Summary: The Ombudsmen will not investigate this complaint about the actions by a Council and NHS Trust in discharging Mrs Y from hospital and rehabilitation placement. This is because Mrs Y had capacity to make decisions about her care and it is unlikely we would find fault.

The complaint

1. Ms X complains about Sunderland City Council (the Council) and South Tyneside and Sunderland NHS Foundation Trust (the Trust). She complains about their roles in successive hospital discharges of her mother, Mrs Y, between September 2021 and January 2022.
2. In particular she complains the Trust and the Council discharged Mrs Y to the care of her youngest daughter, Ms Z, despite her other daughters (including Ms X) raising concerns. Ms X says she did not have the opportunity to discuss concerns about this or about possible financial abuse with the hospital discharge team or social worker. Ms X says this placed her mother at risk of harm and had an impact on her wellbeing.

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The Ombudsmen’s role and powers

3. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
4. The Ombudsmen provide a free service, but must use public money carefully. They may decide not to start or continue with an investigation if they believe:

• it is unlikely they would find fault, or
• the fault has not caused injustice to the person who complained, or
• the injustice is not significant enough to justify their involvement.

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

5. The Ombudsmen have the power to jointly consider complaints about health and social care. These complaints are considered by a single team acting on behalf of both Ombudsmen. (Local Government Act 1974, section 33ZA,as amended, and Health Service Commissioners Act 1993, section 18ZA)

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How I considered this complaint

6. I considered information provided by Ms X, the Council and the Trust.
7. I considered the Ombudsman’s Assessment Code.
8. Ms X had an opportunity to comment on my draft decision and I have considered her comments before completing my final decision statement.

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What I found

Background

9. Mrs Y was admitted to hospital in September 2021. Before that she had been living independently in her own home. When Mrs Y was ready to leave hospital, the discharge team considered the support she now needed. Mrs Y told staff she was going to live with her youngest daughter, Ms Z. Mrs Y’s other daughters had concerns about this and her discharge was delayed.
10. Mrs Y later told the Trust and Council staff she wanted to live with Ms Z when she left hospital.
11. Ms X raised a safeguarding concern with the Council about possible financial abuse by Ms Z. Ms Z had taken over from Ms X helping Mrs Y with her finances when Covid-19 restrictions started. The Council noted Ms X felt since then, her shopping bills were higher and there had been some other unaccounted cash withdrawals from Mrs Y’s bank account. The Council noted Ms X said she thought it was likely Ms Z took advantage of her mother’s generosity than being actual financial abuse (e.g. having money stolen, or being defrauded). After Ms X raised these concerns, Ms Z and Mrs Y agreed that Ms X would recommence dealing with Mrs Y’s finances.
12. Mrs Y returned to hospital in November 2021 with abdominal pain and confusion. She was medically ready to leave hospital nine days later, but because her mobility was less than expected, she transferred to an Intermediate Care Assessment and Rehabilitation (ICAR) placement. She remained there until December.
13. Mrs Y told staff she wanted to return to Ms Z’s home when she was ready to leave. The Council arranged a care package to start and Mrs Y left the ICAR placement to return to Ms Z’s home.
14. Just over a week later, Mrs Y returned to hospital with shortness of breath and raised temperature. The hospital diagnosed her with a chest infection. She remained in hospital until January 2022.
15. When Mrs Y was ready to leave hospital, there were no beds available in the ICAR placement. The Trust consultant spoke to Mrs Y and she agreed to go to a care centre placement for rehabilitation. From there Mrs Y moved to a care home, which the family were happy with.

Assessment

16. Under the Mental Capacity Act 2005 (MCA) individuals are presumed to have capacity unless there is proof to the contrary. The MCA Code of Practice says people who make unwise decisions should not automatically be treated as not being able to make decisions.
17. Hospital discharge is often multidisciplinary and involves staff from health and social care. The Trust and the Council had no concerns about Mrs Y’s ability to understand decisions about her care. The discharge teams discussed this with Mrs Y. She expressed a wish to move into Ms Z’s home when she was ready to leave hospital and the ICAR placement. While Ms X did not agree with this, it was Mrs Y’s decision. Given Mrs Y legally had the ability to understand decisions about her care, it is unlikely the Ombudsmen would find fault in the Trust and/or the Council carrying out her instructions.
18. With regards to the concerns Ms X raised about possible financial abuse, it appears the Council considered this and decided no further action was needed. Mrs Y had capacity to understand and make decisions about her finances. Ms X also said some unaccounted payments were quite likely to be Mrs Y’s generosity.
19. As Mrs Y had capacity and no one held power of attorney for finance, it was ultimately for Mrs Y to decide what she did with her money. Additionally, after Ms X raised these concerns, she took over helping Mrs Y with her finances again. It is therefore unlikely the Ombudsmen would find fault by the Council.

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Final decision

20. The Ombudsmen should not investigate this complaint. This is because we are unlikely to find fault with the Trust’s or the Council’s actions.

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Investigator's decision on behalf of the Ombudsman