BGS responds to ongoing UK COVID Inquiry

08 December 2023

The impact of the COVID-19 pandemic was felt in all sectors of society, and by those of all ages and backgrounds. There is no doubt, however, that older people with frailty were among those most adversely affected.

More than nine out of ten (92.3%) COVID-19 deaths were in people aged 60 and above and over half (58.3%) were in those aged 80 and over. People aged over 85 were 15 times more likely to be admitted to hospital with COVID-19 than those of working age. Focusing on the most vulnerable older people, of the 193,266 deaths in England to date from COVID-19, 36,197 were in care homes. To put this in perspective, that is 19% of COVID deaths occurring in a group who make up less than 1% of the population. During the first wave of the COVID-19 pandemic, almost half of all deaths were among those living in the care home sector.
This was a humanitarian tragedy of devastating proportions. We lost family members, friends and, for those of us working in the health and social care professions, patients, clients and colleagues we cared dearly about. Many BGS members are still recovering from their harrowing experiences during the pandemic. We have supported many families for whom life will never be the same.
With this in mind, we have watched the UK COVID-19 Inquiry closely. We have done so in the knowledge that the challenge facing our country in early 2020 was unprecedented in modern times, and that difficult decisions were made under substantial pressure. Nevertheless, we have watched it with growing concern. Most worrying has been the evidence that older people, particularly those living with frailty and multimorbidity, were not given specific consideration during the early stages of pandemic planning. While the best epidemiologists and virologists were called on to advise government early in the pandemic, it was not until the autumn of 2020 that experts from the BGS were finally invited to provide advice as part of the Social Care Working Group of the Scientific Advisory Group for Emergencies (SAGE).
Some decisions made during the pandemic remain contentious, including the discharge of large numbers of older people from hospital to care homes early in the pandemic. We know from publicly available papers from SAGE that this decision will have contributed in part to some outbreaks and deaths in care homes. We also know, from evidence provided to the Inquiry, that those who instituted this policy had considered that such outbreaks might happen. These decisions were ostensibly taken to protect intensive care capacity in hospital and to protect the hospital sector from becoming overwhelmed more generally. This policy had far-reaching implications for care home residents and staff. We know from our membership, and from the evidence presented to the Inquiry, that services supporting older people were among the last to be able to access effective personal protective equipment (PPE) and testing for SARS-CoV-2. These are all examples of decisions where one population group was prioritised over another. In the early stages of the pandemic such decisions were highly detrimental for older people living with frailty and multimorbidity.
The BGS had not planned to issue a statement on the Inquiry until nearer its conclusion, but the pressure from our membership to speak now is substantial. They are angry at much of what is emerging from the Inquiry and we feel that we should reflect that anger. It is important that lessons are genuinely learned. We hope that the Inquiry, as well as those giving evidence to it, will consider whether ageism impacted upon decisions made as part of pandemic planning and pandemic response. We ask the Inquiry to report, frankly, upon whether more could have been done to protect the most vulnerable groups in society. And we beseech the Inquiry to ensure that future pandemic responses call upon the expertise of health and social care professionals, including those from the care home sector, who are specialists in ageing and frailty. This will ensure that policy recommendations draw from real-world experience alongside the best advice that epidemiologists, virologists and public health specialists have to offer.
Professor Adam Gordon, President of the British Geriatrics Society, said:

I hear from BGS members on a daily basis at the moment about how concerned they are at the revelations from the COVID-19 Inquiry. We have seen evidence presented which is, at best, indicative of tacit ageism. Older people, particularly those living with frailty and long-term conditions, including care home residents, were not given sufficient consideration in the early stages of the pandemic response.

"Decisions about how people most likely to be impacted by the virus would use, and need to use, healthcare resources, were made without the input of professionals who routinely provide frontline healthcare to that group, namely older people. Had there been more recognition of the rights of the largest group using health and social care and the expertise of those who care for them, we believe the quality of care delivered would have been improved and lives could have been saved.’’