Summary: Miss D complained about the lack of mental health and social care provided to her son, Mr B, when he was discharged from hospital. She said this led to a lack of joint working between the Council, the Trust and the Integrated Care Board (ICB). She said they did not make reasonable adjustments when communicating with Mr B. Miss D also complained about the way the ICB handled her complaint. We found fault in the way they organisations considered and provided support to meet Mr B’s holistic mental health and social care needs. They did not properly consider their duty to make reasonable adjustments when communicating with him. The ICB’s complaint handling was poor, and it failed to provide Miss D with a satisfactory complaint response. The organisations agreed to our recommendations and will apologise to Miss D and Mr B, they will make symbolic payments, assess Mr B’s holistic needs and issue guidance to their staff in areas where they need to improve.

The complaint

1. The complainant, who I shall refer to as Miss D, complains that West Northamptonshire Council (the Council) and Northamptonshire Integrated Care Board (the ICB) failed to record her adult son’s, Mr B, entitlement to section 117 aftercare in line with the Mental Health Act 1983. She says Mr B’s discharge from hospital was not properly dealt with by Northamptonshire Healthcare NHS Foundation Trust (the Trust) in 2017 and this led to him not having his section 117 aftercare needs properly recorded as he was only assessed for social care by the Council. Miss D says the organisations have failed to complete holistic assessments and care reviews. She says the lack of proper assessment has led to delays in providing care and caused Mr B’s care and support arrangements and accommodation to break down several times. She says this has impacted negatively on Mr B.
2. Miss D also complains about the way the organisations considered their duty to make reasonable adjustments and assess Mr B’s mental capacity to make specific decisions.
3. Miss D says her needs as a carer have not been met and this has had an adverse impact on her wellbeing. She also complains about the way the ICB dealt with her complaint.
4. As an outcome to her complaint Miss D wants the organisations to apologise for the faults in care planning, ensure a proper personalised section 117 aftercare plan for all her son’s needs is in place and reviewed regularly taking into account Mr B’s capacity to make decisions and his communication needs. She wants the Council to ensure her needs as a carer are met. She also seeks a financial remedy in recognition of the injustice caused to both her and
   Mr B and for improvements to be made.

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The Ombudsmen’s role and powers

5. 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).
6. 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).
7. 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 an organisation has done. (Local Government Act 1974, sections 26B and 34D, as amended, and Health Service Commissioners Act 1993, section 9(4).)
8. When investigating complaints, if there is a conflict of evidence, we may make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened. 
9. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

10. To investigate this complaint I have considered information provided by Miss D in writing and by telephone. I have considered information from the organisations complained about in response to my enquires. I have also considered the law and guidance relevant to this complaint.
11. While parts of the complaint may appear to be late I consider there is good reason to consider historical issues from 2017 which relate to Mr B’s discharge from hospital and entitlement to section 117 aftercare. I have considered how the organisations have worked together to consider Mr B’s holistic health and social care needs including any section 117 aftercare he is entitled to.
12. All parties had an opportunity to respond to a draft of this decision.

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What I found

Law and guidance relevant to the complaint

13. The diagnosis of mental health disorders is often a matter of clinical opinion. It is not always possible to make a diagnosis using conventional clinical investigations (such as tests or scans). A psychiatrist will ordinarily compile a clinical history based on information from the records, the patient, their carers and other relevant professionals. The psychiatrist will also record their own observations of the patient’s behaviour.
14. Under the Mental Health Act 1983, when someone has a mental disorder and is putting their safety or someone else’s at risk they can be detained in hospital against their wishes. This is sometimes known as ‘being sectioned’.
15. Section 3 of the Mental Health Act is for the purpose of providing treatment. Detention under section 3 empowers doctors to detain a patient for a maximum of six months. The detention under section 3 can be renewed for another six months.
16. Before the person is discharged, an assessment should take place to assess if they have any health or social care needs that should be met. People who are discharged from section 3 will not have to pay for any aftercare they will need. This is known as section 117 aftercare.
17. Section 117 of the Mental Health Act imposes a duty on health and social authorities to meet the health and 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.
18. Accommodation can generally only be part of section 117 aftercare if:
• the need is for enhanced specialised accommodation (“accommodation plus”);
• the need for the accommodation arises from, or is related to, the reason the person was detained in the first place (“the original condition”); and
• the “accommodation plus” reduces the risk of the person’s mental condition worsening and the likelihood of the person returning to hospital for treatment for mental disorder.
19. When accommodation is part of a person’s section 117 aftercare, it must be free to the person. Councils and NHS organisations should not advise people to claim benefits such as Housing Benefit to pay for accommodation that is part of their section 117 aftercare.
20. The “Mental Health Act 1983: Code of Practice” is statutory guidance. This means that councils and ICBs must follow it, unless there are good reasons not to.
21. The Care Programme Approach (CPA) is the process by which mental health services assess a patient’s needs, plan how to meet them and ensure they are met. Under Refocusing the Care Programme Approach (Department of Health, 2008), people under CPA should have a comprehensive assessment of their health and social care needs. They should have a care coordinator; have a care plan to show how their needs will be met and have the care plan reviewed by a multi-disciplinary team (MDT). When a patient is in hospital, their care coordinator is the key person responsible for arranging the care and support they will need on discharge.
22. The Community Mental Health Team (CMHT) provides mental health care support from professionals in the community. This usually includes social workers, community psychiatric nurses, psychologists and psychiatrists.
23. A Care & Treatment Review (CTR) is a meeting about an adult who has a learning disability and/or autism and who is either at-risk of being admitted to, or is currently detained in, an in-patient (psychiatric) service. CTRs are part of a national programme led by NHS England called Transforming Care. The aim of Transforming Care is to reduce the number of people with a learning disability or autism living in an inpatient hospital unnecessarily.
24. The Mental Capacity Act 2005 (the MCA) applies to people who may lack mental capacity to make certain decisions. Section 42 of the MCA provides for a Code of Practice (the Code) which sets out steps organisations should take when considering whether someone lacks mental capacity.
25. Both the MCA and the Code start by presuming individuals have capacity unless there is proof to the contrary. The Code says all practicable steps should be taken to support individuals to make their own decisions before concluding someone lacks capacity. The Code says people who make unwise decisions should not automatically be treated as not being able to make decisions. Someone can have capacity and still make unwise decisions.
26. The Code says, at paragraph 2.11, “there may be cause for concern if somebody repeatedly makes unwise decisions exposing them to significant risk of harm or exploitation.” The Code says this may not necessarily mean the person lacks capacity but further investigation may be required.
27. The Equality Act 2010 places a duty on organisations to make reasonable adjustments for certain people. The duty aims to make sure that a disabled person can use a service as closely as is reasonably possible to the standard usually offered to people without disability.
28. When the duty arises, organisations must take steps to remove or prevent obstacles to accessing its service. If the adjustments are reasonable, it must make them.
29. We cannot decide that an organisation has unlawfully discriminated against someone as a disabled person. Only the Courts can do that.
30. Under The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (the ‘Complaints Regulations’) there is a duty to investigate complaints properly and in a way that will resolve them efficiently. There is also a duty to cooperate when a complaint is made to one organisation and contains material relevant to the other.
31. The Complaints Regulations say that the organisations must “co-operate for the purpose of (a) coordinating the handling of the complaint; and (b) ensuring that the complainant receives a coordinated response to the complaint.” This involves a duty on each of them to agree who should take the lead in coordinating the handling of the complaint and communicating with the complainant. They must both provide each other with relevant information if so requested by the other and must attend, or ensure they are represented at any meeting held about the complaint.
32. The PHSO’s Principles of Good Complaint Handling sets out our view on the Principles of Good Complaint Handling. When things do go wrong, public bodies should manage complaints properly so customers’ concerns are dealt with appropriately. Good complaint handling matters because it is an important way of ensuring customers receive the service they are entitled to expect.

Background

33. Mr B is autistic and has a learning disability. His mother, Miss D, says he has specific communication needs because of his disability. He was previously detained in hospital under the terms of the Mental Act 1983. He was released from detention in 2017 and has lived in various supported housing placements since this date. Miss D is her son’s informal carer and has accommodated him when his placements have not worked.
34. The Council and the Trust have been involved with Mr B since he was discharged from hospital and likely prior to that. The Council has assessed him under the terms of the Care Act 2014 and agreed his care and support arrangements which Miss D has disputed over time. She has also raised concerns about her perceived lack of support from the Trust.
35. Miss D complained to the Council about what happened regarding Mr B’s support arrangements from 2017 to mid-2019. The LGSCO previously considered a complaint about this and upheld Miss D’s complaint about the Council’s assessment process relating to the Care Act 2014.
36. Miss D contacted the Trust in 2020 about Mr B’s discharge from hospital in 2017. She asked for documentation relating to section 117 aftercare. The Trust contacted the former Clinical Commissioning Group (CCG) to establish if it held section 117 aftercare documentation relating to Mr B. The CCG said it did not hold the section 117 aftercare paperwork and advised the Trust to contact the hospital where Mr B had been detained.
37. The Trust then made enquiries and contacted the hospital that had dealt with
    Mr B’s discharge. The hospital confirmed that it did not have documentation to confirm a section 117 meeting had taken place in 2017 before Mr B was discharged to his mother’s home. The hospital said a Care and Treatment Review meeting had taken place in March 2017 but it could not find the documentation relating to this review meeting.
38. Miss D complained to the Council again in December 2021. Her complaint related to the Council not assessing Mr B’s capacity to make specific decisions regarding his tenancy and its consideration of reasonable adjustments. Her complaint also referenced the lack of flexibility regarding direct payments and Mr B’s care and support arrangements. She said the situation had placed her under a huge amount of stress as a carer. She said the problems partly stemmed from Mr B not having a section 117 aftercare plan in place.
39. The Council responded to the complaint in September 2022. It apologised for the delay and said:
• It would complete a mental capacity assessment to determine whether Mr B could understand his tenancy agreement and his understanding of relationships and associated risks.
• It would undertake a review of Mr B’s reasonable adjustments and address concerns about his communication and sensory needs. This would include providing information in advance of meetings.
• It had completed a carer’s assessment in 2020 and Miss D had refused a carer’s assessment in 2022 but later agreed to the Council completing one.
• The direct payment had stopped because of an administrative error but it had reinstated the payments and would confirm how the backdated payments could be spent.
• Section 117 reviews were normally arranged via the clinician who had seen him, and it had contacted the Trust for a copy of the section 117 aftercare plan but had not received it. It directed Miss D to complain to the Trust about this.
40. The Council apologised for the distress caused to Mr B and Miss D. It said it would use learning from the complaint to improve practice. It told Miss D she could complain to us.

How we considered the complaint in 2022

41. Miss D contacted us in 2022 about the issues relating to Mr B’s entitlement to section 117 aftercare and the problems she felt this had caused for his health and social care and support arrangements since his discharge from hospital. She also complained about the impact this had on her as a carer.
42. After considering Miss D’s complaint we asked the ICB to undertake a complaint investigation after it had confirmed it had not previously dealt with a complaint. We asked it to liaise with the Trust and contact the Council because of the joint responsibilities relating to section 117 aftercare.
43. The ICB wrote to Miss D in December to gain consent and to agree the statement of complaint. Miss D replied with the information requested and clarified a section of her complaint summary.
44. At the end of May 2023, the ICB wrote to Miss D with the outcome of its complaint investigation. The letter referred to an email from the LGSCO it had received in November 2022. The letter did not show the complaint summary the ICB had agreed with Miss D. The letter replied to a previous preliminary enquiry made by us rather than responding to the complaint summary it had agreed with Miss D.
45. Miss D then asked us to reconsider her complaint about the organisations including how they had dealt with Mr B’s entitlement to section 117 aftercare.

Findings

How the organisations considered Mr D’s entitlement to section 117 aftercare

46. There appears to be no dispute between the organisations about Mr B’s entitlement to section 117 aftercare since his discharge from hospital in 2017. However, there is no evidence of either the Trust or the Council ever having a copy of the section 117 aftercare plan prepared before Mr B was discharged from hospital in 2017. In response to our enquiries the Trust said when he was assessed at the time of discharge (in 2017) a clinician was of the view that Mr B’s needs would predominately be those relating to social care. There is no evidence to show this was written into an aftercare plan.
47. Miss D has consistently expressed her concerns about the lack of joined up approach to meet her son’s needs since his discharge from hospital. Her concerns relate to Mr B’s mental health and social care needs rather than just social care needs.
48. Mr B has needs which fall under section 117 of the MHA. Section 117 requires the Council and the ICB to provide or arrange aftercare services to meet needs arising from a person’s mental disorder. The MHA code of practice says that authorities should interpret the definition of aftercare broadly. For example, aftercare can include health and social care, employment services and support accommodation.
49. The MHA code of practice states, “after-care is a vital component in patients’ overall treatment and care. As well as meeting their immediate needs for health and social care, aftercare should aim to support them in regaining or enhancing their skills…”. Mr B has multiple needs and the organisations should have worked together to consider his needs as a whole.
50. The evidence available supports the view that Mr B’s care and support arrangements have broken down on several occasions over years. It is likely the lack of joined up approach has been a contributory factor. There have been several opportunities for the Council, the ICB and the Trust to work together to address the inconsistencies around Mr B’s care and support arrangements. There is little evidence to show this has happened since the organisations have been involved with Mr B.
51. When responding to our enquiries the Council said, “there is no real joined up working... this is because NHFT feel there generally are no presenting mental health needs…”. It said it has seen minutes where section 117 has been discussed by health but it has not seen a copy of an aftercare plan despite consistently asking for the section 117 issue to be resolved with health.
52. There is limited evidence to show what action has been taken by the organisations complained about to ensure they assessed Mr B’s needs holistically. This is fault. The organisations more than likely should have assessed Mr B in line with the CPA as he was in 2017. The code of practice says, “the CPA care plan aims to ensure a transparent, accountable and coordinated approach to meeting wide ranging physical, psychological, emotional and social needs which are associated with a person’s mental disorder.
53. The lack of joint working between the organisations is likely to have impacted negatively on Mr B because his mental health and social care needs were not properly considered together. This is likely to have led to gaps in his care and support planning and provision. A joined-up approach could have led to him having a robust assessment and support plan in place which considered all his mental health and social care needs and included contingency arrangements.
54. The organisations did not have a locally agreed joint aftercare policy in place during the period complained about. They said they worked to the guidance set out in the MHA code of practice and the terms of the MHA. The organisations said they were developing a joint policy which was almost finalised.
55. The Council accepted sole funding responsibility for Mr B’s care despite the lack of joint agreement. For example, it did not charge Mr B for the care and support it provided and it also paid towards his accommodation. This is evidence the Council tried to support Mr B in line with its statutory responsibility.
56. The Council’s approach implies it has acknowledged Mr B has need for accommodation i.e. “accommodation-plus” because of the needs arising from his mental health condition. Therefore, the ICB should be involved in discussions with the Council and agree their respective responsibilities regarding Mr B’s section 117 aftercare needs including his accommodation.

The care and support provided to Mr B by the Council, the Trust and the ICB

57. The Trust said Mr B had frequent appointments with a Consultant Psychiatrist from 2020. It said the psychiatrist liaised with different services including the autism service.
58. The Trust appears to have provided limited support to Mr B based on the fact it feels he does not have a mental health diagnosis. It feels his issues are substance abuse related, which Miss D strongly disagrees with. It also said he has failed to engage in the process. The consultant psychiatrist who was heavily involved with Mr B’s care while he was in hospital diagnosed him with a mental health condition. I have not seen evidence to show how the Trust kept this diagnosis under review.
59. The Council said the CMHT opens and closes Mr B’s case as and when there is a presenting need. It said it contacted the Trust about a possible CTR in 2022 but the Trust felt this was not required. The Council said it does not coordinate CTRs so it could not take further action. Miss D has asked the Trust to convene a CTR on several occasions.
60. It is unclear how the Trust decided a CTR was not required for Mr B’s case or what rationale it provided to the Council and Miss D. In response to our enquiries it said it determined Mr B was not at risk of admission due to his behaviours or mental health needs. It is likely that Mr B should have remained subject to the CPA and the Trust should have been aware of this due to its involvement with his discharge from hospital.
61. The Trust has been aware that Mr B’s behaviours have placed him at considerable risk on occasion. For example, the evidence available suggests
    Mr B has been exploited by people he has associated with, and they have used his property for criminal activity. Miss D said because her son is autistic and has a learning disability he is vulnerable and other people have encouraged him to participate in offending behaviour or criminal activity. The Trust should have acted to ensure Mr B’s mental health and social care needs were kept under review under the CPA because of these risks. I have not seen evidence to show it has done this. This is fault.
62. The support the Council provided to Mr B included it sourcing supported housing placements and providing direct payments. It said it paid towards his rent as it believed it had a duty towards the rent costs because of the possible section 117 element. This was good practice by the Council.
63. Miss D said the Council stopped providing support to Mr B from December 2022 and this had an adverse impact on his wellbeing. She also said the Council delayed in providing an alternative care package.
64. The Council said Mr B’s support provider ended their involvement in January 2023. When responding to our enquiries it confirmed it was looking to source new supported accommodation. Miss D said the Council stopped the care provider from coming to support Mr B because it had raised a safeguarding alert and the Council had concerns about the provider.
65. The evidence available strongly suggests Mr B was without formal support from January 2023 until November 2023. Previous assessments completed by the Council confirm that:
• Mr B needed formal support to maintain his home environment;
• He had significant difficulty dressing and undressing and needed prompts;
• Miss D provided him with significant informal support; and
• There would be significant impact on his wellbeing if he was without support.
66. The failure of the Council to provide formal support to Mr B for this period is likely to have had significant impact on his wellbeing. It is likely this situation caused Miss D to experience increased carer’s strain and is likely to have had adverse impact on her mental wellbeing.
67. The ICB said it has had no direct involvement regarding Mr B’s case. However, the ICB does have a responsibility regarding Mr B’s care and support arrangements because of his entitlement to section 117 aftercare. Based on the terms of the MHA and the code of practice the ICB should have been aware of
    Mr B’s case and agreed joint care arrangements with the Council.
68. When responding to our enquiries the Council said it had approached the ICB about joint funding arrangements and this was currently under review.
69. The Council has offered Miss D’s carer’s assessments during the time it has supported Mr B. It said its commissioned carer’s service has been actively involved with Miss D. Miss D confirms this is the case but has said the problems caused by the breakdown in Mr B’s care and support arrangements have impacted adversely on her mental wellbeing to the point she has had to seek professional help.
70. The problems caused do not relate solely to the Council’s actions or lack of intervention. All the organisations complained about had a responsibility to ensure Mr B’s mental health and social needs were assessed, met, and reviewed regularly. As this did not happen, the problems relating to his care and support arrangements breaking down is likely to have impacted on Miss D as she reports.

How the Council and the Trust considered making reasonable adjustments and Mr B’s mental capacity to make specific decisions

71. The Council said Mr B did not express a concern about the way it communicates with him. It said he communicated with his social worker by text and in person often. It said it would accommodate any requests regarding communication as a far as practically possible.
72. The Council said its Brokerage and Commissioning Team have tried to find an autism specific provider but has had difficulty doing so within the current provider market. The Council recorded in its assessment that Mr B had mild communication difficulties but did not say how it would consider these. It noted that he struggled with eye contact and talking to new people. During an assessment Mr B also said he struggled with making some decisions.
73. The Trust said it has tried to support Mr B in several ways. For example, it said when he could not come to the Trust’s premises, it rearranged home visits. It said it attempted to work jointly with a substance misuse service which was involved with Mr B and provided a consistent practitioner. It also said it allowed time and space to allow processing within appointments.
74. The Trust has said that Mr B has not always engaged with its teams and he has declined interventions apart from his medication. Miss D has said this is because the Trust did not also take account of Mr B’s communication needs relating to his autism and sensory difficulties.
75. Miss D said Mr B has specific communication needs because he is autistic and has sensory needs. She says this is something she has told the Council and the Trust about for several years and it is recorded in documents the Council and the Trust have access to. The documentary evidence available does refer to Mr B being autistic and refers to his sensory needs. Therefore, the organisations complained about had a duty to anticipate any reasonable adjustments he may have needed.
76. Miss D said Mr B would have benefitted from agreed reasonable adjustments such as receiving written information to say what meetings would be about before the meeting. She said he would prefer text messaging as opposed to phone calls. She also said he could find meetings difficult because of his sensory needs and this was not properly considered.
77. The Council and the Trust (and ICB) have not provided documentary evidence to show what reasonable adjustments they have formally agreed with Mr B other than the statements they have made. Because of this I cannot say what reasonable adjustments they have made and recorded to ensure their staff remained aware of Mr B’s communication needs and the specific reasonable adjustments he needed. This is fault.
78. The failure to properly consider, make and record what reasonable adjustments Mr B needed may have contributed to the view from practitioners that he was not engaging with services or that he was disinterested. Mr B said during the Council’s assessment he found it difficult to engage with professionals. The organisations should have considered this when communicating with him about his mental health and social care support needs.
79. Miss D says she has had concerns about Mr B’s capacity to make specific decisions. She said when a social worker decided Mr B had capacity to make decisions about his care and support needs he was intoxicated and this was the first time the social worker had met him. She said the social worker presumed
    Mr B had capacity to decide he did not want support.
80. The Mental Capacity Act (MCA) code of practice says, “every adult has the right to make their own decisions. Family and carers and healthcare or social care staff must assume that a person has the capacity to make decision, unless it can be established that the person does not have capacity.”
81. The MCA code of practice also lists the symptoms of alcohol as an impairment or disturbance in the functioning of the mind or brain. But it also says the lack of capacity is likely to decrease in time if it is caused by the effects of alcohol. Any mental capacity assessment completed should have considered whether Mr B was under the influence of alcohol and what impact this had on his ability to make decisions.

The ICB’s response to Miss D’s complaint

82. The ICB agreed with us to investigate Miss D’s complaint and if necessary coordinate a response which included the Council and the Trust.
83. When it corresponded with Miss D it gave the impression it was investigating her complaints and referred to contact with the Trust and the complexity of the investigation. It delayed in providing her with a response and said this was partly due to staff absence.
84. The response the ICB sent to Miss D is disappointing and does not align with the principles of good complaint handling. The ICB agreed a complaint summary with Miss D but when it responded to her it referred to completely different issues she had not agreed. The ICB answered initial enquiries made by us in 2022 which it had already provided answers to. This is poor practice and fault.
85. The ICB could have provided Miss D with some of the answers she has been seeking if it had effectively dealt with her complaint. It was uniquely positioned to liaise with the Trust because of commissioning arrangements and with the Council because of the shared responsibility regarding section 117 aftercare. The ICB did not act in line with the regulations and did not ensure Miss D received a coordinated response to her complaint.
86. The fault is likely to have caused Miss D to experience distress, frustration as well as outrage over a prolonged period. The fault is also likely to have led to her spending additional time and trouble in pursuing a complaint which could have been effectively dealt with by the ICB and coordinated with the Trust and the Council.

Conclusion

87. Mr B was discharged from hospital without having his mental health and social care needs recorded in a section 117 aftercare plan in line with the MHA. His needs were not kept under review in line with the CPA or a CTR which may have also been relevant. The organisations complained about missed several opportunities to take the lead on bottoming out the issues relating to Mr B’s entitlement to section 117 aftercare and the absent section 117 aftercare plan. For example, either the Council, the Trust or the ICB could have led on arranging a meeting so they could agree Mr B’s section 117 aftercare needs and then write this into a plan.
88. The ICB should have been aware of its statutory responsibility regarding Mr B’s section 117 aftercare entitlement and agreed a plan and funding with the Council. The Council considered Mr B’s social care needs in line with the Care Act 2014 but should have been more proactive to ensure the ICB and the Trust agreed with it on what Mr B’s section 117 aftercare plan should look like. However, the Council was mindful of Mr B’s entitlement to aftercare and so did not charge him for the care he received. It also contributed to the costs of his accommodation despite the lack of section 117 aftercare plan and agreed funding. This was reasonable, appropriate and considerate action taken by the Council.
89. The Council did not provide Mr B with the support he needed between January and November 2023 and this is likely to have had adverse impact on Mr B’s wellbeing.
90. The Trust has provided limited mental health support to Mr B based on what it says is a lack of mental health diagnosis despite a consultant psychiatrist providing a diagnosis. It also did not properly consider whether Mr B’s communication difficulties and sensory needs was a contributory factor in what it said was a lack of engagement.
91. I have not seen sufficient documentary evidence to persuade me that any of the organisations named in this complaint considered and recorded reasonable adjustments in line with the Equality Act 2010. It is therefore likely that Mr B could not contribute to his care and support planning as close as it is reasonably possible to get to the standard usually offered to a non-disabled person.
92. The faults identified are likely to have had an adverse impact on Mr B’s wellbeing during different periods of his life since his discharge from hospital. The breakdown in care and support arrangements has been a consistent feature and the lack of joined up approach between the Council, the ICB and the Trust is likely to have been a contributory factor.
93. The Council considered Miss D’s needs as a carer and referred her to its commissioned provider. Miss D confirmed she has received respite in the past which includes direct payments she can use flexibly. However, it is likely the breakdown in her son’s care and support arrangements has caused her to experience increased carer’s strain as well as having adverse impact on her mental wellbeing.

Update to the situation

94. Mr B has not been living in the community since the early part of November 2023. It is expected that he will be back living in the community in due course and will need to be assessed and provided with appropriate care and support to meet his mental health and social care needs. Miss D remains concerned about what might happen going forward.

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Recommendations

95. Within one month of our final decision:

1. The Council, the ICB and the Trust will agree which one of them will be the lead agency to coordinate a holistic assessment of Mr B’s mental health and social care needs when he is ready and available for the assessment to take place. They will ensure any needs which fall under section 117 aftercare are properly recorded as such and joint funding agreed as necessary.
2. The organisations will ensure that Mr B and Miss D are fully involved in the assessment and support planning process and will make sure their views and comments at the time are properly recorded within documents. The organisations should make reasonable adjustments where required and ensure Mr B’s capacity to make specific decisions is formally assessed if necessary. The lead agency will provide Mr B and Miss D with a copy of any assessments and care and support plans and obtain their signatures if required.
3. The Trust will consider whether a Care and Treatment Review is required in
   Mr B’s case at an appropriate time. It will write to Miss D and the Council to confirm the rationale for the outcome of its decision.
4. The Council will consider the support Mr B lost out on to meet his eligible needs for around nine months to see what lessons can be learnt. It will make a symbolic payment of £1,000 to Mr B to acknowledge the impact the loss of support for around nine months is likely to have had on his wellbeing. The payment should be made to Miss D who manages his finances.
5. The agreed lead agency will write to Miss D and apologise for the lack of joined up approach on behalf of all the organisations. The letter should acknowledge the adverse impact the faults had on her caring role and her mental wellbeing.
6. The Trust, the ICB and the Council will collectively make a symbolic payment of £600 (£200 each) to Miss D to acknowledge the impact the faults had on her overall wellbeing.
7. The ICB will write separately to Miss D and apologise for its poor complaint handling which likely led to her feeling frustrated and outraged. It will make a symbolic payment of £350 to her to acknowledge her injustice which includes her additional time and trouble pursuing this complaint.

96. Within two months of our final decision:
1. The organisations will provide us with a copy of the agreed Section 117 aftercare policy and procedures document which was due to be finalised and signed by their respective representatives in January 2024.
2. The Council and the Trust will ensure they have guidance in place for their staff to follow regarding the reasonable adjustment duty set out in the
   Equality Act 2010. They will provide training or a reminder to their staff as necessary.
3. The ICB will ensure its staff who deal with complaints are provided with training on effective complaint handling and are made aware of the principles of good complaint handling.
97. The organisations should provide us with evidence they have complied with the above actions.

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Final decision

98. I uphold Miss D’s complaint against the Council, the ICB and the Trust as I found fault causing injustice to both her and Mr B. The organisations have agreed to our recommendations and this remedies the injustice caused. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman