County Durham and Darlington NHS Foundation Trust

3. Mr R complains about the care the Trust provided his mother between October and November 2023. Specifically, he complains that clinicians decided to keep his mother in hospital when her condition was not life-threatening.

4. He says clinicians should have allowed his mother to go home on the day she arrived in hospital as he considers this would have improved her chances of survival. He says remaining in hospital allowed her to deteriorate and contributed to her death. He tells us the Trust’s actions have caused him frustration and anger as his mother died before her time.

5. In bringing the complaint to us, Mr R would like the Trust to acknowledge what it did wrong, apologise and change its procedures.

6. Mrs R was in her 90s and lived with her son Mr R. In October 2023 she collapsed and burned herself with a kettle. Mr R called the district nursing team and asked if a district nurse would be able to visit. The team advised district nurses could not treat Mrs R’s burn as Mr R described it as substantial in size and the skin was coming off.

7. Mr R called 999 and paramedics took Mrs R into hospital the same day. Emergency department (ED) staff sent photographs of Mrs R’s burn to the burns unit. Their initial plan was to transfer Mrs R to the burns unit once she was medically stable.

8. At 7.50am the following day an ED doctor reviewed Mrs R and said she could be discharged home and receive burns unit follow up care as an outpatient.

9. At 9.30am staff contacted Mr R to say his mother was ready to go home and he would need to make an appointment with the burns unit. They agreed to provide all information when he arrived.

10. Staff contacted the burns unit to clarify when the outpatient appointment needed to be. A burns consultant recommended against discharging Mrs R as her burn was too big. Staff communicated the need for admission to Mrs R who wanted to go home against medical advice.

11. At 1.45pm nurses noted Mrs R was unable to mobilise independently and was heavily reliant on nurse’s assistance. They referred her to the acute frailty team for assessment. The acute frailty team assessed Mrs R within an hour. They recommended staff admit Mrs R as she needed more support to mobilise than was available at home.

12. After the initial period of admission, Mrs R remained in hospital for ongoing monitoring and treatment. During this time, she developed chest infections which staff treated with both intravenous (directly into the blood stream) and oral antibiotics.

13. Staff discharged Mrs R home with a package of care in early November. She sadly died a few days later.

17. NHS England statutory guidance says patients should be considered for discharge if they do not meet certain criteria. This criteria includes those patients who have acute functional impairment in excess of home or community provision. This means they should remain in hospital if their health or function worsens to the point that they need more help than they could get at home or in the community.

18. GMC’s good medical practice says doctors must provide a good standard of practice and care. In doing so, they must refer to another practitioner when this suits the patient’s needs.

19. ED staff initially planned to discharge Mrs R the day after she arrived but then kept her in hospital. We acknowledge the change of decision has caused Mr R some confusion. As set out in paragraph 10, this plan changed after a burns consultant said she needed hospital treatment due to the size of her burn.

20. Our adviser said Mrs R’s burn would have been uncomfortable and would likely impair her function to the extent that they would expect staff to be concerned for the safety of her discharge. They said it was likely her function would improve as her burn healed.

21. In line with the NHS England statutory guidance, staff needed to consider if Mrs R would manage at home.

22. We can see the acute frailty team reviewed Mrs R the same day and recommended she remain in hospital. This was because she now required the assistance of two people to mobilise. Whereas prior to the admission she was able to mobilise independently for short distances on her own using a walker. Although she lived with her son he often worked nights.

23. We have seen that Mrs R’s function had deteriorated since sustaining the burn as she could no longer mobilise on her own. She only had the support of one person available at home and needed the assistance of two. This meant she met NHS criteria for staying in hospital as she had acute functional impairment in excess of home provision.

24. Our adviser acknowledged that lengthy hospital stays for elderly patients can contribute to deconditioning and exposes them to risks of confusion, falls and infection in hospital. They said doctors must balance this risk against the risk of discharge when someone is more debilitated than usual. They said there was a risk of Mrs R having a fatal fall at home if staff discharged her too soon.

25. Our role is to consider whether the Trust’s actions were in line with the relevant standards. We think in making the clinical decision that Mrs R should remain in hospital, staff were providing a good standard of practice and care and acted in line with the NHS statutory guidance.

26. We recognise the strength of Mr R’s feelings about his mother’s care and the sadness of her death. We do not underestimate the emotional impact these events have had on him.

1. We have carefully considered Mr R’s complaint about County Durham and Darlington NHS Foundation Trust (the Trust). We are sorry to hear about the death of his mother, Mrs R, and the impact this continues to have on him.

2. We have seen no indication that anything went wrong with the issues Mr R raises about the Trust. For this reason, we are not considering his complaint further. This statement sets out how we reached this decision.