As the Covid inquiry has unfolded, startling revelations have emerged, among them, former health secretary Matt Hancock’s belief that the onus was on him to decide the fate of patients if the National Health Service (NHS) became inundated with cases.
In his testimony, Sir Simon Stevens, the erstwhile head of NHS England, conveyed Hancock’s conviction that he, rather than medical professionals or the public, should determine the preference for patient care if the hospitals reached full capacity. Describing the scenario, Stevens reflected, “Fortunately this dreadful predicament did not materialise.”
In the face of this conundrum, Stevens held the view, “The health and social care secretary thought that he, not the medical profession or the public, should ultimately resolve who should survive and who should perish.”
He was quick to dissuade this approach, adding, “Except in extraordinary circumstances, I wanted to deter the thinking that a single secretary of state should determine how care should be dispensed. I was convinced that we were adequately served by health professionals who, in consultation with patients as much as possible, should make these decisions.”
Stevens retired as the chief executive of NHS England in the summer of 2021.
He also dismissed assertions by then-Prime Minister Boris Johnson, who expressed in his submission to the inquiry, profound frustration of needing to enforce lockdown owing to the failure of the NHS and social care to tackle the longstanding issue of delayed discharges. This situation arises when patients ready for discharge remain in hospital due to insufficient community support. According to Johnson, approximately 30% of beds were occupied under such circumstances.
In response, Stevens highlighted that this would imply almost 30,000 occupied beds. However, under a fairly worst-case scenario, there could have been around 200,000 to 800,000 patients in need of a bed. Stevens countered, “Suppose all those 30,000 beds were made available, for every single COVID-19 patient admitted, there would be another five needing that care but were unable to obtain it. Clearly, I do not see this as a fair rationale for the decision-making during the initial wave.”
