Summary: Mr X complains about a Section 117 after care package provided by the Council. The Council is at fault as Mr X did not consistently receive his full package of care. There is also no evidence to show the Council sent the wellbeing and recovery plans to Mr X. These faults caused uncertainty to Mr X which the Council has agreed to remedy by apologising and making a payment of £300 to him. There is no evidence to show the Council coerced Mr X into accepting a care package or that it failed to consider a request to increase his care package and request for a personal budget.

The complaint

1. Mr X complains about the care package provided by Bury Community Mental Health Team on behalf of the Council following his discharge from hospital in 2020. In particular, he complains the mental health team:

• forced him to accept a care package to facilitate his discharge from hospital in 2020 and 2021.
• failed to draw up and provide a care and support plan;
• failed to provide an adequate after care package as it only provided six hours per week which Mr X considered was insufficient to meet his needs;
• failed to increase his care package to 14 hours per week as the mental health team had undertaken to do;
• failed to provide a personal budget to allow him to source his own care.

2. Mr X considers that as a result he did not receive sufficient and appropriate care.

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What I have and have not investigated

3. I have investigated Mr X’s complaint about his care package between 2019 and 2022.

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The Ombudsman’s role and powers

4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended) I have investigated events from 2019 in order to carry out an effective investigation and establish if Mr X consistently received his after care package.
5. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
6. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

7. I have:

• considered the complaint and the information provided by Mr X;
• made enquiries of the Council and considered the information provided;
• invited Mr X and the Council to comment on the draft decision. I considered any comments received before making a final decision.

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What I found

Section 117 aftercare

8. Anyone who may need community care services is entitled to a social care assessment when they are discharged from hospital. However, Section 117 of the Mental Health Act imposes a duty on councils and NHS integrated care boards (ICBs) to provide free aftercare services to patients who have been detained under certain sections of the Mental Health Act. These free aftercare services are limited to those arising from or related to the mental disorder, to reduce the risk of their mental condition worsening, and the need for another hospital admission for their mental disorder.
9. Paragraph 33.24 of The Mental Health Act 1983: code of practice provides that patients are under no obligation to accept after care services but any decisions they may make should be fully informed.

What happened

10. Mr X has mental and physical health conditions and has been admitted to hospital under section 3 of the Mental Health Act on a number of occasions. Between 2019 and 2021, the Council provided section 117 aftercare to Mr X. The wellbeing plan drawn up for Mr X in 2019 shows the Council would provide a care package of eight hours per week to support Mr X with his mental health needs and risks. The care provider would visit Mr X three times a week with each visit lasting two hours. The remaining two hours of care would be added to Mr X’s preferred day.
11. Mr X was admitted to hospital again in 2020. The Council provided section 117 after care to Mr X when he was discharged. The well being plan again shows the Council would provide a care package of eight hours per week to support Mr X with his mental health and risks. Mr X has said he was forced to accept the care package to facilitate his discharge from hospital.
12. Mr X was admitted to hospital under the Mental Health Act in 2021 and 2022. The Council has said Mr X declined section 117 after care following his discharge from hospital.

Complaint

13. Mr X made a complaint about his care package which the Ombudsman forwarded to the Council to consider. Mr X complaints included that he had been coerced into accepting a care package when he was discharged from hospital in 2020, the conduct of his carers and that he had been left without care. Mr X also requested a personal budget to source his own care as he did not want contact with adult social care.
14. An officer from the Community Mental Health team had a meeting with Mr X to discuss his complaint and needs. In response to the complaint, the Council said it:

• acknowledged Mr X felt he had been coerced into engaging with the care package in 2020 and apologised if he felt that way. But Mr X expressed an understanding of the reasons for the care package. The Council also said that the officer and Mr X had reflected that he had not been pressured into accepting a care package to facilitate discharge.
• Mr X had made it clear he did not want to engage in a package of care provided by adult social care.
• Mr X would like to work towards using a personal budget in the future. In response to my enquiries, the Council has said Mr X was allocated a community psychiatric nurse (CPN) with the intention of completing his request for a personal budget. However, Mr X did not engage and had several hospital admissions following this. The Council has said Mr X has not raised with his current social worker that he would like a personal budget.

Analysis

Did the Council force Mr X to accept a care package to facilitate his discharge from hospital?

15. The wellbeing and recovery plans for 2020 and 2021 and invoices for Mr X’s care show he accepted the after care package. The Council’s response to Mr X’s complaint suggests he reflected that he was not coerced into accepting the care. So, on balance, I do not consider there is evidence to show Mr X was forced to accept a care package to facilitate his discharge from hospital.

Well being and recovery plans

16. The Council has provided copies of the wellbeing and recovery plans drawn up for Mr X in 2019, 2020 and 2021. I am therefore satisfied that the Council assessed Mr X’s needs and produced wellbeing and recovery plans for him.
17. The Council has not provided any evidence to show it sent copies of the wellbeing and recovery plans to Mr X. So, I consider, on balance, the Council did not send the plans to him. This is fault. As a result, Mr X was unaware of the content of the recovery plans which will have caused uncertainty to him.

Did the Council fail to provide an adequate care package?

18. There is no evidence of fault in how the Council decided Mr X was eligible for eight hours per week of care. It made this decision after carrying out an assessment of Mr X’s needs in 2019, 2020 and 2021.
19. There is evidence to show Mr X did not consistently receive the full care package of eight hours per week. The Council has provided invoices for 2019 and a few invoices for 2020 and 2021. Overall, the invoices show the hours of care provided to Mr X fluctuated. Mr X occasionally received more than eight hours per week but more frequently he received around six to seven hours per week. The Council has said this was due to Mr X not engaging with the care package but it has not provided any evidence to support its position. So, there is doubt that Mr X was consistently provided with his full care package. On balance, this is fault. This will have contributed to Mr X’s dissatisfaction with his care package and caused some uncertainty about whether it was meeting his needs. The Council should remedy this injustice.
20. Mr X complained about the conduct of the carers including that they may be stealing from him. In response to our enquiries, the Council said it considered Mr X’s allegations to be symptomatic of his illness. The Council has not provided any evidence to show how it reached this view. But, in response to my enquiries, the Council has said it will discuss the matter with Mr X as part of a current safeguarding enquiry. As the Council will deal with the matter, it is not proportionate to investigate the matter any further.

Did the Council fail to increase Mr X’s care package to 14 hours per week

21. There is no evidence to show Mr X requested that his care package be increased to 14 hours per week or that the Council undertook to increase his care package. I therefore do not find the Council to be at fault.

Did the Council fail to provide a personal budget to allow Mr X to arrange his own care.

22. On balance, I consider the Council has taken appropriate action to offer a personal budget to Mr X. The Council’s response to Mr X’s complaint shows it discussed his request for a personal budget with him. It also arranged for a CPN to assist Mr X with a personal budget. The Council has not provided evidence to show Mr X did not engage but the personal budget could not have proceeded as Mr X was admitted to hospital. I therefore do not consider there is evidence of fault by the Council.

Record keeping

23. I am satisfied the evidence shows Mr X declined a care package from the Council and this was an informed decision. The Council also satisfied itself about how Mr X could meet his needs when it discussed his complaint with him. None of the records provided by the Council note Mr X’s decision to decline the care package and that this was a fully informed decision. This is fault. I do not consider this fault caused injustice to Mr X but the Council should clearly record when patients decline a section 117 after care package and that the Council is satisfied the patient has made a fully informed decision.

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Agreed action

24. That the Council will:
1. send a written apology and make a symbolic payment of £300 to Mr X to acknowledge the uncertainty caused to him by not consistently receiving his full care package between 2019 to 2021 and by its failure to send the wellbeing and recovery plans to Mr X. The Council should ensure the apology to Mr X is in accordance with our new guidance on remedies for Making an effective apology

2. review its record keeping to ensure it clearly records a patient’s decision to refuse section 117 after care and whether the Council is satisfied this was an informed decision. This is to ensure the Council has an audit trail of patients’ key decisions about section 117 after care.
2. The Council should take the action at a) within one month of my final decision and the action at b) within two months of my final decision.
3. The Council should provide us with evidence it has complied with the above actions.

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Final decision

27. Fault causing injustice to Mr X.

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Investigator's decision on behalf of the Ombudsman