Summary: The Ombudsmen will not investigate Mr and Mrs Z’s complaint about the Council’s involvement in planning Mrs Z’s mother’s discharge from hospital. This is because, based on the information we have seen, it is unlikely an investigation would be able to find enough independent evidence to make a meaningful finding.

The complaint

1. Mr and Mrs Z complain about Barnsley Metropolitan Borough Council’s (the Council’s) involvement in planning the discharge of Mrs Z’s mother, Mrs Y, from hospital in April 2018. They complain social care staff did not complete adequate assessments or involve the family in relevant discussions before making a plan to send Mrs Y home. Mr and Mrs Z complain that, had the plan gone ahead, Mrs Y would have been unsafe at home and would have come to harm.
2. Mr and Mrs Z also complain about the way discussions about this were managed by the Council. They complain a Social Worker and her manager dismissed their concerns and showed a lack of compassion and empathy.
3. Mr and Mrs Z said these events caused Mrs Y and the family stress and upset.
4. In addition, Mr and Mrs Z complain the Council’s records of these events are inaccurate and contain false information. Mr and Mrs Z complain the Council has refused to acknowledge this and has not done anything to put things right. Further, Mr and Mrs Z complain the Council is continuing to deny them access to all the records they have asked for copies of.

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The Ombudsmen’s role and powers

5. The Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsman considers whether it has caused injustice or hardship (Government Act 1974, sections 26(1) and 26A(1), as amended).
6. The Ombudsman provides a free service but must use public money carefully. The Ombudsman may decide not to start or continue with an investigation if he believes:

• it is unlikely an investigation would find fault, or
• they cannot achieve the outcome someone wants.

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

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How I considered this complaint

7. I read the correspondence and supporting papers Mr and Mrs Z sent to the Ombudsmen and spoke to them on the telephone. I wrote to the Council and Barnsley Hospital NHS Foundation Trust to request copies of relevant records. I considered all the records they provided.
8. I shared a confidential copy of my draft decision with Mr and Mrs Z to explain my provisional findings. I invited their comments and considered those they made in writing and over the telephone. I also contacted the Council about the option of adding a document to Mrs Y’s records.

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What I found

Background

9. In early 2018 Mrs Y was 93 years old and lived in a bungalow on her own. The Council assessed Mrs Y’s needs and found she needed some support. Carers visited Mrs Y in the morning and evening and Mrs Y’s family provided her with further support.
10. In March 2018 Mrs Y fell at home and went into hospital. After a brief admission she went to a care home for rehabilitation. However, later in the month Mrs Y needed to go back into hospital.
11. An Occupational Therapist (OT) assessed Mrs Y four days after she returned to hospital. The OT planned to complete further assessments to help decide on a discharge plan.
12. Mr and Mrs Z report that, during this hospital admission, Mrs Y’s ability to care for herself deteriorated. They said she was unable to stand, was doubly incontinent and did not want to eat and needed help and encouragement for this. In addition, they said Mrs Y developed pressure sores and her weight dropped (losing 33 percent of her body weight). Further, Mr and Mrs Z said Mrs Y was extremely confused and needed pain management for a mass on her abdomen. Mr and Mrs Z also said that staff on one of the hospital wards told them that Mrs Y would not be able to return home and said they should look for a care home for her.
13. On 4 April 2018 a Social Worker, Ms A, visited the ward and read through Mrs Y’s notes. Ms A noted the OT’s plan for further assessments. Ms A spoke to a Staff Nurse on the ward, Mrs Y and an OT. Ms A asked the OT to reassess Mrs Y, in view of the outcome of their earlier assessment. Ms A planned to wait to hear back from OT before contacting Mrs Y’s family and before completing an assessment. This was in case the OT found Mrs Y would benefit from further rehabilitation. If this was the case it would be too soon to consider what support the Council might need to provide.
14. In the late evening of 4 April the ward Mrs Y was in was full. The hospital admitted a patient as an emergency. This patient urgently needed a bed on the ward. The hospital decided to move Mrs Y to the discharge unit. The Council was not involved in this decision.
15. Mrs Z visited the hospital in the morning of 5 April. Staff told her that Mrs Y had been moved to the discharge unit. Mrs Z went to the discharge unit and found Mrs Y fully dressed and waiting to go home.
16. Also in the morning of 5 April, a Nurse called Ms A and said the hospital had moved Mrs Y to the discharge unit. The Nurse told Ms A the family had found a care home. Ms A said she was still waiting to hear from the OT before social services could assess Mrs Y’s needs. A short time later an OT called Ms A and said Mrs Y would not benefit from further attempts at rehabilitation.
17. After this conversation with the OT Ms A arranged for Mrs Y’s case to be transferred to another Social Worker, Ms B. They noted a plan for Ms B to meet the family in the discharge unit that afternoon.
18. Ms B recorded that she visited Mrs Y in the afternoon and Mrs Y said she wanted her family to be present.
19. Mrs Z said her sister, Mrs X, arrived on the discharge unit at around 1pm. She said that she and her husband arrived around 20 to 30 minutes later. In contrast, Ms B recorded that she spoke to Mrs X and arranged to meet her on the ward at 2.30pm.
20. Regardless of the exact time, Ms B met with Mr and Mrs Z and Mrs X in the afternoon of 5 April.
21. Mr and Mrs Z said when they arrived there was no discussion and the family were just told ‘your mother is going home’. Mrs X said Ms B told her she had completed an assessment and Mrs Y would be going home, with two carers visiting four times a day.
22. Ms B recorded that the family said they had found a residential placement following advice from a health professional. Ms B recorded that she said the health professional should not have said this, as it was for Social Services to determine what Mrs Y’s needs were.
23. Ms B summarised in her notes that she felt it would be safe for Ms B to return home with carers supporting her. She recorded that the family would not accept this.
24. It is evident from Mr and Mrs Z’s and Mrs X’s accounts and from Ms B’s notes that this meeting became heated. The family asked to speak to Ms B’s manager.
25. Ms B’s manager, Ms C, came to the ward. She initially spoke to the family on the ward and then in an office. The family said at first Ms C supported Ms B’s conclusion and continued to say that Mrs Y would go home after she left hospital. They said that, around three and a half hours after the discussions with Ms B began, the social care staff agreed that Mrs Y would be discharged to a short‑term placement.
26. The following day Ms B called the care home the family had approached. She arranged for its staff to visit and assess Mrs Y, which it did later that day. Mrs Y left hospital and went to the care home the next day.
27. Mrs Y sadly died at the end of May 2018.

Analysis

28. In all complaints brought to the Ombudsman we first consider whether there may be any evidence of fault. Where there is likely 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 and Mrs Z have clearly explained their concerns about the possible consequences to Mrs Y if she had been sent home from hospital. However, this did not happen and it is not for the Ombudsmen to try to establish what might have happened. By the end of the discussions the family persuaded the Council to arrange a short-term residential placement, and this is what happened.
29. Nevertheless, Mr and Mrs Z complain that the conduct of the meetings on 5 April caused them upset and distress in its own right.
30. The underlying situation – of seeing a deterioration in Mrs Y’s health, her being in hospital and having to think about her future care – was a stressful and upsetting one. Further, as noted above, the Council was not responsible for Mrs Y’s unplanned move to the discharge lounge late on 4 April. This move, and the way the family learned of it, would also have been upsetting and distressing on its own, but there is no indication this was the fault of the Council. In addition, as the Council highlighted in its complaint response, there will be times when its professional opinion differs from the service user’s or the family’s. This will, inevitably, lead to difficult and challenging conversations. In these situations Council staff still must express their views.
31. In this context, the starting point for the meeting between the family and social services – 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. However, Mr and Mrs Z complain this was made significantly worse by the approach the Council took.
32. It is clear from Mr and Mrs Z’s written accounts and from speaking to them that they have been left upset by these events, and have lasting painful memories. I do not discount their strength of feeling about the matters at hand. However, the Ombudsman is independent and must weigh the evidence of all parties before reaching a decision.
33. The accounts of events on 5 April differ:

• Mr and Mrs Z have provided consistent and detailed accounts of events from their perspective. A complaint from another family member also provides a similar account. I have no call to discount what Mr and Mrs Z said in their letters, or over the telephone, as sources of evidence.
• The Council’s records are kept in a usual style and to a normal level of detail. The records from 4 and 5 April also show a consistent line of thinking. As such, I have not seen anything that leads me to immediately dismiss or discount these records as a valid source of evidence. Mr and Mrs Z have pointed to what they say are inconsistencies and inaccuracies in terms of the timing of the records. However, any concerns about the accuracy of the timings would not cast significant doubt on the broader content. This is because, while the timings may be uncertain, it is clear that there were discussions in the afternoon of 5 April and: the Council felt it would be safe and reasonable for Mrs Y to return home with support from carers; the family felt this would not be safe or appropriate. It is also clear that the meeting became heated and was upsetting for the family.

34. Therefore, an investigation would need to take account of both sources of evidence.
35. I have seen entries from the hospital’s multidisciplinary records in relation to discharge planning. These records do not shed any light on the disputed events of 5 April.
36. Based on what I have seen to date it does not appear it would be possible for the Ombudsmen to objectively determine, in an evidenced way, whether there was an injustice caused solely by fault on the part of the Council.
37. Mr and Mrs Z obtained a redacted copy of parts of Mrs Y’s records in January 2019. They raised concerns about the accuracy and completeness of the records. Mr and Mrs Z attended a meeting with the Council in March 2019 and had further written communication with the Council after this. The Council did not accept the records were flawed, and they remain as they were initially recorded. For the same reasons as above, I do not consider an investigation by the Ombudsman would be able to resolve the dispute about the accuracy of Mrs Y’s records. In this situation it would be reasonable for Mr and Mrs Z to document their concerns about the accuracy of the records of events they were part of. The Council has confirmed it is content for Mr and Mrs Z to add an addendum to Mrs Y’s records (for entries concerning events they took part in). The addendum would need to focus on Mr and Mrs Z’s views about what was factually inaccurate and missing in the records, and should not include any personal comments or criticisms. I consider this is a pragmatic way forward and do not consider an investigation is likely to achieve anything more.
38. The Information Commissioner’s Office is the most appropriate organisation to consider complaints about access to records under relevant legislation. As such, I have not considered any concerns about access to records.

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Decision

39. I have closed our file on Mr and Mrs Z’s complaint as, based on the available information, an investigation by the Ombudsmen 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