Summary: The Ombudsman will not investigate Mr Y and Mrs Z’s complaint about the Council’s involvement in planning their mother’s discharge from hospital. This is because it is unlikely an investigation would be able to find enough independent evidence to make a meaningful finding.

The complaint

1. Mr Y and Mrs Z have concerns about the medical decision to discharge their mother, Mrs A, from hospital in December 2018. This decision was the responsibility of an NHS Trust. The decision that Mrs A could leave hospital led to a discharge planning process which staff from Lancashire County Council (the Council) contributed to.
2. Mr Y and Mrs Z complain about a Social Worker’s role in planning Mrs A’s discharge. They complain the Social Worker lied about the reasons why a placement at a specific care home was not being pursued. Mr Y and Mrs Z complain this was part of an unreasonable effort to send Mrs A home from hospital, which they consider was inappropriate and would have led to harm to Mrs A if it had happened. Mr Y and Mrs Z said these actions caused the family distress.

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The Ombudsman’s role and powers

3. 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’. 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
• the fault has not caused injustice to the person who complained, or
• the injustice is not significant enough to justify our involvement, or
• it is unlikely further investigation will lead to a different outcome.

(Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

4. I read the correspondence and supporting papers Mr Y and Mrs Z sent to the Ombudsmen. This included copies of Mrs A’s records from Lancashire Teaching Hospitals NHS Foundation Trust and the Council. I also spoke to Mr Y and Mrs Z on the telephone.
5. I shared a confidential copy of my draft decision with Mr Y and Mrs Z to explain my provisional findings. I invited their comments and considered those I received in response.

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What I found

Background

6. In December 2018 Mrs A was 88 years old. She had a number of physical health issues and her overall health had been deteriorating since October 2018. Mrs A was admitted to hospital via ambulance in the middle of December 2018. The hospital diagnosed her as suffering from congestive heart failure. Mrs A was also suffering from a condition affecting her bowel, and from pain associated with spinal fractures which related to osteoporosis.
7. Early in Mrs A’s admission staff noted that she would need some support to manage her everyday needs after she left hospital.
8. Four days after Mrs A’s admission a doctor felt she was medically stable enough to be able to leave hospital. (As noted above, Mr Y and Mrs Z have concerns about this decision and are pursuing a complaint about it.) Social Work staff became involved in the discharge planning process a couple of days after this.
9. During discharge planning the prospect of Mrs A being discharged to a specific care home (which does not have doctors on site) was raised. However, it was later determined this would not be possible. The reasons for this, and what was said about this, are disputed.
10. At the end of the month, 14 days after she went into hospital, Mrs A left the ward and went home to be assessed by an Occupational Therapist and Social Worker from the Home First service. It was agreed that it would not be appropriate for Mrs A to remain at home. Mrs A transferred to another care home (with doctors on site) for a short-term placement the same day.

Analysis

11. In all complaints brought to the Ombudsman we first consider whether there may be any evidence of fault. Where there is fault the Ombudsman then looks at whether the fault can be linked to a specific individual injustice which would not have otherwise happened. It is about looking at what did happen rather than what could have happened. Mr Y and Mrs Z have clearly explained their concerns about the possible consequences to Mrs A if she had been sent home from hospital. However, this did not happen and it is not for the Ombudsmen to try to establish or speculate on what might have occurred if it had. As noted above, by the end of a Home First assessment in late December 2018 it was agreed it would not be safe for Mrs A to stay at home. She was admitted to a care home with doctors on site. Mr Y and Mrs Z have noted they are happy with the standard of care Mrs A received there.
12. Nevertheless, Mr Y and Mrs Z complain that the conduct of a Social Worker involved in the discharge process caused the family upset and distress in its own right.
13. The underlying situation – of a deterioration in Mrs A’s health in the community followed by an emergency admission to hospital, a diagnosis of heart failure, other ongoing health conditions and having to think about her future care – was a stressful and upsetting one. The Council was not responsible for this situation, or for the decision that Mrs A was medically stable enough to leave hospital.
14. Once a council receives a referral about someone who might need support when they leave hospital it has a duty to consider the person’s needs. As part of this, social care professionals are expected to consider a variety of options for meeting a person’s needs and are encouraged to promote independence. In this context an exploration of whether it would be possible to go home with a package of care would not be unusual. In addition, there will be times when a professional’s opinion differs from the patient’s or the family’s. This can, inevitably, lead to difficult conversations but this does not mean that council staff should not express their views about how they believe the person’s needs could be met.
15. In this context, the starting point for the discussions between the family and Social Worker – even without the prospect of any fault by the Council – was already somewhat fraught and stressful. This, on its own, is likely to have been upsetting for all the family. However, Mr Y and Mrs Z complain this was made worse by the approach the Council took, and by the change in what it said about a possible move to a specific care home which, they say, was not truthful.
16. It is clear from Mr Y and Mrs Z’s accounts that they have been left with upsetting memories of these events. I do not discount their strength of feeling about these issues. However, the Ombudsman is independent and must weigh the evidence of all parties before reaching a decision.
17. An investigation of this complaint would need to take account of the family’s recollections of events, which is their evidence of wrongdoing. It would also need to take account of what is recorded in the Council’s contemporaneous records, and of any subsequent staff statements about the matters.
18. Based on what I have seen to date it does appear it would be possible for the Ombudsmen to objectively determine, in an evidenced way, whether there was an injustice caused solely by fault in the Social Worker’s actions during the discharge process.

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Decision

19. The Ombudsman will not investigate Mr Y and Mrs Z’s complaint about the Council. This is because an investigation is unlikely to be able to find enough independent evidence to reach a meaningful decision.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman