Mrs B’s confusion and pain when discharged
18. When a patient no longer needs to be in hospital for treatment, it is appropriate to discharge them. This is set out by NHS England in its Frailty Toolkit and the Department of Health and Social Care guidance, as referenced above.
19. Mrs A tells us that because of Mrs B’s condition, she should not have been discharged. We have carefully considered the clinical records and independent advice from our advisers.
20. The first scans show no injury that needed treatment, but the day after being discharged Mrs B was readmitted due to pain in her hip. The medical records show that the clinical team believed there was no need for any specific treatment, due to the X-ray and CT results.
21. Mrs B’s admission was during the coronavirus pandemic. The Trust used the COVID-19 discharge guidance to make beds available and give support at home if needed. The guidance says, ‘acute and community hospitals must discharge all patients as soon as they are clinically safe to do so.’
22. We understand from our physician adviser that the Trust did the right scans when Mrs B was admitted. Our radiology adviser confirmed that no fracture can be seen on the images. The medical records show that the staff believed Mrs B was clinically fit, which was supported by the X-ray and CT scan, and staff had not seen any evidence of confusion. Discharging Mrs B because she was clinically fit, and not in need of any physical care at that time, would be in line with policy and guidance.
23. However, we also know that Mrs B was in pain and expressed this throughout her admission.
24. While Mrs B’s medical records show that there were frequent reviews, there is no evidence of staff examining her leg during admission. There is evidence throughout Mrs B’s admission that she complained about pain in her hip and leg, but there is no evidence of any further attempt to diagnose the cause of the pain. The Trust’s final response recognised Mrs B’s pain and says staff managed this with pain relief. Although the Trust recognised Mrs B’s pain, in our view, not enough was done to investigate the cause of it.
25. The Trust’s final response says that Mrs B’s pain improved during her stay in hospital. However, the clinical records from the physiotherapist and the nurse say her pain was still severe. GMC Good Medical Practice says:
‘You must provide a good standard of practice and care. If you assess, diagnose, or treat patients, you must:
adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social, and cultural factors), their views and values; where necessary, examine the patient’
and
‘In providing clinical care you must:
d. take all possible steps to alleviate pain and distress whether a cure may be possible.’
26. The Trust did not make good enough attempts to assess or diagnose the cause of Mrs B’s pain, in line with GMC guidelines. If there had been a more complete assessment from the medical team, it may have meant more scans and an earlier diagnosis of the fracture. This may have led to more treatment sooner and improved Mrs B’s pain as well as mobility. This could also have affected the decision to discharge her, but we cannot say for sure.
27. Mrs A says Mrs B may have fallen while on the ward, but this was not recorded in her medical records. As Mrs B was admitted with pain in her hip and leg and she told staff about this, it is unlikely that she fell again and suffered a new injury. We do not have any other evidence to look into whether anything else could have caused her pain.
28. There was a failure to fully consider and investigate the cause of Mrs B’s hip pain. Considering the information from Mrs A and the Trust, the Trust did not act in line with the relevant standards and guidance by not assessing Mrs B’s pain further.
29. Having seen evidence that something went wrong, we next considered what, if any, impact this had. Mrs B stayed in pain, had to be readmitted the next day and was later diagnosed with a fracture in her hip. We note that it was only a very short period before she returned to the Trust’s care.
30. The Trust’s actions caused Mrs A avoidable worry, as she witnessed Mrs B in pain when discharged and had to get emergency assistance the next day. We recommend the Trust puts right the worry and distress she experienced.
The Trust’s communication
31. Mrs A says the Trust was poor at communicating with her and updating on her Mrs B’s progress during admission. She says this caused worry and distress for the family, especially not having any updates on Mrs B’s recovery.
32. In its final response letter, the Trust apologised and explained it has introduced a new way of communicating with a patient’s next of kin. The Trust has given us information showing what it has done since November 2020 to improve communication with the relatives of patients.
33. Mrs B was admitted to hospital during the pandemic, and restrictions made it especially difficult to communicate with families and visit loved ones. We fully recognise this. Although we appreciate the difficulties faced by the NHS and its staff during this period, GMC guidance says:
‘You must be considerate to those close to the patient and be sensitive and responsive in giving them information and support’.
34. The guidance shows that consideration should be given to patients’ friends and family members. The evidence available to us suggests the Trust did not act in line with the GMC guidance.
35. The clinical records show the Trust did contact Mrs A during Mrs B’s admission. However, we understand from her point of view this communication was not effective and Mrs A was worried and upset.
36. We thought about what the Trust has done to put right the worry caused to Mrs A. The Trust has recognised her concerns, apologised, and explained how it has learned from her complaint. The Trust has taken on board Mrs A’s feedback and provided us with details of its improvements. This is in line with our Principles of Good Complaint Handling which say, ‘public bodies should ensure that all feedback and lessons learnt from complaints contribute to service improvement’.
37. We understand Mrs A is frustrated. She told us the family felt there had been a lack of communication before, when another family member was under the Trust’s care. She feels nothing has improved since the family’s last experience.
38. The Trust’s evidence shows it has a rolling programme with the aim to train all staff, from July 2021. This may explain why Mrs A did not feel like she had seen any improvement, as the planned changes were still in the process of being completed.
39. We consider the Trust has taken steps to put things right for Mrs A. We do not uphold this part of the complaint.
40. This in line with our principles which say: ‘Where a public body has failed to get it right and this has led to injustice or hardship, it should take steps to put things right. That means, if possible, returning complainants and, where appropriate, others who have suffered the same injustice or hardship as a result of the same maladministration or poor service, to the position they were in before this took place’.