Summary: Miss A complains about her mother’s discharge to a Care Centre from hospital. We will not investigate Miss A’s complaint because we can see no indications of fault by the organisations and could not add to the information the organisations already shared with Miss A.

The complaint

1. Miss A complains about the role the University Hospitals Birmingham NHS Trust and Birmingham City Council played in the discharge of her mother, Mrs B, to a temporary bed in a Care Centre in May 2020. Specifically, she complains;
• Social services allowed the Trust to transfer her mother to a temporary bed in a care centre instead of sending her back to her own home
• A safeguarding enquiry was opened on the day of her mother’s discharge which prevented her from coming home
• The social worker did not listen to Miss A’s wishes, she begged them not to send her mother to the care centre while the COVID-19 pandemic was developing.
2. Miss A explains the events had a damaging effect on her mother’s health, she declined quickly while in the care centre and had to go back to hospital soon after. Miss A worried for her mother and feels the Council should have done more to stop the Trust placing her mother in the care centre.
3. Miss A wants an admission her mother should not have gone to the Care Centre and an apology.

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The Ombudsmen’s role and powers

4. The Ombudsmen have the power to jointly consider complaints about health and social care. Since April 2015 a single team has considered these complaints acting for both Ombudsmen. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA)
5. 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 could add to any previous investigation by the bodies, or
• there is not enough evidence of fault to justify investigating, or
• any fault has not caused injustice to the person who complained, or
• any injustice is not significant enough to justify our involvement, or
• they cannot achieve the outcome someone wants.

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

6. The Ombudsmen cannot question whether a decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the organisation reached the decision. (Local Government Act 1974, section 34(3), as amended, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))

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How I considered this complaint

7. I considered written information provided to us by Miss A, including her complaints to the Trust and the Council. I also spoke to Miss A to understand her remaining concerns.
8. I considered the Ombudsman’s Assessment Code.
9. I asked Miss A for her comments before I made a final decision.

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What I found

10. Mrs B went into hospital on 28 April 2020.
11. NHS England advises hospitals to plan for discharge from the start. As Mrs B’s only carer, professionals from the Trust and the Council spoke to Miss A about her discharge, even before she was ready to leave hospital.
12. In a conversation with a physiotherapist, the Trust said Miss A made some comments which caused it to consider whether Mrs B would be an adult at risk if she was discharged home.
13. The Care Act 2014 sets out the legal framework for how councils should protect adults at risk of abuse or neglect. The Council has a responsibility to protect adults with care and support needs who may be at risk of abuse or neglect and this process is called safeguarding.
14. Following the conversation with Miss A, the Trust spoke to the Council, who opened a safeguarding enquiry.
15. Doctors said Mrs B was ready to leave hospital on 5 May 2020. Because of the ongoing safeguarding enquiry and concerns about her home, the Council needed to find her a bed in a care placement.
16. Government guidance in place at the time because of the COVID-19 pandemic said, “unless required to be in hospital, patients must not remain in an NHS bed.” It adds “acute and community hospitals must discharge all patients as soon as they are clinically safe to do so.” The same guidance provides a model with four pathways for discharge.
17. The Council explained in its response letters of 11 April and 19 June 2023, Mrs B was discharged to the Care Centre on Pathway 2, for “a period of recovery/rehab/assessment of long-term care needs”. This is in line with guidance which explains a pathway 2 discharge is for “rehabilitation in a bedded setting” for a short period.

Analysis

18. Miss A explains she begged professionals to allow Mrs B to return home instead of going to a Care Centre. She worried about the spread of COVID-19 and feared Mrs B may contract it. She felt Mrs B was safer at home and there was no need for her to go into a placement.
19. I understand Miss A is unhappy the organisations discharged Mrs B to a Care Centre instead of allowing her to go home. The Trust reported safeguarding concerns to the Council in line with its wider safeguarding responsibilities. It is unlikely, on balance, we would find fault in the way the Trust made this decision.
20. After considering the report from the Trust the Council decided to discharge Mrs B to the temporary bed because there was a safeguarding enquiry ongoing. The Council had a statutory duty to protect Mrs B and prevent her from harm and reduce any risk of abuse it considered applied in this case. We would not expect the wishes of a family member to be considered above the safety of a vulnerable adult. It is unlikely, on balance, we would find fault in the way the Council made this decision.
21. The organisations discharged Mrs B from hospital as soon as they could, in line with guidance, and because it was not possible for her to go home, the only option was a temporary bed in a Care Centre.
22. It is unlikely I would find evidence of fault with the actions of the organisations. Therefore, I cannot achieve the outcome Miss A wants.

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Final decision

23. The Ombudsmen will not investigate Miss A’s complaint further, it is unlikely I would find evidence of fault with the actions of the organisations.

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Investigator's decision on behalf of the Ombudsman