Summary: We found fault by Norfolk County Council and Norfolk and Suffolk NHS Foundation Trust in how they handled Ms X’s section 117 aftercare and her requests to be discharged from mental health services. We also found fault with their delay in arranging a section 117 aftercare meeting for Ms X. These organisations will apologise to Ms X and pay her a financial remedy. They will also take action to prevent similar problems occurring in future.

The complaint

1. Ms X is complaining about the care and support provided to her by Norfolk County Council (the Council), Norfolk and Suffolk NHS Foundation Trust (the Trust) and NHS Norfolk and Waveney Integrated Care Board (the ICB).
2. Ms X complains that these organisations delayed in discharging her from the health provision set out in her section 117 aftercare plan. Ms X says they also failed to carry out regular section 117 review meetings and provided her with information that was incorrect. Ms X says she was placed on ‘team hold’ by the Trust and left without appropriate care and support.
3. Ms X says she was left without care when she was very unwell and that this caused her great distress. She also says she has lost trust in the services supporting her as they have provided her with inaccurate information for so long. Ms X says she has been required to pay for private psychotherapy services that should have been provided by the Trust.

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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 takes action to stop the same mistakes happening again.
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 Ms X and discussed the complaint with her. I also considered relevant records and information provided by the Council, Trust and ICB. I took account of relevant law, policy and guidance.
10. The Trust and Council provided Ms X’s day to day care. However, the ICB shares the statutory duty to provide or arrange section 117 aftercare services for Ms X. For this reason, the ICB is also included within my investigation.
11. All parties had an opportunity to comment on my draft decision. I considered the comments I received before making a final decision.

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What I found

Relevant legislation and guidance

Mental Health Act 1983

12. 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’.
13. A detention under section 3 of the MHA is for the purpose of providing treatment. 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.
14. The Code of Practice that accompanies the MHA (the MHA Code) sets out that a person’s section 117 aftercare needs should be clearly recorded in their care plan and subject to regular review.
15. The MHA Code 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 is being provided.

Discharge policy

16. The Trust produces a document entitled ‘Discharge from Trust Service’ (the Discharge Policy). This sets out the process staff should follow when discharging someone from secondary mental health services.
17. The Discharge Policy says that the service user should be at the centre of any discharge decision. In addition, the multidisciplinary team should ensure any agencies that will be supporting the service user after their discharge are involved in the discharge planning process.
18. The Discharge Policy says the discharging service should share all relevant information (such as a discharge summary) with the service user’s GP within a week of the discharge taking place. It goes on to say that “[i]f the service user is to remain under S117 the service user and their family/carer (as appropriate) should be given a copy of the Care Plan, Risk Assessment and Core Assessment.”

Background

19. Ms X is entitled to section 117 aftercare services having previously been detained under a qualifying section of the MHA. Responsibility for providing or arranging these services in Ms X’s case rests with the Council and ICB. The ICB commissions the Trust to provide mental health services on its behalf.
20. Ms X was under the care of one of the Trust’s Community Mental Health Teams (CMHT). The clinical records show Ms X had received various diagnoses over her years under the care of the Trust.
21. Ms X had an allocated care coordinator. The Trust’s clinical team also trialled her on various medications. However, Ms X reported adverse side effects and was unable to take regular medication.
22. In addition, Ms X received four hours of domiciliary care visits per week through the Council. This was to support her with activities of daily living.
23. In May 2022, Ms X attended a medical review with a CMHT clinician. By this point, her relationship with the CMHT had deteriorated to the point that the Trust decided to transfer her care to a different team.
24. Throughout June and July, Ms X continued to contact the Trust’s crisis service to report her dissatisfaction with her care. She regularly reported feeling hopeless and suicidal. Ms X told the Trust she would prefer to be discharged from mental health services entirely.
25. Ms X attended a section 117 review meeting in late July. Ms X reiterated her desire to be discharged from the care of the CMHT but said she wanted to remain under section 117 aftercare. Ms X’s care coordinator agreed to check whether this would be possible.
26. In the following year, Trust staff continued attempts to engage Ms X with treatment options. However, Ms X remained adamant that she wanted to be discharged.
27. In May 2023, Ms X contacted the Trust to emphasise that she wanted arrangements to be made for her next section 117 review meeting, which was due to take place in July 2023.
28. From late July 2023, the case records suggest significant confusion between the Council and Trust as to who was responsible for arranging a further section 117 review meeting.
29. In October 2024, Ms X’s support workers made a safeguarding referral to the Council as they were so concerned about her. This led the Council to contact the Trust with a view to arranging a review meeting.
30. The review meeting took place in December 2024. The meeting established that Ms X’s section 117 aftercare needs were primarily of a social care nature. It noted mental health services were available but not essential to prevent her readmission to hospital.
31. Ms X remained under Trust services at the time of her complaint to the Ombudsmen in January 2025.

My analysis and findings

32. In her complaint to the Trust, Ms X said she wanted to be discharged from secondary mental health services so she could seek alternative support. She explained that she was not taking medication and that other interventions from the Trust had been ineffective. Nevertheless, Ms X wanted to remain subject to section 117 as this allowed her to access social care support. Ms X complained that she was initially told this would be possible but then, after much delay, told it was not.
33. In its response, the Trust said it involved a senior officer in Ms X’s case with greater experience of the section 117 framework to deal with her request. However, the officer in question was then off work for an extended period. The Trust acknowledged this had delayed Ms X’s section 117 review meeting. The Trust said further delay had been caused by the Council’s adult social care service. The Trust said Ms X did not meet the criteria for discharge from section 117 and that it had decided instead to place her on the ‘team held’ list. This meant she remained open to the team but was not receiving active treatment.
34. The evidence I have seen suggests the Trust conflated two separate (albeit related) decision-making processes in this case. The first of these relates to whether it would be possible to discharge Ms X only from the health part of her section 117 entitlement. The guidance for discharge from section 117 services can be found in the MHA Code.
35. The other decision was whether Ms X needed to remain under the Trust’s secondary mental health services. The process for discharging a person from these services is set out in the Trust’s Discharge Policy. This policy allows for a person to be discharged from services while remaining subject to section 117.
36. I will first address the section 117 decision-making process. Sections 33.20 to 33.24 of the MHA Code deal with the process for ending a person’s entitlement to section 117 aftercare. The MHA Code sets out that the duty to provide or arrange section 117 aftercare rests with the local authority and ICB. The MHA Code is clear that both organisations must be satisfied that a person no longer requires those services before discharge can take place. The Trust is correct to say that a person cannot be discharged from one part of their section 117 provision, therefore. I find no fault on that point.
37. A person’s section 117 entitlement should be subject to regular review. This is to ensure that person’s aftercare needs (and how these will be met) are accurate and based on their presentation at that time. This may mean the services a person receives can change over time. The MHA Code allows for a person to be discharged from secondary mental health services while remaining subject to section 117 aftercare provisions.
38. It is not for the Ombudsmen to say whether a person should be discharged from care. This is a matter for the service user and the professionals involved.
39. The professionals involved in Ms X’s care convened a section 117 meeting in July 2022. This meeting was needed to consider whether Ms X still required section 117 aftercare to prevent a deterioration in her mental health and, if so, what specific services she would need.
40. The notes of the meeting in July 2022 show Ms X was keen to be discharged from the care of the CMHT. It concluded that Ms X’s care coordinator “will consult with her manager to check if she can be discharged from CMHT as well as to discuss the risks involved.”
41. However, I have seen nothing that would have prevented the Trust from discharging Ms X from the CMHT at her request, while she remained subject to section 117 aftercare. Ms X told the Trust on numerous occasions that she wished to be discharged from its secondary mental health services. I have seen no evidence to suggest Ms X lacked capacity to make decisions about her care. I also note the Trust’s Discharge Policy emphasises the importance of keeping the service user at the centre of any discharge decision.
42. Shortly after this meeting, Ms X’s care coordinator sent an email to colleagues regarding Ms X’s situation. Again, this suggested some confusion. The email stated that “[w]e have had a recent 117 and I discussed this in the team that we could discharge her from the Sec117 and keep her on with regards to social care…We felt that we should respect [Ms X’s] current wishes and discharge her from services”.
43. Over the following months, Trust staff made further efforts to engage her with care. Nevertheless, Ms X continued to advise Trust professionals that she wanted to be discharged.
44. Internal correspondence shows confusion remained about the status of Ms X’s care. In early November, an officer wrote that Ms X “had been discharged off the 117 from the health side of things”. This was incorrect.
45. In January 2023, Ms X a team manager spoke to Ms X. Ms X reiterated her desire to be discharged. The manager noted Ms X “wants to be discharged from the CMHT which we currently [can’t] do while she remains under S117.” Again, this was incorrect. The manager noted Ms X would need to discuss her discharge at a section 117 review meeting.
46. The following day, Ms X also contacted the Council with similar concerns. The Council officer noted Ms X’s frustration that she would need to wait for her next section 117 meeting, which was due to take place in July 2023.
47. Over the following months, there remained a pattern of contact from Ms X to the Trust’s crisis team. However, Ms X continued to report that mental health services were not working for her.
48. In March 2023, Ms X attended a psychiatric review with a consultant. This concluded Ms X should restart medication and therapy. However, by the end of the month this process had stalled.
49. The case records show Trust staff were aware of the need for a further section 117 review meeting “in the next few months”. Ms X continued to press throughout June for the meeting to be arranged. At the end of that month, a Trust officer noted “CMHT remains unaware of S117 meeting at this time, this is to be confirmed.”
50. In July, a Trust manager spoke to Ms X. He advised that, as Ms X’s recently allocated care coordinator was a Council officer, it would be for the Council to arrange a section 117 review meeting.
51. A Trust multidisciplinary team meeting discussed Ms X’s care in September. This does not appear to have led to any resolution in terms of arranging the review meeting, which was by this point overdue.
52. Ms X spoke to a Council officer later that month. This led the Council to email the Trust to ask it to arrange a review meeting. By October, the Trust appears to have been waiting for the Council to allocate a social worker to attend a review meeting. However, the Council was waiting for the Trust to arrange the meeting.
53. This situation had still not been clarified by July 2024, around nine months later. Ms X continued to receive contradictory information from the Council and Trust. The clinical records for this period make clear this was causing Ms X great distress and frustration.
54. The situation was not ultimately clarified until the Council received a safeguarding alert in October. The meeting then took place in December. This meeting established that, while clinical treatment options were available to Ms X, she did not require them to prevent a readmission to hospital.
55. I recognise this was a complex situation as the clinical records suggest Ms X did have mental health needs that would benefit from effective treatment. However, Ms X was unwilling or unable to engage with the offered services.
56. It is also important to be clear that Ms X had extensive contact with Trust services between January 2022 and December 2024. I am satisfied Ms X was not left without clinical support during this period, albeit she considered this support to have been of limited effectiveness. Ms X also continued to receive social care support throughout this same period. I found no fault by the Trust or Council in this regard.
57. However, it is of concern that there was so much confusion surrounding Ms X’s section 117 status and the possibility of her discharge from services. This confusion appears to have been shared by officers from the Trust and Council. It strongly suggests that policies and procedures in these areas were inadequate, or that officers were not familiar with them. This represents fault by the Council and Trust.
58. The situation was exacerbated by the long delay arranging a section 117 review meeting to discuss Ms X’s care. Following the section 117 meeting in July 2022, a further meeting should have been arranged for July 2023. In fact, it did not take place until December 2024, well over a year after that. This is an unacceptable delay, and I found no satisfactory explanation for it.
59. The evidence I have seen suggests the confusion between the Council and Trust as to who was responsible for arranging the meeting was the most significant contributing factor.
60. This was not in keeping with the requirements of the MHA Code and represents further fault by the Council and Trust.
61. I cannot say whether Ms X should have been discharged from secondary mental health services. Nor can I comment on whether she would have been able to secure alternative treatment in the community, even if she had been discharged. Nevertheless, I am satisfied the confusion surrounding the decision caused her significant frustration and uncertainty.
62. The case records clearly show the delays in arranging a section 117 review meeting caused Ms X further distress and frustration.
63. The ICB shares the duty to provide or arrange section 117 aftercare services for Ms X. However, I have not made a finding of fault against the ICB in this case. This is because the ICB was not involved in Ms X’s day to day care, nor in arranging the review meetings.

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Action

64. Within one month of my final decision statement, the Council and Trust will write a joint letter to Ms X apologising for the distress, frustration and uncertainty caused to her by:

• their shared failure to properly consider her requests, between May 2022 and December 2024, to be discharged from mental health services; and
• the significant delay in arranging a section 117 review meeting to discuss her care.

65. The Council and Trust will each pay Ms X £500 in recognition of the impact of these events on her.
66. Within three months of my final decision statement, the Council and Trust will, if they have not done so already:

• convene a further section 117 review meeting to discuss Ms X’s care. This should include Ms X and any relevant professionals involved in her care. This process should result in a comprehensive care plan in keeping with the MHA Code that sets out Ms X’s aftercare needs and how these will be met;
• explain to the Ombudsmen what action they will take to ensure that local policies and procedures for section 117 provide clear guidance for staff around discharge from services. The revised guidance should clarify the distinction between discharge from section 117 aftercare and discharge from mental health services. It should also reflect the requirements of relevant statutory guidance, such as the MHA Code; and
• explain to the Ombudsmen what action they will take to ensure relevant staff are made familiar with the revised guidance.

67. The Council and Trust will provide us with evidence they have complied with the above actions.

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Decision

68. We found fault causing an injustice. The Council and Trust will carry out the above actions to remedy this injustice.

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Investigator's decision on behalf of the Ombudsman