Summary: Mr X complained about the Council’s assessment of, and review of its decision about, his medical priority on the housing register. We have found fault by the Council, causing injustice in the way it carried out the review. The Council has agreed to remedy this injustice by apologising to Mr X, making a payment to reflect his upset and uncertainty, carrying out a fresh review and making a service improvement.

The complaint

1. The complainant, Mr X, complains about the way the Council dealt with his request for medical priority on its housing register. He says it:

• failed to properly consider all the information provided about his serious physical and mental health conditions and urgent need to move from his current accommodation; and
• wrongly decided to assess his medical priority as Band C, instead of Band A.

2. He wants the Council to put this right by assessing his medical priority as Band A, or at least Band B.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these.
4. 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)
5. 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)
6. 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

7. I made enquiries of the Council and read the information Mr X and the Council provided about the complaint.
8. I invited Mr X and the Council to comment on a draft version of this decision. I considered their responses before making my final decision.

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What I found

What should have happened

The Council’s allocations policy

9. Every local housing authority must publish an allocations scheme that sets out who can apply to join its register for social housing, how it prioritises applications for, and allocates, social housing. All allocations must be made in strict accordance with the published scheme. (Housing Act 1996, section 166A(1) & (14))
10. The Council’s current published policy dated January 2023 says it prioritises applications by placing them in one of the following three bands:

• Band A: Emergency and Top Priority
• Band B: Urgent need to move
• Band C: Identified Housing need

11. The policy also sets out the priority categories for each band, and says about the medical priority category:

• applicants who have a medical illness or disability which is affected by their current home can be considered for medical priority banding;
• applicants must demonstrate the medical illness or disability is being worsened by the conditions of their current accommodation and that being moved to alternative accommodation will significantly improve the noted medical condition; and
• the Council may consider, despite the noted conditions, the accommodation is suitable for their continued occupation.

The Council’s medical priority banding procedure

12. The Council’s current policy says it assesses an applicant’s medical priority banding in the following way:
1. Band A medical priority where:

• an applicant or household member has a life-threatening condition which is seriously affected by their current housing, or a terminal illness/ lifespan of less than 12 months and rehousing is needed for their care provision; or
• housing conditions or other circumstances are directly contributing to a significant deterioration in the applicant or household member’s health condition such as to warrant emergency priority, where rehousing will alleviate the effect.
2. Band B medical priority:
• where the applicant’s or household member’s housing circumstances are not suitable and are having a major adverse effect on their medical condition and this can be alleviated by rehousing; but
• this will not apply where the effect of housing conditions on health is comparatively moderate, slight or variable.
3. Band C medical priority where: the housing circumstances are not suitable for the applicant or household member and having a moderate effect on their medical condition which can be alleviated by rehousing.

13. The policy also says:

• information submitted in support of a request for medical priority will be assessed by the Council’s Medical Adviser who will provide a recommendation to the Council;
• the Council will consider the Medical Adviser’s recommendation and information used by the Medical Adviser and consider what the priority band should be, which can include no medical priority; and
• the Council will only re-assess medical circumstances on receipt of new medical information. It will not re-assess information already considered on a previous medical assessment.

Decisions and review rights

14. Housing applicants can ask the council to review a wide range of decisions about their applications, including decisions about their housing priority.
15. Statutory guidance on the allocation of accommodation says:

• review procedures should be clear and fair with timescales for each stage of the process;
• there should be a timescale for requesting a review - 21 days is suggested as reasonable;
• the review should be carried out by an officer senior to the original decision maker, or by a panel not including the original decision maker;
• reviews should normally be completed within a set deadline - 8 weeks is suggested as reasonable.

Our role

16. The Ombudsman recognises that the demand for social housing far outstrips the supply of properties in many areas. 
17. We may not find fault with a council for failing to re-house someone, if it has prioritised applicants and allocated properties according to its published lettings scheme policy.

What happened

18. I have set out a summary of the key events below. It is not meant to show everything that happened. It is based on my review of all the evidence provided about this complaint.

February 2024: Mr X’s application to join the housing register

19. Mr X and his family live in privately rented first floor self-contained accommodation. He applied to join the Council’s housing register in February 2024.
20. In his application Mr X told the Council about his physical and mental health conditions and the impact of his current accommodation on his health. He provided a letter from his GP dated 19 February in support of his request for medical priority. This letter said Mr X had:

• been the victim of attacks close to and at his home in which he was injured;
• struggled with symptoms of post-traumatic stress disorder (PTSD) and severe depression since the incidents, and lately with suicidal thoughts. He was constantly worried about he and his family being attacked again; and
• ongoing pain in his lower back, lower limbs and knee as a result of an accident.

21. The Council referred Mr X’s medical information to its Medical Adviser who recommended:

• the anti-social behaviour should be addressed through the appropriate channels;
• medical priority did not apply; and
• Mr X needed first floor maximum, or lifted, self-contained accommodation.

22. The Council sent Mr X the decision about its assessment of his priority on the housing register. This said:

• it had decided not to award any medical priority;
• it had considered all the information on file and the Medical Adviser’s recommendation. It saw no reason to disagree with this recommendation;
• his priority had been assessed as Band C (as a low-income working household); and
• he had 21 days to ask for a review of this decision.

March 2024: Mr X’s request for a re-assessment

23. Mr X was unhappy about the assessment he had no medical priority. He told the Council his situation was extremely urgent, the safety of his family was a priority, and he was having constant suicidal thoughts.
24. Mr X provided additional evidence from the mental health crisis team treating him. This letter, dated 13 March 2024, also referred to the incidents of assault and said:

• Mr X had been diagnosed with severe PTSD and depressive disorder. He had previously thought of committing suicide;
• he also suffered with lower back, leg, and knee pain; and
• Mr X felt terrified at his current address and awaited council housing to move him and family to another address.

25. The Council referred this new evidence to its Medical Adviser who said they had noted the concerns in the letters and recommended medical priority C should apply.
26. The Council sent Mr X the decision on its re-assessment of his medical priority. This said:

• it had noted the concerns in the letters. Band C medical priority applied;
• on the basis of the information available, it saw no reason to disagree with the Medical Adviser’s recommendation; and
• he had 21 days to ask for a review of this decision.

April 2024: Mr X’s further request for a re-assessment

27. A family member contacted the Council about an incident the previous evening and their concerns about Mr X’s medical condition. They provided a letter from a police officer involved with Mr X and his family. This said:

• they had been in regular contact with Mr X and his family since the assaults;
• A family member had contacted them because of their concerns about Mr X’s health; and
• the family was deeply affected by the assaults. Mr X’s mental health had deteriorated, and he was constantly scared for his and family’s life.

28. The Council sent the further information to its Medical Adviser who recommended:

• they noted the police letter but were concerned the police were not addressing the root cause - the ongoing assaults. The police should prioritise action due to length of housing waiting list; and
• the impact on Mr X’s mental health was noted and Band C applied.

29. The Council sent Mr X the decision on its further re-assessment of his medical priority. This said:

• it had decided his medical priority remained the same. His priority should be Band C low income/working household/medical with a priority date of 12 February 2024;
• it had considered its Medical Adviser’s recommendation, the police letter and all the information available. It could see no reason to disagree with the recommendation; and
• He had 21 days to ask for a review of this decision

May 2024: Mr X requests a review of the assessment of his medical priority

30. Mr X asked for a review of the Council’s assessment of his medical priority as Band C.
31. He provided new medical evidence from a cardiac and respiratory clinic about his asthma diagnosis. The consultant said he had been shown photos of walls and windows at Mr X’s home which looked mouldy.
32. The Council acknowledged Mr X’s review request. It asked him to submit any further information he wanted it to consider for the review.

June 2024: Council’s review decision

33. The Council completed its review of its assessment of Mr X’s medical priority.
34. In the review outcome letter, it referred to the medical information provided and accepted:

• the assaults Mr X experienced exacerbated his mental health issues;
• continuing to stay in Mr X’s current accommodation put him at further risk of being attacked and had worsened his mental health condition; and
• his accommodation was having an adverse impact on him.

35. But it said it had not seen any evidence of a life-threatening situation warranting an urgent move from his accommodation and told Mr X it had decided to uphold its decision to award him Band C medical priority.
36. It explained the reasons for its decision in its letter. I have considered these reasons in my view below.
37. Mr X was not satisfied with the outcome of the review and complained to us about this.

My view - was there fault by the Council causing injustice?

38. 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 an organisation did not follow its process correctly, we may recommend it make a fresh decision.
39. I have considered whether there was fault by the Council in the way it followed its process for its:
1. assessments of Mr X’s medical priority banding; and
2. review of the decision about his medical priority banding.

(a)The Council’s assessments of Mr X’s medical priority banding

40. The Council carried out a number of assessments of Mr X’s medical priority during the period from February 2024 to April 2024.
41. My view is the Council correctly followed its process for these assessments. This is because it:

• referred the information Mr X provided about his physical and mental health to its Medical Adviser;
• considered the Medical Adviser’s recommendation together with the information Mr X provided before making its assessment of his medical priority banding;
• confirmed its decisions in writing to Mr X and notified him of his right to request a review of its decision; and
• re-assessed his medical circumstances on receipt of further and new medical information from Mr X.

42. I don’t consider there was fault in the way the Council carried out its assessments of Mr X’s medical priority.

(b)The review of the decision about Mr X’s medical priority

43. In my view, the Council did not follow its process correctly when it reviewed its decision about Mr X’s medical priority. I consider it failed to properly consider:
1. its current published allocations policy;
2. whether Mr X’s circumstances met the Band B medical priority criteria; and
3. the GP’s medical evidence of February 2024.
44. The Council failed to properly consider its current published allocations policy because:

• the Council told me in its response to my enquiries its current allocations policy was the policy published on its website, dated January 2023.
• it said the criteria for the medical priority bands A, B and C set out in the review outcome letter were taken from the Council’s allocations policy. But the criteria referred to in the letter are not those set out in the published policy dated January 2023; and
• there are differences between the criteria referred to in the letter and the published criteria including:
1. Band A medical priority – the published criteria say this is where housing conditions or other circumstances are directly contributing to a significant deterioration of the applicant’s health condition to warrant emergency priority, and rehousing will alleviate the effect. But the letter says it is where the housing conditions or other circumstances are having such a major adverse effect on the medical condition of the applicant as to warrant emergency priority.
2. Band B medical priority – the published criteria say this is where the applicant’s housing circumstances are not suitable and having a major adverse effect on their medical condition, and this can be alleviated by rehousing. It will not apply where effect of housing conditions on health is comparatively moderate, slight or variable. But the letter says it is where the current housing conditions are having a major adverse effect on the medical condition of the homeseeker; and
3. Band C medical priority – the published criteria say this is where housing circumstances are not suitable for the applicant and having a moderate effect on their medical condition which can be alleviated by rehousing. But the letter says it is where the current housing conditions are having an adverse effect on the medical condition of the homeseeker which creates a particular need for them to move.
• the review letter referred to extracts from section 3 of the policy under the heading “assessments”, when there is no such section in the published policy.

45. The Council failed to properly consider whether Mr X’s circumstances met the Band B medical priority criteria because:

• it considered whether Mr X’s circumstances met the criteria for Band A (and decided they did not) and the criteria for Band C (and decided they did); but
• does not appear to have considered whether they met the published criteria for Band B; and
• in any event the criteria it referred to for Bands A, B and C were not those in the published policy.

46. I consider the Council failed to properly consider the GP’s medical evidence of February 2024. This is because although it referred in its letter to other specific medical evidence, it did not mention the details in the GP’s letter of February 2024 about the impact of Mr X’s current accommodation on his mental health.

Conclusion

47. In my view the Council’s failures set out at paragraphs 43-46 were fault.
48. The review letter is the only record of the Council’s decision-making process. In my view, the review outcome was flawed. Because of the failures, we cannot be sure the Council properly considered and applied the current allocations policy and all the relevant evidence before making its decision.
49. This fault has also caused Mr X upset and uncertainty.

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Agreed action

50. Within four weeks of our final decision, the Council has agreed to:
1. apologise to Mr X for its failure to follow its process correctly when it reviewed its decision about his medical priority. This apology should be in line with our guidance on Making an effective apology; and
2. pay Mr X £250 to reflect the avoidable upset and uncertainty caused by its failure. This is a symbolic amount based on our guidance on remedies
3. arrange for a different senior officer to carry out a fresh review of Mr X’s medical priority;

• the officer should give Mr X the opportunity to submit any further evidence for this review; and
• the Council has confirmed it will consider whether any change in banding is due to new information not previously provided for the original review. It will ensure Mr X receives the correct priority date based on the date the relevant information is received.

51. And within three months from the date of our final decision, the Council has agreed to remind all review officers to make sure they refer to the correct version of the housing allocations policy and not use out of date review letter templates.
52. The Council should provide us with evidence it has complied with the above actions.

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Final decision

53. I have completed my investigation and found fault by the Council causing injustice. The Council has agreed to take the above action as a suitable way to remedy this injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman