Summary: Mrs D complained the Council failed to assess her household’s medical need in line with procedures. I have upheld the complaint, the Council accepts there was delay and that it failed to take account of all the medical evidence. I have completed the investigation because the Council has offered to pay redress and carry out a new medical review.

The complaint

1. The complainant (whom I refer to as Mrs D) says the Council failed to correctly assess medical need for her and her son when they applied for housing.

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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 future 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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What I have and have not investigated

4. I have investigated what took place from January 2024 through to December. Any issues arising after December would need to form a new complaint to the Council before it can be considered by the Ombudsman.
5. 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.

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How I considered this complaint

6. I considered evidence provided by Mrs D and her son (Mr D) alongside evidence from the Council, as well as relevant law, policy and guidance.
7. I shared my draft decision with both parties and considered their comments.

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What I found

What happened

8. On 9 January 2024 Mrs D and her Son applied to the Council for housing. Mrs D said they needed to move to access medical care and could not manage the stairs at the property. They also needed extra space to store medical equipment and bulky medical supplies. Mrs D submitted additional documentation that month and the Council verified the application on 22 March. It awarded Mrs D and Mr D 100 overcrowding points but no housing and health (medical) points. On 7 May Mrs D asked the Council to review its decision and said it had failed to consider the medical evidence for her and Mr D. She also sent additional medical evidence to the Council and a medical form on 14 May. Mrs D said she replied to a question asking if they had a wheelchair with ‘no’ because they had no space to store large mobility aids. Mrs D reiterated they needed to move because of problems using stairs and limited space. She used crutches to walk and gave information about Mr D. The Council’s Medical Assessment Officer considered the case on 24 July and advised the Council there was no evidence of Mrs D’s current home significantly impacting on her or Mr D’s medical conditions. The Reviewing Officer issued a decision on 19 August. They detailed Mrs D and Mr D’s conditions and medications. They agreed with the Medical Assessment Officer and found the current housing was not significantly impacting on Mrs D and Mr D’s conditions. Mrs D subsequently contacted the Council disagreeing with its decision and querying whether all her evidence had been considered. On 20 August the Council agreed to carry out another ‘stage one’ review.
9. On 16 September the Council issued its revised ‘stage one’ review. It reiterated the medical conditions and treatments for Mrs D and Mr D and said Mrs D had advised they did not use a wheelchair. It said having a medical condition did not necessarily result in medical points being awarded. An applicant had to show how their housing directly affected their medical condition, and that rehousing would significantly improve the condition. The Council said it had not awarded medical points because there was no evidence the property was significantly impacting on Mr D’s or Mrs D’s conditions. On 24 September Mrs D asked the Council to carry out a ‘stage two’ review. She said she could not use or store mobility equipment because the property was too small. Mr D was unable to have a wheelchair because of lack of space. She said the Council had not considered all her evidence. On 19 December the Council issued its ‘stage two’ review decision. It apologised for the delay responding. It said additional evidence had been considered but Mrs D and Mr D had access to normal facilities that did not significantly impact on their wellbeing. The need for walking aids was not supported by medical evidence and no medical points had been awarded.

What should have happened

10. When a person applies to the Council for housing, they can ask the Council to assess if they have a medical need to move. They should complete a health and housing form giving details about their medical conditions and supply evidence from medical professionals. The Council’s Medical Assessment Officer considers the evidence and assesses:
• whether the applicant’s conditions are caused or made worse by their housing, and
• if the property can be adapted/ improved to meet the applicant’s needs, and
• if rehousing is likely to significantly improve the condition.
11. The Medical Assessment Officer’s view is then considered by a Council Reviewing Officer. They also look at the three criteria set out above to determine if the Council should award medical points and issue a decision letter. An applicant can appeal and ask the Council to review its decision. The Council will complete a ‘stage one’ review and aims to issue a decision within 21 working days. If the applicant remains dissatisfied, they can request a final ‘stage two’ review, again a decision should be issued within 21 working days.

Was there fault by the Council

12. There is fault by the Council and it has accepted this in its initial response to my enquiries.
13. The Council delayed issuing its review decisions. The ‘stage one’ review was delayed by around six weeks. The ‘stage two’ review was delayed by a month.
14. There was fault in the final ‘stage two’ review process. The Council accepts the Medical Assessment Officer did not see all the medical evidence submitted by Mrs D. This means the validity of the decision reached by the Council is called into question.

Did the fault cause an injustice

15. The delays by the Council meant Mrs D had to wait longer than is reasonable to get the decisions. The final ‘stage two’ review was flawed because the Medical Assessment Officer did not see all the information provided by Mrs D. This means Mrs D cannot be certain the decision was reached correctly.

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Agreed remedy

16. The Council has accepted fault in this case and offered a remedy that is reasonable and in line with what I would have requested.
17. The Council will pay Mrs D £160 for time and trouble caused by the delay. It is also offering a fresh review which will be conducted in line with procedures. The Council should detail in its review decision the evidence it has considered.
18. The Council should provide us with evidence it has complied with the above actions. Redress should be paid and contact made with Mrs D and Mr D about the review process within four weeks of this case closing.

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Decision

19. I find fault causing injustice and the Council has agreed to take remedial action.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman