NHS Somerset Integrated Care Board (23 014 652b)

Category : Health > Mental health services

Decision : Not upheld

Decision date : 25 Nov 2024

The Ombudsman's final decision:

Summary: Mrs X complained about a failure to properly plan her son’s post-discharge care under section 117 of the Mental Health Act 1983. We found fault by the Council and the Trust for failings in their care planning. This led to avoidable uncertainty about whether Mrs X’s son may have missed out on effective support which could have prevented a deterioration in his mental health. We recommend that the Council and the Trust apologise, make symbolic payments and take steps to improve their services.

The complaint

  1. Mrs X complains that:
      1. Somerset NHS Foundation Trust (the Trust) and Somerset Council (the Council) failed to adequately assess her son’s, Mr Y’s, aftercare needs before or after his discharge from hospital in July 2023. Further, Mrs X complains that the Trust and the Council failed to arrange or provide an adequate package of care, treatment and support (including education) for Mr Y in the community after his discharge in July 2023 up until his readmission to hospital in mid‑November 2023.
      2. The Council failed to provide her and her husband with carers’ assessments after Mr Y returned home in July 2023 and before he was readmitted in November 2023.
  2. For the reasons set out in paragraph 11, we are also investigating NHS Somerset Integrated Care Board’s (the ICB’s) role in planning and arranging Mr Y’s aftercare.
  3. Mrs X said that, because of the lack of appropriate aftercare, Mr Y’s mental health deteriorated avoidably. Mrs X said that, as part of this, Mr Y was successfully able to provoke others to attack him which seriously injured him. In addition, Mrs X said that Mr Y attacked her and had destroyed his relationships.
  4. In addition, Mrs X said the situation had a huge impact on her and her husband’s life, causing them considerable stress and leading to a financial impact.
  5. In bringing the complaint to the Ombudsmen Mrs X said she would like appropriate support to be put in place to meet all of Mr Y’s needs in the community. In addition, Mrs X would like a meaningful apology and compensation if it is appropriate.

Back to top

The Ombudsmen’s role and powers

  1. 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).
  2. We may investigate complaints made on behalf of someone else if they have given their consent. We may also investigate a complaint on behalf of someone who cannot authorise someone to act for them, if we consider them to be a suitable representative. (Health Service Commissioners Act 1993, section 9(3) and Local Government Act 1974, section 26A(2)) (Local Government Act 1974, section 26A(1))
  3. 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).
  4. 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.
  5. 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. 
  6. Section 3 of the Mental Health Act 1983 (the MHA) allows people to be detained in hospital for treatment necessary for their health, safety or for the protection of other people. Section 117 (s117) of the MHA imposes a duty on health and social services to provide free aftercare services to patients who have been detained under section 3 of the MHA. Councils and ICBs (which have replaced Clinical Commissioning Groups) cannot delegate these aftercare duties, regardless of the day‑to‑day arrangements for delivering a person’s aftercare. In view of this, the relevant council and ICB will always be included in Ombudsmen investigations about s117 aftercare.
  7. 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 bodies made their decisions.
  8. If we are satisfied with the actions or proposed actions of the bodies 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)

Back to top

How I considered this complaint

  1. I read the documents Mrs X provided and discussed the complaint with her. I also considered the Council, the Trust’s and the ICB’s comments on the complaint, the supporting documents they provided, and relevant law and guidance.
  2. I shared a confidential draft decision with Mrs X and the organisations and offered an opportunity to comment on it. I took account of all the comments I received in response. Under our information sharing agreement, we will share this decision with the Office for Standards in Education, Children’s Services and Skills (Ofsted).

Back to top

What I found

Legislation and guidance

Section 117 of the Mental Health Act 1983

  1. S117 of the MHA requires councils and ICBs to provide free aftercare services to certain people. This includes people (regardless of their age) who have been discharged from detention in hospital under s3 of the MHA. They must provide these services from the point the person leaves hospital until the council and ICB decide the person no longer needs them.
  2. S117 does not define what aftercare services are. The Mental Health Act 1983: Code of Practice (the Code) is statutory guidance. This means that councils and relevant NHS health authorities must follow it, unless there are good reasons not to. The Code gives some guidance on s117 services. It details that: “After-care services mean services which have the purposes of meeting a need arising from or related to the patient’s mental disorder and reducing the risk of a deterioration of the patient’s mental condition (and, accordingly, reducing the risk of the patient requiring admission to hospital again for treatment for mental disorder)” (Section 33.3 of the Code).
  3. It also notes that aftercare can “encompass healthcare, social care and employment services, supported accommodation and services to meet the person’s wider social, cultural and spiritual needs” (Section 33.4 of the Code).
  4. The Code also states that aftercare should aim to support people “in regaining or enhancing their skills, or learning new skills, in order to cope with life outside hospital” (Section 33.5 of the Code).
  5. 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).
  6. The Code also notes that:
  • “Before deciding to discharge or grant more than very short-term leave of absence to a patient…the responsible clinician should ensure that the patient’s needs for after-care have been fully assessed, discussed with the patient (and their carers, where appropriate) and addressed in their care plan…” (Section 33.13 of the Code)
  • “…the care plan should be prepared in close partnership with the patient from the outset, particularly where it is necessary to manage the process of discharge from hospital and reintegration into the community…” (Section 34.10 of the Code)

Children Act 1989

  1. The Children Act 1989 places a duty on local authorities to promote and safeguard the welfare of children in need in their area. Section 17 says the local authority must determine what services should be provided to a child in need. The services should then be set out in a multi-agency child in need plan.

Transition from children to adult care services

  1. When a child reaches 18 years old they are legally an adult. Responsibility for meeting their needs moves from a council’s children’s services to its adult services. The legal basis for assessing their needs changes from the Children Act 1989 to the Care Act 2014. However, councils can decide to treat a children’s assessment as an adult assessment and can also carry out joint assessments.
  2. Statutory guidance says transition assessments should begin when the council can be reasonably confident about what the young person’s needs for care and support will look like when they turn 18.
  3. If transition assessment and planning is carried out as it should be there should be no gaps in the provision of care and support. However, if adult care and support is not in place when the young person turns 18, a council must continue providing the services under children’s legislation until the adult care is in place or until it decides the young person does not have eligible needs.

Care Act 2014

  1. Councils must carry out an assessment for any adult when it appears they might need care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. (Care Act 2014, Sections 9 and 10)
  2. There is no set definition of an assessment. The aim of the assessment is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing. This should then inform the response to any identified needs. The response “might range from offering guidance and information to arranging for services to meet those needs” (Section 6.5 of the Care and Support Statutory Guidance (the CSSG)).
  3. Councils are encouraged to take a holistic approach to assessment in order to “prevent that person having to undergo a number of assessments at different times, which can be distressing and confusing” (Paragraphs 6.75 to 6.78 of the CSSG).

Summary of key events

  1. Mr Y’s GP referred Mr Y to the Trust’s children’s mental health services (CAMHS) in early 2022. They did so because Mr Y had experienced panic attacks, insomnia and suicidal thoughts. Mr Y had also stopped attending college. CAMHS felt Mr Y’s issues could be explained as a response to recent events in his life and did not consider he had any underlying mental health problems it needed to help with.
  2. In early 2023 Mr Y voluntarily went into a mental health ward for a period of assessment. Professionals referred Mr Y to Children’s Services after he returned home. This led to a Child and Family Assessment in April 2023, around four months before Mr Y turned 18. The assessment recommended that the Council support Mr Y via a Child in Need plan under its duties under the Children Act 1989. During the assessment Mrs X said that she wanted Mr Y to go to a specific educational establishment (Provision A).
  3. Toward the end of April 2023 professionals detained Mr Y under section 2 of the MHA. The aims of the detention were to: allow an assessment of Mr Y’s mental state; to try using a medication; and, to help support Mr Y to stop using illegal drugs. Mr Y remained in hospital and, a month later, professionals detained him under section 3 to give him more time to engage in taking medication. At this point Mr Y became eligible for s117 aftercare.
  4. The Council’s Children’s Services remained involved in Mr Y’s case. By the middle of June 2023 Children’s Services knew that Mr Y was being detained under s3. They also noted that the hospital would be likely to discharge Mr Y before he turned 18.
  5. During this period Mrs X reiterated her request for Mr Y to go to Provision A.
  6. At a CPA meeting in the middle of the year Mr and Mrs X raised concerns about whether there would be enough, adequate support in place for Mr Y after he left hospital. They said they would only be able to manage at home with Mr Y if there was a robust care package.
  7. Following the meeting the Trust referred Mr Y to the Council’s Adult Services, asking it to assess his needs. Around a week later Children’s Services also referred Mr Y to Adult Services. This was around a month-and-a-half before Mr Y turned 18.
  8. Toward the end of June 2023 the hospital rescinded Mr Y’s detention under the MHA. They felt that Mr Y was able to make his own decisions about his care and treatment. Mr Y remained in hospital on an informal basis.
  9. Several days later a Children’s Services worker spoke to Mrs X on the phone. Mrs X gave her views about the type and amount of support Mr Y would need in the community. Namely,
  • 24‑hour monitoring and assistance;
  • attendance on courses that would allow him to learn new skills with a view to getting a job; and,
  • regular mental health support.
  1. During this conversation Mrs X said that Mr Y was on the waiting list for Provision A. She said a place was likely to be available at the start of the next school year but this would need to be funded.
  2. At the start of July 2023 an Adult Services team logged the referral about Mr Y. This was its first knowledge of Mr Y.
  3. There was a CPA meeting around a week later. Mrs X reiterated her concerns about the inadequacy of the plans for Mr Y after he left hospital. She said the family would not be able to cope without proper support. Later that day the hospital discharged Mr Y to the family home. There were plans for a CAMHS team to make home visits every other day to monitor Mr Y’s mental health.
  4. In the following days Children’s Services arranged for two workers from a nursing agency to visit Mr Y for around twenty hours a week at times when Mr Y’s parents were at work. Children’s Services continued to talk to Mrs X about the type of support she felt Mr Y would need. Just over a week after Mr Y returned home Mrs X said he had visited Provision A and wanted to go there.
  5. Adult Services allocated a social worker to Mr Y’s case at the beginning of August 2023. Around a week later a social worker asked the Council to continue funding Mr Y’s current support package while they completed an assessment of his needs. A panel agreed to continue funding on a temporary basis.
  6. Also in early August 2023, a complex care panel considered Children’s Services’ request for funding for Mr Y to attend Provision A. It declined the request on the basis that Children’s Services would be unable to commit to funding the placement after Mr Y turned 18, in just over a week’s time.
  7. An Adult Services social worker met Mr Y and Mrs X in late August 2023. They noted Mrs X’s concerns about Mr Y being left alone, and they noted the request for Mr Y to go to Provision A. The social worker planned to start writing up a Care Act assessment and to look at possible support providers for Mr Y, and to look into Provision A.
  8. Less than a week later professionals detained Mr Y under the section 2 of the MHA again. The Adult Services community team did not continue with its recent assessment and care planning. It referred Mr Y’s case to an Adult Services inpatient team.
  9. Mr Y became an informal patient at the end of September 2023 and discharged himself from hospital. Adult Services allocated a different social worker to work with Mr Y as the family’s relationship with the previous worker had broken down.
  10. After seeing Mr Y a couple of times in October, in early November 2023 the social worker completed a new Care Act assessment. The social worker said they would look into arranging support for Mr Y through Direct Payments and attendance at Provision A. Mrs X voiced her concerns that, without funding to travel to and attend meaningful activities with Mr Y, support workers would not be of any benefit.
  11. Around a week later, before Adult Services had arranged anything, professionals detained Mr Y under the MHA again.
  12. Mrs X complained to the Council in August 2023. In response the Council accepted that a s117 plan had not been put in place in a timely way. The Council said this was because of the complexities of the case. The Council also accepted that earlier transition planning would have helped to plan Mr Y’s care. The Trust did not identify any significant failings in the way it had planned Mr Y’s post‑discharge care.
  13. The ICB told us that it and the Council keep a joint register of all individuals who have been identified as: eligible for s117 funding; and, who have complex needs (i.e. needs that are beyond the scope of core commissioned services to meet).
  14. The ICB said it does not routinely get involved in planning or arranging s117 aftercare support for people in inpatient facilities. It said the commissioned service providers are responsible for this. The ICB said that where aftercare provision will exceed the capacity or expertise of core commissioned services individual cases are presented to the complex care panel for consideration. It said that in these instances the ICB “would take a supportive role in attending s117 planning meetings if appropriate”. The ICB said people who are identified as having complex needs have their circumstances regularly reviewed by a multi-agency complex care panel.
  15. The ICB said that it did not become involved in Mr Y’s s117 aftercare planning until November 2023. Mrs X provided us with an email which shows she contacted the ICB in early September 2023. In the email she noted the difficulties she was having in getting a clear plan for Mr Y’s aftercare. She asked for advice. Mrs X also supplied us with screenshots of messages she exchanged with a member of staff at the ICB later in the month. These indicate that the member of staff had verbally said to Mrs X they would email others about the situation.

Analysis

Inadequate s117 discharge planning

  1. In April 2023, when Children’s Services first assessed Mr Y there were about four months until Mr Y turned 18. A manager noted that:

“Between now and [Mr Y] turning 18, will be an important time where support needs to be offered to ensure that his transition to adulthood is a positive and supportive one…there are a number of professionals involved, but as a result of this, co-ordination will be key. A social worker is needed to lead this multi-agency approach, until we are satisfied that each agency knows their role and is positively contributing to improving [Mr Y’s] safety and wellbeing, and that of his parents.”

  1. This was reflective of Mr Y’s situation which was complex. It is apparent from the collective evidence from the time that there would be no easy, quick fix for Mr Y. And, given Mr Y’s age, it was apparent that, more likely than not, he would continue to need support when he became an adult. The manager’s comments were appropriate and should have been followed.
  2. Children’s Services also knew about a month in advance that it was likely Mr Y would return home before he turned 18.
  3. However, Children’s Services did not refer Mr Y to Adult Services until late June, two months and 22 days after the manager’s comments about the importance of collaboration. This was an avoidable and unnecessary delay and it was fault.
  4. Adult Services allocated a social worker to Mr Y’s case just over a month after Children’s Services made its referral. As such, on balance it is likely that, if Children’s Services had referred Mr Y to its Transitions Team in April, Adult Services would have been involved in his case from the early stages of his first detention under s2.
  5. In addition, an Approved Mental Health Practitioner (AMHP) led the assessment which recommended Mr Y be detained under s2 of the MHA for the first time. This meant that the Council’s mental health services also had an opportunity to liaise with Children’s Services and/or Adult Services.
  6. As it was, Adult Services were not involved in planning Mr Y’s ongoing care at any point during his first admission to hospital. This was despite how close it was to Mr Y’s 18th birthday.
  7. In addition, the evidence shows that, after it learned Mr Y had been detained under s3, Children’s Services continued to approach its care planning in terms of its responsibilities under the Children Act 1989. It should have begun thinking in terms of the Council’s overall responsibilities under s117 of the MHA. Children’s Services extended its funding of Mr Y’s support after he became an adult to allow Adult Services more time to complete its own assessments. However, it was clear in its correspondence with Mrs X that it considered its involvement needed to end very soon. In July 2023, in the days after Mr Y returned home, it noted that its “choices are very limited due to [Mr Y’s] age and needs”.
  8. Guidance on transition planning is clear that Children’s Services and Adult Services should have worked together as much as possible to ensure that Mr Y’s ongoing support was effectively and efficiently planned. This is particularly the case when there is an overriding responsibility for the Council to meet the person’s needs under s117.
  9. Of particular note is the consideration of the request for funding for a place at Provision A. Rather than involving Adult Services in the discussions about this, in August 2023 Children’s Services declined funding on the basis that Mr Y was soon to be an adult. Adult Services should have been included at this stage and it was fault that they were not.
  10. The evidence shows that Adult Services continued to consider Provision A as an option for Mr Y. Mrs X advised me in August 2024 that funding had been agreed for this. It therefore seems possible that, if Adult Services had been fully involved sooner, it may have agreed to fund a place at Provision A during this period. However, given the complexity of the situation, it is not possible to say, even on balance, that Mr Y would have been able to take up and maintain this place. Nevertheless, the uncertainty around this alone is an avoidable injustice.
  11. In terms of Mr Y’s care planning more widely, there is evidence to show that the Trust and, at the Council, both Children’s Services and Adult Services considered what support Mr Y might need in the community. They involved Mr and Mrs X in these discussions and spoke to Mr Y directly to find out about his views and wishes. While Mr Y was an inpatient the Trust held multi-agency meetings with Mr Y and Mr and Mrs X.
  12. During Mr Y’s first admission and in the weeks after he returned home professionals noted that Mr Y had not engaged with any of the therapeutic input available on the ward. Mr Y also said that he did not want to have any support from social care in the community. Later, in October and November, Adult Services noted that Mr Y was not requesting any support for himself.
  13. It was appropriate for professionals to talk directly to Mr Y and to consider his capacity to understand his situation and the risks he may face. It was also appropriate to consider his wishes and views about the type of level of support he felt he needed and was willing to accept. Section 33.24 of the Code notes that patients are not under any obligation to accept any aftercare services they are offered. Although this also notes that this does not mean they do not need those services, and it should be a fully informed decision.
  14. However, by the time Mr Y left hospital in July 2023 there was no clear, defined plan which set out what support would be provided for him under s117. This was over a month-and-a-half after Mr Y’s detention under s3, and around half a month since Mr Y’s detention had been rescinded. The evidence suggests that the Trust decided what support it would offer through its own services and left the Council to make its own, separate, decision about what support it would offer. This was fault on the part of both the Trust and the Council.
  15. As per the Code, there should have been one overall, jointly agreed plan about what support Mr Y needed to help prevent his readmission to a mental health hospital. The Trust’s mental health expertise was required to help the Council understand what type and level of support could be deemed to be necessary under s117, rather than through Children’s Services’ usual duties under the Children Act 1989, or Adult Services’ duties under the Care Act 2014. As noted above, support through s117 can encompass a wide range of things. There needed to be a fulsome, properly multi-disciplinary discussion about what could work Mr Y. This could then have been taken to the Council and the ICB to ask for funding.
  16. It is not for the Ombudsmen to determine what care a person should receive. It is not possible to say, even on balance, what support would have been arranged for Mr Y between July and November if there had been more timely, effective and multi-disciplinary planning between agencies. It seems possible that consideration could have been given to activities as well as for support to access them. However, there are too many variables and unknowns to be able to say: what opportunities would have been found; what would have been available; and, what would have been agreed.
  17. Also, we can only speculate about how useful any given plan would have been and whether it would have prevented Mr Y’s re‑admissions to hospital. I cannot ignore what the records show about Mr Y’s level of engagement in the hospital, or the severity of the issues affecting Mr Y’s life. Because of this, it is possible that Mr Y would have found if difficult to effectively engage in any support arranged for him. However, it is understandable that Mr and Mrs X and Mr Y are left feeling that, with better planning, Mr Y would have had a better chance. It is also understandable that they believe that there would have been a better outcome. As before, this uncertainty alone is an injustice to Mr Y and to Mr and Mrs X. I have made a recommendation to address this outstanding injustice, below.
  18. I have not found fault on the part of the ICB in relation to Mr Y’s s117 aftercare planning. As noted in paragraph 51, it aims to allow ‘front line’ services to establish the person’s needs and produce a plan about how they should be met. This allows the professionals who are actively involved in the person’s care to produce the plan and is appropriate. In this instance I have seen evidence to show that Mrs X contacted the ICB in September 2023 to raise her concerns about a lack of progress. However, I have not seen evidence of either the Trust or the Council asking for the ICB’s input or assistance during this period. In this context, the ICB was not at fault here.

Lack of carers assessment

  1. In late August 2023 the Council’s Adult Services offered Mr and Mrs X carers’ assessments, which they both accepted. However, the Council told us that the “relationship with the family broke down so this assessment did not take place”. The Council said it did not consider it would be appropriate for a particular worker to complete a carer’s assessment while Mr Y was an inpatient. Because of this it allocated a worker from another team to complete a carers assessment. However, this did not take place during the period under review.
  2. Mr and Mrs X were entitled to receive carers’ assessments. It was evident from the Council’s interactions with the family that Mr and Mrs X had significant caring duties which were causing them a substantial amount of stress and strain. The failure to complete one is fault.
  3. As with the main issue of Mr Y’s care planning, I cannot say what the Council might have been able to offer Mr and Mrs X had a carers assessment been completed. Also, I cannot say whether any offers would have been beneficial. As such, the impact of this fault is again avoidable uncertainty about having potentially missed out on useful support. This is an injustice.

Back to top

Agreed actions

  1. Within one month of the final decision the Council and the Trust should both write to Mr and Mrs X to acknowledge the fault identified in this decision. They should also acknowledge the impact this had and apologise for this. In doing so they should take account of the guidance we publish on apologies contained within our guidance on remedies at section 3.2; (see Guidance on remedies - Local Government and Social Care Ombudsman).
  2. Within two months of the final decision the Council should make symbolic payments of:
  • £500 to Mr Y to reflect the avoidable uncertainty he has been left with due to the Council’s part in the failings in his care planning, including the failure to involve Adult Services in a timely way and failure to consider funding for Provision A under s117.
  • £400 to Mr X and £400 to Mrs X to reflect the avoidable uncertainty they have been left with due to the Council’s part in the failings in Mr Y’s care planning, and because of the failure to provide them both with a carer’s assessment.
  1. Within two months of the final decision the Trust should make symbolic payments of:
  • £300 to Mr Y to reflect its part in the failure to produce a fully multi-agency s117 care plan in a timely way, which left Mr Y with avoidable uncertainty.
  • £200 to Mr X and £200 to Mrs X, again to reflect its partial fault leading to the uncertainty they have been left with.
  1. Within three months of the final decision the Council should take action to improve its services following this complaint. In particular, it should address:
  • the failure of Children’s Services to refer the case to Adult/Transitional Services in a timely manner;
  • the failure to consider necessary support for the service user under s117 rather than under the Children Act 1989/Care Act 2014; and,
  • the failure to take a fully multi-agency approach in agreeing a complete s117 care plan in a timely manner.

The Council should address these issues in a specific, realistic and measurable way to help ensure that relevant staff properly understand and are properly equipped and able to complete the necessary work.

  1. Within three months of the final decision the Trust should take action to improve its services following this complaint. In particular, it should address the failure to take a fully multi-agency approach in agreeing a complete s117 care plan in a timely manner. The Trust should address this issue in a specific, realistic and measurable way to help ensure that relevant staff properly understand and are properly equipped and able to complete the necessary work.
  2. We will expect the Council and the Trust to provide us with evidence they have complied with all agreed recommendations.

Back to top

Decision

  1. We uphold this complaint. We found fault with the Council and the Trust which caused an injustice to Mr Y and Mr and Mrs X. I have set out action I want the Council and the Trust to take to remedy that injustice. The Council and Trust agreed to the recommended actions and, as such, I have completed this investigation satisfied with their responses.

Back to top

Investigator's decision on behalf of the Ombudsman

Print this page

LGO logogram

Review your privacy settings

Required cookies

These cookies enable the website to function properly. You can only disable these by changing your browser preferences, but this will affect how the website performs.

View required cookies

Analytical cookies

Google Analytics cookies help us improve the performance of the website by understanding how visitors use the site.
We recommend you set these 'ON'.

View analytical cookies

In using Google Analytics, we do not collect or store personal information that could identify you (for example your name or address). We do not allow Google to use or share our analytics data. Google has developed a tool to help you opt out of Google Analytics cookies.

Privacy settings