Gloucestershire Clinical Commissioning Group (17 010 997b)

Category : Health > Other

Decision : Upheld

Decision date : 28 May 2019

The Ombudsman's final decision:

Summary: Mr D complained the Trust, the Council and the Clinical Commissioning Group (CCG) failed to consider what aftercare services his son, Mr B, would need on discharge from hospital. He also said the authorities then failed to implement an agreed care package and this had an adverse impact on Mr B’s wellbeing. The Ombudsmen found the authorities failed to have a specific aftercare plan in place when Mr B left hospital and failed to keep an appropriate plan for his care, support and safety under review in one place. The Trust, the Council and the CCG have agreed to the Ombudsmen’s recommendations to apologise, pay a financial remedy, ensure a robust care and support plan is in place for Mr B, improve aftercare planning and address a gap in commissioning.

The complaint

  1. The complainant, who I shall refer to as Mr D, complains on behalf of his adult son, Mr B. Mr D says Gloucestershire County Council (the Council), 2gether NHS Foundation Trust (the Trust) and Gloucestershire Clinical Commissioning Group (the CCG) failed to properly consider the aftercare services Mr B needed when he was discharged from hospital under the terms of the Mental Health Act 1983.
    Mr D says the authorities failed to implement Mr B’s agreed care package after completing formal assessments and this had an adverse impact on his physical and mental wellbeing. As a result, it is claimed Mr B was readmitted to hospital and this could have been avoided. Mr D also complains about the language recorded by professionals to describe him and his relationship with his son.

Back to top

The Ombudsmen’s role and powers

  1. The Ombudsmen have the power to jointly consider complaints about health and social care. Since April 2015, these complaints have been considered by a single team acting on behalf of both Ombudsmen. (Local Government Act 1974, section 33ZA, and Health Service Commissioners Act 1993, section 18ZA)
  2. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen 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)).
  3. 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.
  4. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their 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 have considered information provided by the complainant and information from the organisations named in this complaint provided in response to the Ombudsmen’s enquiries. I have also considered the law and guidance relevant to this complaint. All parties have had an opportunity to respond to a draft of this decision.

Back to top

What I found

  1. Under the terms of the Mental Health Act 1983, a patient who has a mental disorder and refuses treatment may be detained for treatment if certain conditions are met. Prior to doing so, two qualified medical practitioners must assess the patient and agree the patient is suffering from a mental disorder of a nature or degree that the patient ought to be detained in hospital in the interests of their own health and safety and/or safety of others. In conjunction with the opinion of the two medical practitioners, an Approved Mental Health Professional must also agree the legal criteria for detention are met and that admission, considering all the circumstances of the case, is the least restrictive option in the best interests of the person.
  2. The purpose of detention under section 2 is for assessment of a patient’s mental health and to provide any treatment they might need. Patients can be detained under section 2 for a maximum of 28 days.
  3. Section 3 of the Mental Health Act is for the purpose of providing 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.
  4. Before the person is discharged, a social care assessment should take place to assess if they have any social care needs that should be met. People who are discharged from section 3 will not have to pay for any aftercare they will need. This is known as section 117 aftercare.
  5. Anyone who may have a need for community care services is entitled to a social care assessment when they are discharged from hospital to establish what services they might need. Section 117 of the Mental Health Act imposes a duty on health and social services to meet the health and 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 (e.g. Section 3). Aftercare services provided in relation to the persons mental disorder under S117 cannot be charged for.
  6. The Care Programme Approach (CPA) is the process by which mental health services assess a patient’s needs, plan how to meet them and ensure they are met. Under Refocusing the Care Programme Approach (Department of Health, 2008), people under CPA should have a comprehensive assessment of their health and social care needs. They should have a care coordinator; have a care plan to show how their needs will be met and have the care plan reviewed by a multi-disciplinary team (MDT). When a patient is in hospital, their care coordinator is the key person responsible for arranging the care and support they will need on discharge.
  7. A local authority may carry out a need for care and support or carer’s assessment jointly with another body carrying out any other assessment in relation to the person concerned, provided that person agrees. In doing so, the authority may integrate or align assessment processes to better fit around the needs of the individual. An integrated approach may involve working together with relevant professionals on a single assessment. It may also include putting processes in place to ensure that the person is referred for other assessments such as an assessment for after-care needs under the Mental Health Act 1983.
  8. Where more than one agency is assessing a person, they should all work closely together to prevent that person having to undergo a number of assessments at different times, which can be distressing and confusing. Where a person has both health and care and support needs, local authorities and the NHS should work together effectively to deliver a high quality, coordinated assessment. (Care and Support Statutory Guidance 2014)
  9. The Mental Capacity Act 2005 (the MCA) applies to people who may lack mental capacity to make certain decisions. Section 42 of the MCA provides for a Code of Practice (the Code) which sets out steps organisations should take when considering whether someone lacks mental capacity.

Both the MCA and the Code start by presuming individuals have capacity unless there is proof to the contrary. The Code says all practicable steps should be taken to support individuals to make their own decisions before concluding someone lacks capacity. The Code says people who make unwise decisions should not automatically be treated as not being able to make decisions. Someone can have capacity and still make unwise decisions.

The Code says, at paragraph 2.11, there may be cause for concern if somebody repeatedly makes unwise decisions exposing them to significant risk of harm or exploitation. The Code says this may not necessarily mean the person lacks capacity but further investigation may be required.

  1. Local authorities, NHS commissioners, hospitals, police forces and ambulance services should have local partnership arrangements in place to deal with people experiencing mental health crises. The objective of local partnership arrangements is to ensure that people experiencing mental health crises receive the right medical care from the most appropriate health agencies as soon as possible. The police will often, due to the nature of their role, be the first point of contact for individuals in crisis, but it is crucial that people experiencing mental health crises access appropriate health services at the earliest opportunity.
  2. Section 75 of the NHS Act 2006 allows NHS organisations and councils to arrange to delegate their functions to one another.  These arrangements are known as Section 75 Agreements.  NHS organisations can take on the provision of social work services which are normally the responsibility of councils.  Subsection 5 of the Act says the NHS and councils remain liable for the exercise of their own functions.  
  3. During 2014 and 2015 there was a section 75 agreement in place between the Council and the Trust. The Council entered into a section 75 agreement for Joint Commissioning of Adult Mental Health Services. The agreement and framework enabled the Council to align mental health commissioning budgets with NHS Gloucestershire. The agreement also provided a basis for a single contracting process to be developed for health and social care services commissioned from a provider, currently 2gether NHS Foundation Trust. This means that during the period complained about the Trust acted on behalf of the Council to meet its social care responsibilities for people aged 18-64 years old with mental health problems.
  4. The Council, Trust and the CCG have provided a policy that relates to
    Section 117 aftercare services. In summary, this says all three organisations “share responsibility, for ensuring that for those people who are eligible are considered for aftercare services and that:
    • assessments are coordinated before discharge;
    • appropriate care plans are negotiated with the patient, their carer etc;
    • services that are provided as part of the S117 aftercare plan, are done so free of charge;
    • reviews are coordinated and undertaken regularly;
    • services are ended appropriately and this is recorded.”

Background

  1. Mr B is diagnosed with an autistic spectrum disorder (ASD), an emotionally unstable personality disorder and a generalised anxiety disorder. The Trust has been involved in Mr B’s care and treatment since 2008. This was due to his problems with excessive use of alcohol and symptoms of his mental health illness such as self-harming and overdosing on medication.
  2. Mr B went into hospital in September 2010 under the terms of Section 3 of the Mental Health Act 1983. His discharge was scheduled for 2011 and the notes of a professionals meeting dated October 2011 state “a planned discharge was being arranged but… discharged himself against medical advice before this was complete”. This happened after Mr B had become an informal patient.
  3. Mr B was entitled to S117 at the time of the time of his discharge but the Trust confirmed no specific S117 aftercare plan was completed at the time of his discharge. However, the Trust provided records of CPA reviews completed around the time the discharge occurred. The CPA documentation noted a discharge plan.
  4. Mr B had further periods in hospital because of problems with his mental health and there is evidence to show he sometimes found it difficult to engage with services.
  5. Mr B remained under the care of the Trust and had support from the Recovery Team. A previous investigation by the PHSO considered the care and treatment provided by the Trust between 2008 to 2013. I do not intend to revisit the complaints set out in the PHSO’s decision letter to Mr D.
  6. In March 2013, the local Recovery Team assessed Mr B’s needs and decided he needed three hours of support daily. This assessment referred to Mr D having “a pathological influence on [Mr B’s] life despite his best intentions for [Mr B].” Mr D later complained about this wording used which I will refer to later.
  7. The purpose of the proposed support was to help provide daily structure and routine to Mr B. This included:
    • helping Mr B to monitor his money and collect his medication from his doctor;
    • taking pressure off Mr D who was struggling to monitor Mr B’s needs; and
    • reducing the daily input of the Recovery team.
  8. The assessment document noted the proposed support package would help prevent hospital admission and the need for crisis input. It also recorded S117 applied because of Mr B’s entitlement to S117 aftercare services.
  9. Mr B was readmitted to hospital between March and May 2013. At a professionals meeting held in July 2013 his care coordinators confirmed they had secured funding for the proposed care package and a provider identified. The care package was agreed in August 2013 and an email from the Mr B’s care coordinator confirmed the provider would contact Mr B in September.
  10. The Trust wrote to Mr B in September following a CPA review. People present at the meeting included Mr B, the provider, his care coordinators, the crisis team and his consultant psychiatrist. There was a discussion with the care provider about the proposed care plan which had not yet started. Other discussions centred around medication and Mr B’s general physical health.
  11. The provider wrote to Mr B’s care coordinator in September to say it had not managed to contact Mr B although messages were left asking him to make contact. An email from the consultant psychiatrist to Mr B’s care coordinator confirmed Mr B was willing to engage with the provider. The consultant psychiatrist asked one of the care coordinator to liaise with the care provider.
  12. The care provider wrote a further email to the care coordinator in October and said it could not offer Mr B support due to the slow start and issues getting hold of him. The care coordinator forwarded this email to the professionals working with Mr B asking for thoughts on Mr B’s care plan development. There is no evidence in the records to show what happened in response.
  13. Mr B went into hospital on two separate occasions in 2014. The Trust held a CPA review in September 2014 with Mr B, Mr D and other professionals involved in his care. The review referred to previous care arrangements that had not worked with Mr B. These included engaging with a commissioned care and support package and facilitating a move.
  14. Mr D said the Council and the Trust started a new assessment in 2015 but said the authorities have since denied an assessment was completed. The case records completed in June 2015 state, “[Social worker] spent the first part of the session talking with [Mr B] about his FACE assessment and what was written about what is wanted in terms of his care provision. [Social worker] plans to discuss with [Mr B’s] father…”
  15. A record completed by the social worker a few days later states “Discussion with [Care Coordinator] … explained that father has cancelled my appointment today which was set up to discuss the support/hours [Mr B] requires from a domiciliary care package… father feels that this is too soon for [Mr B] presently…”
  16. Mr B was detained under section 3 of the Mental Health Act in November 2015 following a relapse in his mental health. He remained in hospital for just over 12 months.

Mr D’s complaint to the Trust

  1. Mr D made a complaint to the Trust in July 2016 about Mr B’s care and support arrangements between 2013 and 2016. When the Trust responded to the complaint in October 2016 it said:
    • its records showed Mr B had repeated admissions to hospital between 2013 and 2016 precipitated by his alcohol misuse and associated risks;
    • Mr B had complex needs but the teams working with him provided a good treatment plan within the resources available to them;
    • the Recovery Team felt Mr B would benefit from a period of treatment in a residential setting where he could access support outside of his immediate family. Finding a suitable unit with a vacancy had been difficult and the local authority had not approved previous recommendations for increased support;
    • the Community Care Panel had not assessed Mr B as needing the support
      Mr D and the clinical team believed he needed; and
    • it had identified areas of improvement such as highlighting that services should be more needs based rather than diagnosis based, patient assessments should consider the patient at their most unwell and not when they are stable and there should be closer communication between clinicians and family members to ensure an accurate picture.

Mr B’s discharge from hospital

  1. Mr B was ready for discharge from hospital around December 2016. An officer completed an assessment which identified what support Mr B would once discharged. The plan is undated but has a review date of December 2016. The assessment stated Mr B wanted to live independently but would be discharged to Mr D’s home initially. It outlined a plan for his support which included 24 hours of weekly formal support provided by a care agency, weekly/fortnightly clinical support, informal support from family and crisis telephone support from the Recovery and Crisis Teams.
  2. A consultant psychiatrist completed a discharge summary at the end of
    December 2016. This stated the long-term risk to self-harm was high but all other risks were low. The plan referred to follow up by the Recovery Team and the general practitioner to continue prescribing medication.

Mr D’s further complaints to the Trust

  1. The Trust held a local resolution with Mr D in June 2017. The purpose of the meeting was to discuss Mr D’s complaint issues to the Trust. Some of the points discussed are summarised as:
    • Mr D said he recalled an assessment was completed in 2015. The Trust said there was no record Mr B had had an assessment in 2015 and no evidence to suggest this assessment had gone to a community funding panel;
    • Mr D said the Trust had failed to share care and support plans completed between 2013 and 2015 and the outcome of applications to the community funding panel with Mr B and his family. The Trust said it had sent the paperwork to Mr D (in response to his complaints);
    • Mr D asked why a consultant psychiatrist involved in Mr B’s care had said he had not presented with any clinical signs of autism spectrum disorder (ASD) or mental illness. The Trust’s clinician attending the meeting said the consultant psychiatrist had stated his opinion. However, the Trust was aware of Mr B’s diagnosis; and
    • Mr D said he was offended by a doctor referring to him as having a ‘pathological controlling influence’ on Mr B.

Consideration of Asperger’s Syndrome and CPA Reviews

  1. A consultant psychiatrist from the Recovery Team wrote to the Learning Disabilities Team in February 2018. The clinician said Mr B felt his needs would be better met by this team because of his problems associated with his ASD. The clinician highlighted a 2011 assessment which said Mr B could experience increased distress levels if he did not have regular contact with staff who had specialist skills in autism. The letter confirmed Mr B lived mainly with his father as suitable accommodation had not been found yet and he remained subject to S117 aftercare.
  2. The consultant psychiatrist from the Learning Disabilities Team replied to the letter. The letter said although the learning disability service had trained clinicians in the management of autism there was insufficient capacity to take on people who did not have an intellectual disability. The letter also said discussions were taking place as there was no formally commissioned service suitable for someone like Mr B and a gap in commissioning remained.
  3. Mr B, Mr D and professionals involved in his care attended a CPA review in
    April 2018. Mr B spoke positively about being supported in the community by the care provider. Mr B and Mr D acknowledged the gap in service for people who do not have an intellectual disability but have problems with autistic spectrum conditions. The consultant psychiatrist acknowledged their frustration but recognised the Recovery Team could not fill the gap in service.

Findings

  1. The Ombudsmen will consider, in a complaint involving the NHS and the local authority, whether there are formal or informal arrangements between the two bodies and the nature of those arrangements. Where the NHS and local authority work together under partnership arrangements and the distinction between roles and responsibilities is unclear, the Ombudsmen will not spend disproportionate time deciding individual responsibility. In these situations, if the Ombudsmen find fault they will attribute it to the partnership as a whole and expect each body to contribute to any proposed remedies.

Consideration and provision of S117 aftercare services

  1. Mr B’s needs are complex and he requires services which are tailored to meet his specific needs. The evidence available shows he has at times received services from different teams such as social services and mental services simultaneously. There is no dispute that Mr B is entitled to S117 aftercare services. As such the Council, the CCG and the Trust accept they are responsible for Mr B’s S117 aftercare needs.
  2. The Trust confirms there was no specific S117 aftercare plan for Mr B when he left hospital in 2011. Mr B should have had a care plan completed which related to his aftercare on each occasion he was discharged from section 3. It is unclear which services formed part of Mr B’s aftercare because the authorities did not complete a formal S117 plan in line with their joint policy. Because of the specific statutory obligation to provide S117 aftercare services it is important to keep a record of what services Mr B was and is provided under this section. The authorities did not do this and are at fault.
  3. In response, the authorities said S117 aftercare can comprise a mixture of commissioned care packages delivered by different organisations. They acknowledged that although support arrangements were recorded and provided by different agencies there was no single document or agency that took responsibility for gathering, recording and coordinating the S117 aftercare provision. To improve, the organisations are currently acting to transform the quality of care and support provided to people with the aim of sharing their health and social care priorities in a more joined up way.
  4. Mr B was assessed as needing a commissioned support package to meet his S117 aftercare needs in 2013. The authorities said Mr B refused to engage with support. While the evidence at the time showed the provider had found it difficult to contact Mr B I have not seen evidence to show how frequently and over what period the provider tried to contact Mr B. There is no record to show Mr B refused the support on offer.
  5. Mr B remained entitled to S117 aftercare services even after the provider withdrew from the process. The authorities’ S117 policy states that S117 entitlement should not be discharged or ended if the person refuses services (unless they are subject to other parts of the Mental Health Act). It is accepted that authorities need to balance an individual’s right to autonomy but aftercare services should not be withdrawn solely because someone declines the offer of aftercare services. When the care provider said it could no longer provide the service there is little evidence to show what the authorities did to pursue an alternative provider or option while Mr B remained eligible for this S117 aftercare service. This is fault.
  6. Mr B was subject to the CPA and was reviewed under this system. The CPA plan should have set out a transparent, accountable and coordinated approach to show how Mr B’s wide-ranging physical, psychological, emotional and social care needs which were associated with his mental health condition would be met. The documents I have seen are lacking in detail to show how Mr B’s complex needs were kept under review and planning in view of the high risk of him suffering deterioration in his mental health.
  7. The assessment states the proposed S117 aftercare service was meant to provide daily support and structure to Mr B as this may have helped to change his negative thoughts and prevent alcohol consumption. The service was also proposed to take pressure off Mr D who was struggling to manage his son’s needs. The evidence available suggests an assessment was completed around June 2015 as Mr D said. The Ombudsmen were not provided with a copy of this assessment, but the case records provided suggest the assessment led to consideration of a domiciliary care package. This care package was not provided, and I have not seen evidence to show it was because of fault by Mr B. Therefore, I find the authorities at fault.
  8. Aftercare is a vital component in a person’s treatment and care plan and is designed to help them cope with life outside hospital and prevent readmission. It is fair to assume services were commissioned to prevent Mr B returning to hospital. It is also likely, on balance, the failure to provide the care package and make a concerted effort to provide an alternative service impacted adversely on Mr B’s general and mental wellbeing. This ultimately led to readmission to hospital.
  9. In his complaint to the Ombudsmen, Mr D describes experiencing hardship and distress when he was left to deal with Mr B’s situation due to lack of formal support. He says he continues to have flashbacks and nightmares because of the adverse impact on him. There is no good reason to doubt what Mr D says. It is likely, on balance, that Mr D experienced increased carers strain as Mr B’s informal carer as he was left to pick up the pieces.
  10. Mr B’s entitlement to all S117 aftercare services ended when he was returned to hospital under section 3 of the MHA in late 2015. However, a new S117 entitlement started when he was discharged from hospital following this period of detention. Mr D felt the assessment completed at this time provided a good plan for Mr B’s care and support arrangements. The evidence shows Mr B also spoke positively about his care provider during reviews. This shows some success in care and support planning.
  11. Mr D remained concerned about what should happen if the risks to his son’s safety is increased because of his excessive consumption of alcohol. There has been dispute between Mr D and the Trust about whether Mr D has capacity to make specific decisions relating to his health and safety when he is experiencing crisis and drinks alcohol. There also appears to be a difference of opinion about how much weight is placed on each of Mr B’s diagnosis during these episodes of alcohol consumption.
  12. Mr B is an adult who can make capacitated decisions. The law says capacity must be presumed in the first instance unless there are reasons to question a person’s capacity to make specific decisions. The consumption and intoxication of alcohol on its own is not enough to arrive at a view a person lacks capacity. However, in Mr B’s case, his alcohol misuse is coupled with his mental health illness, his dependency on prescription medication and his diagnosis of ASD. The Mental Capacity Act suggests these factors together are enough to assess someone’s capacity to make specific decisions at times when this becomes necessary. I have not seen evidence to show this has happened.
  13. Mr D feels there should be clear safety plan outlined in Mr B’s care and support plan and specific details to show contingency planning of what to do when Mr B presents a risk to himself and possibly others. The authorities cannot stop Mr B from consuming alcohol when he is in the community. Mr D should accept this is the case regardless of any safety plan in place. On the evidence available, the arrangements in place, for example, telephoning the Crisis Team do not appear to meet Mr B’s specific needs.
  14. It is important for the Council, the Trust and the CCG to have local partnership arrangements in place to ensure people, such as Mr B, receive the right medical care from the most appropriate agencies as soon as possible when experiencing mental health crises. I have not seen evidence to satisfy the Ombudsmen the authorities always had sufficient arrangements in place to manage times when
    Mr B experienced crisis.
  15. The Government’s autism strategy says, “when someone with autism has a mental health problem, such as anxiety or depression, it is essential that they can access appropriate help and support… care planning for people with these needs should reflect their needs related to their specific autism as well as those relating to learning disability or mental or physical health issues.”
  16. The evidence available strongly suggests there is not a suitable service available in the locality to meet both Mr B’s diagnosis of ASD coupled with his mental health illness. His assessments maintain he needs to work with staff who have relevant experience working with people with ASD. The letter from the consultant psychiatrist highlighted a gap in service which needed to be addressed. This appears to be an ongoing problem and a wider issue for the authorities named in this complaint. This creates an area of concern for the Ombudsmen.

Mr D’s complaints to the Trust

  1. Mr D has complained to the Trust consistently about Mr B’s care and support arrangements. Contributory factors are the lack of proper care planning, provision of service and failure to share information such as care and support plans. Time taken to respond to complaints of this nature may inadvertently impede the care and support planning process. Nevertheless, there is no evidence to suggest
    Mr D does not have his son’s best interests at heart.
  2. Mr D complained about the language used to describe him and his relationship with his son within documents which recorded discussions about Mr B’s care and support. In response to the Ombudsmen’s enquiries the clinician involved at the time has since explained the comments were said in a clinical context and were not intended to cause offense or insult. Although these events happened years ago it is important the Trust acts to address Mr D’s complaints by adding an addendum to the records considering the most recent comments from the clinician involved at the time.
  3. When the Trust responded to Mr D’s complaint in 2016 it said the Recovery Team believed Mr B would benefit from a period in a residential setting, but previous recommendations were not approved by the Council. The Trust has not provided sufficient evidence to show it identified a residential placement and then recommended this to the Council. The Council confirmed it did not have a record of these requests ever being considered by the community funding panel. The evidence available suggests the Trust provided misleading information to Mr D. This is likely to have caused him avoidable frustration.
  4. The Trust has said it can no longer consider some of the historical complaints
    Mr D continues to raise, and I find no fault in this decision.

Conclusion

  1. Mr B has wide ranging complex needs which have presented challenges to the teams and professionals working with him. At times, he has not engaged with services and it is unclear whether his reluctance to engage is because of his conditions. Nevertheless, there is insufficient evidence to show the authorities named in this complaint did enough to ensure all of Mr B’s S117 aftercare needs were met or at least kept under review in line with the CPA. This caused Mr B injustice as the faults identified had an adverse impact on his general and mental wellbeing.
  2. Mr D has also experienced avoidable distress and frustration because of the faults identified. He has felt it necessary to complain to the Trust and he has received responses. It is important that Mr D now moves on from the historical issues and works with the Trust to ensure Mr B has a care and support plan which meets his current needs. There is a wider issue which highlights a gap in commissioning and this should be addressed by the authorities tasked with commissioning local support arrangements.

Back to top

Agreed Recommendations

  1. Within four weeks of the final decision the authorities have agreed with the Ombudsmen’s recommendation to complete the following actions:
    • the Trust will coordinate a letter of apology to Mr B which incorporates comments from the Council and the CCG. The letter will acknowledge the adverse impact the failure to provide specific S117 aftercare services had on him;
    • the Trust, the Council and the CCG will each pay Mr B £350 to acknowledge the impact the failure to provide him with S117 aftercare services had on his wellbeing;
    • the Trust will coordinate a letter of apology to Mr D incorporating comments from the Council and the CCG to acknowledge the increased carers strain he experienced. The Trust will also apologise for providing misleading information when it responded to his complaint. The Trust will give Mr D the opportunity to have the comments from the clinician which explains the use of language added as an addendum to its records;
    • the Trust, the Council and the CCG will collectively pay Mr D £300 to acknowledge the increased carers strain he experienced. The Trust will pay
      Mr D an additional £150 to acknowledge the avoidable distress and frustration he experienced when it responded to his complaint;
    • the Trust in consultation with Mr B, his chosen representative, the Council and the CCG will ensure Mr B has a robust care and support plan in place which clearly sets out his needs and the outcomes he wants to achieve. The plan will identify aftercare services provided under S117 as well as any services provided under other legislation, such as the Care Act 2014. The care and support plan will include an agreed safety plan and a contingency plan should there be a breakdown in the arrangements. The Trust will ensure Mr B and his representative receive a copy of the care and support plan once it is finalised;
    • the authorities will consider whether there is a team which can meet Mr B’s ASD, mental health and social care needs. Alternatively, consideration should be given to whether his existing team can undergo specific autism training to improve practice; and
    • the Trust will reiterate to its staff the importance of ensuring a S117 aftercare plan is in place when discharging patients from hospital. It will also remind its staff of the importance of recording all the physical, psychological, emotional and social care needs of patients in CPA documentation and review documents.
  2. Within three months of the final decision the Trust, the Council and the CCG will provide an update to the Ombudsmen to show what they have done to address the gap in commissioning referred to by the consultant psychiatrist. The update should include any new services and preventative measures in place (or progress made) in the local area which are designed to meet the needs of individuals who are diagnosed with both an ASD and mental health illness.

Back to top

Final decision

  1. I uphold Mr D’s complaints against the Trust, the Council and the CCG. The authorities have agreed to the Ombudsmen’s recommendations and this provides a suitable remedy for the faults identified. I have completed the investigation.

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