Summary: Mr X complained the Council failed to provide a proper explanation for its decisions not to grant him additional priority for re‑housing on medical grounds. We found that the Council had not followed its process correctly and there was a lack of explanation of its decisions. We also found there was a lack of oversight and accountability and the Council’s response to Mr X’s representative’s complaints had been poor. The Council has since reviewed Mr X’s medical priority and retrained staff. We recommended the Council checked to ensure Mr X had not lost out on housing as a result of the fault we identified. We also recommended it reviewed quality and monitoring procedures, discussed our findings with its medical advisers and made a modest payment to his representative.

The complaint

1. Mr X complains the Council failed to provide a proper explanation for its decisions not to grant him additional priority for re-housing on medical grounds. This led to uncertainty about why he was not given priority and he remained in housing he found difficult.

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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. 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(1), as amended)
4. 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)

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What I have and have not investigated

5. We expect complaints to be brought to us within 12 months of the person affected being aware of the events which they complain about. Mr X complained to us in April 2025 about decisions made on his housing priority. So, the events before April 2024 are late. Although this is the case, we exercised discretion to investigate events back to November 2023 because Mr X’s 2024 complaint referred to repeated issues and there was a need to establish some earlier events to reach a robust decision on his complaint.

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How I considered this complaint

6. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
7. Mr 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

Council process for considering medical priority for housing

8. The Council told us applications for greater medical priority are referred to an independent medical assessor. Its process is:

• A council officer will make an initial assessment of the applicant’s need to move on medical grounds based on the information provided. If further guidance is needed, the officer may refer to the Council’s medical adviser.
• All referrals to the medical adviser should use a specific template. The referral should document all the supporting information to be considered.
• The Council’s medical adviser will make a recommendation and send it to the Council. The medical adviser must complete an assessment feedback form which confirms the list of documents considered as part of their assessment. The medical adviser may comment on the applicant’s medical need to move and may make a recommendation on the severity of the need to move. These are recommendations only.
• The final decision is made by a council officer. They will make a decision on the application for priority and send the applicant a decision letter. The letter should tell the applicant the decision and the information considered as part of this. The letter should inform them of their right to review. If a review is requested, it will be dealt with by a manager.

Background

9. Mr X lives in a flat above ground floor level. His representative told us he has a disability which causes severe difficulty using the stairs at the property. Mr X needs to use a mobility scooter to go any distance. The lift in his property frequently breaks down and even when it is working, a step outside the property causes difficulty as Mr X is unsteady on his feet. Mr X finds it difficult to access the community as a result of his disability, so his housing situation also affects his mental health.
10. Mr X has been on the housing register with Band 4 priority, seeking a move to a more suitable property since early 2023.

Mr X’s complaint

Housing priority

11. Mr X’s representatives made numerous applications to the Council for higher priority for re‑housing since November 2023. Mr X sent medical records and supporting evidence from his GP and NHS consultants with these applications. In addition to providing general information, medical professionals commented directly on Mr X’s housing situation. They provided relevant information about mental health issues and physical conditions and noted a deterioration in his health. Mr X also noted that he had difficulty accessing the community. They noted he needed a mobility scooter to go any distance which could not be accommodated at his present flat.
12. We saw repeated referrals by officers to the council’s medical adviser from 2023 sometimes sent over several emails. These did not use the agreed template and did not list the information the medical adviser should review. The medical adviser’s recommendations received in response were on the correct template, but they did not confirm what information had been considered, frequently referring to ‘the evidence supplied’. The comments provide little detail about the recommendation being made.
13. We also saw decision letters sent to Mr X in November 2023, April 2024, June 2024 and August 2024. These all appeared to be standard letters. They stated no priority had been given but they provided no explanation about what information had been considered and little indication of how the decision was made.

Bathroom Adaptations

14. In December 2024 an Occupational Therapist (OT) assessment of Mr X’s needs stated his bathroom was unsuitable and his daughter was unable to support him to bathe without risk to her own health. The letter stated ‘[Mr X] is on the waiting list to be re-housed to more appropriate accommodation. Unfortunately, he has been informed that whilst he’s on the waiting list to be re-housed, he cannot be considered for major adaptations to his bathroom’.
15. We asked the Council why adaptations were declined on the basis Mr X was on the housing list for a move, given the Council had decided it should not give any priority for a move. In response the Council accepted that the OT decision not to progress the recommendation for adaptations was incorrect. It should not have been declined due to Mr X being on the housing list. The Council stated the OT team had now allocated to another worker to reassess Mr X.

The Council’s Complaint response

16. Mr X’s representative complained originally in June 2024. They questioned why the Council decided not to grant higher priority despite the medical evidence supplied. They stated they had submitted three change of circumstances forms.
17. The Council responded to the complaint, noting the three medical referrals had not been successful. It did not comment on how its decisions had been made, but it stated a reassessment of medical priority would be done. A further outcome letter was sent on mid-August again rejecting the request for medical priority. This was a further standard decision letter and there was no indication this was treated as a review. No manager appears to have been involved.
18. Mr X’s representatives complained further in August and early September. They re-stated the key evidence and that they believed priority was needed. They also asked for a review of the August 2024 decision.
19. In September the Council again noted how many change of circumstances forms had been considered since November 2023. It noted on each occasion it gave no priority for a move. It told Mr X there was no current supporting information that supported re-referring his case. It said he could complete a new change of circumstances form. The Council suggested reporting the broken lift to his housing provider. However, the Council did not address the complaint about its decisions or explain why the medical evidence submitted was insufficient to grant increased housing priority.
20. Mr X’s representative asked for the complaint to be considered further, finding the response patronising and stated the Council had acted as though Mr X had no health conditions.
21. In October and November 2024 the Council responded further. In October the Council noted there was a delay responding to their review request due to staff shortages and vacancies. It apologised for this.
22. In November the Council listed at length the dates that information had been received and noted it had been sent for medical assessment ‘on five separate occasions’ since November 2023. Each time it had sent it to its external medical advisers and the Council made decision not to give priority on their recommendations. The Council recognised that Mr X’s representative was unhappy with the outcome, but it stated it considered its actions were in line with the allocations policy. Again, it is not clear that the Council gave any consideration as to whether its decisions had been correct.
23. The Council accepted on one occasion it took too long to review the medical information and respond. It apologised for this. However, it otherwise found that the medical assessments were handled properly.

What Should have happened

Housing Priority

24. The Council’s policy requires medical referral requests to document the evidence the Council wishes the medical advisers to consider. It requires the advisers to document what was considered when responding. This would provide an audit trail to record what evidence was part of its decision making and may help explain the recommendations. The Council also requires officers to explain the information considered in its decision letters. The correct process does not appear to have been followed in assessing information submitted about Mr X’s health and wellbeing. Neither officers nor its medical advisers documented what information was being considered. The reasons for the recommendations were not clearly explained by the medical advisers. Also, the letters sent to Mr X and his representative did not provide sufficient detail. As a result, it is not possible to determine whether the medical evidence sent was properly taken account of since Nov 2023.
25. The failure to follow the correct process and the lack of explanation for its decisions at all stages was fault by the Council.
26. As at October 2025 when the Council responded to our enquiries, it told us the review request submitted in October 2024 has still not been done. It stated it remained outstanding, a year later. The failure to conduct the review in a reasonable timescale was further fault.
27. Concerningly, the Council told us that a manager at the Council had now undertaken a review and found ‘it was clear’ that information submitted in April 2024 met the criteria for medical priority under Band 3. This was not granted at the time it was received, and despite Mr X’s representatives repeatedly sending information and making complaints, the Council failed to establish this or deal with their complaints in any meaningful way until they came to the Ombudsman.
28. The Council’s complaint responses suggest they only had a cursory look at what had happened. There is no evidence the actual decisions were examined or questioned. The complaint responses largely list and re-state dates of contacts but they don’t examine if the Council had been following its process correctly or if its decisions had been properly made. When the Council did agree to do a review a decision, it could not fulfil this in a reasonable time due to resource issues, which again delayed accountability.
29. The Council now accepts throughout much of the period, it was clear that medical priority was appropriate. So, there was also fault in the Council’s actual decision making.
30. We found fault throughout the process the Council follows to assess medical priority for housing. There was fault in how it makes referrals, fault in the explanations of decisions by its medical advisers and fault in how these are explained to Mr X. When Mr X complained and queried the outcome, this should have prompted a review of the decisions. The Complaints should have enabled the Council to look again it what it had done and identify the problems with its processes. This raises issues of governance.
31. The combined effect of the fault we found is significant. Mr X has not had the correct housing priority since at least April 2024. In addition to this Mr X and his representative have been put to significant time trouble and effort pursuing the matter due to the way the Council responded.
32. I note the Council has agreed to provide Band 3 priority, and backdate the priority date to 18 March 2024. It has written and explained this decision to Mr X during our investigation.
33. The Council provided us with evidence that since the events of Mr X’s complaint it had carried out a staff briefing and shared updated guidance for officers who are responsible for referring and deciding applications for medical priority to ensure they follow the Council’s policies.

Bathroom Adaptation

34. The Council also accepted fault in not pursuing a bathroom adaptation for Mr X. It wrongly declined to pursue this on the basis Mr X was being rehoused. It has agreed to reassess Mr X and consider progressing adaptations to remedy the situation.

Action

Within four weeks of our final decision

35. The Council should apologise to Mr X for the procedural failings we have identified and for the failure to properly respond to his review request and complaints. The apology should adhere to our guidance on making effective apologies. This can be found on our website, within our Guidance on Remedy here.
36. To recognise the time, trouble and inconvenience to Mr X’s daughter (his representative) in pursuing the correct priority for Mr X the Council should pay her £200.
37. The Council should meet with its medical adviser and discuss our findings. The Council should re-iterate the process it requires the advisers to follow. It should ensure that the advisers document the evidence being considered and provide clear, and sufficiently detailed explanations of their assessments and recommendations. It should provide evidence it has done this.

Within six weeks of our final decision

38. The Council should conduct an exercise to establish if Mr X has lost out on being rehoused due to having less medical priority. It should do this by assessing if other applicants with less priority than Mr X had won bids for housing Mr X was eligible to bid for, from the date his medical priority should have been given to him. If it finds he has missed out on winning a bid for re-housing as a result of fault by the Council, it should prioritise Mr X by making him a direct offer of the next suitable equivalent property. Either way the Council should write to Mr X and explain the outcome of this exercise.
39. A manager at the Council should review how the Council monitors and quality assesses its process for considering and deciding applications for medical priority for housing. It should ensure that the Council robustly monitors the process to ensure applications are being handled properly by its own staff and medical advisers. The review should include how the Council will use issues raised in complaints to highlight learning. The Council should present the review to senior management to consider.
40. The Council should draft an action plan to determine how it will address and clear the backlog of medical priority review requests. It should include how it will identify priority cases within the backlog while this is being done
41. The Council should provide us with evidence it has complied with the above actions.

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Decision

42. I find fault causing injustice.

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Investigator's decision on behalf of the Ombudsman