East Sussex Healthcare NHS Trust (P-001045)

  • 1.	Mrs A told us East Sussex Healthcare NHS Trust (the Trust) discharged her mother, Mrs R, before she could be fully assessed for funded care. Mrs A says this has resulted in the care provider attempting to recover the care costs from Mrs R’s estate.
    
    2.	We found evidence the Trust did not follow its policy when arranging Mrs R’s discharge. This meant Mrs R did not receive an assessment for funding and she became liable for the costs of the care.
    
    3.	We found evidence the Trust did not record or communicate Mrs R’s discharge plan well enough with her or her daughter, Mrs A.
    
    4.	We uphold this complaint and recommend the Trust pays the outstanding bill for Mrs R’s care between 10 December 2018 until 3 January 2019. We also recommend it apologises to Mrs A and it explains what it will do to prevent this happening again.
    
  • 5.	Mrs A complains that on 10 December 2018 the Trust discharged her mother, Mrs R, before adult social care (ASC, a department of social services) assessed her for respite funding. She also says the Trust did not tell her ASC had not completed an assessment. 
    
    6.	Mrs A says this resulted in ASC refusing to fund the care and her mother becoming liable for the costs. Mrs A says it has caused her considerable distress and inconvenience.
    
    7.	Mrs A wants the Trust to acknowledge its failings and refund the cost of the respite care to her mother’s estate.
    
    
  • 8.	On Friday 7 December 2018 Mrs R was admitted to the Trust via A&E with abdominal pain. The Trust found the cause of the problem and agreed a treatment plan. After a short admission the Trust decided Mrs R was fit for discharge. 
    
    9.	Although medically fit, Mrs R was 104 years old and had some hearing and cognitive impairment. The Trust considered Mrs R to have poor mobility at this point. It decided she should be discharged for respite care at a nursing home before returning home. 
    
    10.	The Trust discharged Mrs R to a nursing home on 10 December.
    
  • 11.	We considered:
    •	information Mrs A gave to us, including the complaint form, and the correspondence from the Trust
    •	the Trust’s complaint file
    •	information from ASC.
    
    12.	We also took advice from a senior nurse with 19 years’ nursing and managerial experience in primary and secondary care (our adviser).
    
    13.	We use related or relevant law, policy, guidance and standards to inform our thinking. This allows us to consider what should have happened. In this case we have referred to the following standards:
    •	The ‘Nursing and Midwifery Council Code’ (2015) (the NMC Code)
    •	‘Patient admissions, transfer, clinical handover of care and discharge policy (including escort arrangements)’ (May 2017) (the Trust’s policy)
    
  • 14.	Mrs A says following previous admissions to hospital her mother had been discharged to a local nursing home for respite care. She says she anticipated her mother would need a further short respite placement, so over the weekend she contacted the nursing home to check its availability. It told her it had availability, but it could not assess her mother until Wednesday 13 December due to staff leave.
    
    15.	On Monday 10 December Mrs A visited her mother. She says the Trust confirmed her mother was fit for discharge. Mrs A says she told the Trust she had contacted the local nursing home, it had space, but it could not assess her mother until Wednesday. 
    
    16.	Mrs A says the Trust asked if her mother also needed assessing by ASC to secure funding for the respite care. Mrs A says she told the Trust her mother did need an assessment. She told us she also offered to arrange it herself. 
    
    17.	Mrs A says the Trust told her it would arrange the assessment, as ASC have an office on the Trust’s site. She told us she agreed with the Trust that she would contact the nursing home again to see if there was any way it could assess her mother any sooner. We recognise how concerned Mrs A was about her mother’s safe discharge to a familiar place.
    
    18.	Mrs A says the nursing home managed to complete its assessment sooner and her mother was discharged that day. Mrs R was discharged before ASC assessed her.
    
    19.	Mrs A says the Trust never told her that her mother had not been assessed by ACS. She says she assumed funding was in place.
    
    20.	The Trust says during its discussion with Mrs A on 10 December, she agreed to take care of all discharge arrangements. It says it was only responsible for ensuring 
    Mrs R was fit for discharge and then safely discharged. 
    
    21.	The Trust told us it was not responsible for ensuring Mrs R had an ASC assessment before she was discharged. 
    
    22.	We looked at the Trust’s discharge policy. It says communication is essential for a well coordinated patient journey from pre admission to discharge. It also says all communication relating to the coordination of a patient’s discharge should be recorded in the patient’s medical records. Additionally, it says all information given to the patient at the point of discharge should also be recorded in the patient’s medical records. 
    
    23.	The NMC Code sets out the professional standards and practices for nurses. It reiterates the Trust policy, stating nurses should keep clear and accurate records.
    
    24.	There is no record of the discussion on 10 December. There is also no discharge plan within Mrs R’s records. On the morning of 10 December, the records say ‘poor mobility, very (illegible word). Plan to organise discharge. ASC referral.’ Later that day the records say the nursing home had accepted her referral and transport had been booked. 
    
    25.	There is a discharge advice and information link letter within the records which states that Mrs R has poor mobility and that the mobility goal is to improve mobility. We have seen no evidence the Trust documented how this would or should be achieved.
    
    26.	We have seen no further records relating to Mrs R’s discharge.
    
    27.	We asked our adviser if the records contained enough detail to show the Trust did everything it should have in preparation for Mrs R’s safe discharge. Our adviser told us discharge planning was poorly documented and poorly communicated. This was not in line with the Trust’s policy.
    
    28.	Although the accounts of what was discussed on the day differ, both Mrs A and the Trust agree a discussion about Mrs R’s discharge happened. We have seen no evidence the Trust documented the discussion. Additionally, there is no record Mrs A or Mrs R were given clear information when Mrs R was discharged. 
    
    29.	We have seen no evidence the Trust acted in line with its policy or the NMC Code. This is a failing.
    
    30.	Mrs A says she was left thinking her mother had been assessed before she was discharged, and funding was in place. Mrs A did not become aware of the situation until the nursing home contacted her with a bill for her mother’s stay. 
    
    31.	Although the bill was addressed to her mother Mrs A told us she could not tell her mother what had happened. She knew her mother could not pay the bill and it would have caused her a great deal of worry. We recognise how difficult this was for Mrs A in turn. 
    
    32.	Mrs A says by the time she was aware the assessment had not been completed, she no longer had the opportunity to get her mother assessed. We understand how distressing this must have been for Mrs A, particularly given she says she initially offered to organise the assessment herself. 
    
    33.	Since the bill was issued Mrs R has sadly died. The bill for her care remains outstanding.
    
    34.	The Trust acknowledged its record keeping was not good enough, but it has not considered the impact of its poor communication overall. There is no evidence it gave Mrs A or Mrs R clear information in the discharge planning process or at the point of discharge. 
    
    35.	We have seen no way for Mrs A to request a retrospective assessment of her mother’s eligibility for funding. The local authority told us it cannot complete a retrospective assessment because there are too many variables. 
    
    36.	The local authority agreed to review the referral it received from the Trust alongside its previous assessments of Mrs R. It told us it would probably have recommended a placement at the care home with local authority funding. It says it is possible 
    Mrs R may have needed to contribute around £20 a day. But it told us it cannot be certain of this calculation. 
    
    37.	The evidence shows the Trust prevented Mrs R from accessing a timely assessment. 
    Mrs R then became responsible for the costs of her care. Based on the evidence, it is more likely than not she would not have been responsible for the majority, if not all of it, if the Trust had acted in line with its policy and the NMC Code. 
    
  • 38.	In considering our recommendations, we have referred to our ‘Principles for Remedy’. These state that where poor service or maladministration has led to injustice or hardship, the organisation responsible should take steps to put things right. 
    
    39.	Our Principles state that public organisations should ‘put things right’ and, if possible, return the person affected to the position they would have been in if the poor service had not happened. If that is not possible, they should compensate them appropriately.
    
    40.	To determine a level of financial remedy, we review similar cases where similar injustice has arisen, along with our severity of injustice scale. 
    
    41.	Following this review, we recommend that East Sussex Healthcare NHS Trust should pay the outstanding bill for Mrs R’s care between 10 December 2018 and 3 January 2019, as a retrospective assessment cannot be completed. This means we cannot say with certainty what, if anything, Mrs R would have needed to contribute to the costs of the care. 
    
    42.	By asking the Trust to pay the whole bill we can be certain Mrs R’s estate has been returned to the position it would have been in if the poor service had not happened.
    
    43.	Additionally, the Trust should write to Mrs A within one month of the date of this report to apologise and explain what service improvements it has made.