Transcript of Module 1 Public Hearing on 27 June 2023
(10.00 am)
Lady Hallett: Morning, Mr Keith.
Mr Keith: Good morning, my Lady. Matt Hancock MP, please.
1. Mr Matt Hancock
MR MATT HANCOCK (affirmed).
Questions From Lead Counsel to the Inquiry
Mr Keith: Could you give the Inquiry, please, your full name.
Mr Matt Hancock: Yes, my full name is Matthew John David Hancock.
Lead Inquiry: Mr Hancock, thank you for attending today. Whilst you give evidence, could you please speak up so that we may all hear you clearly, and also so that the stenographer can hear you for the purposes of the transcript.
If I ask a question that is not clear, please don’t hesitate to ask me to repeat it. There will be a break in the course of the morning’s evidence session.
You have kindly provided a witness statement dated 20 April of this year; is that right?
Mr Matt Hancock: That’s right, yes.
Lead Inquiry: Could we have, please, on the screen INQ000181825, and page 14, please. Page 24, I think, is the last page. It’s signed, I think, on 12 May, therefore, and it was accompanied by the usual statement of truth.
Mr Hancock, you were Paymaster General and Minister for the Cabinet Office between 11 May 2015 and July 2016.
Mr Matt Hancock: Yes.
Lead Inquiry: During that time, were you, therefore, responsible ministerially for an important part of this pandemic preparedness structure, namely the National Security Risk Assessment process?
Mr Matt Hancock: Yes, I was formerly the junior minister responsible for that, both for the secret part and for the National Risk Register. I reported to Oliver Letwin, and he in practice led on those areas, but nevertheless I had junior oversight of them.
Lead Inquiry: Is that because the senior minister in that regard is the Chancellor of the Duchy of Lancaster, which he was, and you were the junior ministerial colleague as Minister for the Cabinet Office?
Mr Matt Hancock: I was effectively the number two in the Cabinet Office, yes.
Lead Inquiry: Then did you become Secretary of State at the Department of Health and Social Care between 9 July 2018, when you took over from Jeremy Hunt MP, and 26 June 2021, when you resigned?
Mr Matt Hancock: Yes.
Lead Inquiry: My Lady, for the purposes of – for those who may be listening to Mr Hancock’s evidence, I’m going to make clear that your appearance today is obviously concerned with the discharge of your functions as the Minister for the Cabinet Office and as Secretary of State in the Department of Health and Social Care pre-pandemic.
Mr Matt Hancock: Yes.
Lead Inquiry: We are concerned today only with the issues of emergency planning and preparedness, and so may I make clear that I will not be asking you questions about the detail of non-pharmaceutical interventions, lockdowns, the government’s response, or the test and trace or procurement or PPE issues which arose after the pandemic struck.
Lady Hallett: They will come in later modules, just so people understand.
Mr Keith: They will all be in later modules, particularly Module 2 in the autumn, for which Mr Hancock has provided a draft statement.
EPRR pandemic planning. The functions of the Secretary of State, Mr Hancock, in relation to pandemic planning, are wide-ranging and complex, are they not? There is quite a lot to be concerned with in this field.
Mr Matt Hancock: Yes, and that is in addition to the very broad responsibilities overall as Secretary of State.
Lead Inquiry: You are responsible or were responsible in broad terms for health and social care, and that includes, therefore, health protection, health improvement, the healthcare systems, the social care systems, although that’s largely in the hands of local authorities, and most importantly perhaps the NHS, so it’s a very wide brief indeed.
Mr Matt Hancock: I wouldn’t say most importantly the NHS, I would say that there are many, many areas of importance, and actually one of the challenges of the job is to try to put your attention to the most important areas, because it is so broad.
Lead Inquiry: Is a vital function of the Secretary of State to deal with health emergencies?
Mr Matt Hancock: Absolutely, and going into the job, I had some experience at a more junior level of dealing with crises and emergencies, and so I took my responsibilities as the – as the principal responder to a pandemic very seriously.
Lead Inquiry: Does dealing with health emergencies include dealing with infectious diseases?
Mr Matt Hancock: Yes, of course.
Lead Inquiry: And being ready to deal with them? Being ready to deal with the risk of infectious diseases?
Mr Matt Hancock: Absolutely.
Lead Inquiry: So when concerned in the field of emergency preparedness, resilience, civil contingencies, where there is a health emergency it is the Department of Health and Social Care that is the lead government department, in effect it is the department in the driving seat?
Mr Matt Hancock: Yes, and as Secretary of State I felt keenly the responsibility as essentially the lead responder in the first instance to those sorts of health emergencies, and it was a – it was a part of my day-to-day work, because these emergencies happen from time to time.
Lead Inquiry: Were, when you were Secretary of State, risks prioritised in any way? Was there a grading system to prioritise those most important and serious risks from those that were less so?
Mr Matt Hancock: Yes, of course, that’s absolutely vital, and one of the challenges in a system as big as the health system is making sure the decisions are taken at the right level, because if you escalated everything to the Secretary of State, whoever they are, they would be completely overwhelmed. Yet it’s vital to escalate the things that need to be seen by the Secretary of State to the – to their desk.
Lead Inquiry: Was influenza pandemic prioritised as a Tier 1 risk?
Mr Matt Hancock: Yes, it was. On – I recall that on my first day I was given a briefing document, about as big as this one, and one of the elements of it was making clear my responsibility as a – as the Tier 1 national responder for pandemic flu and for other infectious diseases. I was already aware of this element of the role from my time at the Cabinet Office, but nevertheless it was properly and formally brought to my attention, and on day one I asked for more information on preparedness, because I – having been involved in previous crises, for instance, at the Bank of England in, before I went into politics, I knew that when things go wrong, things move quickly and you need to be as well prepared as you can.
Lead Inquiry: At the highest level of the department, was there a board known as the departmental board which looked at the highest level of major risks confronting the department?
Mr Matt Hancock: Yes, and the role of the departmental board was to ensure that the department was structuring itself properly to deal with the different challenges that it faced.
Lead Inquiry: May we have, please, INQ000023142, which is a copy of your department’s then high level risk register for quarter 3, 2019 to 2020.
If you can go to the top of the page, we will see there the years, “201920 [quarter] 3 [high level risk register]”, and if you go to the far left-hand side of the page, there will be a number of row numbers.
If you could scroll down, please, to row 11. There are two names on the left, in the column second from the left, Mr Hancock, Emma Reed and Clara Swinson, both of whom have been witnesses before this Inquiry:
“[The] Description – (Major national infectious disease outbreak and pandemic flu) …”
The risk identified, for self-evident reasons, is that:
“… the department fails to respond and mobilise adequately to a major national infectious disease hazard, such as pandemic flu or other novel infection.”
The approach taken, the response on the part of the department, is in the next column, to:
“Manage the risk and likely domestic impact of a major pandemic flu or emerging infectious disease outbreak.”
So the risk was identified in terms not just of the pandemic being an influenza pandemic, but obviously the risk of an infectious disease outbreak, an emerging infectious disease outbreak.
Mr Matt Hancock: Yes.
Lead Inquiry: Does its presence in that chart, in that schedule, Mr Hancock, indicate the seriousness with which the department took the risk of a major infectious disease outbreak or pandemic flu?
Mr Matt Hancock: Yes, and the red rating demonstrates that the significance of the impact of this, should it strike, could be very serious, and the day-to-day life of a Health Secretary involves being aware of and, from time to time, being involved in managing the response to potential infectious disease risks, which happen from time to time. And I set out in my statement that over the autumn of 2019 there was a potential flu outbreak, there was a – what’s now known as Mpox outbreak, then known as monkeypox, and over this period we were also dealing with the Ebola epidemic in West and Central Africa, and the particular responsibility of the health department was to ensure that we were prepared, should Ebola come to the UK.
So this was a – this was not a theoretical exercise, it was part of the day-to-day job of being Health Secretary.
Lead Inquiry: It is apparent from the document that, in relation to each risk identified on the left of the schedule, a number of what’s known as mitigations are put in place in order to manage the risk. In other words, the department sets out, in columns K, L, M and N in respect of each risk, what the department is doing to manage the risk, to mitigate it, to ensure either that the risk does not eventuate, it does not come to pass, or to manage the consequences of whatever it is that the risk amounts to, what it brings about and how the consequences can be managed.
Do you happen to know why, in this risk register, there is no mitigation set out in respect of that row 11 risk?
Mr Matt Hancock: No, I don’t know why those boxes are empty, but I do know that there was significant activity under way, both in the department and in Public Health England, to make sure that we were prepared, as prepared as then thought possible – and I’ll come on to that, because it’s absolutely central, that question – and frankly it was a – it was a regular occurrence to deal with these sorts of novel infectious diseases and threats, so it was something that happened all the time.
Lead Inquiry: Do you recall, Mr Hancock, any particular departmental board, which presumably you attended, at which the row 11 risk of a major national infectious disease and pandemic flu was actively debated?
Mr Matt Hancock: No.
Lead Inquiry: Do you have any recollection of the debate surrounding this particular risk at departmental boards? I mean, obviously a great deal – many points go across the Secretary of State’s desk, but do you have any personal recollection of –
Mr Matt Hancock: I don’t at the departmental board, but I also wouldn’t have expected it to be debated at the departmental board, because the departmental board was focused on ensuring that there was appropriate resource in place for any of the different risks that the department faced, and ensuring that the department was set up to respond, not to do the responding itself – it’s an important distinction in terms of how the board operated and what its job was – and I was aware from the day one brief onwards of the work that was – that was under way. So there’s no substantive reason these boxes should be empty, and I think it would be wrong to read from this, which I don’t recall myself, this implying that there wasn’t work ongoing, because as you can see from the other paperwork there was.
Lead Inquiry: My question was, in fact, to ask you whether you recollected what was being done, in terms of: was there a debate about, as you say, the processes that needed to put into place, was there a debate about what needed to be set up to mitigate this risk at a departmental board level?
Mr Matt Hancock: There was at a departmental level.
Lead Inquiry: Departmental –
Mr Matt Hancock: There was not, from my recollection, at the board, but I don’t think the board would have been the – would have been the normal place to have had such discussion.
Lead Inquiry: Well, Mr Hancock, that cannot be right, can it, because this is a schedule of the high-level risks which were put before the departmental board, and therefore it must follow that these are risks and mitigations which are debated by the departmental board, that is what this chart shows?
Mr Matt Hancock: The purpose of the board was to ensure that the department was doing what needed to happen, rather than to debate the substance of it.
Lead Inquiry: All right.
You have referred to the fact that the Department of Health and Social Care was the lead government department when it comes to dealing with planning and preparedness for a health emergency, and also in relation to the necessary response.
As the Secretary of State, what did you understand that responsibility to consist of? What did lead government department in the civil contingencies field mean to you?
Mr Matt Hancock: Oh, it means that if that risk begins to materialise, it is the department’s responsibility to act appropriately. It is also, before that stage, the department’s responsibility to have adequate surveillance to that sort of risk, and therefore, as Secretary of State, it was my responsibility to ensure, as much as possible, given all the other pressures, that there was adequate oversight.
Lead Inquiry: Did that oversight comprise matters such as ensuring that the department played its proper part in the risk assessment process?
Mr Matt Hancock: Yes.
Lead Inquiry: Owning, to use a terrible phrase, the risks for which the department was responsible, dealing with capability, how to respond to risks eventuating, contingency and emergency planning in response to again those risks, and building up the department’s own resilience, how it would cope with the impact of one or more of these risks?
Mr Matt Hancock: Yes, and bringing all of that to the attention of the rest of government should action be needed elsewhere in government in addition.
Lead Inquiry: Indeed.
So focusing firstly, please, on one of those areas, the risk assessment area, when you joined the department as Secretary of State, you wouldn’t, I think, have been engaged in the NSRA process, the risk assessment process, because one wasn’t produced after you took office until 2019 –
Mr Matt Hancock: Correct.
Lead Inquiry: – when the NSRA and NRA process was brought together, but do you recall the detail of that process? Do you recall specific debate about the contents of that 2019 Cabinet Office-produced risk assessment?
Mr Matt Hancock: No, I was not involved in those debates. There was an NSRA and NRR published in 2015, just before I joined the Cabinet Office, so when I joined the Cabinet Office with responsibility for that area, a significant piece of work had just been concluded, which had been led by Oliver Letwin. I of course was aware of and read those documents at the time, but then was not aware of the next iteration of that work going on, and as you say, there wasn’t a publication in that area for a number of years.
And in any case, the language in those documents, as they were revisited over the years, was essentially the same, which is that the category 1 top risk was of a pandemic, influenza pandemic, pandemic influenza, and then there was a – also consideration of other infectious diseases and external threats.
I know there’s been significant discussion so far at the Inquiry on the – of the focus on influenza pandemic. I was told that the reason that was the category 1 risk is because it’s the most likely pandemic, but of course we were aware of other infectious diseases, not least because we were actively involved in responding to Ebola and, to a lesser extent, Mpox and the – and PHE had a day-to-day responsibility for other infectious diseases that tend to happen in much smaller numbers, like Legionnaires’ disease.
So I was aware of it both from the work in the formal production of those risk assessments and in the day-to-day work of the department.
Lead Inquiry: When you joined the department, you were, as you say, provided with, I think it’s called a day one high level briefing?
Mr Matt Hancock: Yeah.
Lead Inquiry: May we please have INQ000183334 on the screen.
This pack, first day pack, included a briefing from the permanent secretary, Sir Chris Wormald, and a number of other senior officials in your department and a number of documents.
Could we please have page 1.
At E – if you could highlight that, please – was one of the areas on which you were briefed, “Global and Public Health”, and that briefing was delivered by Clara Swinson, then a deputy –
Mr Matt Hancock: That’s a director general.
Lead Inquiry: – director general of one of the directorates in the department.
Page 10.
There is the section on global and public health. If you could scroll down the page, please, to paragraph 5:
“The main work areas in the group are …”
Then the first bullet point:
“Emergency Preparedness and Health Protection, (Director – Emma Reed): This directorate prepares for and responds to emergencies, including COBRA, and works on the government’s Prevent strategy. It practices for terrorist or other threats, such as pandemic flu or Ebola. It ensures the delivery of a national immunisation and screening programmes. It also runs a global health security programme, supporting middle and low income countries …”
There was no reference there in that first day briefing pack to the level of risk that pandemic flu posed, so there is no reference to Tier 1, the risk that you’ve identified in relation to pandemic flu.
Were you provided, either on that day or later, with more detail concerning the risk that pandemic flu posed? Did you in fact ask to be better briefed in relation to what the risks to the department were in relation to pandemic threat?
Mr Matt Hancock: Yes. I remember this document, I remember reading it, and on the first evening as Health Secretary I wrote on this particular paragraph to say “More details please”. As you can imagine, I was going through this document working out which areas I needed to focus on, because you have to choose what to focus on, and this was an area that I knew I needed to be across.
Lead Inquiry: So you called for more information, and a written response was provided by, I think, Emma Reed.
INQ000184105, please.
“Introduction to Emergency preparedness, resilience and response (EPRR).”
On that first page, we can see in paragraph 1 a reference to the fact that:
“… DHSC in conjunction with NHS England and Public Health England must provide a co-ordinated response to the challenge of risks set out in the National Risk Assessment … such as natural hazards …”
Of course natural hazards includes, does it not, Mr Hancock, the risk of pandemic flu?
Mr Matt Hancock: Yes.
Lead Inquiry: You can see there references to the department co-ordinating a health response to the incidents in Salisbury and Amesbury.
If you could go further down the page, please, “Emergency Preparedness”, above paragraph 6:
“This Civil Contingencies Act 2004 outlines the national response to civil emergencies, establishing roles and responsibilities for those involved in emergency preparation and response at the local level.”
There is then a reference to the division in the Act, the bifurcation between Category 1 and Category 2 responders, and you, as the Secretary of State, were a Category 1 responder, were you not?
Mr Matt Hancock: Yes.
Lead Inquiry: Then paragraph 7, please.
Category 1 responders are required to carry out exercises and training of staff in emergency planning. The DHSC participates in a cross-government programme of exercises and ministers will be invited to participate in Tier 1 exercises and to participate in COBR style meetings.
You subsequently became aware of the fact that there had, in 2016, in October of that year, been an exercise, Exercise Cygnus –
Mr Matt Hancock: Yes.
Lead Inquiry: – which was an exercise designed to test the United Kingdom’s systems to deal with pandemic influenza?
Mr Matt Hancock: Yes.
Lead Inquiry: Mr Hancock, there’s obviously ample material to show that you became aware of Exercise Cygnus –
Mr Matt Hancock: Yeah.
Lead Inquiry: – and it was an important part of your departmental functions.
Looking back, are you surprised that in this more detailed briefing there was no reference to the fact that, just a year before, Exercise Cygnus had reported and in general terms had found that the plans and capabilities for the United Kingdom were not sufficient to deal with the likely demands of a severe pandemic?
Mr Matt Hancock: That’s a good question. I don’t know why that’s not written here. I did – I was aware, became aware of Exercise Cygnus and the work that was being done to put its recommendations into action. I mean, there’s a bigger challenge with Exercise Cygnus which perhaps we’ll come on to.
Lead Inquiry: Of course.
In your witness statement you say that you asked for further –
Mr Matt Hancock: Yes.
Lead Inquiry: – briefings to be prepared, having read this document.
Mr Matt Hancock: Yes.
Lead Inquiry: Can you now recall what areas concerned you and what areas you asked to be addressed by way of further briefing materials?
Mr Matt Hancock: Yes, I wanted to know about the department’s preparation and its planning processes, and I asked for a – so I asked for further information based on – on this, and I recall receiving a note in – I think it was in August 2018, and continued to ask questions. For instance, one of the areas that I pushed hard on was the lack of UK domestic vaccine manufacturing, given the importance of a vaccine to responding to any pandemic, and that was an area that I worked on intensively up to the – up until the pandemic struck, and obviously then thereafter.
So this was a programme of work for me which was – on which I iterated with the – with the team. I kept asking more questions, and had meetings on it, and the area that I focused on was on the vaccine manufacturing point and others.
Alongside this I was also assured that the UK was one of the best placed countries in the world for responding to a pandemic, and indeed, in some areas, categorised by the World Health Organisation as the best placed in the world. So just to give context to these – you know, this interaction between me, as the new Secretary of State, and my officials, at the same time – you haven’t brought it up, but in one of the documents I got very early on it stated clearly that we are well prepared, and that wasn’t the civil servants’ own assessment, that was the World Health Organisation assessment of the UK. I know that Mr Hunt referred to that last week, but – you know, when you become the Secretary of State, you think about the challenges in front of you. In my case, I had a background in technology and the NHS desperately needed better technology, the NHS needed more people, and we needed to be better at prevention of ill health across the board. Of course, prevention of a pandemic is part of that, but there’s also a huge focus on, for instance, obesity.
I took those as my three priorities. I continued the work on protection from these threats, but it’s important to focus, and you can understand that when you’re assured by the leading global authority that the UK’s the best prepared in the world, that is quite a significant reassurance. That turned out to be wrong.
Lead Inquiry: Coming back to the internal briefing –
Mr Matt Hancock: Yes.
Lead Inquiry: – putting to one side what international authorities said about the United Kingdom’s position, you’ve told us that there was therefore a debate with your civil servants about vaccines; that was one of the issues that you asked about?
Mr Matt Hancock: Yes.
Lead Inquiry: When you were told, however, by your civil servants that the United Kingdom was well prepared –
Mr Matt Hancock: Yes.
Lead Inquiry: – what did they say, when you asked them, as you presumably did, “Well, in what way” –
Mr Matt Hancock: Yes.
Lead Inquiry: – “are we prepared?”
Mr Matt Hancock: Yes.
Lead Inquiry: What did they say about the various other parts of the preparedness structure, stockpiles –
Mr Matt Hancock: Yes.
Lead Inquiry: – diagnostic testing, plans for quarantining or shielding or to deal with the impact of a pandemic, or the supply of antivirals, all of which are other aspects of the system of preparedness?
Mr Matt Hancock: I’m –
Lead Inquiry: What were you told?
Mr Matt Hancock: I was told that we had plans in these areas. So, for instance, on stockpiles, I was told that we had a very significant stockpile of PPE, and we did. The problem was that it was extremely hard to get it out fast enough when the crisis hit.
I was told that we were good at developing tests, and indeed we were. We developed a test in the first few days after the genetic code of Covid-19 was published. The problem was there was no plan in place to scale testing that had any – that we could execute.
On antivirals, we had a stockpile of antivirals for a flu, but not for a coronavirus.
On vaccines, I was concerned that we weren’t in a strong enough position, because we were reliant on manufacturing vaccines overseas, and I thought that in a pandemic scenario, force majeure would mean that it would be hard to get hold of vaccine doses if they were physically manufactured overseas, no matter what our contracts said. So I insisted that we pushed on domestic manufacture and sought the funding to deliver on that. A plan was already in early development to make that happen.
So in each of these cases there was a plan, but the absolutely central problem with the planning in the UK was that the doctrine was wrong, and if I – maybe I should set this out now. I’ve written it in my written statement.
The attitude, the doctrine of the UK was to plan for the consequences of a disaster: can we buy enough body bags? Where are we going to bury the dead? And that was completely wrong. Of course it’s important to have that in case you fail to stop a pandemic, but central to pandemic planning needs to be: how do you stop the disaster from happening in the first place? How do you suppress the virus?
I need to put on the record, if I may, my Lady, that my written statement – I’ve got an update on my written statement, having continued to look through the documents. In –
Lead Inquiry: Mr Hancock, we’ll return, if we may, to correcting one or two parts of your witness statement –
Mr Matt Hancock: Okay.
Lead Inquiry: – a little later. I’m aware that there are one or two areas that you want to say something more about in light of documentation which you have been provided with more recently.
Mr Matt Hancock: Yeah.
Lead Inquiry: Can I bring you back, though, please, to the debate with your civil servants about the state of preparedness?
Mr Matt Hancock: Yeah.
Lead Inquiry: Did you observe to your civil servants or ask, “Well, there is a significant stockpile, but it’s only for flu”?
Mr Matt Hancock: Well, in the case of PPE, the distinction between a flu pandemic and a coronavirus pandemic is really second order. A respiratory disease pandemic requires very similar or, in many, many cases, the same PPE, irrespective of the virology. What matters is the characteristic of the virus.
Lead Inquiry: Indeed. Did you ask whether or not the stockpile about which you received assurances would be adequate for a non-influenza pandemic?
Mr Matt Hancock: I don’t recall whether I did or not, but I also know that if I’d asked the question, I would have been – I hopefully would have been told it’s adequate for other respiratory diseases as well, because indeed it was, because we used it.
Lead Inquiry: Did you ask whether or not the antivirals –
Mr Matt Hancock: Yes.
Lead Inquiry: – in the main a brand antiviral called Tamiflu –
Mr Matt Hancock: Yes.
Lead Inquiry: – which was supplied in – was available in large quantities, whether that was suitable for a non-influenza pandemic?
Mr Matt Hancock: I don’t know whether I asked or I was briefed, but I was certainly aware that that was only useful against a flu, not a coronavirus.
Lead Inquiry: Did you ask or were you made aware that the testing, the diagnostic testing which was in place was on a very small order, and of course was testing designed to deal with a limited high-consequence infectious disease, primarily one involving an outbreak in health settings?
Mr Matt Hancock: Yes, I knew that the testing system was small, and the reason that I explained the flawed doctrine at this point is that by not preparing to stop a pandemic, and worse by explicitly stating in the planning that it would not be possible to stop a pandemic, therefore a huge amount of other things that need to happen when you’re trying to stop a pandemic didn’t happen, and we had to build them from scratch when the pandemic struck.
For instance, large-scale testing did not exist, and a large-scale contact tracing did not exist, because it was assumed that as soon as there was community transmission, it wouldn’t be possible to stop the spread and, therefore, what’s the point in contact tracing? That was completely wrong, and in my view is the absolutely central lesson, is: of course the difference between a flu and a coronavirus is important, but it is a – but it is not nearly as important as getting the doctrine right so in future we’re ready to suppress a pandemic, unless the costs of lockdown are greater than the costs that the pandemic would bring.
Lead Inquiry: Perhaps we’ll return to the issue of the – or the doctrinal arguments about lockdowns a little later.
Mr Matt Hancock: If I may, the reason to bring it up is because it had consequences in all the areas you’ve set out: stockpiles, testing, antivirals, contact tracing and much more widely.
Lead Inquiry: Those were, now, the acknowledged consequences of the doctrinal failure, Mr Hancock.
Mr Matt Hancock: Yes.
Lead Inquiry: But why, if you asked the questions which you say now you did, about the fact that antivirals and the stockpiles of antivirals were only suitable for influenza, that the testing was limited and suitable for high-consequence infectious disease in a healthcare setting, that the PPE was designed for flu, although it had application to HCIDs as well, and that there was no debate about the potential countermeasures, mandatory quarantining, shielding, the impact on education or the economy, if these were questions which were posed when you took office in July 2018, why was the situation allowed to develop in which none of these matters were met, addressed, by the time you had to deal with the consequences of the pandemic in February 2020, when, as you’ve rightly said, you had to build, in all these areas, the entire system from scratch?
Mr Matt Hancock: Because I was assured that the UK planning was among the best and, in some instances, the best in the world, and of course, with hindsight, I wish I’d spent that short period of time as Health Secretary before the pandemic struck also changing the entire attitude to how we respond to a pandemic. And perhaps – you know, one of the reasons that I feel so strongly about the importance of this Inquiry, and why I’m so emotionally committed to making sure that it’s a success, with full transparency and total brutal honesty in answering your questions to get to the bottom of this, is because these – because of these – this huge error in the doctrine that the UK – and, by the way the whole western world – had in how to tackle a pandemic. And that, that flawed doctrine, underpinned many of the problems that made it extremely difficult to respond.
If I may say so, I am profoundly sorry for the impact that had. I’m profoundly sorry for each death that has occurred. And I also understand why for some it will be hard to take that apology from me. I understand that. I get it. But it is honest and heartfelt. And I’m not very good at talking about my emotions and how I feel, but that is honest and true, and all I can do is ensure that this Inquiry gets to the bottom of it and that for the future we learn the right lessons so that we stop a pandemic in its tracks much, much earlier, and that we have the systems in place ready to do that. Because I’m worried that they’re being dismantled as we speak.
Lead Inquiry: Well, we’ll come to that in a moment, Mr Hancock.
So with those words in mind, why in July 2018, when you were made aware of the lacuna in the system of preparedness, the absence of stockpiled PPE for non-influenza pandemic, the lack of antiviral, the lack of mass diagnostic testing, the lack of contact trace systems, why did you not pursue those issues in the following 18 months before the pandemic struck?
Mr Matt Hancock: The only answer I can give is because I was assured that we had the best system in place in the world, and because this system was working towards an approach to pandemic response that was wrong. That’s why it was built that way. And that flaw, that failure, went back years and years and was embedded in the entire system response. So –
Lead Inquiry: Mr Hancock, forgive me. That doctrinal error, to which we’ll come in a moment, in the 2011 strategy explains why the position was as it was in July 2018.
Mr Matt Hancock: Yes.
Lead Inquiry: My question to you, though, is: why, having been alerted to these serious issues, was more not done over the following 18 months? Regardless of why you were in that position, regardless of why the department was in that position, regardless of the doctrinal foundation, why were those practical considerations not followed through?
Mr Matt Hancock: Well, there was no recommendation to resolve those problems that I was aware of. There were recommendations to put into place the learnings from project Cygnus, some but not all of which were taken forward. I was assured that there was a programme of work to put those in place, but there were no recommendations to build a testing system that I was aware of, there were no recommendations to change the stockpile, although on that point the stockpile was effectively transferable from one respiratory disease to another. These recommendations were not there because the system was geared towards how to clear up after a disaster, not prevent it.
Lead Inquiry: You were the Secretary of State.
Mr Matt Hancock: Yes.
Lead Inquiry: It doesn’t need a formal submission from civil servants for something to be done if, in the course of this debate, you asked your civil servants, “Where are the antivirals for a non-influenza pandemic?”
Mr Matt Hancock: Yes.
Lead Inquiry: “Where is the stockpile for a non-influenza pandemic? Where are the plans for mass testing?”
They wouldn’t have said “Secretary of State, we can’t do anything about that, let’s wait to see what the submission we draw up recommends”.
Mr Matt Hancock: That’s right.
Lead Inquiry: You could have ordered it to be addressed and you could have pursued and harried them until something was done?
Mr Matt Hancock: Of course, had I known the pandemic was about to strike, then I would have done that, but this was an unprecedented pandemic and the – nobody was to know. So all I can explain is that when you are – when you become the Secretary of State – when you are the Secretary of State, new in post, there are a significant number of recommendations of what needs to be changed. For example, Dame Sally Davies came into my office and said, “We have to try to prevent more – prevent ill health and tackle obesity, that is the number one problem facing the country”. This was not regarded as a number one problem that needed to be fixed, because we were regarded by external organisations, that had been and investigated our preparedness, we were regarded as one of the best in the world. That’s the only answer I can give you. I know I’ve repeated it, but that’s because it’s true.
Lead Inquiry: The 2011 strategy to which you refer was –
Mr Matt Hancock: Yes.
Lead Inquiry: – the 2011 influenza strategy document dealing, as it says on its face, with the strategy for an influenza pandemic.
Mr Matt Hancock: Yes.
Lead Inquiry: There was only ever one strategy document, wasn’t there? That was it.
Mr Matt Hancock: That was the strategy document that I was aware of. Of course there was a whole load of underpinning documents and further work, but that was the strategy document, yes.
Lead Inquiry: That single strategy document identified no strategy for a non-influenza pandemic other than the hope that the plan for an influenza pandemic could be modified to deal with a high-consequence infectious disease that was not influenza?
Mr Matt Hancock: That’s right. I would also say that any pandemic, by its nature, is a novel disease.
Lead Inquiry: Indeed.
Mr Matt Hancock: So you cannot have a plan precisely for the disease that comes. And the things that matter are: how long is the incubation period? How transmissible is it? How does it transmit? And, crucially, who does it affect more than others, what are the inequalities, the consequences of this disease? Those are the factors that matter.
It would be far better to have a respiratory disease plan and a blood-borne pandemic disease plan and a vector, ie touch-borne – or touch-borne disease plan, that was non-specific about the virology of the pathogen, because what matters is how the thing’s transmitted and how it affects people, as much as the underlying virology as well.
Lead Inquiry: So, in effect, the plan failed to provide for a range of scenarios, it focused too much upon an influenza pandemic, of course that’s what it was called, and although there was a reference in it, Mr Hancock, to the inherent unpredictability of respiratory viruses, there was no detail, was there, of how, given those inherent unreliable characteristics of a respiratory virus, we could be hit by a non-influenza pandemic which had different characteristics to influenza but could be no less catastrophic?
Mr Matt Hancock: So –
Lead Inquiry: That was the flaw, wasn’t it?
Mr Matt Hancock: That was not the main flaw, that was a flaw.
That was of course a problem. However, we also knew there could be another infectious disease and, as I’ve mentioned, we were dealing with a number of them, and I was cognisant of that. For instance, when we did the work on vaccine production, the plan that was put together was a pandemic disease plan, vaccine plan, not an influenza pandemic vaccine plan. So we were cognisant of that.
But I return to my central point, which is that to say that the main problem with that plan was that it was a flu plan and there was – and we ended up with a coronavirus pandemic is of course a flaw, but it is not the central flaw. If we’d had a flu pandemic, we would have had a massive problem because of the doctrinal failure of how to respond to it as well. That was a much bigger error. It was an error across the western world, but it was a much bigger error, and it is absolutely central. I know that I keep stressing this point, but it is central to what we must learn as a country, that we’ve got to be able to hit a pandemic hard, that we’ve got to be able to take action, lockdown action if necessary, that is wider, earlier, more stringent than feels comfortable at the time. And the failure to plan for that was a much bigger flaw in the strategy than the fact that it was targeted at the wrong disease.
Lead Inquiry: They were both major flaws in the strategy, were they not, Mr Hancock?
Mr Matt Hancock: They were both –
Lead Inquiry: It was not just one flaw. You have identified now two major flaws in that strategy.
Mr Matt Hancock: Yes, the point I’m trying to make is that the doctrinal flaw was the biggest by a long way, because if we’d had a flu pandemic, we still would have had the problem of no plan in place for lockdown, no prep for how to do one, no work on how best to lock down with the least damage.
I know – I understand deeply the consequences of lockdown and the negative consequences for many, many people, many of which persist to this day. The problem that we faced was that the consequences of not locking down was much worse, and we need to be able to be – I think John Edmunds is excellent in his evidence saying – and Gus O’Donnell – saying we need to have a way to calibrate as early as possible: what would the damage be of this if we don’t, what would the damage be of this if we do –
Lead Inquiry: I’m afraid I’m going to pause you there.
The issue of lockdown is, as you know very well indeed, something for Module 2, and we are concerned now with your understanding pre-pandemic and what was being done pre-pandemic.
May I ask you, please, to focus on this strategy document which sets out at that time what the thinking was.
Mr Matt Hancock: I understand that, but if I just may say –
Lead Inquiry: Mr Hancock, will you allow me, please. In this forum –
Mr Matt Hancock: It is vital for planning, that’s the point.
Lead Inquiry: – I ask the questions.
Mr Matt Hancock: Of course.
Lead Inquiry: The 2011 strategy was never updated, was it?
Mr Matt Hancock: Not that I – no, it wasn’t, no.
Lead Inquiry: Indeed, the workstream which was due to be carried out by the Pandemic Flu Readiness Board to update that strategy was itself paused, was it not?
Mr Matt Hancock: As I understand it, yes.
Lead Inquiry: There has been ample evidence to show that the work was not done to update this document, this strategy, because of the diversion of resources to the necessary preparations for a no-deal EU exit; is that your understanding?
Mr Matt Hancock: That is correct, yes.
Lead Inquiry: All right.
Were you told, when you were Secretary of State, that the strategy was regarded as inadequate and not up to date?
Mr Matt Hancock: No. Not that I’m aware, not that I recall. On the contrary, we were told that we were one of the best places in terms of preparation.
Lead Inquiry: Are you surprised now that you were not informed that the strategy was deemed to be, and I quote a document from your own department, “out of date, unfit for purpose”?
Mr Matt Hancock: I was not aware of that, no.
Lead Inquiry: By July of 2019, an arm’s length body, I suppose one would call it, or a stakeholder, Public Health England, was stating in its own minutes that there had been no word from the DHSC on the DHSC’s pandemic strategy, so they were concerned that they’d heard nothing from your department in relation to the updating of this strategy, because it was obviously a matter of very real concern.
Mr Matt Hancock: I don’t recall that ever being raised with me, and it highlights the problem of not having a body that was focused only on preparing to defend us against a pandemic, since the Health Protection Agency was abolished in 2012, and that was one of the reasons behind the organisational change I brought in later.
Lead Inquiry: All right.
The Pandemic Influenza Preparedness board was another important part of the department’s work, was it not?
Mr Matt Hancock: Yes.
Lead Inquiry: What was its main function, as you saw it?
Mr Matt Hancock: Well, it was an official-level board whose job effectively was to put into place the conclusions of Cygnus and to make sure that we were as well prepared as possible.
Lead Inquiry: When you became Secretary of State, presumably you were informed of the outcome of Exercise Cygnus and of the fact that the then Prime Minister, Theresa May, had ordered the setting up of the Pandemic Flu Readiness Board –
Mr Matt Hancock: Yes.
Lead Inquiry: – to put those recommendations into place?
Mr Matt Hancock: Yes. I found that reassuring. I’d been reassured that essentially everything was in hand because there was a structure, a resourced structure to make it happen.
Lead Inquiry: As it happens, Mr Hancock, many of the workstreams which the Pandemic Flu Readiness Board planned to carry out were, for reasons we’ve discussed, paused or ceased altogether. So when you were Secretary of State, to what extent were you informed that the recommendations from Exercise Cygnus, about which you had been told, were not in fact being implemented?
Mr Matt Hancock: I don’t know the answer to that question. I take full responsibility for the fact that, in the face of Brexit and the threats that a disorganised Brexit could do, we took – the resources were moved across the department to focus on that threat, including away from pandemic preparedness planning. This was proposed to me by the permanent secretary and the CMO, and I signed it off. I regarded the Secretary of State’s job not to run the department in terms of resource allocation, but to set the direction, but I take – but I signed off that decision. The thing that – the thing is that you face a lot of risks and threats.
Lead Inquiry: But, Mr Hancock, why didn’t you say to your civil servants – this was a major exercise into the United Kingdom’s pandemic influenza preparedness, it was one of the largest command post exercises ever held, it made a number of important recommendations, 22 in fact in all –
Mr Matt Hancock: Yeah.
Lead Inquiry: – across the whole board of the United Kingdom’s plans and capabilities. And by June 2020 – after the pandemic had struck, of course – the DHSC acknowledged that of the 22 recommendations, eight had been fully addressed, six had been partially addressed, and work to address eight more was still ongoing.
How could that have been missed? How could those recommendations not have been put into place between July 2018, when you took that post, and 2020, when the chickens came home to roost?
Mr Matt Hancock: Well, the answer to that question – there’s two ways of answering that question. The first is that as a secretary of state you have a limited set of resources, and you have to make sure that those resources are targeted at the threats that you face, and one of those risks was a disorganised Brexit and it was incumbent on the department to make sure that we were as well prepared for that as possible.
The second way of answering the same question is that it isn’t really about the numbers of recommendations from Cygnus, it’s about what those recommendations were, and the problem with Cygnus is it did not spot the central problem in pandemic planning. So I’m – having looked through those recommendations that were not put in place, I’m not sure they would have helped much when the chickens, as you say, came home to roost. Because Cygnus did not recommend that we should be prepared to stop the spread of a pandemic. It made all sorts of recommendations for how to deal with the worst-case scenario happening.
Therefore, I am not at all convinced that we would have been much better placed to face this pandemic had all of those recommendations been put into place, because – because there was a much bigger error.
Lead Inquiry: All right. But those exercises take place for good reason, do they not?
Mr Matt Hancock: Yes, but they still – but it still didn’t spot the main problem.
Lead Inquiry: Are they important matters, Mr Hancock?
Mr Matt Hancock: Of course.
Lead Inquiry: And were recommendations made, a number of them, as a result of that exercise?
Mr Matt Hancock: Yes.
Lead Inquiry: And did your department fail to implement all those recommendations?
Mr Matt Hancock: I’m not denying any of that. I’m explaining, firstly, the different pressures that you have on resources, and Brexit was real and a pressure, and I’m also explaining the consequences of those decisions, and I’m – I’m trying to articulate that there was a much bigger problem that we must – and the central lesson that I think we need to learn.
Lead Inquiry: Well, we’ll come to that in a moment.
The report into Exercise Cygnus was not published, was it, in July 2017, when it reported?
Mr Matt Hancock: No.
Lead Inquiry: Could we have, please, INQ000057514, and page 2.
Mr Matt Hancock: Yeah.
Lead Inquiry: You were asked in May of 2020 – of course after the pandemic had struck – whether or not you agreed that the report into Exercise Cygnus from July 2017 should be published.
Mr Matt Hancock: Yes.
Lead Inquiry: We can see, the top left-hand corner of the page, number 2, “SoS”, Secretary of State?
Mr Matt Hancock: Yes.
Lead Inquiry: If you could scroll back out, please, the issue is – the issue identified in the submission was that “a number of public, parliamentary and legal requests for release of the report of Exercise Cygnus” had been received. It was “a pandemic influenza preparedness exercise carried out in 2016”.
“To date, we have declined to release this report based on a balanced assessment of the public interest.”
You were invited in fact to agree that the time had come for the publication of that report?
Mr Matt Hancock: Yes.
Lead Inquiry: Do you know why, in general terms, the report – or why the decision was taken in July 2017 not to publish the report, and why this only came to you for a decision in May 2020?
Mr Matt Hancock: I’ve no idea about the 2017 decision. I know why it came to me for a decision in 2020, and that’s because people were understandably asking to see it, and I supported publication.
Lead Inquiry: Could we have a look, please, at page 4, paragraphs 8 and 10. Thank you.
Paragraph 8:
“Some projects had to be re-scheduled in 2018 and 2019 due to competing priorities in civil contingencies.”
Is that a partly concealed reference to the fact that workstreams had to be stopped to deal with the necessary preparations for a no-deal EU exit?
Mr Matt Hancock: Yes. There will also have been – there were other civil contingencies. For instance, there was a crisis of human body parts being left in hospital car parks that the civil contingencies team had to deal with. There were various other civil contingencies in that period. So it is not purely a euphemism for Brexit, it is an accurate description of the pressures on the civil contingent – on the team.
Lead Inquiry: Mr Hancock, this is a document which is solely concerned with the publication of the report in Exercise Cygnus, which was itself only concerned with emergency preparedness for pandemic influenza?
Mr Matt Hancock: Yes.
Lead Inquiry: The reference to “some projects” in paragraph 8 –
Mr Matt Hancock: Yes.
Lead Inquiry: – is only a reference, isn’t it, to the projects which came from Exercise Cygnus?
Mr Matt Hancock: That’s correct, yes.
Lead Inquiry: The only reason that those projects were rescheduled by virtue of decisions of the Pandemic Influenza Preparedness Programme board, the Pandemic Flu Readiness Board and your own department, was because of the diversion of resources to deal with a no-deal EU exit?
Mr Matt Hancock: I’m explaining that the competing priorities in civil contingencies of course included that, but there are also other competing priorities.
The context I’m trying to set, explain, for all of this is that in health you have a certain amount of resources and you have a very broad set of risks, and whilst it’s vital that this Inquiry uses hindsight to learn the lessons, we didn’t have that at the time, and we didn’t know that a pandemic was about to strike.
Lead Inquiry: Could we have, please, the bottom of page 5:
“Communications and public confidence. While this would not be a consideration for [freedom of information] purposes [this is in the context, of course, of deciding whether the report should be published] it is if you are considering going beyond your legal duties. Advice on communications is below:
“- Mitigation …”
That is to say, mitigation of damage done in the public sphere by virtue of the communications.
“You should note that while work is ongoing, there are no major gaps in our implementation of the lessons from Cygnus.”
That wasn’t quite right, was it?
Mr Matt Hancock: I think that the officials writing this document have used the word “major” to explain that the central recommendations from Cygnus were implemented. For instance, Cygnus recommended that we have a draft legal Bill ready to go, and that proved to be incredibly important in the early response to the pandemic. And I made the point earlier that the Inquiry would be wrong to conclude that because not every lesson from Cygnus had been implemented – that had every lesson been implemented, the response would have been that much better, because Cygnus was flawed in its central assumption about how best to respond to a pandemic.
Lead Inquiry: So you’ve referred, Mr Hancock, then to one particular workstream, which was the drawing up of a draft pandemic Bill –
Mr Matt Hancock: Yes.
Lead Inquiry: – to justify your answer that “there [were] no major gaps in our implementation of the lessons from Cygnus”. What other workstreams were completed, as far as you’re aware, in addition to the drafting of a Bill?
Mr Matt Hancock: Were completed? Well, I don’t have that paperwork to hand, but I’d be very happy to supply it.
Lead Inquiry: Page 7, please, paragraph 15:
“On 7 May, the Guardian newspaper published the full report on its website with personal information redacted. This was alongside an article highlighting there was no evidence recommendations from the report around social care preparedness had been acted on.”
That was right, wasn’t it?
Mr Matt Hancock: Yes.
Lead Inquiry: One of the areas, the important workstreams which had not been concluded or even in part developed was to do with the capacity of the adult social care sector to be able to deal with –
Mr Matt Hancock: That’s not quite right.
Lead Inquiry: – the demands of a pandemic?
Mr Matt Hancock: As part of the work ongoing when I was Secretary of State, preparedness in social care was one of those workstreams, yes.
Lead Inquiry: Work was done, wasn’t it, in order to try to see whether or not the department could make itself better informed as to the sheer number of people in the adult –
Mr Matt Hancock: Yes.
Lead Inquiry: – social care sector? Work was done on producing some policy papers that would be of use to local authorities, who of course are primarily responsible for the adult social care sector, but no work was done, was it, in relation to preparing the individual care homes for the necessary surge in numbers attendant upon a pandemic?
Mr Matt Hancock: Work was done in the first two areas you mention. This report, the article, was inaccurate. However, the responsibility for ensuring preparedness in social care formally fell to local authorities, and there was work required of local authorities to put in place pandemic preparedness plans. When the pandemic struck, and I was told that local authorities were required to have pandemic preparedness plans, I asked to see them, and my minister for social care, Helen Whately, found that there were only two, which she saw, and reported, to me, them to be wholly inadequate.
One of the central challenges in social care is that whilst I had the title Secretary of State for Health and Social Care, the primary responsibility, legal responsibility, contractual responsibility for social care falls to local councils. In a national crisis, this is a very significant problem, because, as I put it in my witness statement, we – I had the title, I was accountable, but I didn’t have the levers to act. And we didn’t even have the data, and this is the work that was ongoing before the pandemic, which is why this statement here from The Guardian, reported from The Guardian is inaccurate, there was work ongoing to try to find out even the basics of the provision of social care.
For instance, how many care homes are operating right now in the UK? That was a fact that we did not know at that time. And I’m glad to say now there’s far better data, but that was one of the workstreams.
And, you know, it’s – it was very important, and that work continued.
Lead Inquiry: Some work was done by the department to make itself better informed, in particular in relation to the numbers of persons in care homes and the working arrangements in the adult social care sector, but the vital work directly concerned with the preparation of those care homes, which was part of the workstream meant to be done by the Pandemic Flu Readiness Board, was not done, was it?
Mr Matt Hancock: That’s not –
Lead Inquiry: Those two plans were all that there was on the local authority side, and the surge planning in relation to the adult social care sector fell far behind that done for the NHS, did it not?
Mr Matt Hancock: That work nevertheless was done, and being done, and it is a – in fact, this discussion is an example of the challenge of why it’s so hard for policy in social care when the accountability falls, understandably, to the Secretary of State, but in this case pandemic preparedness was a legal responsibility at the local level, and whilst we at the health department could require that, the money for social care from central government goes through a different department, and so the requirement to produce those plans fell to the local authorities and they were in very large part not concluded before the pandemic struck. And that is – that is a major problem with how social care’s run in this country.
Lead Inquiry: The obligation to get ready did not rest solely on the local authority, did it?
Mr Matt Hancock: The obligation for the policy rested with me. The obligation for delivery in social care rests with local authorities. They’re the ones who contract individual care homes.
Lead Inquiry: The Department of Health and Social Care understood that an important line of work, a workstream, to be carried out by the Pandemic Flu Readiness Board and the Pandemic Influenza Preparedness Programme board, was ensuring that the adult social care sector was ready in terms of plans, what would they do in the event of a pandemic, and surge capacity, how would they physically cope –
Mr Matt Hancock: Yeah.
Lead Inquiry: – with the impact of a catastrophic pandemic?
Mr Matt Hancock: Yeah –
Lead Inquiry: Those were the obligations on the Department of Health and Social Care and they were not completed, were they?
Mr Matt Hancock: They were to be delivered through local authorities, which proved extremely difficult, and that is a structural problem with how social care has been organised in this country since 1948.
Lead Inquiry: That may be so, Mr Hancock, but it was a responsibility that the Department of Health and Social Care was aware of, otherwise it wouldn’t have directed that these workstreams be drawn up at all?
Mr Matt Hancock: Absolutely.
Lead Inquiry: Right.
Mr Matt Hancock: Absolutely.
Lead Inquiry: The NSC(THRC), the National Security Council Ministerial sub-committee on Threats, Hazards, Resilience and Contingencies was the committee to which you referred earlier, the committee chaired by the then Prime Minister, who had ordered the setting up of the Pandemic Flu Readiness Board?
Mr Matt Hancock: Yes.
Lead Inquiry: The terms of reference for that board required the Secretary of State for Health to report progress to the National Security Council THRC committee on the work of the Pandemic Flu Readiness Board.
Could we have, please, INQ000022743.
Lady Hallett: I think if we’re going to a slightly different topic, Mr Keith –
Mr Keith: Yes, my Lady.
Lady Hallett: – I think, probably, if that’s convenient for you?
Mr Keith: Yes, indeed.
Lady Hallett: We take regular breaks because we have a brave stenographer who copes with us all, but …
Very well, I shall return at 25 past – half past.
(11.12 am)
(A short break)
(11.30 am)
Lady Hallett: Mr Keith.
Mr Keith: Mr Hancock, I was about to put to you the terms of reference for the Pandemic Flu Readiness Board.
They are at INQ000022743, page 1, please.
The first paragraph on page 1 provides the background to the setting up of the board, and refers back to that meeting about which you gave evidence earlier, the NSC(THRC) meeting in February 2017.
The board and the discussion reaffirmed the government’s commitment to ensuring the UK was prepared to manage the health effects of severe pandemic influenza as defined by the reasonable worst-case scenario, and the wider consequences.
“Since the demise of the Pandemic Flu Implementation Group, there has been no dedicated group with responsibility for preparations for the cross-government impacts of pandemic influenza.”
Mr Hancock, the Pandemic Flu Readiness Board was co-chaired, of course, by your then department, DHSC, and the Cabinet Office. But it was the only board which provided “oversight for a programme which will deliver the plans and capabilities to manage the wider consequences of pandemic influenza”.
Then on page 2, please, paragraphs 5 and 6, “Roles and Responsibilities of Members”:
“5. The membership of the Board is intended to reflect the breadth of the Government’s responsibility for the potential consequences of an influenza pandemic on the nation. Members of the Board will represent the interests of their department …”
Then at 6:
“The Board will report progress to NSC(THRC) [that’s the ministerial committee which set up the board] via the Secretary of State for Health and Minister for the Cabinet Office, who will receive regular progress updates in parallel.”
It is obvious that the Department of Health and the Cabinet Office regarded it as essential that the work being done by this sole cross-government body, the only body dealing with cross-government pandemic influenza preparedness, provide regular updates to the ministerial committee which set it up.
There were two NSC(THRC), that’s the overarching committee, two such committee meetings attended by officials.
How many of those overarching meetings, NSC(THRC) meetings, did you go to in order to inform them of those regular progress updates?
Mr Matt Hancock: Personally?
Lead Inquiry: Personally.
Mr Matt Hancock: None that I can remember. I attended the National Security Council from time to time when the agenda included areas that I was responsible for. I was not a standing attendee. But I don’t recall ever being asked to attend to report on this.
Lead Inquiry: Did you know of the existence of the NSC(THRC), the ministerial – overarching ministerial committee to which you were expected to report?
Mr Matt Hancock: Yes, I attended it. That’s essentially the National Security Council.
Lead Inquiry: No, the NSC(THRC), the threats, hazards, resilience and contingencies committee.
Mr Matt Hancock: Yes, that’s a subcommittee. That one is a subcommittee of the National Security Council.
Lead Inquiry: How many of those subcommittee meetings did you attend?
Mr Matt Hancock: I can’t recall.
Lead Inquiry: Did you attend any?
Mr Matt Hancock: I may well have attended none, but I can’t recall.
Lead Inquiry: Have you seen any piece of paper that suggests you did attend?
Mr Matt Hancock: No.
Lead Inquiry: Why not?
Mr Matt Hancock: I’ve no idea. Because the Department for Health was not responsible for the agenda of that, that committee or indeed the wider National Security Council. The attendance of ministers in the Department of Health was determined by whether they were invited.
Lead Inquiry: Mr Hancock, your own department’s committee, the board, which it co-chaired with the Cabinet Office, knew full well that you were expected to report to the NSC(THRC) with updates on the board’s work. Can you think of any reason why you didn’t attend those meetings, why you weren’t told about the meetings, why you weren’t informed of the expectation that you attend those meetings?
Mr Matt Hancock: The only explanation I can give is that the team faced a significant number of different threats and challenges, and they chose, during the relatively short period I was Secretary of State before the pandemic struck, to focus on other issues that they felt to be appropriate.
I mean, my experience in government, both as Secretary of State for Health and Social Care and before, was that the officials who handle and are responsible for the National Security Council and its subcommittees are exceptionally diligent, extremely hard working, and have the highest integrity, and that goes for all of the officials I worked for in the department – I worked with in the Department for Health and Social Care. All I can say is they would have known and it would have been incumbent on them to consider all threats and make decisions as to the agenda according to what’s necessary.
Lead Inquiry: May we have, please, INQ000180188. This is a document relating to the officials’ subcommittee of the NSC(THRC), in fact the NSC(THRC)(O) meeting, O for officials.
Mr Matt Hancock: Yes.
Lead Inquiry: It’s dated 19 December 2018, so after you took office in July 2018.
If we could go to page 3, paragraph 2:
“EU Exit Planning”:
“The Cabinet Office updated members on Civil Contingencies Secretariat … prioritisation work in the lead up to EU Exit. They planned to move into the operational mode of EU Exit planning in early January. CCS stressed that capacity will be maintained to continue normal preparedness activities and ensuring that Part 2 of the CCA is refined if required … In discussion members raised the following points:
“As part of the normal preparedness activities – would continuity of crisis management continue? The Cabinet Office advised that it would be maintained … but … some elements will be prioritised.
“… some departments still wished to provide feedback …”
Then there was a debate about:
“Would hostile state activity exercises … continue?”
“The Chair summarised that officials should continue to brief ministers on what level of business as usual activities/departmental responsibilities could continue following a move to the operational mode of EU Exit planning.”
So in the autumn and the winter of 2018, over a year before the pandemic struck, at this officials’ meeting of the National Security Council THRC committee, there was debate about the fact that the EU exit planning was starting to have an impact or would be likely to start to have an impact on preparedness planning, because of the prioritisation of work.
There is a clear reference there to ministers being briefed as to what levels of business as usual activities would continue, notwithstanding the necessary prioritisation of work towards a no-deal EU exit.
When were you briefed in the autumn and winter of 2018 as to what was coming?
Mr Matt Hancock: Well, I was, of course, aware that Brexit was a significant part of the national debate and that in the department we needed to be prepared for it.
And the – so that briefing was ongoing. And as we discussed earlier, there was a moment at which we had to move resources on to prepare for that, in the summer, I think, of 2019. And we did that – within the department, the plans to do that were drawn up by the team, and I signed them off.
But I return to my broader point, which is the professionalism and diligence with which the civil service team looked at all of the different challenges and threats that were faced was exemplary.
Lead Inquiry: Could we have INQ000057430, please.
This is a memo from within your department to Professor Sir Chris Whitty, the current CMO, of course, who you know very well, and I think he was a former departmental Chief Scientific Adviser –
Mr Matt Hancock: Correct.
Lead Inquiry: – in the department.
It’s dated 27 March 2019, and it concerns the reallocation of work. Paragraph 1, to Sir Chris Whitty:
“You are aware that, following re-organisation and re-prioritisation of DHSC work due to EU Exit no deal planning, pan flu preparedness and high consequence infectious disease … policy has moved to your portfolio of responsibilities on a temporary basis.”
Then at paragraph 3:
“ExCo …”
What is ExCo?
Mr Matt Hancock: That’s the executive committee of the Department for Health and Social Care chaired by the permanent secretary. That’s the committee that effectively runs the department on an executive basis.
Lead Inquiry: But subject to the supervisory role of the departmental board to which you referred earlier, perhaps?
Mr Matt Hancock: Yes, and of course working to ministerial priorities and decisions.
Lead Inquiry: “ExCo agreed that the Department would need to do less work in some areas in order to free up resource for EU Exit preparations. As a result, Emma Reed and Clara Swinson agreed a range of work related to pan flu and HCID that would be scaled back or paused before this policy area transferred across to you. Annex A summarises the work areas that are continuing and those which are on hold.”
So this paragraph makes plain that at the highest level in your department, subject only to the supervisory review of the board and yourself, not just that there was a prioritisation across government in favour of EU exit work, but that a range of work related to pan flu and HCID would be scaled back or paused.
That was a policy decision of great significance, was it not?
Mr Matt Hancock: It was a policy decision. I would query whether it had great significance.
As you can see from the numbers on this page, the numbers of people working in this area, the numbers of movement, is small, and my second observation is that this work was following a wrong – the wrong approach, and I’m not sure it would have been any use in the pandemic. That’s my judgment from having been the man in the – you know, the person in the hot seat when the pandemic struck.
Lead Inquiry: Do you recall that debate before ExCo?
Mr Matt Hancock: Yes, I recall the debate, because I discussed it with the permanent secretary, because whilst he was responsible for the running of the department, he of course would then check with me that I was content with the proposals that he’d put together, and there were many other areas of work that had to be stopped in order to prepare for Brexit as well. I mean, this wasn’t the only area, there were a whole series of them.
Lead Inquiry: So you were aware and you agreed that a range of work relating to pan flu and HCID would have to be scaled back or paused?
Mr Matt Hancock: Yes, and I wasn’t enthusiastic about it but I signed it off, and the reason that I signed off the overall reshaping of the department is because we had a very real and material threat, should a disorganised Brexit happen, that we needed to be prepared for. And it comes back to the point about context, that there are many, many bad things you have to prepare for when you’re the – in the health department.
Lead Inquiry: Moving forward eight months to the eve of the pandemic, in November 2019, INQ000023089, the minutes for the Pandemic Flu Readiness Board:
“The Pandemic Flu Readiness Board … has not met since November 2018 due to reprioritisation in 2019 to plan for a potential no-deal EU Exit.”
So the sole cross-government body set up by direction of the Prime Minister did not meet at all, did it, between November 2018 and 27 November 2019?
Mr Matt Hancock: That’s what this paper says.
Lead Inquiry: Were you aware, Mr Hancock, that for a whole year the board did not even meet?
Mr Matt Hancock: I do not recall being aware of that, no. But also – but I do know that work under the board’s guidance continued, because I was engaged in some of the work, as we’ve discussed, especially but not only on vaccine manufacturing.
Lead Inquiry: Page 5, paragraphs 7 and 8.
“… PFRB had committed to meet every 6-8 weeks until the key outputs of the work programme were delivered. It is proposed that in 2020 [it] meets every 3 months. This will ensure that progress can be communicated to key planning partners through updated documentation where appropriate.”
So it was understood, wasn’t it, that although it had committed to meet every six to eight weeks, the failure to meet for a whole year fell very far short of what it had apparently committed itself to doing?
Mr Matt Hancock: That’s what I understand too from reading these papers, yeah.
Lead Inquiry: It says:
“NHS(THRC) [it should be NSC(THRC)] – Under the PFRB’s current governance arrangements, the Board reports on progress to NSC(THRC).”
The board which you – the subcommittee which you cannot recall attending.
“Due to EU Exit pressures, NSC(THRC) were not updated at the end of Year 2, March 2019.”
So it didn’t not just not meet, it wasn’t even updated at the end of Year 2, March 2019, the second full year of its operations, was it?
Mr Matt Hancock: Evidently, from reading these papers. I wasn’t aware of these papers at the time.
Lead Inquiry: Then of course after the pandemic struck – INQ000023114 – on 15 January 2020:
“Pandemic Influenza Preparedness Programme Work Stream Updates (Last Updated: 15 January 2020)”
The healthcare workstream:
“Progress has slowed …”
For a number of reasons.
“2 – Community Care.
“Progress on the community healthcare side has slowed …”
For a number of reasons.
Then over the page, please, or further down the page, “Excess deaths”, that was one of the workstreams on which work was completed, wasn’t it?
(Pause)
Lead Inquiry: You referred earlier in your evidence to the fact that you were aware that was a workstream on which work was done?
Mr Matt Hancock: Work was done, I’m not sure that it was completed, because we had to do further work on it when the pandemic struck. That’s why I was pausing, to try to recollect and express that correctly.
Lead Inquiry: Over the page, “Sector Resilience”:
“There has been no further work on this work stream as the statements of preparedness are finalised … it was agreed that the sharing of the business checklist should be paused as a result of the need to communicate other risks, including EU Exit.”
What is sector resilience, Mr Hancock?
Mr Matt Hancock: Well, sector resilience is ensuring that there is resilience especially of supply chains.
Lead Inquiry: Where?
Mr Matt Hancock: Well, in –
Lead Inquiry: Which sectors?
Mr Matt Hancock: In this case pharmaceutical in particular, but also non-pharmaceutical goods required for the health and social care sector.
Lead Inquiry: Health and social care sectors?
Mr Matt Hancock: Within the department, that would have been the purview.
Lead Inquiry: Yes.
“Cross Cutting Enablers.
“All England clauses and supporting documentation complete including explanatory note and assessment of impacts.”
Is that a reference to the drafting of the Bill to which you made reference earlier?
Mr Matt Hancock: The … it – it appears so. That’s what – “4 Nations Bill” was used as the shorthand –
Lead Inquiry: Yes, there is a reference to clauses and supporting documentation. So that appears to –
Mr Matt Hancock: That appears so. On the previous one, on number 4, of course, the work that was intended to be prepared for a no-deal Brexit was itself important, incredibly important, when it came to the pandemic. So this paper doesn’t quite capture – capture it. It captures the planning, and later –
Lead Inquiry: Is that a reference to the fact that work was done on securing and safeguarding medicinal supply chains –
Mr Matt Hancock: Yes.
Lead Inquiry: – to deal with a no-deal EU exit?
Mr Matt Hancock: Yes.
Lead Inquiry: But that issue of supply chains, Mr Hancock, was just one, wasn’t it, of a very much larger number of areas in which work was required across the health sector and the adult social care sector? Not unimportant, but it was just one of the areas, wasn’t it, where work was required?
Mr Matt Hancock: I wouldn’t put it like that. If I may, the way I’d say it is that the work done for a no-deal Brexit on supply chains for medicines was the difference between running out of medicines in the peak of the pandemic and not running out. We came extremely close, within hours, of running out of medicines for intensive care during the pandemic, it wasn’t widely reported at the time, and I think the only reason that we didn’t run out is because of the work that Steve Oldfield and his team did, which they did during 2019 in preparation for a no-deal Brexit, but became extremely useful in saving lives during the pandemic.
At the point at which the pandemic struck, because of the no-deal Brexit work, we knew more about the pharmaceutical supply chain in the UK than at any time in history, and we had relationships with the pharmaceutical suppliers, and the data to know exactly who had what available and where, and the extent of that information was the difference between running out and not running out of drugs in intensive care in the pandemic.
Now, that, of course, wasn’t the intention of the work, but it was the consequence of the work. So when it comes to the question of the overall impact of Brexit, absolutely the paperwork is very clear that some of the preparation work was stopped and a small number of people were moved off that work. On the other hand, we were better prepared in terms of supply chains. Who knows the overall impact and which of those balances in the scales is greater. I’m afraid it’s impossible to know.
Lead Inquiry: Mr Hancock, whilst that may well be right, that there was valuable work done in an important area of preparation, namely medicinal supply chains, this chart, and in particular row 4, “Sector Resilience”, makes plain that across the swathe of the healthcare and adult social care sectors, important other areas of work, of which there were many more than the single issue of medicinal supply chains, were paused or interrupted. That is the point, isn’t it?
Mr Matt Hancock: That is one point. I agree.
Lead Inquiry: Thank you.
Mr Matt Hancock: And a further – but the further point is of significance: which is the most significant? And it’s impossible to know whether one was more significant than the other.
Lead Inquiry: Than the others.
Mr Matt Hancock: Whether the reduction in the number of people that – as demonstrated by the paperwork, on pandemic preparedness, whether the impact, the negative impact of that is outweighed or is not outweighed by the positive impact of the supply chain planning. As I’ve said, the number of activities is not as important as their consequence. And because Operation Cygnus, which was guiding this work, itself was flawed in conception, I’m not convinced that there would have been that much help, even if all of these things were done.
Of course it would have been better if they had, but I simply have no idea how helpful they would have been.
Lead Inquiry: Were you told, as Secretary of State, that the PFRB had not met for a year and that, as this document shows, by January of 2020 in a number of important areas work had paused?
Mr Matt Hancock: I was aware that some work had paused. I don’t recall being aware that the board hadn’t met.
Lead Inquiry: There was another board, the Pandemic Influenza Preparedness board, again to which you’ve referred earlier. Do you recall that it was in the nature of that board’s work to prepare annually a risk register setting out in the field of influenza preparedness what the greatest risks were?
Do you recall that?
Mr Matt Hancock: I don’t – I don’t recall that, but I’m not surprised.
Lead Inquiry: All right.
Mr Matt Hancock: But from one year to another, I doubt it would have changed much. You know, again, the central failing of that sort of risk register was not to learn the lessons from MERS and SARS, as has been discussed, and, as I’ve made clear in my submission, not to have the right plan to deal with a pandemic.
Lead Inquiry: Would you agree that in 2016, the risk register for that central DHSC-led board showed a risk that supplies of face masks, respirators and gloves could be below the optimum requirement in the event of a pandemic, and that the health and social care systems would be unable to cope with an extreme surge in demand for services in the event of a pandemic?
Mr Matt Hancock: I wasn’t aware of that, no.
Lead Inquiry: That in 2017, the following year, countermeasures were still a risk issue, the supply of face masks, respirators and gloves could be below the optimum requirement, and an extreme surge in the NHS and social care system was still an identified risk? That’s 2017.
Mr Matt Hancock: Yes. If I may say so, my recollection was being reassured that we had a huge stockpile of PPE. Of course it’s possible to write that it may be below the optimum, because the optimum may be an absolutely enormous quantity, which is exactly what we needed. So it’s – can be perfectly true to say it’s below the optimum and at the same time reassure that it’s huge.
Lead Inquiry: The health and social care system may be unable to cope with an extreme surge in demand. That was an identified risk in the PIPP risk register in 2017, and by 2018, 24 September, the following risks were still being identified: issues with face masks, respirators, gloves below the optimum requirement; plans for the surge that would be required in the health and social care systems were not fully tested; there was a risk in relation to the health and social care systems being unable to cope in the event of a pandemic and that risk remains.
So for two and a half years those risks, having been identified by the PIPP board, were not mitigated by virtue of being addressed. They remained, did they not?
Mr Matt Hancock: They certainly did, and we had to deal with them when they materialised.
Lead Inquiry: Indeed. But that is a board and a programme which was led by your department, so the next question, Mr Hancock, is: how can that have been allowed to happen? With the inevitable consequence, Mr Hancock, that you yourself of course had to deal with the consequences of those risks not being mitigated when you –
Mr Matt Hancock: Yes.
Lead Inquiry: – faced the pandemic in January 2020.
Mr Matt Hancock: Absolutely. The inability to get the PPE out fast enough was a very significant problem. One recommendation I have for the future is that every health and social care setting should be required to have its own stockpile of PPE, and that should be paid for by the government. Because in the early days getting it out fast enough, when there was a sudden increase in demand, just as explained there, that was incredibly difficult.
So, yes, I totally accept that.
Lead Inquiry: And a PIPP paper, a Pandemic Influenza Preparedness Programme board paper dated October 2019, on the eve of the pandemic – may we have INQ000023070, page 1, paragraph 1:
“This paper:
“- [reminded] the … Board of the pan flu programme re-prioritisation that took place at the end of 2018 …”
And:
“- sets out the progress made on those areas of work that continued and new priorities that arose …”
At paragraph 3, there is a reference to an annex. Perhaps we could have a look at that annex, please. It’s at the end. If you could go back up, please, to the start of the annex, thank you.
(Pause)
Lead Inquiry: Thank you.
Annex A:
“Pan flu programme re-prioritisation at the end of 2018.
“Work Areas.
“Pan Flu Bill.”
That’s a reference to the draft Bill to which you referred.
“Perm Sec meetings on Pan Flu – Continue.
“Perm Sec written updates on Pan Flu – Continue.
“Quarterly Finance meetings – Continue …
“Moral and Ethical Advisory Group – Membership and Recruitment – Stop.
“UK Pandemic Influenza Strategy Refresh – Stop.
“… healthcare surge (largely complete, DA [devolved administration] engagement to develop plans outstanding – Stop.
“… adult social care (largely complete for [Pandemic Flu Readiness Board], [but] CMO actions outstanding) – Stop.
“PFRB paper on [the updating of the NSC] – Stop.
“… Comms … Stop.
“… benchmark NHS readiness internationally – Stop.
“… engagement in Clinical Countermeasures Board – Stop.”
And so on.
Mr Matt Hancock: Yeah.
Lead Inquiry: Were you told of the extent and nature of the stop categories?
Mr Matt Hancock: Well, I’m absolutely accountable for it, because I’m accountable for everything that happened in the department. I would also, though, ask you to consider each of these in detail, because it comes to the point we discussed earlier on significance.
For instance, the Moral and Ethical Advisory Group existed, it had membership, when the pandemic struck. So further membership and recruitment was not a consideration that would have made a material difference to planning for the pandemic.
The influenza strategy refresh, that was a 2011 document, it would – that would only have been significant if that refresh had completely changed the strategy that the entire western world was following that was regarded as – by the WHO as best in class –
Lead Inquiry: May I pause you there? Is that the 2011 strategy –
Mr Matt Hancock: Correct.
Lead Inquiry: – which, in your witness statement, you state that, for the purposes of pandemic planning was “woefully inadequate”?
Mr Matt Hancock: Woefully inadequate. And –
Lead Inquiry: Thank you.
Mr Matt Hancock: – I don’t think a refresh would have changed that, because all of the independent external advice, the World Health Organisation advice, indeed the International Health Regulations stated that we should not have lockdowns. In fact, in a 2017 document it said:
“The evidence is not strong enough to warrant advocating legislative restrictions.”
This is where I need to add to what I’ve written in my written statement, because I thought at the time it was simply an oversight not to consider lockdowns. Actually it was an explicit decision. The London Resilience Partnership published document, May 2018, and I quote:
“It will not be possible to halt the spread of a new pandemic …”
That was the attitude, it was the doctrine, and it was wrong. So that refresh would have made very little difference.
Healthcare surge is – was largely complete. The final action there is on involvement of the DAs. Since healthcare is devolved that would have been – not been a terribly important area.
Adult social care, largely complete. I’m not exactly sure what the CMO actions outstanding are. There’s a question –
Lead Inquiry: May I –
Mr Matt Hancock: – my point is about materiality.
Lead Inquiry: May I just pause you there to ask you some more questions about adult social care –
Mr Matt Hancock: Sure. Yes.
Lead Inquiry: – since you raise it.
Mr Matt Hancock: Yes.
Lead Inquiry: In your statement you refer to the fact that one of the major problems with the department’s supervision of the adult social care sector was the lack of policy levers –
Mr Matt Hancock: Yes.
Lead Inquiry: – which would enable the department to ensure pandemic preparedness –
Mr Matt Hancock: Absolutely.
Lead Inquiry: – in social care?
Mr Matt Hancock: Yes.
Lead Inquiry: And as you said earlier –
Mr Matt Hancock: But that’s not what this is referring to.
Lead Inquiry: Well, I want to ask you whether or not you can say that the adult social care sector was well prepared for a pandemic when the department had no means of finding out whether or not they had the right plans in place, whether local authorities had planned sufficiently, let alone how many numbers were in the care sector?
Mr Matt Hancock: No, it was terrible, and –
Lead Inquiry: The department had no visibility of whether or not the health – adult social care sector was prepared at all –
Mr Matt Hancock: That –
Lead Inquiry: It wasn’t within your ability?
Mr Matt Hancock: That’s not my contention. My contention is this action here would not have solved that. The CMO could not have solved the problems in terms of the oversight of the adult social care sector. It was –
Lead Inquiry: Mr Hancock –
Mr Matt Hancock: – much bigger than that.
Lead Inquiry: – what was the name of your department?
Mr Matt Hancock: I’ve already talked about this. It’s the Department of Health and Social Care, and yet the legal responsibilities are with local authorities. And we had a programme, a separate programme of work under way – that did not stop because of Brexit planning, that was accelerated by the new Prime Minister in summer 2019 – of reform of adult social care. We had ongoing work to get better data that was continued in this process.
Adult social care desperately needs reform. It needs more support, it needs more resilience. And I feel that very strongly, as does the current Chancellor of the Exchequer, who has been clear about that not only when he was in my job but in his current job.
My point and my contention is that whatever the CMO actions outstanding were here, they would not have solved the huge challenges of adult social care in this country, which requires significant improvement and work.
Lead Inquiry: By January 2020, did the department have in place, the department of social care have in place, a single coherent plan to identify vulnerable service users across the country, that is to say how many people are in the care sector?
Mr Matt Hancock: No.
Lead Inquiry: Did it have a central plan for the sharing of data between private and public care providers and emergency responders in order to be able to better prepare them all for a pandemic?
Mr Matt Hancock: Something along those lines was being developed, but it was definitely not in place.
Lead Inquiry: Was there a single national guidance for pandemic preparedness in the adult social care sector?
Mr Matt Hancock: The guidance for pandemic preparedness went through local authorities and so there was not a single one, no.
Lead Inquiry: Did all the LRFs, the local resilience forums, have plans in place on the local authority level for dealing with the impact of a catastrophic pandemic on the elderly?
Mr Matt Hancock: No, they were required to and, as far as I’m aware, only two had done the work.
Lead Inquiry: Was the Department of Health and Social Care able to verify the extent of the pandemic preparedness planning that was being done by local authorities?
Mr Matt Hancock: No, we didn’t have the policy levers to do so, despite having the name “Social Care” in the title.
Lead Inquiry: Did the Department of Social Care put into place a national standard by which the plans from the local authority could be gauged?
Mr Matt Hancock: No.
Lead Inquiry: In relation to those local resilience forums, did the department prepare, in fact, a pandemic flu standard at the latter end of 2019, which for the very first time obliged local resilience forums to compare their plans against a national standard for influenza pandemic planning?
Mr Matt Hancock: Well, yes is the answer.
Lead Inquiry: It is.
Mr Matt Hancock: And the – and I suppose what that demonstrates – because that came into place late in 2019 –
Lead Inquiry: Yes, indeed –
Mr Matt Hancock: – is my central contention in this area, which is that the system for how we run adult social care is flawed. There was work ongoing to try to resolve it, including work directly related to pandemic planning, but it was in nowhere near good enough shape, and it meant that, as the person trying to solve this problem, with a disease that self-evidently impacted on older people most, we were in an incredibly difficult position to do so when the pandemic struck. Despite the enormous hard work of everybody in that sector, and in the department, in relation to adult social care, it was very, very difficult early on. That’s in part because this planning was ongoing, but the systems in this country for managing adult social care are not good enough, and that reform – that reform work was under way, but it still hasn’t been completed.
Lead Inquiry: So drawing some of these threads together, please, Mr Hancock, would you accept the following propositions: firstly, there was a long-standing bias within the Department of Health and Social Care, as the risk owner of the pandemic influenza risk and as the author of that strategy which you described as woefully inadequate, in favour of influenza, a failure to place sufficient regard to the risk, admittedly a lesser risk, of another, different, catastrophic HCID?
Mr Matt Hancock: It would have been better, yes, if the plans had been for a generic respiratory disease, because what matters is the characteristic of the novel virus.
Lead Inquiry: Indeed.
Proposition 2: there was a failure to think through properly the risks of a non-influenza pandemic. Due to the inherent unpredictability of viral respiratory pathogens, and their characteristics – as you say, transmission rate, high or stuttering; incubation period, long or short; viral loads, great or less; whether viruses congregate in the upper or lower respiratory tract – whatever they may have been, because those other characteristics were simply not thought about enough, the real risk of an HCID with catastrophic consequences was not adequately thought about either?
Mr Matt Hancock: I wouldn’t put it like that, and I think there’s an irony here. The irony is that one of the major problems we had early on, which I’m sure we’ll come to in M2, was the fact that Covid-19 has asymptomatic transmission. It’s the first known coronavirus that affects humans that can be transmitted asymptomatically, and the WHO assumption was that this wasn’t possible until April 2020. There is a really important reason I’m saying this. A flu plan assumes asymptomatic transmission.
Lead Inquiry: Indeed.
Mr Matt Hancock: There are some ways in which the flu plan was, in fact, more appropriate as a planning document than a generic document or, indeed, a document that had been written to consider the impact of one of the then known coronaviruses, because that plan, a coronavirus pandemic plan, would have assumed no asymptomatic transmission.
So this underpins my point that of course it would have been better to plan for a generic, you know, respiratory Disease X, and that is what we should do in future, however, planning for the flu – planning for flu did have some benefits, and it brings me back to my central contention that, whilst this was an error, it was in no way the biggest error. And it’s not just that there were two errors in the core plan, you know, flu rather than coronavirus and wrong doctrine; the error of the flawed doctrine was significantly bigger than the error of targeting a flu rather than a coronavirus pandemic.
Lead Inquiry: All right. Well, I don’t need to trouble you about degrees of failure. We’ll come on to identifying the various propositions.
Mr Matt Hancock: Yeah.
Lead Inquiry: The third issue is one you’ve just touched upon, which is that that approach in the risk assessment was cause agnostic, it simply failed to identify a sufficiently broad range of scenarios. And as you know, the risk assessment process has been rewritten, thanks in the main to a report from the Royal Academy of Engineering –
Mr Matt Hancock: Yes.
Lead Inquiry: – to make that plain.
Mr Matt Hancock: Yes, and there is an irony there as well, which is that we were dealing with a live Ebola epidemic, with the potential threat that would come to this country as a pandemic, and yet at the same time the paperwork was all focused on a flu pandemic.
Lead Inquiry: Yes.
Mr Matt Hancock: So the theory written down in these strategies was actually not what was playing out in the day-to-day practice of infectious disease management that we were undertaking as a department and that PHE was undertaking.
Lead Inquiry: But, Mr Hancock, it’s not just a question of irony, is it? These failing materially hampered the United Kingdom’s ability to prevent death?
Mr Matt Hancock: The central failing that hampered the UK’s response, common with the rest of the western world, was the refusal and the explicit – the explicit decision that it would not be possible to halt the spread of a new pandemic. That is wrong, and that is at the centre of the failure of preparation. I know that, because I was the person responsible, as the Category 1 responder, when this pandemic struck.
All of the other considerations are small – important but small – compared to the colossal scale of failure in the assumption that it will not be possible, and the lack of ambition in the assumption that you can’t stop the spread of a disease. We can.
You know, imagine if this disease had tragically killed children as much as it did old people, and maybe it transmitted twice as easily as Covid; would it then be possible to halt the spread? Of course it would. We would do whatever it took.
And that’s where we got to. But we got there far, far too slowly, because none of the preparation included any thinking around that.
Lead Inquiry: That is my fourth proposition, it’s the one that finds a place at the front of your witness statement, it is that there was a failure, a complete systemic failure to think about how to prevent catastrophic consequences arising at all, as opposed to how to manage catastrophic consequences which were assumed to result?
Mr Matt Hancock: I couldn’t agree more, and it’s an absolute tragedy.
Lead Inquiry: Number 5: there was an associated failure to think about countermeasures. Because, of course, flu has a shorter incubation period, it is symptomatic, there are antivirals, there are vaccines available. There was, therefore, a failure to think about, in the way that other countries, particularly in the Far East, had done, countermeasures such as mandatory quarantines?
Mr Matt Hancock: Yes.
Lead Inquiry: Shielding?
Mr Matt Hancock: Yeah.
Lead Inquiry: Social restrictions?
Mr Matt Hancock: Yes.
Lead Inquiry: Border control?
Mr Matt Hancock: Yes.
Lead Inquiry: There was, as you say, a complete lack of imagination?
Mr Matt Hancock: Yes. I had to overrule the initial advice not to quarantine people being brought back from Wuhan. I mean, that is – it is madness. And it was written into the International Health Regulations that you shouldn’t close borders.
This was not a UK problem, it was a World Health Organisation problem, and the World Health Organisation, of all people, should have learned the lessons from MERS and SARS.
So we had diligent, hard working teams working on this pandemic preparedness, but there was an absolutely central doctrinal failure in the response of the UK and almost every other western country.
Lead Inquiry: Number six, coming to the government particularly, through the Cabinet Office and the DHSC: there was a failure to implement, in a general sense, the recommendations from the various earlier exercises, because the majority of them were simply not implemented, for good or ill, by the time the pandemic struck, and actions and workstreams which were identified as being necessary in the field of pandemic preparedness were not carried through to fruition?
Mr Matt Hancock: Well, while that is true, my evidence to you is on materiality of what really mattered when the pandemic struck. And as we saw when we went through that list on the screen, those workstreams that were stopped, I couldn’t identify any of them that would have made a material impact had another year’s work been done on them. We just – we went – we got halfway through them.
What I put that down to is the team prioritising within the resources that were available to do the things that really mattered, and the thing that was most useful to me when the pandemic struck was making sure we had a piece of legislation ready to get on to the statute book.
Now, we, you know, there is a lesson there as well, which is we need a new piece of legislation both for civil contingencies and we need an update to the 1984 Public Health Act, and I’m very happy to give further evidence on what’s needed there, but my point is that I think the team were working very hard to try to do the things that were the most material in terms of preparation.
What everybody missed, in the western world, was that lockdowns were going to be necessary, and that’s why I’m stressing this point so much, because it is the most – single most important thing we can learn as a country.
Lead Inquiry: Mr Hancock, you’ve just said, “I couldn’t identify any of [those workstreams] that would have made a material impact”. Was not one of the workstreams the need to identify data, numbers, the planning for the number of people in the adult social care sector who would be affected by a pandemic, and the planning for the required surge capacity which would be required in the event of a pandemic?
Mr Matt Hancock: My –
Lead Inquiry: Are you saying those didn’t matter –
Mr Matt Hancock: My recollection is that data work continued as part of the adult social care reform plans.
Lead Inquiry: Did that work get completed by the time of the pandemic?
Mr Matt Hancock: It didn’t get completed but the work continued.
Lead Inquiry: Was a fully developed plan for surge capacity in the adult social care sector put into place by 1 January 2020?
Mr Matt Hancock: A fully developed plan, no. Your question originally, to which I responded, was what – the work being done. But it hadn’t been completed, no. There’s a difference between doing work and completing work.
Lead Inquiry: There is a difference between planning something and not even completing the plan so that the work can’t be done. Was the planning complete to allow the surge capacity to be developed?
Mr Matt Hancock: I’m very happy to look further into the paperwork and write to you on that point. My point – but my point was a – was a more strategic one, about what really matters in terms of protecting lives in the future, and that’s why I’m at so much pains to stress it.
Lead Inquiry: There were significant areas of preparation overlooked or not progressed; would you agree?
Mr Matt Hancock: Absolutely.
Lead Inquiry: Were the nation’s preparations for a pandemic of this nature good enough?
Mr Matt Hancock: No.
Lead Inquiry: Was there a serious and significant inadequacy of preparation for a pandemic health emergency?
Mr Matt Hancock: Yes.
Lead Inquiry: Preparing for this Tier 1 risk of a catastrophic health emergency was at the core of your own department’s functions; would you agree?
Mr Matt Hancock: Yes.
Lead Inquiry: Therefore, as Secretary of State, you bore and you bear ministerial responsibility for that calamitous state of affairs, do you not?
Mr Matt Hancock: I bear responsibility for all the things that happened, not only in my department, but also the agencies that reported to me as Secretary of State.
Lead Inquiry: You will no doubt have given a great deal of thought, and it’s evident from your evidence today, Mr Hancock, as to how to make things better.
Mr Matt Hancock: Yes.
Lead Inquiry: You’ve mentioned many of them today in the course of evidence. Are you aware of some of the matters that Sir Oliver Letwin –
Mr Matt Hancock: Yes.
Lead Inquiry: – spoke about when he gave evidence? Do you agree that there is now a need for a formal system of training for ministers and senior civil servants in civil contingencies?
Mr Matt Hancock: Yes, there’s an irony here, another one, which is that I was in the process of putting one in place with the Blavatnik School of Government when the pandemic struck, and we stopped that work because the pandemic became overwhelming.
Lead Inquiry: Is there a case for a Cabinet minister to be appointed to be in sole charge of EPRR?
Mr Matt Hancock: Yes, across government, and then the responsibilities of lead government departments would need to report in to that minister, who would then act on behalf of the Prime Minister. That’s effectively the job that Oliver Letwin did when he was in office.
Lead Inquiry: Therefore there needs to be a head of resilience at the apex of an official structure, a civil servant, who will then report to that Cabinet minister?
Mr Matt Hancock: Yes, there is one subtlety that’s incredibly important here, which is that it would be a mistake if such a structure took away the sense and the feeling of accountability for an individual department. What you wouldn’t want is the department thinking: oh, well, the Cabinet Office has got that covered. You need the department to still feel that it is accountable and held to account by the Cabinet Office, rather than replaced by the Cabinet Office, which would be suboptimal.
Lady Hallett: Sorry, I’m not following. What are you suggesting would be different from the present system, Mr Hancock?
Mr Matt Hancock: That you would have, as we had when Oliver Letwin was in post, a minister responsible for resilience across the board and for challenging the different resilience plans that came up, and obviously that would require an official structure underneath her or him, and – but the key point is that needs to be like a RED team effort, as has been discussed, rather than letting the departments off the hook for the areas for which they’re responsible.
Lady Hallett: Would you have that minister solely responsible for resilience? I’ve heard that Cabinet Office ministers get quite a large portfolio on occasions.
Mr Matt Hancock: Yes. I think I – whether or not they attended Cabinet, what mattered actually is in practice whether they had the ear of the Prime Minister. You could easily make it the person who was in my old Cabinet Office job, as number two, so long as they had a direct line to the Prime Minister when it mattered.
Mr Keith: Is there now a case for an independent perhaps statutory resilience academy or some such body to warn, advise, guide, in relation to EPRR, train, organise exercises and make sure that recommendations and actions are properly implemented –
Mr Matt Hancock: Yes, I think there’s value to that. Again, you wouldn’t want to take away from the individual responsibility of the area it concerned.
Let me give you an example. We know, once again, have a body whose sole responsibility is preparing Britain to be resilient to health, external health threats, UKHSA, and Dame Jenny Harries is an excellent chief executive of UKHSA. You wouldn’t such a body to replace UKHSA or make UKHSA feel less accountable. I want Jenny Harries and whoever is in her job to wake up every morning worrying about the next pandemic and what needs to be put in place.
You can of course supplement that with better resilience training at the centre as well, but you can’t – you mustn’t take away from the real burning accountability of the person in that job.
And also one of the recommendations was that they would – these people would make recommendations in terms of allocation of budget, because it isn’t – there’s obviously been a discussion of the impact of budgets in the last couple of weeks – it isn’t just about the total quantum of budget, it’s about how it’s spent. In this country this year we’ve spent £53 billion on physical military defence. UKHSA’s core budget is £450 million, that’s less than 1%, and yet over 220,000 people died of Covid – have died of Covid so far.
The impact on the health of the nation and the well-being of the nation of health protection is an order of magnitude bigger than as currently represented in the UKHSA budget, and the idea that we spend over 50 billion on defence and under 500 million on UKHSA is, for me, completely indefensible.
Lead Inquiry: All right. I was asking you in fact about a general resilience academy to deal with civil contingencies.
Mr Matt Hancock: Yeah.
Lead Inquiry: You responded by reference to the United Kingdom Health Security Agency.
Mr Matt Hancock: Yeah.
Lead Inquiry: That is, of course, involved with health emergencies –
Mr Matt Hancock: Exactly.
Lead Inquiry: As were you.
Mr Matt Hancock: So it’s worth having it across the board as well.
Lead Inquiry: Yes. I intended to ask you, and I perhaps didn’t make it sufficiently plain, whether there is a case for a resilience academy to deal with civil contingencies, for example a collapse in critical national infrastructure or a cyber attack or some other mass event –
Mr Matt Hancock: Yes.
Lead Inquiry: – or catastrophe which could befall our nation; it’s now beyond time, is it not?
Mr Matt Hancock: It is beyond time. My – sorry, the reason I got into budgets is that it’s only a central body that can also make recommendations in terms of allocation between different departments. As a departmental head you can’t do that.
Lead Inquiry: Yes. Is there, therefore, also, a case for a fundamental rethink on this whole CCA 2004 structure and the lead government department model? I don’t want to intrude into Module 2 issues –
Mr Matt Hancock: Sure.
Lead Inquiry: – but obviously, when dealing with a national crisis –
Mr Matt Hancock: Yes.
Lead Inquiry: – it’s beyond the ability of a single department to be able to cope, because, of course, all national crises, by definition, will have an impact, a range of impacts, across government?
Mr Matt Hancock: Yes. I think that you need – I actually support the lead government department structure because you need somebody who feels accountable for looking out for that threat all of the time, but you then need a system in the centre that is stronger at holding that accountability – holding feet to the fire, and the – but the co-ordination element of it in – when you get to a massive crisis, goes up to – the chain to the Prime Minister anyway, and so that is a role of the Civil Contingencies Secretariat which, when you have a huge crisis like Covid, then was replaced with a Covid-specific central secretariat –
Lead Inquiry: But some of these issues, Mr Hancock, didn’t go to you, even though you were the Secretary of State in your own lead government department.
Mr Matt Hancock: Yes, but –
Lead Inquiry: So – so, with respect, is there not now a need for a much stronger co-ordinating body – not perhaps just part of the Cabinet Office, but a stronger body – which can ensure that in the run-up to a crisis, in terms of the preparation, the preparedness, the planning, things that need to be elevated to the highest levels are?
Mr Matt Hancock: Yes. The way that I put it is that the goal of it should be to hold the lead department’s feet to the fire. For instance, if you had one of these bodies in the centre, if they tried to do the job of the Health Secretary as the Category 1 responder, then who guards the guardian?
Far better would be that they are in a position to haul in the Health Secretary and say, “Are you doing your – doing that enough?” Because I wasn’t called to the National Security Council, for instance, in order to answer those questions in my 18 months as Health Secretary before the pandemic struck.
Lead Inquiry: Finally I want to ask you some questions, please, about some other aspects of the system which you found to be deficient when you were faced with the terrible crisis in January of 2020.
Mr Matt Hancock: Yeah.
Lead Inquiry: You’ve touched on many of them already but I just want to summarise the position in order to be able to focus minds for when we get to the next module and thereafter –
Mr Matt Hancock: Yes.
Lead Inquiry: – the areas that require particular and detailed consideration.
Mr Matt Hancock: Yeah.
Lead Inquiry: There was obviously this issue, therefore, of there being a stockpile of PPE but, as it happened, given the sheer number of casualties, those who were sick and ill, and of course those who died, the stockpile was depleted –
Mr Matt Hancock: Yes.
Lead Inquiry: – and it was necessary for the government to try to secure further supplies through just-in-case contracts and deal with the mayhem of the international markets.
Mr Matt Hancock: Yes.
Lead Inquiry: Is there, therefore, an issue which requires further consideration in relation to how we make sure that next time such stocks as there are, such stockpiles as there are for the particular pandemic which may eventuate, are sufficient or at least that there is an ability to improve the numbers, to increase the numbers –
Mr Matt Hancock: Yes.
Lead Inquiry: – in a way that doesn’t leave the Secretary of State, as you were, having to make up the deficit?
Mr Matt Hancock: So we started buying PPE in January 2020, long before it was certain this would become a global pandemic, but the problems with the stockpile were very significant, and I’m sure that we’ll come to this in future modules. What is vital for preparation is that there are stockpiles that are accessible, pickable, in the technical language, that can be distributed quickly and can be distributed to all health and social care settings. And, as I say, I think there should be a legal requirement on health and social care settings to hold a significant amount of PPE to be able to get through the early weeks of a future pandemic, because the sheer logistical complexity of setting up these supply chains in short order is exceptionally difficult, as we learned.
Lead Inquiry: All right. I don’t want to ask you to address the solutions or, in fact, to identify the specific problems that arose, only to acknowledge that there were very real difficulties in these areas.
Mr Matt Hancock: I see. Yes, of course.
Lead Inquiry: The availability of mass diagnostic testing –
Mr Matt Hancock: Yes.
Lead Inquiry: – you’ve already referred to.
Mr Matt Hancock: Terrible.
Lead Inquiry: The availability of mass contact tracing systems.
Mr Matt Hancock: Yes, there was no such thing.
Lead Inquiry: Obviously there are the NHS-related issues concerning resilience, bed capacity, workforce planning, all of which are issues which you’ve referred to –
Mr Matt Hancock: Yes, there’s a bigger thing there as well within the NHS, which is that, you know, whilst the discussion on how much resources the NHS should get is a highly political one, and we’ve seen it play out over the last couple of weeks in this Inquiry, there is actually a really big question that the nation needs to ask itself, which is that – you wouldn’t ever send the whole of your army out into battle at once. You have spare capacity in case there’s a crisis. You have what they call redundancy in the military sense. Yet every single day we send our whole army of the NHS out into the field and there is no redundancy. We run the NHS incredibly tight. It’s an incredibly efficient organisation in the grand scheme of things. Despite obvious areas that can be improved, it is overall run very tight, and that means that there simply isn’t the resilience when a crisis comes. But that would require a materially huge increase in the already very, very large NHS budget. But other countries choose to spend a higher proportion of GDP on healthcare and have that redundancy, and it means that they are better able to respond.
But it also comes back to doctrine, because no health system of any size would be able to respond unless you suppress a virus when it’s as bad as Covid-19.
Lead Inquiry: But as my Lady has already observed in another context, there are choices that will have to be made, and there is, therefore, an issue about resilience and about bed capacity and surge capacity and so on –
Mr Matt Hancock: Absolutely.
Lead Inquiry: – for the future?
Mr Matt Hancock: Absolutely.
Lead Inquiry: All right.
Then in your statement you address issues such as the changes over time in the public health structures?
Mr Matt Hancock: Yes.
Lead Inquiry: There’s an issue about the necessary degree of co-ordination across the United Kingdom, given the fact that health security is a devolved issue –
Mr Matt Hancock: Yes.
Lead Inquiry: – but at the same time, of course, viruses honour no boundaries.
Then, finally, you say that –
Mr Matt Hancock: Well, they honour geographic boundaries, they honour no administrative boundaries. The fact that we are an island is an advantage that we should use much more aggressively in future in preventing a pandemic coming here.
Lead Inquiry: All right.
You refer finally to the need to examine more closely the degree of required international co-ordination?
Mr Matt Hancock: Yes.
Lead Inquiry: I don’t want you to develop that point.
There remains the final issue, which I think I’d be grateful for your views on, which is the degree to which you materially assisted in the development of what turned out to be life-saving vaccine production.
Mr Matt Hancock: Yes.
Lead Inquiry: We heard evidence from Jeremy Hunt MP as to how he assisted to the process by which – the process of the UK Vaccine Network when he was Secretary of State.
Mr Matt Hancock: Right.
Lead Inquiry: Were you also materially concerned in ensuring that we had the proper structures in place for future development of vaccines when you were Secretary of State?
Mr Matt Hancock: Yes, I thought this was very important. And in fact, in terms of pandemic preparedness, given the reassurances that we were well prepared, this was the area I put most effort into, and it – a lot of the preparedness work was very helpful here. The Oxford vaccine was essentially built on a project that started with an attempt to get a vaccine for Ebola. That was before my time.
I worked to try to enhance the domestic manufacturing capability, and I did a huge amount of work also on stopping anti-vax content. I was worried about that for normal everyday vaccines like MMR and the flu jab, but it was also very important ahead of a pandemic. Because the point is that once you have the right doctrine of suppressing a virus until the vaccine can make us safe, you’ve got to make sure that you get the vaccines and that people have the confidence to take them. So there was a huge amount of preparation work in that area that I was directly involved in, and that ended up being one of the areas where we performed incredibly well and we, of course, had the first vaccine in the world.
Lead Inquiry: Mr Hancock, my final question: do you know why no pathogenic outbreak-related exercise or any governmental policy or guidance or paper paid any regard to the impact or consequences of a pandemic on the vulnerable, on members of our community in our minority ethnic sectors, or on the marginalised, or otherwise suffering from inequalities? There appears to have been absolutely no thought given at all, at any time, other than in relation to the obvious point that there would be a clinical risk, to what the likely impact would be of a pandemic sectorally, and therefore no thought was given to how the plans might be adjusted to cater for that significant risk.
Mr Matt Hancock: It saddens me enormously that the central work that the CMO was planning to do when I appointed him in October 2019 was to focus on the reduction of the completely unacceptable health inequalities that exist in this country. The life expectancy of a man born in Blackpool is 15 years less than a man born in Buckinghamshire, and I appointed Chris Whitty to the CMO job based on his proposal that he wanted to do everything that we could to address this. So health inequalities were right at the forefront of his and my agenda.
Of course the different impact clinically of a virus on different groups is absolutely front of mind, and implicit in all of the planning.
Lead Inquiry: Well, that’s obvious, as I’ve suggested to you –
Mr Matt Hancock: It has to be. But in terms of the social and socio-economic impacts, all I would say is that an assumption that you’re not going to stop a pandemic running through the population is implicitly an assumption and a decision that those most vulnerable to it will be hardest hit. So the single best thing we can do to protect those who are most vulnerable is stop viruses from killing hundreds of thousands of people.
It brings me – and we end on the central – my central contention, which is you’ve got to work out – there are costs to lockdown, you’ve got to work out whether the impact of the virus is going to be worse than the costs of lockdown, and if it is going to be worse, as was the case with Covid-19, you’ve got to hit it hard and very, very early.
Lead Inquiry: But, Mr Hancock, as you now have acknowledged, our system of preparedness for being able to deal with a pandemic was materially hindered and weakened, and the sad reality is that, as part of that failure, there was no consideration of the needs of the most vulnerable at all?
Mr Matt Hancock: There was consideration on a clinical basis of the needs of the most vulnerable, but not on a socio-economic basis.
If I may add finally, this was of course an unprecedented pandemic in anybody’s lifetime, and those who worked so hard to respond to it had to respond from the basis of the preparation that there was. And they did work incredibly hard, and I think everybody in the health area that I was responsible for gave their all with humility in the face of this virus, an unprecedented event. But that just underlines why it’s so important that we get the right lessons out of this Inquiry.
Lead Inquiry: Lions led by structural donkeys, Mr Hancock; personally everyone gave their all but the system was not fit for purpose, was it?
Mr Matt Hancock: That’s absolutely right, and it goes – that is a – was a problem across the western world, and it goes back a long, long way in the assumptions underpinning how we plan for these things, and it must never happen again.
Mr Keith: My Lady, that concludes my questioning of Mr Hancock. There is one area submitted by Covid-19 Bereaved Families for Justice UK and Northern Ireland Covid-19 Bereaved Families for Justice, for which you have given permission.
Lady Hallett: Mr Weatherby.
Sorry, you’ve not quite finished, Mr Hancock.
The Witness: No problem.
Questions From Mr Weatherby KC
Mr Weatherby: Yes, thank you very much.
Mr Hancock, I ask you a few questions on behalf of the Covid-19 Bereaved Families for Justice, which represents the interests of many, many bereaved families around the United Kingdom.
It’s centred around the Pandemic Flu Bill, which was one of the two key workstreams that were kept going when most of the rest of the refresh, as we’ve heard it called, was paused because of Brexit; is that right? So that gives the importance with which you looked at the Pandemic Flu Bill and the –
Mr Matt Hancock: Yes, and I would say it was one of the most important things to come out of Operation Cygnus.
Mr Weatherby KC: Okay. I just want to explore the background of that and what was in it very, very briefly indeed.
Mr Matt Hancock: Yes.
Mr Weatherby KC: You have already indicated to Mr Keith that the 2011 doctrine strategy was woefully inadequate?
Mr Matt Hancock: Yes.
Mr Weatherby KC: And you put that in your statement?
Mr Matt Hancock: Yes.
Mr Weatherby KC: I just want to read that one paragraph from your statement to flesh that out.
Mr Matt Hancock: Yes.
Mr Weatherby KC: This is your words:
“Clearly the approach in the 2011 strategy was woefully inadequate. I have no idea why the 2011 strategy did not consider the approach taken by countries affected by SARS, and learn the lessons for the UK. I also do not know why the WHO considered the UK one of the best prepared countries in the world, when our strategic approach did not consider it possible to take social distancing measures necessary to stop the spread of a killer disease.”
Mr Matt Hancock: Yes.
Mr Weatherby KC: Yes? So you’re emphasising the lack of learning and the emphasis around social distancing measures?
Mr Matt Hancock: Yes.
Mr Weatherby KC: That would, of course, include lockdowns?
Mr Matt Hancock: Absolutely.
Mr Weatherby KC: Okay. You have also elsewhere, paragraph 29, referred to the WHO as an authoritative source?
Mr Matt Hancock: Yes.
Mr Weatherby KC: So you’re giving respect to the view of the WHO; yes?
Mr Matt Hancock: Well, it is the –
Mr Weatherby KC: Yes.
Mr Matt Hancock: – UN agency in this area. It needs radical reform but, nevertheless, it is what it is.
Mr Weatherby KC: We’ll leave that one for a different day, but you were regarding that as an authoritative source.
In 2018, at precisely the time that this work on the Pandemic Flu Bill was being completed or being looked at, considered, the WHO, as part of its global influenza programme, published an update to a document which had been around since 2005 entitled A checklist for pandemic influenza risk and impact management. I just want to take you to one passage of that.
Mr Matt Hancock: Okay.
Mr Weatherby KC: And it’s INQ000187748, please, and page 1. Have you got it in front of you there?
Mr Matt Hancock: I’ve got the title screen but not the paragraph.
Mr Weatherby KC: No, no. I just want to orientate us all. This is the WHO document 2018. I’m going to take you to page 11 in a minute.
In the interests of time I’m just going to flag up one other reference, which is at page 6, where this document refers to the importance of prevention and mitigation and not simply response and recovery.
Mr Matt Hancock: Right.
Mr Weatherby KC: So by 2018, the WHO were putting out guidance which underlines the necessity for prevention and mitigation and not just response and recovery, which I think is one of your points, isn’t it, as one of the problems with the UK’s doctrine?
Mr Matt Hancock: Well, I haven’t seen this document. It depends what you mean by prevention and mitigation, because the initial containment and an attempt to contain the virus was part of the UK’s plans. The problem with the UK plan was that once we got to community transmission, it was wrongly assumed it wasn’t possible to stop the spread.
Mr Weatherby KC: Yes. Okay.
Mr Matt Hancock: Mitigation in this context tends to mean dealing with the consequences, which is not – which is not good enough.
Mr Weatherby KC: Well, that, with respect, is response, rather than mitigation.
Mr Matt Hancock: Well, I’d be very happy to read the document and consider it.
Mr Weatherby KC: Well, okay.
Can I take you to page 11, please, and we will just have a quick look at this, because this is the important passage of it, with respect to the Pandemic Flu Bill. So this is paragraph 2.2 within this document, and it’s headed “Legal and policy issues”, which is why it’s relevant to what I’m asking you about with the Bill.
Mr Matt Hancock: Yeah.
Mr Weatherby KC: So the “Rationale”:
“Public health measures during a pandemic are designed to reduce the spread of the pandemic virus and save lives. In some circumstances, it may be necessary to overrule existing laws or (individual) human rights in order to implement measures that are in the best interests of community health.”
Then I’ll skip the next sentence, again in the interests of time.
Mr Matt Hancock: Yeah.
Mr Weatherby KC: At the end of that paragraph:
“These decisions need a legal framework to ensure transparent assessment and authority for the measures being considered, as well as coherence with relevant international laws …”
Mr Matt Hancock: Yes.
Mr Weatherby KC: So here’s the WHO saying that you need to consider the measures and then you need to have the legal backing in place before the problem strikes; yes?
Mr Matt Hancock: Yes.
Mr Weatherby KC: Next part, this document splits the guidance into essential, what the WHO regards as essential, and what is desirable.
Mr Matt Hancock: Yeah.
Mr Weatherby KC: This is under “Essential”, the first bullet point:
“Review existing legislation, policies or other government instruments relevant to pandemic influenza risk management …”, et cetera.
Yes?
Mr Matt Hancock: Yes.
Mr Weatherby KC: That’s what you’re doing –
Mr Matt Hancock: Yes.
Mr Weatherby KC: – around 2018 with the Pandemic Flu Bill?
Mr Matt Hancock: Yes.
Mr Weatherby KC: Then the second bullet point –
Mr Matt Hancock: Yeah, all that.
Mr Weatherby KC: This is the important point.
Mr Matt Hancock: That was all in – yeah.
Mr Weatherby KC: Yeah.
“Assess the legal basis for all public health measures that are likely to be proposed during a pandemic response, such as:
“- isolation or quarantine of infected individuals, people suspected of being infected, or people from areas where pandemic influenza infection is established …”
So a legal measure in place for an emergency to restrict the ordinary rights of people who are infected or may be infected; yes?
Mr Matt Hancock: Yes.
Mr Weatherby KC: Second bullet point:
“- travel or movement restrictions” –
Mr Matt Hancock: Yeah.
Mr Weatherby KC: – “(ie on leaving or entering areas where pandemic influenza infection is established) …”
So travel and movement –
Mr Matt Hancock: Yeah.
Mr Weatherby KC: – would include lockdowns?
Mr Matt Hancock: Yeah.
Mr Weatherby KC: “- closure of educational institutions …”
Mr Matt Hancock: Yeah.
Mr Weatherby KC: And:
“- prohibition of mass gatherings.”
Mr Matt Hancock: Yeah.
Mr Weatherby KC: Okay. So all relatively straightforward in concept –
Mr Matt Hancock: Just one point I would challenge, which is you said “travel restriction – or movement restrictions, that means lockdown”. That’s not right.
Mr Weatherby KC: No, no.
Mr Matt Hancock: What it doesn’t have in there is a stay at home order, because the isolation or quarantine of infected individuals is for, as it says, infected individuals.
Mr Weatherby KC: Okay, I said “would include lockdowns”. In parentheses that is:
“… on leaving or entering areas where pandemic influenza infection is established) …”
Mr Matt Hancock: No, that’s – a lockdown is where people are required by law to stay at home, which is different.
Mr Weatherby KC: I’m not going to fence with you over that one.
Mr Matt Hancock: No, but it really matters, because if the question is, “Given that the WHO published this in 2018 why didn’t we have it in place?”, right, if that’s the question, the pandemic flu draft Bill, which became the Coronavirus Act, and the Public Health Act 1984 has the legal framework for all of this in it, however the review compliance with obligations under IHR – sentence in the top bullet point – that IHR includes the rule that you should not close your borders in a pandemic, and the fact that the second bullet point does not include a stay at home order precisely supports my point that there was not consideration given, even at the WHO level, to the requirement for lockdown.
Mr Weatherby KC: Okay.
Mr Matt Hancock: Because a travel restriction is not lockdown.
Mr Weatherby KC: Okay, I haven’t got the time to go into the International Health Regulations with you. We can perhaps deal with that in a different way.
Mr Matt Hancock: Sure.
Mr Weatherby KC: But here you have a list of straightforward, sensible options which the WHO referenced to the spread of the pandemic or stopping the spread of the pandemic –
Mr Matt Hancock: Yes.
Mr Weatherby KC: – and they are options which are likely to be proposed in an emergency situation such as a pandemic; yes?
Mr Matt Hancock: That’s what it said.
Mr Weatherby KC: Yes.
Mr Matt Hancock: That wasn’t the policy of the UK at the time.
Mr Weatherby KC: It wasn’t the policy of the UK at the time, indeed, because we get to the Pandemic Flu Bill – and in light of what you’ve just said I think we will need to put it up, just the contents page, and it’s INQ000023118, please. So this is the Bill as drafted –
Mr Matt Hancock: Yeah.
Mr Weatherby KC: – dated 2020, in fact, so this is after the work presumably is completed. What we see here is the Bill has clauses which relate to the emergency registration of health professionals?
Mr Matt Hancock: Yes.
Mr Weatherby KC: A raft of provisions dealing with the easing of ordinary business as usual –
Mr Matt Hancock: Yes.
Mr Weatherby KC: – duties within the mental health system and the health system, and an indemnity in terms of healthcare?
Mr Matt Hancock: Yeah.
Mr Weatherby KC: Now, which of that list that we’ve just looked at from the WHO guidance is in this Pandemic Flu Bill, Mr Hancock?
Mr Matt Hancock: I don’t know, but I do know that of that list in the WHO guidance many of those are in the Public Health Act 1984, because it was the Public Health Act 1984 that we used as the legal basis for restrictions.
Mr Weatherby KC: Yes. So in fact it’s clause 14, is the temporary closure of educational institutions. So the only one of that list that made its way into this Bill is the restriction or temporary closure of educational facilities.
Mr Matt Hancock: Right.
Mr Weatherby KC: So you’ve referred to other Acts, but this is the workstream which is refreshing the – or supposed to be refreshing or updating the doctrine, and this is the Bill which is supposed to be there to give you an armoury in an emergency situation, and it doesn’t follow this authoritative source from the WHO. How was that allowed to happen?
Mr Matt Hancock: Because the other recommendations from the WHO were already in law in this country, in the Public Health Act 1984.
If I may say so, I essentially think that the core point you’re making, which is that we should have been ready and had legal powers in place and we should be ready to lock down, that I agree with wholeheartedly, and I agree with it, and I think that, you know, on – to do justice – you know, nothing can bring the people who died back, and each and every one, but we must learn that lesson, that we need to take the measures necessary early to stop a future pandemic from killing people.
Mr Weatherby KC: Yes.
Mr Matt Hancock: But to say they’re not in this Bill and – without considering what other Bills there might already be doesn’t really prove that point.
Mr Weatherby KC: Okay, well, I’m sure we can look at the legislation as we go along, but this is the workstream which is putting the –
Mr Matt Hancock: I know, but I used that legislation extensively, I understand that the Public Health Act 1984 very well and what I can tell you is that the WHO recommendations in 2018, other than on temporary closure of educational institutions, those powers are available, as far as I understand it, in the Public Health Act already.
Mr Weatherby KC: Finally, just in terms of the devolved nations –
Mr Matt Hancock: Yes.
Mr Weatherby KC: – it’s right, isn’t it, that this legislation was developed, this draft legislation was developed with some input from the devolved nations?
Mr Matt Hancock: Yes.
Mr Weatherby KC: It’s also right that none of them used it in the event?
Mr Matt Hancock: Because they had their own other legislation already on the statute book.
Mr Weatherby KC: Yes.
Mr Matt Hancock: I mean, I actually think that we could do – part of the reason for a need to reform the 1984 Act is to have a UK-wide approach, because I think that, whilst it’s totally appropriate to devolve health and the NHS, because of the nature of how pandemics spread, it would be far better to respond to the next pandemic on a UK-wide basis rather than an England, Scotland, Wales and Northern Ireland basis, and I think that way we’d save more lives.
Mr Weatherby KC: Yes.
Finally this, are you able to point to any document or any briefing or any meeting where the fact of powers or legislation being elsewhere was a factor in what was included in this draft Bill?
Mr Matt Hancock: Oh, yes, of course. That was the – important consideration in what to put into the Bill, because one of the things that Parliamentary counsel who draft Bills absolutely hate is legislating in an area where policy is already legislated for –
Mr Weatherby KC: Yes.
Mr Matt Hancock: – so that is a material consideration.
Mr Weatherby: Yes. That’s all I ask, thank you.
Lady Hallett: Thank you.
Mr Keith: My Lady, we’ve received an email from Covid-19 Bereaved Families for Justice Cymru who wish, I think perhaps vicariously, to ask permission for a point to be put to Mr Hancock, who said in the course of his evidence that coronavirus was the first coronavirus known to be – or the first coronavirus that could be transmitted asymptomatically. The position is, as the chart that you directed be prepared amply demonstrates, that MERS and SARS were also – are also asymptomatically transmitted, and therefore there is clear evidence to correct that position.
I don’t want to give evidence about it, but there is that material there in the chart.
Further Questions From Lead Counsel to the Inquiry
Mr Keith: Perhaps I could be permitted to ask you one question, Mr Hancock, in light of the question from Covid-19 Bereaved Families for Justice Cymru.
The transmission rates in relation to MERS and SARS-1 –
Mr Matt Hancock: Yes.
Lead Inquiry: – are of course very different to Covid?
Mr Matt Hancock: Yes. What I stated was the clinical fact, as I was advised at the – during the debate about asymptomatic transmission, which no doubt we’ll cover in M2 because it was absolutely central to the challenges of the early response to the pandemic.
Mr Keith: Thank you.
My Lady, that concludes Mr Hancock’s evidence.
Lady Hallett: Thank you very much, Mr Hancock. That completes the evidence you’ll be giving, certainly in this module. Thank you for your help.
The Witness: Okay. Thank you.
(The witness withdrew)
Lady Hallett: 2 o’clock.
(1.00 pm)
(The short adjournment)
(2.00 pm)
Lady Hallett: Ms Blackwell.
Ms Blackwell: Good afternoon, my Lady.
The next witness is Mr Duncan Selbie, who is appearing this afternoon at the Inquiry through a link from the Kingdom of Saudi Arabia. I hope, my Lady, you can see Mr Selbie on your screen.
Lady Hallett: I can, thank you.
Ms Blackwell: Mr Selbie, would you please take the affirmation.