11. When we consider 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 for several parts of the complaint we have not seen any indications that something went wrong. Regarding the hospital discharge, we have identified a failing, but we have not seen this led to any impact to Mr X.
Hospital Discharge
12. Mr A complains that his father was inappropriately discharged from hospital on 16 January 2024. Mr A says his father was not medically fit for discharge at that time.
13. The evidence available to us shows Mr X was reviewed by a consultant geriatrician on the day of his discharge, where he was seen on a routine ward round. He was reported to be ‘not symptomatic’. Mr X’s clinical observations (blood pressure, heart rate, oxygen levels) were unchanged, and blood tests on the day before his discharge were normal, except for a slight rise in one of the inflammation markers (C-reactive protein).
14. We understand from our adviser that this is a non-specific blood test and as a single result, in the absence of clinical findings of infection, there is nothing to indicate further action should be taken forward. Clinical records indicate there was a discharge plan for Mr X’s GP to repeat his blood tests in a week’s time. On the day before Mr X’s discharge, it was recorded in his clinical notes ‘patient expressed that he felt well within himself and was keen for home’.
15. Mr X was also seen by multiple members of the multidisciplinary team that day, and there is no evidence in the documentation that any healthcare professional had concerns regarding his medical condition. Having carefully considered the clinical records, there is no evidence to indicate Mr X was not medically fit for discharge at that time.
16. NHS England guidance referred to in our ‘evidence’ section sets out the criteria for a patient to be discharged from a hospital setting. We understand from this guidance, the available evidence and our adviser that Mr X no longer met the criteria to stay in a hospital setting. This is because he did not show any signs of acute illness which involved care needs that could not be met at home or through services providing care in the community. At the point of discharge, we can see evidence of regular input from medical, nursing and therapy staff which identified his care needs, in keeping with NICE guidance NG27 referred to in our ‘evidence’ section. We can see the Trust acted in line with the relevant guidelines when it discharged Mr X from hospital, and there is no evidence to indicate the discharge was inappropriate.
17. Mr A says the Trust must have made a mistake in discharging his father at that time as his condition deteriorated very quickly afterwards, indicating the Trust had failed to diagnose his father’s pneumonia when discharging him from hospital. This was found to be the cause of his death, which occurred a few hours after his discharge.
18. Pneumonia is an inflammatory condition of the lungs. We understand from our adviser a diagnosis is reached on the basis of clinical signs and is supported by evidence of those signs on a chest X-ray. NICE NG250 guidance referenced in our ‘evidence’ section defines pneumonia as ‘an acute illness (present for 21 days or less), usually with cough as the main symptom, and with at least 1 other lower respiratory tract symptom (such as fever, sputum production, breathlessness, wheeze or chest discomfort or pain) and no alternative explanation (such as sinusitis or asthma)’.
19. There was no evidence from Mr X’s clinical records that he showed any of these symptoms or clinical signs before being discharged. There is no recorded evidence of symptoms or clinical suspicion of pneumonia during his admission, including when he was reviewed on the day of his discharge. In view of this, we cannot see any indication the Trust failed to act in line with established clinical guidelines in not diagnosing Mr X with pneumonia and so discharging him at that time.
Post-discharge support arrangements
20. Mr A complains the Trust said it had arranged for carers to visit Mr X after his discharge, but this did not happen. In its response the Trust explained it had investigated this as part of its internal incident reporting process. It found arrangements had been made for the short-term support care team to visit Mr X on the evening of 16 January but they did not attend because of miscommunication between them and the discharge team. The Trust apologised and said it has made service improvements to ensure this does not happen again. In not providing the necessary agreed support after discharge, we can see an indication of a failing, as the Trust did not act in line with the NHS England guidance referred to in our ‘evidence’ section.
21. We have therefore looked at whether this had a negative impact on Mr X and his family, and, if so, whether the Trust has put things right.
22. Mr X became unwell at home on the same day of discharge, and although an emergency ambulance attended Mr X sadly died. We understand this was due to pneumonia which, as explained above, he had not displayed any clinical signs of at discharge. Neither were any clinical signs noted by an occupational therapist who accompanied Mr X home for a discharge assessment hours before his death.
23. We have not seen anything to indicate from the evidence available, including our independent advice, that the carers not attending on the evening of 16 January would have made any difference to the sad outcome of Mr X’s unexpected death at that time. This is because Mr X’s condition deteriorated and instead of carers he was seen by ambulance clinicians, who were ultimately best placed to provide him with the care he needed at that time.
24. Due to this we cannot see the communication error between Trust teams led to the clinical impact Mr A describes, which is a missed opportunity to provide his father with timely care that might have avoided his death. We were sorry to hear of the circumstances of Mr X’s death and we can understand that this must have been an upsetting situation for Mr X’s wife and family, so we hope this provides reassurance to them.
Communication
25. Mr A complains the Trust did not communicate anything to the family about Mr X’s condition, treatment and care plan during his admission.
26. The clinical records show a number of interactions between Mr X’s wife, son, and nursing and therapy staff during his admission. We understand from our adviser that there were no significant changes in Mr X’s condition from a medical point of view which would have required a more formal discussion. While the GMC guidance referred to in our ‘evidence’ section includes guidance on when it is appropriate to discuss patient information with family members, there are no specific guidelines on how often communication is required with family members. We further understand from our adviser there is no evidence to suggest Trust staff had concerns about Mr X’s capacity to make his own decisions and so discussions regarding his discharge were primarily held between staff and Mr X himself. If a patient then wishes to discuss the details of those conversations with family members, they can do so.
27. According to the NHS England hospital discharge guidance referred to earlier, ‘the relevant Trust must take any steps that it considers appropriate to involve the patient and the carer of the patient’. The available evidence indicates a meeting was held with the Mr X’s wife and son on 11 January 2024 regarding discharge plans and appropriate post-discharge support to be put in place. We can see discharge planning communication was in line with these guidelines.
28. Mr A further complains the Trust informed Mr X’s wife of his discharge when he was in a taxi on the way home. In its complaint response the Trust has explained the discharge was actioned once it received confirmation it could put the necessary arrangements in place, including short-term support at home and an assessed discharge on the same day. The evidence available to us shows the Trust received the confirmation for short-term support at home at 10:30am on the morning of discharge, and Mr X’s wife was notified at 11:30am, once he had already departed from the hospital.
29. We can understand the short notice must have been stressful for Mr X’s family and it was not an ideal situation for them to be in. We can see from evidence mentioned earlier Mr X’s family were involved in his discharge planning discussions during his stay. The NHS England guidance for hospital discharge does not define a notice period for family members to be notified of a discharge. The Trust had ensured the correct support was arranged before it discharged Mr X and he was deemed as having capacity regarding his care decisions. While it was unfortunate that Mr X was in the process of travelling when the call was made, we cannot see any evidence the Trust failed to act in line with guidelines in informing Mr X’s wife of his discharge once he had departed the hospital, nor that this had any impact on his care.
30. Mr A also complains a Trust staff member hung up the phone on Mr X’s wife when she rang the ward for help, while Mr X was dying in front of her. We are sorry to hear about this and we can understand this would have been a very distressing time for Mr X’s wife. We have reviewed the documentation recorded by the Trust staff member regarding the telephone conversation in addition to considering what Mr A told us.
31. The staff member recorded she was trying to gain information to understand what was happening. The documentation indicates Mr X’s wife was understandably very upset about Mr X’s condition deteriorating and said she would call an ambulance, then terminated the call herself. Unfortunately, we have been unable to find any further evidence to confirm the details of the verbal discussion and to confirm how the call ended. Therefore, we are unable to provide a view on the balance of probabilities as to what exactly was discussed and how the call ended, meaning we cannot take any further action here.
32. In light of the above, we have decided to take no further action with this complaint. We are sorry to hear of the distress Mr X’s family experienced and we hope we have explained the thorough consideration we have given to our decision and clearly outlined the reasons for it. We hope our independent view offers some clarity and reassurance to Mr X’s family. We would like to thank Mr A for bringing his concerns to our attention.