Summary: Ms Y complained on behalf of her late father, Mr X, that the Trust and Council failed to assess Mr X properly before he left hospital, that Mr X was transferred to a care home that was not suitable for him and could not meet his needs, and that Mr X sustained an unexplained eye injury. Ms Y also complained the Trust failed to protect Mr X’s dignity. We will not investigate Ms Y’s complaint as it is unlikely we would find fault, or add to the responses Ms Y has already received from the organisations.

The complaint

1. Ms Y complained on behalf of her late father, Mr X, that:
1. Medway NHS Foundation Trust (the Trust) failed to protect Mr X’s dignity by not giving him appropriate clothing while on the ward. Ms Y said he often had only a gown on and on one occasion when she visited him, Mr X had no clothing on at all;
2. the Trust and Medway Council (the Council) did not assess Mr X’s mobility properly during discharge planning;
3. the Council did not listen to Mr X’s family when they expressed concerns that he needed nursing care;
4. the Council placed Mr X in a care home which was not suitable and could not meet his needs, and was a long distance from his family; and
5. Mr X sustained an injury to his eye on the day he moved from hospital to the care home, and this has not been explained.
2. Ms Y said this had an impact on Mr X’s dignity and meant he did not get the care he needed. Ms Y also said this caused great distress to Mr X’s family.
3. As an outcome of her complaint, Ms Y seeks improvements to services so that other people do not go through the same experience.

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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. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• it is unlikely we would find fault, or
• it is unlikely we could add to any previous investigation by the organisations.
  (Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

6. I considered evidence provided by Ms Y, the Council and the Trust, as well as relevant law, policy and guidance.
7. Ms Y had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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My assessment

8. Mr X had diagnoses of dementia and Parkinson’s disease. He went into hospital after a fall at home. Both the Council and Trust were involved in arranging Mr X’s discharge from hospital. On leaving hospital, Mr X went to a care home on a temporary basis. This was so the level of care he needed could be assessed.
9. Mr X was later readmitted to hospital after a fall. Sadly, Mr X died several days later.
10. Ms Y complained to the Council and Trust. As Ms Y has raised several issues in her complaint, I have set these out under separate headings, below.

a) complaint about dignity on the hospital ward

11. Ms Y said that while on the ward, Mr X often had only a gown on, or no clothing at all on one occasion when she visited. In responding to Ms Y’s complaint, the Trust acknowledged the upset caused by this and apologised. The Nursing and Midwifery Code says nurses should make sure people’s dignity is preserved, and the Trust response says staff would have wanted to protect Mr X’s dignity. I recognise this incident must have been distressing for Mr X and Ms Y. As the Trust appropriately apologised to Ms Y in its response to her complaint, it is unlikely we could add to this response for Ms Y by investigating this part of the complaint.

b) complaint that the Trust and Council did not assess Mr X’s mobility

12. Ms Y said Mr X’s mobility was not properly assessed before he left hospital, meaning he did not get the support he needed with his mobility in the care home.
13. The Trust’s response to Ms Y’s complaint refers to Mr X’s medical records, and says physiotherapists reviewed Mr X before he left hospital. The information provided by the Council also indicates it considered the input from the physiotherapy assessments and included this in Mr X’s support plan. Therefore, it is unlikely we would find evidence of fault by the Trust and Council in their assessments of Mr X.

c) complaint that the Council did not listen to Mr X’s family about the level of care he needed

14. In response to Ms Y’s complaint, the Council referred to records of discussions with Mr X’s family about his care after he left hospital. The Council acknowledged there were different views about the care Mr X would need. The Council said because of the concerns raised by Mr X’s family about this, it proposed a period of assessment to confirm the level of support he required.
15. The Department of Health and Social Care issued statutory guidance: Hospital discharge and community support guidance (the National Discharge Guidance) in April 2022 (updated January 2024). This provides guidance to NHS bodies and local authorities on discharging adults from hospital. The guidance says that NHS bodies and local authorities should ensure that, where appropriate, unpaid carers and family members are involved in discharge decisions. I recognise Ms Y disagreed with the choice of placement. However, as the available information indicates the Council discussed discharge planning with Mr X’s family and took account of their views, an investigation would be unlikely to find fault by the Council on this point.

d) complaint that the Council placed Mr X in a care home which was not suitable and could not meet his needs, and was a long distance from his family

16. The Council acknowledged the concerns of Mr X’s family that the care home’s location meant it was difficult for the family to visit. The Council said it could not provide a closer placement at that time as these were the only available assessment beds.
17. The National Discharge Guidance says assessments of a person’s longer-term care needs should take place after they have left hospital and after an initial period of recovery. It says that other than in exceptional circumstances, no one should be discharged directly into a permanent care home placement for the first time without first giving them an opportunity to recover in a temporary placement before assessing their long-term needs.
18. The Council’s response to Ms Y’s complaint explained the purpose of the assessment bed placement in the care home was to confirm the level of support Mr X needed. The Council apologised for any breakdown in communication about this. It said it had taken on board Ms Y’s comments and would be mindful of this in future communications. I recognise Ms Y considered the placement was not suitable. However, the Council explained that these were the only available assessment beds at that time. The Hospital Discharge Guidance makes clear that although NHS organisations and councils should involve patients and carers in discharge decisions, issues about choice of placement cannot delay discharge. It is unlikely we would find fault with the Council’s actions in arranging Mr X’s discharge placement.

e) complaint that Mr X sustained an injury to his eye

19. Ms Y said that on his first day at the care home, Mr X was found to have an injury to his eye. The Council and the Trust said they could not establish how Mr X sustained the injury as they had no records of what had happened. I recognise this leaves Ms Y without an explanation, and the uncertainty and distress this may cause. We would be unlikely to add anything further for Ms Y if we investigated this part of her complaint, because of the lack of records about this issue.

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Decision

20. We will not investigate Ms Y’s complaint as we would be unlikely to find evidence of fault, and could not add to the responses Ms Y has already received from the Council and Trust.

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Investigator's decision on behalf of the Ombudsman