Summary: We do not uphold Mr X’s complaint about the way Durham County Council and County Durham and Darlington NHS Foundation Trust discharged his mother, Mrs Y, from hospital on three occasions. We have not found fault with the way Mrs Y was discharged or the reablement care she received at home.

The complaint

1. Mr X complains on behalf of his mother, Mrs Y. He complains about the way Durham County Council (the Council) and County Durham and Darlington NHS Foundation Trust (the Trust) discharged Mrs Y from hospital on three separate occasions in March 2024.
2. Mr X complains Mrs Y was discharged from hospital before she was medically fit and had to return to hospital within 24 hours. Following the second discharge, he complains about the quality of care provided by a domiciliary care provider. Mr X complains about poor communication around Mrs Y’s third discharge. He says the Council and Trust provided him with contradictory information about Mrs Y’s abilities and did not adequately explain her care charges. He is also unhappy with the Council’s decision to withdraw Mrs Y’s free reablement care.
3. Mr X says, as a result, Mrs Y was discharged too early and received poor care. Mr X and his wife have also found the situation upsetting and distressing. Mr X is seeking systemic improvements and financial redress.

Back to top

The Ombudsmen’s role and powers

4. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
5. 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).
6. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

Back to top

How I considered this complaint

7. I have considered the information Mr X provided in support of his complaint. I have also received information from the Council and the Trust including relevant care records. I have carefully considered all the written and oral evidence submitted, even if it is not all mentioned within this decision statement.
8. I shared a copy of my draft decision with Mr X, the Council and the Trust and they had an opportunity to comment. I have carefully considered the comments I received.

Back to top

What I found

9. Mrs Y was living independently at her home. In late February 2024, Mrs Y had a fall and fractured her spine. She was admitted to hospital.
10. On 1 March 2024, Mrs Y was discharged home. The Council arranged for Mrs Y to receive reablement care through home care visits. Reablement care is free short-term care designed to support a person to regain their independence with daily living tasks.
11. A care agency was arranged to start visits two days after Mrs Y’s discharge. Mr X and his wife agreed to bridge the care gap and support Mrs Y over the weekend until the care package could start.
12. During her first night at home, Mrs Y got up then passed out on the bed. Mr X says Mrs Y also had several episodes of diarrhoea in bed. Mrs Y called the police, and she was taken back to hospital by ambulance.
13. Mrs Y did not require any treatment and was moved to another hospital while her home care package was rearranged. On 6 March, Mrs Y was discharged home again. A care agency visited her three times a day.
14. On 16 March, Mrs Y returned to hospital with lower back and abdominal pain. During this admission, Mrs Y was diagnosed with diverticulitis. This is inflammation or infection of pouches in the bowel wall. Mrs Y was prescribed antibiotics.
15. Two days before discharge, Mrs Y was transferred to a community hospital while a new care package was arranged. Mrs Y was no longer eligible for reablement care. Mr X was unhappy Mrs Y would not receive any further free care. Mr X and Mrs Y declined a paid care package and decided she would move in with Mr X while she recovered.
16. On 25 March, Mrs Y was discharged to Mr X’s home. Three weeks later, Mrs Y returned to her own home.

Analysis

First hospital discharge

17. Mr X complains Mrs Y was discharged from hospital before she was medically fit and had to return to hospital within 24 hours. Mr X says she should have been kept in hospital to recuperate but was sent home early to free up her bed. Mr X says Mrs Y developed a bowel infection in hospital and he was not made aware of this when he agreed to bridge the care gap.
18. I have reviewed the records relating to Mrs Y’s inpatient care and discharge. Prior to discharge Mrs Y was reviewed by multiple professionals including the discharge team, an Occupational Therapist and a physiotherapist. All reviews found Mrs Y was moving and transferring well, either independently or with minimal support. Mrs Y is recorded as being continent and independent overnight. There is no reference to any episodes of diarrhoea while she was in hospital. Mrs Y was prescribed pain medication to help manage her back pain and it was under control prior to discharge.
19. The records show Mr X and Mrs Y agreed with the discharge plan and Mrs Y was happy to be going home. Mr X says he was not informed that Mrs Y had a bowel infection when he agreed to support her over the weekend. However, as explained above, Mrs Y was not experiencing diarrhoea in hospital and there is nothing to indicate the professionals could have anticipated this issue. In fact, on the day of discharge, Mrs Y reported mild constipation.
20. Mrs Y’s medical records show she had an existing diagnosis of diverticulosis. This is a condition which causes abnormal pouches in the bowel wall. When these pouches become inflamed or infected, this is called diverticulitis.
21. Although Mr X reports Mrs Y had some episodes of diarrhoea at home, the medical records do not record any diarrhoea prior to her discharge on 1 March or during her second hospital admission from 2 to 6 March.
22. I cannot say what caused Mrs Y’s diverticulitis. The condition can flare up suddenly without an obvious cause. It can occur for many reasons, such as bacteria build up from faeces caught in bowel pockets. While Mr X believes this was a hospital acquired infection, I have seen nothing to confirm her diverticulitis was because of the Trust or its actions.
23. Mr X says Mrs Y should have remained in hospital to recuperate. There is a difference between medically fit for discharge and recuperation. A person should not be discharged from hospital until they are medically fit. However, then it is in a person’s best interests to be discharged promptly. Recuperation can take place at home or in a suitable community setting. Prolonged hospital stays can increase risks, such as losing mobility and independence.
24. It is unfortunate Mrs Y needed to return to hospital so soon after discharge. This would have been distressing for Mrs Y and Mr X. However, I have not seen any evidence Mrs Y was not fit for discharge at the time she was discharged. Further, I have seen nothing to suggest her deterioration at home could have been predicated by the Trust or the Council. I have not found fault in relation to Mrs Y’s first discharge.

Second hospital discharge

25. Following Mrs Y’s second discharge from hospital, Mr X complains about the quality of care provided by a domiciliary care provider. He says the carers did not do anything and spent their visits on their phones. Mr X says the Council does not properly monitor the standard of care providers.
26. Mrs Y’s care package was provided via Council funded reablement care. As explained above, reablement is a period of free short-term care to support a person to regain their independence and daily living skills.
27. Mr X complains the carers did not support Mrs Y with her medication. The care agency completed a care plan with Mrs Y to identify the areas she wished for support. Mrs Y told the care agency that her daughter in law supported her with all medication and she wished for this to continue. As such, the care agency would not be expected to support Mrs Y with her medication. Mrs Y also said she could prepare her own food and drink and would like to do so.
28. Mrs Y asked for support with personal hygiene, such as supervising her in the shower, and emotional support as she was not feeling herself. The care plan was completed with Mrs Y, to offer support in the areas she wanted and to encourage independence in the areas she wished to complete herself. The social worker spoke with Mrs Y, who said care package was going well and did not report any unmet needs.
29. Mr X said Mrs Y was left in soiled bedsheets for hours and his wife needed to change these. There is nothing in the daily care records to indicate Mrs Y needed support during visits with toileting or the carers needed to change her bedsheets. When asked by the carers, Mrs Y generally seemed happy and did not raise concerns about continence issues. During the morning call, Mrs Y often said she was comfortable in bed and wished to stay there a bit longer.
30. Mr X raised some specific complaints about the care agency staff including leaving early on occasion and shouting through the letter box instead of using the key. The Council reviewed the daily care records but was unable to confirm what happened. We are unable to add to the Council’s investigation on these points.
31. Mr X complained about staff doing nothing, looking at phones and reading newspapers. The Council’s complaint response explained staff use work phones to update electronic care records. One carer confirmed she looked at a newspaper while supervising Mrs Y from outside the bathroom as Mrs Y wanted to be independent while showering.
32. The care provided to Mrs Y was in line with the aim of reablement care. Mrs Y was encouraged to be independent and provided support in the areas she asked for. Sometimes Mrs Y would decline care, choosing to delay care or complete it herself. The daily care records show the carers acted in line with Mrs Y’s wishes.
33. When Mrs Y raised concerns that she was struggling, the care agency escalated this to her social worker to consider her long-term care needs. I have not found fault with the care provided to Mrs Y.

Third hospital discharge and decision to end reablement funding

34. Mr X complains about poor communication around Mrs Y’s third discharge, specifically that there was contradictory information between the Trust and the Council about Mrs Y’s abilities. He is unhappy Mrs Y was not offered further reablement care and says care charges were not properly explained to her.
35. The day before Mrs Y’s third hospital admission, the care agency had raised concerns that Mrs Y was not progressing, and she wanted long term care for support with personal care and meals.
36. Mr X complains the Trust discharge summary said Mrs Y needed minimal support, but the Council assessed her as needing long term care. Mr X says this is contradictory.
37. The Council’s complaint response explains that a person may only require a small amount of care but can still need this provided long term. The social worker spoke with Mrs Y. Mrs Y said she struggled as the care agency reduced its visits and she felt she needed long term support with personal hygiene and meals.
38. The social worker carried out a mental capacity assessment. Mental capacity is the ability to make an informed decision based on understanding a situation, the options available, and the consequences of the decision. The assessment found Mrs Y had capacity to make decisions around her discharge and care.
39. Mr X complains Mrs Y did not know how expensive long-term care would be when she requested it. The social worker’s notes record discussing financial implications with Mrs Y and advising her that she may need to pay towards any long-term care. Mrs Y would have needed to complete a financial assessment to know how much she would contribute.
40. Regardless of whether Mrs Y would choose to pay for a long-term care package, she had been clear she felt unlikely to return to her previous function level. Mrs Y and Mr X signed an agreement which explained reablement care can last from one day up to a maximum of six weeks and any long-term care would be chargeable. It is not guaranteed six weeks of free care will be provided. Reablement care can be stopped at any point in this period if it is felt it is no longer appropriate. For example, the person no longer requires support or is unlikely to regain their previous level of function. Mrs Y was no longer eligible for free reablement care as she appeared to have long term care needs. I have found no fault with the decision to end Mrs Y’s reablement care.
41. Mr X disagreed Mrs Y needed long term support and wanted further reablement care. He complains about the social worker’s attitude during a telephone call about this. I have reviewed the social worker’s notes of this call, however I am unable to make a finding on her attitude based on the evidence I have seen. Without any independent evidence to confirm what happened, I am unable to resolve this point.
42. The social worker explored a small long-term care package based on Mrs Y’s request. Following conversations with Mr X, Mrs Y decided she did not want to proceed with a financial assessment or long-term care. The social worker then facilitated Mrs Y’s request to move in with Mr X on discharge, while she recovered.
43. The social worker also arranged to assess Mrs Y’s care needs after discharge. At this point, Mrs Y was happy with the support Mr X was providing and maintained her decision to decline long term care.
44. Mrs Y had capacity to make decisions about her care, and the social worker acted in line with her wishes.
45. I have not found fault with the way Mrs Y’s third discharge was handled.

Back to top

Decision

46. I have not found fault by the Council or the Trust in relation to Mrs Y’s discharges from hospital and the reablement care she received.
47. I have now completed my investigation.

Back to top

Investigator's decision on behalf of the Ombudsman