Summary: The Ombudsmen have decided not to investigate Mr X’s complaint about a decision to discharge his mother from hospital into a care home. This is because there are no indications of fault by the Council or the NHS Trust. At the time, measures were in place due to the COVID-19 pandemic and the decisions appear to have been in line with government guidance.

The complaint

1. Mr X complains about the discharge of his mother, Mrs Y, from hospital to a care home in January 2021 against her wishes. He says this decision increased ‘exponentially’ his mother’s chance of catching COVID-19.
2. Mrs Y tested positive for COVID-19 13-days after she transferred to the care home. She returned to hospital and she sadly died shortly after.

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The Ombudsmen’s role and powers

3. 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).
4. The Ombudsmen provide a free service, but must use public money carefully. They may decide not to start or continue with an investigation if they believe:

• it is unlikely they would find fault, or
• the fault has not caused injustice to the person who complained, or
• the injustice is not significant enough to justify their involvement, or
• it is unlikely they could add to any previous investigation by the bodies.

(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

5. I considered information provided by the complainant and the complaint responses from the Council.
6. The complainant commented on a draft of my decision statement and I considered these comments before reaching my final decision.

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My Assessment

7. Mrs Y was admitted to hospital in December 2020. While she was waiting to be discharged she was identified as a close contact with someone who had tested positive for COVID-19. She therefore had to isolate in hospital for 14 days, in line with government advice.
8. Mrs Y was in hospital a bit longer than planned as she had to isolate because of a possible contact with someone who had tested positive for COVID-19. When her isolation period ended, there was no need for her to remain in hospital and discharge planning restarted.
9. The Government updated its guidance for hospital discharge and social care assessments in September 2020. This set out that social care assessments should recommence and patients should not remain in hospital longer than necessary. This guidance was still in place during Mrs Y’s hospital admission.
10. The decision where to discharge a patient to when they are ready to leave hospital is a social care decision. We are therefore unlikely to find fault by the Trust in relation to the decision to discharge Mrs Y from hospital as soon as she was medically ‘fit for discharge’.
11. The Council allocated Mrs Y a social worker to consider her needs following discharge from hospital. Mr X spoke to the social worker and made it clear he did not want the Council to discharge Mrs Y to a care home. He was particularly concerned about COVID-19 infection rates in care home settings.
12. The Council’s complaint response noted the social worker accepted this was a difficult conversation, but their recollection about what was said differed to Mr X’s, particularly around Mrs Y’s needs. Given the different recollections and lack of independent evidence to verify either account it is unlikely, even if we investigated, we could determine exactly what was said. This does not mean we dispute Mr X’s concerns, but we are unlikely to reach a decision of fault by the Council.
13. However, the Council has already acknowledged the social worker should have been able to empathise with Mr X and it apologised if this did not happen. It said it had taken learning from the complaint that time is taken to explain processes and decision to families, while also providing assurance it listened to their concerns. Given the evidence available, this seems a proportionate outcome and I consider it unlikely we would achieve more from an investigation.
14. With regards to the discharge planning, the social worker completed a mental capacity assessment for Mrs Y. This found Mrs Y was able to understand decisions about her discharge from hospital and she took part in these discussions.
15. Mrs Y did not previously have a care package in place, but the social worker recorded that Mrs Y understood she now had additional needs that would have to be met before she could manage at home.
16. As Mrs Y’s needs had increased since her hospital admission she would need a care package in place to return home safely. It was the social worker’s professional view, based on their review of records and discussion with Mrs Y that her needs were too great to return home without having her care needs fully assessed. Exerts from the records appear to support this.
17. The social worker recorded that Mrs Y agreed to move to a discharge to assess placement for completion of a social care assessment before she returned home. It is unlikely we could establish exactly what the social worker discussed with Mrs Y or how much emphasis they placed on her transferring to a care home for assessment. However, from the information I have seen discharge to a reablement based residential care bed was in line with Government guidance.
18. I understand Mr X was unhappy that Mrs Y moved to a care home and he had valid concerns about the risks. Mrs Y had a lateral flow test 13 days after transferring to the care home. The test result was positive for COVID-19. Mrs Y returned to hospital and sadly she died shortly after. While this was a tragic outcome, we cannot link this to fault by the Trust or the Council.

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Decision

19. The Ombudsmen should not investigate this complaint. There is no indication of fault by the Trust or the Council in their respective roles in Mrs Y’s discharge from hospital. Additionally, we are unlikely to find fault in the way a social worker handled conversations with Mr X.

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Investigator's decision on behalf of the Ombudsman