UK COVID-19 inquiry|16 Jul 2025

Astonishing evidence from Caroline Abrahams. Director. AGE UK.

NB: Contains distressing details. A must read witness statement. The oral evidence was watered down and barely scratched the surface.

Introduction

Caroline Abrahams is the Director of AGE UK and oversees influencing work and positioning, covering policy and research, public affairs and campaigns, engagement with older people, media and PR and (charity) content and brand. Caroline was awarded a CBE in the Queen's Birthday Honours 2021. Age UK is the leading charity for older people.

‘‘In some places these policies or informal practices amounted to effective bans on older people being admitted to hospital, whether they had Covid-19 or not.’’

-Paragraph 44 of statement

‘‘Some care home residents were denied admission to hospital for any reason (including fractures, strokes and injuries)…

..In one example, we were told by a senior clinician overseeing a community hub through the pandemic that any older resident with respiratory symptoms was assumed to have contracted Covid-19 and would not be considered for further care. He described intervening personally on behalf of a resident he in fact judged to have a case of treatable pneumonia.’’

-Paragraph 45 of statement

As global anti-biotic use (particularly broad spectrum penicillins in higher oncome countries who suffered the most ‘COVID’ deaths) for pneumonia in 2020 reached an all time low how many patients were not so fortunate?

But that’s not all….

‘‘We also heard accounts of people receiving phone calls in their own homes from unknown callers to persuade them to compete DNACPR instructions and care home managers under pressure to sign wholesale DNACPR instructions on behalf of all residents within a home.’’

-Paragraph 46 of statement

‘‘Some residents were restrained in chairs (for example, with the use of cot sides to prevent them getting up and falling).’’

‘‘Some older people had become so heavily sedated that they were unable to drink or eat and they were dehydrated, lost weight and muscle mass and were experiencing malnutrition. This information was brought to our attention from reports from relatives, calls from care home practitioners, and other feedback, including from Age UK's Information and Advice line.’’

-Paragraph 55 of statement

‘‘Many care home residents were isolated from those they loved for long periods of time, causing them enormous distress and, in some cases, leading them to give up all hope or reason for living.’’

-Paragraph 72 of statement

‘‘Older people in receipt of care, in care homes especially, have been catastrophically let down. Many have died before their time as a result and in a manner that was inhumane. That similar tragedies have unfolded in other countries too is no consolation and no excuse.’’

-Paragraph 116 of statement

Testimony highlights

• Changes to the care act.

• Safeguarding failures.

• Concerns over lack of access to healthcare services.

‘‘Access to routine healthcare became impossible or stopped…people with health conditions, quite serious ones went for quite long periods of time often without seeing their consultant, without having their regular check ups.’’

‘‘Inevitably that caused some of those conditions to get worse more quickly than they otherwise would have done.’’

‘‘It may have made it more likely some people would have stopped taking their medication for example.’’

‘‘Mental health conditions definetely got worse…made worse by the isolation and the loneliness and fear of watching the news.’’

‘‘Many people living at home were told to stay put..in later life if you don’t move around..you stiffen..loose your muscle mass.’’

‘‘As the pandemic went on the unintended consequences of LOCKDOWNS on older people and on everybody became better appreciated.’’

Staff impacts in care homes

• ‘Plugging the gap’ left by GPs etc without the skills.

‘‘We heard awful stories about staff who felt overwhelmed by having to ‘plug the gap’ that health professionals not visiting was unintentionally leaving.’’

Scottish GP letter

• No attendance to care home.

• Senior clinician had to intervene to have patient treated with antibiotics for pneumonia and not abandoned as a suspected COVID diagnosis.

• Non conveyance to hospital of sick care home residents widespread in UK.

‘‘We would plan to nurse our patients and not transfer them to hosptial.’’

‘‘Certainly the issue of whether an older person in a care home would be taken to hospital if they became unwell was something we heard quite alot about right across the UK.’’

‘‘Regardless of whether you are in care home or in hospital we all have the same right and that right was not being observed.’’

End of life care and medications

• Concerns about changes to medications and prescriptions.

‘‘Sadly (during the early months of the pandemic) that led to people dying in care homes not in a dignifed way, not in a pain free way.’’

DNACPR

• Phone calls out of the blue. Sometimes from unidentified callers.

• Denial of older people’s rights.

• Rebuliding trust difficult due to legalising assisted dying.

Denial of visits/end of life

• Residents receiving end of life care and suffering dementia adversely effected the most due to isolation.

‘‘The absence of support for that group was TERRIBLE and i think in some cases led to people deteriorating very quickly, dying faster than otherwise would have been the case.’’

Statement highlights

‘‘Age UK raised a number of concerns regarding the impact of the pandemic on care recipients, many of which could be described as safeguarding failures.’’

‘‘Older people were always going to be disproportionately impacted by measures that would impact the usual running of those health and care services.’’

-Paragraph 33

‘‘The Coronavirus Act 2020 meant that many duties contained in the Care Act 2014 were suspended (regulations to expire the Care act eased on 21 April 2021), enabling local authorities to temporarily stop or reduce the support someone received.’’

-Paragraph 35

‘‘We noted a marked deterioration amongst older people with care needs as well as a general decline in the health of informal carers with many more people reporting a range of challenges including physical and mental deconditioning, accumulation of chronic illness, loss of cognitive function, decreased confidence and reduction in their overall quality of life and wellbeing.’’

-Paragraph 36

‘‘We were aware of places where there were no visits to care homes being made by the GPs, Pharmacists, Allied Health Professionals, Physiotherapists, Speech and language therapists (who also support with swallowing problems), or Community nurses.’’

‘‘Residential care homes rely on NHS community teams to deliver all clinical interventions, for example diabetic care including insulin injections, regular dressing for serious wound care etc. In some cases, unqualified residential care home staff were left to perform clinical tasks and provide clinical care that they weren't trained or skilled to undertake, including with respect to strokes, fractures, falls, cuts and wounds.’’

-Paragraph 37

‘‘When people died, their unused medication was wasted, despite it being in short supply. The consequence was that some older people missed out on end-of-life pain relief and symptom control and tragically will not have experienced a dignified or pain-free death. For the first two months of the pandemic, these issues were particularly severe.’’

-Paragraph 38

‘‘Many older people have also found it hard to recover from the effects of withdrawal of routine care and support services, long periods of isolation and loss of access to facilities and support, suffering irreversible loss of health, physical function and independence as a result.’’

-Paragraph 39

‘‘Even as we moved out of the first wave of Covid-19 and restrictions began to be lifted, many older people continued to be extremely cautious and did not leave their home, and for some that caution remains even to this day. Months, and for some years, of staying inside, with limited social interactions, reduced opportunities for physical activity, and limited access to health and social care, has led to deconditioning for large numbers of older people and taken a huge toll on their physical and mental health.’’

-Paragraph 40

‘‘We heard stories of people living with dementia getting lost, their carers scared to go out to find them in case they breached lockdown rules. As a result, this confusion led to some people getting less support than was allowed within the rules and that they badly needed.’’

-Paragraph 41

-Paragraph 42

‘‘We heard extensively from older people both in care homes and community settings who were either unable or unwilling to access urgent or emergency care for acute health conditions when they needed it. Age UK was particularly concerned by non-conveyance practices and was involved in protracted arguments about these with responsible organisations. At worst these meant a lack of access to urgent services in hospital for older people with significant needs living in the community or in care homes, simply on the basis of their age or where they lived. In some cases, this was because they were discouraged or prevented from accessing services, amounting to direct discrimination against older persons. In some places these policies or informal practices amounted to effective bans on older people being admitted to hospital, whether they had Covid-19 or not.’’

-Paragraph 44

‘‘In some cases individuals told us they felt under pressure to agree to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices and/or to decline the option of being admitted to hospital in an emergency.’’

‘‘We are also aware of cases where older people and their families were directly discouraged from accessing healthcare services by clinicians or healthcare providers, or simply told that in the event of a health event they would not be given access to services. In one such example, we heard from a woman caring for her husband with CORD, cognitive impairment and epilepsy who told us she had been contacted 'out of the blue' by his GP in late March 2020 and told `bluntly' that if he became ill he would not be taken into hospital or receive any treatment. She was told that a DNACPR notice had been placed on his file. As you would expect, she described this experience as having `frightened and upset her a great deal' and she felt it left her not knowing what to do if her husband experienced breathing difficulties.’’

-Paragraph 47

‘‘For older people with care and support needs, closures of clubs, classes, facilities, churches, leisure centres (many of which either haven't reopened or have reopened in ways inaccessible to those communities) have had a massive impact on health and wellbeing.’’

-Paragraph 50

‘‘In the early months of the pandemic, many older people had to forgo medicines reviews leaving them at higher risk of inappropriate polypharmacy. We heard that medications with contraindications and side effects were prescribed by clinics and the polypharmacy was not adequately joined up. Further, a reduction in routine monitoring increased older people's risk of experiencing inappropriate polypharmacy, including unnecessary or adverse side effects. contraindications and associated health risks.’’

-Paragraph 52

‘‘The use of mental health medications was a particular worry, with concerns raised over a perceived rise in prescribing antidepressants, antipsychotics, hypnotics and sedatives, and corresponding concerns that GPs were overprescribing because it was the only therapeutic intervention available to them at the time. Specific concerns were raised over the prescribing of anti-psychotic medication.’’

-Paragraph 53

‘‘Care staff told us that they found it hard to care for residents safely. Many people who had a diagnosis of dementia and/or behavioural difficulties were struggling when they were confined to their rooms for long periods and prevented from walking along corridors. Some very challenging behaviour and symptoms emerged as dementia patients became disorientated, frustrated and upset and were consequently more prone to anxiety, aggression and sometimes violent behaviour. Sadly, the only treatment available was often an increase or new prescribing of psychotropic medications, leading to overmedication of these patients.’’

‘‘Visits by GP and otherhealthcare professionals had ceased and the only contact was by a virtual round (often irregularly scheduled). Anti psychotics such as haloperidol (Haldol) and Risperidone (Risperdal) were prescribed as a tool to manage behaviours, often on a PRN basis ('as needed’), which was not ideal as it was given at irregular times, for example, when personal care was needed, and residents could not co-operate.’’

-Paragraph 54

‘‘Use of these types of medications also brought with it side effects (including dizziness, blurred vision, drowsiness and fatigue, dry mouth, constipation and changes in appetite) leading to an increased risk to residents of trips and falls.’’

-Paragraph 55

See Scottish COVID inquiry testimony by Bill Jolly who’s father fell FIVE TIMES in total before being admitted back to a care home to be placed on Morphine and Midazolam as a suspected COVID case.

‘‘Older people from minoritised ethnic communities have experienced higher mortality from COVID-19 for the majority of the pandemic than white older people. This difference was particularly stark during the first wave of the epidemic, through the spring and summer of 2020.’’

-Paragragh 58

‘‘Interruption to family visits had a particular impact on people living with dementia who did not understand why their relatives were no longer coming to see them. At times these bans seemed disproportionate to the actual degree of infection risk.’’

‘‘Unfortunately, the appropriate balance between keeping people physically safe, ensuring their wellbeing and quality of life, and respecting individual preferences, was not achieved.’’

-Paragraph 69

‘‘It was not until later in 2020 that visiting guidance in care homes and hospitals was adapted to ensure in-person visits for people at the end of life, meaning thousands of people were left to die without the support of their loved ones.’’

-Paragraph 70

‘‘Age UK heard reports of care staff being told that their job was to provide end of life care for residents who were sadly dying from the virus, without enough back up support from GP and community based palliative care services, and without the possibility of these older people being admitted to hospital. Such prescribing and treatment expectations were often beyond residential care staff training and experience. Residential care services were not able to give anticipatory medicines (as these are controlled drugs) and in some places supplies of end-of-life medication ran out. These are serious breaches of accepted practice.’’

-Paragraph 74

‘‘Quality of social care declined during the pandemic, and has not recovered, as evidenced by current levels of staff urnout and turnover.’’

-Paragraph 74

‘‘The Department of Health and Social Care came perilously close to adopting a national blanket policy on admissions to critical and intensive care units which would have denied access to intensive and critical care to the older population at large, on the basis largely of their age. Thankfully, the Guidance and resource allocation tool associated with it were not formally endorsed or published by the Department, but we subsequently became aware that it was used in some acute settings.’’

-Paragraph 87

‘‘For many older people the main route for information, particularly at the start of the pandemic, was through the broadcast briefings undertaken by the Scottish Government and UK Government. Calls to Age Scotland's helpline would spike in the moments after the televised briefings concluded.’’

-Paragraph 93

‘‘Malnutrition significantly increases the risk of infection, illness and injury and reduces capacity for effective recovery. Practical difficulties accessing and preparing food, lack of motivation (associated with poor mental health, loneliness and isolation) and issues such as poor dentition or medication side effects (i.e. nausea) are all common causes. The pandemic severely exacerbated these challenges for many older people and Age UK, working with partners in the Malnutrition Taskforce, are aware of a rise in malnutrition. We heard directly from older people and families detailing the impact as they struggled to secure sufficient appropriate food, including instances of older people found to have become severely malnourished at home.’’

-Paragraph 107

‘‘Differential presentation of Covid-19 symptoms, including probable delirium, were recognised by geriatricians, care professionals and others who had been working with older people long before the possibility was more broadly considered in guidance.’’

-Paragraph 110

‘‘Encouraging millions of people to severely restrict their freedoms purely because of their age was disproportionate and risked preventable harm. Age-based recommendations posed a risk to older people's health and would mean that many would become increasingly frail a situation that would be difficult if not impossible to reverse once the pandemic receded.’’

-Paragraph 112

‘Lessons are being learned.’

‘‘We must also manage the legacy of the Covid-19 pandemic itself. Millions of older people are now living in a poorer state of mental and physical health than would otherwise be the case.’’

-Paragraph 117

‘‘Policy makers should adopt precautionary principles rather than relying on definitive scientific proof before implementing changes (mask wearing, asymptomatic transmission). Evidential thresholds are high in the scientific community, but that shouldn't be a barrier to making good policy decisions when the risks of implementing changes (like mask wearing) are low.’’

-Paragraph 120

‘‘The impact of Covid-19 on older people must continue to be monitored now and in the coming months and years. This should include ongoing data collection and analysis of how Covid-19 and Long Covid affects the financial wellbeing, physical and mental health of older people.’’

-Paragraph 125

Thanks for your attention.

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