Summary: Miss A complains the Council did not suitably consider her medical needs when deciding to deny her medical priority for housing allocations. This meant she has not received the correct allocation and has caused significant distress. The Ombudsman finds fault with the Council for how it reached the decision not to award medical priority. The Council has agreed to pay a financial remedy for the distress caused and reassess Ms A for medical priority.

The complaint

1. Ms A complains the Council has not properly consider her medical needs when assessing her appeal to the housing register.
2. Ms A also complains the Council has not communicated properly about how it reached its decision, and has discriminated against her and her medical needs.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by 'maladministration' and 'service failure'. I have used the word 'fault' to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. If they have caused an injustice we may suggest a remedy (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
5. If we are satisfied with a council’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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How I considered this complaint

6. I considered Ms A’s complaint and the information she provided. I also considered the Council’s complaint responses and its housing allocations decision. I considered comments from Ms A and the Council on a draft of my decision.

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What I found

Council’s allocations policy

7. The Council’s allocations policy sets out how it allocates space on its housing register.
8. There are times when people need to move because of their health or a disability. Priority on health or disability grounds will only be awarded after an assessment if someone in the household has:

• a severe long-term limiting illness, or a permanent and substantial disability AND
• their health or quality of life is severely affected by the home they live in

9. A priority medical award is not given on the basis of the medical condition or disability alone but upon the effect the housing circumstances are having on a long term and serious medical condition or disability.
10. An officer in the Lettings Team will make decisions on medical applications and may ask qualified health advisers to recommend who should be given additional preference for housing on health or disability grounds. The health advisor does not make a recommendation based upon how ill you are. They will look at how your health or disability problem affects you on a day-to-day basis and how your housing affects your health or quality of life. They will assess each person with a health or disability problem and also consider the impact on your whole household. In addition, other non- medical factors affecting you or members of your family can be taken into account where appropriate.
11. In reaching a decision on whether or not to make a priority award on medical grounds, an officer from Lettings, where appropriate, will have regard to comments and information from your own doctor as well as other medical professional opinions.
12. This recommendation will normally be considered if you, someone on your application or for whom you provide care, has a severe long term limiting illness or permanent and substantial disability. Health or quality of life must be severely affected by the place you live in now.
13. We will also consider if where you live now can be reasonably adapted to meet your needs. It may also be that there are combinations of serious health or disability concerns that mean that the health or quality of life of a household is being severely affected. Examples include:

• the current home does not reasonably allow essential health treatment there e.g. renal dialysis;
• the ability to live independently in the community is at risk without suitable accommodation;
• someone is housebound, effectively housebound or cannot reasonably access the essential facilities in their home;
• if they have a severe cognitive impairment that means they do not sense danger, are at risk of wandering and so need constant supervision;
• if they have a severe, permanent and substantial disability or severe long-term illness.
• limiting illness and caring for children is causing concern such that their continued residence is at risk, or the stress of caring for them is exacerbating the health problems; or
• if they have a sensory impairment and/or a guide dog and they live alone or only with others with disabilities.

What happened

14. Ms A has several health issues and disabilities. These include a stomach condition which means she needs regular access to a toilet.
15. Ms A also has 3 children and lives in 2 bedroom property. One of Ms A’s children also has a diagnosis of a disability.
16. Ms A applied to the Council’s housing allocations scheme in November 2020. Ms A applied for medical priority due to her health conditions and her daughter’s disability. Ms A said that due to her stomach condition, she needed access to the toilet regularly, however her daughter’s condition meant the toilet was often unavailable. Ms A asked the Council to place her with priority for a property with an extra toilet.
17. Ms A provided medical information including;

• details of her medical issues and how they impact her daily living
• The difficulties she was facing due to her medical conditions
• The impact of the conditions on her children
• Letters and information from her professional healthcare team saying that Ms A struggles to manage with her current living conditions because of her medical needs and child’s disability.

18. Ms A also provided evidence of her children’s disability, this included

• Diagnosis of her daughter’s condition and current needs
• The professional teams that were supporting her daughter

19. The Council assessed Ms A’s housing application. It decided not to grant Ms A medical priority. It send Ms A’s application to a specialist medical assessor.
20. The Council declined Ms A’s application for medical priority. In its decision, the Council said “for medical priority to be applicable, there needs to be a permanent substantial disability or a severe long-term limiting illness, and the current accommodation must be severely affecting the applicant. This criteria is not met in this case so medical priority does not apply”.
21. Ms A appealed the Council’s decision not to grant medical priority. She complained the Council had not properly considered her and her daughter’s needs.
22. The Council reviewed the decision and did not uphold Ms A’s appeal. The Council told Ms A that she already resided in suitable accommodation with access to normal facilities. The Council was of the view the accommodation was not severely unsuitable and therefore Ms A did not meet the threshold for medical priority.
23. The Council notes also stated that Ms A could use a commode in emergency situations.
24. Ms A remained unhappy with the Council’s decision and complained to the Ombudsman.

Analysis

25. Ms A has said the Council has wrongly denied her medical priority on the housing allocations scheme. She said the Council has not properly considered her and her children’s medical conditions and disabilities when making the decision not to award medical priority.
26. I have reviewed Ms A’s application for medical priority. In her application, Ms A makes it clear she is applying for medical priority on the grounds of both her and her daughters needs. Ms A set out both sets of medical circumstances and provided evidence from both her and her daughter’s professional healthcare network.
27. The medical documents provided by Ms A support her application on the grounds that she needs access to a toilet which is not always available due to her daughter’s own needs
28. I have reviewed the medical assessors’ notes and the Council’s communication with Ms A. The Council documents that it accepts Ms A’s condition is “be a permanent substantial disability or a severe long-term limiting illness”. However, it says that as she lives in suitable facilities by already having access to a bathroom, she does not meet the criteria for medical priority.
29. I can see no evidence the Council considered Ms A’s daughter’s needs in the application. I can see no evidence the Council’s medical assessor considered Ms A’s daughter’s needs or the evidence submitted by healthcare professionals regarding this issue.
30. The Council has not been able to evidence how it considered both Ms A’s needs alongside her daughter’s needs and what this may mean for the access to suitable facilities. It has not been able to show it suitably considered whether their health or quality of life is severely affected by the home they live in.
31. The Council has commented that Ms A can use a commode in emergency circumstances, however it has not considered Ms A’s daughter’s needs and how regularly she obstructs Ms A’s capacity to use the bathroom.
32. This was fault by the Council and is evidence the decision-making process was flawed. Therefore, the decision not to award Ms A medical priority cannot be relied on.
33. The Council’s policy also states that “We will also consider if where you live now can be reasonably adapted to meet your needs. It may also be that there are combinations of serious health or disability concerns that mean that the health or quality of life of a household is being severely affected. Examples include if they have a severe, permanent and substantial disability or severe long-term illness”. I have no evidence from the Council that it considered whether Ms A’s current property could be adapted to meet her needs.
34. This has caused Ms A significant distress. As well as trying to manage her and her daughter’s health conditions, she has had to pursue her complaint and bring it to the Ombudsman. She has also been left feeling uncertain about whether her application should have been approved if she was assessed without fault.

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Agreed action

35. Within 4 weeks of my final decision, the Council has agreed to

• Write to Ms A and apologise for the fault identified above.
• Pay Ms A £250 for the distress and uncertainty caused by not properly considering her application.
• Reassess Ms A’s application for medical priority, ensuring it considered all her and her daughter’s health needs, and evidence from medical professionals.
• If the Council reassesses Ms A’s needs and finds she is eligible for medical priority, it should backdate the date of the approval to when the first decision was made in January 2021.

36. Within 12 weeks of my final decision the Council has agreed to

• Remind staff the importance of suitably considering all information on an application for medical priority.

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Final decision

37. I have now completed my investigation. I find fault with the Council for how it reached its decision not to award Ms A medical priority.

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Investigator's decision on behalf of the Ombudsman