Summary: Mr B complained about the way an NHS Trust and a Council planned his mother’s, Mrs Z’s, discharge from hospital. We have not found fault in the way the organisations considered Mrs Z’s capacity or how they planned where she should be discharged to for further assessments. And we have not found fault in the way the Trust communicated with the placement about the equipment Mrs Z needed, or the way it communicated with the family about when Mrs Z would leave hospital.

The complaint

1. Mrs Z was admitted to hospital in the spring of 2025 and remained there until the summer. Stockport NHS Foundation Trust (the Trust) is responsible for the hospital and Stockport Metropolitan Borough Council (the Council) is responsible for Adult Social Care (ASC) services in the area.
2. Mrs Z had significant needs which would require support after she left hospital. During her admission professionals decided Mrs Z did not have capacity to decide where she should live and how her needs should be supported after she left hospital. As such, decisions about this were made in her best interests. Professionals arranged for Mrs Z to leave hospital and transfer to a Discharge to Assess (D2A) placement.
3. Mr B, one of Mrs Z’s sons, complains:
1. The Council failed to complete an assessment of Mrs Z’s care needs before she left hospital, and failed to tell the family about a plan to assess her needs in another location.
2. Professionals unfairly decided that Mrs Z did not have the capacity to decide where she would live or how her needs should be met when she left hospital.
3. Professionals failed to properly consider Mrs Z’s wishes during best interests meetings, and failed to properly involve and communicate with Mrs Z’s family during discussions about her post-discharge care.
4. The Trust wrongly decided that Mrs Z required residential dementia care when she left hospital and failed to properly consider the possibility of supporting her in her own home.
5. The Trust transferred Mrs Z to an inappropriate placement which was unsuitable for her needs.
6. The Trust failed to manage Mrs Z’s discharge. Mr B said the Trust did not:
1. ensure the receiving care home was properly prepared and equipped for Mrs Z’s arrival; and
2. tell Mrs Z’s family of the discharge plans in advance.
4. Mr B said Mrs Z was very unhappy in the D2A placement. He said she cried and shouted for help and repeatedly asked to be taken home. Mr B said the placement had to prescribe medication to manage Mrs Z’s anxiety and agitation, and Mr B said Mrs Z self-harmed by hitting herself in the face. Mr B said this, in turn, had caused the family a significant emotional strain.

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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 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).
7. If it has, they 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.
8. When investigating complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened. 
9. 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))
10. 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

11. I considered evidence provided by Mr B, the Council and the Trust. I have also considered relevant law, policy and guidance.
12. Mr B, the Council and the Trust all had an opportunity to comment on my draft decision. I considered the comments and additional information I received before making a final decision.

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What I found

Legislation and guidance

Hospital discharge

13. The Department of Health and Social Care issued statutory guidance: Hospital discharge and community support guidance (the National Discharge Guidance) in January 2024. This provides guidance to NHS organisations and local authorities on discharging adults from hospital. It said local areas should adopt discharge processes that best meet the needs of the local population. This could include the ‘discharge to assess, home first’ approach.
14. The National Discharge Guidance says in section 2 that planning for discharge should begin on admission to hospital. It also says that, from the outset, “people should be asked who they wish to be involved and/or informed in discussions and decisions about their hospital discharge”. It also says that “Multi-disciplinary teams…should work across hospital and community settings – including with services provided by community health, adult social care and social care providers – to plan post‑discharge care”.
15. Section 3 of the National Discharge Guidance notes that professionals “should consider a range of factors when supporting the individual and their family, unpaid carers or independent advocate to decide an individual’s care pathway and post‑discharge support. This includes the individual’s preferences, existing provision of care, and whether unpaid carers are willing and able to support an individual’s recovery.”

Mental capacity

16. The Mental Capacity Act 2005 (the MCA) is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The MCA (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so.
17. A person aged 16 or over must be presumed to have capacity to make a decision unless it is established they lack capacity. A person should not be treated as unable to make a decision:

• because they make an unwise decision;
• based simply on: their age; their appearance; assumptions about their condition, or any aspect of their behaviour; or
• before all practicable steps to help the person to do so have been taken without success.

18. Organisations must assess someone’s ability to make a decision when that person’s capacity is in doubt. How it assesses capacity may vary depending on the complexity of the decision. However, assessments of someone’s capacity should be specific to the decision to be made at a particular time.
19. A key principle of the MCA is that any act done for, or any decision made on behalf of a person who lacks capacity, must be in that person’s best interests. The decision-maker also has to consider if there is a less restrictive choice available that can achieve the same outcome.

Background

20. Mrs Z had a stroke and was admitted to hospital in the spring of 2025. She was paralysed on her left-hand side, required a wheelchair to get around, had difficulty hearing and had dementia.
21. During her admission professionals determined that Mrs Z was unable to decide where she should live or how her needs should be met after she left hospital. The Trust arranged best interest meetings which were attended by members of Mrs Z’s family and professionals. Professionals decided Mrs Z should go to a residential dementia placement when she left hospital, to allow further assessments of her needs.
22. Mrs Z moved to the placement at the end of July 2025. Mr B said Mrs Z had to stay in bed for two days after she arrived as there was no suitable wheelchair available. Mr B also said the bed at the placement was too high for Mrs Z and there was no crash mat and no pressure-relieving mattress.

Analysis

Complaint (a) – The Council failed to complete an assessment of Mrs Z’s care needs before she left hospital, and failed to tell the family about a plan to assess her needs in another location

23. The records show the Trust referred Mrs Z to the Council toward the end of May. A duty social worker attended a best interest meeting in the middle of July. As above, this recommended that Mrs Z move to a residential placement with a view to further assessing her needs to consider how they could and should be met in the long-term. Several days later, while Mrs Z remained in hospital, a social worker completed a Care Act assessment of Mrs Z's needs. It included details of Mrs Z’s needs provided by ward staff along with the views of family members.
24. Overall, there is evidence to show that Council staff undertook proportionate steps to get a fair understanding of Mrs Z’s needs. The intent was to transfer Mrs Z out of the inpatient environment to allow further assessments of her needs, before deciding how her would be best met in the long-term. This is in line with national guidance on hospital discharge which promotes completing assessments outside of hospital. I have not identified any fault in the Council’s actions here.

Complaint (b) – Professionals unfairly decided that Mrs Z did not have the capacity to decide where she would live or how her needs should be met when she left hospital

25. The records show that at the end of May two Trust therapist assessed Mrs Z’s capacity to understand her needs and associated risks. They noted they had been prompted to complete this assessment because Mrs Z had had a stroke which had exacerbated her dementia and led to marked physical and cognitive impairments.
26. The records show the therapists used a standardised format for their assessment which considered relevant and appropriate tests. The records also show that the therapists thought analytically about their interaction with Mrs Z in the context of these key tests. Overall, I have not identified any failings in the way the professionals assessed Mrs Z’s capacity. As such, there are no grounds on which to question the professional judgement they exercised and the decision they made.

Complaint (c) – Professionals failed to properly consider Mrs Z’s wishes during best interests meetings, and failed to properly involve and communicate with Mrs Z’s family during discussions about her post‑discharge care

27. The records show the Trust first arranged a best interest meeting for early June and invited Mrs Z’s family to attend. The meeting did not go ahead as her family were unable to attend on the day. This is not a criticism of Mrs Z’s family. I note that Mrs Z’s husband died around this time.
28. Later in June the Trust arranged a best interest meeting for early July, again inviting the family. This took place although neither Mrs Z’s allocated social worker nor the duty social worker were able to attend. A further meeting was arranged for the middle of the month.
29. In advance of that meeting a social worker noted that members of Mrs Z’s family wanted her to return home and said this was what Mrs Z wanted. These wishes were also documented in the notes of the best interest meeting in the middle of July. The views of professionals were also recorded, noting their view that Mrs Z’s needs would be best met in residential care as she needed 24-hour care and supervision.
30. It is not uncommon for there to be differing views during a best interest meeting. However, regardless of how challenging and finely-balanced the discussions may be, a decision still needed to be made. The records show all the professionals involved considered the differing views and appropriately weighed up the relative pros and cons of Mrs Z either returning home or going into a residential placement. I have not identified any fault in the process the organisations followed before deciding on where Mrs Z should be discharged to.

Complaint (d) – The Trust wrongly determined that Mrs Z required residential dementia care when she left hospital and failed to adequately consider the possibility of supporting her in her own home

31. As above, there is evidence to show professionals were aware of, and considered, the request for Mrs Z to return home with support. The evidence shows medical, nursing and therapy staff were asked for information about the nature and extent of Mrs Z’s day-to-day needs and the care she required. This included questions about whether she required nursing care or whether her needs would be safely met in a residential home which specialised in people with dementia.
32. Staff also considered the type of equipment and adaptations Mrs Z was likely to require. And the Council considered the cost effectiveness of different ways of meeting Mrs Z’s needs, which it is allowed to do. Overall, there is evidence to show the Trust and the Council followed an appropriate process to understand the extent of Mrs Z’s needs before planning her immediate post-discharge care. As such, I have found no fault here.

Complaint (e) – The Trust transferred Mrs Z to an inappropriate placement, unsuitable for her needs

33. The records show that, following the best interest meeting in the middle of July, the Trust requested a D2A placement, for the purpose of facilitating a further assessment of Mrs Z’s needs. Several days later the Council’s brokerage team invited care providers to say whether they were able to offer the required level of care. Two placements responded, confirming they would be able to safely and fully meet Mrs Z’s needs. The Council arranged the placement that Mrs Z’s family preferred. I have not found any fault in the process either the Trust or the Council followed here.

Complaint (f1) – The Trust failed to ensure the receiving placement was properly prepared and equipped for Mrs Z’s arrival

34. While Mrs Z was cared for as an inpatient staff transferred her from bed to a tilt‑in‑space wheelchair. (A tilt-in-space chair tilts the entire seating system backward as a single unit, maintaining your fixed hip and knee angles.) The Trust told us these are the types of chair available on the ward. During a family meeting on 4 July 2025 therapy staff noted that Mrs Z had been using the tilt-in-space wheelchair on the ward.
35. Therapy staff spoke to Mr B in early June about the prospect of Mrs Z leaving the ward to attend her husband’s funeral. Staff said that, in this context, a standard wheelchair would not be appropriate and recommended a tilt-in-space wheelchair for the time Mrs Z was off the ward.
36. During Mrs Z’s admission therapy staff completed various forms which detailed the type of chair Mrs Z needed. This included:

• On 30 May 2025 a capacity assessment which said that Mrs Z would need a “supportive/recliner chair”.
• On 18 July 2025 a discharge-to-assess referral said Mrs Z needed a “supportive chair/wheel chair".
• On 22 July 2025 a home information pack which said Mrs Z needed a “supportive recliner chair”.
• On 31 July 2025 a referral to the community stroke team which said Mrs Z was “likely able to sit in a normal recliner chair (bucket chair/recliner)”.

37. Shortly after Mrs Z moved to the placement (on the same day) Mr B contacted the Trust to raise concerns that the placement did not have an appropriate wheelchair for Mrs Z.
38. Two days later a member of Trust staff arranged for one of the hospital’s wheelchairs to be sent to the placement until a longer-term solution could be found. It noted internally that it made this decision after multiple attempts to arrange a wheelchair another way. It also noted this was not something the hospital usually did, but it had done so because it had run out of options.
39. The Trust completed an incident form the same day. It noted the discharge referral form had not included adequate detail about the type of wheelchair that Mrs Z needed. It said the referral “did not state that this person required a specialist chair all it stated was a supportive chair”. The Trust said that it would seek to ensure that, in future, the relevant referrals were appropriately thorough and included enough detail about the equipment required. This incident stemmed from a concern raised by the placement which, in turn, appears to have stemmed from information it had received from either Mrs Z’s family and/or the Council. However, the evidence shows that that appropriate professionals within the Trust had considered Mrs Z’s equipment needs and had provided a consistent view that she needed a supportive chair. As such, the incident report’s conclusion that the referrals had failed to state that Mrs Z needed a specialist chair were misguided, as the referrals had properly reflected professional assessments of Mrs Z’s needs. In summary, there is no evidence of fault by the Trust here as its referrals were appropriately clear about the type of equipment Mrs Z needed.

Complaint (f2) – The Trust failed to tell Mrs Z’s family of the discharge plans in advance

40. The Trust said it did tell Mrs Z’s family of its intention to transfer Mrs Z to the placement. It apologised if the family had been left with an expectation they would be invited to accompany Mrs Z when she moved.
41. The records support Mr B’s complaint that the family were told their mother had gone to the placement after it had happened. However, there is also evidence that staff told Mrs Z’s family of its plans to discharge her the day before it did so.
42. Overall, from the limited information available about this issue, on balance, the Trust appears to have done enough to advise Mrs Z’s family of its intent to discharge Mrs Z ahead of time. In view of this, I have not found fault here.

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Decision

I have not found fault by the Trust or the Council in the way they planned and arranged Mrs Z’s discharge from hospital. There is evidence to show they followed the correct processes and took account of relevant information.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman