Shrewsbury and Telford Hospital NHS Trust

4. Mr P complains about the care his wife, Mrs P, received from the Trust in September and October 2023.

5. Specifically, Mr P complains his wife did not receive adequate physiotherapy in hospital following hip surgery which limited her recovery.

6. He also complains the Trust discharged his wife before she was ready. Mr P said his wife was almost completely immobilised and could hardly move or get out of bed. He said the Trust was in a rush to discharge his wife and did so through a pathway three placement to a nursing home which meant they had to cover the associated costs.

7. Mr P is frustrated the Trust did not discharge his wife through a pathway two placement, which would mean the NHS covered the costs.

8. Mr P tells us his wife was mobile, outgoing and confident, but this changed following her surgery and discharge. He said his wife entered the care home frightened and was unable to get out of her chair or communicate. He said the Trust irreparably damaged his wife’s quality of life and this caused him considerable upset and distress.

9. Mr P wants the Trust to acknowledge its mistakes and apologise for them. He also wants the Trust to pay him a financial remedy.

10. On 22 September 2023 Mrs P suffered a fall at home. An ambulance took her to hospital, and she received hip surgery the next day. The Trust discharged Mrs P to a nursing home on 12 October.

15. Mr P tells us his wife did not receive adequate physiotherapy in hospital, and this limited her potential for recovery.

16. Mr P said the Trust discharged his wife before she was ready. He adds they discharged her via a pathway three placement which meant they had to pay the associated nursing home costs.

17. Hospital discharge guidance describes a pathway two placement as a short-term basis for rehabilitation, reablement and recovery in a community bedded setting (bed in a care home, community hospital or other bed-based rehabilitation facility).

18. It describes a pathway three placement as being for those with the highest level of complex needs. This means discharge to a care home for assessment of long-term or ongoing needs.

19. The Trust said Mrs P was at times unable or did not wish to engage in physiotherapy. It said medical staff decided to discharge her from the therapy service as she had reached her mobility potential. It added nurses provided further mobility support before her discharge.

20. The Trust also said it discussed with Mr P that it did not think his wife had further rehabilitation potential owing to increased levels of confusion and her not engaging with therapy. It noted her new baseline was being able to safely transfer with the assistance of two people.

21. Transfer, or transfer practice refers to the process of teaching patients how to safely move from one surface to another. For example, from a bed to a wheelchair or from a wheelchair to a toilet.

22. It said Mr P agreed he would not be able to manage his wife’s limited mobility at home and they discussed a pathway three placement, which was felt to be the most appropriate route for her.

23. NICE hip fracture guidance, NICE joint replacement guidance and BOA guidance all supply advice on how medical staff should manage physiotherapy in post-operative patients like Mrs P.

24. All three pieces of guidance say physiotherapy should be offered on the same day following surgery or the day after. It also says physiotherapy should be offered regularly.

25. Hospital discharge guidance says people do not have the right to remain in a hospital bed if they do not need acute care.

26. Our physiotherapist adviser said physiotherapy was offered daily. They note there were two occasions where they can see Mrs P declined this therapy. Our Physiotherapist adviser can also see physiotherapy was offered the day after Mrs P’s surgery.

27. Our Physiotherapist adviser also notes once the Trust’s physiotherapy team stopped providing Mrs P with active physiotherapy, nurses continued to provide transfer practice in the leadup to her discharge.

28. We have therefore found no evidence to indicate the Trust failed to provide Mrs P with appropriate physiotherapy during her admission. We see this element of her care was, overall, handled in line with NICE hip fracture guidance, NICE joint replacement guidance and BOA guidance.

29. We will now consider Mr P’s concerns about his wife’s condition at discharge and the Trust’s decision to discharge her via a pathway three placement.

30. We recognise Mr P is concerned the Trust discharged his wife in poor physical condition and she was discharged before she was ready. We acknowledge this experience will likely have been upsetting and distressing for them.

31. Having carefully reviewed Mrs P’s medical records we cannot see Mrs P’s poor physical condition was due to a lack of physiotherapy, as we have described earlier in this statement.

32. Our physiotherapist adviser explains there were multifactorial reasons for Mrs P’s poor physical condition. Multifactorial reasons for confusion and decline in condition can include the pain Mrs P was experiencing, her nutrition levels, the medication she was receiving and the change in environment (i.e. being in unfamiliar hospital surroundings).

33. Our Physiotherapist adviser said the key reason for any decline in Mrs P’s mobility and general condition were most likely the result of a change in environment and her advanced dementia. They note there is nothing to indicate the other multifactorial reasons described above played a significant role.

34. Mrs P’s advanced dementia would have been a barrier to ‘carry over’. This means she could not have remembered her physiotherapy exercises and routine so was unlikely to have the potential for full recovery.

35. She had also just undergone hip surgery which can have a significant impact on elderly people because it greatly limits mobility and means those patients spend longer periods in bed. This can further contribute to their decline.

36. There is no evidence to indicate Mrs P’s poor physical condition at discharge was caused by a lack of physiotherapy. As set out at paragraph 26, we can see the Trust handled Mrs P’s physiotherapy in line with applicable guidance and standards.

37. Having reviewed Mrs P’s medical records, there is nothing to suggest the Trust discharged her before she was ready. As we have set out earlier in this statement, Mrs P did not have rehabilitation potential so there is little further physiotherapy at hospital could achieve.

38. Discharge home, or placement at a nursing home would have been the next appropriate step. We see the Trust’s decision to discharge Mrs P is in line with hospital discharge guidance.

39. We will now consider the Trust’s decision to discharge Mrs P via a pathway three placement.

40. Based on what we have seen, Mrs P did not have rehabilitation potential. Our physiotherapist adviser explained patients in this condition would usually be discharged home, but we can see Mr P said he would not have been able to cope. Mrs P was therefore discharged to a nursing home for 24-hour support.

41. Mrs P’s condition, which included advanced dementia, was complex and would have required long-term support. As such, we cannot see she would have been viable for a pathway two placement. We therefore see the Trust’s decision to discharge her via pathway three is correct and in line with hospital discharge guidance.

42. We recognise Mr P is frustrated they had to cover the nursing home costs. Our physiotherapist adviser explained long-term care associated with pathway three is usually means tested. If the user has the means to pay, it would be expected they do so.

43. While we are unclear about the specific funding arrangements associated with Mrs P’s placement at the nursing home, we do not see this will impact upon what we agreed to investigate. Overall, the Trust discharged Mrs P via a pathway three placement and this was in line with applicable guidance and standards.

44. We understand Mr P has been through a great deal recently. We hope our statement can provide him with some reassurance that the Trust handled his wife’s care correctly in line with applicable guidance.