Anyone around who understands the NHS? Need to complain and don’t know where to start

[DrRamsesEmerson]

MIL is in her 90s and broke her hip three weeks ago. She was in hospital for a week after surgery, then was discharged to a rehabilitation centre where she was supposed to stay for four weeks while the hip mended. They sent her home with no warning after a week and with no follow up care. (She has carers coming in daily, paid for by her, fortunately- that was in place before she broke her hip.)

Where do we start to try and get her proper help? She was meant to have physio to get her as mobile as possible while the hip mended. Her GP is useless and uninterested, although I’ll write to them to make sure it’s on record that she’s been sent home in this state. We don’t really know what she’s been told, because although she has full capacity she’s extremely deaf so she almost certainly hasn’t heard everything that’s been said to her. I work FT, so does BIL, DH is part time and looking after our DD. We live 100 miles away and BIL not much closer.

PALS are the people to complain to. They’re usually based at the hospital.

www.nhs.uk/nhs-services/hospitals/what-is-pals-patient-advice-and-liaison-service/

I would skip PALS and look up the formal complaints procedure for the hospital - each hospital usually has a page about it on their website. I would also copy in the chief executive via email, the email should be on the complaints page but you can also ring the main hospital number and ask for this.

I have complained about treatment several times (I have a very rare autoimmune disorder and have been let down badly several times).

Unfortunately I fear you’ll struggle to get help as easily now as generally the time to set this up is whilst the person is still in hospital (had this with my own mum)! For future reference refuse to accept discharge / have them home without a care plan being put in place. They usually liaise with your local council to arrange short term carers up to 4 times day whilst they arrange assessments to see how that person can cope at home (see nhs continuing healthcare - have a google).

I would start with a complaint and also ring the ward your mum was on and explain the situation now and see if they can help. Also ring your local council and ask them what they can do.

www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/nhs-continuing-healthcare/

www.nhs.uk/using-the-nhs/about-the-nhs/how-to-complain-to-the-nhs/

I feel similarly. My DM fell and broke a hip earlier this year. She was discharged with 6 weeks reablement care which was daily carer visits and weekly physio. So it sounds like your MIL is missing out on the physio. However, based on my experience she’s not actually missing much. My mum was discharged with a leaflet showing exercises to do daily and the weekly physio visit basically just went through them. It was a different person each week so there was no continuity or sense of progress. And she has not regained mobility yet. And following the end of the 6 week period she has been assessed as needing further physio and put on a waiting list. We’ve been told to expect the initial triage assessment in 4-5 months, with nothing provided before that. So we’re paying for a private physio. Sorry for your MIL, it’s a rubbish situation to be in

It seems unusual fir her to discharged with no care package in place. There should have been an ot assessment and interim care provided as part of that. Does anyone live with her, could she have told the hospital that she had provision in place? You may need to lay it on thick that this is not the case and she is at risk of falls and readmission. PALS is first port of call for information and complaints. Most support like physio can be accessed by GP referral but a call to the discharge team at the hospital may speed things along.

Sorry you've had this experience. I just wanted to signpost for the avoidance of confusion @Bagelsandbrie Continuing Healthcare is essentially for end stage end of life costs of nursing support and care.
Your MIL should be under the care of a 'short term' reablement service which is usually provided via the local community NHS trust or the social work department of the council so they would be a good place to start in terms of accessing support.

What did the person who discharged her from the rehabilitation centre say?
How often are the carers going in to see your MIL?
Are you able to go down to see your MIL and sort it out?

@PintOfBovril

Sorry you've had this experience. I just wanted to signpost for the avoidance of confusion *@Bagelsandbrie* Continuing Healthcare is essentially for end stage end of life costs of nursing support and care. Your MIL should be under the care of a 'short term' reablement service which is usually provided via the local community NHS trust or the social work department of the council so they would be a good place to start in terms of accessing support.

It used to be but that’s not strictly true anymore. There is a set criteria to meet, as laid out in the link. It’s just a starting point - I’m not necessarily saying that’s absolutely what the ops mum needs.

My Mum ended up having difficulties after a knee replacement (she had Crohn’s disease and severe anemia and ended up back and forwards in hospital) and was eventually given 4 a day carer visits from the council and then assessed under nhs continuing healthcare where they then offered either a live in carer or fully funded nursing home - we went with this option, she owned her own home outright and couldn’t have sold it quickly to pay for care so used the continuing healthcare to fund the nursing home and her own home sat empty - she died 1.5 years later, she went on to develop bowel cancer (she didn’t have this at the time she was originally assessed, as an only child I attended every appointment with her).

What exactly is your complaint? What were you expecting that didn’t happen? Does your mum want you to complain?

She has full capacity and carers in place - presumably they judged she was safe to go home, and she agreed. Is she able to manage at home? If she has capacity then the hospital have to deal with her as an independent person capable of making her own decisions. Does your mum feel there are grounds for complaint?

Of course she should be having physio, but unfortunately as MrsW said the physio tends to be pretty scanty. And of course it would be lovely if she could spend more time being cared for, but hospitals aren’t residential homes and the onus right now is on getting people out of hospital as soon as they are able.

By all means complain, it may well be that the standard of care fell below what was appropriate, but I have a nasty feeling you’ve just encountered the norm for current standards of care (check out Discharge To Assess guidance).

Maybe time for a chat with your mum - I assume you have health/financial POA in place? You could also register as her carer with her GP.

You can get private physio which is better, as someone else said physio on nhs can be a one off demo of exercises to do and a leaflet which in our experience isn’t a lot of help to a deaf elderly person who needs rehab after breaking bones. We got a private physio to do an assessment at home she was excellent and returned weekly at first to check movement was improving.
I think sadly a lot of help is now left to the family GP’s can only do so much, luckily you had carers going in already, but the sending home early without informing family is terribly bad care and should be reported.

Contact your local authority today for a care needs assessment. But I do agree that the hospital shouldn’t have discharged without an adequate care plan in place

This is the problem with health and care being funded by two entirely difference channels (NHS and local govt respectively)

She lives alone. I don’t know what she was told at the point of discharge, if anything, because she didn’t hear it properly (and her short term memory isn’t great now, even if she had). Carers are coming in four times a day.

None of us were allowed to visit her in hospital so we weren’t there at the time of discharge, so there wasn’t any scope for protest then.. BIL visited her in the rehab centre but they didn’t even hint that they were about to send her home!

She’s not my mum, she’s my MIL. DH and BIL are joint attorneys for her.

@Purplewithred, they thought, and said, that she needed 4 weeks of rehab in a specialist centre before she could safely go home. I have no idea why that changed, and if they explained to her she didn’t take it in. It would be completely typical of her treatment by the NHS that they told her what was happening but didn’t check that she’d heard and understood, so they’ve fallen short of basic standards of care for a deaf patient. There is no follow up care at all.

Yes this happened to an elderly relative I know too, sent home in nhs ambulance van in middle of a freezing winter wearing a nightie slippers and dressing gown and she was on it for hours as they dropped others off around the city. Her sons live long way away and hadn’t been told she was being discharged. Luckily a neighbour saw her arrive and had a key to let her in got the heating in and brought her some food supplies!
Welcome to the world of elderly “ care” it’s awful, not joined up and you feel like it’s all left to you and sadly it is.

Who was supposed to arrange physio? Was it the hospital? Has she had a discharge summary?

If she was supposed to be in the rehabilitation centre for 4 weeks it sounds like its them whos fucked up? As the hospital would have presumed she was getting everything she needs there

The best person to sort this out is the GP, they can arrange physio and contact the team she was under for further guidance, they should also have the discharge from the hospital which will mention follow ups. But obviously they are being useless

I would ignore bagels approach, firstly the MIL does have care in place. And presumably the care plan from the hospital was the rehabilitation centre. Secondly if MIl has capacity its up to her to accept discharge or not. PALs is by far the best place to get help, at this point you need assistance not complaints. Complaints can come later once you've got MIL the care she needs

The fist thing you need is consent to act. Get consent and written permission from her.
The next thing is to determine who was responsible for her care at point of discharge- that may be the acute trust, it may be a community NHS trust or provider such as a CIC off maybe a commissioned care home service. The easiest way to do this is to speak with the CCG about what is commissioned from whom and what the SLA is.

Once you understand that, you can decide whether there are grounds for complaining. At that point ask to speak to someone senior from the responsible organisation. There may be factors you’d are unaware of and that would influence what you were complaining about.

It could be your mother in law refused carers on grounds she had her own. It could be that during current times direct contact physio has been reduced. It could be your mother in law said she wasn’t wanting to do physio at all. Understanding how decisions were made is key to how you should act.

Then you need to decide what your complaint I should actually about. What you want to happen and what a good outcome looks like.

Does she have a copy of her discharge notes? That may have a point of contact named for follow up. Did BIL meet an ot when he visited or any phone discussion?

I think your MIL has fallen victim to the NHS 'discharge to assess' process that has been instigated during the pandemic. The link below describes how this is supposed to work but sadly there are many many examples of where this has fallen well short of its aims:

https://www.nhs.uk/nhsengland/keogh-review/documents/quick-guides/quick-guide-discharge-to-access.pdf

If you or she can afford it, I would urgently look at arranging for an assessment with a private physio. There is a huge waiting list for NHS physio treatment so I would be concerned that even if she is on the list, by the time it is available it may be too late to be as effective as it could be.

With regard to complaints process, I would write a physical letter addressed to the chief executive of the Trust that runs the hospital (and also the chief exec responsible for the rehabilitation centre if not a part of the same Trust). Reviewing the process described above and highlighting where this guidance has not been followed in your MILs case would be a good starting point.

In my experience (and I've spent a lot of time in the management corridors) well written complaints addressed the Chief Exec are taken very seriously and you will get a formal response.

I'm an OT in a community rehab team.

In my experience this is very common - hospitals make promises about rehab follow up that they don't control. It sounds like she went to the rehab place and they felt she was too good to be there and safe to go home. Four times a day is maximum care you will get at home and if she pays for her own package they would assess if this was sufficient and discharge her home. I'm surprised they didn't discuss it with any family but they need her consent to do this - is it possible she said something along the lines of "oh don't bother them?"

You can phone the rehab place and ask for a discussion about their decisions and why you weren't consented. If nothing else they usually like the family to do the shopping.

However is she safe at home? Can she mobilise herself to toilet/commode between care calls (with or without a frame) and does she want to be at home?

The hip is fixed through surgery. Physio will help strengthen the muscles and assess her safety to mobilise. She should have had some in hospital and the rehab place. It will be mainly exercises based. She should have physio at home within 72 hours as per guidelines but certainly in our team we're so busy we're not meeting anywhere near that target.

Ask the Gp to refer to community physio (tho it may have been done on discharge from rehab bed and she's on a waiting list but second referral won't hurt).

Then you need to identify what you're complaining about - risks, care that does not meet guidelines, poor communication etc. Also if you feel she is unsafe at home contact GP and social services today to raise safeguarding concerns.

Good luck. Care in the NHS has been less than optimal for a long time, But with COVID and the backlog of care and deconditioning of elderly patients it's unmanageable.

Find a private physio in her area and get them to go in. It would be helpful if one of her sons could be there at the initial appointment.

Complaints can be done later.

Before you start any complaint you need to find out exactly what was said to her and what she told them . It could well be that she told them that she would be fine at home with her existing care package and if that’s the case then there is not really much to complain about . I hope you get to the bottom of it but frankly from our experience in the last few years NHS rehab for elderly patients is basically shit .

Yes, private physio is almost certainly the practical answer. I am pretty confident she won't have told them she would be fine at home.

Your MIL sounds awfully let down by NHS. It doesn’t sound safe either. Not sure how far you will get with a complaint through, due to Covid (age old excuse) lots of NHS roles have been seconded, you need action now. Contact Adult Social care team at MIL’s local council, you MIL requires urgent assessment. Good luck

@DrRamsesEmerson

Yes, private physio is almost certainly the practical answer. I am pretty confident she won't have told them she would be fine at home.

A private physio may help but it's not a quick fix. You really need to establish if she's safe at home first and if not then she needs alternative arrangements ASAP.

If family can't visit due to distance can you call the care agency (who will know mil baseline and how she is managing now to compare) and GP.

Call the rehab centre and see if you (or husband/bil) can speak to a therapist who assessed mil. If they won't speak to family escalate to GP.

She may be safe at home, some people do very well after hip fixation but it's likely she'll need follow up.