University Hospitals Birmingham NHS Foundation Trust

4. Mr L complains doctors failed to act on the results of Mr E’s computerised tomography (CT) scan. He questions whether it was right for them to discharge his father from hospital. He says the discharge document doctors completed did not contain enough information. He believes they should have referred specifically to the results from the CT scan.

5. Mr L says when his father returned to the Hospital the next day, doctors were surprised to find out the scan showed small vessel disease. He questions whether his father’s health was affected by the decision to discharge him from the Hospital. He says the Trust’s complaints responses left him with unanswered questions.

6. Mr L wants the Trust to formally apologise for its failings. He wants to ensure there are changes to procedures so other patients and families do not have the same experience.

7. Mr E was over 90 years old, had a history of Parkinson’s disease and iron deficiency. Mr L accompanied his father to the Hospital on 24 February 2020. Mr E had recently fallen and had been disorientated since then. Doctors decided to admit Mr E to the Hospital for tests and investigations. This included a CT scan, which they arranged for early the next morning.

8. The CT scan showed no evidence of bleeding. It highlighted small vessel disease. Doctors considered Mr E had conjunctivitis and was frail. They gave him antibiotics and, after further assessments, discharged him.

9. Mr E returned to the Hospital on 26 February 2020. He was increasingly confused and had low blood pressure, and a low body temperature. The next day, doctors diagnosed delirium. Over the following days he became increasingly unwell with frailty, kidney problems, and a chest infection. Sadly, despite medical treatment, Mr E died on 12 March.

Discharge from the Hospital

12. Mr L asks whether doctors should have discharged his father from the Hospital based on the CT scan results. He also says these results should have been included in his father’s discharge letter.

13. The Clinical Adviser confirmed Mr E’s CT scan, from 25 February 2020, showed small vessel disease. They said this is a very common finding in people in their nineties. Small vessel disease happens when arteries harden, and this can affect the flow of blood through the vessels in the brain. Many people do not have symptoms, but it can cause dementia and other problems.

14. In Mr E’s case, the main purpose of the CT scan was to check for blood clots and bleeding. There was no evidence of these, and the CT scan did not show any other issues that required urgent attention. The small vessel disease had developed slowly over many years and was age related. Mr E’s records suggest the disease was present when he had previous scans in 2011 and 2015.

15. Good Medical Practice says doctors should promptly arrange any investigations or treatments that are needed. Mr E’s clinical records show doctors ensured Mr E had relevant tests and scans. The evidence shows they gave him appropriate treatment. They followed Good Medical Practice.

16. The Clinical Adviser told us it was important to avoid people with frailty staying in hospital unnecessarily. Mr E was frail towards the end of his life. Evidence suggests people with frailty often have their needs met best in settings outside of an acute hospital. Remaining in hospital exposes people to risks, such as developing infections.

17. The DH Guideline sets out key practices and principles for clinicians when considering discharging patients from hospital. It stresses the importance of planning and involving patients and carers with decisions.

18. Mr E’s records show he was reviewed by a consultant. The older persons team also came to see him and involved Mr L in discussions about the planned discharge. There were plans for follow up care after the discharge. The evidence suggests there was a clear multidisciplinary assessment, as hospital staff tried to find alternatives to keeping Mr E at the Hospital. The Clinical Adviser said they appear to have managed Mr E’s discharge well. The evidence shows staff followed the DH Guideline.

19. The Clinical Adviser told us there are no specific standards about what should be included in discharge letters. The NICE Guideline simply says a discharge summary should be given to the patient and their GP. In this case, the discharge record is brief, but the clinical records suggest not much happened during the admission. The findings of the CT scan were not new and there was no requirement for doctors to make specific reference to them in the discharge letter. Doctors followed the NICE Guideline.

20. We have seen no indications of service failure relating to the management of Mr E’s discharge from the Hospital and the discharge letter.

Complaint handling

21. Mr L also complains about the Trust’s responses to his complaint. He believes the Trust has not fully answered his questions.

22. Our Principles of Good Complaint Handling says organisations should be ‘open and accountable’ in complaint handling. This includes providing evidence-based explanations and reasons for decisions. It also says organisations should ‘act fairly and proportionately,’ which includes investigating complaints thoroughly and fairly.

23. Mr L emailed the Trust with his initial complaint in June 2020. This included his recollection of events and twelve specific questions. The Trust sent its first response to Mr L in September. It responded to each of the twelve questions.

24. Mr L sent his second email complaint to the Trust in October 2020. In his email he referred to the Trust’s first response and provided additional recollections. Some of these essentially restated the original complaint and others did not appear to require any further comment. The Trust identified there were five areas that required an additional response.

25. We cannot see evidence the Trust has failed to answer Mr L’s questions. It provided detailed responses to each of the issues he raised. The responses are based on the clinical records. The Trust based its explanations on the evidence and gave reasons for decisions. It was also thorough and fair.

26. There are no indications of maladministration in the Trust’s complaints handling. The Trust acted ‘fairly and proportionately’ and has been ‘open and accountable.’

27. We were sorry to learn about the distressing circumstances of Mr E’s illness in the last few days of his life. We can see how these events were distressing for Mr L, who was with his father for much of that time. We have seen no indication of failings in care and treatment or complaint handling. We have decided not to take any further action.

1. We have carefully considered Mr L’s complaint about the Trust. We have seen no indication anything went seriously wrong. We have decided not to carry out a detailed investigation.

2. Mr L complains about the way doctors managed his father’s discharge from hospital A (the Hospital - part of the Trust) on 25 February 2020. He also considers the Trust did not fully address his concerns in its responses to his complaint. In this document we refer to Mr L’s father as Mr E.

3. We can see how these events were distressing for Mr L. We offer our sincere condolences to him for his loss. We have seen no indication of failings in care and treatment, or complaint handling.