Summary: We do not consider Peterborough City Council acted with fault when it arranged Mr D’s Section 117 aftercare from Availl Huntingdon. While the Council acted with fault when it communicated the end of that care package, it has remedied the injustice to Mr D and his father, Mr C. Also, Availl did not act with fault in the way it supported Mr D.

The complaint

1. Mr C complains on behalf of his son, Mr D, about Peterborough City Council (the Council), NHS Cambridgeshire & Peterborough Integrated Care Board (the ICB) and Availl Huntingdon (Availl). He says:
• The Council hastily commissioned Availl to provide his son’s Section 117 aftercare and support, meaning Availl did not properly assess his needs.
• Availl (jointly commissioned by the Council and ICB) did not meet Mr D’s needs between January and July 2024, which was not safe.
• The Council failed to tell him Availl cancelled its support in July 2024.
2. Mr C said his son’s mental and physical health suffered due to the actions of Availl and the Council. Mr C also said he had to pick up a lot of the support, leading to carer burden.
3. Mr C would like the organisations to apologise, make a payment to reflect the impact they have suffered, improve their local procedures and provide training to staff.

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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. The Ombudsmen 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) If it has, we 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.
6. 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. 
7. 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))
8. 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

9. I considered evidence provided by Mr C and the organisations as well as relevant law, policy and guidance.
10. Mr C and the organisations had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Relevant legislation and guidance

Section 117 of the Mental Health Act 1983

11. Section 117 of the Mental Health Act imposes a duty on councils and NHS Integrated Care Boards to provide free aftercare services to people who have been detained in hospital under certain sections of the Mental Health Act. These free aftercare services are limited to those arising from or related to the person’s mental disorder, to reduce the risk of their mental condition worsening and the need for another hospital admission for their mental disorder.
12. In this case, the Council and ICB were jointly responsible for commissioning Mr D’s section 117 aftercare. We also consider Availl was an NHS-funded provider of Mr D’s aftercare services. This is because, under the Health Service Commissioners Act 1974, the Parliamentary and Health Service Ombudsman has the power to investigate and find fault with both the commissioner and the provider of NHS-funded care. For these reasons, we have investigated the Council, ICB and Availl.

The Council’s commissioning arrangements

13. Typically, when sourcing care and support packages (including for Section 117 aftercare) the Council would rely on its Home and Community Support Services (HCSS) contract. That contract has less than 15 registered providers available to support people in the Peterborough area.
14. But the Council commissioned Availl using the Dynamic Purchasing System (DPS) which is overseen by another council. It gives the Council access to a wider range of providers when it cannot successfully identify a provider using the HCSS contract.

What happened

15. In late 2023, the Council started exploring a new package of Section 117 aftercare for Mr D. It recommended Availl could support him and arranged for Availl to assess Mr D in January 2024.
16. Availl completed its assessment on 5 January and started supporting Mr D a few days later. Availl provided 12 hours support every day with the aim to improve Mr D’s independence skills. Those skills would help him move into his own home. Availl noted Mr D needed support preparing meals, changing his bedding, helping maintain the home and to go on walks and trips outside the home.
17. In January and February, Mr C said staff were proactive and supportive. However, Mr C detailed concerns about the number of new carers. He said he needed to explain the detailed house rules and Mr D’s preferences each time.
18. By early March, Mr C had started refusing new carers attending the home and cancelled care shifts without explanation. Following a care review with the Council and Availl, all parties agreed to keep the care in place.
19. In March and April, Mr C cancelled care shifts more regularly. The Council recommended Availl induct any new carers with an established carer. Mr C agreed with that approach. Availl said that was difficult to plan for when Mr C would cancel care shifts with short notice.
20. In late April, the Council carried out another care review. Mr C and Mr D agreed to keep the care in place and discussed activities outside the home to improve Mr D’s confidence.
21. By May, carers were mainly supporting Mr D on reduced hours on and around weekends. The last day carers supported Mr D was on 12 June. Mr C cancelled all care after then.
22. From June, the Council and Availl discussed the Section 117 aftercare package and how sustainable it was. Then on 12 July, Availl served notice to the Council, and would end its support 28 days later.
23. On 15 August, Availl emailed Mr C and confirmed it had ended Mr D’s support.

What I found

The Council’s commissioning of Availl

24. In response to my enquiries, the Council said five providers made offers to support Mr D under the HCSS contract. However, for different reasons they could not support him. That was mainly because Mr C and Mr D were away in early January 2024 so the providers could not discuss their suitability to support Mr D. When Mr C and Mr D returned, the providers no longer had capacity to support Mr D. So the Council used the DPS to commission Availl to support him.
25. I do not consider the Council acted with fault in the way it commissioned Availl to support Mr D. I will explain why.
26. Mr C says the decision to commission Availl was financially led. I have reviewed the Council’s evidence, and there is no evidence to support Mr C’s view. The Council has been transparent with me in explaining how Availl came to support Mr D. I have not seen any evidence the cost of Availl’s support was a factor in the Council’s decision to arrange that support.
27. I consider the Council decided Availl was a suitable provider based on the quality of its previous performance and ability to meet Mr D’s needs. The Council correctly shared a copy of its latest assessment and care and support plan with Availl, who then decided they could meet those needs. I consider the Social Worker accurately captured Mr D’s needs and had supported him for a significant time previously (nine months). That Social Worker also spoke with Availl at length a few weeks before they agreed to support Mr D. While I can understand the process may have felt quick to Mr C and Mr D, Availl had been working with the Council a few weeks earlier than the assessment in January 2024.
28. I do not consider the Council acted with fault in the way it decided Availl could support Mr D’s section 117 aftercare needs.
29. I have not found fault with the ICB in this complaint, considering its joint duty to commission section 117 aftercare. That was because the Council took the lead in arranging Mr D’s support.

Availl’s care and support to Mr D

30. Mr C has fundamentally said Availl did not meet Mr D’s care and support needs. So, in his view, it’s support was not safe, not person-centred.
31. I have reviewed Mr D’s care plan, Availl’s daily care notes and the Council’s care records from 2024.
32. The daily logs show that carers:
• Tried to engage Mr D around mealtimes and prepared food for him. Carers regularly noted when Mr D refused or did not engage with them. They also recorded how Mr C would advise them how to prepare certain dishes to Mr D’s liking. There were many occasions when Mr C decided to cook for his son himself.
• Regularly changed Mr D’s bedding, hoovered, tidied and washed up after meals.
• Regularly took Mr D into the town centre for walks. Carers also accompanied Mr D on trips further away to London and Cambridge. While these activities did not happen in January 2024, I consider that was most likely because staff were building their relationship with Mr D, before they left the house with him.
33. I consider Availl acted in line with Mr D’s care plan and did not act with fault.
34. Mr C says Availl’s support was not autism appropriate. Aside from the daily care of Mr D, I have considered if Availl’s staff were suitably trained to support Mr D’s complex needs, including his autism. I am satisfied they were. Availl has shared evidence its staff attended a specific training course (Oliver McGowan Mandatory Training) to understand how to safely support people with autism and learning disabilities before it started to support Mr D. It also held mandatory training with staff in areas such as managing conflict behaviour and mental health first aid. I have also seen evidence the Council was assured Availl’s staff had the appropriate training. I consider Availl showed good practice to ensure its staff received training to manage Mr D’s complex needs.
35. Availl clearly struggled to provide the support it hoped to improve Mr D’s independence skills. I consider that was due to factors outside its control – Mr C cancelling care shifts and Mr D’s lack of engagement with carers. The evidence from the time showed those organisations made efforts to induct new carers to reduce the burden on Mr C, and in turn decrease the cancelled care shifts. There was no fault on Availl or the Council’s part.

The Council’s communication about Availl

36. In response to my enquiries, the Council said in July 2024, Availl had concerns about the sustainability of Mr D’s care and support because Mr C was regularly cancelling support, and Availl were not getting paid for those occasions. Then on 14 August, Availl confirmed it would end it support.
37. I have reviewed the Council’s correspondence with Availl in July and August 2024.
38. Availl were clear on 12 July 2024 they were serving notice to end Mr D’s package. They repeated that on 24 July. I have not seen any evidence the Council confirmed it accepted the notice. But I can see Mr D’s new Social Worker planned to discuss Availl’s decision, and future care and support on 2 August. That meeting did not happen, and the first time Mr C and Mr D were aware Availl had ended Mr D’s care package was on 15 August when Availl emailed Mr C.
39. I consider the Council should have better communicated Availl’s decision to end the care package to Mr C. That was fault. While the Council and ICB have the statutory duty to commission Mr D’s section 117 aftercare, the Council clearly took the lead sourcing the care package. Therefore, I consider the Council were solely responsible for communicating Availl’s decision to Mr C. Availl did not support his son in July and August 2024, but I understand the Council’s lack of communication would have caused Mr C uncertainty.
40. The Council has already accepted this fault and apologised to Mr C, which appropriately remedies Mr C’s uncertainty. Therefore, I do not consider the Council needs to take more action.

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Decision

41. I find no fault with how the Council decided Availl could meet Mr C’s needs, or how Availl supported those needs. While the Council’s communication about the end of Availl’s care was fault, it has appropriately remedied the injustice to Mr D.

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Investigator's decision on behalf of the Ombudsman