Transcript of Module 2 Public Hearing on 02 November 2023
(10.00 am)
Lady Hallett: Mr O’Connor.
Mr O’Connor: My Lady, our first witness this morning is Lord Stevens.
1. Lord Simon Stevens
LORD SIMON STEVENS (affirmed).
Questions From Counsel to the Inquiry
Mr O’Connor: Could you give us your full name, please?
Lord Simon Stevens: Simon Laurence Stevens.
Counsel Inquiry: Lord Stevens, you have kindly prepared a witness statement for the Inquiry at our request, a copy of the front page of it is up on the screen now. I’m sure you’re very familiar with the contents of that statement, and we don’t need to go there, but on the last page you’ve signed that statement with a date of 22 September of this year underneath the statement of truth saying that you believe the facts contained in the statement are true. Is that right?
Lord Simon Stevens: It is.
Counsel Inquiry: Thank you. Lord Stevens, you had a lengthy career in the NHS, latterly in NHS England, and of particular interest to the Inquiry, you were chief executive of NHS England for over seven years between April 2014 and July 2021; is that right?
Lord Simon Stevens: That is.
Counsel Inquiry: And it’s clear, therefore, from the dates that the final year and a half of your tenure as chief executive was during the Covid pandemic?
Lord Simon Stevens: Yes.
Counsel Inquiry: We also know that you were made a life peer on stepping down as chief executive in 2021; is that right?
Lord Simon Stevens: Mm-hm.
Counsel Inquiry: Lord Stevens, help us a little bit, if you will, with the nature of your role as chief executive of NHS England. Is it right that you were, as it were, the operational head of that organisation?
Lord Simon Stevens: Yes.
Counsel Inquiry: It is, of course, an enormous organisation, enormous budgets, huge staff, buildings and so on. Just give us an idea, if you will, as to the scope of your role in that post.
Lord Simon Stevens: The NHS in England is not one and the same as NHS England, somewhat confusingly. So NHS England is the body that was created by Parliament in 2012, in the first instance to oversee the funding for different health services across the country, but as part of that 2012 Act of Parliament, actually quite a number of the responsibilities for the health system overall were distributed, some might say fragmented, between different bodies, of which NHS England was one, but Health Education England had responsibility for education and training, NHS Digital for the data, Public Health England for obviously not just infectious diseases, but PPE stockpiles and so forth, and so over time, frankly, we attempted to try to ensure that, together, pieces of the jigsaw were coming together to form the full picture, but the consequence of that is that in legal terms at least, before a set of changes were made in 2022, NHS England was not actually directly responsible for the totality of what was happening in the NHS in England. Confusing as that sounds, but that is the legacy that Parliament bequeathed us.
Counsel Inquiry: Well, perhaps not responsible for the totality of the NHS in England, but what, in summary, was it responsible for?
Lord Simon Stevens: Well, de facto, particularly when Covid struck, our job was to lead the NHS response.
Counsel Inquiry: So that was the role of NHS England.
Lord Simon Stevens: Yeah.
Counsel Inquiry: Your role with it, as its chief executive, in summary?
Lord Simon Stevens: To be responsible for the work of NHS England itself and also to be directly accountable to Parliament as the accounting officer for the funding that flows to the NHS in England, which was about £150 billion a year.
Counsel Inquiry: Thank you. And that brings us to a point I wanted to raise, which is that we need to be clear, don’t we, about the relationship between NHS England but, in this case, you, and the Department of Health and Social Care and its Secretary of State, Mr Hancock. Putting it crudely, he was not your boss, was he?
Lord Simon Stevens: The chief executive of NHS England is accountable to the board of NHS England. I must say, frankly, it felt as if I had many bosses. So the board of NHS England was one. I obviously had an accountability to the Secretary of State and to the government, but also more widely to Parliament, as I’ve described, as the accounting officer for the organisation. And frankly I felt an obligation to patients, the public and the staff in the NHS as well.
Counsel Inquiry: All right.
Moving on to the pandemic itself, Lord Stevens, it is obvious that the NHS was involved really at every level of the response to the pandemic, and that involvement will find its reflection in the involvement of NHS England with this Inquiry. There is to follow this module, as you know, a module that will focus on the NHS itself, there will be a vaccines module, there is a module to consider PPE, care homes, all of which the NHS will have a strong interest in.
Lord Simon Stevens: Absolutely.
Counsel Inquiry: This module, as you know, is focusing on core political and administrative decision-making, essentially decisions about the pandemic made in Downing Street and the Cabinet Office, and so the scope of my questions today will be on the role that you and NHS England took, first of all, in that decision-making and also on issues that affected that decision-making. But we need to bear in mind that those operational matters, if you like, will be covered in subsequent modules.
So let me start, if I may, by asking you: what role do you think that you played, in general terms, in that core political decision-making in the period that you were in office during the pandemic?
Lord Simon Stevens: Well, I think the main responsibilities that we had and I had were to do everything we could to ensure that the NHS was able to look after severely ill Covid patients and also all of the other non-Covid patients who needed our care during the course of the pandemic. So, first and foremost, it was about the operation and the availability of the NHS.
We were not directly asked to contribute to debates that government was having about lockdowns and so-called non-pharmaceutical interventions or other ways of controlling the spread of the virus –
Counsel Inquiry: Just pausing there a moment, Lord Stevens.
Lord Simon Stevens: Sure.
Counsel Inquiry: If you can try to keep your answers relatively – speak relatively slowly and relatively short, that would help us all.
Lord Simon Stevens: I’ll stop there then.
Counsel Inquiry: All right. So you’ve described, in essence, most of your work, unsurprisingly, given what you’ve said, was on operational matters: helping the NHS deal with Covid, and of course dealing with all of the other things it would have been dealing with anyway?
Lord Simon Stevens: Yeah, I think that’s right.
Counsel Inquiry: And you’ve said you were not routinely involved in those discussions about lockdowns and other NPIs.
We can see and you describe in your statement – perhaps we can look at paragraph 13 of your statement on page 5 – you say that you did attend several of the COBR meetings, we’ve heard about these meetings, held in the early part of 2020.
Lord Simon Stevens: Yes.
Counsel Inquiry: Several, all, maybe you can’t remember now?
Lord Simon Stevens: Probably almost all. I know the Inquiry has the COBR minutes and whether I was there or not will be there. But certainly a number during February and then in March. But as I think I mention, in a sense COBR fell out of use as a mechanism by which the government decided to take its decisions or review progress against the pandemic, so that abated as a forum for this type of discussion.
Counsel Inquiry: Well, we’ve certainly heard that the COBR meetings stopped, but are you saying that you stopped going to them for that reason?
Lord Simon Stevens: No, I think – well, I went to every COBR meeting I was asked to go to, as far as I’m aware.
Counsel Inquiry: Was it routine that either you or someone else from NHS England was invited to those meetings?
Lord Simon Stevens: During February 2020 I think that’s right, and probably March as well. I mean, I’d have to literally go back and look at all of the COBRs and the minutes and so forth, but that’s my recollection, yes.
Counsel Inquiry: You’ve mentioned just now, and you describe in your statement, a view that these meetings were not, in your words, optimally effective. Can you expand on that?
Lord Simon Stevens: Yes. I – my observation is that the COBR meetings were very large, so lots of people, which often makes it hard to have very substantial discussions, and sometimes the seniority of representation, ministerially, at the COBRs varied between departments. So it wasn’t always the case that a minister necessarily had the full authority of their department when a discussion was taking place, was my observation. Now, you know, others in government may take a different view.
Counsel Inquiry: There’s a particular point you make, which we can see in this paragraph on the screen, Lord Stevens, which is that when, as we know they were, in the early stage, the COBR meetings were chaired by Matt Hancock, other secretaries of state sometimes avoided attending, and sent junior ministers instead. Was that a reflection you had at the time?
Lord Simon Stevens: I’m not saying that was cause and effect, but that is the fact of the matter.
Counsel Inquiry: Well, I’m sorry, the inference in your statement is that it was cause and effect, but you’re not going that far?
Lord Simon Stevens: Well, I just observed that those two coincided.
Counsel Inquiry: Can you offer a view as to whether, in light of that, the phenomenon that you were observing, it would have been better for the Prime Minister to have chaired the COBRs at the early stage? Would that have, do you think, ensured that more senior people, secretaries of state, attended those meetings?
Lord Simon Stevens: I think it’s very likely that if the Prime Minister had chaired those COBRs then other secretaries of state would have chosen to go as well, but whether the substance of those COBR meetings was such that not having all of those folks there made a big difference, I defer to others.
Counsel Inquiry: Of course.
Just following down the page, Lord Stevens, you indicate that you did attend some Cabinet committees, and I think we can see – I’m not going to take you to the document – you were an attender, were you not, of the MIG, the health – there was a particular health MIG early in 2020, which I think you did attend; is that right?
Lord Simon Stevens: Yeah, I think I went to several of them, but not all of them. And as I think I perhaps diplomatically say in my statement, I did not consider that they were the most effective forum for resolving operational questions, shall we say, and that’s why, in fairly short order, they were abolished and replaced by a different system.
Counsel Inquiry: They were replaced by what we, I think everyone, referred to as Covid-O, Covid-S, operational and strategy?
Lord Simon Stevens: Yeah.
Counsel Inquiry: I think you’re saying that your MIG was replaced essentially by Covid-O; is that right?
Lord Simon Stevens: I think all of the MIGs were, in a sense, replaced by Covid-O and Covid-S, the point being that I think having fragmented subject-specific ministerial groups didn’t really deal with the cross-cutting issues which actually were the main purpose of having those kinds of forums. And when it came specifically to figuring out things that required political involvement, a ministerial decision on health, the MIG was probably not the best place to get that done.
Counsel Inquiry: Did you attend either Covid-O or Covid-S and did you find that they were more effective forums for the –
Lord Simon Stevens: Yes, I did from time to time, and that was my assessment. And as I think I say as well, I think when the Cabinet Office created with Number 10 this thing called the Covid Taskforce, that substantially improved the coherence of what the centre of government was doing relative to individual government departments, was my impression.
Counsel Inquiry: You also say in your statement, Lord Stevens, that there were a few occasions at least where you had ad hoc meetings with the Prime Minister and other senior decision-makers.
Lord Simon Stevens: Yeah.
Counsel Inquiry: I’d like to take you to a document which records one of those meetings.
It’s INQ000146616, please.
So this, Lord Stevens, is an email, is it not, dated 10 October 2020, so we’re in the autumn of that year. It’s an email from Imran Shafi, who has given evidence to the Inquiry, essentially recording a meeting which had happened I think earlier that week, and we can see from the start, the first line of the email, it was a meeting which included the Prime Minister, the Chancellor, Chris Whitty, Stuart, Vallance and you, and it may well be others as well.
Lord Simon Stevens: Sure.
Counsel Inquiry: We don’t see your name on the copy list. This appears to have been an internal Number 10 document, but I know you’ve had a chance to look at this document, and obviously if there are any things in it which don’t accord with your recollection, you’ll tell us.
First of all, do you remember going to this meeting in the autumn of 2020? I say “going”, it may have been a virtual meeting.
Lord Simon Stevens: Yeah, I do – I do remember it. I think this note is 10 October, I think it relates to a meeting that Thursday, I think it was probably 8 October.
Counsel Inquiry: Right. And we see again from the first line that the purpose of the meeting was to discuss Covid, perhaps in particular NHS preparedness.
Lord Simon Stevens: Mm-hm.
Counsel Inquiry: Preparedness for the winter to come?
Lord Simon Stevens: Yeah, and in the light of rising Covid cases which were apparent by early October.
Counsel Inquiry: We’ll look at just a little bit of the detail in a moment, but before we do, can you give us a sense of how frequent meetings like this were? Did you have meetings with the Prime Minister and the Chancellor weekly, monthly, less than that?
Lord Simon Stevens: It ebbed and flowed. So during March 2020, and April, very frequently. Then as Covid numbers decreased and the pressures on the NHS likewise, then far fewer during May, June, July, August. But then from October they increased again, and certainly by the time we were in, say, late December, early January 2020, very frequently. In fact I think I had between New Year’s Day and 10 January something like six separate meetings with the Prime Minister and others on both winter, Covid pressures and the vaccine roll-out. So that was the sort of pattern of it over the course of the pandemic.
As I think I also say in my statement, Number 10 got into this sort of rhythm of having these so-called daily dashboard meetings at 9.15 that the Prime Minister would chair, and their frequency kind of changed a bit depending on what was happening with Covid. They could sometimes be every day, they could be three times a week, and I personally found those very useful sessions, because it was a chance to kind of tell it straight direct to the relevant senior politicians, and to the extent there were things that frankly I thought we could benefit from some support on, to sort of lodge that direct with the Prime Minister and others.
Counsel Inquiry: Just helping us to imagine what you’re describing, obviously, can you just give us an indication of whether those meetings were virtual or not? I mean, were you spending your life going back and forth to Downing Street when you were having these regular meetings or did you, for example, dial in to those 9.15 meetings?
Lord Simon Stevens: Yeah, some were virtual and some were face to face, so yeah, it was absolutely a mix of both.
Counsel Inquiry: We will come to the detail, but since you’ve given us that overview of your interplay –
Lord Simon Stevens: Yeah.
Counsel Inquiry: – the exchanges you had, the meetings you had with the Prime Minister and his team, you are of course aware that we have heard evidence in the last few days, the last week or so, of difficulties in the decision-making process, a certain level of dysfunction. There has been evidence of the Prime Minister finding it difficult to settle on a particular decision. “Oscillating” is one of the words, one of the words that’s been used to describe that.
Can you give us an overview of your experience of those months that you spent discussing Covid, helping him make those decisions?
Lord Simon Stevens: Well, in a sense, I don’t think I did help him make those decisions, if by “those decisions” you mean lockdown restrictions, social restrictions and so forth. So I can’t –
Counsel Inquiry: Just pause there. What I meant, because you have just given evidence that you had frequent meetings with the Prime Minister –
Lord Simon Stevens: Sure.
Counsel Inquiry: – at times very frequent –
Lord Simon Stevens: Yeah.
Counsel Inquiry: – I’m not suggesting that you were making the decisions with him –
Lord Simon Stevens: Sure.
Counsel Inquiry: – but one assumes that the purpose of him having those discussions with you was to help him make decisions. That’s what I meant.
Lord Simon Stevens: Yes, but actually the way the rhythm of it tended to work was we would have the session specifically on the NHS and then ministers would go off and have a separate session without the NHS present, where then the consequences of that for their wider decision-making would be taken account of. So I think a lot of what you’ve heard, as I understand it, over the last several days really relates to sessions that, frankly, I wasn’t present at, so I can’t give you good commentary on those.
Counsel Inquiry: You would, though, have experienced the consequences of his decisions, and you would have found yourself at the next meeting hearing a decision you might have expected to have been taken either had or hadn’t been taken, so is there really nothing that you can say about the way in which the decision-making process took place?
Lord Simon Stevens: Well, I mean, obviously I can see some of the evidence that you can see now as well, not all of which obviously we were privy to at the time. What I would say is that in respect of decisions that we needed from Government on NHS capacity, I mean, sometimes decisions were taken which we didn’t like but nevertheless, you know, those were the decisions.
I think the best example in a way of the sort of interface with Prime Ministerial decision-making that I can personally speak to was around the roll-out of the vaccine programme, where the Prime Minister was very personally involved in that, and for the most part that was actually a, you know, constructive engagement on what needed to get done. And we can obviously talk specifically about that, but …
Counsel Inquiry: Yes. All right, we won’t, because, as I said –
Lord Simon Stevens: Right.
Counsel Inquiry: – there is another module to come, and I’m sure there will be an opportunity for you to talk about vaccines in the vaccines module.
Let’s look, if we can, at this document, and it’s perhaps the third paragraph where we see that:
“The PM asked about NHS capacity.”
There is then a record of a relatively detailed review, if you like, that you conducted of the position as it stood regarding the NHS. We see reference to regional variation, and we also see in the first line that you stressed “the NHS was not overwhelmed”.
Lord Simon Stevens: On 8 October 2020, correct.
Counsel Inquiry: Exactly. And so you are saying it wasn’t overwhelmed at the time of the meeting, and then, reading on, you describe the regional position and give some view about the future. I’m going to come back to the question of NHS overwhelm shortly, but just looking a little bit further down the document, there’s the next paragraph, we see that the discussion “turned to the question of NPIs”. Simon Ridley, one of the Cabinet Office officials, gave a presentation about NPIs.
Then there is another paragraph where it appears that you contributed to the debate, perhaps about NPIs, it says:
“Simon Stevens argued that – stepping back – not everyone currently accepted there was a problem, people did not think measures were fair, they questioned whether they worked, and if they did work, they wanted financial support. Government response should take these factors into account.”
So, first of all, slightly contrary to what you said a moment ago, this does appear to suggest that you were contributing to discussions beyond simply the NHS capacity matters?
Lord Simon Stevens: Well, I think on this occasion I was asked: what are people in the health service in Liverpool, Merseyside, the northwest seeing about what’s happening in their local situation? Because obviously part of my responsibilities were often to be out and about around the country, talking directly to people who were affected, and I think in that comment I was reflecting what I had been told directly from people in Merseyside, Manchester and elsewhere, that frankly the set of mechanisms that were then supposedly in place in those areas were not working, and their view was that part of the problem was that there wasn’t sufficient financial support for people who were being asked to self-isolate. So when I was asked the question, I answered.
Counsel Inquiry: Yes. And in fact one of the themes of the evidence that we’ve heard is precisely on that issue, that there was a live question about whether sufficient financial support was being provided, including in fact to workers in the healthcare sector, and I think are you saying that perhaps it was workers in the healthcare sector that you were reporting back on, as it were, needing further financial support?
Lord Simon Stevens: You know, I can’t remember that specifically, because obviously there were different arrangements for NHS staff, furlough and so forth, so I can’t say that directly. But what I can say is that I think this was a time, as I recall it, when it was a pretty variegated set of local restrictions that were in place around the country, and frankly a lot of people were struggling to understand the rationale and what they were supposed to be doing in one place or another, and I think it’s the case that after this the government then moved to their more sort of clear-cut tiering system to try to respond to that.
Counsel Inquiry: Quite. And on any view you were voicing support for the idea that further financial support needed to be given to people self-isolating?
Lord Simon Stevens: That was my personal view. I think actually what these notes show was that I was describing what I’d heard other people saying, but yes, that was also my personal view.
Counsel Inquiry: Thank you.
I’m going to move away from this document, but stay, as it were, with that general issue of exchanges between you and the Prime Minister.
I’d like to go, if we can, please, to the written witness statement of Helen MacNamara, which is INQ000273841, paragraph 71, on page 39, I think. Yes.
Lord Stevens, I don’t know if you have had a chance to look at this document before. I hope you have.
Lord Simon Stevens: Sorry, which part are you looking at?
Counsel Inquiry: Well, let me show you. One of the observations that Helen MacNamara makes in her witness statement, and in fact that she expanded on in evidence yesterday, is the last sort of five or six lines of this paragraph we’re looking at. She, of course, is talking about her experience of dealing with officials and politicians in Number 10, but she said this:
“I do not remember anyone working in the centre or who was part of the conversations who had a detailed understanding of the way the NHS operated. This is not unusual or unique …”
And she talks about the fact that social areas of policy are less well represented in Downing Street than military, national security type matters.
I’m interested in your views on that, with your experience of – long experience of dealing with politicians, but perhaps particularly that period during the pandemic, did you feel there was, as it were, a deficit in their understanding of the granular way in which the NHS works?
Lord Simon Stevens: I think Helen’s description seems to me accurate, particularly as regards the Cabinet Office. The extent to which the Prime Minister’s office, Number 10, has health expertise is to some extent a function of how the Prime Minister of the day chooses to staff their Number 10 policy unit.
During the pandemic itself, I think there is truth in what she says, but to some extent, as long as that doesn’t lead to ill-informed second-guessing of the decisions that people in the NHS are actually trying to take, that need not in itself be a problem.
Counsel Inquiry: One can certainly see how it would be a problem if there was that sort of second-guessing, but surely even if they leave the operational decisions to you, it would still be necessary for them to have that level of detail in making the higher level decisions, for example NPIs and so on?
Lord Simon Stevens: Yeah, I think to some extent that is – that is true. I mean, I think there was a – as I think Helen described, and I agree with her, there was a sort of disconnectedness between aspects of what the Cabinet Office was doing early on in the pandemic and what, sort of, we were seeing in terms of the operational realities.
As I say, I think the Covid Taskforce really helped with that because that brought together people who had that more detailed set of expertise into one place with a single voice where you could have a direct conversation and know that the advice that would then go to the Prime Minister and others would be properly informed by what we were telling them.
Counsel Inquiry: Just sticking with that, then, we will hear more about the Covid Taskforce in evidence, in fact, next week.
Lord Simon Stevens: Right.
Counsel Inquiry: Help us with this: were there people, civil servants, involved with the taskforce who had this sort of granular understanding of the NHS in a way that perhaps the earlier structures didn’t have?
Lord Simon Stevens: I think to a greater degree, yes, and there were some – even if there were some generalists, they I think, you know, pretty quickly understood the moving parts, shall we say.
Counsel Inquiry: I want to move to a slightly different topic, Lord Stevens, and it’s still to do with your engagement with the Prime Minister and Mr Hancock and others, but it’s a rather basic question, of whether Mr Hancock in particular, but others, were encouraging you to resign or otherwise remove you from office during the period of the pandemic.
I’ll take you to some documents, but were they, or not?
Lord Simon Stevens: No.
Counsel Inquiry: Let’s look –
Lord Simon Stevens: Not to my face, anyway.
Counsel Inquiry: Let’s just look at a couple of WhatsApp messages, if we may.
First of all, INQ000129176. Let me say these are both – these messages are from very early in the pandemic, but you can see January 2020 Dominic Cummings is texting to the owner of the cellphone, who is Mr Hancock, saying:
“Where are we with SS?”
Simon Stevens.
He says:
“It’s in train. I am first getting Ara Darzi to persuade him it’s in his best interests to go now. If that doesn’t work I’ll move directly.”
Then if we can go, please, to INQ000129185, ten days or so later, 3 February, it’s just at the top, Dominic Cummings says:
“When SS off?”
Matt Hancock says:
“Wanted to talk to you about this in the margins of meeting [tomorrow]. Short answer is his initial proposal is to announce in Sept & go at Christmas. I haven’t yet engaged. How hard to push for sooner?”
Dominic Cummings says:
“We must get on with it now. Announce next week as part of reshuffle frenzy and it will all get lost in that.”
Matt Hancock says:
“Let me see if I can square him for that? If I can’t, we can still go if we want.”
So at least on the basis of these messages, first of all, there certainly do seem to have been discussions between Mr Hancock and Mr Cummings about you leaving.
Lord Simon Stevens: Mm-hm.
Counsel Inquiry: And it does appear that Mr Hancock had had some discussions with you about that?
Lord Simon Stevens: Well, take a step back. I, as I said at the start, was appointed in 2014. When I took up post I envisaged serving for around five years, which would have taken me to 2019. As you may recall, there was a degree of political chaos in the United Kingdom during the course of 2019, a change of Prime Minister, a general election, and I therefore did not feel it was quite the right moment to create a gap in the leadership of the NHS, so I think it was known that that was something that had been in my mind, but felt that I should stay through to the New Year, and then sort of make a decision at some point during the course of 2020.
Now, of course Covid then came along and it would have been completely wrong to have left a vacuum during the first wave of Covid. Come summer 2020, the thought recurs, but I have a discussion with the Prime Minister about that during summer 2020, but by the time that possibility would crystallise, we were back into another wave of Covid. So I therefore, again, felt duty bound to see the winter period through and then the roll-out of the vaccine, at which point, in July 2021, I was able to – I was able to leave.
Counsel Inquiry: Well –
Lord Simon Stevens: By the way, can I just say on some of these things, I think there’s a suggestion there, asking Lord Darzi to persuade me. These emails I think have previously been leaked to The Daily Telegraph and, in response to those, Lord Darzi has said on the record that is not correct, and I think his actual words were “that is misinformation”. So he did not seek to persuade me in the way that’s described here.
Counsel Inquiry: Well, thank you for clarifying that and for the earlier answer, Lord Stevens.
Let me be clear, the reason I’m asking these questions is to understand whether there was a relationship of confidence and trust between you doing your very important job and Matt Hancock, Boris Johnson and others during the period of the pandemic.
I think it follows –
Lord Simon Stevens: Can I just say on that, I think it’s relevant, as I saw Dominic Cummings’ statement earlier in the week, I think he has said on the record that when the pandemic struck he was then not seeking to do this, and I believe Matt Hancock has said the same in his written statement. So I have no insights other than what the two of them have said on the record.
Counsel Inquiry: And your evidence, putting those exchanges in context, is that there was no sense in which you were somehow defying them in staying in your role in January/February 2020?
Lord Simon Stevens: No.
Counsel Inquiry: I do want to ask you about one more message, which is from later in the year, August 2020. I’m not going to bring it up on screen, but let me just read it out.
Its primary focus is Mr Cummings coming back to the question of whether Mr Hancock should leave his role, but he does mention you as well. He says this:
“I also must stress I think leaving Hancock in post is a big mistake – he is a proven liar who nobody believes or shd believe on anything, and we face going into [an] autumn crisis with the cunt still in charge of the NHS still – therefore we’ll be back around that cabinet table with him and stevens bullshitting again in [September]. Hideous prospect.”
So, leaving aside the question of Mr Hancock, did you later on in 2020, in August, have the impression that Dominic Cummings or Boris Johnson was dissatisfied with the way that you were running the NHS or “bullshitting” them?
Lord Simon Stevens: Well, by the standard of Dominic Cummings’ adjectives, that’s one of his gentler epithets. So, look, what I would say is – well, I just said it a moment ago actually – I did have a discussion with the Prime Minister in the summer of 2020 about whether or not I would be able to be released from active duty in the NHS. We discussed specifically whether I might play a role in helping improve social care in the country. To be frank about it, I was pretty clear cut about what I thought success would look like if we were going to improve social care, that it needed to be not just about ensuring that people didn’t have to sell their homes but also that the availability of social care increased and that the social care workforce was addressed. I was clear that I didn’t think this could be done just as a private Whitehall process, a sort of behind the bike sheds agreement between ministers, it had to be a public open process. And ideally, if it was going to create a national consensus, so social care reform actually got done, it needed to be on a cross-party basis. That was the basis on which I suggested action was required. Those points did not find favour and therefore I didn’t do it.
Counsel Inquiry: Did you think that Boris Johnson, Dominic Cummings trusted you to do your job during the summer and autumn of 2020?
Lord Simon Stevens: I can’t speak for Dominic Cummings but there was nothing – because I had no conversations about Dominic about this question, but my regular interactions in the autumn with the Prime Minister did not give me a different sense of that, no.
Counsel Inquiry: What about Mr Hancock, Mr Stevens? It is important to understand whether there was a fruitful relationship of trust between the two of you. The Inquiry has heard evidence that other people working with Mr Hancock found him someone who was untruthful. Was that your experience or not?
Lord Simon Stevens: There were occasional moments of tension and flash points, which is probably inevitable during the course of a 15-month plus pandemic, but, look, I was brought up always to look for the best in people.
Counsel Inquiry: I’m sorry, Mr Stevens, that’s not an answer to my question.
Lord Simon Stevens: Which question? Which bit of it?
Counsel Inquiry: Did you find Mr Hancock to be truthful or not?
Lord Simon Stevens: Well, I know various people have made quite strong accusations against – against Matt Hancock. All I would say is strong accusations need strong evidence to back them up, and I don’t think I’ve seen that evidence.
Counsel Inquiry: I’m still not sure you’re quite engaging with my questions, Lord Stevens, and it is important, because you were at the head of the NHS, he was at the head of the Department of Health and Social Care?
Lord Simon Stevens: Sure.
Counsel Inquiry: In your working relationship with him, during these most extreme and important of times, was he someone you found you personally could trust?
Lord Simon Stevens: Yes, for the most part, yes.
Counsel Inquiry: What do you mean by “for the most part”, Lord Stevens?
Lord Simon Stevens: Well, as I think I said right at the start, I’m not denying that there were a small handful of occasions during the course of the year, year and a half, when there were tensions, but that I don’t think is particularly surprising given the circumstances under which everybody was working.
Counsel Inquiry: I’m going to move on to ask you some questions about something called Operation Nimbus.
Let’s look, first of all, at your statement, please, paragraph 21, page 7.
I think it’s right to say you attended this operation –
Lord Simon Stevens: Yeah.
Counsel Inquiry: – which was a tabletop training exercise?
Lord Simon Stevens: Yes.
Counsel Inquiry: I’m not going to call it up, but we can note that it was an exercise that was implemented following a SAGE meeting – sorry, a COBR meeting on 29 January, we could see it in the minutes, that there needed to be an exercise, and, as I think we’ve said, it occurred about two weeks later on 12 February 2020.
Can you just describe in a few sentences, Lord Stevens, what that exercise was about and what you took from it?
Lord Simon Stevens: Yes, the purpose of the exercise was to look at the so-called reasonable worst-case scenario, which I know the Inquiry has heard evidence about, which is saying: if it’s the case that Covid turns out to have these features, maybe 81% of people are infected and a proportion of them then die, that obviously is a huge and devastating impact on the United Kingdom, what are the responses the different government departments need to make?
And so I think it was less specifically aimed at the health response and more about having a broader range of Whitehall departments who had not been so involved in those conversations kind of getting their head around: my goodness, this would be an absolutely terrible thing, what would we need to do to make sure our plans are prepared?
Counsel Inquiry: We haven’t actually seen any report or summary from this exercise.
Lord Simon Stevens: Right.
Counsel Inquiry: Do you happen to know whether such a document existed or would you have expected such a document to exist?
Lord Simon Stevens: Yeah, I would have assumed that the Cabinet Office relevant secretariat would have produced some sort of notes from that, actions for departments. Whether they have or not, I leave to you –
Counsel Inquiry: Understood.
Lord Simon Stevens: – but I would have thought so, yes.
I mean, I might also say that, in a sense, the effectiveness of this exercise was slightly undermined by the fact that this took place on 12 February 2020, with a lot of ministers from a range of departments other than Health around the table, and then the very next day there was a Cabinet – a ministerial reshuffle, and quite a number of them lost their jobs. So it was an entirely new set of ministers who had not been exposed to any of that 24 hours before.
Counsel Inquiry: I was going to ask you, without wanting to stretch your memory too much, in fact, who was there. Do you recall whether the Prime Minister was there?
Lord Simon Stevens: I don’t think he was, no. I don’t think so. But I’m sure there will be records to that effect.
Counsel Inquiry: Well, we haven’t seen any, but we can carry on looking.
Lord Simon Stevens: Right.
Counsel Inquiry: I think it’s implicit in what you say, then, that certainly, I think, Mr Hancock was there –
Lord Simon Stevens: Yeah.
Counsel Inquiry: – we’ll come on to talk about that, and other junior ministerial people, who, as you’ve said, some of whom may have lost their jobs or changed their jobs the next day.
Lord Simon Stevens: Yeah.
Counsel Inquiry: Let’s look at what we do have about Operation Nimbus, Lord Stevens, which is – if we can call up on screen, please – INQ00052022.
This is a set of, I think, slides, perhaps a PowerPoint demonstration. It’s perhaps what the participants in the operation were shown or at least part of what they were shown.
If we can go to page 7, please, we see the synopsis, which is – very much as you’ve already outlined, it is to be imagined that the Covid pandemic has advanced, as it were. We see that the participants are asked to imagine that the date is 14 April, so two months further on from 12 February, which was the date this took place. Sustained transmission has been ongoing for a month and a half, hypothetically, by that stage.
There are various facts and figures given, but the most striking one is in the last bullet point, which is that there might – it is, as of the synopsis, to be assumed that there may be around 840,000 excess deaths over the 16-week wave of infection, which, as you say, reflects the reasonable worst-case scenario at the time. Is that fair?
Lord Simon Stevens: Yes.
Counsel Inquiry: Then if we look over the page, we see a wave, which was the scenario that was being engaged with. The sort of solid line is the hypothetical line up to the date of the exercise and then there’s a sort of projected dotted line after that. The wave lasts for 16 or so weeks, and the idea is that within that time there would have been that very large number, 840,000, excess deaths.
Just a couple of points I want to ask you about leading on from that. The first is that, as you describe in your witness statement, this exercise seems to have provoked a discussion about who should be responsible for making decisions about prioritisation, allocation of stretched NHS resources in a situation like this.
Perhaps we can take this down and look at paragraph 21 of your witness statement. It’s on page 7. Sorry, perhaps I should have said that. So it’s at the bottom of the page.
So we can see, Lord Stevens, you say:
“It …”
That is the exercise:
“… did result in – to my mind at least – an unresolved but fundamental ethical debate about a scenario in which a rising number of COVID-19 patients overwhelmed the ability of hospitals to look after them and other non-COVID patients. The Secretary of State … [that’s Mr Hancock] took the position that in this situation he – rather than, say, the medical profession or the public – should ultimately decide who should live and who should die. Fortunately this horrible dilemma never crystalised.”
Just before I ask you about this, to note that is it right that the previous Secretary of State or possibly a previous Secretary of State, but Jeremy Hunt had taken a different view of this matter, had he not? I think it was connected to Exercise Cygnus, which had happened some years before. He had taken the view, and this is in fact something that he spoke about in evidence in Module 1 of this Inquiry –
Lord Simon Stevens: Right.
Counsel Inquiry: – that decisions of this type ought to be reserved to clinical staff. Is that something you’re aware of?
Lord Simon Stevens: Yes, I’ve heard Jeremy Hunt say that, yes.
Counsel Inquiry: So there you are. I mean, he took one view and you’re saying in your statement that on 12 February Mr Hancock took a very different view. Did you have a view as to whether that was an appropriate line for him to take, desirable or not?
Lord Simon Stevens: I thought it would be highly undesirable other than in the most extreme circumstances, and you can argue that these are the most extreme circumstances, and that is one of the reasons why the Department of Health and Social Care I think created an ethical, moral advisory panel to sort of ask the question, you know, if absolute disaster strikes then how would you ration care, limit it, in a way that would be fairest and have the – you know, be the most defensible under this, you know, horrible situation.
But I certainly wanted to discourage the idea that an individual Secretary of State, other than in the most exceptional circumstances, should be deciding how care would be provided. I felt that we are well served by the medical profession, in consultation with patients, to the greatest extent possible making those kinds of decisions.
Counsel Inquiry: And this, I suppose, was Operation Nimbus doing its job, in the sense that it raised in advance an issue like this, while there was still time to think about how to deal with it. And did you then take steps to at least pursue that debate as to whether Mr Hancock should have that level of decision-making in a worst-case scenario?
Lord Simon Stevens: Well, I think, and this is something that – I think you’re seeing Sir Christopher Wormald from the Department of Health and Social Care later, that was probably something that Chris Wormald may be able to give you information on as well. As I say, the department had this Moral and Ethical Advisory Group, and I think they continued in existence during this period. So I actually don’t think this was a question that was resolved. There were specific instances that gave rise to this type of question. At one point during the first wave there was a group that had come up with essentially rationing criteria that might be used for critical care in the event that there were not enough critical care beds for severely ill patients.
Our view was – my view was that – actually by the time that was drawn up, it was clear it wasn’t going to be needed, and in any event it was far too crude a tool, that would result in bad decisions being made around the country, so that was never promulgated.
Counsel Inquiry: I want to move to a second issue sort of stemming from Operation Nimbus, Lord Stevens, which takes us back to this question of the NHS being overwhelmed.
We know that a month later than Operation Nimbus, 12 February, we know that on 13 March or thereabouts there was a change of policy from the mitigation strategy towards a suppression strategy which, in the end, involved a lockdown. We also know that one of, if not the key rationale for that change of policy was a fear of the NHS being overwhelmed unless the policy was changed.
But we’ve also heard from a number of scientists who sat on SAGE who, in summary, have said that it, in fact, was obvious or fairly likely or very likely to them that the NHS would be overwhelmed some time before 13 March, and they – I mean, for example, Professor Medley, who I’m sure you know, the chair of SPI-M, said that throughout February it became increasingly clear that NHS capacity in the UK would be overwhelmed.
Just looking at this Nimbus exercise, it’s inherent in what we’ve been saying about decisions of life and death, and so on, that the exercise that was run there had, as part of its core, a situation in which clearly the NHS would have been overwhelmed.
So just drawing those strands together, from your perspective, was it as late as 13 March or thereabouts that it became obvious and only then did it become obvious that the mitigation strategy would involve the NHS being overwhelmed, or is it something, to your mind, that was apparent earlier or at least should have been considered earlier?
Lord Simon Stevens: I think it was clear that, if the reasonable worst-case scenario were to come about in the UK, then the NHS would be overwhelmed, and we had a group of our clinicians and analysts working, for example, intensely with the SPI-M modellers on Sunday 1 March to refine what the parameters might be for thinking about how many intensive care beds each sick patient might need, and so forth, and that produced a set of scenarios that evening, Sunday/2 March, SAGE papers, as I see them now, on 3 March 2020, have two separate papers, one from Imperial, one from the London School of Hygiene and Tropical Medicine.
SAGE on 3 March says three things: it says it is highly likely there is sustained transmission of Covid-19 in the UK at present; secondly, they say, given current surveillance systems, it will not be possible to time the start of interventions optimally; and, third, they say, whatever the exact figure, NHS demand will greatly exceed supply in a reasonable worst-case scenario even with behavioural interventions and – behavioural and social interventions.
So I think it is – it is apparent that, certainly by the beginning of March, it could be seen that, if action was not taken to reduce the growth of Covid, then the NHS would be overwhelmed.
Counsel Inquiry: Thank you, and one of the issues that we are considering is whether advice from bodies like SAGE was clear enough. It may be that your reference there to the minutes slightly makes the point that sometimes these messages can be confused. But what I really want to get to is your own view, not with hindsight but at the time, and do I take it from what you’ve said then that, first of all 12 February, so Operation Nimbus, although the exercise involved a set of facts which included the NHS being overwhelmed, are you saying that, at that stage, because it was still then a worst-case scenario, it perhaps wouldn’t be fair to say that, at that point, it was clear that, in reality, really the cards were on the table and the NHS was going to be overwhelmed at that stage?
Lord Simon Stevens: Yeah, as you say, I want to be very careful of hindsight bias, but I think Nimbus was explicitly presented as a scenario, as a possibility, as an exercise. It was not being suggested by the epidemiologists or anybody else that “This is the course we’re on, so now plan against it”. And I think I’ve made the point in my written statement that one of my observations looking back is that there was too much ambiguity about what the status of this reasonable worst-case scenario was during the course of February and the first part of March and the probability that the reasonable worst case was actually going to become the case.
Obviously, that probability evolved during the course of February and early March, but I think, you know, for example, minutes of the COBR meeting on 29 January say that, informally at least, it was thought there was a 90% probability that the reasonable worst-case scenario would not come to pass, and then, sort of, a few days later, early February, I think it was said there was a four-fifths probability that it wouldn’t come to pass.
But I think one of the takeaways from this is that there needs to be much greater clarity about what is the probability that is being assigned to these different potentials, so that policymakers can understand what exactly they’re being told.
Counsel Inquiry: One way of looking at it, and this is – I think it was Professor Woolhouse who said this, is that the point of having a reasonable worst-case scenario is that that’s what you should be preparing for, and so, in a sense, you leave aside the probability of that situation eventuating, you just prepare for it. But I think, perhaps, your point is that that might be a slightly sort of – it’s too difficult to achieve that situation in real life, people are always going to want to know how likely it is that this sort of terrible event is going to happen.
Lord Simon Stevens: You know, I make the point, I think, elsewhere in my statement that the government obviously has a pandemic – sorry, has a National Risk Register and there are all sorts of reasonable worst-case scenarios in that. If we were actually to act on all of those, ie give them a probability that, on the balance of likelihood that they’re going to come about, then, you know, life would grind to a halt. So at some point when these national risks begin to crystallise you have to be clear as to whether you move from a purely theoretical possibility to: this thing is happening, do something.
Counsel Inquiry: Let me move the conversation on, Lord Stevens, but sticking with this question of NHS overwhelm just for a few more minutes. We have been focusing on March 2020, but it’s right, isn’t it, that the later lockdowns, towards the end of 2020 and then into 2021 were also triggered, amongst other things, by a concern that without it the NHS would again be overwhelmed.
Of course then much more water had flowed under more bridges. Do you think that later in the pandemic there was a clear sense amongst decision-makers of what NHS overwhelm actually meant?
Lord Simon Stevens: Yes, in the sense of – look, I mean, if you’re confronted with the situation where you have, say, 100,000 hospitals beds in England and you’re being told that, if the pandemic runs out of control, you might need between 200,000 and 800,000 then, you know, that’s orders of magnitude above what can be created. You cannot clone a new NHS in eight to 12 weeks and you were certainly can’t clone seven of them, and, by the way, nor can any other country, and the same exact issues were being confronted in France and Germany and Spain in winter 2021 as well.
So that’s, I think, the, sort of, first point to make. The second point to make though is that, by the time we got to autumn 2020, actually we obviously knew a lot more about the virus, hospitals had done a lot of work to create the ability to turn on so-called surge capacity, extra critical care or other beds, as cases rose, and we had new treatments for Covid, and so forth.
So taking, as it were, England as the unit of analysis and saying just is the NHS overwhelmed or not overwhelmed in a binary way kind of misses the point because, actually, you have a graduated set of negative impacts as Covid pressures increase on the NHS. But I would make another point as well, which is that I personally do not think solely viewing the amount of Covid through the lens of whether or not there are NHS beds to cope for severely ill patients is by itself the right lens because, even with unlimited hospital capacity, if you have large amounts of coronavirus for vulnerable people, lots of people will still die.
So the right question is: how do you control the increase in the numbers infected, not just how do you match the number of people who are going to be very, very ill to the number of hospital beds?
Counsel Inquiry: Thank you. As you say, that’s a point which you develop in your witness statement and it’s what I wanted to ask you about, which is: did you feel that taking the risk of NHS being overwhelmed as, if you like, the switch, the trigger for lockdowns was the right approach for the government to take?
Lord Simon Stevens: Well, it was clearly highly desirable to avoid a situation where ill patients weren’t able to get the healthcare that they would benefit from, and we did, I think, for the most part achieve that. But by itself that, if you’re interested in saving lives, is not the only goal.
Counsel Inquiry: Let me take you, please, to a different issue, and it is the question of the discharge of patients from hospitals into the community, into care homes, in March 2020.
Now, as you know, that’s a set of issues which has already been, amongst other things, the subject of litigation, and it will also be addressed in a module of this Inquiry, so I don’t want to go into it in any detail. But there is one issue that is raised in Mr Johnson’s witness statement for this module, and which you touch on as well, and so I’d like to address that, please.
Can we do it by going to Mr Johnson’s witness statement. Excellent, we have it on the screen. It’s paragraphs 330 to 331. So starting at the bottom of the page, we see that Mr Johnson notes that, on 17 March Cabinet meeting, there was a note that over 30,000 patients were imminently expected to be discharged from hospital and into social care.
If we can go over the page –
Lord Simon Stevens: Yeah, just to clarify, it wasn’t that number – I wasn’t at that meeting but I do see that the full Cabinet did discuss that question before the policy was announced, yes, on 17 March.
Counsel Inquiry: This is really just setting up, Lord Stevens, Mr Johnson’s evidence and then I’m going to ask you about it. So he describes, as we can see, on 22 March, being provided with a copy of a DHSC document, Covid-19 response was discussed, there was an estimate in that document that:
“… between 12,500 and 15,000 hospital beds could be freed by postponing non-urgent elective operations, and that potentially 15,000 further acute beds were being occupied by patients awaiting discharge or with lengths of stay over 21 days …”
Lord Simon Stevens: Can I just clarify one point, sorry. Although that may well have been in the Department of Health and Social Care’s draft on 22 March, that information had already been presented to and discussed with the Prime Minister on 12 March.
Counsel Inquiry: I’m not – it’s quite a high level point I want to take you, Lord Stevens, so don’t worry too much about the chronology or the dates, sorry, or the numbers.
If we can go to the next paragraph, please, it’s really this that is the core of it. Mr Johnson’s position, he says:
“It was very frustrating to think that we were being forced to extreme measures to lock down the country and protect the NHS [as we’ve said, protect it from an overwhelm] – because the NHS and social services had failed to grip the decades old problem of delayed discharges, [he says] commonly known as bed blocking.”
And he says that before the pandemic began he was trying to address that. That’s the point –
Lord Simon Stevens: Right.
Counsel Inquiry: – whether, if you like, I think as Mr Johnson might say, he’d been painted into a corner of having to have a lockdown, in part because of the people he describes as bed blockers, and that’s something that you address in your witness statement, and perhaps we can go to that, please, on page 12 and footnote 9.
We really will have to –
Lord Simon Stevens: Reading spectacles at this point, yes.
Counsel Inquiry: I mean, Lord Stevens, this is the part of your statement where you address that assertion.
Lord Simon Stevens: Yeah.
Counsel Inquiry: And, in summary, you don’t accept it. Let’s not read that out, but you tell us in your own words what your response to Mr Johnson’s line is.
Lord Simon Stevens: Well, I think Boris Johnson is right to point to the fact that there have been long-standing problems with the availability of social care that has often meant that patients end up stuck in hospital when they could be being looked after at home. That is without a doubt correct. However, if you think about his suggestion just a moment, even if you accept that there were 30,000 hospital beds full in that way, which I think is certainly at the high end of what most people would estimate, but even if you think it’s 30,000, we, and indeed he, were being told that if action was not taken on reducing the spread of coronavirus, there wouldn’t be 30,000 hospital in-patients, there would be maybe 200,000 or 800,000 hospital in-patients. So you can’t say that you would be able to deal with 2 – or 800,000 in-patients by reference to 30,000 blocked beds. So I don’t think the maths works.
I mean, another way of saying it is, even if all of those 30,000 beds were freed up, for every one coronavirus patient who was then admitted to that bed, there would be another five patients who needed that care but weren’t able to get it. So, no, I don’t think that is a fair statement describing the decision calculus for the first wave. And by the way, I think when you look at the second wave, when actually a lot of these problems have been addressed by the Treasury funding a lot more community health services and social care, getting rid of the means testing, so in a sense that problem had been significantly addressed, the Prime Minister still decided to have second and third lockdowns, with this problem having been substantially resolved. So for both reasons I think that is – that suggestion doesn’t stand up to scrutiny.
Counsel Inquiry: Thank you.
Another issue, please, and this time it’s a question about PPE.
Lady Hallett: I think I’m getting that I’m being asked to take a break now.
Mr O’Connor: My Lady, certainly.
Lady Hallett: I hope you were warned, Lord Stevens, that we take regular breaks. I shall return at 11.25.
(11.10 am)
(A short break)
(11.25 am)
Lady Hallett: Mr O’Connor.
Mr O’Connor: Lord Stevens, I want finally to ask you a set of questions about PPE. I think I may have said that before the break. With the same caveat as the questions about the discharge of patients in March in the sense that, of course, detailed issues about PPE will be covered in another module. But this just picks up on some evidence that Helen MacNamara gave yesterday.
So if we could go to Helen MacNamara’s statement, please, INQ000273841, page 53, paragraph 104.
When it comes up on screen, Lord Stevens, we will see that this is a part of Ms MacNamara’s statement where she is describing various initiatives she took in the early months of the pandemic to try to effect certain changes, encourage issues to be addressed.
We will see, about halfway down this paragraph, one of those issues that she became concerned about related to what she describes as “the inadequacies of PPE for women”. She says she tried to make sure this was taken into account in any new supply.
Lord Simon Stevens: Mm-hm.
Counsel Inquiry: She gave evidence about that orally yesterday, and we looked at an internal email in which she raised this issue in March – sorry, in mid-April, with Simon Ridley and Mary Jones within the Cabinet Office, and that she was then told by another official within Downing Street, Cleo Watson, on 30 April that the matter had been raised, and her evidence, as you can see, is that it was the Prime Minister who raised this issue with you on April 30, 2020, and that you reassured the Prime Minister and ministers that the issues with PPE fitting women’s bodies were misreported and that there wasn’t a problem.
Do you recall that?
Lord Simon Stevens: Well, first of all, Helen was absolutely right to raise this issue, because there were real concerns and we were very concerned about it, and we were taking action. So she raised it within the Cabinet Office, as you say.
As it happens, we were already acting and in fact a week before this meeting the Chief Nursing Officer, the National Medical Director for the NHS, had written to every head of nursing, every medical director, every chief executive in the country on this very issue of fit testing to make sure that it was being done properly and that the issues that Helen describes were taken into account.
So it certainly wasn’t something that took the Prime Minister on 30 April to raise, it was already being specifically addressed and we were very concerned about it.
As to the specific – as to my remarks in the meeting, I think I take it from what Helen said that she wasn’t at the session itself, so that’s not what I actually said, and if we could pull up the minutes of the meeting then I think that will be – will show itself. So it’s actually INQ000088643 on page 7.
Counsel Inquiry: Sorry to interrupt you.
Lord Simon Stevens: Right.
Counsel Inquiry: But as far as I’m aware, we haven’t –
Lord Simon Stevens: It’s on your system. Can I just at least read it, then, even if you’re not going to pull it up?
Counsel Inquiry: Yes, that’s what I was going to suggest.
Lord Simon Stevens: So actually the Cabinet Office’s own minutes of that meeting say, first of all, that the permanent secretary at the Department of Health and Social Care responded on the availability of PPE, given that the Department of Health and Social Care has responsibility for securing PPE for the NHS, and then it goes on to say:
“The chief executive for the National Health Service said there was ongoing work to investigate the suitability of PPE for all those using it, and testing to make sure it was suitable for women, for those who are black, Asian and from minority ethnic backgrounds, and those with different face shapes or facial hair.”
So I think the Cabinet Office’s own records show that what is attributed to me second-hand is not actually what I said at the meeting.
Counsel Inquiry: Well, that’s very helpful, and – so the answer that you gave to the Prime Minister was perhaps a holding response, saying that there was a problem but that you were looking into it?
Lord Simon Stevens: Yes, and the minutes of the meeting as well from the Cabinet Office set a specific action, which was that the Department of Health and Social Care should confirm that PPE had been procured and was fit for purpose for staff in response to reports that gowns did not fasten as they were too small and that certain items did not fit women. So this was specifically being addressed.
Counsel Inquiry: What we know, and we can see in other evidence, is that in fact this issue of misfitting PPE continued to be a problem for weeks, months, even years afterwards, didn’t it, Lord Stevens?
Lord Simon Stevens: I don’t know about years, but it definitely was a problem as a result of the short supply of PPE overall, with the result that it was often very difficult for DHSC to get sufficient range of masks in different locations at the right time. There’s no doubt about that.
Counsel Inquiry: Well, just finally let’s look at one last document, which is INQ000097875.
A letter written by the BMA to the chief executive of Public Health England, so to be clear not either you or your organisation, but dated January 2021, not quite a year after that meeting.
If we can go to the second page, please, we see the last substantive paragraph:
“We have written separately to DHSC to raise concerns about PPE failing to meet the diverse needs of the medical workforce – in particular, that many female doctors have reported struggling to find respiratory masks that pass fit testing.”
So the message that you had given to the Prime Minister that this was being looked at, I think that’s a fair summary of the minutes?
Lord Simon Stevens: Well, not just looked at, that action was being taken to try to resolve the problem, given the pressures on the supply of PPE, yes.
Counsel Inquiry: And was action still being taken to try to resolve the problem all those months later in January 2021, Lord Stevens?
Lord Simon Stevens: Well, as you say, that was not – a letter I don’t think I saw, because it was sent to Public Health England. And I think the specific point that Dr Nagpul is raising in that letter is whether or not there should be a change in the rules or the recommendations for what type of PPE should be being worn. I think he specifically says that in the letter. And I’m sure the reason this was addressed to Public Health England is they set those rules and then everybody else sough to follow them.
Mr O’Connor: Yes. Thank you very much, Lord Stevens.
Thank you, my Lady. There are some questions to be asked by core participants.
Lady Hallett: Thank you.
Mr Weatherby.
Questions From Mr Weatherby KC
Mr Weatherby: Thank you very much.
Lord Stevens, I am going to ask you questions about that final topic on behalf of the Covid Bereaved Families for Justice UK.
Lord Simon Stevens: Yeah.
Mr Weatherby KC: Just picking up on that, your answer to Mr O’Connor, regarding the lack of appropriate fitting PPE for women but also for people from black and ethnic minority workforce, is that, by the time it’s raised with you, there’s ongoing work; is that right?
Lord Simon Stevens: Well, I think – yes, essentially, yeah.
Mr Weatherby KC: Okay. So there’s two issues here. First of all, in January and February 2020 NHS England did a stocktake, I think, of PPE; is that right?
Lord Simon Stevens: No, I think that was Public Health England and the Department of Health and Social Care because Public Health England was responsible for creating and overseeing the PPE stockpile that supposedly would be sufficient if a pandemic struck and we all now know it wasn’t.
Mr Weatherby KC: It wasn’t sufficient?
Lord Simon Stevens: Correct.
Mr Weatherby KC: Yes, and as the chief executive of NHS England that would be a major concern to you –
Lord Simon Stevens: Yes.
Mr Weatherby KC: – and of great relevance, whoever did the stocktaking?
Lord Simon Stevens: Absolutely.
Mr Weatherby KC: So that’s sufficiency, first of all, it’s insufficient, but this point about fitting face masks, and also training to use PPE, is a further important point, isn’t it?
Lord Simon Stevens: Yes.
Mr Weatherby KC: So it’s sufficiency on the one hand but also, even if you have lots of it, if it doesn’t fit or if your staff don’t know how to use it, then that’s an additional problem?
Lord Simon Stevens: It is, although the two points are somewhat related, in that if you can’t be certain of getting the same type of face mask or PPE with each delivery, because there’s a shortage, then that is probably one of the root causes of the problems that I think you’re describing.
Mr Weatherby KC: Yes, so if you know about the problem in advance, then the sufficiency of different types of PPE should be catered for?
Lord Simon Stevens: Absolutely.
Mr Weatherby KC: Yes.
Lord Simon Stevens: Now, of course, as you know, what was actually happening at this time was there was a worldwide scramble for PPE, given that the –
Mr Weatherby KC: Yes.
Lord Simon Stevens: – UK stockpile was not sufficient –
Mr Weatherby KC: Yes.
Lord Simon Stevens: – and the Department of Health and Social Care, the Cabinet Office, the Department for International Trade went on a huge buying spree to try and secure us the PPE we needed.
Mr Weatherby KC: Yes. So at this point, the stable door was open and the position was trying to be recovered –
Lord Simon Stevens: Yes.
Mr Weatherby KC: – and it was difficult because there wasn’t PPE available, even if you knew what you needed?
Lord Simon Stevens: Yes, I mean, I think the national position and the National Audit Office had looked at this and I think their conclusion was that no individual item had a national stock-out –
Mr Weatherby KC: Yes.
Lord Simon Stevens: – but I think that’s only part of the story, because obviously, if you’re really up against it, then the ability to get PPE to where it’s needed at the right time for the right person is much harder.
Mr Weatherby KC: Yes, and the management of it is something that no doubt the Inquiry will be going into, as Mr O’Connor indicated, in a future module, but an important point.
It’s right, I think, that in 2016 NERVTAG had made a formal recommendation to the Department of Health that there should be a rolling NHS programme for the fit testing of respirators, FFP3 masks, effectively as an important part of infection control. That’s right, isn’t it?
Lord Simon Stevens: I’d need to see the NERVTAG papers.
Mr Weatherby KC: Okay.
Lord Simon Stevens: I’m not disputing that but I would need to see them, yes.
Mr Weatherby KC: As the chief executive NHS, this is something directly relevant to you, let me put it up on the screen –
Lord Simon Stevens: Thank you, yeah.
Mr Weatherby KC: – and hopefully that will jog your memory.
INQ000022737, please.
And, as you can see, the heading of it “NERVTAG Sub-committee on the pandemic influenza”, so directly related to pandemics and face masks and respirators stockpile, and then formal recommendations to the Department of Health, and I’ll try to deal with this quickly but, if we can go to page 2 – I’m so sorry, it’s the bottom of page 1 and then 2. Have you got that?
So under “Discussion points” and “Stockpile”:
“Fit testing in the face of an emerging pandemic is a major challenge …”
Then, going over the page, the point I’m trying to get to is the first bullet point:
“Just in time fit testing was proposed – however, there may not be sufficient time to put this in place, between pandemic virus emergence and the first UK impact. It was agreed that there is no substitute for a rolling programme of fit-testing in NHS trusts during inter-pandemic periods. There should be a caveat about fit testing in any recommendations.”
Okay? Does that help you in terms of the knowledge about this?
Lord Simon Stevens: Well, I mean, this is the first time I’m seeing this document, but yes, I can read what you have put up there.
Mr Weatherby KC: But you were chief executive from 2014 –
Lord Simon Stevens: Sure, but this was a document I think to Public Health England and the Department of Health and Social Care, wasn’t it?
Mr Weatherby KC: I fully take that point.
Lord Simon Stevens: Sure.
Mr Weatherby KC: It directly relates to the NHS. It’s a recommendation that the fit testing rolling programme should take place across the NHS and you’re the chief executive.
Lord Simon Stevens: Yeah, it may well be, but I do not want to give you an answer that is not fact based. I can certainly ask that question and make sure you get that answer –
Mr Weatherby KC: Okay –
Lord Simon Stevens: But clearly, just really skimming this document now and seeing it for the first time –
Mr Weatherby KC: Yes.
Lord Simon Stevens: – it appears to be suggesting that fit testing was obviously specifically confined to intensive care units. The issue with Covid was obviously that it was a much wider set of requirements –
Mr Weatherby KC: Yes, but it’s?
Lord Simon Stevens: – and, frankly, the pandemic planning for influenza flu was wide of the mark for the sort of PPE requirements that Covid brought about.
Mr Weatherby KC: Yes, Lord Stevens, this is a document related to pandemic flu, it’s related to PPE, it’s related to a recommendation for a rolling programme across the NHS –
Lord Simon Stevens: Sure, but the point –
Mr Weatherby KC: – did you know about that recommendation or the issue –
Lord Simon Stevens: I didn’t about that specific recommendation –
Mr Weatherby KC: Yes.
Lord Simon Stevens: – but, just to be clear, the recommendation in respect of pandemic flu, it was a completely different set of PPE requirements, well not completely but substantially different, and the type of staff who would be involved in this type of fit testing, as I think this document itself suggests, were different than what we ended up with. So, look, there’s no doubt –
Mr Weatherby KC: Yes, we’re talking about respirators for a respiratory virus.
Lord Simon Stevens: Yeah, I mean, I’m talking about the aerosol generating procedures but also the use of these PPE in far wider settings than frankly was envisaged for the flu stockpile and that’s one of the great misjudgements, essentially, that was made and resulted in the fact that, when Covid struck, we did not, as a country, have the PPE that we needed.
Mr Weatherby KC: Okay, let me just focus my question then. You told us that, by the time it’s raised with you in April 2020, there was ongoing consideration about fit testing and the propriety of the types of PPE that you had. Was there a rolling programme of respiratory fit testing during the period from 2016 to 2020?
Lord Simon Stevens: Well, I think it’s likely there would have been in those parts of hospitals and health services that were using that PPE but, as I say, I don’t want to speculate, let’s find out the facts and get those to you.
Mr Weatherby KC: Yes, okay, well, that’s very helpful, it’s just that, when you said there was ongoing work, you obviously did look into this in April 2020 so –
Lord Simon Stevens: Yeah, that was ongoing work as had been recommended for Covid.
Mr Weatherby KC: Yes, I understand that but did you understand when that ongoing work had started?
Lord Simon Stevens: Well, this was specifically in response to Covid where a far wider group of health service staff were needing PPE.
Mr Weatherby KC: Yes.
Lord Simon Stevens: So I think that’s what the Chief Nursing Officer and the National Medical Director were focusing on.
Mr Weatherby KC: Of course the context is Covid, that’s what you were dealing with –
Lord Simon Stevens: Yeah.
Mr Weatherby KC: – but it was about respiratory – respirators and other PPE, which went rather beyond Covid, didn’t it?
Lord Simon Stevens: Well, as you know, there was a live and indeed ongoing debate, which I was not directly involved with, but a scientific debate as to the circumstances under which it was appropriate to use the type 2R mask as against the FFP3 –
Mr Weatherby KC: Yes, okay –
Lord Simon Stevens: Masks and I think it’s the FFP3 masks that you’re referring to specifically here.
Mr Weatherby KC: Well, I think that’s something that possibly we’ll leave to a different module, the granular detail of it.
But finally this, had there been a rolling programme of fit testing across the NHS, do you agree with me that these problems with non-fitting PPE for women healthcare workers or black and minority ethnic healthcare workers would have been flagged up much earlier and would have been dealt with or should have been dealt with prior to the pandemic –
Lord Simon Stevens: No, I think almost the reverse, because if you were doing – if you were doing it in a situation where there was ample PPE supply because there wasn’t a pandemic on, you wouldn’t actually have detected the problem. It was only when the shortage arose that it was so evident that there was a problem.
Mr Weatherby: Those are my questions.
Lady Hallett: Thank you, Mr Weatherby.
Ms Harris.
Questions From Ms Harris
Ms Harris: Good morning, my Lady.
Lady Hallett: Good morning.
Ms Harris: Good morning, Lord Stevens.
Lord Simon Stevens: Good morning.
Ms Harris: I appear on behalf of Covid-19 Bereaved Families for Justice Cymru –
Lord Simon Stevens: Right.
Ms Harris: – representing bereaved families in Wales, and I would like to ask you some questions relating to just two areas, if I may.
First of all, in relation to hospital discharge, and this is said, as Mr O’Connor has already highlighted this morning, that the details in relation to discharge into care homes are going to be dealt with in another module, but they are to some extent dealt with in this module, and I wish to ask you about one particular aspect to do with the discussions that preceded the policy or the guidance in March 2020 with regards to discharge and the impact on social care settings.
You have – to introduce my question, I would just like to ask you to recall that in your witness statement at paragraphs 31 to 36 you have referred to a series of fora where there were discussions of the matter of measures to free up hospital capacity.
Lord Simon Stevens: Mm-hm.
Ms Harris: And you have referred – and that includes a discussion in Cabinet on 17 March. I think you said earlier that you didn’t attend that particular meeting. You’ve also referred to a meeting on 18 March 2020 with the Prime Minister. I don’t know whether you immediately recall that meeting. It might be helpful if you do recall whether you attended that particular meeting on 18 March.
Your reference to it, I think, is that it was specifically in relation to the matter of NHS resilience and a meeting on NHS resilience with the Prime Minister on 18 March 2020.
Lord Simon Stevens: Yeah, I mean, there had been meetings with the Prime Minister before that as well, so this question was, for example, also discussed with him and others on 12 March. I know it was discussed in the Department of Health and Social Care with Matt Hancock, with DHSC officials, some of the senior doctors in the department, social care advisers and so on.
Ms Harris: Thank you.
Lord Simon Stevens: But I was not at that 11 March meeting, I don’t believe.
Ms Harris: Thank you for that. And the guidance itself was published on 19 March, and that is referred to in your witness statement as the hospital discharge, the multi-agency hospital discharge guidance, and is it correct that the purpose was to secure swift discharge of hospital patients who were considered to be no longer in need of – to be in hospital, to secure their swift discharge, and this included envisaging that there would be a considerable number of individuals who would be discharged into social care, including, here, care homes?
Lord Simon Stevens: Not that more people would be discharged than would normally be the case, but just that the discharge would not be delayed in the way that, as we’ve discussed earlier this morning, was often the case.
Ms Harris: Thank you.
In terms of the impact of that guidance, I’m noting that in paragraph 32 you have quoted specifically:
“… ‘to free up hospital beds over 30,000 patients were expected to leave hospital into social care imminently’ …”
Lord Simon Stevens: I don’t think I’ve quoted that, because I think actually it was – the original modelling was that 15,000 of the bed capacity would be as a result of postponing routine surgery, and then, if it was possible to get better support for people at home and social care, which the government funded and changed the regulations on, then that would mean people who would have gone to social care and back home or care homes would be able to do so faster rather than slower, as had been happening up until then. So about half of that I think was attributed to the length of stay reduction, half of the 30,000.
Ms Harris: Thank you.
But in any event, it was part of the picture that was envisaged resulting from the guidance that there were going to be individuals discharged from hospital into care home settings?
Lord Simon Stevens: Well, people are obviously all – if people have been living in a care home then, when they’re ready to go home from hospital, they would return to their care homes. So it wasn’t a new group of people who would be going to care homes who would not otherwise have done so, it was just trying to take out some of the delays in the system. And indeed, of course, the actual number of people who returned from hospitals to care homes went down in this period, not up.
Ms Harris: If I could just pick up on one point there, there would be some new admissions to care homes as a result of this policy, would you not agree?
Lord Simon Stevens: I don’t agree, no, that there would be a higher number of people, newly or returning, going back to care homes, it’s just that the delays of being stuck in hospital would be reduced.
Ms Harris: But we’ve agreed in any event that there would be people who would be discharged from hospital into care homes?
Lord Simon Stevens: As always, yes.
Ms Harris: And the question arising out of this is: what discussions were you aware of or party to with regards to the risks for residents in care homes arising from discharge plans in terms of infection?
Lord Simon Stevens: Well, I think – as I say, I know there was a discussion at the Department of Health and Social Care with ministers and senior doctors on 11 March. I also know that over the following days there was a discussion about whether the risk was greatest if people were about to need hundreds of thousands of hospital beds and instead were going to, as we’d seen in northern Italy at that time, be left in hospital car parks dying – so there was a risk the hospital beds weren’t available. I think there was a related but separate decision that the Secretary of State took, which is: if you’re going to have testing, how should you allocate a limited number of tests? And I think the Secretary of State had said that he made that decision on 11 March as to who would be prioritised, and that did not include people being discharged into care homes. He did so on clinical advice, but that was the decision that he took.
Ms Harris: In the context of there not being testing, was there a discussion that you were aware of or were party to of the issue of possible asymptomatic cases of infectiousness going into care homes and the impact that that could have? Was that specific discussion had, about that specific type of risk?
Lord Simon Stevens: I understand, looking back on it, I – based on some of the materials that I’ve subsequently seen is that there was a discussion involving some of the senior clinicians and there was a balance of risk argument. I think they also contend that although the possibility of asymptomatic infection had been identified, it was not known how substantial a risk that was at that point in time. That is obviously something that there are conflicting views on and I’m sure, rightly, the Inquiry will want to look at that in very great detail when the Inquiry comes to care homes.
Ms Harris: So just to clarify, are you saying it was recognised that there was such a risk from asymptomatic discharges, even though there was uncertainty around the extent of asymptomatic infectiousness?
Lord Simon Stevens: I think potentially different people had different understandings of that and I don’t have a, you know, comprehensive overview as to who was saying what, but I think that was, in some senses, taken into account but whether it was appropriately taken into account that’s obviously something that, again, the Inquiry will have to look at very carefully.
Ms Harris: Yes, thank you.
Just on that question of whether it was appropriately taken into account, as you view matters, whose responsibility was it primarily to initiate consideration of the taking into account of that matter?
Lord Simon Stevens: Well, I think, as was referred to earlier, this is something that the High Court has independently looked at, and I can’t second-guess their judgment, their assessment was that it was reasonable for ministers to free up hospital capacity and it was reasonable for ministers to make the prioritisation of testing decisions that they did, but that what should have happened was clearer guidance to care homes about isolating people who were coming back to the care home. That’s what the court found.
I also defer to the medical evidence that is contained in the Chief Medical Officer’s review of this matter, and their assessment is that the majority of the infections that tragically entered care homes came from the community rather than from patients returning to them.
Ms Harris: Thank you, and I note – and I think I’m nearly at the end of my time, so I think I’ll have to finish very quickly on this – but it’s correct, isn’t it, that that report also does note – that very report which I know you have referred to in your witness statement, it does also note that there – some care home outbreaks were introduced or intensified by discharges from hospital?
Lord Simon Stevens: Yes, the report does say that. The overarching evidence, I think, is that, unfortunately, in any country where Covid is out of control in the community, it found its way into care homes, and that was true in many countries around the world.
Ms Harris: Thank you. I think I’ve come to the end of my time and many apologies if I went over. Thank you.
Lady Hallett: Thank you, Ms Harris.
Mr Metzer.
Questions From Mr Metzer KC
Mr Metzer: Thank you, my Lady.
Lord Stevens, I ask questions on one topic only, on behalf of the Long Covid groups.
Lord Simon Stevens: Right.
Mr Metzer KC: In your evidence, you said that solely viewing the amount of Covid through the lens of whether or not there were enough NHS beds was wrong and the right question, you said, was how you control the numbers of people infected. Linked to that, I wish to explore with you long-term morbidity from Covid-19 infection, which is another metric of harm in the pandemic.
NHS England announced the Your Covid Recovery platform on 5 July 2020, which was a platform to support patients suffering from prolonged symptoms after infection from Covid-19. Would it be right to say from this announcement that by July 2020 the NHS were concerned about the prevalence and risk of Long Covid?
Lord Simon Stevens: Yes.
Mr Metzer KC: Thank you. Would the NHS have been assisted by a public health messaging campaign on Long Covid at this time?
Lord Simon Stevens: So I think I’d break that question into two parts, if I might. There would be public messaging for people who might be experiencing what came to be known as Long Covid, so that they were able to come forward and engage with services. But perhaps the second part of your question is a different one, which is: would it have made sense for the Government to talk about the risks of Long Covid as a way of trying to encourage people to take action to limit the spread of the virus. Is that what your second – is that –
Mr Metzer KC: Yes, it’s really about the assistance that would be given to the NHS by messaging coming from the government.
Lord Simon Stevens: Well, I mean, the root cause of the problem obviously is the amount of Covid infection, so I think, you know, there was a clear understanding that less Covid is better.
Mr Metzer KC: Yes, but Long Covid comes from Covid infection.
Lord Simon Stevens: Indeed.
Mr Metzer KC: So do you agree that the NHS therefore would have been assisted by such a messaging campaign?
Lord Simon Stevens: Sort of reminding, telling people about the existence of Long Covid so people therefore were sort of appropriately cautious about their interactions? Is that the –
Mr Metzer KC: Yes.
Lord Simon Stevens: Is that the thought? Yeah, I mean, possibly, yes. I haven’t – I mean, possibly.
Mr Metzer KC: In August 2020, NHS England published a detailed briefing note on managing the long-term effects of Covid-19. The paper estimated that a significant number of the UK population will need some form of rehabilitation support for ongoing conditions over the year, and Long Covid is described as a new healthcare challenge requiring actions to strengthen NHS services to meet new demand.
Do you agree that by August 2020 the NHS were concerned that emerging evidence of longer term sequelae of Covid-19 would pose an additional cost to the NHS?
Lord Simon Stevens: Absolutely.
Mr Metzer KC: And was the new healthcare challenge and its associated cost communicated to Number 10 and the Cabinet Office?
Lord Simon Stevens: Well, inasmuch as we were making public announcements and they would have known we were making the announcements about the NHS services that were being responded, yes, I’m sure they would have been aware.
Mr Metzer KC: So assuming that your answer is you agree, how, if at all, did the decision-makers respond?
Lord Simon Stevens: Well, I think the Department of Health and Social Care shared our concern, and I know that senior clinicians, ministers, over the summer and into the autumn, were also engaging with the question of Long Covid and how appropriately to support, and there was a sort of active dialogue between the Department of Health and Social Care and us in the NHS about what that should look like. I can’t say what the discussion was between them and the centre of government though.
Mr Metzer KC: So does that mean you’re not able to say how the decision-makers, those in Number 10 and the Cabinet Office, responded?
Lord Simon Stevens: That’s right.
Mr Metzer: Thank you very much, Lord Stevens.
Thank you, my Lady.
Lady Hallett: Mr Dayle.
Questions From Mr Dayle
Mr Dayle: Thank you, my Lady.
Lord Stevens, I ask questions on behalf of FEHMO, the Federation of Ethnic Minority Healthcare Organisations. One of FEHMO’s main concerns is about the UK’s pandemic response, and what it perceives as a seeming lack of urgent, centralised and coherent programmatic response to the spectre of disproportionate deaths of black, Asian and minority ethnic healthcare workers and their wider communities, and certainly at the early stages of the pandemic. As such, I have four discrete sets of questions for you, and my first question is: when did it become clear that black, Asian and ethnic minority communities were disproportionately being affected by Covid-19, specifically in terms of the death rates?
Lord Simon Stevens: I think – sorry, I’m not quite sure what I – I don’t want to turn my back to you.
Mr Dayle: Certainly. It’s not impolite. That’s been established.
Lady Hallett: I don’t want you turn away because of the microphones, Lord Stevens.
So you won’t consider it an insult, will you Mr Dayle?
Lord Simon Stevens: Right.
I think the answer to your question is sort of early spring, and to be precise, more precise about it, I know that, for example, on 9 April 2020 the NHS National Medical Director, Professor Stephen Powis, having seen some of those emerging figures, as you rightly describe, raised the concern about the disproportionate impact at the senior clinicians group, and on the strength of that, I believe that Chris Whitty, the Chief Medical Officer, commissioned Public Health England to investigate more fully.
Mr Dayle: And that speaks to sort of an investigatory response for perhaps a more reflective response to this phenomenon. I want to button down on that in particular and ask you: do you consider that there was a timely response to this phenomenon?
Lord Simon Stevens: Well, in terms of what the health service was doing, I think this matter was raised with me at about the same time as Steve Powis discussed it with those other senior clinicians, and in fact I had a very important letter from a group that I respect immensely called BAPIO, the British Association of Physicians of Indian Origin, again probably around maybe 9 April, something like that, and also from Dr Chaand Nagpaul at the BMA, and so I pretty immediately convened a meeting to – with them and other stakeholders to say what do we think’s going on, what is the action that is needed, and we held that meeting on 15 April 2020.
Mr Dayle: From your vantage point, was there an escalation of concerns around this issue, and in answer to Mr O’Connor’s questions, you spoke about regular meetings with the Prime Minister, for example. Was there an escalation in terms of how this issue was addressed or what the response was?
Lord Simon Stevens: Well, I think there are maybe – there’s an element that obviously relates to what we were seeing in the NHS and then there’s an element that relates to the information that people like Public Health England and others were showing about in the community, the disproportionate impact on people who were getting Covid and dying. In terms of the first of those, what we were doing in the NHS – obviously we were able to take action in respect of the second of those, the broader impact on the community – I think that is a question that I can’t answer, and that’s probably a question for, you know, the Department of Health or Public Health England as to the extent to which the centre of government was having a policy discussion with them about that. I don’t know.
Mr Dayle: And finally, can you tell us about any specific targeted intervention that was put in place in those early months to address disproportionate death rates among black, Asian and minority ethnic communities?
Lord Simon Stevens: So within the NHS, on 17 March, we asked every part of the NHS to make sure that staff at higher risk of Covid and having a bad outcome from it were identified and were able to work in lower risk areas. We followed that up on 29 April and 30 April with a request that specific risk assessments be done across the service, and then, at the same time, I think I commissioned Professor Kamlesh Khunti from the University of Leicester with colleagues to identify specific risk reduction frameworks that would take account of the extra risk that appeared to be in place for minority ethnic staff. And that was produced in combination, I think, with the Faculty of Occupational Medicine.
Mr Dayle: Thank you. Thank you, Lord Stevens.
Thank you, my Lady.
Lady Hallett: Thank you, Mr Dayle.
Mr O’Connor: My Lady, those are all the questions for Lord Stevens.
Lady Hallett: Thank you very much indeed, Lord Stevens, thank you for your help.
The Witness: Thank you.
(The witness withdrew)
Lady Hallett: I’m not going to rise but I’m told that the stenographer would like – so we’ll take our time in the handover.
(Pause)
Mr Keith: My Lady, the next witness –
Lady Hallett: No, you’re not allowed to say anything. I’m giving the stenographer a rest.
(Pause)
Lady Hallett: Right.