Town Hall agrees to improve medical review process after Ombudsman’s investigation of family’s housing ordeal

Hackney Council has agreed to improve the way it carries out medical reviews of residents in housing cases, after a Local Government & Social Care Ombudsman (LGSCO) report found it caused “injustice through unnecessary time, trouble and distress” to a man with a life- threatening condition and his family.

The resident, named only as Mr X in the report and who has cancer, anaemia, and blood clots on his lungs, first had concerns raised on his behalf by his family in July 2018, with his daughter, Miss Y, applying for medical priority for housing after the council’s own occupational therapist found Mr X’s home, which he shares with Miss Y and her adult son, “unsuitable”.

A period of delays on the council’s part of around 10 months followed, in which the ombudsman saw no signs that the Town Hall properly considered the evidence submitted by Miss Y in applying for medical priority, and found that in its initial decision to not award any priority to Mr X, the council in the first instance “relied entirely” on the opinion of its external advisor, named only as ‘the Company’ in the LGSCO report, but which the council has confirmed is NowMedical.

Deputy Mayor Cllr Rebecca Rennison, Cabinet Member for Finance, Housing Needs and Supply, said: “While we use NowMedical’s fully qualified GPs and psychiatrists to advise on medical conditions that might dictate a residents’ vulnerability and housing needs, this is considered alongside other evidence for us to make our own decision on medical priority.

“We acknowledge that this approach was not correctly followed in this instance, and that it took too long to properly review and overturn the initial decision in-house, using our own occupational therapists.

“We have agreed a set of actions with the LGSCO to remedy this complaint, have issued an apology and compensation to the resident for the hardship caused, and are committed to ensuring that this failure does not happen again.”

The council occupational therapist’s report noted that Mr X was unable to manage either the nine external steps to get to his block, or the internal stairs which his grandson had to help him climb with the lift in the property often broken, with difficulty getting in and out of the bath due both to “his physical weakness and the size of the bath,” suggesting a ground floor level access property with a wet room shower and Mr X’s own bedroom.

NowMedical gave its opinion on Mr X’s priority in September, based on the occupational therapist’s report and a form completed by Miss Y. The ombudsman notes in its report that NowMedical neither carries out face-to-face examinations nor has access to medical records and that additional information about the seriousness of Mr X’s condition was only drawn to the council’s attention after NowMedical had reported. That information was not passed on to the company, despite the council telling Miss Y that it would be, after she requested a review.

There is no suggestion that NowMedical or its advisors acted improperly, unethically or unprofessionally in forming its opinion on Mr X’s case in this way. The LGSCO’s report is critical of the local authority’s handling of the case, rather than NowMedical’s.

The report states: “On 20 September [NowMedical] gave its opinion. It based it on the form Miss Y completed and the OT report. It said Mr X had a relatively benign blood cancer. [NowMedical] said Mr X previously had a blood clot and gets blood thinning injections. It noted Mr X walked with a stick.

“[NowMedical] said: ‘It is contended that the property is unsuitable on the basis of lift breakdown. This is not primarily a medical matter and should be dealt with by local technical/engineering services. Medical priority does not apply.’

“[NowMedical] said Mr X had a future housing need for a shower and, if the property was above ground floor, a lift. [NowMedical’s] report does not mention Mr X’s difficulty using the external steps and the bath.”

The LGSCO points out that the view that the Town Hall accepted from NowMedical, that the lift was a maintenance issue, is “difficult to reconcile” with the view it later expressed to Miss Y in January that it “had a significant impact on the family’s wellbeing,” adding that no explanation was offered to Miss Y by the council on why it did not consider Mr X’s inability to climb stairs or difficulties using the bath as medical issues directly related to his home.

The report from the company was sent to Miss Y by the council in November 2018 along with notice that her father had not been awarded priority, shortly after which she asked for a review of this decision.

Miss Y then told the council that her son had to help her father up two flights of stairs when the lift was not working, stressing that he was unable to get in and out of the bath without assistance and had on occasion fallen, pointing to the small bathroom and kitchen as causing him difficulty, as well as claiming that Mr X’s cancer was not “relatively benign,” but was “life threatening with only regular transfusions and medical treatment keeping him alive.”

A delay of two months followed, which the council told Miss Y in January 2019 was due to understaffing, further letting her know that appeals were now being sent to be handled by NowMedical, though the ombudsman’s report explains that Miss Y’s review was not in fact sent to the company.

A spokesperson for NowMedical said: “NowMedical does not and cannot make any decisions on behalf of local authorities. We simply provide medical opinions to assist the local authority to understand the documents submitted in support of applications, ensuring that those who are most vulnerable receive the accommodation and fair treatment to which they are entitled.

“Our opinions only form part of the information that councils consider as part of their decision- making process.

“NowMedical provided its opinion in respect of Mr X in September 2018, five months before the council was told that Mr X was undergoing treatment for chemotherapy. We had no further involvement in or knowledge of this case after September 2018.”

The ombudsman echoes NowMedical’s statements, saying that while the Town Hall can take account of external medical advice, it must make its own decision, with the LGSCO having seen no evidence the council did this, but rather relied entirely on what NowMedical said, sending the company’s view to Miss Y as its decision on Mr X’s case.

Whilst the LGSCO cannot instruct the council to personally examine applicants for medical priority, the local authority is obliged to properly consider the paper evidence on which the ombudsman says it is reliant.

Having contacted the Town Hall twice in February of 2019, providing new medical information from Mr X’s GP on the second occasion and saying that he now needed to attend hospital every day for chemotherapy, the case’s review was considered by the Town Hall’s own senior medical advisor who emailed Miss Y in May to once again tell her that Mr X had not been awarded priority.

The report adds: “In a telephone call Miss Y told the officer how upset she was. She said she had to take Mr X to the hospital every day for chemotherapy and he returned by ambulance. She said the lift breaks down about twice a week.

“The Senior Medical Officer contacted Mr X’s GP by telephone. The GP confirmed Mr X attended hospital every day for chemotherapy and he would not be alive without this. The Senior Medical Officer then awarded urgent band A priority backdated to November 2018.

“Miss Y complained to the Council about its handling of the application, including the delays, the failure to assess Mr X in person and the failure to consider Mr X’s safety in the home. The Council accepted it had delayed, apologised for this and backdated the urgent award to October 2018 in recognition of this.”

Subsequently, Miss Y started to bid for properties with the urgent priority but said that the council sent her to view further unsuitable properties.

Whilst the council has said it is up to the bidder to check if a property is suitable from the description in its advert and has not been found at fault for this part of the case, the LGSCO has said that “it might save the time of bidders and council officers” if it checked the suitability of those it invites to view its properties.

The Town Hall has agreed, as a means of “putting matters right” for Mr X and Miss Y, to apologise to them both, and pay the family compensation totalling £600 for the unnecessary time, trouble and distress caused by the delays.

An LGSCO spokesperson said: “After agreeing to improve the way it carries out medical reviews, we have worked with the council to agree a practical way to deliver the change to try and prevent the same issues occurring.

“We have agreed the council can ask its external advisor for a case review but this must not be carried out by the original assessor and the council must make the ultimate decision.”