Summary: Mr B complained that the London Borough of Islington, North Central London ICB and North London NHS Foundation Trust did not assess or meet Mrs X’s aftercare needs after she was detained under the Mental Health Act 1983. We find fault with the Council, the ICB and the Trust. They should have completed a comprehensive assessment of Mrs X’s needs when her detention ended, and should have produced a clear plan of how all her needs would be met. The failure to do so has caused confusion, stress and frustration. The organisations have agreed to take action to address the injustice.

The complaint

1. Mrs X is eligible to receive aftercare under section 117 (s117) of the Mental Health Act 1983 (the MHA). The London Borough of Islington (the Council) and North Central London Integrated Care Board (the ICB) share the responsibility to assess and meet any needs Mrs X has which are eligible for support under s117. North London NHS Foundation Trust (the Trust) was also involved in the process of assessing Mrs X’s needs.
2. In the late summer of 2023 Mrs X left a care home and moved to private accommodation in another part of the country. Her daughter, Ms A, and Ms A’s partner, Mr B began supporting Mrs X in her home.
3. Mr B complains that, since Mrs X told professionals she wanted to leave residential care, the Council had failed to fulfil its duty under s117 to meet Mrs X’s needs. Mr B complains the responsible organisations have not provided the support Mrs X needs. This investigation has looked at the period from mid-2023 to the end of 2024.
4. Specifically, Mr B complains:
1. the Council has wrongly and unjustifiably sought to separate Mrs X’s physical and mental health needs,
2. the Council led him, his partner and Mrs X to believe it did not accept its responsibility for Mrs X’s s117 aftercare for close to nine months. Mr B said it had still not explained what caused this breakdown in communication,
3. there was an extensive, unreasonable delay (which remained ongoing at the time of the complaint) in the Council acting on its responsibility to arrange suitable s117 aftercare for Mrs X. Mr B complains the Council has not explained what caused the extensive delay in assessing Mrs X’s needs and presenting a request to the relevant funding panel,
4. the assessment process was flawed as professionals inappropriately denied Mrs X an advocate at critical stages, and failed to meaningfully consult with him or his partner about Mrs X’s needs. Mr B said this led to an inadequate and inaccurate assessment, and
5. the Council failed to provide adequate updates or clear communication to him and his partner.
5. Mr B noted the Council and Trust have acknowledged some failings and partly upheld their complaints. However, Mr B complains they have failed to acknowledge the true impact of the failings or offer a proportionate remedy.
6. Mr B said the delays and miscommunication caused the family uncertainty and “perpetual stress”. Mr B said the stress exacerbated Mrs X’s physical condition and mental wellbeing.
7. Further, Mr B said the failure to fund or provide adequate support for Mrs X meant he and his partner had been forced to provide 24‑hour care for her. Mr B said this has caused them to become exhausted and prevented them from earning an income. Mr B said this loss of income and consequent financial troubles had caused more stress. Mr B said they had also been unable to relax or take time for themselves.

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The Ombudsmen’s role and powers

8. 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).
9. 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).
10. If it has, they 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.
11. When investigating complaints, if there is a conflict of evidence, we 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. 
12. We cannot decide what level of care is appropriate and adequate for any individual. This is a matter of professional judgement and a decision that the relevant organisation has to make. Therefore, my investigation has focused on the way that the body made its decision.
13. 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))
14. If we are satisfied with the actions or proposed actions of the organisations 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), as amended)

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How I considered this complaint

15. I have considered the written submissions Mr B sent to the Ombudsmen and considered the legislation and case law examples he highlighted. I also spoke to him on the phone.
16. I considered evidence provided by the Council, the ICB and the Trust as well as records from the local council. I also considered relevant law, policy and guidance.
17. Mr B and the organisations had an opportunity to comment on my draft decision. I considered all the comments they made before making my final decision.

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What I found

Legislation and guidance

The Mental Health Act 1983

18. Under s117 of the MHA local authorities and integrated care boards (ICBs) have a duty to provide or arrange free aftercare services for people who have been detained under s3 of the MHA.
19. S117 aftercare services are defined in the MHA as services which serve both of the following purposes:

• To meet a need arising from or related to the person’s mental disorder; and
• To reduce to risk of a deterioration of the person’s mental condition and, accordingly, to reduce the risk of the person needing another admission to hospital for treatment of that mental disorder.

20. The Department of Health produces the Mental Health Act 1983: Code of Practice (the Code) to accompany the MHA. This provides guidance for professionals on how to implement the MHA in practice.
21. The Code encourages local authorities and ICBs to “interpret the definition of after-care services broadly”. (section 33.4)
22. Care planning for s117 aftercare should be via the Care Programme Approach (CPA). Under the CPA, the person must have a comprehensive care plan and a named care coordinator who is responsible for ensuring the care plan is prepared, carried out and reviewed. The care coordinator should use a CPA care plan to document aftercare plans. The care plan should specify the services funded through s117. The Code notes that care planning, including aftercare planning, requires a thorough assessment of the patient’s needs and wishes. It notes this is likely to involve consideration of a range of mental health, physical health and social care factors. (Section 34 of the Code) The care plan should specify that the person is entitled to s117 aftercare and detail which services will be s117 funded.
23. The ICB advised us it delegated its responsibility for providing s117 aftercare for people in Islington to the Council via formal agreement. As such, the ICB said it was never advised of Mrs X’s eligibility for s117 aftercare. And it said it did not engage in any discussions about her identified needs.
24. The ICB said it is in the process of developing a dedicated register of people it commissions s117 services for. The Council told us it holds its own s117 register.
25. I have, however, still included the ICB as an organisation under investigation. This does not reflect a provisional view about possible fault. Rather, it relates to the legal landscape and the Ombudsmen’s usual process in most complaints about the provision of s117 aftercare. Namely, to always include the NHS organisation and local authority which hold shared responsibility for the provision of the s117 aftercare package. Regardless of the day-to-day, frontline management of the process, the overarching responsibilities cannot be delegated.
26. The council and ICB responsible for the person’s care are the ones in which the person was ordinarily resident immediately before they were detained. This responsibility does not change when the eligible person moves area

Care Act assessments

27. Aside from responsibilities under the MHA, councils must carry out an assessment for any adult when it appears they might need care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. (Care Act 2014, Sections 9 and 10) The council where the person currently lives is responsible for meeting the person’s needs under the Care Act 2014.
28. There is no set definition of an assessment. The aim of the assessment is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing. This should then inform the response to any identified needs. The response “might range from offering guidance and information to arranging for services to meet those needs”. (Care and Support Statutory Guidance, Section 6.5)
29. Councils are encouraged to take a holistic approach to assessment in order to “prevent that person having to undergo a number of assessments at different times, which can be distressing and confusing” (Care and Support Statutory Guidance, Paragraphs 6.75 to 6.78)

Brief summary of events

30. Professionals detained Mrs X under s3 of the MHA in early 2021. She had symptoms associated with late onset psychosis (having experienced a first psychotic episode – losing some contact with reality – over the age of 40). Mrs X has also been diagnosed with Parkinson’s disease. This affects Mrs X’s movement, causing symptoms like tremors, slowness of movement, and rigidity.
31. Mrs X’s detention was rescinded and she moved to a care home in the spring of 2021. Mrs X moved to a different care home in the autumn of 2022.
32. In the summer of 2023 Mrs X said she wanted to leave “the care home system” and go to live in a house in another part of the country. Mr B said that, at this time, staff from the Trust were encouraging and positive about Mrs X receiving direct payments funded through s117. Mr B said staff did not suggest there would be any problems obtaining funding for the necessary support in the community. In addition, Mr B said staff at the Council indicated that the local council would decide what level of support Mrs X needed in the community.
33. Mrs X left the care home and moved to private accommodation in September 2023. Ms A and Mr B began supporting her in her new home.
34. Mrs X’s local council assessed Mrs X’s needs and contacted the Council about the outcome, in September 2023. Ms A and Mr B requested a direct payment for Mrs X, for her to use to pay them to care for her full-time. Records show that, at the time, social care staff from the local council told Ms A and Mr B they could not arrange this because they all lived at the same address. Mr B told us the social worker discussed the possibility of considering an exception to this. Mr B said the local council never made a formal decision about this and, to date, this arrangement has not progressed.
35. In May 2024 a Council professional began an assessment of Mrs X’s needs, which they continued during June 2024. The professional met Mrs X with a translator and Ms A and Mr B to discuss Mrs X’s views and wishes. The assessment also included information from an email from Ms A and Mr B about the support they routinely provided to Mrs X. Mrs X said she wanted to remain in the community and said she only wanted to receive care from her family. Ms A and Mr B said Mrs X would need 24-hour care and support at home. They said that, on average, Mrs X needed support every 15 minutes in the day, and about three to five times during the night.
36. The assessment recorded that, since 2021, Mrs X’s mental health had remained stable with no signs of psychosis. The assessment noted a range of areas where Mrs X needed regular support, in relation to the symptoms of Parkinson’s disease. It said Mrs X would not be able to live independently and had needs eligible for local authority support in several areas.
37. The assessor noted that “At the same time of this assessment, [a] S117 Review was completed. A…Split Funding Tool [was also completed] in accordance with organisational policy”. The assessor said the recommendations of the s117 review would be discussed at a Mental Health Panel and a decision would be made about Mrs X’s “S117 Status and [the Council’s] responsibility thereof”.
38. The Council told us that, after it completed this assessment in August 2024, it was waiting for the local council to complete its own assessment and request a care package for Mrs X.
39. Mr B said he responded to the Council’s assessment with 75 corrections. Mr B said he did not want the Council involved any longer and wanted an independent social care assessment.
40. In late December 2024 the local council completed a new Care Act assessment of Mrs X’s needs. The assessment noted that Mrs X was eligible for s117 and that the Council was responsible for her care under s117. It said the Council had used a “funding matrix” and decided that Mrs X’s needs were 10% mental health‑related and 90% physical health‑related. The local council said this meant that the Council would fund 10% of Mrs X’s care and support and the remaining 90% would be financially assessed under the Care Act 2014. The local council noted Ms A and Mr B had disputed the Council’s assessment but the Council was satisfied the assessment met the correct criteria and would not change it. It also noted that a Council panel needed to consider the proposed funding split before it was finalised, “but we don’t know when this will be”.
41. The local council’s assessment also noted that both Ms A and Mr B “are full time unpaid carers for [Mrs X]; they…are willing and able to continue caring for her at home; [Mrs X] does not currently have any formal care in place.”

Complaint process

42. Mr B complained to the Council and the Trust in late March 2024. The Council:

• Accepted it was responsible for Mrs X’s aftercare needs but that Mr B was led to believe this was not the case. It said it was investigating how this happened. The Council apologised for the upset and frustration “any miscommunication and decision making has had on [Mrs X] and family”
• Maintained a person could have physical health needs which would not be eligible for support under s117, and said those needs would have to be considered by the local council under the Care Act.
• Apologised that there had been a delay in the relevant assessment being completed due to miscommunication between the local council and the Council in transferring Mrs X’s care.
• Offered a payment of £300 to reflect the impact of the Council’s failings on the family.

43. The Trust:

• Accepted there had been a breakdown in communication with Mr B about “the nature of s117” and that the Council remained responsible for meeting Mrs X’s eligible needs under it. The Trust apologised that the rights to funding under s117 were not fully explained.
• Said, while it accepted there could be an interaction between physical and mental health needs, some of Mrs X’s needs “are clearly either physical or mental health”.
• Acknowledged that, by late June 2024, the specific details of Mrs X’s physical and health needs had not been resolved since Mrs X left a care home in September 2023. The Trust said this had taken longer than necessary to conclude, although there had been some mitigating factors. The Trust said that, following a recent assessment the Council and Mrs X’s local council would work together to identify Mrs X’s mental health and physical needs and work out how they would be met.
• Said, in late November 2024, that a Care Act assessment had been completed to the expected standards and accurately reflected Mrs X’s needs

Analysis

Complaint (a) – that the Council has wrongly and unjustifiably sought to separate Mrs X’s physical and mental health needs;

Complaint (c) – that there was an extensive, unreasonable delay in the Council acting on its responsibility to arrange suitable s117 aftercare for Mrs X; and,

Complaint (d) – that the assessment of Mrs X’s needs was flawed as and led to an inadequate and inaccurate assessment

44. Mr B complains the Council has incorrectly argued that Mrs X’s physical health needs do not relate to her mental health condition. Mr B said the Council said that, as such, Mrs X’s physical health needs are not eligible for support under s117 and should be considered under the Care Act by Mrs X’s local council.
45. Mr B said Mrs X’s physical and mental health needs cannot be separated because a failure to manage Mrs X’s physical health needs would directly lead to a deterioration in her mental health. Further, Mr B said the Council previously did not make any such distinction (between physical and mental health needs) and had fully funded Mrs X’s residential care through s117.
46. As detailed in paragraphs 18 to 22, the eligibility criteria for support under s117 are broad and the types of support which can be provided are varied. If something meets a need arising from, or related to, the person’s mental disorder and it will help prevent their readmission to hospital, it should be provided through s117. Eligibility for support under the Care Act 2014 is determined by different criteria. As such, there are circumstances where aspects of a person’s support are not eligible for support under s117 but are eligible for support through the Care Act. As such, the Council’s approach is not, in and of itself, wrong.
47. Because of this, each s117 aftercare plan should be bespoke and should be based on a comprehensive, robust assessment of the totality of the person’s needs. The resulting plan should clearly explain what support the person needs, and what support has to be provided under s117, with a coherent rationale.
48. The Council told us there was no formal s117 aftercare plan or paperwork at the time when Mrs X’s detention under s3 ended. The Council said the record of Mrs X’s needs is what was recorded during a ward discharge meeting in late May 2021, and what was later recorded through a Care Act assessment.
49. The lack of a clear s117 assessment and care plan is fault. Because of this we are left with an incomplete understanding of what professionals considered Mrs X needed because of her mental health condition and to prevent her readmission to hospital.
50. It is not the Ombudsman’s role to assess Mrs X’s needs or to say what her section 117 aftercare should be. We can only consider how the relevant organisations fulfilled their responsibilities. Mr B has clearly stated and explained his views about the nature of Mrs X’s needs and their interconnectedness. In other words, that all of Mrs X’s needs are “related to” her mental health diagnosis because a failure to meet them would result in a deterioration in Mrs X’s mental health.
51. The records show that, prior Mrs X’s detention under the MHA, she needed support because of the consequences of Parkinson’s. Tremors, slowness of movement and muscle stiffness prevent her from completing a lot of day‑to-day tasks on her own. In December 2020 the Council commissioned a care agency to provide waking-night support for Mrs X, along with support in the mornings and evenings. It arranged this support under the Care Act. Within the assessment which led to this support, the Council noted that Mrs X’s “mental health is being effected by the stress and anxiety [she felt] from the changes in [her] health as well as the stress my family are feeling in their caring role”.
52. The assessment also noted Mrs X was experiencing pain which was having an impact on her mental health and she had severe mood swings. The assessment found that Mrs X needed support in a number of areas, including for her emotional and psychological needs as she needed “constant reassurance”.
53. It was symptoms and behaviours associated with psychosis which led to Mrs X’s detention under s3 in 2021. By the end of Mrs X’s admission a nursing assessment noted that Mrs X’s mental state had improved and she no longer showed any challenging behaviour.
54. The hospital discharge summary noted that possible triggers to the deterioration in Mrs X’s mental health had been “poor medication compliance, complex social situation… and social isolation due to language barrier worsened by coronavirus restrictions”. The Trust also noted that “No organic cause was identified to explain the deterioration in [Mrs X’s] mental state”. The summary said Mrs X had “improved remarkably since restarting and adhering to” a prescription of an anti‑psychotic medication. The summary said Mrs X’s current stability was “most likely due to adherence to” the anti-psychotic medication. The summary also said Mrs X needed “increased care due to Parkinson’s disease”.
55. When the Council assessed Mrs X’s needs in August 2022 it noted that her “mental health has been stable on antipsychotic medication with no signs of psychosis”. In January 2023 a consultant psychiatrist reviewed Mrs X. They noted Mrs X no longer wanted to live in a care home and was likely to move to another area where her daughter and Mr B were. The psychiatrist noted that Mrs X continued to take her prescribed dose of antipsychotic medication and said her mental health had been stable for some time.
56. After Mrs X moved from Islington, the local council assessed her needs, under the Care Act, in September 2023. The Council told us the intention was for the local council to assess Mrs X’s needs under the Care Act and then to agree with the local council who would be responsible for which elements of Mrs X’s care and support plan. The local council’s assessment noted that Mrs X needed support in several areas. It said those needs arose from or were related to a physical or mental impairment or illness. It did not specify what impairment or illness they related to. The assessment said if Mrs X’s needs were not met there would be an impact including on Mrs X’s physical and mental health and emotional wellbeing. It noted Mrs X needed support to manage her mental health and physical health conditions and, without support, there could be a deterioration which could lead to a further hospital admission. The assessment also noted Mrs X’s “physical, emotional and mental health would be promoted by the opportunity to access recreational activities and reduce the likelihood of relapse”.
57. The assessment concluded that Mrs X was eligible for support. It said “This package of care would be funded by Islington who have s.117 responsibility for [Mrs X’s] aftercare. Without support there is a significant risk that [Mrs X’s] physical, emotional and mental health would deteriorate and [Mrs X] would be at risk of further hospital admission under the Mental Health Act”. In later email correspondence the local council reiterated its view that Mrs X’s full care package should be funded through s117 “as her physical health impacts on her mental health”.
58. The Council did not accept this assessment and create a support plan based on it. However, I have not seen any evidence which sets out an analysis of its consideration of the local council’s (and Ms A and Mr B’s) views. And I have not seen evidence of a coherent rationale to explain the Council’s own conclusions about Mrs X’s needs, and which of those needs were eligible for s117 support. Having asked the local council to assess Mrs X’s needs, rather than complete its own s117 assessment, this lack of analysis and rationale is further fault.
59. A complaint response from the Trust in June 2024 agreed that, up to the time of it writing, the specific details of Mrs X’s physical and mental health needs had not been resolved since she left a care home in September 2023.
60. In August 2024 the Council completed its own assessment of Mrs X’s needs and a s117 review. This review said Mrs X’s mental health disorder had “not required treatment to prevent deterioration, (other than her anti-psychotic medication of which she is concordant), and does not require S117 to stay well at this time”. The review said Mrs X’s care and support needs “demonstrate those needs being predominantly attributed to her physical health needs due to her Parkinson’s Disease”.
61. However, the assessment and review did not specifically address the issues the local council had raised in its earlier assessment, and which Mrs X’s family had raised. Namely, their views that a failure to meet Mrs X’s wider needs could contribute to a decline in the mental health condition that led to her detention. It is also notable that a link of this type had also been commented in the Council’s own Care Act assessment before Mrs X’s first detention (as referenced in paragraphs 51 and 52). This was a significant issue which warranted careful consideration and analysis and a clear conclusion. The lack of appropriate analysis is fault and meant this delayed, late s117 assessment is flawed.
62. A further assessment by the local council in December 2024 reiterated its view that Mrs X needed support in a range of areas. The assessment also said that Mrs X needed “ongoing support to manage her mental health and physical health conditions in order to prevent any deterioration or hospital admission”. It noted Mrs X’s “mental health and wellbeing is…impacted by her Parkinson’s as she requires constant reassurance by [Ms A and Mr B]. This was recognised by her Psychiatrist Consultant in April 2024.”
63. Overall, the responsible organisations in Islington are at fault for failing to complete a comprehensive assessment of Mrs X’s s117 aftercare needs when her detention ended. The Council, the ICB and the Trust are all at fault as they all had responsibilities under s117. As above, although the ICB delegated the day‑to‑day work to another organisation it cannot delegate its overarching responsibility. There should have been systems and processes in place to ensure Mrs X’s aftercare needs were assessed and established before her discharge from hospital, or very soon after, and then kept under regular review.
64. It is evident that Mrs X has considerable needs which are complicated by the interaction between diagnoses of Parkinson’s and psychosis. Because of this, there needed to a careful examination of all her needs with a clear conclusion about what type of support was necessary as s117 aftercare. This should have had a clear rationale to explain how and why those conclusions had been reached.
65. The Council told us when Mrs X moved out of area it referred her to the local council for it to complete an assessment of Mrs X’s needs under the Care Act. It said the plan was then to agree with the local council who would be responsible for which elements of Mrs X’s care and support plan. However, when the local council completed its own assessment (including a view of whether Mrs X’s needs qualified for s117 support) the Council did not act on it. As Mr B complains, despite the occasional contact between organisations, little of consequence happened in terms of agreeing a care plan and a care package. This is further fault by the Council and the ICB, because of their ongoing responsibilities under s117.
66. Further, as referenced in paragraphs 58 and 61, the Council’s assessment of August 2024 did not address the specific points which had been raised by Mrs X’s family and in the local council’s assessment (and references in its own, pre‑detention Care Act assessment). Namely, about Mrs X’s need for reassurance and whether a failure to meet her physical needs would have a direct impact on her mental health.
67. From the evidence I have seen this lack of clarity and lack of progress has caused confusion – for Ms A and Mr B and for the local council. This also likely extended the apparent dispute between Islington services and the local council about what should be funded through s117.
68. Throughout the period under review staff from the Council and the local council recorded Mrs X’s, Mr B’s and Ms A’s enquiries about various forms of support for Mrs X. For example: Direct Payments to pay either Mr A and Ms B to support Mrs X or to pay for care workers who speak Mrs X’s native language; Direct Payments to support the use of community activities; meditation sessions; and gym/personal training sessions. However, the only support the local council commissioned was a four‑week period of respite care. While outside the period under investigation, I have noted that, in March 2025, the local council told the Council “the only thing that has been requested and implemented so far is respite stays”. The local council said “We do not currently have any other care and support requests from [Mrs X] or family”.
69. It is not possible to say what care and support would have been commissioned had the initial fault, or the delays, not occurred. I do not know what a suitable, comprehensive assessment would have concluded. I cannot discount the possibility that it would have concluded that some of Mrs X’s needs did not meet the criteria for support through s117. However, the uncertainty alone, along with associated stress and frustration, represent injustice in their own right. The fault mostly impacted Ms A and Mr B. They supported Mrs X day-to-day and corresponded with the organisations about these issues, through frontline services and the complaints process. Assessments show Mrs X was happy with the care and support she received from Ms A and Mr B and do not report concerns about her wellbeing. However, on balance, it is more likely than not that Mrs X was impacted by the overall stress, strain and uncertainty of this period, and this was an injustice to her. I have made recommendations to address this below.

Complaint (b) – that the Council had still not explained what caused a breakdown in communication about the Council’s responsibility for Mrs X’s s117; and

Complaint (e) – that the Council failed to provide adequate updates or clear communication to him and his partner

70. In its response of May 2024 the Council accepted it did hold responsibility for Mrs X’s s117 aftercare. The Council said it was sorry Mr B was “led to believe that this is not the case”. The Council said it was undertaking an investigation to find out how this happened. In a letter from the Trust in June 2024 it reiterated that the Council had retained responsibility for Mrs X’s s117 aftercare. The Trust said it was “clear from the interviews with staff and scrutiny of the available documentation that this has always been the case.” The Trust said the expected process was followed. However, the Trust was also clear that “the nature of Section 117”, and the Council’s responsibility for it, had not been communicated to Mr B. Therefore, the Trust partially upheld the complaint and apologised for the breakdown in communication.
71. Overall, the organisations have been open in accepting there was fault here. The papers I have seen support the organisations’ claim that, internally, there was no dispute about Islington’s ongoing responsibility for Mrs X’s aftercare. In view of this, the organisations have provided a proportionate and adequate response to the complaints about inadequate communication.

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Agreed actions

72. Within one month of the final decision the Council, the ICB and the Trust should all write to Mrs X, Ms A and Mr B to acknowledge the fault identified in this decision. They should also apologise for the impact of these failings. The organisations should follow LGSCO’s guidance on making an effective apology (at part 2.2 of its Guidance on remedies). The organisations should make a reasonable adjustment and translate their letters to Mrs X to her first language, as Mrs X does not read English.
73. Within one month of the final decision the Council and the ICB should ensure Mrs X has a comprehensive s117 aftercare plan which includes consideration of, and a conclusion about, which of her needs are eligible for support under s117 and why. This should include consideration of the interaction between Mrs X’s physical and mental health needs. The organisations should adhere to relevant legislation and guidance on s117 aftercare planning when producing this plan. The plan should set out options for the delivery of any necessary support.
74. Within two months of the final decision the Council, the ICB and the Trust should each pay £250 to Ms A and £250 to Mr B. (I.e. each organisation should pay a total of £500, and both Ms A and Mr B should individually receive £750 in total). These payments are to act as a symbolic, tangible acknowledgement of the injustice their failings caused Ms A and Mr B, in terms of the uncertainty and frustration they have experienced. I have not recommended payments to Mrs X as she appears to have protected from the full extent of the stress and uncertainty of situation by the advocacy and support of Ms A and Mr B.
75. Within three months of the final decision the Council, the ICB and the Trust should produce an action plan to address the fault this investigation found. Specifically:

• the failure to complete their own comprehensive s117 assessment and care plan at the time of Mrs X’s discharge or in a timely manner following it,
• the failure to complete their own comprehensive s117 assessment and care plan when Mrs X moved out of residential care,
• the failure to fully consider and analyse the views expressed (in a previous Care Act assessment, by Mrs X’s family and by other professionals) about the relationship between Mrs X’s physical and mental health needs after a local council gave its own clear view on this, and when they later completed their own assessment.

The plan should seek to identify and implement specific and realistic ways of improving its processes to help avoid recurrences.

76. The organisations should provide us with evidence they have complied with the above actions.

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Decision

There was fault by the Council, the ICB and the Trust which caused an injustice to Ms A and Mr B. The organisations have agreed to complete actions to remedy the injustice.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman