Summary: The Ombudsmen will not investigate this complaint about an avoidably delayed hospital discharge. The Trust and the Council have already accepted there were failings and apologised for them. It is unlikely that an investigation would be able to find evidence of an unremedied injustice.

The complaint

1. Mrs X complains about an avoidable and unnecessary delay in arranging her husband’s, Mr X’s, discharge from hospital in the summer of 2023. Mrs X complains that hospital staff failed to arrange for social care staff to start planning Mr X’s discharge. In addition, she complains that it was unnecessary to arrange two meetings about Mr X’s discharge arrangements two weeks apart.
2. Mr X died soon after returning home. Mrs X said the delays meant she and her husband only had several weeks together at the end of Mr X’s life. She said that without the delays she could have spent more time with him.
3. In bringing her complaint to the Ombudsmen Mrs X said she would like reassurances that lessons will be learned and improvements made to prevent recurrences.
4. Staff from South Tyneside and Sunderland NHS Foundation Trust (the Trust) and Sunderland City Council (the Council) both had responsibilities in arranging Mr X’s discharge.

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The Ombudsmen’s role and powers

5. The Local Government and Social Care Ombudsman (LGSCO) and the Health Service Ombudsman (HSO) 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 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, or
• we cannot achieve the outcome someone wants.

(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

7. I considered Mrs X’s written complaint to HSO and a HSO caseworker’s notes of their conversation with Mrs X. I read Mrs X’s complaints to the Trust and the two written responses she received including the information it included from the Council. I also read copies of the Council’s adult social care records for Mr X for the relevant period.
8. I considered relevant legislation and guidance along with LGSCO’s Assessment Code.
9. I shared a confidential copy of my provisional decision with Mrs X and invited her comments on it. I spoke to Mrs X about my provisional decision and considered her comments about it.

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What I found

10. Mr X had dementia. He was admitted to hospital in the middle of 2023. Just over a month later medics decided that Mr X was medically stable enough to leave hospital.
11. The hospital referred Mr X to the Council Adult Social Care department for assistance in planning his discharge from hospital. Professionals had concerns about how safe it would be for Mr X to return to his home. In particular, they worried about him falling and one person alone being unable to help him. In addition, they had concerns that he may not get enough fluids. They asked for colleagues from physiotherapy to assess Mr X. After the physiotherapy review the social worker arranged a meeting involving medical, nursing, physiotherapy and social care staff along with Mrs X and her son.
12. The meeting agreed that Mr X should return home with more support from care workers. The Council liaised with a care provider who arranged to provide the care required. Mr X returned home around a week after this meeting, and about five-and-a-half weeks after medics said he no longer needed treatment in a hospital. Mr X sadly died around three‑and‑a‑half weeks later.
13. Mrs X complained to the Trust in October. The Trust shared the complaint with the Council and sent a joint response at the start of 2024. The Trust sent a further response in February 2024.
14. The Trust said it had been appropriate for staff to voice and evaluate their concerns about how safe it would be for Mr X to return home. It said it took time to complete this work but it was necessary. However, the Trust acknowledged that there were “perhaps some avoidable delays once [Mr X] was [determined to be medically optimised for discharge], often due to a breakdown in communication between the teams involved in his care”. It accepted that “the delays in [Mr X’s] discharge planning caused [Mrs X] considerable distress”. It said it was sorry for this. The Trust also said it would use the complaint to improve the way teams worked together and would hopefully avoid recurrences.
15. The Council did not identify any failings in the way it progressed Mr X’s discharge after the case had been allocated to a social worker. It did however accept that it had failed to communicate with Mrs X adequately. It apologised.

Analysis

16. When arranging for someone to transfer out of hospital both Trust and Council staff have responsibilities to ensure that the person will be safe and that their needs will be safely met. From the available evidence, the professionals’ concerns about Mr X’s safety were understandable. They were grounded in what staff had observed about Mr X’s needs during his inpatient admission. An investigation by the Ombudsmen would not criticise staff for raising concerns about a person’s safety. It also would not criticise them for seeking to explore those concerns through assessments, discussions with other professionals and the family. While this does inevitably create delays it would be inappropriate for staff to ignore their concerns, even when the family have clear, conflicting views.
17. I have considered the individual steps of the discharge process. Firstly, the time that elapsed between doctors declaring Mr X to be medically optimised for discharge and staff referring him to social services. From the papers I’ve seen it appears it took three days for the Trust to refer Mr X to social services. While the Trust did not specify as much, it seems probable that this is one of the “small delays” it acknowledged in its complaint responses.
18. As the Council noted in its part of the complaint response, it took three working days for it to allocate Mr X’s case to a social worker after it received the referral. The Council has accepted it should have been two days at most. As such, there was another delay of one day here.
19. From the Council notes I have seen, on the same day the social worker was allocated to the case, they spoke to Mr X’s current care provider. They discussed their concerns about how Mr X may manage at home. They also arranged for the care staff to come to the ward to assess Mr X in person four working days later. An investigation would be unlikely to find fault in the social worker’s actions here. It appears that they sought to address their concerns and arrange an assessment in a timely way.
20. In addition, based on the records of the meeting in early August, the decision to seek a further a physiotherapy review seems understandable. The aim was to obtain a more thorough assessment of Mr X’s needs. This appears a proportionate step. Therefore, again, it is unlikely an investigation would find fault with this decision.
21. Based on the papers I have seen it seems it took around five working days for staff to complete this physiotherapy review. It seems possible that this is another of the points where the Trust accepts there was an avoidable delay. It appears the impact is likely to be a further delay or two or three days in getting Mr X home.
22. The Council noted that, during these events, Mr X’s case was reallocated to a different worker. However, I have not seen anything that indicates that this reallocation caused a notable delay, in and of itself. This happened around the same time as the wait for a physiotherapy review.
23. The Council records show that once it knew the outcome of the physiotherapy review it spoke to Mr and Mrs X’s son the same day. During this call it arranged a meeting for four working days later. As the professionals’ concerns remained an investigation would be unlikely to find fault with the decision to arrange a multi‑disciplinary meeting with the family to discuss everything and agree a plan. Such an approach is recommended in relevant guidance. Further, an investigation is unlikely to find fault in the timing of this meeting.
24. After the meeting the Council then took a week to arrange the increased care package. I have seen notes to show it contacted the care provider soon after the meeting and stressed the urgency of it. It then had to rely on the care provider’s availability. The care provider decided when it would be able to start the package. As such, an investigation would be unlikely to find fault with the Council here.
25. Overall, the faults that an investigation may find seem likely to amount to avoidable delays of about a week in total:

• a three day delay in the Trust referring Mr X to social care;
• a one day delay in the Council allocating Mr X’s case to a social worker; and,
• a two-to-three day delay after the first meeting in completing the requested physiotherapy review and letting social care know the outcome.

26. As noted above, the Trust has already accepted that there were avoidable delays which caused Mrs X distress. It seems improbable that an investigation would find significantly more fault and injustice than has been acknowledged and apologised for during the local complaints process.
27. The Trust also undertook to learn from Mr and Mrs X’s experience. It did not identify any specific actions it would take. However, given the nature of the apparent failings, an investigation is unlikely to be able to recommend any particular actions which could help to promote specific learning points or administrative changes.

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Decision

28. We will not investigate Mrs X’s complaint because it is unlikely an investigation would be able to find evidence of an unremedied injustice.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman