The Ombudsman's final decision
Summary: We investigated a complaint about the section 117 aftercare provided to Ms A by the Council, the Trust and the ICB after she was detained under section 3 of the Mental Health Act 1983. We found no fault by any of the organisations.
The complaint
Ms A complains about Cornwall Council (the Council), Cornwall Partnership NHS Foundation Trust (the Trust) and NHS Cornwall and Isles of Scilly Integrated Care Board (the ICB).
Ms A was detained under section 3 of the Mental Health Act 1983 (the MHA). She was discharged at the end of March 2022. In the period between release and her admission to hospital under section 2 in December 2022, she complains she did not receive enough section 117 aftercare.
Specifically, Ms A complains; The home treatment team rejected a referral and Ms A did not know what other support was in place to help her.
She was allocated a care coordinator she had never met, and they were on leave when she left hospital. She was then not contacted until two weeks after, leaving her alone and vulnerable.
She did not receive family therapy or reintegration into her family environment as promised.
The Trust’s complaint response implies the difficulties were because Ms A was not cooperating and does not provide reassurance she will receive support in the future if she needs it.
Ms A says she was caused unnecessary distress as she was unable to re-build her relationship with her children. She feels the lack of support has contributed to her children living elsewhere. She feels let down by the organisations and felt alone when she needed care and support.
Ms A wants an explanation why she did not receive support and an apology. She also wants reassurance she will receive support in the future if she needs it. Ms A wants financial redress for the unnecessary distress caused by the lack of support.
The Ombudsmen’s role and powers The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA). The Local Government and Social Care Ombudsman investigates complaints about adult social care providers. (Local Government Act 1974, sections 34B, and 34C, as amended). The Health Service Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’ in the delivery of health services (Health Service Commissioners Act 1993, section 3(1)).
We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
If it has, we may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused. We might also recommend the organisation takes action to stop the same mistakes happening again.
We cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended, and Health Service Commissioners Act 1993, sections 3(4)- 3(7)).
If we are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, we can complete our investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i)).
How I considered this complaint
I considered the complaint Ms A made to us and information she provided via her representative. I also considered the information the Council, the Trust and the ICB provided in response to my enquiries.
I shared a confidential draft with Ms A, the Council, the Trust and the ICB to explain my provisional findings and invited their comments on them. I considered any comments I received before making a final decision.
Background
Ms A was detained under section 3 of the MHA and discharged in early April 2022.
Section 117 of the MHA states a person may be eligible for aftercare services, if they are intended to meet a need that arises from or relates to a mental health problem and reduces the risk of the person’s mental health condition getting worse.
Anyone who may have a need for community care services is entitled to a social care assessment when they are discharged from hospital to establish what services they might need. Section 117 of the Mental Health Act imposes a duty on health and social services to meet the health/social care needs arising from or related to the person’s mental disorder for patients who have been detained under specific sections of the Mental Health Act (e.g. Section 3). Aftercare services provided in relation to the person’s mental disorder under S117 cannot be charged for. This is known as section 117 aftercare.
S117 does not define what aftercare services are. Section 33.3 of The Mental Health Code of Practice 2015 (the MHA Code) explains “after-care services mean services which have the purposes of meeting a need arising from or related to the patient’s mental disorder and reducing the risk of a deterioration of the patient’s mental condition (and, accordingly, reducing the risk of the patient requiring admission to hospital again for treatment for mental disorder)”. Section 33.4 adds aftercare can “encompass healthcare, social care and employment services, supported accommodation and services to meet the person’s wider social, cultural and spiritual needs”.
Section 33.7 of the MHA Code states Councils and CCGs (Clinical Commissioning Group, since replaced by ICBs) should “maintain a record of people for whom they provide or commission aftercare and what aftercare services are provided.”
The ICB shares a statutory duty with the Council to provide, or arrange, s117 aftercare services for eligible service users in the area.
As part of my investigation, I asked the Council and the ICB what their roles were in arranging Ms A’s aftercare. They confirmed the Trust managed Ms A’s s117 aftercare for the period under investigation and neither provided funding.
Care coordinator and home treatment team Ms A complains she was allocated a care coordinator she had never met, who was on leave when she left hospital. Ms A also complains a referral to the home treatment team was rejected and she was not told what other support was available. Ms A said she did not receive her first contact until two weeks after she left hospital leaving her alone and vulnerable after release.
On 29 March 2022 at her discharge planning meeting, s117 aftercare was discussed. Ms A said she would like support from the home treatment team, and a referral made. She was given a dedicated named care coordinator, and the notes show Ms A agreed to this, but they were not at the meeting.
There is no guidance which says a patient being discharged from section 3 should meet their care coordinator before discharge. The MHA code of practice says Ms A should have been supported with a care plan approach, and a care coordinator appointed to manage this, which is what happened. Therefore, the Trust’s actions were in line with guidance.
Before Ms A left hospital, the home treatment team refused the referral because she told her care team she planned to visit Ireland immediately after her release for one week. During this investigation, Ms A said she did not tell the Trust this, and did not visit Ireland when she left hospital.
Ms A left hospital on 6 April. On 8 April, a community nurse who is part of the community mental health team (CMHT) tried to call Ms A three times, they did not speak to her.
This is in line with NHS England guidance, discharge challenge for mental health and community service providers, which says “follow up to be carried out with the person by CMHT or Crisis Resolution & Home Treatment Team (CRHTT) at the earliest opportunity and within a maximum of 72 hours of discharge to ensure the right discharge support is in place."
On 11 April, the same community nurse spoke to Ms A. The notes from this call say Ms A told the nurse she did not want any involvement with the home treatment team. Therefore, even though Ms A disputes telling the Trust she was visiting Ireland, when asked again five days later she told the Trust she did not want help from the home treatment team. Instead, the nurse gave Ms A the contact phone number for the community mental health team who would be handling her care. Nothing in these notes suggests Ms A felt unsupported or had concerns about her care coordinator being on leave.
A community nurse tried to call Ms A on the morning of 12 April but could not reach her. They tried again in the afternoon and spoke to Ms A. The notes show Ms A raised some concerns about her children and about her finances, and the nurse gave advice.
On 14 April, a social worker from the community mental health team telephoned Ms A. They explained they were contacting her because her allocated care coordinator was off and to offer support. The social worker booked a visit for 19 April.
I can appreciate why Ms A was frustrated her care coordinator who was off when she left hospital. However, there is evidence the Trust considered this and did all it could to support Ms A until the care coordinator was back. It made first contact within the 72-hour guideline and followed up with other calls regularly to offer support to Ms A. There is no suggestion from the notes Ms A was experiencing difficulties the Trust ignored. I find no fault.
Family therapy Ms A complains she was promised family therapy when she left hospital. She explains she was separated from her children, and therapy would help reduce tensions with her children. Ms A explains she did not receive this and feels this has contributed to the breakdown in her relationship with her children.
The ward notes from her section 3 detention do show Ms A worried about the effect her mental health was having on her children.
On 29 March at the discharge planning meeting, Ms A’s eldest child was present. There is no mention of family therapy as a s117 aftercare need and there is no concern voiced by either Ms A or her child at this meeting.
Ms A went on section 17 leave before she left hospital. This is an authorised leave of absence from the ward for detained patients, to allow them to reintegrate into society and under the MHA, it is seen as an essential part of recovery. Ms A’s notes show during this leave there was some conflict with her children, and she discussed this with staff on the ward when she returned.
Ms A’s notes shows the difficulties with her children worsened over time. Because of this, her care coordinator made referrals to children’s social services, who were already working with Ms A’s children so they were aware of the problems the family were dealing with.
In August 2022, the Trust offered Ms A and her children an appointment with the family service. Ms A cancelled the appointment because her children were in education; the Trust offered another date and Ms A chose a suitable time. Ms A also cancelled this appointment for the same reason as before. The Trust offered a third appointment which Ms A accepted, but again Ms A cancelled for the same reason. The Trust placed the referral on hold until a suitable time could be found.
S117 aftercare only includes “services which have the purposes of meeting a need arising from or related to the patient’s mental disorder and reducing the risk of a deterioration of the patient’s mental condition.” Ms A’s discharge notes do not say she needs family therapy as part of these services, so the Trust had no obligation to offer them to her. However, when the Trust realised the negative effect the difficult family situation was having on her mental health, it did what it could to help her. I find no fault with the Trust’s actions.
Complaint response from Trust Ms A complains the Trust’s complaint response implies the difficulties were because she was not cooperating and does not provide any reassurance she will receive support in the future.
I have reviewed the complaints responses from the Trust. The information it provided matches the evidence I have seen during my investigation. I can see the Trust does say things such as “visits that had been arranged were later cancelled by you”. While this is an accurate reflection of what happened at the time, I can understand why Ms A is unhappy with this wording, especially when she felt unsupported by the Trust at a difficult time.
During my investigation, the Trust told me it continues to work with and support Ms A.
I find no fault.
Final decision
I do not uphold this complaint. I have found no fault with the actions of the Council, the Trust or the ICB.
Investigator's decision on behalf of the Ombudsman