Manchester University NHS Foundation Trust

4. Miss J complains the Trust discharged her mother five days earlier than expected and she was too unwell to be discharged. She also says the Trust did not put any support in place for her mother and she had to go home in a taxi instead of an ambulance.

5. Miss J says when she got home her mother struggled to get up the stairs to her flat for over an hour. Ms L was then readmitted to hospital a few hours later and sadly died. She feels this is a result of the Trust’s actions. Miss J tells us the loss has had a huge impact on her and has triggered her anxiety and depression. She also says she had to pay a costly funeral bill.

6. Miss J wants the Trust to accept its failings, an apology and service improvements. She would also like a financial payment.

7. Ms L was in her early fifties when she went to the Trust’s A&E in early October 2022 with breathlessness. She had a history of chronic obstructive pulmonary disease (COPD is a lung condition that causes breathing difficulties), heart failure and leg oedema (swollen legs). She also had a burst blister on her left leg.

8. The A&E team admitted Ms L. Doctors diagnosed her with and treated her for respiratory failure and a pulmonary embolism (a condition where a blood clot blocks a blood vessel in the lungs). The Trust discharged Ms L later that month.

9. Ms L travelled home in a taxi but then struggled to get upstairs to her top floor flat. Around three to four hours later, Ms L then struggled to catch her breath and became unconscious. An ambulance was called which arrived two hours later.

10. Ms L was admitted again the next day at 2.55am due to a cardiac arrest (heart attack). The hospital staff attempted to resuscitate her but agreed to stop shortly after 3am.

Discharge decision

14. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect that the organisation has not put right. We have decided we cannot link the Trust discharging Ms L with her deterioration and then death.

15. The NHS hospital discharge service guidance outlines the criteria for a patient to stay in hospital:

• requiring intensive care or high dependency unit care • requiring oxygen therapy or non-invasive ventilation • requiring intravenous fluids (fluids given through the veins) • National Early Warning Score (NEWS is a system that alerts staff to deteriorating patients) greater than three • reduced level of consciousness where recovery is unrealistic • acute functional impairment beyond what can be cared for at home or in the community • at the last hours of life • requiring intravenous medication (medication given through the veins) • had lower limb surgery within 48 hours • had thorax-abdominal or pelvic surgery with 72 hours • within 24 hours of an invasive procedure.

16. If a patient does not meet these criteria, they are considered medically fit for discharge. Our adviser has reviewed Ms L’s medical records from her stay in hospital. They explained that Ms L was medically fit for discharge and that her NEWS score was normal.

17. We understand Miss J has concerns that her mother had pneumonia at the time of discharge. Ms L had a chest X-ray on 19 October which reported no pneumonia so we can see no sign of this.

18. Our adviser confirmed the only criteria Ms L met was the sixth point about acute functional impairment because she needed a package of care at home. Although she was clinically well enough to be discharged, her package of care was not in place at the time, meaning she met the criteria to stay in hospital. The Trust discharged Ms L before this package was in place and this suggests a failing. The Trust has already accepted this.

19. We considered if there is any sign that not having a care package led to Ms L’s death. Our adviser said the package of care would have involved carers coming to help Ms L with personal care and meals. The carers would not be fully qualified nurses so would not have been giving any medical input. Our adviser did not think the carers visiting Ms L would have helped prevent her deterioration.

20. Taking this advice into account, we can see no sign that this failing led to Ms L’s death. And, because Ms L was readmitted to hospital a short time after her discharge, we cannot say she was negatively affected by the care package not being in place.

21. Our adviser explained that even if Ms L had not been discharged, she may still have had a cardiac arrest in hospital. They explained she was at increased risk of this due to her COPD. Ms L had a ‘Do Not Attempt Resuscitation Order’ in place during her first admission so if she had stayed in hospital and had the cardiac arrest, resuscitation would not have been attempted.

Discharged home in a taxi rather than an ambulance

22. The Trust said staff documented that Ms L needed an ambulance on discharge and an ambulance risk assessment for property access, but this did not happen. Again, this is an indication of a failing which the Trust has accepted.

23. We are very sorry to hear that Ms L then struggled to go upstairs at home. We appreciate how distressing this must have been. We also understand why Miss J is concerned that her mother struggling to get upstairs without help caused her deterioration and death.

24. From what Miss J has told us, there was a three-to-four-hour delay between Ms L arriving home and her having what seems to be a cardiac arrest. Our adviser said if the cardiac arrest happened because of having to go upstairs without help, it would have happened at the time and not several hours later.

25. We cannot link Ms L’s death with her struggling to get up the stairs without help. But, we do agree that she should not have been left in this situation.

26. We understand why Miss J is so concerned about her mother’s deterioration after her discharge from hospital. We hope we have clearly explained why we are not taking her complaint further.

1. We are very sorry to hear about Miss J’s complaint about the care the Trust gave to her late mother, Ms L. We can see her mother’s death has been very distressing and we pass on our sincere condolences.

2. We have carefully considered Miss J’s complaint. We have seen some signs of failings in the Trust’s discharge process and the Trust has already acknowledged these. We cannot link these issues in care to Ms L’s death. For this reason, we have decided not to take Miss J’s complaint further.

3. We appreciate this may be a disappointing decision for Miss J as we know how much her complaint means to her. We have fully explained the reasons for our decision below and we hope this gives her some reassurance.