Summary: Miss D complained that Stoke-on-Trent City Council, Staffordshire and Stoke-on-Trent ICB and Cheshire and Wirral Partnership NHS Foundation Trust failed to provide her with appropriate care following her discharge from long-term inpatient care. We found no fault with the care and support provided to Miss D by these organisations.

The complaint

1. The complainant, Miss D, is complaining about the care and support provided to her by Stoke-on-Trent City Council (the Council), Staffordshire and Stoke-on-Trent ICB (the ICB) and Cheshire and Wirral Partnership NHS Foundation Trust (the Trust). Miss D complains that these organisations:

• failed to provide her with the section 117 aftercare services to which she is entitled as a result of her detention under section 3 of the Mental Health Act 1983;
• left her without an allocated social worker for six months;
• placed her in inappropriate accommodation with staff that cannot meet her complex needs;
• reduced her care hours inappropriately;
• failed to provide care to meet her physical health needs;
• failed to provide the psychological therapy she requires; and
• failed to arrange transport for her to visit family.

2. Miss D says the failure of the Council, Trust and ICB to provide her with appropriate care has left her feeling depressed, confused and ignored. She says she feels that professionals do not listen to her. Miss D says she cannot afford the transport costs to visit her family and that this affects her mental health.
3. Miss D would like to be placed in accommodation that can meet her complex needs and to receive the care she requires.

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The Ombudsmen’s role and powers

4. 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).
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 acts 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(i), as amended)

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How I considered this complaint

8. I considered evidence provided by the Council, the Trust and the ICB. as well as relevant law, policy and guidance. I also considered information provided by Mrs H and discussed the complaint with her.
9. I shared a copy of my draft decision statement with all parties and considered the responses I received.

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What I found

Relevant legislation and guidance

Mental Health Act 1983

10. The Mental Health Act 1983 (the MHA) allows that 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’.
11. Section 3 of the MHA is for the purpose of providing treatment. Detention under section 3 empowers doctors to detain a patient for a maximum of six months. The detention under section 3 can be renewed for another six months.
12. A person who has been detained under section 3 of the MHA is entitled to free aftercare services under section 117 of the same legislation. These services are intended to prevent a deterioration in the person’s mental health and reduce the risk of them requiring further admission to hospital. Specialist accommodation can be included in a person’s section 117 aftercare provision if it meets a need arising from, or related to, the person’s mental disorder.
13. Responsibility for providing or arranging these services in Miss X’s case rests with the Council and ICB.

The Code of Practice that accompanies the MHA sets out that a person’s section 117 aftercare needs should be clearly recorded in their care plan and subject to regular review.

14. The Code of Practice also explains that local authorities and ICBs are required to maintain a record of all local people for whom they provide or commission aftercare. This should include details of what aftercare these organisations are providing.

Care Act

15. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment of any adult who appears to need care and support. They must assess anyone, regardless of their finances or whether the council thinks they have eligible needs. The assessment must consider the adult’s needs and how they impact that person’s wellbeing. It must also consider the outcomes they want to achieve. The assessment must involve the person and, where appropriate, their carer or any other person they might want to be involved.
16. The Care Act gives councils a duty to produce a care and support plan for a person with care and support needs. The plan should provide a comprehensive record of the person’s needs, what they hope to achieve, and how their needs will be met. The Care Act gives an expectation that a council should review a person’s care and support plan no later than every 12 months, or if the person requests one.

Personal Independence Payment

17. The Personal Independence Payment (PIP) is a benefit payment intended to help with the extra living costs of a person who has:

• a long-term physical or mental condition or disability; and
• difficulty doing certain everyday tasks or getting around because of their condition.

18. There are two parts to PIP. The first relates to daily living. This is for people who need help with everyday tasks. The second relates to mobility. This is for people who have difficulty getting around because of their condition.
19. A person may be eligible for one, or both, parts of the PIP. Miss D is in receipt of both parts of the PIP.

Background

20. Miss D has complex physical and mental health care needs. In January 2023, Miss D was discharged to a supported living placement after a long period of inpatient care. During her admission, Miss D had been detained under section 3 of the MHA. This meant she was entitled to free section 117 aftercare services on discharge.
21. Miss D received support from staff at the placement. In addition, she received a further 28 hours per week of 1:1 support. This included emotional support, assistance with household tasks and help to access clinical appointments. The Council subsequently increased this to 33 hours per week temporarily.
22. Care staff at the supported living placement were also supporting Miss D to apply topical creams to her legs. In April, the Care Quality Commission (CQC) advised the placement that it would no longer be able to do so as staff were not registered to provide this care.
23. The Trust’s psychology service declined a referral for Miss D for psychological therapy in July. It said there was no clinical basis for this therapy. Nevertheless, it placed Miss D on a waiting list for a full review.
24. During this period, Miss D told her social worker she would prefer to be placed in her own accommodation or a specialist nursing placement. However, the Council concluded the supported living placement was meeting Miss D’s needs.
25. In early November, Miss D’s social worker visited to discuss her care. Miss D raised concerns that she was not receiving psychological therapy from the Trust. In addition, she said she was not being provided with a driver to take her on trips to visit family.
26. In December, Miss D’s social worker went on sick leave. In the meantime, Miss D remained in contact with the Council’s duty team.
27. The Council allocated Miss D a duty solicitor in March 2024 as her original social worker remained absent from work. The social worker completed a review in May. The review recommended a five hour reduction in Miss D’s care hours. This left Miss D with 28 hours of support per week.
28. The following month, the Council allocated Miss D’s case to another social worker. The social worker completed a section 117 review in late August. The supported living placement manager advised that Miss D was only using around 12 hours of her weekly support to meet her identified needs. The manager said Miss D was using the remainder to get care staff to complete unrelated tasks.
29. The social worker then completed a fresh Care Act assessment. The social worker recommended a reduction in Miss D’s care hours to 21 hours per week, with the arrangement to be reviewed in six months.
30. Miss D was unwilling to work with the social worker any further and the Council reallocated the case again in January 2025.
31. Later that month, Miss D began a six-month course of psychological therapy.

My analysis and findings

Section 117 and care hours

32. Miss D complained that the Council, Trust and ICB failed to provide her with the section 117 services to which she is entitled because of her detention. Miss D also complained that the Council reduced her care hours inappropriately.
33. At the point of Miss D’s discharge from hospital, the multidisciplinary team had identified three key areas of need in terms of section 117 aftercare:

• support to access the community, with a view to increasing her independence;
• emotional support to promote her mental wellbeing; and
• assistance to maintain her home.

34. Miss D also had eligible care needs under the Care Act 2014. Miss D’s care plan set out that she needed support with her personal care, nutrition and mobility.
35. At the point of Miss D’s discharge from hospital in January 2023, she was in receipt of 28 hours of care per week. The Council subsequently supplemented this with a further five hours (33 hours in total) on a temporary basis to assist Miss D’s transition into the community.
36. The Code of Practice sets out that a person’s section 117 aftercare needs should be subject to regular review. The process of review is also an important part of the Care Act. This is to ensure that a person’s care needs, and how these will be met, are accurately reflected in their care plan.
37. The Council first reviewed Miss D’s care in June 2023. This was prompted by the fact that staff were no longer able to apply topical creams to Miss D’s legs. that the hours used for this task would no longer be needed. The social worker was satisfied Miss D was using the hours allocated to this task for other appropriate support. This included assistance with hospital appointments and social activities.
38. However, the social worker noted her plan to reduce Miss D’s support by five hours per week after six months. It is unclear whether the social worker made this plan clear to Miss D at that time.
39. The Council carried out a further review in May 2024 after the case had been allocated to a new social worker. The social worker recommended reducing Miss D’s support by five hours per week, in accordance with the previous social worker’s plan. This was to reflect that support staff no longer needed this time to apply the topical creams. This left Miss D with 28 hours of support per week.
40. In July, a social worker visited Miss D at the placement. The manager of the support staff raised concerns that Miss D was not using her care hours to meet her support needs. Rather, the manager said Miss D was asking staff to complete other, unrelated tasks.
41. This was considered further at a section 117 review meeting in August. A social worker then completed a fresh Care Act Assessment the following month. This found Miss D had increased in confidence since her discharge and no longer needed the same level of support. The assessing social worker recommended a further reduction to 21 hours of support per week to reflect this.
42. We cannot decide whether a person should receive care services. Nor can we determine the nature, or level, of care a person does receive. This is a matter of professional judgement for the health and social care professionals supporting that person.
43. I am satisfied the case records show the Council and Trust conducted regular reviews of Miss D’s care needs. These reviews incorporated extensive input from Miss D and her mother, who sometimes acted as her representative. The Council then revised Miss D’s care and support plan accordingly to reflect changes in her needs and presentation. This was in keeping with the requirements of the Mental Health Act and Care Act, albeit I accept Miss D does not agree with the level of support she received during this period. I found no fault in relation to this aspect of Miss D’s care.

Social worker

44. Miss D complained that the Council failed to allocate her a new social worker for six months after her original social worker went on sick leave.
45. The Council acknowledged that there was a delay before it could allocate Miss D a new social worker. However, it said Miss D was supported during this period by the Council’s duty team and the wider multidisciplinary team.
46. Miss D’s social worker was absent from work from around December 2023. The Council did not allocate a new social worker to the case until May 2024. This was a delay of around five months.
47. The case records show Miss D contacted the Council in February and March 2024. In February, Miss D said she was experiencing problems with her accommodation and obtaining transport to visit relatives. The Council’s duty team explained that Miss D’s concerns around transport had been escalated to the management team for consideration.
48. In March, Miss D reported that she was experiencing problems with her feet and hands. The duty social worker advised Miss D to contact her GP, as this was a physical health issue. In addition, Miss D said she was having problems with a neighbour. The duty team advised Miss D to contact her landlord regarding her concerns.
49. In summary, there was a delay before the Council was able to allocate a new social worker. However, I am satisfied Miss D had access to support via the Council’s duty team during this period. I found no fault on this point.

Accommodation

50. Miss D complained that the organisations involved in her care placed her in unsuitable accommodation with staff that cannot meet her complex needs. Miss D said the staff at the placement were unable to support her with her physical health needs.
51. In response to my enquiries, the Council said Miss D was involved in the decision to place her in supported living and that the placement was in an area she had chosen.
52. The case records from December 2022 record that Miss D would prefer a retirement village. However, the Council explained that Miss D would be too young for this type of placement. The Council instead identified a suitable supported living placement and Miss D agreed to the move.
53. Over the next month, Miss D’s social worker spoke with her and her mother on several occasions to discuss her concerns about the move. By the end of February 2023, the social worker noted Miss D was “upbeat and happy” to be in the flat. At that stage, Miss D’s social worker was assisting her to move her specialist bed and associated equipment to the property.
54. However, In April, Miss D was informed that staff would no longer be able to apply cream to her legs as they were not registered with the CQC to provide personal care. This led Miss D to become concerned that the placement would break down. Miss D said a nursing home placement would be more appropriate.
55. Later that month, Miss D’s social worker visited her at home. The social worker suggested that a GP or district nurses could apply the creams. As an alternative, the social worker also suggested arranging separate home visits to allow care workers to apply the creams. Miss D refused these options.
56. Over the coming months, Miss D continued to send emails of complaint as she remained of the view the placement was not suitable for her. This included raising concerns about some of the placement staff and problems with transport.
57. The case records show staff at the placement were supporting Miss D appropriately, although she found it more difficult to work with some staff than others. I accept that, because of CQC intervention, placement staff could no longer apply the topical creams. However, Miss D declined alternative interventions suggested by the social worker.
58. There is evidence to show that occasional care calls were missed or shortened due to staff availability. This was exacerbated as Miss D refused to work with some members of staff. Nevertheless, I am satisfied the evidence shows care staff were meeting Miss D’s daily care needs overall.
59. With regards to her physical and mental health needs, Miss D is registered with a GP, is now receiving psychological therapy and has an allocated care coordinator from the Trust.
60. In summary, I found no evidence to suggest the placement is unsuitable to meet Miss D’s needs, albeit I accept Miss D disagrees. I found no fault on this point.

Psychological therapy

61. Miss D complained that the Trust failed to provide her with the psychological therapy she needed.
62. The case records show Miss D was receiving weekly psychological therapy sessions for several years prior to her discharge from hospital. She was keen to recommence these sessions following her discharge.
63. The clinical records show Miss D discussed this possibility with her Trust care coordinator in March 2023. Miss D’s care coordinator agreed to make a referral for her to the Trust’s psychological therapy service and subsequently did so. The care coordinator also advised Miss D that she could use the mental health crisis line if necessary.
64. However, in July, the psychology service declined the referral as it said there was no clinical basis for psychological treatment in Miss D’s case. Miss D’s care coordinator asked her to explain what she was hoping to achieve through therapy so she could explore alternatives. However, Miss D refused to do so.
65. The records show evidence of a dispute between Miss D and the psychology service as to whether psychological therapy would be appropriate for her. Miss D made clear her view that she had found therapy beneficial as an inpatient. However, the psychology service concluded there was no clinical basis for therapy in Miss D’s case. This was ultimately a matter of clinical judgement for the professionals involved. I am satisfied the Trust appropriately considered Miss D’s request for psychological therapy at that time.
66. Nevertheless, as the dispute remained ongoing, the Trust added Miss D to its waiting list for a full review by the psychology service. Miss D’s care coordinator informed her the waiting time was around 14 months.
67. In October and November 2024, Miss D attended a series of appointments with the psychology service to establish whether she was suitable for psychological therapy. The psychologist agreed to commence a six month course of therapy beginning in January 2025. This was intended to increase her confidence around her ability to manage in the community.
68. The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 (the Regulations) set out expectations for NHS waiting times in England. Regulation 45 sets out that 92% of patients should start treatment within 18 weeks of being referred to a consultant-led, non-emergency service. However, this is a target duty. There are times when, as in Miss D’s case, it is not possible to meet this duty due to pressure on a particular service. Nevertheless, I am satisfied the Trust appropriately informed Miss D there would be a delay before she could access the service.
69. In summary, I am satisfied the Trust properly considered Miss D’s request and arranged for her to receive therapy following a period of assessment. I found no fault by the Trust in this regard.

Transport

70. Miss D complained that the Council failed to arrange transport for her so she could visit family. Miss D said she had been promised transport as part of the agreement for her to move to the placement. Miss D said she should not have to pay costs associated with the transport.
71. The Council said it had advised Miss D on discharge that staff at the placement would be able to support her to visit relatives. However, it said Miss D would have to pay any petrol costs. The Council said it had explored the possibility of placing Miss D closer to her family but that she wished to remain in her current area of residence.
72. Miss D is in receipt of the mobility component of PIP. This payment can be used to pay for certain travel costs, such as taxi fares. However, it cannot be used to pay for petrol.
73. The case records show there were staff at the placement who could drive Miss D to appointments or to visit family. However, Miss D was required to pay the cost of the petrol for these trips.
74. Miss D spoke to a social worker about transport in February 2023. The social worker noted Miss D “has agreed to paying for petrol when visiting her Mum as this would be cheaper than paying for a taxi.”
75. Miss D raised concerns about the transport situation in November after a member of staff who sometimes drove her left the service. Miss D reported that she did not like being supported by the other two staff members at the placement who could drive.
76. Later that month, Miss D complained that she should not have to pay petrol costs and that these should be paid by the Council. A social worker advised that Miss D would remain liable for petrol costs as agreed. She noted “social care or health won’t pay towards costs for petrol, all individuals have to manage those finances personally.”
77. Miss D remained dissatisfied with this arrangement and raised it again at a care review in July 2024. A social worker reiterated to Miss D’s mother that Miss D could be transported by staff but would still need to pay petrol. Alternatively, it was open to her to use her PIP to pay for taxis.
78. Miss D continued to raise this as a concern over subsequent months.
79. The evidence I have seen shows Miss D was offered various transport options. The first of these was the option to be taken to appointments or on visits to family by staff at the placement. This was not always possible as there was a limited number of staff who could drive, some of whom Miss D was unwilling to work with.
80. When transported by staff, Miss D was expected to pay for petrol. This is an everyday expense that is not specific to a person’s disability. For this reason, the Council had no duty to pay these costs.
81. Alternatively, it was open to Miss D to pay for taxis using her PIP payments. The care records suggest she was unwilling to do so due to the cost of these journeys.
82. It was also open to Miss D to utilise public transport with staff support to attend hospital appointments.
83. Taking everything into account, I am satisfied the evidence shows the Council offered Miss D appropriate transport options. I found no fault on this point.

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Decision

84. I found no fault by the Council, Trust and ICB with regards to the care and support they provided to Miss D.
85. I have now completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman