Overview
The complainant (Mr C) complained about the care his late father (Mr A) received at the Southern General Hospital (the Hospital) in February 2011. Mr C was concerned that the staff involved in Mr A's care had failed to consider and assess his cognitive function, or communicate with Mr C in relation to the plans for discharge, resulting in Mr A being inappropriately discharged. Mr A fell and was injured two days after being discharged home, and was re-admitted to the Hospital.
Specific complaints and conclusions
The complaints which have been investigated are that Greater Glasgow and Clyde NHS Board (the Board):
- (a) did not provide reasonable care and treatment to Mr A during his admission to the Hospital between 10 and 24 February 2011 (upheld);
- (b) did not reasonably consider whether Mr A was fit for discharge on 24 February 2011 (upheld);
- (c) did not dress Mr A in the outdoor clothes that had been provided for his journey home on 24 February 2011 (upheld); and
- (d) did not provide a reasonable response to Mr C's complaint (upheld).
Redress and recommendations
The Ombudsman recommends that the Board:
- (i) provide evidence to the Ombudsman of the implementation of a policy for the assessment of cognitive function of elderly patients, which should include documenting whether or not clinical staff find a patient has capacity to participate in decision making;
- (ii) provide the Ombudsman with a copy of the new discharge policy to demonstrate it states that relatives and carers must be engaged with during the planning for discharge process;
- (iii) ensure that their discharge policy and checklist contains a reminder that patients are dressed appropriately upon discharge;
- (iv) provide a full apology to Mr C for all of the failings identified within this report; and
- (v) review and clarify their policy in relation to the review of hip fracture patients by the DOME.
The Board have accepted the recommendations and will act on them accordingly.