Summary: Ms D complained the Council placed her in the wrong medical priority housing band. Based on current evidence I have found fault by the Council including a failure to clearly document its decision making process. I have not found an unremedied injustice to Ms D. I asked the Council to consider improving its record keeping as a service improvement and it has introduced a new decision form for assessments.

The complaint

1. The complainant (whom I refer to as Ms D) says the Council has failed to follow procedures when assessing her household’s medical priority in 2024. She says this has resulted in being placed in the wrong housing band.

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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. (Local Government Act 1974, sections 26(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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What I have and have not investigated

4. I have considered how the Council handled Ms D’s application for medical priority from January 2024 through to October when she received the final complaint reply from the Council.

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How I considered this complaint

5. I considered evidence provided by Ms D and the Council as well as relevant law, policy and guidance.
6. I shared my draft decision with both parties.

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What I found

What happened

7. At the end of January 2024 Ms D submitted a housing register application to the Council stating she needed to move because of her medical condition and her child’s condition. In March Ms D sent the Council some medical information, the Council explained it needed more evidence about how the medical needs of the family related to their need to be rehoused. Ms D sent in further documentation and in June the Council advised her to send it recent medical evidence so it could seek the view of the Independent Medical Advisor (Medical Advisor). Ms D submitted more information to the Council in mid-July and her case was referred to the Medical Advisor on 24 July. The Council sent the Medical Advisor a copy of all the documents provided by Ms D relating to the previous 12 months. Also, in July the Council advised Ms D her housing register application had been assessed, and she was in band D.
8. Ms D chased up the Council in August for the outcome of the medical assessment. The Council sent an email to the Medical Advisor on 14 August and received a reply the same day. The Medical Advisor stated Ms D should be in band C for medical priority because her and her child’s conditions were exacerbated by their current accommodation. This email was referred to the Housing Operations Manager two days later. On 3 September the Manager emailed a Housing Officer. She had reviewed the file and the Medical Advisor’s recommendation but did not agree the property was causing a detrimental effect. She said the application should remain at band D. The Council wrote to Ms D the same day and said the Medical Advisor had assessed the case and “recommended that no additional medical priority” be awarded and this was “agreed by the Housing Operations Manager”. Ms D emailed the Council that she disagreed and should be in band A. The Council had failed to consider the evidence provided. On 5 September the Council emailed Ms D, it had reviewed her representations and awarded her band C on medical grounds. It advised her about her right to ask for review of the decision. Ms D told the Council she wanted to complain about the decision. A Housing Manager then exchanged emails with Ms D explaining he would investigate her complaint and for her to send in any additional evidence she wanted considered. Ms D subsequently sent the Council over 30 photographs and video files. I understand the Council was unable to open three video files because it did not have the necessary software available.
9. On 18 September the Housing Manager sent a reply to Ms D’s complaint. He explained in some detail how the Council deals with medical priority requests and that a decision about medical banding lay with the Housing Operations Manager. The Council accepted it had failed to notify Ms D about her right to request a review of the banding decision in its initial September letter, but this had been rectified by 5 September. The Housing Manager said he had now reviewed the evidence provided by Ms D although he could not open some video files. He set out how he had looked at evidence and how he had concluded that Ms D should remain in band C for medical need. Ms D then requested the Council escalate her complaint. The Council sent its final complaints response on 4 October. It accepted the initial decision letter on banding on 3 September had been “misleading” because it incorrectly stated no medical priority had been recommended by the Medical Advisor. It said this was due to a standard template being used without properly amending it. It explained it would take steps to prevent this error reoccurring. The Council detailed the Housing Manager had been unable to open three named files when considering the initial complaint, but he did look at 35 videos and pictures which was sufficient to provide information about the condition of the property and its location. The Housing Manager had also considered evidence from medical professionals when reviewing the banding. The Council did not find fault in how the initial complaint had been considered.

What should have happened

10. A housing register applicant can ask the Council to assess if they have medical priority which means their housing band should be changed. Under the Council’s Allocations Policy, it can award a housing band from D (low medical need) through to A (critical medical need) for an applicant where the applicant’s medical condition is made worse by their current housing and could be improved by rehousing. The Council requires recent medical evidence (from the last 12 months). Once it has sufficient evidence from an applicant a Housing Officer will forward the information to a Medical Advisor. The Medical Advisor should consider all the evidence and assess whether the applicant meets the Allocation Policy criteria for medical priority. The Medical Advisor emails the Council with their recommendations. The recommendations are then considered by a Housing Operations Manager who should review the case file and evidence and decide what band the applicant is placed in if they have medical priority. The Council sends a decision letter to the applicant which should explain there is a right to ask for a review of the decision. If an applicant asks for a review a senior officer will consider the evidence to determine if the correct band for medical priority is in place.

Was there fault by the Council

11. The Council has already accepted there was some fault and set this out in its complaint responses to Ms D. The initial September 2024 decision incorrectly said the Medical Advisor had not recommended any change to banding. That letter had also failed to set out the right to ask for a review of the decision. The Council also explained how it had taken steps to prevent the fault happening again.
12. I have considered whether there is any additional fault by the Council. It is my view there are issues with some of the processes currently in place regarding documenting medical priority assessments. I see the Medical Advisor send their recommendations to the Council without any confirmation of which documents have been considered. There is also minimal detail about how the allocations policy has been taken into account when deciding what banding to recommend. For example, there is no explanation of why an applicant should be placed in a specific band. I do not consider this to be adequate as it fails to evidence in sufficient detail how the assessment took place. Furthermore, the note then made by the Housing Operations Manager fails to specify what evidence was considered. In this case there was also a failure to explain why she revised her decision on 5 September. This means I am unable to say with any certainty that the Council adhered to the correct process and took account of the relevant evidence when issuing its decisions on 3 and 5 September. This is a service improvement issue, and I set out below how the Council should consider taking steps to prevent this problem causing fault in future cases.
13. That said, in this case the Council did go on to provide a much more extensive review and explanation on 18 September. In that letter the Council set out the evidence it considered and how this was assessed. I consider that decision letter to be satisfactory. It shows the Council reassessed the banding in line with procedures by taking account of the evidence provided and determining if this meant Ms D was in the correct band.
14. I appreciate that Ms D strongly disagrees with the banding decision made by the Council and contests she should be in a higher band. As I have previously advised Ms D, 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 the Council 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 Ms D disagrees with the decision the Council made. In this case I consider there are weaknesses in the current process the Council has for documenting its decision making at the Medical Advisor and Housing Operations Manager stages. However, I do not see there is fault in how the Council then reviewed Ms D’s case. It followed the correct process and explained to a proportionate degree how it decided she should remain at band C. I have no basis to question the validity of that decision.
15. Ms D also refers to delay by the Council when assessing the medical information. There is no set timeframe for the process. I have considered the evidence and do not see the Council delayed reaching a decision. The case was with the Medical Advisor for around three weeks which is not an unreasonable timeframe, and the Council then issued its decision within a further three weeks. I have not found any evidence of fault in this part of the complaint.

Did the fault cause an injustice

16. I do not see the failure to properly document the decision making process during August to 5 September 2024 resulted in a significant unremedied injustice to Ms D. That is because she received a sufficiently detailed decision on 18 September which explained how the banding decision had been reviewed. In addition, the Council has already apologised for the errors it identified and taken steps to improve its template letter.

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Action

17. I recommended the Council review its current process for documenting the Medical Advisor assessment and the Housing Operations Manager decision making stages where an applicant has requested a medical banding assessment. The Council has now provided a form which officers will complete at the assessment stage. I am satisfied this will better document what information has been assessed including that the allocations policy has been taken into account.

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Decision

18. I find fault not causing an unremedied injustice. I have made a service improvement recommendation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman