Summary: Ms X complained about a failure to complete a s117 aftercare plan before she left hospital or after she returned home. We found fault that a council and an NHS trust did not complete a s117 aftercare plan. This caused Ms X stress and frustration which is an injustice. Further, we found fault in the way the Trust handled Ms X’s complaint which caused more injustice. The council and NHS trust agreed to apologise, take corrective action and make financial payments to address the injustice.

The complaint

1. Ms X was detained in an NHS hospital, under section 3 of the Mental Health Act 1983 (the MHA), in June 2023.
2. Northamptonshire Health Care NHS Foundation Trust (the Trust) is responsible for the services provided by the hospital. West Northamptonshire Council (the Council) and Northamptonshire Integrated Care Board (the ICB) are responsible for providing the aftercare Ms X is eligible for under section 117 (s117) of the MHA.
3. Ms X complains:
1. the Trust failed to arrange care for her during periods when she was on leave from the ward;
2. the Trust failed to complete a s117 aftercare planning meeting before she left hospital, and did not provide her with a care plan. Ms X also said the Trust did not provide any explanation of why it had not addressed her aftercare needs or produced a care plan; and,
3. a s117 aftercare planning meeting still had not taken place at the time of her complaint, around a year and three months since she left hospital.
4. Ms X also complained:
1. about significant delays in the Trust’s complaints process,
2. the Trust’s complaint responses:
1. did not answer her questions about s117;
2. did not result in a s117 meeting; and,
3. falsely claimed that a s117 meeting had taken place.
5. Ms X said because of the failings she remained without a s117 aftercare plan. Ms X said the lack of a suitable aftercare plan contributed to her attempt to end her own life in August 2023. Ms X also said she was also unable to return to university. Further, Ms X said these experiences had caused her to lose faith in the NHS and she no longer seeks health care. Also, Ms X said these failings had an impact on her family as they had watched her mental health worsen, and Ms X’s mother had to become her carer.
6. Ms X said the Trust’s poor complaint handling had worsened her mental health and left her without answers or acknowledgements of failings.
7. In bringing her complaint to the Ombudsmen Ms X said she would like:

• the organisations to put a suitable s117 aftercare plan in place,
• an acknowledgement that the Trust failed to handle her complaint adequately,
• an apology for the failings,
• changes to relevant procedures, and
• a payment of £3,700.

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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 considered the written submissions Ms X sent to the Ombudsmen. I asked questions of the Council, the ICB and the Trust and I considered the answers and supporting information they provided. I considered relevant law, policy and guidance.
16. I sent a provisional decision to Ms X, the Council, the ICB and the Trust and invited their comments on it. I considered all their responses before making a final decision.

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What I found

Legislation and guidance

The Mental Health Act 1983

17. Under the MHA, 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. Section 3 of the MHA empowers doctors to detain a patient for a maximum of six months at a time.
18. Whilst detained the person may be able to leave the hospital if authorised by the clinician in charge. This is known as section 17 leave.
19. 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.
20. S117 aftercare services must meet a need arising from, or related to, that person’s mental condition. The aim of aftercare services is reduce the risk of the person’s mental condition worsening and thereby reduce the risk of further hospital admissions.
21. 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. The Code encourages local authorities and ICBs to “interpret the definition of after-care services broadly”. (Section 33.4 of the Code)
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)

Brief overview of relevant events

23. In the spring of 2023 Ms X voluntarily admitted herself to a privately funded mental health hospital, outside of her home area. Around a month-and-a-half later an approved mental health professional (AMHP) from the private hospital’s local area assessed Ms X under the MHA. The AMHP recommended Ms X be detained under s3 of the MHA.
24. Ms X remained in the private hospital, now as a formally detained patient. On the following day the private hospital contacted the Trust to request it accept Ms X into its care. Ms X moved to a Trust hospital in the middle of June 2023.
25. There was a treatment planning meeting several days later. A doctor noted Ms X wanted a s117 aftercare plan that would provide her with all the therapy and support she had at in the private hospital. Namely, a programme of therapy, medication, mindfulness and trauma therapy. Ms X said she had been having interventions for three months and did not want to go on an NHS waiting list for the same type of therapy. Ms X said she wanted her s117 plan to include an agreement to commission the relevant therapy from a private organisation.
26. After speaking to Ms X, a consultant agreed she would remain detained under the MHA but would have periods of unescorted home leave.
27. A discharge meeting took place eight days after Ms X entered the Trust hospital. The hospital rescinded Ms X’s detention and discharged her from hospital in the following days. She did not have a s117 aftercare plan when she left.
28. A keyworker from one of the Trust’s Community Mental Health Teams (CMHT) saw Ms X weekly after she returned home. At times, when Ms X’s mental health deteriorated, staff from the Trust’s Urgent Care and Assessment Team (UCAT) saw her daily. Twice during August 2023 Ms X deliberately took an overdose of prescription medication which led to admissions to hospital emergency departments.
29. Throughout Ms X’s time under Trust community services she maintained that the only thing that would help her was trauma therapy at the private hospital. The Trust said it could not refer her to the private hospital. It also decided that it was too soon to offer therapy via its own psychology services. It did not change its view that Ms X needed to complete stabilisation work first. (Stabilisation work is a preliminary form of trauma therapy. It focuses on building coping skills to give people strategies to navigate daily life without the need to relive traumatic experiences).
30. Ms X returned to university in another part of the country in January 2024. Trust community staff continued to see her until that time. The Trust then discharged Ms X from its services.

Complaints process

31. Ms X first made a complaint toward the end of her admission to the Trust hospital. The Trust replied in August 2023 and Ms X made a follow-up complaint just over a month later. The Trust replied to that in mid‑January 2024. Following unsuccessful attempts to arrange a meeting Ms X asked for clarification about several issues in May 2024. The Trust sent a written response in mid‑January 2025.
32. In its responses the Trust:

• said that, during Ms X’s periods of unescorted leave, it had provided appropriate and proportionate support,
• acknowledged that, during Ms X’s time in its care, “there were some unanswered questions about how the funding of your [s117] aftercare would be provided at this time”. The Trust said it took until mid‑July 2023 to resolve who was responsible for funding Ms X’s s117 aftercare. However, the Trust said the funding dispute had not impeded its ongoing assessment of Ms X’s needs and the support she required,
• acknowledged the need to hold s117 meetings before it discharges a patient. It also acknowledged that guidance says that discharge planning should start from the point of admission,
• acknowledged that:
• its discharge paperwork “did not fully meet your needs on this occasion”,
• Ms X “did not receive Section 117 guidance, discussions, or input into formal planning, prior to 18 July 2023”, and
• if staff had had a conversation with Ms X, they could have provided her with relevant information about the next steps for her care in the community,
• said the plan it produced at the time of Ms X’s discharge “represented as comprehensive a plan as could be achieved given the constraints of an acute emergency psychiatric service and balancing the clearly negative effects of ongoing detention of a person that no longer required, or was benefiting from, hospital admission”,
• said, in August 2023, one of its CMHTs was in the process of assessing Ms X’s needs. It said it was meeting Ms X on a weekly basis for an ongoing assessment. The Trust said it remained committed to developing a support package that would meet her needs.

33. In the Council’s responses it did not identify any failings in its actions since the Trust referred Ms X to it. The Council said, in July 2023, since getting the referral its staff had spoken to Ms X on several occasions as the start of an assessment process. It said it was in the process of gathering information about what Ms X wanted to achieve and what support she felt would be helpful.

Analysis

Complaint (a) – that the Trust failed to arrange care for Ms X during periods when she was on leave from the ward

34. Section 27.10 of the Code provides guidance on what responsible clinicians should do when considering and planning leaves of absence. As well as considering relevant risks and benefits, along with the patient’s wishes, clinicians should also “undertake a risk assessment put in place the necessary safeguards”.
35. In addition, section 27.22 of the Code details that hospitals should have a standardised system of recording any leave they authorise along with any conditions attached to it. It says these authorisations should be given to the patient and others who need to know about it.
36. Also, section 33.2 of the Code says the relevant organisations are required to arrange s117 aftercare to patients detained under s3 “who then cease to be detained. This includes patients granted leave of absence under section 17”.
37. In correspondence with the Ombudsmen the Trust acknowledged there was no documented risk assessment before Ms X’s s17 leave. The Trust said it would have been good practice to have documented the clinical view of the level of risk before Ms X went on leave.
38. It is fault that the Trust did not properly record its risk assessments as well as its care and contingency plans, via an aftercare plan, before granting Ms X s17 leave. She had only recently been detained under s3 because of the risk of her attempting to end her own life. The level and type of risk involved warranted better record keeping.
39. The Trust said multi-disciplinary staff had seen Ms X before this leave and had considered her level of risk. The Trust also said that Ms X said she did not want any support from UCAT, and it said it gave her information about how to access its crisis services and how to contact the ward for support.
40. The Trust’s records support these comments. They provide evidence that staff were considering relevant risk factors and were thinking about how risks could be mitigated. The records also show that staff took account of Ms X’s wishes and views when deciding on its plans. Ms X did not come to any harm while she was on s17 leave. As such, while the lack of proper documentation was a failing, I have not seen evidence which links this to an injustice to Ms X.

Complaint (b) – that the Trust failed to complete a s117 aftercare planning meeting before Ms X left hospital, and did not provide her with a care plan

41. In the Code:

• Section 33.10 notes that “the planning of after-care needs to start as soon as the patient is admitted to hospital”. It says the relevant staff and commissioners should take reasonable steps to identify appropriate aftercare services for patients in good time for their discharge.
• Section 33.13 says that, before discharging someone, the responsible clinician “should ensure that the patient’s needs for after-care have been fully assessed, discussed with the patient…and addressed in their care plan”. It continues that “the arrangements for the patient’s care should…be properly recorded”.
• Section 33.14 says that it is important “that records are kept of what is provided to” patients entitled to aftercare under s117.

42. Ms X left hospital without a s117 aftercare plan. This is fault because it is not in line with the relevant guidance. The fault at this stage lies with the Trust. The Council and the ICB share responsibility for ensuring Ms X receives appropriate aftercare. However, at this time the Trust had not told either organisation that Ms X was eligible for s117 aftercare.
43. The Trust told us it appeared that “a decision was made to prioritise [Ms X’s] discharge to the community over arranging a further s117 meeting which would have delayed discharge.” In relation to this it is notable that Ms X’s admission to the Trust was short and that she spent a considerable amount of time away from the ward on leave. The records also show that Ms X was clear in her views that she did not want to be on the ward and considered it to be detrimental to her mental health. There is, therefore, some support for Trust’s decision to prioritise getting Ms X out of hospital above completing a s117 meeting and plan.
44. However, there is evidence to show that professionals had given some consideration to Ms X’s needs and risks. As such, on balance, the Trust should have completed a s117 plan of some description at the time Ms X left hospital. It could have formally documented the decisions to request a social care assessment and to offer support from the CMHT. It potentially could also have documented any decision the Trust had made about what it would not support or pursue, contrary to Ms X’s requests. Further, it could have noted that the plan was subject to review pending more detailed assessments of Ms X’s needs in the community.
45. The absence of any form of s117 plan at the point of discharge meant Ms X was left with uncertainty. It also meant she was without anything “concrete” which she could challenge or appeal. The contemporaneous records from the weeks and months after Ms X returned home show, clearly, that this lack of clarity was a source of considerable frustration for her. This is an injustice.

Complaint (c) – that a s117 aftercare planning meeting still had not taken place at the time of Ms X’s complaint, around a year and three months since she left hospital

46. As noted in section 33.6 of the Code, the duty on local authorities and ICBs to provide aftercare services “continues as long as the patient is in need of such services”. In order to help manage the ongoing nature of aftercare, and the necessary reviews, section 33.7 of the Code sets out that local authorities and ICBs “should maintain a record of people for whom they provide or commission after-care”.
47. In correspondence with the Ombudsman:

• the Trust said “There didn’t appear to be any documents regarding the S117 aftercare”. The Trust said it could not explain why there are no papers,
• the Council told us it closed its file on Ms X in March 2024 and it does not know if she remains eligible for s117,
• the ICB said it has no record of having been informed – by either the Council or the Trust – of Ms X’s eligibility for s117 aftercare,
• the Trust also said it did not make any documented requests to a local authority or an ICB for their involvement in completing a s117 review in the community.

48. There was fault here on the part of the Trust and the Council. First and foremost, having failed to complete a s117 aftercare plan before Ms X left hospital, services should have completed one when Ms X returned home. By early July 2023 both the Trust and the Council knew Ms X was eligible for s117 aftercare. As noted in paragraph 46, there are numerous entries in Ms X’s care records which clearly document her wish to have a s117 aftercare plan.
49. As well as working on a s117 aftercare plan, both the Trust and the Council should have checked that the ICB was aware of Ms X’s eligibility. The ICB shares a statutory duty to meet Ms X’s s117 needs but it could not fulfil that duty if it did not know about her. Further, it is fault that the Council does not know if Ms X remains eligible for s117 aftercare. It has a statutory responsibility to keep track of this and keep it under review until it is confirmed that Ms X is no longer eligible.
50. A properly created plan would have been able to set out, in clear terms, what support the Trust and the Council were proposing to provide for Ms X, and which aspects would be provided through s117. It would also have allowed services to be clear about they would not or could not provide. This, in turn, would have given Ms X greater clarity.
51. It is not for the Ombudsmen to decide what should or should not be in any person’s care plan. These are decisions for appropriately qualified professionals to make. Throughout the period under review Ms X was clear about what she felt should be included in her s117 aftercare plan. I cannot say that, even with a formal s117 plan, the organisations would have included the support she wanted. There is evidence in the case notes to show that Trust staff had regular contact with the Ms X from the time she left hospital until she went to university. During that time a variety of professionals considered Ms X’s needs and decided it was too soon to offer psychological, therapeutic interventions. There is evidence to show they made this decision after considering Ms X’s history and having spoken to her directly. Overall, even on the balance of probabilities, I cannot say if Ms X would have been provided with different support had a s117 aftercare plan been put in place. Further, I cannot say if Ms X’s mental health would have been more successfully helped. There are too many variables and unknowns to be able to be able to say what would have happened without the fault. Nevertheless, it is evident that the uncertainty alone was a cause of distress and frustration to Ms X and this, in and of itself, is an injustice.

Complaint (d) – that there were significant delays in the Trust’s complaints process

52. The Trust responded to Ms X’s initial complaint 31 working days after she made it. That was an acceptable time and does not represent fault.
53. After Ms X made a follow-up complaint it took the Trust 80 working days to respond. That was too long and is fault.
54. Following the second response an advocate representing Ms X contacted the Trust to raise outstanding concerns. The Trust scheduled a meeting to take place within an adequate time. However, it cancelled this meeting several days before it was due to take place. The Trust and Ms X exchanged correspondence about possible alternative dates over the next couple of months but they were unable to find a mutually convenient time.
55. At the end of May 2024 Ms X sent detailed email to the Trust and asked for clarification about a number of matters. The Trust sent her a written response in January 2025, 164 working days later. Again, this is too long and is fault.
56. These delays caused Ms X further, avoidable frustration and stress. This was a further injustice to Ms X.

Complaint (e) – that the Trust’s responses to Ms X’s complaint were inadequate

57. The Trust’s complaint responses were open about several shortcomings and attempted to explain some things. However, they did not identify the lack of a s117 aftercare plan as a significant omission and did not seek to put that right. The complaints process should, first and foremost, seek to put people back into the position they should have been. It should be an open and transparent process where shortcomings and failings are accepted and addressed. This did not happen in this case and this is further fault. This exacerbated the injustice Ms X experienced because of the delays in the complaints process.

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Agreed actions

58. Within one month of the final decision the Trust, the Council and the ICB should arrange a suitable meeting to consider Ms X’s ongoing eligibility for s117 aftercare and, if necessary, to create an appropriate s117 aftercare plan. The organisations should also check and ensure that Ms X is properly recorded in their databases and that, if necessary, her case will be appropriately flagged for review at suitable times.
59. Within one month of the final decision the Trust and the Council should both, individually, write to Ms X to acknowledge their part in the fault which occurred and to apologise for the injustice it caused Ms X. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisations should consider this guidance in making their apologies.
60. Within two months of the final decision the Council should pay Ms X £300 as a tangible, symbolic recognition of the impact of its fault, in terms of the avoidable stress and frustration she experienced due to the lack of a s117 aftercare plan.
61. Within two months of the final decision the Trust should pay Ms X £500 as a tangible, symbolic recognition of the impact of its fault: in terms of the avoidable stress and frustration she experienced due to the lack of a s117 aftercare plan; and, due to the fault in its complaint handling.
62. Within three months of the final decision the Trust and the Council should both review this case – either independently or collaboratively – as a learning tool, with a view to making specific, measurable and realistic service improvements. The Trust and the Council should also consider involving the ICB if this would help to create more robust and effective improvements.

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Decision

63. I find fault causing injustice. The Trust and the Council failed to create a s117 aftercare plan for Ms X, or involve the ICB. This caused Ms X avoidable stress and frustration. Further fault in the complaints process by the Trust caused Ms X further frustration. I recommended action to address the lack of a s117 aftercare plan, along with apologies and symbolic payments to address her injustice. In addition, I recommended work be done to learn from the case and improve working practices. The organisations agreed to these recommendations and I have, therefore, completed and closed this investigation.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman