London Borough of Enfield (19 018 880)

Decision : Not upheld

Decision date : 09 Dec 2020

The complaint
The Ombudsman’s role and powers
How I considered this complaint
What I found
Final decision

The Ombudsman's final decision:

Summary: Mr X complains that the Council has wrongly assessed his family as low medical priority for housing allocation and ignored medical advice that his daughter needs her own bedroom. Mr X says he and his family are exhausted. The Ombudsman does not find the Council at fault.

The complaint

The complainant, who I refer to here as Mr X, complains that the Council has wrongly assessed his family as low medical priority for housing allocation, and ignored medical advice that his daughter needs her own bedroom.
Mr X says he cannot put in place the sleep plans for his daughter that have been recommended by professionals. He says he and his family are exhausted.

The Ombudsman’s role and powers

We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’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. (Local Government Act 1974, section 34(3), as amended)

How I considered this complaint

I considered the information and documents provided by Mr X and the Council. I spoke to Mr X about his complaint. Mr X and the Council had an opportunity to comment on an earlier draft of this statement. I considered all comments received before I reached a final decision.
I considered the relevant legislation and policies, set out below.

What I found

What should have happened

Councils must have an allocations scheme to determine priorities and set out the procedure it will follow when allocating housing. Each council’s allocations scheme will be different but in general most will award 'reasonable preference' to allocations by awarding points or placing an applicant in a certain priority band.
Applicants have a right to request a review of a council’s decision about the number of points or band they have been awarded.

The Council’s allocations policy

This policy says that pairs of children of either sex up to ten years old will be expected to share a bedroom.
Regarding entitlement to an additional bedroom, the policy says an extra bedroom may be considered where:

“an applicant has a child with behavioural syndromes including extreme hyperactivity or autism and a Health and Well-being assessment has confirmed the applicant needs their own room.”

The Council’s Health and Wellbeing Assessment Guidelines

This says a Medical Assessment Officer (MAO) will carry out the Health and Wellbeing Assessment and it will be based on information in the Health and Wellbeing Assessment Form.
The Council’s Guidelines outline the issues a MAO will consider during a Health and Wellbeing Assessment. It says only the most severe cases are likely to attract health and wellbeing points.
It says where a MAO’s decision is challenged under the review process the case may be referred to NowMedical, an independent organisation that specialises in providing medical advice for the Council’s housing services.
The Guidelines set out the three health and wellbeing categories (also known as medical priority): low, medium, and high.
The low category is for living conditions that cause the applicant difficulty in carrying out daily activities, but this is neither life-threatening nor would greater harm or progression of the illness be caused if they did not move.
The medium category is applied when an applicant’s living conditions are unsuitable but their need to move is less urgent and not life-threatening, but if left unresolved, their quality of life will deteriorate.
For the medium category, it gives an example of children with complex needs below school age and/or attending special schools, who are undertaking strategies to enable them to deal with behavioural problems.

What happened

Mr X and his wife live with their two young children (a son and a daughter) and Mr X’s parents in a three-bedroom house. The children share a bedroom. Mr X’s daughter (D) has been diagnosed with autism and has problems with disturbed sleep.
In 2019, Mr X applied to the Council for housing. He provided medical evidence for D’s diagnosed conditions.
In April 2019, the Medical Assessment Officer (MAO) assessed Mr X’s application and considered the medical evidence. She determined that Mr X should be placed in the low health and wellbeing category. The MAO said that an extra bedroom was not essential.
In June, the MAO twice reassessed Mr X’s application. The MAO considered the medical evidence (slightly different evidence for each reassessment), and confirmed that Mr X should be placed in the low health and wellbeing category. The MAO said on both occasions that an extra bedroom was not essential.
Mr X appealed the Council’s decision to place him in the low health and wellbeing category.
The Council referred Mr X’s application to NowMedical. Dr P from NowMedical assessed the application. He considered the medical information, and that D has a sleep pattern impairment.
Dr P determined that an extra bedroom was not currently medically essential. He recommended discussing appropriate strategies with a specialist to improve D’s sleep. Dr P said Mr X may wish to consider informally screening one room to provide independent space for D.
Dr P said medical priority did not apply in this case. He acknowledged D’s needs may change as she gets older. He recommended the case was reviewed as D’s development progresses and the outcome of any management strategies are known.
In September, the Council wrote to Mr X with the outcome of the appeal. It listed all the information, evidence, and policies considered as part of his appeal.
The Council acknowledged that D has autism and experiences disturbed sleep. It said its allocations policy states only that an extra bedroom may be agreed, and this depends on the MAO’s recommendation. It said the MAO did not conclude that D needs her own room at this stage.
The Council concluded that while an additional bedroom would be ideal, it is not a necessity at this time. It said there is no evidence to suggest that D’s difficulty sleeping through the night is because she shares a room with her brother. Rather, it is due to her diagnosed conditions. The Council said an additional bedroom would not necessarily solve the problem.
The Council said it had not dismissed professionals’ recommendations for an additional bedroom. It said none of those professionals confirmed that an additional bedroom was essential.
The Council said Mr X had pointed out that its Health and Wellbeing Assessment Guidelines give an example for medium priority as children with autism.
The Council said the MAO awarded Mr X low health and wellbeing priority because there had not been a sufficient period of time to assess how professional interventions were working. It said that D had not been in the special school system long enough to assess how the plan was working.
The Council found that the low award was appropriately given. It said autism is not life-threatening and in D’s case there is no evidence that continuing to share a room with her brother would cause her harm or result in a deterioration in her condition.
The Council said its Health and Wellbeing Assessment Guidelines say that when considering medium award for those with autism, the MAO must look at whether strategies are being undertaken to enable Mr X to deal with any behavioural issues. The Council said it was satisfied that various assessments were taking place to decide how D will navigate her way through school.
The Council upheld its decision to place Mr X in the low health and wellbeing category.
Mr X then complained to the Ombudsman.

Analysis

Mr X complains that the Council has wrongly assessed his family as low medical priority for housing allocation, and ignored medical advice that his daughter needs her own bedroom.
I find that the Medical Assessment Officer (MAO) carried out the Health and Wellbeing Assessments in line with the Council’s Health and Wellbeing Assessment Guidelines.
The allocations policy says an extra bedroom may be considered where: