Inquiry hears of older people ‘cull' as Matt Hancock defends care home policies
There were tense exchanges as the former health secretary returned to give evidence to the wide-ranging probe, this time focused on the adult social care sector.
Mr Hancock, who resigned from government in 2021 after admitting to breaking social distancing guidance by having an affair with a colleague, responded to an accusation he had 'blatantly lied about the situation with care homes'.
At a Downing Street press conference on May 15 2020, Mr Hancock said: 'Right from the start, we've tried to throw a protective ring around our care homes.'
Bereaved families have previously called the phrase a 'sickening lie' and a 'joke'.
The inquiry has heard there were more than 43,000 deaths involving the virus in care homes across the UK between March 2020 and July 2022, and a civil servant was quoted earlier this week describing the toll as a 'generational slaughter within care homes'.
On Wednesday, remarks were read to the inquiry from an anonymous witness, who accused Mr Hancock of not being heartfelt or having a proper understanding of the situation care homes were in during the pandemic.
Counsel to the inquiry Jacqueline Carey KC, who gave no further information on the person's identity or their role, said: 'One person in particular said 'He (Mr Hancock) blatantly lied about the situation with care homes, there was no blanket of protection. We were left to sail our own ships. He wasn't heartfelt. He had no understanding or appreciation of the challenges care homes face, pandemic or not, it felt like we were the sacrifice, a cull of older people who could no longer contribute to the society'.'
Mr Hancock said he felt it was 'not helpful' for the inquiry to 'exchange brickbats' – a term used to describe a verbal attack.
He added: 'I've been through everything that we did as a department, a big team effort, and we were all pulling as hard as we possibly could to save lives – that's what I meant by saying that we tried to throw a protective ring around.
'Of course, it wasn't perfect. It was impossible – it was an unprecedented pandemic, and the context was exceptionally difficult.
'What I care about is the substance of what we did, the protections that we put in place, and most importantly, what we can do in the future to ensure that the options available are better than they were last time.'
He said the emphasis was on ''tried' – it was not possible to protect as much as I would have wanted'.
He added that he and others were 'trying to do everything that we possibly could' in 'bleak circumstances' at a time when 'I also had (former government adviser) Dominic Cummings and a load of people causing all sorts of problems for me, and I had Covid'.
Elsewhere in his evidence, Mr Hancock – who said one of his own relatives died in a care home but did not give further details – acknowledged the policy around discharging patients from hospital into care homes early in the pandemic was an 'incredibly contentious issue'.
When the pandemic hit in early 2020, hospital patients were rapidly discharged into care homes in a bid to free up beds and prevent the NHS from becoming overwhelmed.
However, there was no policy in place requiring patients to be tested before admission, or for asymptomatic patients to isolate, until mid-April.
This was despite growing awareness of the risks of people without Covid-19 symptoms being able to spread the virus.
The High Court ruled in 2022 that government policies on discharging hospital patients into care homes at the start of the pandemic were 'unlawful'.
While the judges said it was necessary to discharge patients 'to preserve the capacity of the NHS', they found it was 'irrational' for the Government not to have advised that asymptomatic patients should isolate from existing residents for 14 days after admission.
Asked about the policy, Mr Hancock said there were no good options, adding: 'It's the least-worst decision that could have been taken at the time.'
Pressed further, he said he had both agreed with and defended the decision at the time.
He added that 'nobody has yet provided me with an alternative that was available at the time that would have saved more lives.'
He said while the policy had been a government decision, it had been 'driven' by then-NHS chief executive Sir Simon Stevens, now Lord Stevens.
The inquiry heard Mr Hancock said in his witness statement that NHS England had 'insisted' on the policy, and while he did not take the decision himself, he took responsibility for it as then-health secretary.
Asked about March 17 2020 when NHS bosses were instructed to begin the discharge process, Mr Hancock said officials were 'pushing very hard' to get more PPE (personal protective equipment) into care homes. He said not advising care homes to isolate returning residents without symptoms was a 'mistake', but it was in line with clinical guidance at the time.
In 2023, appearing for a separate module of the inquiry, Mr Hancock admitted the so-called protective ring he said had been put around care homes early in the pandemic was not an unbroken one, and said he understood the strength of feeling people have on the issue.
Mr Hancock's statement, referred to during Wednesday's hearing, said while there had been 'widespread concern' that patients being discharged from hospital were the main source of infection in care homes, 'we learned in the summer of 2020 that staff movement between care homes was the main source of transmission'.
He told the inquiry he had wanted to bring in a ban on staff movement between care homes but that being unable to secure funding from the Treasury to compensate affected workers was a 'killer blocker' so it did not happen.
Nicola Brook, a solicitor representing more than 7,000 families from Covid-19 Bereaved Families for Justice UK (CBFFJ), said Mr Hancock's claim that the discharge policy had been the least-worst decision available was 'an insult to the memory of each and every person who died'.
The CBFFJ group has written to inquiry chairwoman Baroness Heather Hallett, to express their concern at some 'key decision-makers' not expected to be called in this module, including former prime minister Boris Johnson and Lord Stevens.
Outlining the state of the adult social care sector at the outbreak of the pandemic, Mr Hancock said it 'was badly in need of, and remains badly in need of, reform', but rejected the suggestion of it being a 'Cinderella service to the NHS'.
He said pandemic contingency plans, prepared by local authorities for adult social care, had been 'as good as useless' at the time, and described a 'hodge podge of accountability' between local councils and government departments.
He claimed the situation has 'got worse not better' for care homes in the event of another pandemic hitting, and suggested a series of recommendations, including having isolation facilities in care homes and ensuring a stockpile of personal protective equipment (PPE).
Hearings for module six of the inquiry, focused on the effect the pandemic had on both the publicly and privately funded adult social care sector across the UK, are expected to run until the end of July.
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All statements, other than statements of historical facts, included in this press release are forward-looking statements. These statements include, but are not limited to, Inventiva's expectations with respect to forecasts and estimates with respect to Inventiva's pre-clinical programs and clinical trials, including design, protocol, duration, timing and costs of Inventiva's pre-clinical studies, and the results and timing thereof and regulatory matters with respect thereto, preclinical study data releases and publications, the information, insights and impacts that may be gathered from preclinical studies, clinical trials, the potential therapeutic benefits of lanifibranor, potential regulatory submissions, approvals and commercialization, the clinical development of and regulatory plans and pathway for lanifibranor, the expected benefit of having received Breakthrough Therapy Designation and Fast Track Designation, including its impact on the development and review timeline of Inventiva's product candidates and approvals, and future activities, expectations, plans, growth and prospects of Inventiva. Certain of these statements, forecasts and estimates can be recognized by the use of words such as, without limitation, 'believes', 'anticipates', 'expects', 'intends', 'plans', 'seeks', 'estimates', 'may', 'will', 'would', 'could', 'might', 'should', 'designed', 'hopefully', 'target', 'potential', 'opportunity', 'possible', 'aim', and 'continue' and similar expressions. Such statements are not historical facts but rather are statements of future expectations and other forward-looking statements that are based on management's beliefs. These statements reflect such views and assumptions prevailing as of the date of the statements and involve known and unknown risks and uncertainties that could cause future results, performance, or future events to differ materially from those expressed or implied in such statements. Actual events are difficult to predict and may depend upon factors that are beyond Inventiva's control. 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Future results may turn out to be materially different from the anticipated future results, performance or achievements expressed or implied by such statements, forecasts and estimates due to a number of factors, including that interim data or data from any interim analysis of ongoing clinical trials may not be predictive of future trial results, the recommendation of the DMC may not be indicative of a potential marketing approval, Inventiva cannot provide assurance on the impacts of the Suspected Unexpected Serious Adverse Reaction on the results or timing of the NATiV3 trial or regulatory matters with respect thereto, that Inventiva is a clinical-stage company with no approved products and no historical product revenues, Inventiva has incurred significant losses since inception, Inventiva has a limited operating history and has never generated any revenue from product sales, Inventiva will require additional capital to finance its operations, in the absence of which, Inventiva may be required to significantly curtail, delay or discontinue one or more of its research or development programs or be unable to expand its operations or otherwise capitalize on its business opportunities and may be unable to continue as a going concern, Inventiva's ability to obtain financing and to enter into potential transactions, Inventiva's future success is dependent on the successful clinical development, regulatory approval and subsequent commercialization of its product candidate, lanifibranor, preclinical studies or earlier clinical trials are not necessarily predictive of future results and the results of Inventiva's and its partners' clinical trials may not support Inventiva's and its partners' product candidate claims, Inventiva's expectations with respect to its clinical trials may prove to be wrong and regulatory authorities may require additional holds and/or additional amendments to Inventiva's clinical trials, Inventiva's expectations with respect to the clinical development plan for lanifibranor for the treatment of MASH may not be realized and may not support the approval of a New Drug Application, Inventiva's ability to identify additional products or product candidates with significant commercial potential, Inventiva's expectations with respect to its pipeline prioritization plan and related workforce reduction, including potential benefits, expenses and consequences relating thereto, Inventiva's ability to execute on its commercialization, marketing and manufacturing capabilities and strategy, Inventiva's ability to successfully cooperate with existing partners or enter into new partnerships, and to fulfill its obligations under any agreements entered into in connection with such partnerships, the benefits of its existing and future partnerships on the clinical development, regulatory approvals and, if approved, commercialization of its product candidates, and the achievement of milestones thereunder and the timing thereof, Inventiva and its partners may encounter substantial delays beyond expectations in their clinical trials or fail to demonstrate safety and efficacy to the satisfaction of applicable regulatory authorities, the ability of Inventiva and its partners to recruit and retain patients in clinical studies, enrollment and retention of patients in clinical trials is an expensive and time-consuming process and could be made more difficult or rendered impossible by multiple factors outside Inventiva's and its partners' control, Inventiva's product candidates may cause adverse drug reactions or have other properties that could delay or prevent their regulatory approval, or limit their commercial potential, Inventiva faces substantial competition and Inventiva's and its partners' business, and pre-clinical studies and clinical development programs and timelines, its financial condition and results of operations could be materially and adversely affected by changes in law and regulations, unfavorable conditions in its industry, geopolitical events, such as the conflict between Russia and Ukraine and related sanctions, the conflict in the Middle East and the related risk of a larger conflict, health epidemics, and macroeconomic conditions, including developments in international trade policies, global inflation, financial and credit market fluctuations, tariffs and other trade barriers, political turmoil, and natural catastrophes, uncertain financial markets and disruptions in banking systems. 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The key cause is an overactive immune system, leading to a rapid increase in skin cell production that forms raised, scaly patches on the skin, ranging in color from red to purple. Those affected report that it itches, burns, and stings. It's linked with other serious health conditions such as heart disease, diabetes, and depression. Treatment options include light therapy, topicals, nonsteroidal anti-inflammatory drugs, biologics, and biosimilars, among others. Yet support groups and social media communities are full of people looking for more help. The Long Trail of Approval The 21 biosimilars approved for psoriasis correspond to reference biologic products Enbrel, Humira, Remicade, and Stelara. The medications adjust the immune system and inhibit the processes that lead to inflammation and increased skin cell production. But the lag from approval to availability can be long. Adalimumab-atta (Amjevita) was approved in 2016 but did not become available until January 2023. Of the 16 adalimumab biosimilars FDA-approved for skin-related problems, the median time from approval to commercial access was just over a year, Sarin found. Many biosimilar makers are the same companies – or subsidiaries of the companies – that produce the original biologics, Sarin said, potentially giving them an incentive to delay or control competition. While there's no confirmed evidence of that happening, some biosimilar launches have been delayed after confidential settlements with originator companies. The Preserve Access to Affordable Generics and Biosimilars Act (S. 142), introduced in the U.S. Senate in March 2023, would prohibit such agreements – but the bill has stalled. Costs of biologics vary. As one example: Two pens of Humira can be $7,300, or $3,650 each, without insurance. A Humira biosimilar pen is listed online at $674. 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He also found that those who switched from a biologic to a biosimilar were more likely to stop treatment, citing mild side effects, reactions where the shot went in, or going back to the original. That could be due to differences in the injection device or to psychological factors, Phan said. "Some patients might be wary of switching to a drug they perceive as 'cheaper' or not the same, which can affect how well they feel it works." He also cited the "nocebo effect" – when someone expects a treatment not to work and that leads to a worse experience. He advises doctors to tailor the treatment to the patient. It's also worth noting, Phan said, that some may develop an immune response to a biologic drug over time, making the treatment (and its biosimilars) less effective. In that case, switching to a different biologic with a different mode of action might be needed, he said. He urges ongoing research, as biologics are relatively new. The Old Switcheroo Even if you do get a prescribed biosimilar, it could be switched to a different product – another biosimilar or the original biologic – without warning, said Melissa C. Leeolou, a fourth-year medical student at Stanford University who co-authored a report with Sarin. "Medication substitution can occur when insurers or pharmacy benefit managers change formulary coverage, typically for financial reasons," Leeolou said. "If a biosimilar is designated as interchangeable to a reference biologic by the FDA, pharmacies in some states may substitute it for the reference product without notifying the prescriber [your doctor]." Even without that designation, the insurer may require a switch by denying coverage for the prescribed product. If the prescription switches to a less expensive product, any cost savings may go to the insurer or the pharmacy benefit manager, not the patient, Leeolou said. It depends on the plan, Sarin said. A Patient-Researcher's View "We're so lucky to have biologics," said Leeolou, a lifelong psoriasis patient. "It's important to know they exist as an alternative and [for patients] to talk to their doctors about them." Sarin suggests that patients with psoriasis become more aware – not just of access to and the promise of biosimilars, but of the possibility of being switched, once on a biosimilar, from one to another without being alerted. If that happens to you, you should tell your doctor, who may be able to help you figure out why the switch was made and answer any questions you may have about the new treatment. If coverage was denied, your doctor can request a prior authorization or file an appeal. A prescription marked "dispense as written" may help, but it doesn't always override insurer policies.
