Summary: Ms X complains about flaws in hospital discharge, communication and complaint handling by an integrated discharge team working for Warrington & Halton Hospitals NHS Foundation Trust and Warrington Council. We have decided not to investigate this complaint as it does not meet the tests set out in our Assessment Code.

The complaint

1. Ms X complained to us about Warrington Council (the Council) and Warrington & Halton Hospitals NHS Foundation Trust (the Trust). Ms X complained there were faults in the way the Trust’s and Council’s integrated discharge team (IDT) managed her late mother, Mrs X’s, discharge from hospital to residential care. Ms X’s original complaint to us included the following key issues:
• poor documentation;
• failures to assess Mrs X’s ability to make her own decisions;
• flawed consultation with Ms X and her father; and
• placing Mrs X in residential care that did not offer rehabilitation.
2. Ms X also complained about flawed communication and complaint handling related to Mrs X’s hospital discharge.
3. Ms X told us what happened caused her significant distress and upset. She told us she would have serious concerns about having to go through a similar experience again.
4. Ms X wanted better oversight and accountability for the IDT, and service improvements.

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The Ombudsmen’s role and powers

5. 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).
6. We cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))
7. 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 injustice is not significant enough to justify our involvement, or
• it is unlikely we 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

8. I have considered:
• information Ms X has provided in writing and by telephone;
• written information provided by the Council and Trust, including some of Mrs X’s medical and social care records; and
• the Ombudsman’s Assessment Code.
9. I discussed my preliminary views with Ms X and gave her an opportunity to provide comments before reaching a final decision on the complaint.

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What I found

10. Mrs X’s records indicate the IDT did the following:
• considered medical issues such as complications related to low blood pressure meant that Mrs X did not have potential for rehabilitation when she was ready to leave hospital;
• assessed Mrs X’s ability to make her own decisions around discharge from hospital and ongoing care;
• made a formal ‘best interest decision’ about where to discharge her to following a discussion with Ms X and Mrs X’s husband, Mr X; and
• made written records of the above.
11. In these circumstances, it is unlikely that an investigation by the Ombudsmen would find fault in Mrs X’s hospital discharge process. Also, even if an investigation were to find faults in the process, we would not be able to:
• conclude the outcome for Mrs X would have been different; or
• suggest a remedy for the late Mrs X.
12. I have carefully considered Ms X’s concerns that:
• the IDT’s communication with her and Mr X was so poor they could not properly understand the process or the financial implications of Mrs X going into residential care;
• the IDT’s telephone communication was confrontational and caused Ms X significant upset; and
• the complaint response did not provide sufficient explanations.
13. An investigation by the Ombudsmen is unlikely to be able to reach a robust conclusion, even on balance of probabilities, about the sufficiency of information provided to Mrs X’s family and the tone of the IDT’s telephone communications. While we do not underestimate the upset Ms X has experienced, this injustice is not of a scale and nature that would warrant an investigation by the Ombudsmen.

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Final decision

14. We will not investigate Ms X’s complaint about her late mother’s hospital discharge. An investigation is unlikely to find fault in the hospital discharge process and cannot now remedy matters for the late Mrs X. The injustice to Ms X from any flaws in communication and complaint handling is not of a nature and scale that would meet the discretionary test for investigation in our Assessment Code.

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Investigator's decision on behalf of the Ombudsman