Social worker suspended for six months over ‘unsafe’ hospital discharge of elderly man

Experienced practitioner failed to assess elderly man's needs or provide evidence of a care plan, leaving him at risk of harm, panel finds

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A Health and Care Professions Council (HCPC) tribunal has suspended a social worker after she placed an elderly man “at significant risk of harm” by failing to properly assess his needs after his hospital discharge.

The tribunal panel found “no evidence” the social worker, who had 16 years’ experience, had completed a care plan for the man – named as ‘Service User A’ – or informed others about his discharge.

The social worker was barred from practice for six months. She offered an apology for her conduct without making any specific admission as to the particulars of the case against her.

She did not attend the hearing with the panel citing her lack of engagement as a factor in the “limited evidence that she fully appreciates the gravity of her behaviour”.

The tribunal noted the social worker had ongoing health issues – which were discussed in private – but decided there was insufficient evidence these had any bearing on her fitness to practice.

Left home alone

Concerns about the social worker’s practise around Service User A were raised in May 2016 and investigated by a manager at Durham council, where she worked. Unusually, the manager, who was the primary witness in the hearing, could give evidence by telephone after the panel decided this would cause “no injustice”.

The panel heard Service User A, who had painful cellulitis in his legs, affecting his mobility, as well as other medical problems, had been admitted to hospital after a fall.

The social worker visited him twice in hospital during April 2016, prior to his discharge on 4 May. She arranged for an additional care visit but, the tribunal found, failed to consider how he would get his lunch, visit the toilet or otherwise deal with the “long periods he would be home alone”. No authorisation for the care package amendment was sought.

As well as deciding that she had not carried out an adequate assessment, the tribunal found:

  • No evidence the social worker had ever completed a care plan following his discharge. The panel noted “Service User A’s GP, his family and the care agency engaged to deliver his care all raised immediate concerns about the inadequacy of the twice daily care visits set in place for him”.
  • The social worker had not informed her supervisor or other colleagues about Service User A’s discharge, despite being aware of an expectation to do so. Case management records relating to the period of his discharge were not maintained in a timely manner.
  • Service User A’s family were not adequately involved in the assessment process, and information was not shared as it should have been with him or his care agency.

‘Serious departure from expected standards’

The tribunal found the social worker had breached a series of standards relating to working in partnership with service users and carers, accounting for their needs and wishes, reducing the risk of harm and maintaining records.

“The assessment, the care plan, communication and record keeping fell far below what would be proper in the circumstances, and represents a serious departure from the standards expected of a registered social worker,” the HCPC said.

The panel acknowledged there was “no evidence of actual harm to Service User A as a direct consequence of the Registrant’s acts or omissions”. It also cited the practitioner’s long unblemished record and admission of a “major error” in a letter to the HCPC as mitigating factors.

But the social worker’s conduct and behaviour presented “a significant risk of harm, which was unnecessary and avoidable”. It found the social worker’s conduct could have affected other service users as resources were redirected to resolve Service User A’s problems.

In opting to suspend the social worker for six months, the HCPC said the social worker’s failings, which related to a single incident, were capable of remediation. However it said “the Registrant has provided no information that would assist the panel in this regard”.

“The panel took the view that in the absence of sufficient insight and any steps that the Registrant has taken towards remediation, there remains an ongoing risk of repetition which has the potential to place service users at risk of harm.”

The HCPC recommended the social worker attend a review panel in person and provide written evidence of reflection and professional development before returning to practice.

21 Responses to Social worker suspended for six months over ‘unsafe’ hospital discharge of elderly man

  1. Stuart January 8, 2018 at 1:18 pm #

    Why would somebody not even attend the hcpc hearing? And why wouldn’t the hcpc, who claim to act fairly and openly, not take steps to ensure the worker did attend as I can’t see how they’re able to justify reaching the conclusions they have without personally discussing with the worker?

    I’m generally as unhappy as anyone with what I read of what they do and what they decide, to say nothing of their appointment in the fnrst place, but for now the hcpc exists and has powers that need to be recognised – but used fairly!

  2. Anonymous January 8, 2018 at 2:24 pm #

    Should have been struck off !!

    • C McCarthy January 10, 2018 at 11:29 pm #

      Yes of course, with your comment you remained anonymous

  3. Social Worker January 9, 2018 at 9:42 am #

    Where is the view of A?

  4. Ruth Cartwright January 9, 2018 at 1:07 pm #

    Difficult to understand why this previous good social worker got this so wrong, but there may well have been pressure from hospital and managers to discharge in a hurry. We rarely read about people in need of care discharged by the hospital (sometimes without a social work assessment having been requested) and left on a doorstep or taken indoors to get on with things alone, but this happens. Nor do we read of those who are readmitted because they should not have been discharged in the first place – again this is a regular occurrence. Not to condone what this worker did (or didn’t do) but hospital social work is a very high pressure environment.

  5. Eco-social worker January 9, 2018 at 1:07 pm #

    A judgement that raises more questions than it answers.

    Unsafe hospital discharges are pretty much a fact of life these days, but hearing anyone taking the blame for them is very, very rare indeed.

  6. Dan Fee January 9, 2018 at 1:45 pm #

    I don’t condone the inaction by the social worker by any means, but with any discharge from hospital Doctors, nursing staff, OTs and Physio teams would surely have questioned why the patient was going home without care. If families are involved from my experience the ward usually contacts them prior to discharge and surely the care plans would have been discussed.

    Whenever I do hospital work I clearly outline in the medical notes and my contact notes why someone does not require care or if they have declined support. Not only does this provide clarity and a chance for other teams to question decisions it also covers me if I can show my thinking on record. Other teams would have been aware of a possible inappropriate discharge so I cant see the fault laying expressly with the social worker.

    • RK January 10, 2018 at 6:51 pm #

      Agree with you, discharge is not or should not be a solo decision.

  7. Catherine January 9, 2018 at 3:58 pm #

    This is nothing compared to some of the discharges I see medical professionals and ward sisters organise. The world is too harsh on social workers.

    • Long in the tooth January 10, 2018 at 8:49 pm #

      My thoughts exactly. Although I can see why this was wrong

  8. Eileen Tighe January 9, 2018 at 7:30 pm #

    The exact same thing happened to my father. Couldn’t be more exact. She met my father once the evening before he fell out of bed again at home. He was admitted to hospital where he spent the last few weeks of his life till he died 6 weeks later. The voice of my father, his family and his main carer (me, a nurse) was totally disregarded. The social worker knew best. Why are lessons never ever learnt!

  9. alison Strang January 10, 2018 at 2:33 pm #

    What part did the social work hospital manager play in this in terms of supervison?
    one has to ask if the ward staff made adequate steps to ensure that the social work team had been informed of the discharge report etc.

  10. Sarah January 10, 2018 at 5:19 pm #

    Interesting but not uncommon. In the pressure to expedite discharges from Hospital – Assessment and care planning processes are rushed and inadequate not to mention the difficulty in getting adequate funding. Not sure why Sociial worker didn’ attend though

  11. Janet January 10, 2018 at 5:54 pm #

    Had the patient mental capacity to decline a care package that could have met all his needs?
    Experience of many years of being a social worker, is that whilst you can see the necessity of x amount of calls per day, unless the service user was prepared to accept this recommendation, if the service user has capacity – there is very little you can do to enforce this.
    Families are frequently not informed by the hospital of discharges, many are telephoned by the ward whilst their relative is on the transport home. Last minute changes to discharges are frequent – social workers are advised patient will be going home on the Wednesday to receive a phone call from the ward on Tuesday morning that the patient was in the discharge lounge.

  12. Annoyed January 10, 2018 at 6:28 pm #

    The Social Worker as part of the MDT would be the person responsible for arranging the persons needs at home following discharge. This problem must have come to light by someone alerting the manager.
    I am surprised at the lack of empathy for the person involved, and equally surprised at the comments made here.
    If the SW has not carried out a robust assessment of need, involving the person and their family, nor followed the procedures of her employer and thus failed to make the necessary care arrangements for a vulnerable person, then the decision made to suspend that person from practise is the right one.
    I doubt this is the only concern that has been raised about the individual concerned.
    If Social Workers want respect then they need to earn it.
    Let’s hope lessons are learned.
    This practise should not be considered a fact of life, if the person had lost their life as a result of not receiving care then I doubt the comparison would be made.

    • Catherine January 11, 2018 at 2:35 pm #

      This is a response from someone who clearly has no idea of the pressure of hospital social work or is not a social worker. It is an MDT decision, the ward have a duty of care and are also responsible to ensure a person’s discharge from hospital is safe.
      Of course there is empathy for the person involved. The pressures placed on hospital social work is very intense. Social workers need to support each other. Could this issue not have been dealt with by management? Every profession makes mistakes particularly when under a lot of pressure. Have you read what doctors get suspended for? A recent hearing I read was one doctor drinking on the job and another one was a doctor sexually assaulting patients! Social workers get suspended for one mistake. Please do not tell me social workers need to earn respect. If you feel that way then you have no idea of the work we do.

  13. Emma January 10, 2018 at 10:25 pm #

    This raises so many questions. It should be added that ultimately the hoapital discharged the patient not solely the social worker. Hospital discharge planning 99% of the time necessitates multidisciplinary decisions and plans. Given previous experience, I wouldn’t be surprised if the social worker in question was under pressure from the hospital to facilitate discharge plans asap. Maybe the patient/service user/person declined to have any further additional care visits. There is no mention of the persons wishes, views, decision making ability. Maybe he declined for plans to be shared with his family/others. Maybe the social workers manager gave verbal agreement for additional funding and failed to adequately record this decision – it happens more often than it should! Maybe the care plan wasn’t recorded on the system due to time pressures and IT failings – again it happens more often than it should. infond it really difficult to believe that a single social worker is solely accountable for this situation.

  14. Claudia January 11, 2018 at 9:52 am #

    As a Hospital Social Worker for nearly 4 years, I fully agree with the comments saying that hospital discharge is a multi-disciplinary decision. And I also see inappropriate discharges agreed by NHS professionals all the time, without Social Work input, yet they don’t get blamed…
    As regards HCPC, I don’t think they have the powers to force someone to attend a meeting – was the Social Worker under arrest and had no human rights?

    • Anonymous January 12, 2018 at 9:07 pm #

      I agree with both Emma & Catherine entirely. I too have been a social worker in a hospital team. Hospitals leave discharge planning too late make a referral to social care. Then expect a miracle @ Short notice & put enormous pressure on individual workers to unblock beds. Actually threatening them with unbelievable sanctions. I do not condone what has occurred but as others have said there’s 2 side’s & the decision ultimately should be MDT. Ward’s discharge patients all the time with out consultation with all parties and people are readmitted or go into crisis as its been an unsafe discharge but as someone had stated you don’t hear about these cases !
      The SW concerned has paid the price unfortunately for poor practice but as high lighted views from others involved haven’t been heard. Additionally there is lots of good practice via hospital discharges but as usual we only hear about bad.

  15. Kirk January 12, 2018 at 1:46 pm #

    I have 9years experience as a Hospital Social Worker, I am struggling to understand why a very experienced Social Worker would make these errors. I wonder if the investigation considered other professionals within the MDT who are equally responsible and have duty of care. I wonder what therapists’ assessments in the hospital recommended? There is mention that other Service Users could have been at risk? If this is the case, what was her manager’s responsibility or LA to safeguard? I believe Local Authorities have duty to supervise their Social Workers. In addition, LA has duty to ensure all assessments completed on their behalf are of a good standard. Had this been noted, Social Worker should have received enough support to improve her practice.

  16. Anonymous January 12, 2018 at 7:06 pm #

    I agree with Catherine. At times people are very quick to cast stones on social workers but forget the pressure they work under. What accountability is placed on those from the NHS. Why is she the only one investigated? A lot of questions are indeed unanswered? Let’s not be so quick to judge social workers, as it’s a difficult shoe to wear……

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