Carers described their unease at an Upminster mother and son’s living situation days before they were found dead in their home.

On the sixth day of an inquest into the deaths of Vera Savage, 89, and John Savage, 54, the court heard that John, the sole carer for his mother, never received a psychiatric assessment despite his erratic behaviour and attempted suicide.

The pair were found dead on the morning of July 10, 2017, having each sustained a stab wound to the neck.

Police concluded John was likely to have killed his mother and then himself, but coroner Nadia Persaud has yet to deliver a formal conclusion.

Ceri Sturgeon had been a carer at Barking-based agency Carewatch for just three weeks on the morning she found the pair in their upstairs bathroom, covered in blood.

"The whole house", she said, "was in darkness. The kitchen was spotless. The door to the living room was open but the curtain was drawn."

On discovering neither were in their bedrooms but the beds were neatly made, she said, "My heart started to race and I thought this was a prank."

She went to the bathroom where she saw both of the bodies and screamed before running outside and calling 999 at 9.33am.

Both she and Carewatch colleague Sharmin Raz had raised concerns about the way the pair had been living.

Vera, they said, was "very thin, with bones sticking out" and had large unexplained bruises on her arms, legs and nose. Ms Raz also reported scratch marks on her back "in areas she couldn't reach".

Ms Raz said John was "controlling" of his mother, who had dementia, and would not let anyone else give her medication.

She said: "She wouldn't speak unless he spoke. He wouldn't let her make any decisions. He wouldn't let her get out of her seat or get changed.

"He said he and his mum had to be together and couldn't be separated."

Vera, they said, had the same breakfast - milky tea and custard creams - every day, and a regimented lunch approved by John. Neither could be certain she was eating in the evenings at all.

John had opened up to both of them about his depression, having attempted suicide in February 2017. He wore the same white T-shirt and boxers every day, they said, and did not care for his appearance. Ms Raz said: "I was trying to get him to go outside but he wouldn't."

During their last exchange on July 9, she said, John, a psychology graduate, had talked about his method of killing rats, saying he "didn't believe in poison" and it was best to kill them quickly. She added: "He made me nervous."

On May 31 that year, John Savage had been referred to North East London NHS Foundation Trust's access, assessment and brief intervention team (HAABIT) amid concerns for his mental health.

Consultant psychiatrist Dr Marianne Hayward said that "whilst it was clear that there were risks identified to John and to Vera... the understanding was that it was not primarily a mental health need.

"He was never diagnosed with a severe and enduring mental health condition. For patients who don't quite fit into any of the boxes it's difficult to work out what should be offered."

To her recollection, she said, John never underwent a full psychiatric assessment. She added: "I agree in retrospect it would have been helpful."

Dr Erin Butterworth, who was briefly Vera's GP and attended their home on July 7, said she recalled seeing bruises on Vera's shins and a rash on her back, adding: "Vera couldn't explain how she came about her injuries."

She said she could not recall how far she was aware of safeguarding concerns around the pair, and did not have training in how to spot signs of domestic abuse.

The inquest continues.