The two most senior health officials at the time of the pandemic have revealed to the Covid inquiry more details on the government’s lack of planning, exasperation with the focus on blame, and ethical rows surrounding life-and-death decisions. Here are some of the key passages from their evidence. Simon Stevens refused Boris Johnson’s offer to lead reform of social care after failing to get commitments on funding and ambition The former NHS chief executive told the Covid inquiry that in 2020 he was invited by the prime minister to lead the government’s manifesto commitment to reform social care. He said he turned down the job after his suggestions about the scale, funding and need for cross-party agreement “did not find favour” with Johnson. He said: “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. “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 increase and the social care workforce was addressed. I was clear that I didn’t think this could be done just as a private Whitehall process, as 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.” Matt Hancock and Dominic Cummings tried to sack the head of the NHS at the start of the pandemic behind his back Andrew O’Connor, counsel to the inquiry, asked Stevens whether Hancock and others had encouraged him to resign. “Not to my face, anyway,” Stevens replied. The inquiry was then shown WhatsApp exchanges of Cummings and Hancock plotting against Stevens. On 21 January 2020, Cummings asked: “Where are we with SS?” Hancock: “It’s in train. I am first getting [NHS England board member and ex-Labour health minister] Ara Darzi to persuade him it’s in his best interests to go now. If that doesn’t work I’ll move directly.” On 3 February 2020, Cummings asked: “When SS off?” Hancock: “Wanted to talk to you about this in the margins of meeting tmw. 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?” Cummings: “We must get on with it now. Announce next week as part of reshuffle frenzy and it will all get lost in that.” After being shown these messages, Stevens told the inquiry: “Lord Darzi has said on the record that is not correct. And I think his word is that is ‘misinformation’. So he did not seek to persuade me in the way that’s described here.” O’Connor asked: “There was no sense in which you were somehow defying them in staying in your role in January, February 2020?” Stevens replied: “No”. Stevens was shown a message from Cummings complaining about him “bullshitting”. O’Connor asked: “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?” Stevens said: “Well, by the standards of Dominic Cummings adjectives, that’s one of his gentler epithets.” Matt Hancock thought he should decide who would live or die if the NHS was overwhelmed In his witness statement, Stevens said Hancock thought that if decisions had to be taken about who would live and who would die, that should be a ministerial matter rather than for clinicians. The former health secretary Jeremy Hunt had come to a different view in a previous planning exercise about a flu pandemic, the inquiry heard. In his written evidence, Stevens said: “[There was] 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 for health and social care took the position that in this situation he – rather than, say, the medical profession or the public – should ultimately decide who should live and who should die. Fortunately, this horrible dilemma never crystalised.” Stevens told the inquiry: “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, in making those kinds of decisions.” The most senior health civil servant said there was too much attention on a ‘blame game’ at start of pandemic Chris Wormald, the permanent secretary of the Department of Health and Social Care, said he had not realised how many people in government felt Matt Hancock had lied. He said: “I knew that there was some toxic relations between the Cabinet Office and No 10 and the secretary of state [for health]. What has come out very clearly from your witnesses is it was much more widespread and much more toxic than I knew at the time. And had I known at the time, that would be a big worry. “One of my reflections so far on the evidence that the inquiry has heard is the amount of time and energy that appears to be taken up very early in the pandemic on the blame game. That energy would clearly much better have been better spent solving the problems that the pandemic was bringing.” Boris Johnson had doubts about whether lockdown did more harm than good In the prime minister’s written evidence shown to the inquiry, he wrote: “I would be surprised if I ever said that I had been manipulated or pushed into the first lockdown, or that I had been gamed on the numbers or anything of this effect. I have no recollection of this. It is true that I have reflected (no doubt out loud and no doubt many times) about whether the lockdowns would do (and did do) more harm than good. I believe that it was the duty of any pragmatic and responsible leader to have such a debate both with himself and with colleagues. We were between a rock and a hard place, the devil and the deep blue sea. We simply had no choices, and it was necessary at all times to weigh up the harms that any choice would cause. I was very worried about the economic harm caused by the action we took against Covid 19 and whether it would do more damage to the country than the virus itself. But I always attached the highest priority to human life and public health.” The cabinet secretary and Wormald advocated chickenpox parties in mid March 2020 Messages between the cabinet secretary, Mark Sedwill, and Wormald showed they were both arguing for a herd immunity strategy. In an exchange on 12 March 2020, Sedwill said: “I was v struck by your point about differential mortality rates between healthy and sick. I don’t think PM & Co have internalised yet the distinction between minimising mortality and not trying to stop most people getting it. Indeed presumably like chicken pox we want people to get it and develop herd immunity before the next wave, we just want them not to get it all at once and preferably when it’s warm and dry etc. So alongside the measures to achieve that, our driving focus should be on those most likely to die of it. Agree?” Wormald replied: “Exactly right. We make the point every meeting, they don’t quite get it.” Johnson’s frustration about bedblocking during Covid was unfair, Stevens claimed In his evidence to the inquiry, the former prime minister wrote: “It was very frustrating to think that we were being forced to extreme measures to lock down the country and protect the NHS – because the NHS and social services had failed to grip the decades-old problem of delayed discharges, commonly known as bedblocking. Before the pandemic began I was doing regular tours of hospitals and finding that about 30% of patients did not strictly need to be in acute sector beds.” Responding to this evidence, Stevens said Johnson’s calculations were wrong. He said: “Even if you accept that there were 30,000 hospital beds full in that way, which is at the high end of what most people would estimate, 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 inpatients, there would be maybe 200,000 or 800,000 hospital inpatients. So you can’t say that you would be able to deal with 800,000 inpatients by reference to 30,000 blocked beds. So I don’t think the maths works … I don’t think that is a fair statement in describing the decision calculus for the first wave.” Cobra meetings were not optimal and were avoided by cabinet members when chaired by Hancock Stevens said senior ministers “sometimes avoided” Cobra meetings in the early days of the pandemic when they were chaired by Matt Hancock. He added: “I think it’s very likely that if the prime minister had chaired those Cobras, then other secretaries of state would have chosen to go as well.” In his witness statement, Stevens said: “These meetings were arguably not optimally effective. They were very large, and when Cobra meetings were chaired by the health and social care secretary other secretaries of state sometimes avoided attending and delegated to their junior ministers instead.”