Wirral University Teaching Hospital NHS Foundation Trust

3.Ms A complains about the actions of Wirral University Teaching Hospital NHS Foundation Trust (the Trust) during October 2024. Specifically, she says the Trust prematurely discharged her partner, Mr E, whilst he had poor mobility, was suffering from aspiration pneumonia and could not eat or drink properly.

4.Ms A explains this caused significant distress as she could not care for Mr E after he was discharged. Ms A said Mr E fell through the door on his arrival at home. She adds the carers that had been arranged for Mr E also said they could not care for him until a hospital bed was delivered. Ms A feels the discharge contributed to Mr E’s premature death as aspiration pneumonia was given as the main cause of his death. Ms A explains the events have had a significant financial impact due to Mr E’s pension being one of the main sources of income into the household.

5.Ms A would like an apology from the Trust, service improvements and a financial remedy.

6.Mr E was admitted to the Trust in September 2024 with abdominal pain and distension. The Trust diagnosed him with decompensated liver cirrhosis. During his admission, Mr E received treatment for acute kidney injury, ascites and aspiration pneumonia. The Trust treated Mr E’s aspiration pneumonia with antibiotics which led to a notable improvement in his infection markers and his overall condition.

7.In October 2024, the Trust’s therapy team assessed Mr E’s level of mobility and concluded he would require the assistance of two staff members for all of his transfers. The Trust agreed a discharge plan and recommended a care package of four times a day for when Mr E was at home, with two staff attending on each visit.

8.At the end of Mr E’s admission, his modified early warning score (MEWS) was recorded as zero, indicating that all his vital observations were stable. The Trust completed a thorough examination of Mr E’s chest which confirmed it was all clear.

9.Mr E’s recommended package of care was referred, accepted and in place at the time of his discharge. Mr E was discharged in late October. He sadly died in November.

13.Before we decide if we should conduct a detailed investigation of 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 have not found any indications that something has gone wrong.

14.Ms A is unhappy that the Trust made the decision to discharge Mr E from hospital. She says the Trust should not have discharged him as he had poor mobility, was suffering from aspiration pneumonia and could not eat or drink properly. She says this is supported by the fact that Mr E fell through the door when he arrived home. Ms A confirmed the paramedics who arrived at home with Mr E told her that he should not have been discharged and referred to it as a ‘failed discharge’.

15.Ms A says these events caused significant distress to both her and Mr E. She explained she feels the discharge contributed to Mr E’s premature death as the main cause of his death was given as aspiration pneumonia, which is something he was treated for in hospital. We understand how difficult this was for both Mr E and Ms A and we are sorry to learn about him falling through the door upon his arrival home.

16.In its complaint response, the Trust said that during Mr E’s admission, it treated him for acute kidney injury, ascites and aspiration pneumonia. The Trust said that at the time of Mr E’s discharge, Mr E’s modified early warning score (MEWS) was recorded as zero, indicating that all his vital observations were stable.

17.The Trust said that keeping Mr E in hospital would have increased the risk of him acquiring hospital-associated infections, especially given his compromised liver condition. The Trust confirmed that Mr E did not need to remain in hospital for further treatment. The Trust apologised for the problems Mr E had following discharged but reassured Ms A that it was not a failed discharge.

18.The relevant Department of Health & Social Care guidance says:

‘Health and social care professionals should support and involve the patient to be discharged in a safe and timely way to ensure they do not spend longer than necessary in an acute or community hospital, or local authority run community setting. People should be discharged once they no longer need care in that setting. Timely discharge from acute settings improves a person’s outcomes and reduces the risk of medical complications such as deep-vein thrombosis, hospital acquired infections and loss of independence.’

19.Our adviser said that prior to discharging a patient, it is expected that any active medical conditions have been appropriately addressed with no further inpatient treatment required.

20.The evidence shows that the Trust treated Mr E for decompensated liver disease with an ascitic drain, diuretics and laxatives. The Trust also treated Mr E for the aspiration pneumonia (which he acquired in hospital), with IV antibiotics. Our adviser said the treatment the Trust provided Mr E was appropriate.

21.Our adviser also said that prior to discharge, they would expect a patient to have been assessed by the appropriate therapy and social work teams and for a plan to be put in place.

22.The evidence shows that Mr E’s mobility was assessed by the therapy team who concluded Mr E required the assistance of two staff members for all his transfers and recommended a care package involving two nurses attending to Mr E at home four times a day. We can see the referral for this package of care was completed, accepted and in place by the time of Mr E’s discharge. Our adviser explained that the Trust’s discharge plan for Mr E was appropriate.

23.Our adviser explained that given Mr E’s complex medical condition, it is not surprising he developed complications at home soon after discharge. Our adviser added that does not mean the decision to discharge him was wrong and suggests that Mr E was a complex patient. Our adviser confirmed that the Trust treated Mr E appropriately and at the time of discharge, his blood tests and observations were stable. Our adviser said the priority should have been to get Mr E home as soon as possible and confirmed there is no evidence to suggest Mr E should not have been discharged in October 2024.

24.We can understand Ms A’s frustrations with the decision to discharge Mr E, especially given that as soon as he arrived home, he fell through the door. Whilst we acknowledge this must have been incredibly difficult and traumatic; we do not consider this means the Trust was incorrect to discharge him from the hospital.

25.Guidance is clear in that organisations should discharge patients once they no longer require care in that setting. In this case, the Trust had treated Mr E, ensured his vital observations were stable and arranged for a suitable package of care to be in place for him following his discharge. We consider those actions to be reasonable and in line with the above quoted relevant guidance.

26.We are very sorry to learn of the complications Mr E suffered after he was discharged from the Trust. Whilst we acknowledge the difficulties Mr E and Ms A suffered once Mr E got home, we do not consider this to be a result of the Trust incorrectly discharging him. The evidence shows the Trust treated Mr E appropriately and ensured an appropriate care plan was in place for Mr E prior to discharge. In summary, we have seen no evidence to suggest the Trust should have kept Mr E in hospital and we hope Ms A is reassured by what we have found. For these reasons, we shall not consider this complaint further.

1. We have carefully considered Ms A’s complaint about Wirral Teaching Hospital NHS Foundation Trust (the Trust). We are very sorry to learn of the events which led Ms A to complain and understand the difficult experience both she and Mr E went through after his discharge from hospital. We recognise the importance of Ms A’s complaint and acknowledge how these events have impacted her.

2.We have looked at what Ms A told us and evidence we received from the Trust. We have investigated the complaint regarding the Trust’s decision to discharge Mr E, and we have found no indications that the Trust were incorrect to discharge him.