Wirral University Teaching Hospital NHS Foundation Trust

3. Mrs A complains the Trust should not have sent her husband home on 21 January 2021. She says her husband was not fit for discharge as he was still struggling with his breathing. Mrs A also says the Trust sent Mr A home with no information or advice on what to do if he continued to feel unwell.

4. Mrs A says her husband’s condition worsened at home and he was readmitted to hospital on 30 January. Mr A died in early February. Mrs A says had the Trust not discharged her husband on 21 January, he would have been in hospital when his condition worsened and may have survived.

5. Mrs A says she has lost her husband and their children have lost their father. By bringing her complaint to our office, Mrs A wants the Trust to accept it failed her husband, apologise and put steps in place to ensure a similar situation does not happen again.

6. Mr A was admitted to the Trust on 10 January 2021 with breathing difficulties, having tested positive for COVID-19 several days before. Mr A spent most of his inpatient stay in the critical care unit before being sent home on 21 January.

10. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and do not find any signs that anything went wrong in the matters Mrs A is complaining about.

Decision to discharge

11. The NHS Hospital Discharge Service Policy says every person on a general ward should be reviewed on a twice daily ward round to determine the answers to the following questions:

• Requiring intensive therapy unit (ITU) or high dependence unit (HDU) care?

• Requiring oxygen therapy/non-invasive ventilation (NIV)?

• Requiring intravenous fluids?

• National Early Warning Score (NEWS) 2 greater than 3 (a clinical judgement used for people with atrial fibrillation (AF – an abnormal heart rhythm) and/or chronic respiratory disease)?

• Reduced level of consciousness in which recovery is realistic?

• Acute functional impairment in excess of home/community care provision?

• In final hours of life?

• Requiring intravenous medication > b.d. (including analgesia)?

• Had lower limb surgery in past 48 hours?

• Had thorax-abdominal/pelvic surgery in past 72 hours?

• Had an invasive procedure in past 24 hours (with associated risk of acute, life- threatening deterioration)?

If the answer to each question is ‘no’, staff must consider discharging the patient to a less acute setting.

12. Mrs A says the Trust should not have sent her husband home as he was still unwell and struggling to breathe. We see no signs Mr A had any of the above conditions on 21 January 2021, so he was medically fit to be sent home. Our adviser explains it is standard practice to discharge COVID-19 patients the same day oxygen therapy is stopped. Our adviser says Mr A’s oxygen therapy had been stopped for a safe amount of time before his discharge and we see no signs Mr A was still having difficulty with his breathing.

Discharge information

13. Mrs A says the Trust sent her husband home with no information or advice on what to do if he felt unwell. In its response to Mrs A’s complaint, the Trust accepts it did not provide Mr A with a copy of the discharge-summary letter as there was a problem with the printer on the ward that day. It apologised for any distress or reluctance to seek earlier medical advice this may have caused.

14. We can see the discharge letter says, ‘Patient advised to seek medical advice if he becomes unwell or concerned. Safety netting advice given prior to DC.’ This is in line with the GMC Good Medical Practice guidance, which says doctors must give suitable advice (safety netting advice) to patients. While we appreciate the Trust did not give a printed copy of the discharge summary to Mr A, it appears it did give him suitable information and advice before discharging him.

15. We are sorry to hear the circumstances of Mrs A’s complaint and of the loss of her husband. We appreciate this is a difficult time for Mrs A and we thank her for sharing details of her experience with us.

16. We hope this statement provides reassurance that we have considered the evidence carefully. We see no signs anything went wrong in the matters Mrs A is complaining about, so we will not consider this further.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mrs A’s complaint about Wirral University Teaching Hospital NHS Foundation Trust (the Trust). We are very sorry to hear her concerns about the care her husband, Mr A, received before he sadly died.

2. Having considered all the available information, we see no indication that anything went seriously wrong in the matters Mrs A is complaining about. We recognise Mrs A may find our decision disappointing.