Summary: Miss Y complains the Council and ICB will not pay for a gym membership for her, which she believes she is eligible for under her S117 aftercare plan. I have reviewed Miss Y’s plan. The Council and the ICB did not say they would provide funding so there is no fault.

The complaint

1. Miss Y was sectioned under Section 3 of the Mental Health Act 1983 in September 2023. Durham County Council (the Council) and NHS North East & North Cumbria Integrated Care Board (the ICB) provide funding aftercare needed by people in their area after their Section 3 detention ends. This is known as S117 aftercare.
2. Miss Y complains the organisations have refused to provide funding for a gym membership under her S117 aftercare plan.
3. Miss Y says this is vital to her mental wellbeing and she cannot afford the classes she wants to take without the funding.
4. Miss Y wants the organisations to agree to fund a membership and also wants to be able to visit a spa.

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The Ombudsmen’s role and powers

5. We have the power to jointly consider complaints about health and social care. Since April 2015 a single team has considered these complaints acting for both Ombudsmen. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA)
6. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe it is unlikely we would find fault. (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

7. I considered all the information provided to us by Miss Y.
8. I considered the Ombudsman’s Assessment Code.

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What I found

Background

9. Miss Y was detained under section 3 of the Mental Health Act 1983 (MHA)in September 2023.
10. 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. This is sometimes known as ‘being sectioned’.
11. 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 person’s mental disorder for patients who have been detained under specific sections of the Mental Health Act (e.g. Section 3). Aftercare services provided in relation to the person’s mental disorder under S117 cannot be charged for. This is known as section 117 aftercare.
12. S117 does not define what aftercare services are. Section 33.3 of The Mental Health Code of Practice 2015 (the MHA Code) explains “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 33.4 adds aftercare can “encompass healthcare, social care and employment services, supported accommodation and services to meet the person’s wider social, cultural and spiritual needs”.
13. Section 33.7 of the MHA Code states Councils and CCGs (Clinical Commissioning Group, since replaced by ICBs) should “maintain a record of people for whom they provide or commission aftercare and what aftercare services are provided.”
14. The ICB shares a statutory duty with the Council to provide, or arrange, S117 aftercare services for eligible service users in the area.

The complaint

15. Miss Y complains the organisations have refused to provide funding for a gym membership under her S117 aftercare plan.
16. I have reviewed the S117 aftercare plan the Council created for Miss Y before she left hospital. In it, Miss Y says “she would benefit from support to attend exercise classes on discharge.” It further explains Miss Y asked the organisations to prioritise certain classes for the purpose of healing from trauma and empowerment.
17. The practitioner who completed the assessment said “Under S117 Aftercare, it has been identified that [Miss Y] will benefit from a direct payment to cover the cost of an exercise class” but then does not go on to recommend this payment be put in place, it is a suggestion for the Council to consider.
18. In its complaint response letter of 12 April 2024, the Council confirmed it had received the assessment and decided not to make a direct payment to Miss Y. It explained “I appreciate that attendance at a gym would benefit your mental health and wellbeing, this is also applicable to the general population who do not have a formal diagnosis of a mental disorder and have not experienced admissions into hospital under the Mental Health Act. It would be an activity that you would make a personal decision about whether to engage, in the same way as the general population, rather than a part of a formal section 117 plan and your specific health and social care needs in relation to your mental disorder.”
19. It added, “The request for the provision of attendance at the gym under section 117 was considered by both the Strategic Manager for Mental Health Services for Durham County Council, and the Locality Lead for North of England Care System Support, on behalf of the Integrated Care Board. Both officers have the responsibility of authorising the funding of any care provision under section 117 on behalf of health and social care organisations. Both agreed that this would be a general need that could be met by yourself.”
20. While I appreciate Miss Y would like the Council and the ICB to pay for exercise classes, I have seen the evidence both the Council and the ICB properly considered the request under the relevant guidance before refusing it. An Ombudsmen investigation would be unlikely to find evidence of fault.

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Final decision

21. We will not investigate this complaint because it is unlikely we would find fault.

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Investigator's decision on behalf of the Ombudsman