Gauteng Premier David Makhura has accepted accountability for the death of 144 Life Esidimeni patients, adding that it happened under his watch.
"If there is no truth here. I will work with the families to pursue any truth elsewhere," he said.
Makhura was testifying in the Life Esidimeni arbitration hearing in Parktown, Johannesburg, on Tuesday.
Makhura said, as the head of the provincial government, the buck stopped with him.
Addressing the families, Makhura told them that an apology could never be enough.
"You have suffered," he told victims' families.
"I'm also hear to account," he said, adding that "apologising doesn't mean a lot if there is no truth".
Makhura said since the hearing started, families have heard a lot of blame being shifted and excuses made, but very little of what happened.
"There can be no justice without the truth," he said.
Makhura emphasised that at each budget council meeting, there was always the conclusion that cost-cutting measures were not to be applied to core services.
Makhura also revealed that he was assured by former Gauteng Health MEC Qedani Mahlangu and Head of Department Barney Selebano, that the department had the capacity to house patients at state facilities.
"I could have done something to be more responsive and bring the NGOs around the table with the department," he said.
Makhura added that, knowing what he knows now, he would have intervened.
Former deputy chief justice Dikgang Moseneke, who is chairing the hearing, asked Makhura if he was aware that department employees were intimated by Mahlangu.
Makhura also said there were no officials who said anything about being misled or being afraid.
"Everybody who came here said they were steamrolled. In the meetings, we had none of them [who] said they were forced or intimidated by the MEC," he said.
Levy Mosenogi, the head of the project which led to the death of 144 Life Esidimeni patients, claimed that he was scared of her.
Mosenogi was not the only one. Selebano previously claimed he was afraid to stand up to her after he continued acting in contravention of the rights of mentally ill patients under her instruction.
But Mahlangu testified that she did not know why her subordinates said they were scared of her.
"I know myself to be a very warm person," Mahlangu said during her testimony last Wednesday.
Moseneke also asked: "Why did the MEC resign, was she was pushed or did she jump?"
Makhura said he always maintained that, when something goes wrong in a person's line of duty, there will be consequences and Mahlangu said she will resign if needed.
He said he was assured in a meeting that the patients would be taken to proper institutions, but this did not happen.
The hearing also heard evidence from Gauteng Finance MEC Barbara Creecy who said that at no point had provincial Treasury told departments that they should cut costs.
"Treasury has never demanded that any department cut core services," Creecy said.
"The pressure to cut costs was not on core services," she said.
Creecy said, in November 2014 the health department indicated that it wanted to move patients to government institutions.
She added that the department was told that it should not compromise the quality of services.
She also revealed that more than R47m was paid to NGOs and only three NGOs were not paid.