Summary
Mr C, who works for an advocacy and support agency, complained on behalf of Mr A about a number of issues relating to Mr A's discharge to a nursing home following an admission to Newton Stewart Hospital. First, Mr C complained about the length of time it took clinicians to tell Mr A that an operation to help with a complex medical condition was not going to be possible for him despite it being initially proposed. Had Mr A known that the operation would not be possible, Mr C said Mr A would not have allowed himself to be discharged to the nursing home. Instead, when Mr A was discharged, he believed that he would be able to return home after a short time in the nursing home following the operation. Second, Mr C said that Mr A had not been given the option to return home with a funded care package before being discharged to the nursing home. Third, Mr C said that board staff had failed to explain clearly to Mr A the financial repercussions of his discharge to the nursing home before discharge and then, given his mental health issues, unreasonably failed to arrange an advocate for him to help him throughout the discharge process. Finally, Mr C said that Mr A's time in the nursing home should be considered as NHS continuing care because he was waiting for an NHS funded operation.
We took independent advice from a consultant in care of the elderly and considered guidance on choosing a care home on discharge from hospital and on hospital-based complex care (ongoing hospital care) in place at the time of the complaint. We found that when Mr A was discharged, he did not need hospital care and so it was reasonable to discharge him given his clinical needs at the time. Given this, we also found that the board's decision not to pay the nursing home charges was made in line with the guidance on ongoing hospital care. In relation to the time it took the board to reach a decision about Mr A's operation, the advice we accepted was that the operation was specialist and complex and so it was reasonable for the decision to take as long as it did. However, we identified a number of significant failings about the way Mr A was discharged.
We found that the board failed to take all reasonable steps to ensure Mr A was in a position to make an informed decision about the move to a nursing home and that an opportunity for discharge home was missed. Staff failed to explore with Mr A the option of discharge home with a care package in a reasonable way, and failed to provide clear written information to Mr A about his discharge, particularly around the financial implications of the move. Staff also let Mr A retain an over-optimistic view about the potential of an NHS-funded operation to improve his health when clinicians considered this was unlikely. Finally, we found that the board should have offered advocacy services to Mr A given his mental health problems to support him during a complex and uncertain time with extremely significant implications.
We upheld two of Mr C's complaints and made a number of recommendations to address the issues identified.
Redress and Recommendations
What we are asking the Board to do for Mr A:
|
Complaint number |
What we found |
What the organisation should do |
Evidence SPSO needs to check that this has happened and the deadline |
|---|---|---|---|
|
(a) and (b) |
The Board failed to take all reasonable steps to ensure Mr A was in a position to make an informed decision about the move to a nursing home, in line with the guidance, and an opportunity for discharge home was missed |
Cover the costs of the nursing home fees Mr A has paid for the time he was in the nursing home on production of an invoice or receipt (or other evidence it was paid). The resulting payment should be made by the date indicated: if payment is not made by that date, interest should be paid at the standard interest rate applied by the courts from that date to the date of payment |
Evidence of payment By: 22 January 2018 |
|
(a) and (b) |
The Board failed to take all reasonable steps to ensure Mr A was in a position to make an informed decision about the move to a nursing home, in line with the guidance, and an opportunity for discharge home was missed |
Apologise to Mr A for failing to ensure he was discharged in a reasonable way and, in particular, in a position to make an informed decision about the move to a nursing home. The apology should comply with the SPSO guidelines on making an apology, available at https://www.spso.org.uk/leaflets-and-guidance |
A copy or record of the apology By: 22 December 2017 |
We are asking the Board to improve the way they do things:
|
Complaint number |
What we found |
What should change |
Evidence SPSO needs to check that this has happened and deadline |
|---|---|---|---|
|
(a) and (b) |
Staff failed to follow elements of the guidance on choosing a care home on discharge from hospital and hospital-based complex clinical care to ensure Mr A was discharged in a reasonable way |
Staff should comply with the relevant guidance when arranging discharge |
Evidence the guidance has been raised with relevant staff, and that staff are complying with the terms of the guidance. This could be via an audit, undertaken regularly, to evidence compliance By: 22 January 2018 |
|
(a) and (b) |
Staff failed to provide clear written information in line with the hospital-based complex clinical care guidance about discharge to Mr A to ensure Mr A was discharged in a reasonable way |
Staff should ensure information is provided as part of the hospital based complex clinical care guidance |
Evidence that the process relating to the provision of information has been reviewed to ensure it complies with guidance By: 22 January 2018 |
|
(a) and (b) |
Staff failed to offer advocacy service to Mr A to ensure he was in a proper position to make an informed choice about his discharge |
Staff should ensure patients are offered advocacy services where appropriate |
Evidence Mr A's complaint has been raised with the staff responsible for advising advocate services in his case in a supportive way; and to staff involved in advising advocate services in cases such as this By: 22 December 2017 |