Summary: Miss B complained that the Council failed to properly assess her medical needs in respect of her housing application. We found fault in the way the Council reached its decision that she was not eligible for higher priority which caused Miss B significant distress and uncertainty as to whether she had missed out on the chance to move to more suitable accommodation at an earlier point. The Council has backdated the medical priority to the date Miss B applied for it. The Council has agreed to apologise to Miss B and make a symbolic payment.

The complaint

1. Miss B complained that the London Borough of Camden (the Council) failed to properly assess her medical needs in reaching its decision that she only qualifies for the lower medical priority attracting 150 points, rather than the higher priority giving 500 points. This has caused Miss B significant distress as she is living in unsuitable housing conditions which greatly impacts her daily life.

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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)

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How I considered this complaint

4. I considered evidence provided by Miss B and the Council as well as relevant law, policy and guidance.
5. Miss B and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Council’s housing allocations policy 2018

6. The Council’s allocations policy awards points to people in need of housing. One of the categories is for people who need to move for health reasons. In order to qualify for points in this category an applicant must show:
• their medical condition is being caused or made worse by their housing conditions, and
• Their current property cannot be improved or adapted to meet their needs at a reasonable cost, and
• rehousing is likely to significantly improve your condition.
7. If the applicant medical and housing circumstances are having a serious impact on their health and wellbeing and they are in urgent need of rehousing the Council will award them 500 points. For people with lesser needs where rehousing is necessary, the Council awards 150 points.
8. Applicants can then bid on housing and the Council will offer the property to the person with the highest points. If there is a tie it will determine the successful applicant on the basis of the date they received those points.
9. The policy goes on to give examples of where an award of the higher medical points might be necessary. These include where a person:
• is housebound due to their housing conditions,
• is a full-time wheelchair user requiring wheelchair adapted housing,
• has advanced Motor Neurone Disease or Multiple Sclerosis.

LGSCO Practitioner Guidance July 2024

10. This guide shares our learning from investigations on medical assessments in housing allocation cases. The key learning points were grouped into three themes:
• independence: councils should make their own decisions about medical needs, taking into account all the evidence, and not automatically accept the view of the independent medical adviser.
• evidence: councils should address all the issues an applicant raises in a medical assessment and provide sufficient evidence and reasoning in their decision. This allows the applicant to understand why the decision has been made
• timeliness: councils should carry out medical assessments and reviews, and issue decisions within a reasonable timeframe

What happened

11. Miss B has multiple sclerosis and uses a wheeled walker to mobilise. She lives in a ground floor studio flat. It has a very small bathroom and the shower tray has a very high step to access it. Miss B cannot shower unaided as she cannot lift her right leg to get into the shower and she is at high risk of falling. The building has a step at the front access and Miss B struggles to lift her walker over this step.
12. In late 2023/early 2024 Miss B’s condition worsened. She was experiencing dizziness, poor balance, numbness and unsteadiness and was falling frequently inside and out. She applied for housing on medical grounds in April 2024 and the Council awarded her 150 points considering her condition had a serious impact on her and it was necessary for her to be rehoused. The medical adviser said she needed wheelchair accessible accommodation.
13. On 11 October she submitted a new medical needs form . She said she had a problem using the stairs and ticked the lowest box saying she could climb up to five steps. She said there was a step to access the shower and the building. She said she used a wheeled walker at all times and a wheelchair outside as there was no space in the flat for a wheelchair. She said she had been discharged from the wheelchair service due to the narrowness of the doors in her flat. She said she was housebound. She said she only showered once a week when her carer was there and could not access the washing machine on the first floor unless her carer was there.
14. The medical adviser confirmed the previous award remained applicable. Miss B appealed against the decision. The Council reviewed the case on 23 December and upheld the previous decision. It noted that she had difficulty walking and climbing stairs due to her physical health and could only mobilise a few metres with a walker due to pain. It said her situation remained the same as in May 2024 and she needed ground floor accommodation with no steps and a level access shower or space to install one close to shops and transport.
15. On 10 January 2025 Miss B appealed against the decision at stage two of the Council’s review procedure. She said the offer of ground floor housing was not the main issue, but she needed to have a property with no steps inside or out. She provided photographs of the bathroom with the high step into the shower and the step into the building. She also provided five recent letters from medical professionals all confirming that she could not access the shower or the building due to the steps and her inability to raise her right leg. The evidence also confirmed she was at a high risk of falling and had done so three times in the previous month, twice in the bathroom. The letter from her multiple sclerosis consultant said her housing was unsuitable and unsafe because she could not get into the building or use the shower. The letter from the hospital neurology and stroke service confirmed that she had balance problems, right foot drop and could not raise her right leg which meant she could not access the shower. Furthermore, the bathroom was too small to accommodate any equipment.
16. The Council sent the case to its external medical adviser. On 26 March they looked at the case and noted:
• Miss B’s progressive condition which caused fatigue, walking and balance difficulties.
• She used a wheeled walker and had difficulty using stairs.
• The current accommodation was a third floor council flat with access to normal facilities and no lift.
• There was no application form available to look at.
• She needed ground floor accommodation with a level access shower and space for a walker but that 150 points was appropriate.
17. The Council notified Miss B on 15 April that her medical priority remained at 150 points. The decision said that it noted Miss B had no difficulty using the toilet, bathing and dressing although her carer may sometimes support her with these activities. It said the medical adviser had noted her condition but did not think higher points were necessary. The Council said in support of this view that Miss B lived in accommodation with access to normal facilities that did not severely impact her wellbeing.
18. Miss B disputed the decision on 30 May saying she had not taken a shower for four months and had to be washed by her carer at the kitchen sink. She said she was housebound and could not use the wheelchair in the flat as it was too small. She could not even manage the steps to the bathroom to urinate and had to use a special bottle.
19. The Council replied that she should seek legal advice.
20. In June 2025 Miss B complained to us. In November 2025 we decided to investigate the complaint and Miss B sent us a copy of an Occupational Therapy report dated 16 September 2025. The Occupational Therapist (OT) who worked for the Council said that Miss B’s current accommodation was completely unsuitable and untenable; it was very, very limited in space and did not provide suitable washing facilities for her as she needed a level access wet room and her current shower was completely unsuitable due to the large step which put her at greater risk of falling. It also confirmed that Miss B was at high risk of falling and had fallen over 20 times in the previous year due to the fact she could not use her wheelchair in the flat as it was too small. The size of the flat also limited what help her carer could provide and there was no room for equipment. The OT said they would email the rehousing department to try and get Miss B into more suitable accommodation.
21. I made enquiries of the Council and sent it a copy of the report on 19 November. In response to these enquiries the Council said it has reviewed Miss B’s case and awarded her 500 points/Band A priority from the date of receipt of my enquiries which it said was 24 November 2025, It said Miss B had a duty to notify the Council of a change of circumstance and she had not provided a copy of the report to the lettings team.

Findings

22. It is for the Council to consider applications for medical priority and make a decision based on all the evidence. However, we expect the Council to make its own decision and not simply repeat the view of the medical adviser. We also expect the Council to explain how and why it has reached its decision explaining which pieces of evidence it has given most weight to, so an applicant can understand the decision that has been made. I do not consider the Council has followed this process or made the decision based on the content of its own allocations policy.
23. Miss B first told the Council in October 2024 that she was housebound, due to the step at the front of the property and could not access the shower alone. I do not know what evidence she provided to support her application as the Council has not provide an accessible copy of the documents. I note the medical adviser gave no reasons for their recommendation that the points should stay the same which the Council endorsed. I consider the Council should have explained why being housebound and unable to shower herself did not qualify her for the higher points with an urgent need to move, especially as the allocations policy mentions have multiple sclerosis and being housebound as examples of qualifying criteria. The failure to provide reasons was fault, as Miss B could not understand how or why the decision had been made.
24. The stage one review decision gave no explanation as to why Miss B’s mobility difficulties including using stairs and her inability to access the shower or the building, did not qualify her for the higher priority. This was fault which caused Miss B frustration and uncertainty.
25. As part of her stage 2 appeal Miss B provided significant evidence from hospital consultants and other health professionals confirming she:
• was at high risk of falls and had fallen three times recently;
• could only mobilise with a walker;
• could not use her wheelchair indoors;
• could not access the shower;
• could not get into or out of the building due to the step; and
• the shower room could not accommodate any equipment as it was too small.
26. But the Council’s medical adviser did not comment on any of this evidence, they referred to the wrong type of property, wrongly said there was no health needs questionnaire, wrongly said Miss B lived in accommodation with access to normal facilities (when she could not access the bathroom or leave the building unaided) and failed to provide any reasons as to why her needs meant she did not qualify for the higher award. The inaccuracies in the advice are fault which casts doubt on the recommendation given.
27. The Council’s stage 2 decision relied on this advice without any reasoning as to why this one medical adviser’s view containing inaccuracies outweighed all the evidence Miss B had provided from hospital consultants and physiotherapists. The decision wrongly stated Miss B had no difficulty washing when she had provided significant evidence since October 2024 that she could not access the shower without her carer who only came once a week. It repeated the view that Miss B had access to normal facilities when she could not wash or leave the flat unaided. The failure to show how it had taken account of all the evidence or explain why Miss B’s evidence had been discounted was fault which caused Miss B further injustice.
28. I also consider the Council was at fault in not reviewing its decision when Miss B pointed out the errors in May 2025. She said she could only be washed at the sink and was housebound. It was a missed opportunity to properly review the evidence and note the medical adviser’s errors. This fault caused Miss B further injustice as she had to complain to us.
29. I welcome the Council’s acceptance in November 2025 that Miss B was eligible for 500 points and Band A priority. But I do not agree with the date of the award. The Council has blamed Miss B for not supplying it with evidence of a change of circumstance and so has only awarded the higher priority from 24 November 2025.
30. Firstly, I do not agree with this date, as I emailed the evidence to the Council on 19 November 2025. Secondly and more importantly I do not consider it was a change of circumstance as it simply confirmed the situation Miss B had been describing since October 2024 and of which she provided significant evidence in January 2025. Thirdly the OT was an employee of the Council who said they were going to email this information to the Lettings Team. Whether or not they did so is immaterial to my finding of fault. It is information the Council as a whole, held about Miss B which should have been taken into account in assessing her housing needs. It was not Miss B’s fault that this information did not reach the Lettings Team until I sent it. This was further fault by the Council which has caused further delay to Miss B receiving the correct housing priority.
31. The Council in response to an earlier draft of this decision has backdated Miss B’s Band A priority to April 2024, when she first applied for medical priority. It has confirmed she has not missed out on any suitable properties during this period.

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Action

32. In recognition of the injustice caused to Miss B, I recommended the Council within one month of the date of my final decision:
• apologises to Miss B and makes a symbolic payment to her of £500;
33. I also recommend within three months that the Council shares a copy of our practitioner guidance (Medical Assessments for Housing Applications) to all staff involved in medical assessments and ensures they are aware of the need to consider all the evidence provided from all sources weigh that evidence appropriately and give full reasons for their decision based on the evidence and not just the view of the external medical adviser.
34. The Council has agreed ot my recommendations and should provide us with evidence it has complied with the above actions.

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Decision

35. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman