Summary: Miss B complained about the way the Council considered her medical needs in connection with her housing application. We have found some fault in the way the Council communicated its decisions to Miss B. But we consider the Council’s most recent review properly explained the decision. The Council has agreed to review the content of its medical assessment decision letters for the future.

The complaint

1. Miss B complained that the London Borough of Lewisham (the Council) failed to properly consider her medical needs in connection with her housing application and delayed in doing so. It also failed to explain why she is not eligible for higher medical priority which would place her in Band 2 of the Council’s allocations system or why it has discounted her evidence. This has caused Miss B distress and frustration.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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 have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. Miss B 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

The Council’s allocations policy

5. This policy allocates priority to housing applicants according to their housing need placing them in one of four bands:
• Band 1 for emergency or very urgent situations.
• Band 2 for high priority cases, including those people who have high medical priority due to an urgent need to move because their medical condition is affecting their health and wellbeing very severely.
• Band 3 for medium priority cases, including those people who have medical priority due to a need to move because their medical condition is seriously affecting their health and wellbeing.
• Band 4 is for low priority cases.

LGSCO practitioner guidance: Medical assessments for housing applications

6. Councils must give reasonable preference to applicants who need to move on medical grounds. Many allocation schemes say the council will do a medical assessment if an applicant says their physical or mental health conditions are made worse by their current housing situation. The purpose of the assessment is to decide if they qualify for medical priority under the allocation scheme.
7. Applicants will usually need to provide evidence from a health professional to support their request.
8. When considering their request, councils may seek advice from external independent medical advisers or ask their own occupational therapist (OT) to carry out an assessment. But the decision about whether the applicant qualifies for priority, and at what level, is for the council to make based on its allocation scheme and all the evidence provided.
9. We also expect councils to consider all the medical evidence the applicant has provided, to keep a proper record to show how it has considered the evidence and explained its reasons for the decision. In the case of a refusal this means explaining why it has discounted the evidence the applicant has provided or why it was not sufficient to justify awarding a higher priority.

What happened

10. Miss B has physical and mental health conditions. She applied to the Council for housing in 2010 and says she was placed in Band 2. She was then rehoused in her current housing association accommodation. In 2021 she was back on the housing register due to increased medical needs and overcrowding. She was placed in Band 3 needing three bedroom accommodation with a lift, if above ground floor level.
11. In June 2022 Miss B requested another medical assessment as she said her conditions were getting worse and her mental health was significantly affected by her current accommodation. She completed a change of circumstances form in February 2023. She provided supporting information, including letters from her GP, a social worker and her child’s paediatrician.
12. The Council sent her a letter on 30 August 2023 confirming she was in Band 3 due to medical needs. It said the medical adviser had determined her present home was affecting her health due to safety and accessibility issues and it was overcrowded. It gave no further details but said she needed a three bedroom property with a lift, if above ground floor level.
13. Miss B requested an appeal in October 2023 saying the impact of her current living conditions on her mental health warranted Band 2 priority. The Council accepted the late appeal and referred the case to the medical adviser again. On 30 January 2024 it sent its decision, confirming the same priority as before. The letter repeated the same standard information that she would only be awarded a high medical priority if she had an urgent need to move.
14. Miss B complained to the Council via her MP about the decision. The Council responded to her MP and repeated the content of the decisions since 2021. It said it would not carry out a further review unless there was a change of circumstances.
15. Miss B complained to us. She also spoke to the Council in March 2024, and it agreed to review Miss B’s medical assessment. It obtained consent to access Miss B’s medical records and passed the case to another medical adviser. On 4 July 2024 it sent her a decision. It concluded that her existing priority and type of property was correct. The medical adviser did not consider her mental health condition was severe enough to warrant high medical priority and the Council agreed with that conclusion. It gave some reasons from the medical records to support the decision.
16. In response to my enquiries the Council said it had no record of Miss B ever being awarded Band 2 priority.

Analysis

17. The Ombudsman is not an appeal body. This means we do not take a second look at a decision to decide if it was wrong. Instead, we look at the processes an organisation followed to make its decision. If we consider it followed those processes correctly, we cannot question whether the decision was right or wrong, regardless of whether you disagree with the decision the organisation made.
18. I understand Miss B is very unhappy in her current accommodation and experiences distress from her mental health condition. However, I consider the Council has properly considered the evidence provided about her medical conditions in reaching its view that she is eligible for Band 3 priority for a three bedroom home with lift access above ground floor level. The letter sent in July 2024 properly explains the reasons for that decision and makes clear that the Council has made that decision taking into account the medical adviser’s view and the medical records/documents it had seen.
19. But I do not consider the decision letters sent in August 2023 and January 2024 make clear that the decision has been made by the Council rather than the medical adviser and do not give adequate reasons for why the decision was made. For example, neither of the letters explain why Miss B is not eligible for Band 2 on the basis of the information she has provided and just repeat the standard paragraph that she needs to have an urgent need to move to qualify for Band 2 priority. The Council should have explained why it did not consider she reached that threshold referring to the evidence she had provided.
20. The failure to do so was fault but I consider the fault was rectified by the fuller explanation provided in the recent review decision.
21. I also note the Council delayed in considering the review in 2023: it took six months when its target time is 8 weeks. It has acknowledged the delay was due to a backlog of cases at the time and since then has provided evidence that the situation has improved. I am satisfied that there is no ongoing issue and that as Miss B’s priority has not changed, there is no injustice to her because she has not missed out on the opportunity of alternative accommodation.

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Agreed action

22. There is no remaining personal injustice to Miss B, but given the fault in the decision letters identified above, I recommend the Council within two months of the date of my final decision:
• Reviews the content of its medical assessment decision letters to ensure it makes clear that the Council, not the medical adviser, has made the decision and provides full reasons for its decision based on the evidence provided.
23. The Council has agreed to my recommendation and should provide us with evidence it has complied with it.

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Final decision

24. I have completed my investigation into this complaint as I consider there is no ongoing injustice to Miss B from the fault identified in the initial decision letters and the Council has agreed to review the content of the letters.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman