Summary: Miss X complained the Council did not properly consider the new medical evidence she provided when she requested a reassessment for medical priority. We found fault with the Council for not demonstrating proper consideration to her evidence. The Council has agreed to our recommendations to remedy the injustice caused to Miss X.

The complaint

1. Miss X complains about the Council’s decision to not reassess her medical priority on the housing register. She says it has not properly considered her medical evidence from March 2022 which demonstrated her health has deteriorated because of the negative impact her housing and living conditions have on her. This is causing her significant stress on a day to day basis.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
4. 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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What I have and have not investigated

5. Part of Miss X’s complaint refers to decisions made by the Council in early 2021. I consider this is late as she could have complained to us about these sooner. Therefore, I am not taking a viewing on these specifically. I have outlined these decisions and what happened in Paragraphs 17 to 19 for relevant background and context for the rest of the complaint. The scope of my investigation considers events from March 2022 up to when she complained to us.

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How I considered this complaint

6. I discussed the complaint with Miss X and considered her views.
7. I made enquiries of the Council and considered its written responses and information it provided.
8. Miss 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

9. 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))
10. 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))
11. 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

12. The Council’s scheme (applicable at the time of Miss 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.
13. 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.
14. 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.

Background

15. Miss X lives in a property owned by her sibling with several members of extended family.
16. Miss X has Obsessive Compulsive Disorder (“OCD”) and other mental health conditions. She says her strained relationships with the others and overcrowding causes her psychological strain and distress. She has a lack of free space which can continually stress her out and she says she needs a property with specific requirements for her condition and mental health. Her housing situation is having a negative effect on her wellbeing and quality of life.
17. In late 2020, Miss X submitted a form for medical priority to the Council. In early 2021, the Council sent a decision letter to confirm it was not awarding her additional priority. She requested a review.
18. In March 2021, the Council reviewed the decision and wrote to her to say it stood by its decision not to award additional priority on medical grounds. It considered the issues she faced were because of the impact of overcrowding, which was not a medical matter. It had already awarded her priority under its overcrowded category.
19. Miss X has been in frequent contact with the Council about these decisions since, including raising formal complaints. The Council said she had exhausted its medical process with its final decision in March 2021 and would not carry out a further assessment, unless she provided new evidence her condition had deteriorated.

Summary of key relevant events

20. In March 2022, Miss X sent the Council new evidence for it to consider: a letter from her GP and a letter from the therapy service. They both confirmed her referral to the mental health team for therapy. There was mention of her current housing situation contributing to a deterioration in her health and her OCD escalating.
21. The Council said it considered the letters and concluded there was no new information. It was aware of the impact her current living arrangements were having on her. It considered it had properly assessed and prioritised her according to its allocations scheme. It refused to reassess her.
22. Miss X has asked it to reconsider several times since, stating her living conditions continually exacerbate her mental health and her OCD. The Council has maintained its position throughout.

Analysis

Medical assessment

23. It is not my role to say whether a Council’s decision is right or wrong or whether an applicant should be awarded medical priority or not. However, I can consider whether there is fault in the decision-making process.
24. The Council doesn’t appear to have engaged with the contents of the letters Miss X provided in March 2022. It said they did not show “any new information”, but they referenced a referral to the mental health team and said Miss X’s health had deteriorated. In my view, the Council did not demonstrate proper consideration of this specific point. In its decision making and rationale, I would have expected the Council to have recognised the evidence indicated her condition had worsened. It did not in this case.
25. I also highlight the Council previously said to Miss X it would reassess her if she provided evidence of her condition deteriorating since its last decision. Miss X did. As the Council did not acknowledge her evidence appeared to show this and then refused to re-assess, I consider this raised her expectations and caused her frustration and uncertainty.
26. How much weight should be placed on this evidence is a professional opinion and a decision for the Council to make. However, I would have expected the Council to have at least considered the deterioration part further.
27. Therefore, I am not satisfied the Council has demonstrated it has properly or fairly considered the evidence to make a robust decision that Miss X should not be reassessed for medical priority. This is fault. I consider this has caused Miss X injustice as it would have given her a fresh decision and a right to review if she disagreed with it.

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Agreed action

28. To remedy the injustice set out above, the Council has agreed to carry out the following actions:
29. Within one month of the final decision:
• Apologise to Miss X in writing for how it did not properly consider her new evidence when she requested a reassessment for medical priority;
• Begin to carry out a reassessment on Miss 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 Miss X and write to her to clearly explain the reasons for that decision;
• Should the Council decide Miss X is eligible for medical priority, it should backdate the date of the approval to when she provided the evidence in 2022. If the Council decides not to award priority, it should inform her of her right of review; and
• Pay Miss X £100 for her avoidable distress and uncertainty caused by the fault.
30. The Council should provide us with evidence it has complied with the above actions.

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Final decision

31. I found fault with the Council which caused injustice to Miss 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