Summary: Ms X complained the Council did not suitably consider her medical needs and the negative impact her current home has on her when deciding not to award medical priority on the housing register. We found fault with the Council for failing to properly explain its decision making to Ms X. We also found fault with delays in processing her application. The Council has agreed to our recommendations to remedy the injustice caused to Ms X.

The complaint

1. Ms X complains about the Council’s decision to not award her additional priority on the housing register. She says it failed to properly consider how her home negatively affects her because of her medical needs and health conditions, which means she should meet the test for medical priority. This is causing her ongoing distress and frustration; she says she is vulnerable and is continuing to live in a house that is not suitable or safe for her needs.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I discussed the complaint with Ms X and considered her views.
5. I made enquiries of the Council and considered its written responses and information it provided.
6. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Law and administrative background

Housing allocations

7. Every local housing authority must publish an allocations scheme that sets out how it prioritises housing applicants, and its procedures for allocating properties.  All allocations must be made in strict accordance with the published scheme. (Housing Act 1996, section 166A(1) & (14))
8. An allocations scheme must give reasonable preference to applicants in the following categories:
• homeless people;
• people in insanitary, overcrowded or unsatisfactory housing;
• people who need to move on medical or welfare grounds;
• people who need to move to avoid hardship to themselves or others.
  (Housing Act 1996, section 166A(3))
9. Applicants have a right to request a review of a council’s decision about the priority band they have been awarded.

The Council’s scheme

10. The Council’s scheme (applicable at the time of Ms X’s complaint) says priority on health or disability will only be awarded after an assessment if someone in the household has:
• a severe long-term limiting illness, or a permanent and substantial disability AND
• their health or quality of life is severely affected by the home they live in.
11. Its scheme says a priority medical award is not given on the basis of the medical condition or disability alone but upon the effect the housing circumstances are having on a long term and serious medical condition or disability.
12. An officer will make decisions on medical applications and may ask qualified health advisers to recommend who should be given additional preference for housing on health or disability grounds. In reaching a decision on whether or not to make a priority award on medical grounds, an officer, where appropriate, will have regard to comments and information from the applicant’s doctor as well as other medical professional opinions.

What happened

13. I have summarised below an overview of the key relevant events. This is not intended to be a detailed account of each communication between the parties or an exhaustive chronology of everything that happened.
14. Ms X has several health issues and medical conditions. She lives in a two bedroom maisonette with her three children.
15. In May 2022, Ms X emailed her completed application form for medical priority to the Council. She wrote she had movement issues affecting her spine and a condition affecting her knee joints. There was no toilet downstairs, and she could not manage the stairs in her home as it caused her pain and dizziness. She asked for a ground floor house with easy access.
16. At the start of October, the Council wrote to Ms X. It confirmed it received her form at the end of August and had started the assessment process. The Council referred Ms X’s application to its external independent medical advisors.
17. At the end of October, Ms X sent a medical letter to the Council. She asked for a recent diagnosis to be added to her application.
18. In mid-November, the Council sent a decision letter to Ms X confirming it was not awarding her additional priority. It said it considered her circumstances, the information available, and the advice from its independent medical advisor (“Advisor 1”). The Council said it was satisfied she met the first part of the test for medical priority as she had long standing disabilities. It did not consider she met the second part; that her current home was having a detrimental effect on her. The Council shared Advisor 1 had noted Ms X’s condition about her joints and said the internal flight of stairs appeared reasonable. The Council said it was in agreement with these comments.
19. Ms X asked the Council to review this and said it had not properly considered how her home affected her. She said with no downstairs toilet, she found it difficult to climb the stairs to reach it on time. She had joint pains, chest pain, shortness in breath in using the stairs, and bladder weakness.
20. The Council reviewed the decision. It sent the referral to its independent medical advisors, and it was allocated to a different advisor (“Advisor 2”). Advisor 2 said she lived in accommodation with access to normal facilities and could manage some stairs. They did not find the accommodation had a severe adverse effect and said the threshold for medical priority was not met.
21. In January 2023, Ms X chased for a response. The Council sent her a decision about its review. It confirmed it stood by its decision not to award additional priority and shared Advisor 2’s comments.
22. Ms X responded further about her home not being suitable for her needs. She said she had had falls using the stairs because of her medical and health issues when trying to access the toilet upstairs. The Council said it was its final position.
23. Ms X then complained to us.
24. In response to my enquiries, the Council said Ms X’s form was uploaded to its system in August 2022. It could not find evidence of when she submitted it.

Analysis

Delay

25. Ms X sent me an email evidencing she sent her application to the Council in mid-May 2022. The Council said it aims to make decisions to applications within eight weeks. She did not receive the Council’s decision until November - six months after she submitted it. I note the Council said it was not uploaded to its system until August, but it has not been able to explain why. This delay in processing Ms X’s application is fault, causing avoidable uncertainty and frustration for Ms X.

Decisions

26. It is not my role to say whether a Council’s decision is right or wrong. However, I can consider whether there is fault in the decision-making process, and, if so, whether this was remedied by the review decision.
27. The Council can ask the advice of third party medical advisors, but it must make its own decisions on the priority it gives to housing applications.
28. Both the Council’s initial decision letter and later review letter said it had considered Ms X’s completed form and additional information provided, as well as advice from its independent medical advisors. However, in my view, it has not demonstrated this. The Council copy and pasted each Advisors comments and either said it agreed with them or did not offer any further explanation. It appears to have simply adopted the opinion of its Advisors. This is fault.
29. There is no evidence from the Council to explain how it came to this decision in its letters or clearly why it did not consider her home severely affected her. Ms X clearly outlined her medical conditions in her form and how her home’s layout negatively impacted her because of these. I would have expected the Council to have engaged specifically with these points as these are relevant to its tests for awarding medical priority. It did not do so. Therefore, I consider the Council has not properly explained its reasons to Ms X for deciding she does not qualify for medical priority or shown proper consideration about how she says her home impacts on her on medical grounds. This is fault. It has caused uncertainty to her about whether her application was properly considered.

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Agreed action

30. To remedy the injustice set out above, the Council has agreed to carry out the following actions:
31. Within one month of the final decision:
• Apologise to Ms X for not properly explaining its decisions to her application;
• Begin to carry out a fresh review on Ms X’s application for medical priority, taking into account any further evidence she wishes to provide. It should make its decision within 8 weeks of receiving the relevant information from Ms X and write to her to clearly explain the reasons for that decision;
• Should the Council reassess Ms X and find she is eligible for medical priority, it should backdate the date of the approval to 11 July 2022. This is 8 weeks from when she made her original application; and
• Pay Ms X £150 for her avoidable distress and uncertainty caused by the fault and delay.
32. Within two months of the final decision:
• Send written reminders to relevant housing staff that responsibility lies with the Council to make decisions on whether to award priority for applications, not medical advisors. It should also remind them to ensure decision letters clearly explain how the Council has reached its decision and what account it has taken of evidence provided, as well as the views of its medical advisors.
33. The Council should provide us with evidence it has complied with the above actions.

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Final decision

34. I found fault with the Council which caused injustice to Ms X. The Council has agreed with my recommendations to remedy this, and I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman