Lewisham and Greenwich NHS Trust also did not fully explain the man’s prognosis to his family
A South London NHS trust has apologised to the family of a cancer patient who was discharged from hospital without medication to treat his “severe pain”.
The Local Government & Social Care Ombudsman found fault with how Lewisham and Greenwich NHS Trust handled the man’s discharge from hospital in September 2023, causing his family “confusion and distress”. The trust runs University Hospital Lewisham and Queen Elizabeth Hospital in Woolwich.
The man—anonymised as Mr C in the Ombudsman report—was diagnosed with cancer and several other long-term health conditions. He had a cancerous tumour on his left collarbone that caused him pain and made breathing more difficult.
On 29 August 2023, Mr C suffered a fall at home and was complaining of chest pains. An ambulance transported him to hospital and he was admitted that evening. The report does not state at which of the trust’s hospitals he was being cared for.
In mid-September, doctors met with Mr C’s family who said they felt they were not being kept updated about his care. Notes show clinicians discussed Mr C’s prognosis and the fact his cancer was advanced and had spread to his bones and other organs.
The notes record that “it was likely [Mr C] was approaching the last weeks/months of his life” and the clinical team decided he was not suitable for cancer treatment due to his overall frailty.
Mr C’s daughters met with the hospital’s discharge coordinator on several occasions throughout late September pushing for their father to be placed on the Continuing Healthcare (CHC) fast track, something they said Mr C’s doctor had told them he was eligible for.
CHC is a package of ongoing care following hospital discharge that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. The threshold for meeting the CHC checklist is low, and CHC funding allows care arrangements to be put in place without delay.
The discharge coordinator repeatedly said Mr C did not meet the criteria to be placed on the CHC fast track pathway. The Ombudsman found fault with how the NHS trust did not adequately record and explain this decision to Mr C’s family, causing them “unnecessary confusion and frustration”.
This frustration was only exacerbated when Mr C was eventually placed on the fast track pathway in early November.
Mr C was discharged from hospital on September 29. The NHS Trust made a referral for him to Bexley Council, which in turn arranged for a carer to visit Mr C four times a day. His family expressed concerns he would not cope at home on his own.
A social worker contacted one of Mr C’s daughters, named as Mrs B, on October 9 and they discussed Mrs B’s concerns about the handling of her father’s discharge. Mrs B said Mr C had not been referred to the palliative care team and had been discharged without the medication he needed.
The social worker assessed Mr C four days later and found he would require support on a long-term basis. They arranged an increased care package, noted he was under the care of the palliative team and recorded that Mr C “has not been fast tracked but his prognosis is less than a year”.
On 23 October, Bexley Council completed a CHC checklist for Mr C. Subsequently, on 3 November, the local Integrated Care Board (ICB) found Mr C to be suitable for the CHC fast track pathway and so the ICB assumed responsibility for Mr C’s care.
The Ombudsman found fault in how Mr C’s family didn’t have his prognosis fully explained to them until he was discharged, despite the multiple September discharge meetings.
Lewisham and Greenwich NHS Trust was also criticised for how it handled Mr C’s discharge. The discharge summary Mr C’s GP received from the hospital made no mention of his need for a palliative care referral, and so Mrs B had to contact the GP herself to arrange the referral.
The discharge summary also stated Mr C had been prescribed opioid medication and paracetamol to treat his “severe pain”, but he was discharged only with paracetamol. Again, Mrs B was required to arrange a prescription for the correct medication through Mr C’s GP.
Mrs B also complained that the carers who supported her father following his discharge were “inadequately trained and inexperienced” but the Ombudsman found no evidence of poor care in the “relatively limited” records available.
A Lewisham and Greenwich NHS Trust spokesperson said: “We accept the findings of the Ombudsman and fully recognise the impact this situation had on this family at an already extremely difficult time.
“We are working through the identified improvements and will provide evidence that they have been completed as soon as possible.
“We have written to the family to offer our sincere apologies for the additional distress caused and are committed to ensuring that the lessons from this case lead to meaningful and sustained improvements in our practice.”
The Ombudsman also ordered the trust to pay Mrs B £500 and carry out training with its staff to ensure a similar event does not occur in the future.
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