Summary: Mrs A complains about the section 117 aftercare being provided to her sister, Ms B. We should not investigate this complaint because the Trust has already admitted fault and taken steps to remedy the injustice to Ms B. Further investigation would not achieve anything more.

The complaint

1. Mrs A complains about the lack of section 117 aftercare provided to her sister Ms B by Gloucestershire County Council (the Council), Gloucester Health & Care NHS Foundation Trust (the Trust) and NHS Gloucestershire Integrated Care Board (the ICB).
2. Specifically she complains;
• Ms B has not had a section 117 aftercare plan created for her which shows her needs.
• She has not had any s117 reviews.
• The Trust suggested a personal health budget may help, but this has not been put in place.
3. Mrs A says Ms B feels unsupported and her underlying mental health issues are not being addressed.
4. Mrs A wants a full investigation, reassurance Ms B will receive the help she needs in a format that is accessible to her and a financial remedy for the distress caused to both her and Ms B over many years.

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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). 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)).
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. 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.
8. 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)).
9. 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)).

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How I considered this complaint

10. I considered written information provided to us by Mrs A, including her complaints to the Council and the Trust.
11. I considered the Ombudsman’s Assessment Code.
12. Mrs A can commented on my draft decision, and I considered her comments before making a final decision.

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What I found

Background

13. Ms B was detained under section 3 of the MHA. After she left hospital, she became eligible for section 117 aftercare.
14. Section 117 of the Mental Health Act 1983 (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.
15. 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 MHA 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 MHA (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.
16. 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”.
17. The ICB shares a statutory duty with the Council to provide, or arrange, s117 aftercare services for eligible service users in the area.

Mrs A’s complaints

18. After her complaint to the Trust, the Trust admitted it had made mistakes in handling Ms B’s s117 aftercare.
19. In its complaint response letter of 31 January 2024, it said “The investigator was unable to find any evidence of a formal assessment of s117 need from a health perspective or clear consideration of why staff would believe holistic therapy would be helpful for [Ms B] … as such, it is possible that alternatives could be considered under the GHC Complementary Medicines and Therapy Policy (which is separate to s117 entitlement). We are sorry that this has not been properly explored with you.”
20. The letter also said “the investigator found that there appeared to be an inconsistent understanding within Elizabeth’s team regarding the process for s117 reviews.” It added it would speak with the Council to ensure a multi-disciplinary approach going forward, and arrange a s117 review as soon as possible. Mrs A told the Ombudsmen this review took place in March 2024, although Mrs A has said they were not told it was a review at the time.
21. The Trust thanked Mrs A for highlighting an area of “significant learning” for the Trust and listed several areas across the Trust where it was working to improve.
22. In summary, the Trust has admitted it got things wrong, taken steps to remedy this with Mrs A and Ms B, and taken learning to improve its overall service. This is what the Ombudsman would expect and further investigation is unlikely to achieve more.
23. The Council has said it has not considered a complaint from Mrs A about s117 aftercare specifically. She can make a formal complaint to the Council if she wishes.

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Final decision

24. I close this assessment on the basis Ombudsmen investigation would be unlikely to achieve more.

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Investigator's decision on behalf of the Ombudsman