Summary: Mrs Y complains about aftercare planning by a Council, NHS Trust and Integrated Care Board for her son, Mr X, under the Mental Health Act. Based on current evidence I have not found fault by the organisations.

The complaint

1. Mrs Y complains for her son, Mr X, about Somerset Council (the Council), Somerset NHS Foundation Trust (the Trust) and NHS Somerset Integrated Care Board (the ICB). She complains about the care Mr X after he was admitted to hospital under the Mental Health Act 1983 in November 2023. The complaints include that:
• The Trust, the Council and the ICB failed to properly assess Mr X’s needs or plan his aftercare under section 117 of the Mental Health Act. Mrs Y says the Trust has not told Mr X what his assessed needs are or provided him with a discharge plan.
2. Mrs Y says the failings prolonged Mr X’s hospital admission and he did not have the right care and support he needed in place when he was ready to leave hospital.

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The Ombudsmen’s role and powers

3. 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).
4. We may investigate complaints made on behalf of someone else if they have given their consent. We may also investigate a complaint on behalf of someone who cannot authorise someone to act for them, if we consider them to be a suitable representative. (Health Service Commissioners Act 1993, section 9(3) and Local Government Act 1974, section 26A(2)) (Local Government Act 1974, section 26A(1))
5. 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).
6. 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.
7. 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(1), as amended)

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How I considered this complaint

8. I considered evidence provided by Mrs Y, the Council, the Trust and the ICB as well as relevant law, policy and guidance.
9. All parties will had an opportunity to comment on my draft decision and I considered all comments before reaching a final decision.

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What I found

Legislation and guidance

Section 117 of the Mental Health Act 1983

10. Section 3 of the Mental Health Act 1983 (the MHA) allows people to be detained in hospital for treatment necessary for their health, safety or for the protection of other people. Section 117 of the Mental Health Act imposes a duty on health and social services to meet the health/social care needs arising from or related to the person’s mental disorder for patients who have been detained under specific sections of the Mental Health Act (e.g. Section 3).
11. Aftercare services provided for the person’s mental disorder under section 117 cannot be charged for. Councils and ICBs cannot delegate these aftercare duties, regardless of the day‑to‑day arrangements for delivering a person’s aftercare. Therefore, the relevant council and ICB are included in Ombudsmen investigations about section 117 aftercare. In this case, the ICB delegates responsibility for managing health-related Section 117 needs to the Trust, so it is also included in our investigation.
12. The Mental Health Act 1983: Code of Practice (the Code) is statutory guidance. This means that councils and relevant NHS health authorities must follow it, unless there are good reasons not to.
13. The Code says:

• “Before deciding to discharge or grant more than very short-term leave of absence to a patient…the responsible clinician should ensure that the patient’s needs for after-care have been fully assessed, discussed with the patient (and their carers, where appropriate) and addressed in their care plan…” (Section 33.13 of the Code)
• “…the care plan should be prepared in close partnership with the patient from the outset, particularly where it is necessary to manage the process of discharge from hospital and reintegration into the community…” (Section 34.10 of the Code)

Brief background

14. Mr X had previously been admitted to hospital under section 3 of the MHA. The hospital rescinded this in June 2023 but Mr X remained in hospital on an informal basis. He discharged himself from hospital at the end of September 2023.
15. In November 2023 professionals detained Mr X again for treatment under the MHA. He was detained under section 3 and remained an inpatient at the hospital until July 2025.
16. Mr X received confirmation of his autism and ADHD (attention deficit hyperactivity disorder) diagnosis in November 2023.
17. Mrs Y complained to the Council about Mr X’s discharge from hospital in September 2023 and the lack of aftercare planning. She brought this complaint to the Ombudsmen and we completed this investigation in November 2024. We found fault by the Council and the Trust with care planning and made recommendations to take steps to improve their services, in particular about taking a multi-agency approach.
18. Mrs Y later complained about Mr X’s more recent hospital admission and aftercare planning. She complained before Mr X’s discharge from hospital. PHSO is considering the complaints about care during Mr X’s hospital admission separately. The complaint we are considering is only about section 117 aftercare planning.

My findings

19. Mr X’s situation was complex. His readmission to hospital under the MHA was soon after his previous discharge where a previous investigation found failings with aftercare planning.
20. Aftercare planning should start soon after admission to hospital. For longer admissions this is likely to need regular review and updating to reflect potentially changing needs. The records show there was early communication between the Trust, the ICB and the Council to discuss what support Mr X needed and what they could offer. The records also show the organisations were planning to incorporate assessments for section 117 and the Care Act to ensure they considered all needs. The Council records show it formally started the section 117 aftercare assessment in February 2024.
21. The records show there was early collaboration between the organisations, and oversight by the ICB to commence section 117 aftercare planning. This is in line with the Code. I have found no fault with how the organisations agreed to start the process of section 117 aftercare planning.
22. The support planning documents record the assessment was completed with input from health and social care professionals, as well as Mr X and Mrs Y. The assessment considered Mr X’s background, physical and mental health, current status, risk factors and needs, including accommodation and education/employment, when he was ready to leave hospital.
23. The assessment was comprehensive and started to formulate a plan for support on discharge. The assessment recommended that supported living be considered to try to manage possible tensions between Mr X and his parents when he was at home. However, at this point Mr X wanted to return home. It was also identified that attending the gym has a positive impact on Mr X’s emotional, physical and mental health and was likely to reduce the risk of readmission to hospital under the MHA.
24. Following Mr X’s diagnosis of Autism and ADHD, he received other related services from the ICB and the Trust while he was an inpatient. These continued during his admission, but are not part of this investigation.
25. The records show the Council, the Trust and the ICB maintained regular communication about Mr X’s aftercare needs. This included discussions between Mr X, social workers and mental health professionals during ward rounds. I have seen the Council also kept Mrs Y updated about these and other multidisciplinary meetings on a regular basis.
26. The Council and the Trust kept the section 117 aftercare plan under review. The records show an update in June 2024 included information showing Mrs Y’s views from ward rounds and email exchanges with professionals.
27. By mid-2024, records show Mr X was taking increased amounts of section 17 leave (temporary leave from hospital, authorised by a responsible clinician). The ICB had also arranged funding for a trial of boxing sessions for Mr X to help support resettlement in the community. Mrs Y raised concerns that these were not part of Mr X’s section 117 aftercare plan. The Trust explained the boxing sessions could potentially be part of a section 117 aftercare plan, but it wanted to ensure they were suitable for Mr X. On this basis, the ICB agreed funding for the boxing sessions could start before Mr X left hospital, then they could review these as part of Mr X’s section 117 aftercare planning.
28. By October 2024, the records show discussions about Mr X leaving hospital. The Council still recommended supported living, but Mr X wanted to go back to the family home. However, the records note Mrs Y wanted 24-hour support in place if Mr X was to return home.
29. Mr X’s assessment did not support the need for 24-hour care. The Council discussed the possibility for a supported living trial while Mr X was under section 17 leave to see how he managed. The records show it discussed this with a supported living provider, but unfortunately they did not have a space available.
30. The Council also sourced a care provider (provider A) and they agreed to assess Mr X to see if they could meet his assessed needs in the community.
31. The Trust updated Mr X’s social circumstances report in November 2024. This records that he wanted to return to the family home, but there were issues to work out with Mrs Y with the support that was available for Mr X.
32. By December 2024, Mr X had agreed to be discharged under a CTO (Community Treatment Order - supervised treatment in the community, subject to certain conditions). The Trust and the Council arranged a further section 117 meeting.
33. The records note Mrs Y had concerns about Mr X returning home with support from Provider A as she had not had the chance to meet them. This was because she had been in hospital.
34. The Council considered Mr X could make decisions about his own care, including the choice of care provider. However, it completed a formal mental capacity assessment to confirm its view. This assessment included discussions about supported living and returning home with support to check he understood the implications of both.
35. A section 117 meeting took place the following week. Mr X did not attend the meeting by choice, but Mrs Y and her husband did attend. This confirmed the plan for Mr X to return to the family home when he left hospital. The Trust and the Council said the plan was for Mr X to leave hospital in early January 2025. However, Mrs Y raised concerns about funding for mileage (to allow support workers to take Mr X to his boxing sessions). She did not think the issue would be resolved by early January and said she could not agree to his discharge until this happened.
36. The Trust sought advice about the mileage payments and confirmed this would not prevent Mr X’s discharge. However, Mr X’s family did not want to go ahead until the issue had been resolved.
37. In February 2025, the ICB agreed to fund the mileage payments for 14 weeks. This was not section 117 funding but agreed under a different funding stream.
38. However, by March 2025 provider A had ended its contract and unfortunately Mrs Y’s own health meant it was not sustainable for Mr X to live at the family home at that time.
39. Records show the Trust, ICB and the Council continued to discuss how to address the mileage payments. There was no agreement to include this under section 117, but the Council did find a solution and agreed to cover these costs under the Care Act as respite care.
40. The notes from a further section 117 meeting in April 2025 noted the Council had identified a new care provider (provider B). They had met Mr X and it is recorded this had been positive.
41. Records from a professionals meeting in May 2025 noted Mr X and Mrs Y had also met provider B and they were all happy that Mr X could return home. The Council agreed six extra hours support a week, for three weeks, to help Mr X’s transition from hospital to home.
42. As noted above, the records show evidence of discharge planning from early in Mr X’s hospital admission. There was regular contact between the Council, the Trust and the ICB throughout Mr X’s hospital admission, including emails, meetings and joint ward rounds. The Council also provided Mrs Y with regular updates.
43. In terms of aftercare planning, the section 117 documents are detailed and considered Mr X’s needs on leaving hospital to help reduce the risk of readmission. The Trust and the Council reviewed and updated the plans regularly while Mr X was in hospital and Mr X largely agreed with the outcomes. I consider the records support evidence of collaborative working between the organisations and also with Mr X and his family.
44. There were some areas Mrs Y disagreed with the Trust and Council’s plans. This included consideration of independent living; provision of night-time support; and how travel costs would be paid for. This does not mean these plans were wrong, but the records show the organisations engaged with Mr X and his family and sought solutions acceptable to Mr X.
45. Mr X’s discharge from hospital was delayed from the point clinical staff felt he was ready to leave hospital. However, having considered the complexity of Mr X’s situation, I do not consider this was due to fault by the organisations. Mr X had the ability to make decisions about his care and declined to consider independent living. His discharge to his family home was therefore dependent on agreement by his family. Some early delay was because of disagreement with the level of support Mr X needed and there were issues with provider A withdrawing its services. Unfortunately there were also periods when Mrs Y was undergoing treatment for her own health problems, which meant a return home at that point was not possible or safe.
46. Once professionals decided Mr X was ready for discharge in December 2024, the main sticking point appears to have been transport costs. The organisations did not consider this was a need that was under section 117. This was a professional judgement. Mrs Y did not agree.
47. The organisations satisfied their position by seeking advice and explaining its reasoning to Mr X and his family. The Council and the Trust also continued to seek alternative arrangements to cover travel costs to Mr X’s gym sessions. Mrs Y was clear she did not want Mr X to be discharged home until the organisations had sorted this issue.
48. We will never know whether the organisation would have agreed funding for travel costs to Mr X’s satisfaction had he left hospital sooner and before the Council agreed to cover this under alternative arrangements. However, I understand why Mrs Y held her view.
49. Mr X’s previous admission to hospital and discharge had not gone to plan. Mrs Y was naturally anxious that his mental health needs were properly considered and support in place before he left hospital this time. I therefore understand why Mrs Y felt pressure to challenge decisions and ensure everything was in place before Mr X left hospital. I also recognise that her own health problems must have made this harder.
50. I consider the Trust, ICB and Council carefully and considerately considered Mr X’s wishes and listened to Mrs Y’s objections and concerns. They found ways to plan around these and eventually reached a position that satisfied the requirements under the Code to produce an aftercare plan and provide the support Mr X needed and wanted. Although discharge was delayed from when Mr X was ready to leave hospital, the this was not because of fault by the Council, the Trust or the ICB.

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Decision

I find no fault by the Council, the Trust or the ICB with Mr X’s section 117 aftercare planning.

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Investigator's decision on behalf of the Ombudsman