A man died from hypothermia a week after a "rushed" discharge from a hospital which needed to free up beds during winter, a coroner's report has found.
Timothy Clayton passed away on December 12, 2022 at Epsom Hospital in Surrey.
He had been suffering from alcohol-related brain damage and malnutrition as a result of "chronic" alcohol use in the weeks leading up to his death.
A coroner has raised concerns in a prevention of future deaths report over "inadequate planning" undertaken by the hospital for his discharge.
Mr Clayton was taken to hospital three times in the weeks preceding his death and discharged on each occasion, but the "underlying cause of his condition" was not diagnosed.
On December 5, 2022, clinicians at Epsom Hospital discharged Mr Clayton to live in his own flat, where the heating was "inadequate" and he did not eat. He died seven days later at the same hospital after developing hypothermia in his flat.
Mr Clayton's family had raised concerns that he was not well enough to care for himself "on a number of occasions" but were ignored, coroner Caroline Topping said in the report.
She wrote: “Discharge decisions were taken in a vacuum without understanding the recent history of frequent admissions, his diagnosis and without sufficient investigation of his home circumstances.”
Clinicians instead relied on Mr Clayton's "expressed wish to go home alone" as a justification for an "unsafe discharge", on the basis that he could independently make decisions about his care.
Ms Topping concluded: "The pressure to vacate bed spaces impacted on clinicians’ ability to prepare a properly considered discharge plan and led to rushed underinformed decision making."
The coroner noted that Epsom and St Helier University Hospitals NHS Trust (ESTH), which runs Epsom Hospital, had since put in place “a number of improvements” to improve information sharing and recognition of safeguarding issues.
“The policy in relation to discharge planning remains under review, including how families are to be involved, so it has not been possible to assess the adequacy of the new policy,” Ms Topping added.
The Trust has until June 12 to respond to the report.
A spokesperson for ESTH told the Standard: "We are deeply sorry that we didn’t give Mr Clayton the care that he and his family were entitled to expect, and our heartfelt apology and condolences go out to Mr Clayton’s family.
“We took immediate steps to review our discharge process, adding in additional checks, greater contact with families of vulnerable patients and we have also improved safeguarding training for our staff.”
