Royal United Hospitals Bath NHS Foundation Trust

Miss O complains that on 12 September 2025, she was discharged to unsafe and unsuitable accommodation. Miss O says that staff should not have discharged her until they found her safe and suitable accommodation. She says that as a result, she experienced multiple falls and a high level of distress at her accommodation.

Miss O also complains that staff didn’t involve her or her social worker in decisions surrounding her discharge during her hospital admission, which was extremely distressing. Miss O says that if she or her social worker were involved in the decision-making, then the decision to discharge her to unsuitable accommodation would not have happened.

Miss O complains that when she was discharged, she had to wait in the discharge lounge, which was unsuitable for her needs. Miss O says that she requested to wait elsewhere and was told to wait in a busy corridor, which was also unsuitable.

Additionally, Miss O complains that her discharge paperwork was incorrect, and as a result, she waited for six hours without the right amount of her medication.

Miss O says that as a result of the events on the day of her discharge she had to adjust her neurostimulator to its highest level, which has meant that she has not been able to increase her neurostimulator any higher during challenging environments since, which is incredibly distressing and anxiety-provoking.

As a result of Miss O’s complaints, she lost faith in the hospital to provide safe and effective care, and says she was advised by her specialist care team not to attend this hospital again. She tells us this means that she now has to travel to Bristol to receive treatment.

Miss O is seeking an apology, service improvements and financial remedy.

5. Miss O is a wheelchair user who has Tourette’s syndrome.

6. On 5 September 2025, Miss O was admitted to hospital with symptoms of a headache and dizziness. On the same day, Miss O was assessed by a consultant as medically fit for discharge with no outstanding care needs.

7. Prior to Miss O’s admission, she was living at her partner’s family house, which is where she was discharged to on 12 September.

Accommodation

10. Before we decide if we should investigate a complaint in more detail, we look at a few different factors. We consider whether there are signs the organisation concerned has got something wrong. We do this by comparing what should have happened with what did happen. If what happened fell far short of what should have happened, we call this a failing. We also look at whether what happened had a negative impact on the person in question. If we think it did, we will go on to consider what, if anything, the organisation has done to try to put things right. If we think there was a failing, and that this had an impact that has not been put right, we will usually investigate in more detail.

11. Miss O told us that during her hospital stay in September 2025, staff discharged her to unsafe and unsuitable accommodation. Miss O says that staff should not have discharged her until they found her safe and suitable accommodation.

12. The Trust explained staff’s discharge decision-making process throughout Miss O’s admission and said that its homeless team worked with the council’s housing team and Miss O’s social worker to alleviate her housing crisis. The Trust said that the council’s housing team confirmed that Miss O had already been awarded a Band A under the council’s housing duty; meaning that she was on the highest band for bidding on the local housing register.

13. The Trust said that its homeless team asked the council to assess Miss O for emergency accommodation. In response the council offered temporary hostel accommodation in Bristol, due to unavailability in Bath. The council explained that if Miss O accepted any temporary accommodation, then she would move to Band B on the local housing register. The Trust explained that this is the local housing process and the hospital does not have any authority over council housing decisions, the availability of housing stock or the limited options for temporary accommodation. It said this was explained to Miss O and her social worker, and Miss O chose to decline the council’s temporary accommodation offer and return to her partner’s address, to retain her Band A place on the council’s housing register.

14. The Trust’s Discharge Policy says how it should manage discharge for those who are homeless or at risk of homelessness. It says that a person is considered homeless if they do not have any accommodation which is available for them which they have a legal route to occupy, or if it is not reasonable for the person to occupy their current accommodation. It says that patients assessed as homeless should be referred to the homeless discharge team, who then assess the patient and submit a Duty to Refer form to a local authority of the patient’s choice, which notifies the council a patient is homeless or at risk of homelessness.

15. The policy outlines that people do not have the right to remain in a hospital bed if they do not need acute care, including to wait for their preferred option to become available. It says that where a patient has capacity and is not willing to accept any of the available, appropriate alternatives, then it may be appropriate that they are discharged, after being advised of the risks and consequences of doing so.

16. Miss O was immediately assessed as medically fit for discharge and referred to the hospital’s homeless team to support her discharge. During her admission, Miss O told the homeless team and other staff that she was not coping with her Tourette’s symptoms at her partner’s address as the home environment was not adapted to her needs. She said that her partner’s house had physical obstacles caused by hoarding and her bedroom was on the top floor, which had caused her to fall down the stairs.

17. The homeless team submitted a Duty to Refer form to the local authority and requested emergency accommodation for Miss O. On 10 September, the homeless team relayed to Miss O her two housing options as outlined by the council. The options were as described in the Trust’s response to her complaint, above.

18. Miss O felt she was being pressured into accepting a hostel placement despite her vulnerabilities. Miss O also told staff that the hostel had heavy doors which made access to the otherwise accessible building difficult. She told staff that she recently came around twenty or thirty on her local housing bid, so it would take weeks before she has permanent accommodation. She felt it would be more appropriate for her to go a community hospital or nursing home, as she was not able to cook, wash or use the bathroom by herself.

19. Miss O’s social worker and housing officer both advised Miss O that returning to her previous address was the most viable option. Records say that on the day of her discharge, Miss O said she hoped that her social worker would be to sort her a flat for next week and accepted that she was able to leave hospital to await this.

20. We consider that staff acted in line with the Trust’s policy. Staff took appropriate actions in referring Miss O to the homeless team, who submitted a Duty to Refer form to the local authority and requested emergency accommodation for Miss O.

21. As the policy outlines, if Miss O was not willing to accept any of the available accommodation options, then it would have been appropriate to discharge her, as staff had assessed that she had capacity and was advised of the risks and consequences of each option. As it stands, Miss O accepted that returning to her partner’s was her best option.

22. Ultimately, it is the responsibility of the council’s housing team to find appropriate accommodation for those experiencing homelessness. That is not within the remit of this complaint. We consider that staff from the Trust took appropriate steps to refer and request accommodation for Miss O, in line with its policy. The hospital’s homeless team could not control the council’s housing options, nor the council’s banding process which meant that Miss O had to return to her partner’s address to retain her Band A placement.

23. Miss O was experiencing undeniably challenging and distressing housing circumstances. We can see from Miss O’s medical notes and conversations with us that this understandably had a detrimental impact on her mental health. We hope that our work assures Miss O that staff acted in line with its policy to find her suitable accommodation.

Involvement in discharge

24. Miss O told us that staff did not involve her and her social worker within their decision-making process to decide where she would be discharged to. Miss O said that if they had both been involved, then the decision to discharge her to unsuitable accommodation would not have happened.

25. The Trust explained that Miss O’s discharge had been discussed with her and her social worker throughout her admission. It said her social worker had agreed that the best option for Miss O was to return to her partner’s address, which would place her in the best position to secure her ultimate goal of her own independent accommodation. It said that it appreciated that the final discharge destination and date was not immediately clear.

26. The Trust’s policy outlines that discharge planning is a collaborative proactive process involving the patient, their families and carers, and inclusive of all agencies and disciplines as required. It says that all discussions with those involved must be documented in the patients notes. It says that staff should make every effort to ensure that the patient is supported to make as many decisions as possible for themselves. It says that staff should start planning for discharge on admission, and where possible should give patients twenty-four hours’ notice of the date of discharge.

27. Miss O’s records say that staff discussed her housing options with her and her social worker throughout her admission. On the day of her discharge, staff noted that Miss O accepted that she was able to leave the hospital whilst she waited for her social worker to hopefully sort out a flat next week – however, Miss O since tells us she thinks she was not fit for discharge. We have not taken a view on that as that element of her complaint was not ready for us. Miss O’s records note that the risks and consequences of each accommodation option were discussed with her and her social worker. Importantly, records note that Miss O’s social worker and housing officer advised her that returning to her previous address was the most viable option.

28. We consider that staff acted in line with the Trust’s policy. On the day Miss O was admitted, staff immediately assessed her as medically fit for discharge and started to arrange and discuss discharge options with her and her social worker. Miss O’s records reflect that staff took her concerns and preferences on board within their conversations with her. The homeless team appropriately shared information with Miss O, explaining her options and the local authority banding system throughout her admission. Records note that Miss O understood these options and chose to return her partner’s address to retain her Band A.

29. Ultimately staff could not control what the council’s Housing team could offer. Where Miss O was discharged to was not a reflection of her or her social worker’s involvement in the process, but of the council’s available housing stock and banding system.

30. Miss O says that being told on 12 September that she would be discharged on the same day was an abrupt shock. The policy says staff should give patients 24 hours’ notice where possible. We don’t know why this was not possible in Miss O’s case, but we have to acknowledge that the policy does not require this much notice as an absolute. Given this, and the fact that her discharge options were discussed throughout her admission, we do not consider this to fall so far short of what should have happened that it would amount to a failing.

31. We are pleased that Miss O received a step-down bed two weeks after being discharged, and that she is now living in accommodation which she says meets her needs.

Discharge issues

32. One of the other things we look at before we decide if we should investigate a complaint in more detail is whether we can reach a fair, robust conclusion on what happened, and whether we can achieve a meaningful outcome for the person who made the complaint.

33. Miss O told us that she was placed in the discharge lounge, when this was unsuitable for her needs. She told us that while there, other patients laughed at her as they didn’t understand that her tics were not her choice. Miss O says that she requested to wait elsewhere and was told to wait in a busy corridor, which was also unsuitable, so she had to wait in the lunch hall which was also unsuitable.

34. Miss O also complains that her discharge paperwork was incorrect, and as a result, she waited for six hours without the right amount of her medication. Miss O says that once she informed staff of this mistake, they refused to administer her medication and would not allow her to administer it.

35. The Trust explained that the Pharmacy team checked and dispensed the medication they understood to be correct on the day of discharge and apologised if there was further medication that Miss O did not receive. With regard to the discharge lounge, it apologised that she was not given time to discuss what to expect or any concerns she had about going there.

36. Unfortunately, there is no evidence to support Miss O’s recollection that she asked to be placed in a different area or that her medication was wrong and she told staff about this at the time. We thought about whether we could accept her evidence on its own. Unfortunately, we do not think that would give us enough detail about exactly what happened. For instance, it may not be possible to establish who she spoke to about these things, what they said and what reasons there might have been for any decisions that might have been made, for example about moving Miss O out of the discharge lounge. The evidence available regrettably does not enable us to reliably establish what happened.

37. This means we have decided that there is no reasonable prospect of us making a fair, robust conclusion, even if we did investigate further.

38. We also thought about the impact Miss O says the issues on the day of discharge had on her and we decided we could not reach an evidence-based conclusion that they had the impact she says they did. Miss O says that as a result of the issues with her discharge she had to adjust her neurostimulator that day, which means that she now cannot increase her neurostimulator any higher during challenging environments, which is incredibly distressing and anxiety-provoking.

39. There is evidence in Miss O’s records that show her neurostimulator was already on the highest level during her hospital admission prior to being in the discharge lounge. Therefore, it would be difficult for us to say any issues on the day of discharge led to her still having her neurostimulator on the highest intensity level today. For these reasons, we consider a formal investigation would not be practical for this complaint.

40. We appreciate that the discharge lounge was a challenging place for Miss O to wait in and we are sorry to hear that other patients made her experience difficult.