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Investigation into a delayed discharge - Ms ST

Publication date: 12 Sep, 2019

The Mental Welfare Commission today published an investigation report into the case of a woman who was not discharged from hospital until 18 months after she had been deemed fit to leave.

The woman, Ms ST, remained in hospital due to a prolonged disagreement between her family, health professionals and the Health and Social Care Partnership (HSCP) about discharge plans. 

Ms ST has learning disabilities, cerebral palsy and diabetes and is registered blind. She was in her late 50’s in December 2015 when she was admitted to hospital following a neck fracture, and was judged fit to leave hospital in March 2016. 

She had lived in the family home all her life, cared for by her mother and brother, with additional social care support paid for by both the HSCP and the family since 2012. 

The dispute arose primarily because the HSCP believed Ms ST should move to a care home, and the family wanted her to return home. The family bought a ground floor adapted flat in March 2016 specifically to make life easier once she did so. 

Ms ST was finally discharged to her home in September 2017 and continues to live there successfully with her mother, with social care support, which is again funded by both the HSCP and the family, as well as direct care from her family. 

The Commission decided to investigate this case because it felt that Ms ST had experienced a very lengthy delay in an unsuitable environment, and this had impacted on her human rights.

The Commission found that the principal underlying reason for Ms ST spending so long in hospital was the continuing disagreement between social work and the family on whether or not she could return home. Had a genuinely open and collaborative planning process taken place, there might not have been a need for other steps that lengthened her stay in hospital, such as an application for guardianship, which was a long process with many delays. 

This investigation, like all such investigations by the Commission, is anonymised to protect the individuals involved. Its purpose is to identify lessons that can be learned, not only by the Health and Social Care Partnership concerned, but by all Health and Social Care Partnerships across Scotland.

Kate Fearnley, executive director (engagement and participation) at the Mental Welfare Commission, said:

“It is our view that discharge could have taken place within a few weeks, rather than after almost 18 months of delay. This delay caused unnecessary distress to Ms ST and her family, and meant that Ms ST was living in a single room on a busy general orthopaedic medical ward rather than at home.

“Health and Social Care Partnerships were designed to create closer partnerships between health, social care and hospital-based services. But in this case that was not working; there appeared to be no mechanism between these services to address and progress fundamental differences of professional opinion, which resulted in a protracted series of delays.

“The Health and Social Care Partnership also appear to have concluded that the family were impossible to work with. This attitude led to the Partnership becoming unwilling to take on board other perspectives, which we feel does not reflect the partnership approach that characterises good social care.

“Ms ST had a family who were willing and able to have their loved one living back at home, with support, yet had to fight their cause over many months. 

“We ask all Health and Social Care Partnerships and local authorities in Scotland to read this report and our recommendations, and to act on those recommendations. There are specific additional recommendations for the Partnership involved in this case which we expect to be followed.”

A copy of the full report is available here.