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Former UK health secretary Matt Hancock wanted the right to decide “who should live and who should die” if hospitals were overwhelmed with patients suffering from Covid-19, the ex-head of NHS England has said.

Lord Simon Stevens told the official inquiry into the pandemic on Thursday he sought in 2020 to “discourage the idea” that a government minister should decide how the NHS treated people during a national health crisis.

In his witness statement, Stevens said there was “an unresolved but fundamental ethical debate” about how hospitals would decide who to treat if they were overwhelmed by Covid-19 patients.

Referring to a government planning meeting in February 2020, he said: “The secretary of state for health and social care took the position that in this situation he — rather than, say, the medical profession or the public — should ultimately decide who should live and who should die.”

He added: “Fortunately this horrible dilemma never crystallised.”

Stevens’ remarks add to the string of damaging revelations from the inquiry about Britain’s response to coronavirus under Boris Johnson, who served as prime minister between 2019 and 2022.

The inquiry is examining the government’s response, including the UK’s preparedness and senior decision-making, and is due to run until the summer of 2026.

In oral evidence on Thursday, Stevens said he “certainly wanted to discourage the idea” that a minister would decide how care should be provided “other than in the most exceptional circumstances”.

He said he felt the NHS was “well served by the medical profession” in making such decisions.

Matt Hancock
Former UK health secretary Matt Hancock during the pandemic © Pippa Fowles/No10 Downing Street

The remarks came as the inquiry was shown an extract from Johnson’s written evidence, in which the former prime minister claimed the NHS’s failure to “grip” the issue of “bed blocking” had forced him to impose the first national lockdown in March 2020.

Stevens told the inquiry the NHS was being advised that if no action was taken to slow the spread of the virus, “there wouldn’t be 30,000 hospital inpatients, there would be maybe 200,000 or 800,000 hospital inpatients”.

He added: “You can’t say that you would be able to deal with 200,000 or 800,000 inpatients by reference to 30,000 blocked beds.

The inquiry was also told that in diary entries submitted as evidence, Sir Patrick Vallance, the government’s former chief scientific adviser, had described the health department as “ungovernable”.

Hugo Keith KC, lead counsel for the inquiry, said Vallance had “expressed on multiple occasions in his evening notes” that he had observed “chaos” and “operational mess”. 

On Thursday, the inquiry was also shown an exchange in which Britain’s former top civil servant Lord Mark Sedwill compared Covid-19 to chickenpox. 

“I don’t think PM & Co have internalised yet the distinction between minimising mortality and not trying to stop most people getting it”, he wrote on March 12, 2020.

“Indeed presumably like chickenpox we want people to get it and develop herd immunity before the next wave,” Sedwill added.

The inquiry was on Tuesday shown messages from 2020 in which Dominic Cummings, Johnson’s former chief adviser, warned that Hancock was “unfit for this job” and had “killed people”.

A spokesperson for Hancock said: “Mr Hancock has supported the inquiry throughout and will respond to all questions when he gives his evidence.”

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