis every year, I was seeing huge pressure in A&E departments, I was seeing pressure on waiting lists. And when I arrived at Health Secretary, there was a view that we would need fewer and fewer hospital beds because surgery was getting quicker and you had a lot more day surgery, you could discharge people more quickly, pregnant mums could go home much more quickly after they’d had their babies and so on; and that changed when I was there, because I thought that was more than counterbalanced by the increase in older people and the pressures caused by demography.

So I decided we did need more capacity, and I think the number of employees went up by over 100,000 during my time as Health Secretary, the number of doctors went up by 17,000. But it didn’t happen in a structured way and I think what we need in the NHS going forward is a much more structured way of analysing how many doctors and nurses we’re going to need in five, ten, 15 years’ time.

That is for the NHS’s regular business. When it comes to the pandemic, I think there’s a very specific reason why that matters, because I think the NHS did extremely well in the pandemic. I think, you know, the majority, if not the vast majority of people with Covid who needed an intensive care bed got one. But we did so because we were able to do what, for example, the German health minister isn’t able to do, which is through a centralised structure switch off everything else and say, “We’re just going to focus the 100,000 beds we have on Covid patients and make sure that that is the priority”.

And when you read comments in the papers about how good the NHS – how well prepared the NHS was for a pandemic compared to other health systems, I think that’s really what they were talking about. They were saying there was a centralised structure that allowed you to make big decisions from the centre in the way that other countries would not be able to do with a more fragmented healthcare system. But the price we paid for that was a big interruption to cancer care and other treatments, which is partly why we have this big backlog that we’re trying to bring down now.

So I do think you have to make a judgement about: you can’t obviously build empty hospitals, you know, to deal with a pandemic that might happen around the corner, no country in the world could afford to do that, but you do need to think about some latency in the capacity, and that was part of the reason why I argued that we should have the big funding increases that I secured in 2015 and 2018.

Lead Inquiry: Does the same analysis apply to workforce planning in particular and the numbers of NHS doctors and nurses?

You refer in your statement to the fact that there have always been issues, of course, with numbers of the NHS workforce and with planning, and you describe how you became aware of the importance of workforce planning.

In the context of pandemic planning, is there any way in which you can have a latent capacity in terms of sheer numbers of NHS employees to be able to deal with the contingent possibility of a catastrophic pandemic?

Mr Jeremy Hunt: I don’t think any healthcare system can plan to have as many doctors or nurses as you would need in an extreme pandemic situation, just because of cost, and also because of the fact that you just don’t know what kind of situation you’re going to be dealing with.

Lead Inquiry: Indeed.

Mr Jeremy Hunt: But I think that we should be better at long-term workforce planning, and I did conclude as Health Secretary that the structure we have – because it takes seven years to train a doctor – means that it’s never given a higher enough priority in the system, and when a Chancellor and a Health Secretary are negotiating a spending review settlement, they’re thinking about: how are we going to relieve pressure in A&E departments this year? How are we going to have more cancer treatments next year? But the number of doctors coming onstream in eight or nine or ten years’ time is inevitably further down the priority list, and you need to have some mechanism that makes sure that it always gets the priority it deserves, rather than what we have at the moment which is a rather lumpy way of increasing doctors.

I persuaded Theresa May in 2016, I was very proud to do so, and we had a big increase then, but the first doctors from that decision will be coming onstream next year, so that gives you an idea of the time delays involved.

Lead Inquiry: So is the stark reality that an improvement in resilience structurally walks, and can only walk, hand in hand with a general improvement in terms of workforce numbers and the health and the financing of the NHS as a whole?

Mr Jeremy Hunt: Yes.

Lead Inquiry: There is no practical way of bifurcating the two issues?

Mr Jeremy Hunt: I think that structured workforce planning will make a very big difference to our overall pandemic resilience, yes.

Lead Inquiry: What about social care and in particular adult social care?

You say in your statement that one of your regrets as Secretary of State for Health and Social Care was that you were unable to secure a longer term funding settlement for social care or a long-term plan to relieve pressures and iniquities in the social care system.

Does the same analysis apply, that an improvement in resilience must necessarily depend on improvement in the system as a whole, and of course that depends on funding?

Mr Jeremy Hunt: It does. It’s slightly more complex, because I don’t think any country in the world that I’m aware of has a nationalised care system where all the care homes are owned and provided by the state, and so I think all countries have a semi-public, semi-private system.

Again there were – I think there was an increase of over 100,000 in the social care workforce in my time as Health Secretary, but I wanted there to be a long-term plan for the social care sector. I negotiated the long-term plan for the NHS with Theresa May and Philip Hammond in 2018, and was hoping to do so for the social care sector, and I think that was next on their list too but then unfortunately that government fell and we had the pandemic and it didn’t happen.

When I became Chancellor, in the autumn statement last year I did put through a £4.7 billion annual increase in the social care budget because it was unfinished business in my mind, and I hope that will make a difference.

I would say that in social care, though, if I’m looking at global best practice and resilience, I think the experience of MERS and SARS in Korea and Taiwan, I did look at what they did with their care homes, and I think I spoke to a professor from Hong Kong University during the pandemic who said that they had not had a single care home death in Hong Kong, and there the key issue was not so much the long-term planning – by the way, we should do the long-term planning anyway, because it’s very important for the social care sector, but that wasn’t the key issue. The key issue was the infection prevention and control, and the fact that following MERS they’d said that every care home had to have a named person responsible for pandemic planning in the care home, and they very quickly stopped external visitors going into care homes to stop infection being brought into care homes from the community, and I think they were required to have a supply of PPE as well permanently there.

So I think – and I think in Korea they had some care homes where the staff were asked to live on-site at the peak of the dangerous period to stop residents getting infections.

So it was really around – I would say the biggest difference we could make in the social care system when it comes to pandemic planning is that area.

Lead Inquiry: Those latter issues are of course matters which will be looked at in greater detail in my Lady’s later module on social care.

Finally, the topic of Operation Yellowhammer, with which you’ll be familiar. The emails and the letters from the Department of Health and Social Care when you were Secretary of State make plain that following that NSC(THRC) meeting to which you referred earlier, that committee had put into place, or rather the Prime Minister had directed the institution of the pandemic flu readiness programme.

In the bundle, as you’re aware, there are a number of letters from yourself to both Theresa May MP and to two others in which you stress the vitality:

“It is vital that this work continues to be prioritised and resourced by departments, given the significance and scale of the risk.”

So you were concerned to ensure that the work ordered by that committee, which is the workstreams done by the Pandemic Flu Readiness Board, be continued to be prioritised.

You ceased to be Secretary of State on 9 July 2018, and thereafter the necessary preparations for a no-deal exit intervened, and evidence has been heard by my Lady as to the extent of the interruption and the impact of those necessary preparations.

To what extent were you aware, once you had left that post as Secretary of State for Health and Social Care, of the degree to which the work that you had called to be prioritised was being affected by Operation Yellowhammer?

Mr Jeremy Hunt: I don’t think I was aware at all.

Lead Inquiry: And is that because of course you were Foreign Secretary?

Mr Jeremy Hunt: I was Foreign Secretary.

I mean, I will say, you know, in answer to the broader question of: because the Brexit vote happened when I was Health Secretary, how did it impact my work as Health Secretary? It was really one very specific thing: I was concerned about the future of our life science industry, so I spent a lot more time than I had previously visiting life science companies in this country and around the world because I wanted to protect our ongoing life science investment, so I did spend time on that.

But I – I don’t recall ever hearing that pandemic preparedness had been deprioritised when I became Foreign Secretary.

Mr Keith: My Lady, those are all the questions I have for the Chancellor.

May I ask you, please, for permission to publish the Chancellor’s witness statement?

Lady Hallett: Yes, and let that be a standing direction –

Mr Keith: Yes.

Lady Hallett: – unless anybody indicates for some reason it shouldn’t be published.

Mr Keith: Then there are – as I can see, my Lady, you are alive to – two requests to ask questions from the core participants under Rule 10(4), Covid-19 Bereaved Families for Justice UK and Northern Ireland and the Trades Union Congress.

Lady Hallett: Thank you. First Mr Weatherby and then Mr Jacobs, thank you.

Questions From Mr Weatherby KC

Mr Weatherby: Mr Hunt, I ask a very few questions on behalf of the Covid-19 Bereaved Families for Justice, which represents the interests of many bereaved families across the UK.

Just picking up from where Mr Keith left off with capacity and resilience, and particularly nursing resilience and staffing levels, were you aware that the Welsh Government put in place in 2016 legislation providing for nursing staffing levels, health boards and NHS trusts in Wales during the relevant period?

Mr Jeremy Hunt: No, but I … what happened was that – and this may or may not be connected to that – we had a terrible scandal at Mid Staffs, and we in England had a very radical overhaul of hospital regulation and we introduced Ofsted rating for all hospitals and so on –

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: – and the Welsh Government were asked what they were going to do in response to this, because there were some issues in Welsh hospitals. I believe that might have been their response.

Mr Weatherby KC: Yes. I think it was to have regard to the importance of providing appropriate numbers of nurses in all settings. Is that something that you ever considered, given staffing levels in England, was that anything you considered bringing in in terms of England?

Mr Jeremy Hunt: I thought it was extremely important to have appropriate staffing levels.

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: I think the number of nurses increased by 24,000 during the period that I was Health Secretary. My – the main focus of my time as Health Secretary was patient safety, and I was very aware as to how staffing levels would have an impact on patient safety, and I did look at whether one way to address this was to mandate staffing levels.

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: But I think in the end the problem with that approach is that you can only mandate staffing levels if you actually have the doctors and nurses to mandate, and that’s why you need a long-term workforce plan to make sure you have the ability to do that.

Mr Weatherby KC: If you have staffing levels, then you’ve got something to work up to, though?

Mr Jeremy Hunt: Well, if you mandate it.

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: So I did look at whether you should simply say it’s a requirement, for example, that, you know, there should be one nurse for every –

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: – eight patients on a dementia ward. If you make that a legal requirement, then the hospitals will have to pull those nurses from somewhere else –

Mr Weatherby KC: Yes, understood.

Mr Jeremy Hunt: – and if those other areas matter, then you would cause damage to patients in those other areas. So that’s why I didn’t believe it was an option –

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: – until we increased training levels.

Mr Weatherby KC: You mentioned a couple of times the number of nurses and the number of doctors that you put in place, but yesterday the Inquiry heard powerful evidence from Professor Davies, the Chief Medical Officer who worked closely with you, and she described the disinvestment – her word – in the NHS as affecting resilience and the UK being at the bottom of the table in regard to the numbers of doctors and nurses with comparator countries.

So isn’t that a powerful argument for why there should be minimum levels of doctors and nurses, probably other things as well, but isn’t that a powerful argument for that?

Mr Jeremy Hunt: It’s a powerful argument to increase the numbers of doctors and nurses so you can put those levels in place, safe staffing levels, and I would support that. I wouldn’t use the word “disinvestment” because, I mean, in my time I think the investment in the NHS budget went up from £101 billion to £124 billion.

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: But do we need greater workforce capacity? Absolutely we do.

Mr Weatherby KC: Yes. I think the point was the bottom of the table in terms of comparator countries, in terms of those numbers.

Mr Jeremy Hunt: Well, I think if you – I don’t want to suggest that we have got to the right place when it comes to workforce planning, I think we need to go further. But I think the latest figures I’ve seen, out of the 38 OECD countries we’re fifth in terms of the proportion of GDP we invest in health. So I think in the period since 2010 –

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: – compared to other countries we’ve grown, but I think we can do better –

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: – when it comes to workforce planning.

Mr Weatherby KC: Second point, similar point, though, that the Inquiry’s going to hear evidence from the chair of the BMA, British Medical Association, UK Council, Professor Banfield, and in his statement to the Inquiry he indicates that the BMA regularly raised concerns with government in relation to the state of public health and healthcare systems and their lack of capacity and resilience, and the BMA’s communications ensured that government were fully aware that the public health and health systems were struggling to provide adequate services even in normal times and that actions needed to be taken; and then no doubt when he comes to give evidence he will be able to show the documents and reports he’s referring to.

But during your period, in the period running up to the pandemic when you were in office, do you recall those persistent concerns being raised by the BMA that the government funding was insufficient to sustain the NHS?

Mr Jeremy Hunt: Very much so, because there was a junior doctors strike that lasted nearly a year, and it was because I was trying to – the immediate cause of the strike was my request that we should have better weekend staffing at hospitals, because I thought that mattered for patient safety, but in the course of that strike I was trying to understand why it became such a bitter and long strike. Doctors were saying “You’re asking us to work more on Saturdays but we don’t have enough doctors in the week” –

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: – and I looked at the evidence and I thought that they had a point, and that was why I introduced a 25% increase in doctor training places in October 2016, followed incidentally by a 25% increase in nurse and midwife training places.

Mr Weatherby KC: Isn’t the real answer to these issues that insufficient consideration has been given, and needs now to be given, to long-term sustainable funding for the NHS to bring its resilience up and to ensure long-term that there is sufficient doctors, nurses and other resources for business as usual, but also to be able to play a full part in emergency shocks?

Mr Jeremy Hunt: I don’t think you can fairly say that there weren’t big increases in the clinical workforce during either the time I was Health Secretary or even the broader period since 2010, but what I would say is that I don’t think it happened in a structured way that it should have, and I think it would be much better if it was done not because a particular Health Secretary at a particular moment –

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: – takes an interest in it, but because there’s a long-term plan, which includes thinking about resilience –

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: – as to how many doctors you’re going to need in five, ten, 15 years’ time –

Mr Weatherby KC: And clear minimum long-term standards with proper funding, transparent, so everybody can see?

Mr Jeremy Hunt: Well, yes, but just for the avoidance of doubt I think it is important to say that the funding levels did go up significantly –

Mr Weatherby KC: Yes.

Mr Jeremy Hunt: – and we do fund comparable levels to other European countries.

Mr Weatherby: Thank you, Mr Hunt.

Lady Hallett: Thank you very much, Mr Weatherby.

I said Mr Jacobs, but I can’t see him.

Mr Jacobs: I’ve moved to the back of the room, my Lady.

Lady Hallett: Oh, there you are.

Mr Jacobs: I may be obscured from you, but I think I can see the Chancellor.

Questions From Mr Jacobs

Mr Jacobs: Good afternoon, Chancellor. I have just a few questions on behalf of the Trades Union Congress.

Chancellor, could I start with an answer that you gave just a few moments ago to Mr Weatherby, and your evidence that in terms of spending on the NHS as a proportion of GDP the UK or the NHS features fifth, I think you said, amongst the 38 OECD countries.

When looking at NHS spend as a proportion of GDP currently, does that in reality reflect at least in part not so much an increase in funding but our GDP falling behind or our growth in GDP falling behind our peer countries?

Mr Jeremy Hunt: I don’t believe so, because we’ve grown at broadly the same rate as Germany since 2010. I think our GDP growth rate has – you know, some years it’s up and some years it’s down, but we’ve – our GDP’s actually grown faster than France and Japan since then, so I don’t believe that’s the reason.

Mr Jacobs: Chancellor, you pick Germany. Is Germany not the sole other G7 country that has a broadly similar GDP growth, or lack of it, than the other G7 countries, for example?

Mr Jeremy Hunt: No, I think we grew faster. If you’re talking about since 2010 as a baseline, we’ve grown faster than Italy, Japan, France –

Mr Jacobs: Sorry, Chancellor, focusing on recent developments, so during the course of the pandemic.

Mr Jeremy Hunt: Well, if you’re talking about we spend fifth out of 38 countries, that – that’s where we are today, and, as I say, in terms of recent GDP growth over the last decade I think – I’m not sure I – I think the point I would say is – I think what you might be saying is: could we have gone up to league table quite a lot because of growth in the last couple of years, because of a lack of growth over the last couple of years, is that the question you were asking?

Mr Jacobs: Well, Chancellor, let’s look at it a slightly different way, given that we are focusing on the NHS as we go into a pandemic, at the beginning of it.

You’ve said where we are today, but is it right that in the decade or so leading to the pandemic we generally lagged behind peer countries in terms of spending on the NHS as a proportion of GDP?

Mr Jeremy Hunt: Well, I just remember when I was asked that question as Health Secretary many times, I seem to remember that we were generally bang on the Western European average and the OECD average during the period I was Health Secretary. I don’t have the exact figures in front of me, but I think we were broadly at the average level.

Mr Jacobs: However we compared, I think your evidence a few moments ago was that, in your time as Secretary of State for Health and Secretary of State for Health and Social Care, you did become convinced of a need for more capacity within the NHS; is that right?

Mr Jeremy Hunt: Correct.

Mr Jacobs: One of the matters you describe in your statement is that after Operation Cygnus in 2016, you agreed that both the NHS and social care system were fragile and in need of more funding; is that right?

Mr Jeremy Hunt: Correct.

Mr Jacobs: And in response that, there was an announced increase in funding in June 2018. That was when the announcement was; is that right?

Mr Jeremy Hunt: There was also an earlier announcement in October 2015, or December 2015, towards the end of 2015, but the bigger announcement was then, yes.

Mr Jacobs: Yes. So the bigger announcement, June 2018; and is it right to say that that related to an increase in funding over five years that was to start in 2019/2020?

Mr Jeremy Hunt: Either 2019/20 or 2018/19.

Mr Jacobs: Okay. Do you think it’s correct to say, Chancellor, that realistically that funding would have been too close to the pandemic to address the fragility in the NHS that you were concerned about in 2016?

Mr Jeremy Hunt: Well, it’s – I think the way to put it is, as I mentioned earlier to Mr Keith, that when I arrived the NHS budget was £101 billion, when I left it was £124 billion, that was a negotiation for an additional £33 billion.

Mr Jacobs: Yes, that might be an answer to a slightly different question. My question was: you’re concerned about fragility in 2016, the funding increase comes in, I don’t think you can quite recall, but the 2019/20 tax year; do you agree with the simple point that that was too late to address the fragility which you yourself were concerned about?

Mr Jeremy Hunt: I don’t think so, because – look, I accept your broad point that I think there needed to be more capacity, that I think the system, the health and social care system were fragile, but I also recognise that as a country we had very fragile finances in 2010 following the global financial crisis, and we had to do some work in order to get ourselves in a position where we could afford the big increase that I negotiated in 2018. So I don’t think it would have been possible to negotiate that increase any earlier, because I don’t think the funding existed to do so.

Mr Jacobs: One final matter, Chancellor. We heard yesterday from Dame Sally Davies. She was your Chief Medical Officer, wasn’t she, throughout your time as Secretary of State for Health and for Health and Social Care? You describe her in your statement, don’t you, as your “excellent Chief Medical Officer”; is that right?

Mr Jeremy Hunt: Yes.

Mr Jacobs: What she said yesterday, and Mr Weatherby touched on a part of it, she described not having resilience in the NHS and by comparator data, compared to similar countries, per 100,000 population, we were at the bottom of the table on number of doctors, number of nurses, number of beds, number of ITUs, number of respirators, number of ventilators.

Is that a picture you recognise, and do you think it’s a pretty damning picture of the state and capacity of the NHS as we went into the pandemic?

Mr Jeremy Hunt: It’s a picture I recognise, and I tried to do something about, with big increases in doctor, nurse and midwife training places, with big increases in the NHS budget so that we would be able to afford to employ them.

So, yes, that is exactly what I thought. I thought the NHS needed more capacity to increase the doctors per head to closer to Western European levels. But the context, that was the NHS that the government inherited and there was also a financial crisis, so it was going to take some time in order to address those issues. But do I agree with Dame Sally that we need to improve our capacity in those areas? Absolutely, yes.

Mr Jacobs: Chancellor, thank you.

Thank you, my Lady.

Mr Keith: My Lady, Covid-19 Bereaved Families for Justice Cymru have emailed in to say that they have been thoroughly traduced by my failure to ask a question that they were told I would ask, and therefore they seek your permission for me to put the question that wasn’t put. May I have your permission to do so?

Lady Hallett: Certainly.

Further Questions From Lead Counsel to the Inquiry

Mr Keith: Chancellor, did you have communications with the Welsh ministers for health in connection with pandemic preparedness and preparation, and how effective were the systems of communication? Were they as effective as they could have been and, if not, how could they have been improved?

It describes itself as a single question, it may not be. What’s your response?

Mr Jeremy Hunt: No, and I think it’s probably in response to a negative comment in the papers from the then Welsh Health Minister about his lack of engagement with me as Health Secretary.

Lead Inquiry: Mr Vaughan Gething?

Mr Jeremy Hunt: Correct, and the answer is that they were quite strained relations because the Welsh Government responsible for the NHS was Labour, the Scottish NHS was under the control of the SNP, and I was the English Health Secretary and I was responsible – and I was obviously Conservative, and the reason – and that doesn’t mean to say you can’t have cordial relations with people from different parties, but in this particular case the NHS was the central battleground in every general election, and so in every general election there was a narrative that Labour would say here, “The NHS is in a terrible state”, we would say, “It’s in an even worse state in Wales”, and – and this is not the place obviously to get into the rights and wrongs of those claims, but they were the claims that were made. So we didn’t have very good relations, I fully accept that.

For the sake of pandemic preparedness, what was my strategy? My strategy was that we needed to have the best possible relations at an official level, and I think that actually that was one of the positives that came out of Exercise Cygnus, that the Chief Medical Officers for the four nations did develop a network, and actually I think that was something that worked pretty well during the pandemic as well.

Lead Inquiry: I think I should observe, Chancellor, that given that the etymology of this issue was Mr Vaughan Gething, that in his witness statement to my Lady’s Inquiry he says:

“In the context of Exercise Cygnus Jeremy Hunt was the United Kingdom Government Health Secretary. Although he was, I think, present for the opening of the ministerial engagement element of the exercise, he was absent for the second day and a junior UK health minister took the chair.”

And he says this:

“My impression was that UK ministers did not take ministers and officials from the devolved governments seriously.”

Has your evidence been, in fact, that you were present on that day when the decision had to be made by the de facto Secretary of State in that exercise to make decisions about triage to which you have referred and so you were very much part of that exercise?

Mr Jeremy Hunt: I was there for the first day, I think in its entirety. But, as I say, I was conscious of the political challenges of close co-operation given the context we were in, and so my approach was always that we should nurture the closest possible relationship at an official level, where those political rivalries didn’t exist.

Mr Keith: Thank you.

Lady Hallett: Thank you very much.

Mr Keith: My Lady, that concludes the evidence for today.

Lady Hallett: Chancellor, thank you very much indeed. I hope we haven’t taken up too much of your time. Thank you for your thoughtfulness.

(The witness withdrew)

Lady Hallett: 10 o’clock tomorrow.

Mr Keith: Thank you, my Lady.

(4.30 pm)

(The hearing adjourned until 10 am on Thursday, 22 June 2023)