Summary: Mrs A complained about the hospital discharge process for her mother and the Council’s complaint response. We found fault with how the Council communicated with Mrs A; it did not provide a full explanation of how it made decisions. This caused uncertainty and Mrs A felt she wasn’t listened to. We also found fault with the language used in the Council’s complaint response which led to further uncertainty for Mrs A. The Council agreed to our recommendations to remedy this. We found no fault with the Trust’s actions.

The complaint

1. Mrs A complains about the hospital discharge process in February 2025 which involved staff from Gloucestershire County Council (the Council) and Gloucestershire Health & Care NHS Foundation Trust (the Trust) for her mother, Mrs B. Specifically, she complains about the following issues.
• The organisations did not fully explain why Mrs B could not move closer to her home out of county.
• The organisations did not fully explain why Mrs B could not return to her own home with an increased package of care which would be partly funded by the Council and/or NHS Funded Nursing Care from the Integrated Care Board (ICB).
• The Council’s complaint response said Mrs B’s health was ‘unstable’ but has not explained why she was allowed to leave hospital.
• The organisations have not explained why a hospice was not considered if Mrs B was thought to be at the end of her life.
2. Mrs A feels she was not listened to and the impact on her was not considered. She had to travel to see her mother, despite it being reasonable for her to move closer. The decisions made during the discharge process had a direct effect on the remainder of Mrs B’s life and yet neither organisation has fully explained why it made the decisions it did.
3. Mrs A wants a full explanation of what happened and service improvements to ensure other families are not placed in the same situation.

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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 investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we 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). If it has, we may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
6. If we are satisfied with the actions or proposed actions of the organisations that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(1), as amended)

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How I considered this complaint

7. I have considered information Mrs A provided in writing and by phone. I considered documents and comments on the complaint from the Council and the Trust. I also considered relevant law, policies and guidance.
8. Mrs A and the organisations had the opportunity to comment on my draft decision.

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What I found

Background

9. Mrs B had a fall at home and went into hospital in November 2024, she was 101 years old.
10. After an operation at one hospital, Mrs B went to a community hospital for rehabilitation.
11. Before going into hospital she lived alone, with a carer who visited her three times a day on weekdays and once a day at the weekend to help with cooking and cleaning. This carer had worked for Mrs B for many years and they were friends.
12. Mrs A lived in another county and visited at weekends to help support Mrs B.

What happened

Decisions around where Mrs B went

13. Mrs A complains the organisations did not fully explain why Mrs B could not move closer to Mrs A’s home or why Mrs B could not return to her own home. She also does not understand why a hospice was not considered.
14. Mrs B was medically well enough to leave hospital on 9 January 2025. However, the professionals caring for her noted her needs had changed significantly since the operation.
15. The Trust’s notes explain she was very frail, scoring seven on the Rockwood frailty scale which is the recognised clinical judgement scale used to measure the fitness of those over 65 years old. Score seven is described as “severely frail: completely dependent for personal care, from whatever cause (physical or cognitive). Even so, they seem stable and not at high risk of dying (within 6 months).” This score also explains why a hospice was not considered, as it would only be so when a patient is thought to have less than six months to live.
16. Mrs B could not decide about her own care. Professionals held a best interest meeting on 9 January 2025, Mrs A attended as she held lasting power of attorney for Mrs B.
17. The notes from this meeting show Mrs A explaining she wished for her mother to move closer to her so she could help care for her. However, it also notes she understood how much Mrs B loved living in her own area. She decided it was in her mother’s best interest to move to a nursing home in that area so her carer could then continue to visit. The notes show it was discussed that Mrs B now had significant nursing needs, and therefore the least restrictive option would be for her to move to a nursing home as it was likely she would decline without 24-hour care and support.
18. The Trust applied for NHS funded nursing care (FNC) for Mrs B from the local ICB, this was granted for a period of six weeks. It was felt in this time the Council could assess Mrs B’s longer-term needs and then a decision about her longer-term care could be made, including further discussion about her moving closer to Mrs A.
19. While the notes from the Trust and the Council are clear, I cannot see that a full explanation of what was happening was given to Mrs A. She was at the best interest meeting, and her views were clearly noted, she did also consent to the application for FNC for her mother’s care. But I cannot see any evidence if it was explained to Mrs A that FNC could only be awarded towards care in a nursing home, and not if Mrs B were to return home.
20. The Council were leading the conversations with Mrs A through an allocated social worker as it was the Council who looked for a nursing home for Mrs B. I also cannot see any evidence that it was explained to Mrs A that her mother’s move to the nursing home was only for six weeks and she would be under assessment in this time and then a longer-term plan would be discussed.
21. The Council’s records explain its reasoning for the decisions about where Mrs B would move to, but there is no evidence it explained what it was doing, and why to Mrs A. If the situation had been fully explained as it was in the written notes, I do not think Mrs A would have felt the need to make a complaint. This is fault which has led to Mrs A being left concerned her views were not being fully considered. This is an injustice to Mrs A.

The Council referred to Mrs B as ‘unstable’

22. As part of this investigation, I asked the Council to explain why it had referred to Mrs B as ‘unstable’ in its complaint response letter 1 August 2025.
23. It said it had used this term because although Mrs B was medically well enough to leave hospital, she was much frailer than when she went into hospital and needed more support.
24. It is my view the Council has used the term ‘unstable’ without fully considering the consequences the use of such a term would have. This is fault. Mrs A told the Ombudsmen when she read the complaint response letter, this wording caused her immediate concern, and she began to question why it was appropriate for Mrs B to leave hospital if she was concerned ‘unstable’ and caused her avoidable distress. This is an injustice to her.

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Action

25. I recommend and the Council agreed to the following actions.
26. Within one month of the final decision on this complaint, the Council should apologise to Mrs A for the faults the Ombudsmen have identified.
27. Within three months of the final decision, the Council should:
• Prepare a briefing note and send it to all its social care staff which emphasises the importance of clearly explaining decisions in care, emphasising that clear explanations could prevent complaints.
• Prepare a briefing note and send it to all its complaint handling staff, emphasising the importance of the use of plain English in its responses.
28. The Council should provide us with evidence it has complied with these actions.

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Decision

29. I found fault by the Council and have recommended actions which will remedy the injustice to Mrs A. I found no fault with the actions of the Trust.

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Investigator's decision on behalf of the Ombudsman