Summary: Mrs C complained about the way the Council in respect of her housing application, dealt with her request for a medical assessment and her request for a direct offer of accommodation. We found fault in the Council’s actions. It has agreed to apologise to Mrs C, make a symbolic payment and improve its procedures for the future.

The complaint

1. Mrs C complained that the London Borough of Tower Hamlets (the Council), in respect of her housing, failed to properly consider her application for medical priority or her request for a direct housing offer. She says the Council dismissed her medical evidence, failed to notify her of the decision on two occasions, falsified a report and failed to give her a right of review against the refusal of the direct offer. She says this has caused her ongoing harm, and distress and that her health and safety will not improve until she is in permanent 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 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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What I have and have not investigated

4. I have investigated the period from March 2025 when Mrs C requested a medical assessment.

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How I considered this complaint

5. I considered evidence provided by Mrs C and the Council as well as relevant law, policy and guidance.
6. Mrs C 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

The published scheme

7. Every local housing authority must publish an allocations scheme that sets out how it prioritises applicants, and its procedures for allocating housing. All allocations must be made in strict accordance with the published scheme. (Housing Act 1996, section 166A(1) & (14))

Reasonable preference

8. An allocations scheme must give reasonable preference to applicants in the following categories:

• homeless people;
• people in insanitary, overcrowded or unsatisfactory housing;
• people who need to move on medical or welfare grounds;
• people who need to move to avoid hardship to themselves or others;
  (Housing Act 1996, section 166A(3))

Right to request a review of decision relating to allocations

9. Section 166(9) of the Housing Act 996 says the allocations scheme must be framed so as to secure that an applicant for an allocation of housing accommodation has the right to request the authority to inform them of any decision about the facts of his case which is likely to be, or has been, taken into account in considering whether to allocate housing accommodation to them and has the right to request a review of such a decision, and to be informed of the decision on the review and the grounds for it.

Suitability of accommodation

10. The law says councils must ensure all accommodation provided to homeless applicants is suitable for the needs of the applicant and members of their household.
11. Homelessness temporary accommodation must be legally suitable. (Housing Act 1996, section 206) Anyone who believes their temporary accommodation is unsuitable can ask the Council to review the accommodation’s suitability. (Housing Act 1996, section 202) If the Council’s review decides the accommodation is unsuitable, the Council must provide suitable accommodation. If the review decides the accommodation is suitable, the applicant has the right to appeal to the county court on a point of law. (Housing Act 1996, section 204)
12. The duty to provide suitable accommodation is immediate, non-deferrable and unqualified (Elkundi, R (On the Application Of) v Birmingham City Council [2022] EWCA Civ 601).

Council’s Allocations Policy

Banding and medical priority

13. The Council awards priority to applicants based on their circumstances with the highest being Band 1A for emergency cases and Band 3 the lowest for those who are adequately housed. Band 2A is for homeless applicants with children in priority need and for those who are living in overcrowded conditions, lacking a bedroom.
14. The Council awards two levels of medical priority: Emergency and Priority. Those with a Priority medical award are eligible for Band 1B.

Direct Offers

15. The Council’s allocations policy says in respect of direct offers that it will as far as possible, let the majority of property through the Choice Based Lettings scheme. However, it can offer a home directly to some applicants without advertising the home through the scheme if circumstances justify it. Reasons for this can be: to meet the need of a high priority applicant, or to meet a legal obligation, to facilitate an under occupation move, or for effective management of the Council’s or partner’s housing stock, in relation to public protection cases, as part of overcrowding reduction initiatives, or for split households.

Right of Review

16. The policy says a person can ask for a review on any decision that is made about their application, within 28 days of the decision.

LGSCO Guidance for Practitioners: Medical assessments for housing applications

17. Our guidance sets out our expectations for standards of decision-making when considering medical assessments. We consider councils should make their own decision on medical priority and not simply say the ‘medical adviser has decided’. We also expect councils to consider all the medical/health evidence provided and to fully explain the reasons for its decision including why certain evidence has been discounted or considered insufficient to merit priority.

What happened

18. Mrs C has physical and mental health conditions. She had been living in temporary accommodation with her husband and two young children since she was made homeless in 2023. They were in Band 2A on the housing register.
19. In March 2025 they were living in a one-bedroom first floor flat with no lift access, outside of the borough. Mrs C struggled to use the communal stairs particularly with two small children and she said being away from her support network significantly affected her mental health. The property was also too small: she slept on the sofa while her husband shared the bed with the two children. She requested a medical priority assessment form.
20. On 8 May the Council informed Mrs C that the landlord wanted the property back and so it would look for new accommodation for them. It mentioned that one of the options was a direct offer.
21. On 12 May Mrs C submitted the completed form with evidence from her GP and Psychiatrist both supporting a move to alternative accommodation on physical and mental health grounds.
22. The Council acknowledged the medical assessment form and said that the average wait in Band 2A for permanent housing was 12 years. They had been on the register for less than two years. Mrs C’s husband, Mr C, responded saying they wanted a direct offer of permanent housing, due to their exceptional circumstances.
23. On 15 May the Council’s medical adviser (CMA) said their current accommodation was suitable and recommended up to first floor without a lift, second floor and above with a lift and a shower seat for bathing safely. The Council did not progress the assessment any further at this point or notify Mrs C of its decision.
24. Towards the end of May, Mr C submitted further medical evidence including:
• an Occupational Therapy (OT) assessment which recommended a property without any stairs either internal or external, and ideally a level access wet room and toilet frame.
• A letter from Mrs C’s clinical mental health nurse specialist who noted the cramped nature of the property and the lack of a support network which was worsening Mrs C’s mental health.
25. Mrs C made a formal complaint on 28 May regarding the lack of response to the direct offer request.
26. The Council responded on 9 June saying that it was unable to expedite individual positions on the housing list. Its procedures were designed to ensure fairness and equity for all applicants, and it must adhere to the established order of priority. There was separate banding for those with medical priorities which did not apply in her case on the current evidence. It did not provide a right of review against the decision.
27. On 23 June Mrs C complained that the Council had failed to consider the request properly, had not given any reasons for the decision and had not given her a right of appeal.
28. The Council replied on 22 July. It said it had passed the medical evidence to the CMA on 15 May and the CMA did not award any medical priority. There was no evidence the Council had notified Mrs C of that decision. However, as Mrs C had since submitted more medical evidence the Council would make a further referral to the CMA for a review of the medical priority. In respect of the direct offer, it said depending on the outcome of the CMA referral it may refer the request to the Lettings Manager for a decision on a direct offer.
29. On 1 August the Council offered Mrs C alternative temporary accommodation (a two-bedroom ground floor property in a different borough). Mrs C accepted the offer and moved there on 7 August but said it was unsuitable due to its distance from her support network and health professionals. She asked for details of how to request a suitability review.
30. On 15 August the Council sent her the outcome of the CMA referral from 15 May and gave her a right of review against it. Mrs C again asked how to request a suitability review and once again on 21 August.
31. Between 21 and 28 August the Council responded to three different complaints from Mrs C about the direct offer and the medical assessment. In one it said the housing officer had reviewed the situation and determined that the case did not meet policy guidelines for a direct offer referral to the Lettings Manager. It apologised if this was not made clear. In another it said the Lettings Manager had reviewed the case but did not consider they were eligible for a direct offer. In all of the responses it apologised for the delay in notifying them of the outcome of the medical assessment in May 2025.
32. In September 2025 Mr C submitted another medical letter from mental health professionals in the new borough saying that Mrs C was having a relapse in her mental health and her current accommodation was unsuitable. It said she needed permanent accommodation in Tower Hamlets close to her support network. Around this time Mr C chased an outcome of the review of the medical assessment which the Council had promised in June.
33.  
34. On 23 September the CMA sent their recommendations to the Council saying that she qualified for medical priority as the current accommodation was directly linked to the deterioration in her mental health.
35. In early November Mr C chased the Council again and complained to us. Mrs C also fell in the shower of the property around this time fracturing her ankle.
36. The Council responded the next day apologising for the delay. It said when the Council received the CMA advice it referred her case for an OT assessment and there was a waiting time for this. It accepted her current accommodation was unsuitable and it agreed to move her to a two-bedroom property without stairs in or close to Tower Hamlets. It would also increase her priority to Band 1B until suitable temporary accommodation was found.
37. The Council confirmed on 12 November that her application was in Band 1B for a three-bedroom property. Mrs C said she wanted a four-bedroom property to accommodate Mr C as her carer. On 19 November we decided to consider the case further.
38. In January 2026 the Council again refused a direct offer, saying that permanent homes were accessed through the allocations scheme and their case was not exceptional. They did not qualify for a four-bedroom property, and the Council was looking for alternative suitable accommodation for them.
39. On 25 February 2026 Mrs C and her family moved to new three-bedroom accommodation on the third floor with a lift within Tower Hamlets.

Invite to remedy

40. In January 2026 we asked the Council to remedy the complaint by offering Mrs C a right of review against the decision that she was not eligible for a direct offer. We referred to s166(9)(c) of the Housing Act 1996 in support of our request. We considered that only one substantive decision had been made on the request (the decision of the Lettings Manager during the complaint procedure) and that her review right had not been exhausted.
41. The Council declined to offer a review. It said the decision did not affect eligibility, qualification, banding, effective date or access to bidding. It said a statutory right of review only arises in respect of decision relating to section 202 of the Housing Act 1996 (decisions on homelessness issues) and does not provide a general right of review against all housing-related decisions.

Findings

Medical priority

42. When Mrs C first requested a medical priority assessment in May 2025 the Council promptly referred the case to its CMA, who replied within a day saying that the household did not qualify for any medical priority and setting out the type of suitable accommodation, which included their current accommodation. However, the Council did not make a decision on the medical priority or notify Mrs C of the outcome of the CMA referral until 15 August. This was fault which caused Mrs C uncertainty as to whether she might be eligible for a higher priority on the housing list.
43. The first CMA advice was also inadequate as it did not refer to Mrs C’s mental health condition at all and gave no view as to whether this was made worse by her current accommodation, despite Mrs C submitting supporting evidence from her health professionals. This was fault. The fault was compounded by the Council’s failure to consider all the evidence when making its own decision as it should have picked up that this element had been missed. This prolonged the injustice caused to Mrs C by at least two months.
44. In June 2025 the Council did agree to carry out another review including additional evidence which eventually led to a new recommendation on 23 September that Mrs C was eligible for medical priority. However, the Council again failed to notify Mrs C about this advice or make a decision on the housing priority until 7 November. This was fault which delayed Mrs C being offered more suitable accommodation and meant she endured a move to more unsuitable accommodation in a different area. If the review had been done more promptly it is possible the move could have been avoided.
45. If the Council had acted without delay, it should have carried out a review of the initial decision within eight weeks of 9 June 2025, by 5 September. It received the CMA advice on 23 September but did not reach a decision on the medical priority banding until 7 November, a delay of two months. This meant Mrs C and her family continued to live in unsuitable accommodation for longer than was necessary.

Direct offer

46. The offer of a direct let is a discretionary decision for the Council to make in exceptional circumstances. It is not for me to say whether or not the Council should have made a direct offer.
47. However, the way in which the Council communicated its decision to Mrs C was contradictory:

• In June 2025 a housing officer decided she did not qualify for a direct offer.
• In July the Council said it would wait for the outcome of the CMA review before deciding whether to refer to the Lettings Manager to reconsider.
• In August it said the housing officer had reviewed the situation and determined that the case did not meet policy guidelines for a direct offer referral to the Lettings Manager.
• But then it also said in August that the Lettings Manager had reviewed the case and decided they did not qualify for a direct offer.
• In January 2026 a housing officer again said they did not qualify because their case was not exceptional.

48. This has caused confusion and uncertainty for Mrs C.
49. Furthermore, the Council’s Allocations Policy does not say a housing officer should first make a decision which could then be reviewed by the Lettings Manager. But the policy does clearly state that a person can ask for a review on any decision that is made about their application, within 28 days of the decision. Mrs C was not given a right of review. This was fault as she was denied the opportunity to have the decision properly reviewed.
50. I do not agree with the Council’s view that there is no statutory right of review against the decision on a direct offer. Aside from the fact its own policy allows for a review of any decision made about an application, the law as set out in paragraph 9 above, also says that a person can request a review of any decision about the facts of their case which has been taken into account in considering whether to allocate housing accommodation to them. The Council in deciding not to make a direct offer to Mrs C, has made a decision about the facts of the case relating to an allocation of housing and so it should attract a right of review.
51. However I note the Council has considered Mrs C’s request on at least five occasions and explained that her case is not high enough priority or exceptional to justify a direct offer of accommodation. I am satisfied that the Council has in effect reviewed the decision and I see no benefit in doing this again unless Mrs C’s circumstances have changed significantly.
52. I will however make a recommendation for a service improvement to ensure the Council is making decisions in accordance with the law and its own allocations policy.

Suitability of the accommodation

53. Mrs C requested a suitability review of her temporary accommodation in early August 2025. The Council did not consider the suitability until November 2025 when it belatedly acted on the reviewed medical assessment. I consider it should have considered the question of suitability within eight weeks, by the beginning of October 2025. The delay of a month was fault which caused injustice to Mrs C as she had to live in unsuitable accommodation for longer than was necessary.
54. The injustice was exacerbated by the subsequent delay of over three months in finding more suitable accommodation. I understand the Council was making efforts to find somewhere but the duty to find suitable accommodation is immediate. Even allowing a month for practicality purposes, the process was delayed by over two months. This was fault which caused Mrs C injustice.

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Action

55. In recognition of the injustice caused to Mrs C, I recommend the Council within one month of the date of my final decision:
• apologises to Mrs C and makes a symbolic payment of £1400 for living in unsuitable accommodation for approximately six months longer than she should have done and having to move to different but still unsuitable accommodation.
56. I also recommended the Council within three months:

• reviews the implementation of its allocations policy in respect of direct lets to ensure it is acting consistently in accordance with that policy and the law and that it offers a right of review against those decisions.

57. The Council has agreed to the recommendations but asked if the review of the direct lets aspect of the allocations policy could be included in its forthcoming review of the whole Allocations Policy which is due to be completed by the end of the financial year. I have agreed to this timescale.
58. The Council should provide us with evidence it has complied with the above actions.

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Decision

59. 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