12. 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 have not found any indications that something has gone wrong.
Decision to discharge
13. We considered Annex D of the DHSC discharge guidance. This reflected that when any person is reviewed on a ward round, doctors should actively consider discharging them to a less acute setting. This should happen unless there is a clinical need or exception. This helps to ensure there is capacity to care for patients who need to be in hospital.
14. We looked at whether the Trust acted in line with that guidance. Mrs V’s records reflect the medical input she received. Our adviser explained Mrs V was stable but had ongoing symptoms she felt were an issue, like her shortness of breath. Although she had COVID-19 chest infection, this was not severe enough to require oxygen therapy.
15. The Trust considered Mrs V medically fit for discharge from 28 December but she did not want to go home. Our adviser explained being in hospital puts people at risk of infection so patients would be discharged at the earliest opportunity, in line with the DHSC guidance, unless there is a good reason not to do so.
16. Mrs V’s records show she was still mobilising independently with a Zimmer frame on 27 January, the day she was discharged, and had not had any falls during her admission. There are limited observations available in the records, but doctors have noted no concerns that required her to remain in hospital.
17. As Mrs V fulfilled all the criteria for discharge, as set out in the guidance, we have not identified any indication of a failing.
Communication about discharge
18. Social care is practical help for people with illness or disability, funded by local councils and users. People can arrange care and support privately themselves. If they want the council to arrange or pay towards their care, they have to ask it for a needs assessment. The assessment tells them what type of care will help them and how it will be delivered.
19. In Mrs V’s case, the Trust’s records refer to her awaiting a social package. Often staff will have limited notice on when the package of care a patient needs will be ready. We appreciate Mrs R may therefore have felt her mother was not as well-informed as she would have liked. This must have added to what was already a difficult time.
20. Mrs V’s records show psychiatrists did discuss the plans for discharge with her. Due to the potential distress it would have caused her, our adviser said they would not have had a daily discussion about where the plans were up to. Staff would not necessarily have had information to share and there is no indication the Trust withheld any information from Mrs V.
21. We recognise Mrs R feels the Trust did not communicate with her mother as it should have. We hope we have helped her understand why there is no indication of a failing here.
Soft diet
22. GMC ‘Good medical practice’ covers information sharing with colleagues. Point 44a says ‘You must contribute to the safe transfer of patients between healthcare providers and between health and social care providers. This means you must: a share all relevant information with colleagues involved in your patients’ care within and outside the team’.
23. During Mrs V’s first admission, the speech and language therapy team (SALT) did not make a strict recommendation that needed to be adhered to. This meant Mrs V was able to eat what she wanted. The team noted her dental situation meant a level 6 diet, of bite-sized food, would be easier for her to manage.
24. Mrs V appeared to be having a relatively unmodified diet during this admission. She had a fish dinner on 19 January, and pureed chicken stew on 21 January. She had carrots and chicken casserole on 23 January and cottage pie with vegetables on 25 January. She had a normal meal on the day the Trust discharged her, too.
25. There is no evidence of a SALT assessment when Mrs V was readmitted. She was noted to be ‘tolerating normal diet (soft option)’. Our adviser said it might have helped for the care home to have information about her bite-sized diet but there is no indication there was a clinical need, as such.
26. Based on the available information, we have not identified any indication of a failing in this part of the complaint either.
27. Overall, we have seen no reason to investigate the concerns Mrs R brought to us further. We would like to thank her for bringing the complaint to us and we hope we have reassured her about the care her mother received.