Summary: The Ombudsmen will not investigate Mrs D’s complaint about the care and treatment provided to Mr Y after he was discharged from detention under s3 of the Mental Health Act. This is because I do not consider that an investigation would achieve anything further for Mrs D.

The complaint

1. Mrs D complains about the lack of support provided to the late Mr Y, who was receiving care under Section 117 of the Mental Health Act. Mrs D complains that although he had been detained under Section 3 of the Mental Health Act on six separate occasions in a 16-month period, no adequate care and support plan was put in place. She further complains that she and Mr Y were repeatedly told they would need to pay for Mr Y’s respite care. Mrs D said this was incorrect, as the care should have been free under s117.
2. Mrs D said the repeated requests for payment upset and depressed Mr Y, and that he was very vulnerable. Mrs D told us she was also upset by these invoices and the comments from the social workers involved, as she felt they were trying to imply they “wanted something for nothing”, when this was not the case.
3. As a result of her complaint, Mrs D would like the social workers to be disciplined. She also wants the Trust and Council to acknowledge that this should not have happened, apologise for the demands for payment, and to improve their policies and knowledge of s117 aftercare.

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The Ombudsmen’s role and powers

4. The Ombudsmen provide a free service, but must use public money carefully. They may decide not to start or continue with an investigation if they believe:

• it is unlikely they could add to any previous investigation by the bodies, or
• they cannot achieve the outcome someone wants.

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

5. I have considered information provided by Mrs D over the telephone and in writing. I have also considered information provided by the Council and Trust. I have considered Mrs D’s comments in response to a draft version of this decision statement.

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What I found

6. Mr Y had a diagnosis of bipolar disorder. He had been admitted to hospital several times during 2016 and 2017. On 23 June 2017, he was discharged from hospital, where he had been detained under Section 3 of the Mental Health Act. The purpose of detention under Section 3 is to provide 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.
7. Before the person is discharged, if they may have a need for community care services, they are entitled to a social care assessment to establish what services they need. Section 117 of the Mental Health Act imposes a duty on health and social services to meet the health/social care needs arising from or related to the persons mental disorder for patients who have been detained under specific sections of the Mental Health Act, including Section 3. Aftercare services provided in relation to the person’s mental disorder under Section 117 cannot be charged for. This is known as Section 117 aftercare.
8. Mrs D complained that at the time Mr Y was discharged, she received a phone call from the hospital to say that he was being taken to a respite care placement, and this would be free under Section 117. Mr Y’s care coordinator also told them they would not have to pay for the placement. However, they later received an invoice and financial assessment forms. Mrs D felt the Trust and Council were not complying with their own policies, which she said states that there is no charge for any service provided under Section 117 aftercare.
9. Mrs D further complained that each time Mr Y was discharged from Section 3, no care plan or support was put in place. She said a care package was arranged after she complained, but the care itself did not match the recommendations of the occupational therapist. Mrs D felt that the support provided to him at his home, two hours of care a day, was not sufficient.
10. In February 2018, the Council and Trust responded jointly to Mrs D’s complaint. They said they had reviewed the Trust’s policy on Section 117 aftercare, as well as the information given to patients and their families. They accepted that an invoice had been sent to Mr D for £600.00 per week for respite care. They said the financial assessment form was sent to determine whether Mr Y would be able to pay a lower rate. They said an invoice for £268.00 was sent later, and that this suggested the weekly charge had been reduced, even though the financial assessment had not been completed.
11. The Council and Trust investigated and found that the lower rate invoice had been sent because it was understood that Mr Y was receiving pension credit. They confirmed there would be no charge for the respite care, and apologised for any confusion or distress caused by the conflicting information given.
12. However, they went on to say that the respite care should not have been provided under Section 117, as this only covers needs arising from a mental health condition and to prevent readmission to hospital. They said the reason Mr Y needed respite was not that he required 24-hour care, but because his home environment was not suitable for him to return to at the time (there was a leak in his flat).
13. My view is that this is a reasonable response. Aftercare can include supported living, but not ordinary accommodation, and Mr Y had not been found to require supported living. When a person needs residential care or specialist accommodation, this is only eligible for Section 117 if the need for it results from their mental disorder. It seems that this was not the case for Mr Y.
14. I recognise it was distressing and confusing for Mr Y and his family to be sent invoices for the placement, but the Trust and Council accepted he was given contradictory information and have offered appropriate apologies for this. They also agreed not to charge Mr Y for the respite placement because of this, which seems a reasonable way to address this part of the complaint.
15. The Trust and Council also accepted that their staff would benefit from more thorough knowledge about Section 117 and the Trust’s own policy, and said this would be arranged.
16. It is apparent from the response that the Council and Trust have acknowledged that Mr Y and his family were sent conflicting information about how his respite accommodation would be paid for. I recognise that this caused Mr Y and Mrs D confusion and distress. However because no charge was made, and the Council and Trust have offered appropriate apologies for the way they communicated with Mr Y and Mrs D, my view is that an investigation by the Ombudsmen would be unlikely to achieve any more for Mrs D on this matter.
17. Regarding Mrs D’s complaint about appropriate care plans not being put in place and a lack of support when Mr Y was discharged from hospital over a period of 16 months, the Trust and Council accepted some shortcomings here. They said the care plans were not holistic, as they should have been, and covered either Mr Y’s health or social care needs, rather than both.
18. The Trust and Council also accepted that the care plans were not given to Mr Y and Mrs D in a timely way. The Trust and Council apologised to Mrs D for this. They said that in view of her complaint, managers and supervisors would be reminded to ensure care plans for patients receiving Section 117 aftercare included both health and social care needs, and that they were provided to patients before discharge from hospital. My view is that this is a reasonable response to this aspect of the complaint, as it addresses Mrs D’s concern about a lack of support for Mr Y and puts in place improvements to prevent recurrence.
19. I appreciate that this has been a distressing experience for Mrs D. However, my view is that the Trust and Council have provided a reasonable response to her complaint.
20. I have discussed with Mrs D the types of outcomes the Ombudsmen can achieve, and she is aware that disciplinary action is not one of these. The Health and Care Professions Council (HCPC) might be better placed to consider this part of her complaint, should she wish to take it forward.

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Final decision

The Ombudsmen will not investigate Mrs D’s complaint. An investigation by the Ombudsmen is unlikely to achieve anything further for Mrs D.

Investigator’s final decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman