Summary: Mrs X complains the Council failed to meet her mother’s needs when she left hospital in March 2020. The Council was at fault for failing to provide an enhanced package of care when Mrs X’s mother returned home in March 2020. It needs to apologise to Mrs X for the avoidable distress this caused and pay financial redress.

The complaint

1. The complainant, whom I shall refer to as Mrs X, complains the Council failed to meet her mother’s needs when she left hospital in March 2020, causing unnecessary distress.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, sections 30(1B) and 34H(i), as amended)
4. This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. We can consider whether the Council followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.

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How I considered this complaint

5. I have:
• considered the complaint and the documents provided by Mrs X;
• discussed the complaint with Mrs X;
• considered the documents provided by the Hospital; and
• shared a draft of this statement with Mrs X and the Council, and invited comments for me to consider before making my final decision.

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What I found

6. Following a cyber-attack in October 2020, the Council no longer has access to its social care records from before the attack.
7. On 19 March the Government and the NHS issued the COVID-19 Hospital Discharge Service Requirements. The aim was to discharge people within three hours with:
• 50% leaving with no input from health or social care;
• 45% returning home with support from health and/or social care;
• 4% going for rehabilitation in a bedded setting; and
• 1% moving permanently to residential care because of a life changing event.

Funding was available from the NHS for enhanced packages of care.

What happened

8. Mrs X’s mother, Mrs Y, lived at home with a package of care (three calls a day) to meet her care needs. Mrs X, who does not live in London, visited her mother every weekend. Mrs Y went into hospital in January 2020 with back pain, which further limited her mobility. She had been in and out of hospital since 2018.
9. A family meeting was held at the hospital on 13 February to discuss discharge options. Mrs X attended the meeting with other family members, a Social Worker, an Occupational Therapist and NHS staff. Mrs Y expressed some concern about returning home and was particularly worried about night times. Her family wanted her to move to residential care and had identified three homes with vacancies close to where they live. The Social Worker suggested Mrs Y return home and trial an enhanced package of care comprising three or four calls a day plus an overnight carer. However, the decision was for Mrs Y to move to a residential placement, to which she agreed. The plan was for the Social Worker to complete an assessment of Mrs Y’s needs. The family were to provide information about the preferred care home so the Council could arrange a placement. The Council told Mrs X it could do this within a week.
10. Mrs Y’s family identified their preferred care home on 16 February.
11. On 20 February, the Council told Mrs X it would not fund a care home as her mother did not need 24-hour care.
12. The Council assessed Mrs Y’s needs on 25 February. The Hospital’s record of a meeting, which included its staff and the Social Worker, says Mrs Y had “made a small improvement in function and mobility since admission however overall has functionally declined”. The notes also recorded Mrs Y was awaiting placement in a care home close to her family. However, she had developed pneumonia, which delayed discharge.
13. Other Hospital records say:
• 26 February – the Hospital told Mrs X the Council had resubmitted an application to fund a care home.
• 27 February – Mrs Y was awaiting discharge planning.
• 2 March – Mrs Y was “for placement follow[ing] family meeting”.
• 5 March – Mrs Y continued to be ready to leave hospital and was on antibiotics which could continue on discharge.
• 17 March – Mrs Y was a fall risk because of deconditioning while in hospital. The Social Worker completed a care and support plan for Mrs Y to return home with an increased package of care and was waiting for funding approval. The Social Worker e-mailed Mrs X to let her know the plan.
• 19 March – Mrs Y’s Social Worker told the Hospital the Council was commissioning a package of care. Mrs Y’s Abbreviated Mental Test Score (a quick test for signs of dementia) was 9 out of 10, which meant there was no reason to refer her for more detailed tests. Mrs Y was independent in bed mobility but remained a falls risk. She needed the help of at least one person to stand from a sitting position and to get back into bed using a rigid frame.
• 20 March – Mrs Y had been due to leave hospital, but this was delayed to 23 March as her package of care was not ready.
14. Mrs X says she protested when told about the plan for her mother to return home, but the Council said she would be safer from COVID-19 at home.
15. Mrs Y left hospital on 23 March and returned to her home with a package of care based on three calls a day. After she returned home Mrs Y was very confused, trying to call a relative who had died many years ago and picking up her mobile phone when the landline rang. She was frightened of being alone at night.
16. Mrs Y had a fall in the morning of 24 March and was on the floor until a Care Worker visited at lunchtime. Paramedics attended but did not take her to hospital. Mrs X asked the Council to reassess their mother. She said Mrs Y would feel comfortable in a hospice where she had once volunteered, as the care home they had identified for her was no longer accepting new residents.
17. The Hospital tried calling Mrs Y on 24 March for a post-discharge review but there was no answer. Her family reported increased confusion to the Hospital, which noted this was unlikely to be due to infection and was probably due to disorientation after being in hospital for three months.
18. On 25 March Mrs Y had a fall around 04.30. A paramedic visited but Mrs Y did not need to go to hospital. A Doctor visited around 17.00 to check Mrs Y. Her oxygen levels were good and her Abbreviated Mental Test Score was 8 out of 10. Shortly after the Doctor’s visit a Care Worker found Mrs Y on the floor again and called the paramedics. Two relatives stayed overnight with Mrs Y. They reported helping her five times that night. The Council increased Mrs Y’s package of care to four calls a day.
19. On 26 March another Doctor and an Occupational Therapist visited Mrs Y. They found her to be responsive and asked Care Workers to prompt her with medication.
20. On 27 March a Care Worker found Mrs Y on the kitchen floor in the morning. She was shivering, so had presumably been there some time. The Council asked Mrs X what care home they had identified for Mrs Y, but it was not taking new residents. So the Council identified a care home in London which said it could take her on 30 March. Mrs X asked the Council to provide overnight support for her mother until she could move to the care home. The Council said it was too late to arrange this.
21. On 28 March Mrs X was told her mother could not move on 30 March because of problems arranging transport and the need to agree additional funding for her dietary needs. In the evening Mrs Y wanted to get out of bed, despite finding it difficult to walk. Mrs X tried to persuade her to stay in bed so she would be safe.
22. On 29 March Mrs Y was again found on the floor. Paramedics told Mrs X they would have taken her to hospital, but it was too risky because of COVID-19.
23. On 30 March the Council agreed to provide overnight support for Mrs Y.
24. Mrs Y died on 31 March.
25. When the Council replied to Mrs X’s complaint on 2 September, it said:
• Mrs Y’s return home was in line with the COVID-19 Hospital Discharge Service Requirements;
• she was happy to return home when discharged;
• Mrs Y had made good progress with transfers while in hospital so her falls risk had reduced;
• it accepted there had been avoidable delays in moving Mrs Y to the care home as the problems which caused the delay could have been better anticipated;
• it would remind the Integrated Discharge Team of the need to respond quickly to requests for additional care.

Is there evidence of fault by the Council which caused injustice?

26. There was some delay by the Council in assessing Mrs Y’s needs in February. The meeting to discuss discharge options was on 13 February but the Council did not assess her until 25 February. It is unclear how the Council could have decided on 20 February that Mrs Y did not need 24-hour care when it had not assessed her needs. However, it is clear from the hospital records that after the assessment the Council was not planning to move Mrs Y to residential care. It is not possible to remedy any injustice this may have caused Mrs Y, as she has now died.
27. The Council says Mrs Y’s discharge from hospital was in line with the COVID-19 Hospital Discharge Service Requirements. However, Mrs Y returned home with the same package of care that she had before she went into hospital. The hospital records show the expectation was for Mrs Y to return home with an enhanced package of care (an increase from three to four calls a day). In February the Council offered overnight support and there is nothing in the Hospital’s records to suggest her mobility improved in March, as she needed staff to help her. She had also become deconditioned due to her long stay in hospital. This indicates the Council should have been considering overnight support in March as well. The Council’s failure to put in place an enhanced package of care, and to consider including overnight care, is fault.
28. The Council accepts there were avoidable delays in moving Mrs Y to a care home in March. It also accepts it should have responded more quickly to Mrs X’s requests for additional help. These delays are fault.
29. These failures caused injustice to Mrs X through avoidable distress. This was made worse by the fact she could not visit her mother because of COVID-19, so was left trying to provide support over the telephone.

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Agreed action

30. I recommended the Council:
• within four weeks writes to Mrs X apologising for the failure to send her mother home with an enhanced package of care and the distress this caused, and pays her £400.

The Council has agreed to do this.

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Final decision

31. I have completed my investigation on the basis that the Council has agreed to take action to remedy the injustice caused to Mrs X by its faults.

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Investigator's decision on behalf of the Ombudsman