London Borough of Lewisham (18 010 781)

Category : Adult care services > Charging

Decision : Upheld

Decision date : 24 Oct 2019

The Ombudsman's final decision:

Summary: Faults by the Trust, Council and CCG led to Mrs X paying for accommodation which should have been free section 117 aftercare. Faults by the Council in dealing with Ms X’s enquiries and complaints caused her unnecessary time and trouble. The Council has already offered a fair remedy for Ms X’s injustice. The Trust, Council and CCG have accepted the Ombudsmen’s recommendations for service improvements and to address the injustice to Mrs X. We have therefore completed our investigation.

The complaint

  1. The complainant, whom I shall call Ms X, complains that:
    • delays by London Borough of Lewisham (the Council), South London and Maudsley NHS Foundation Trust (the Trust) and Lewisham Clinical Commissioning Group (CCG) have led to delays in the Council and CCG paying for sheltered accommodation which should be provided free for her mother (Mrs X) under section 117 of the Mental Health Act 1983;
    • the Council and CCG are failing to pay for the accommodation’s service and utilities charges as part of section 117 aftercare; and
    • the Council has delayed responding to Ms X’s attempts to resolve the matter.
  2. Ms X says this has caused the following problems:
    • the security of Mrs X’s tenancy has been affected and Mrs X has had to spend over £14,000 from her own account to meet rent demands since April 2018;
    • Ms X has had to spend unnecessary time and trouble in trying to resolve the problem and has now lost all confidence in the Council.
  3. Ms X’s desired outcomes are:
    • a refund for Mrs X;
    • for the Council to set up regular payments for Mrs X’s accommodation, service and utilities charges as part of Mrs X’s section 117 aftercare; and
    • an apology for Ms X.

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The Ombudsmen’s role and powers

  1. The Ombudsmen have the power to jointly consider complaints about health and social care. Since April 2015, these complaints have been considered by a single team acting on behalf of both Ombudsmen. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA)
  2. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen 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).
  3. 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.
  4. 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

  1. When considering this complaint, I have taken into account:
    • information Ms X has provided in writing and by telephone;
    • the Trust’s written response to my enquiries and supporting documentary information; and
    • the Council’s written response to my enquiries, sent on behalf of the Council, Trust and CCG and supporting documentary information.
  2. Ms X, the Council, the Trust and the CCG have had an opportunity to comment on a draft version of this decision.

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What I found

Key legislation and guidance

  1. 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’. Section 3 of the Mental Health Act is for providing treatment. People discharged from section 3 will not have to pay for any aftercare they will need. This is known as section 117 aftercare.
  2. Section 117 of the Mental Health Act imposes a duty on NHS clinical commissioning groups (CCGs) and council social services to meet the health/social care needs arising from or related to the person’s mental disorder for patients detained under specific sections of the Mental Health Act (e.g. Section 3). Section 117 aftercare also applies to people on Community Treatment Orders (CTOs) and can apply to people granted leave from hospital under section 17 of the Mental Health Act.
  3. Section 117 aftercare services must:
    • meet a need arising from or related to the mental disorder for which the person was detained; and
    • have the purpose of reducing the risk of the person’s mental condition worsening and the person returning to hospital for treatment for the mental disorder.
  4. The “Mental Health Act 1983: Code of Practice” (the Code) is statutory guidance. It says that section 117 aftercare can include supported accommodation and continues as long as the person needs these services.
  5. Councils and CCGs must keep a record of the people for whom they provide aftercare services and what those services are.
  6. Care planning for section 117 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 section 117.
  7. 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.
  8. 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.
  9. People are entitled to aftercare until both the council and CCG agree they no longer need it. When they both agree on this, they should formally discharge the person (keeping a record).
  10. The Code says that, even when aftercare provision has been successful in that a person is well-settled in the community, the person may still need aftercare services to prevent a relapse.
  11. The Code also says that, if aftercare services included accommodation:
    • the arrangements for the person’s move to more suitable accommodation should be in place before withdrawing support under section 117; and
    • it is important to fully involve the person and, if appropriate their advocate in making the decision.
  12. “Care and support statutory guidance” (CSSG) is guidance on the Care Act 2014. It says that care planning under the CPA should, if accommodation is an issue:
    • identify the type of accommodation which is suitable for the person’s needs;
    • afford the person the right to a choice of accommodation; and
    • involve the person in their care planning.

Background

  1. Mrs X has a diagnosis of chronic paranoid schizophrenia, which is only partially responsive to treatment. She has had many stays in hospital mental health wards since the 1970s. In February 2016, following an accidental fire in her home, Mrs X was detained in hospital under section 2 of the Mental Health Act 1983, for assessment. At the time she had a history of not allowing the community mental health team into her home. In March, she was detained for treatment under section 3 of the Mental Health Act 1983.
  2. Mrs X moved from psychiatric hospital to a sheltered housing unit in July 2016. At first this was on section 17 leave. She was discharged from section 3 detention and placed on a CTO in August 2016. She has lived at the sheltered housing unit since then.

Key events

  1. Mrs X’s discharge summary from the psychiatric hospital says that Mrs X’s “daughter met with [her social worker] and agreed that she did not think her mum should return to her own home, and so extra care sheltered accommodation was to be arranged”. The discharge summary also contains the following information.
    • “On 15/6/16 a discharge CPA/best interests meeting was held, as a flat had become available at [the extra care sheltered housing], to discuss the arrangements around discharge. It was discussed that [Mrs X] didn’t have the mental capacity to make a decision about going home or not…it wasn’t in her best interests to go home…It was discussed that her mental and physical health would be optimised with more support and the risk issues would be minimised by her being at” the extra care sheltered housing.
    • Mrs X went on section 17 leave to the extra care housing on 4 July 2016.This went well, so the Trust started a CTO on 16 August 2016. The CTO contained a condition that Mrs X had to continue to live at the extra care housing unit.
  2. The CTO expired in February 2017. The Council carried out a social care review on 23 May 2017. The review record says that Mrs X had a post discharge treatment plan in line with the conditions of her CTO and that she continued to accept this.
  3. In May 2017, the Council’s financial assessments and welfare benefit team wrote to Ms X stating “I have had confirmation that your mother is subject to Section 117 Aftercare. I have ensured that no invoices will be sent to you”. Ms X asked the Council to confirm that section 117 aftercare would apply to any rent not paid by housing benefit. The Council replied that section 117 aftercare only covered the support Mrs X received to keep her safe while cooking and support her daily care needs. It said the rent was a separate issue which needs to be paid for separately.
  4. In July 2017, Mrs X’s community psychiatric nurse (CPN) and psychiatrist carried out a CPA review. The CPN’s letter to Mrs X’s GP dated 10 July 2017 summarises the CPA review and says that:
    • while in psychiatric hospital in July 2016, Mrs X was assessed as needing to go into extra care sheltered housing following discharge from hospital; and
    • Mrs X accepted her depot injection [slow-release and long-acting injection] for treating schizophrenia while detained in hospital and in sheltered accommodation.
  5. The letter of 10 July 2017 does not state that Mrs X no longer needs extra care sheltered housing.
  6. In July 2017, Ms X complained to the Council about charges related to Mrs X’s accommodation. In August 2017, the Council wrote to Ms X to confirm the decision to place Mrs X in sheltered accommodation was made to meet a need arising from her condition. The Council said it would refund any rent already paid, minus the housing benefit contribution already made by the Council. The Council has not refunded this money so far. The Council also said it would reflect on what had happened to learn from its mistakes and avoid repeating them.
  7. Between September and December 2017, Mrs X was in hospital following a stroke, complicated by pneumonia.
  8. On 16 February 2018, Mrs X’s psychiatrist and community psychiatric nurse carried out a CPA review. The psychiatrist wrote to Mrs X’s GP with the following information.
    • Mrs X’s condition is complicated by cerebrovascular disease (conditions that affect the blood supply to the brain) which may have resulted in some cognitive impairment. However, the community mental health team has not completed a formal assessment because Mrs X will not comply.
    • High blood pressure and poorly controlled diabetes make Mrs X susceptible to further strokes.
    • Mrs X often denies she is unwell and refuses to take medication.
    • Mrs X’s current mental state “appeared relatively stable”. The primary concern was Mrs X’s physical health and overseeing her condition is difficult if she refuses assessment.
  9. Ms X told the Council in May 2018 that Mrs X’s housing benefit would end due to a change in her circumstances. She asked the Council to start paying for Mrs X’s accommodation using section 117 funding. She also told the Council she thought the amount of refund it proposed in August 2017 was wrong. The Council told her it considered the refund amount was correct and asked her to provide more information if she disagreed. It also said it would ask the community mental health team to make arrangements for future rent payments through section 117 funds. On 29 May 2018, Ms X provided the extra information and accepted that section 117 funds would not cover utilities.
  10. After receiving a reminder from the sheltered housing unit about rent arrears,
    Ms X contacted the Council in June 2018 to remind it that Mrs X’s housing benefit had stopped and to ask it to start paying Mrs X’s rent.
  11. The Council replied to Ms X the next day and said that section 117 money cannot pay for service charges and utilities. The Council confirmed that, because of the time taken to resolve Ms X’s complaint, it would refund Mrs X’s rent, service and utilities charges, minus housing benefit, up to the third week of the financial year 2018/19. The Council calculated this would come to £2,072.22. The Council said it would support future section 117 costs from its Adult Social Care budget but before it could set up payments, it needed to complete Mrs X’s section 117 review. Ms X confirmed she was happy with this.
  12. On 3 July 2018, the Council emailed Ms X to say a refund would take about 28 days to go through its payment system. Ms X then chased the Council for the refund and rent payments twice in July 2018. The Council told her the Community Mental Health Team (CMHT) had yet to finish its review and were waiting for advice from a psychiatry consultant. The Council said it could not decide what could be paid under section 117 until this had been completed. The Council has not provided any evidence to show the CMHT sought advice from the psychiatrist or chased the psychiatrist for a response at that time.
  13. On 11 July 2018, Mrs X’s social worker asked the Council’s head of social care for advice. The social worker considered that, given Mrs X’s “independence and stable mental health since hospital discharge, there are clear indications for withdrawal of S117 in this instance”. He said he was going to discuss this with Mrs X’s psychiatrist with a view to stopping section 117 aftercare. The Council has not provided any evidence to show the social worker asked the psychiatrist for advice at that time. The head of social care replied asking whether mental health services would stay involved with Mrs X and stating that if so, “this would generally constitute a need for “aftercare””. The social worker replied that the mental health team continues to see Mrs X to provide her depot injection. The head of social care advised that if the current care package was for Mrs X’s physical health then she should get a financial assessment.
  14. In response to a request for clarification from the Council’s finance department, and following discussion with the Council’s head of social care, the Trust stated on 11 July 2018 (in summary) that:
    • to stop section 117 aftercare, both health and the Council must agree, the head of social care and the legal team must approve the decision;
    • section 117 aftercare can remain without being used for rent, utility bills, or social care needs;
    • Mrs X has a monthly depot injection and the CPN asks her how her mental health is;
    • Mrs X has no symptoms of mental health problems at present which indicates “the aftercare provided (care package) is adequate to meet her needs”;
    • the care package she received is for her physical health needs and this is what the social services finance team needs to assess;
    • the rent is not included in section 117 aftercare because Mrs X’s sheltered accommodation is not a specialist mental health care home; and
    • the reason Mrs X could not originally return to her own house was that it needed refurbishment because of fire damage. The sheltered housing was agreed because Mrs X had nowhere else to live and the care package agreed at the time was to supervise Mrs X when doing laundry and cooking to prevent another fire.
  15. Ms X chased the Council in August about both the refund and the continuing rent payments for Mrs X. The Council told her that due to a change in payment systems there was a delay in the refund payment. The Council also said that it had escalated her question about rent payments to the head of the adult social care service and the community mental health team was waiting for legal advice. The Council advised Ms X to either contact its head of law, or the Ombudsman.
  16. In September 2018, Ms X sent her email correspondence with the Council to its head of law and chased them for a response after 16 days. In October, the head of law acknowledged her email, said they were looking into the matter and will reply as soon as possible. Ms X complained to the Ombudsmen in October after not receiving a further response or a refund from the Council.
  17. On 16 November 2018, Ms X says the Council wrote to say that it needed to do a financial assessment for Mrs X’s contribution towards non-residential home charges. Ms X challenged this, and the Council wrote to her on 23 November stating that her mother does not need to make a client contribution toward the non-residential home care services she receives.
  18. The Trust held a CPA review for Mrs X on 27 November 2018. Present were
    Mrs X and her daughters, Mrs X’s CPN, an officer from Mrs X’s sheltered housing unit and social work staff.
  19. The Council’s minutes of the CPA review meeting contain the following information (in summary).
    • The purpose of the review was “to discuss the mental health, physical health, accommodation and social care input since” Mrs X’s move to sheltered accommodation.
    • Mrs X accepts her depot injection regularly and her mental health has been stable.
    • Mrs X recovered well following a stroke in September 2017. She has been accepting her physical health medication.
    • Mrs X enjoys interacting with carers but chooses not to take part in the activities available at the sheltered housing scheme.
    • The current care package was four 15-minute carer visits a day, plus 1.5 hours of domestic and laundry help a week.
  20. The CPA plan for Mrs X was to:
    • continue receiving monthly depot injections;
    • “continue to stay in [the extra care sheltered housing] and have input from the PMOA team (Psychological Medicine and Older Adults) to keep [her] mental health stable”; and
    • have her needs reviewed yearly.
  21. The CPN summarised the CPA review in a letter to Mrs X’s GP dated
    11 December 2018. The letter included the following information:
    • Mrs X’s mental health has remained stable and she has complied with most medication, although she will sometimes refuse to take her physical health medication;
    • part of Mrs X’s crisis and contingency plan was for staff at the sheltered housing unit to liaise with the community mental health team about Mrs X’s progress;
    • in the past, when Mrs X was living in her own house, she would not allow access to members of the community mental health team or take medication for her schizophrenia;
    • since July 2016 [when Mrs X moved into sheltered housing], the community mental health team has been able to see Mrs X and she has accepted depot injections; and
    • the next CPA review was due in one year.
  22. Neither the social worker’s minutes nor the CPN’s letter state that Mrs X no longer needs extra care sheltered housing.
  23. On 26 February 2019, the Council replied to our initial enquires about the complaint. In response to a question about who should be paying Mrs X’s accommodation charges, the Council said “Not yet determined. Awaiting decision following Consultants view”. There is no evidence the Council sought or chased the consultant’s view at that time.
  24. On 11 March 2019, Mrs X’s social worker completed a care plan review. Mrs X and representatives from the extra care sheltered housing were present but
    Mrs X’s family were not. The review decided to reduce the duration of the carers’ visits because Mrs X could do many of her activities independently.
  25. Later the same day, Mrs X’s care coordinator, her social worker and the social worker’s manager met to review the CPA completed on 27 November 2018. The objective of the meeting was “to discuss the current mental and physical health, accommodation and social care needs of [Mrs X] following the care plan review completed by the allocated social worker on 11/3/2019”. The meeting heard the following (in summary).
    • Mrs X’s psychiatrist had last seen her on 18 January and considered her mental state was relatively stable.
    • Mrs X complied with monthly depot injections but not her physical health medication and monitoring.
    • Mrs X received four carer visits a day to check her wellbeing and supervise her physical health medication. The care review of the same day had reduced their duration from 30 to 15 minutes each. Mrs X also received an hour a week help with laundry. Mrs X chooses not to take part in any of the activities and social events on offer in the sheltered housing scheme.
  26. The care coordinator and social workers concluded that Mrs X’s current care package could be provided with the same level of support in other accommodation, such as ordinary sheltered housing. They discussed that, when she lived in her own home, Mrs X would sometimes prevent access by leaving the key in the lock, but noted she had not done this while living in the sheltered accommodation. The social worker’s view was that she would continue to let carers in if she lived in alternative accommodation.
  27. The Council wrote to the Ombudsmen on behalf of itself, the Trust and the CCG in May 2019. The Council said, in summary:
    • its letter of August 2017 confirmed Mrs X was placed in extra care sheltered housing to meet a need arising from her condition, but that letter did not indicate a continuing need;
    • it would not be appropriate to refund Mrs X’s accommodation costs since April 2018 because accommodation is not an integral part of her aftercare;
    • this is because the accommodation no longer meets a need arising from a mental health condition and does not reduce the chance of Mrs X’s condition getting worse resulting in return to hospital;
    • Mrs X could safely return to her own home, if not for the fact that it has been sold;
    • the Council, Trust and CCG made this decision having reviewed Mrs X’s past CPA review documents in March 2019 and having had a meeting in May 2019.
  28. Ms X says that she was unaware of March 2019 review or the May 2019 decision until she found out about them through the Ombudsmen’s investigation in August 2019. She disputes the conclusions of the March 2019 review and says that it relied on incorrect information. She says Mrs X has never left a key in a lock to prevent access when living in her own home, but has refused to take medication or engage with health and social care staff, occasionally becoming aggressive.

My analysis

  1. The records of the organisations’ original consideration of what Mrs X needs as section 117 aftercare are limited. There is no section 117 aftercare assessment or aftercare plan dating to Mrs X’s discharge from hospital. The only records available to us are a discharge summary and a medical report to a mental health tribunal when Mrs X challenged the CTO in 2016. The lack of records is fault, because all three organisations should keep adequate records of section 117 aftercare planning and of what is provided under section 117.
  2. I have been able to establish the following from the available records.
    • The discharge summary says that Mrs X should not return home. It says her “mental and physical health would be optimised with more support and the risk issues would be minimised by her being at” the extra care sheltered housing unit.
    • In 2016, the CTO required Mrs X “to continue living at” the sheltered housing unit. The Trust made this a condition of Mrs X’s CTO because it considered she was vulnerable, and her needs would be better met in sheltered housing. It also considered this environment would provide accessibility, supervision and support, whereas Ms X had in the past refused access to health professionals when she lived at home. Mrs X could have been recalled to hospital and detained again had she moved elsewhere while the CTO was in place.
    • In August 2017, the Council wrote to Ms X agreeing that Mrs X was placed in the sheltered housing unit in order to meet a need arising from her condition. The Council therefore agreed to refund any rent costs over and above those already covered by benefits.
  3. Based on this information, I consider it more likely than not that the extra care sheltered accommodation was originally part of Mrs X’s section 117 aftercare because:
    • Mrs X was placed in the extra care sheltered accommodation to meet a need arising from or related to her mental disorder;
    • this was ‘accommodation plus’ because it allowed a level of supervision and access needed to ensure Mrs X would receive her depot injections and to monitor her mental state since her condition is only partially responsive to treatment; and
    • the reason for placing Mrs X in the extra care sheltered accommodation was to reduce the risk of her mental state deteriorating and her being re-admitted to hospital.
  4. The Council and CCG have a joint duty to provide section 117 aftercare. Mrs X and her family should not have been approached to fund this through housing benefit. While the extra care sheltered accommodation remained part of Mrs X’s section 117 aftercare, the Council and CCG should have met the full cost of her residence there including service and utilities charges. This is because payment of these charges was required in order for Mrs X to continue living at the accommodation.
  5. Since Mrs X was discharged from hospital and became eligible for section 117 aftercare, it was appropriate for the Council and CCG (or Trust acting on the CCGs behalf) to review her aftercare needs regularly. The care planning and reviews for the entirety of her aftercare should have been managed jointly under the CPA. However, in Mrs X’s case, the Council continued to assess and plan for what it considered her social care needs separately, while the Trust did the same for what it considered her mental health needs. This approach is contrary to the statutory guidance on both the Care Act 2014 and the Mental Health Act 1983 and hence fault. This may have contributed to the organisations’ confusion about what care Mrs X was receiving or entitled to under section 117.
  6. The duty to provide aftercare services under section 117 remains until both the Council and CCG are satisfied that the person no longer needs the services. A properly conducted and considered review can lead to services ending. The Code of Practice says that, where specialist accommodation is part of section 117 aftercare, the Council and CCG should put in place arrangements for a move to more appropriate accommodation before finally withdrawing support. They should also fully involve the patient and their carer or advocate in the decision-making process. The Trust’s section 117 policy also says:
    • patients and carers should be present at review meetings where possible; and
    • the “after-care plan, within the CPA, will be monitored and reviewed by the care co-ordinator or social worker/care manager and responsible consultant psychiatrist”.
  7. The Council, Trust and CCG have not shown evidence of a thorough re-assessment of Mrs X’s section 117 needs, in line with guidance and local policy, since she was discharged from hospital. This was fault. I have reached this view for the reasons below.
    • The Council and Trust considered Mrs X’s mental health and social care needs separately rather than jointly under the CPA approach.
    • None of the CPA reviews conducted by the care coordinator and consultant psychiatrist between 2016 and 2018 have stated explicitly what Mrs X receives under section 117.
    • None of the CPA reviews between 2016 and 2018 stated that she no longer needs extra care sheltered housing.
    • Records of the last CPA review, in November 2018, state that the plan is for Mrs X to continue living in the extra care sheltered housing. There has not been a CPA review since.
    • The meeting of March 2019 concluded that Mrs X’s current care could be provided with the same level of support in different accommodation, for example ‘ordinary’ sheltered accommodation. However, this was not a formal CPA review, the minutes refer to it as a review of the November 2018 CPA review.
    • There is no evidence of an attempt to involve Mrs X or her family in the meeting of March 2019, as required by the Code of Practice and the Trust’s policy.
    • While the notes of the meeting mention a psychiatrist’s report dated January 2019, there is no evidence of Mrs X’s psychiatrist being involved in the meeting or in considering whether she still needed accommodation as part of her aftercare. The section of the psychiatrist’s report quoted does not address this question. There is no written recommendation by Mrs X’s psychiatrist for a change to her section 117 aftercare, as required by paragraph 16.8 of the Trust’s section 117 policy.
    • There is no evidence that the Council, Trust and CCG communicated their decision to Mrs X and her family or tried to source alternative appropriate accommodation.
  8. I consider that Mrs X’s accommodation and associated service and utilities charges should be treated as section 117 aftercare until the Council, Trust and CCG can show that a proper review of her section 117 aftercare (in accordance with the Mental Health Act 1983, Code of Practice and their own policy) has concluded she no longer needs it. They cannot end the entitlement retrospectively.
  9. As a result of faults by the Council, CCG and Trust in the way they recorded and reviewed her aftercare needs, Mrs X has had to pay for extra care sheltered accommodation and associated charges, which should have been provided free of charge.
  10. The Council has delayed and at times completely avoided replying to Ms X’s enquiries and complaints about charges and funding for her mother’s aftercare. This was fault. This has led to Ms X having to spend unnecessary time and trouble in chasing the Council for responses and in complaining to the Ombudsmen. The Council has already offered to apologise to Ms X and to pay her £500 to remedy her injustice. This is a fair remedy for Ms X’s injustice.

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Agreed actions

  1. To remedy the injustice to Mrs X, the Council and CCG will refund any rent, service and utilities charges she has paid since 2016, minus Housing Benefit. They will also start paying her rent, service and utilities charges at the extra care sheltered accommodation until a properly conducted review decides that she no longer needs this accommodation as part of her section 117 aftercare. They will pay the refund and start paying the rent and associated charges within two months of this final decision. They will let the accommodation provider know they will do this within a month of this final decision.
  2. To remedy the injustice to Ms X, within a month of this final decision the Council will write to her with an apology and pay her £500, as already offered.
  3. To prevent similar problems in future, within three months of this final decision, the Council, CCG and Trust will ensure:
    • all relevant policies and procedures make it clear the duty to pay for accommodation which is part of section 117 aftercare lies with the relevant council and CCG, and that patients should not be asked to claim Housing Benefit instead;
    • all staff whose responsibilities may include administering, commissioning, assessing for or providing section 117 aftercare have knowledge of the relevant law, guidance and policy, as appropriate to their roles; and
    • they have provided evidence to the Ombudsmen that this has been completed.
  4. Within three months of the date of my decision, the Trust will share a copy of the decision and evidence of completed recommendations with NHS Improvement.

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Final decision

  1. Faults by the Trust, Council and CCG led to Mrs X paying for accommodation which should have been free section 117 aftercare. Faults by the Council in dealing with Ms X’s enquiries and complaints caused her unnecessary time and trouble. The Council has already offered a fair remedy for Ms X’s injustice. The Ombudsmen have completed their investigation because the Council, Trust and CCG have accepted our recommendations for service improvements and to address the injustice to Mrs X.

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Investigator's decision on behalf of the Ombudsman

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