Summary: Mr B says the Council failed to properly consider his medical needs and the medical information he provided when awarding him band 3 medical priority. The Council failed to explain its reasoning for the first decision and included some information in the review decision which causes concern. It is unlikely though that affected the decision on Mr B’s banding. An apology and reminder to officers is satisfactory remedy.

The complaint

1. The complainant, whom I shall refer to as Mr B, complained the Council failed to properly consider his medical needs and the medical information he provided when giving him band 3 medical priority.
2. Mr B says as a result he is having to live in unsuitable accommodation.

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The Ombudsman’s role and powers

3. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. 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(i), as amended)

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How I considered this complaint

5. As part of the investigation, I have:
• considered the complaint and Mr B's comments;
• made enquiries of the Council and considered the comments and documents the Council provided.
6. Mr B and the organisation 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

The Council’s allocations policy

7. The Council’s allocations policy sets out how medical priority will be assessed and the various bands.
8. It says priority on medical grounds may be considered where an applicant or a member of their household suffers with medical conditions or disabilities which are adversely affected by their current housing situation. It says the level of priority awarded depends on the extent to which their health or disability is adversely affected by their current housing situation.
9. It says where the Council seeks advice from its medical adviser the information provided is advice only and the decision on whether to award priority is taken by the housing service.
10. It says if an applicant disagrees with the outcome of the Council’s decision they can request a review. The Council will only undertake a further assessment for priority on medical grounds following a decision or review decision where it is satisfied there has been a change in circumstances relevant to the assessment or significant new information is available.
11. Band 2 includes urgent medical. It says this is awarded where an applicant or a member of their household is assessed as suffering from a serious medical condition which is seriously affected by their current housing situation and would be improved by moving to appropriate accommodation.
12. Band 3 says priority is awarded for medical need where an applicant suffers with a moderate medical condition which is being adversely affected by their current housing situation to a more than minor degree.

What happened

13. Mr B was living in a three-bedroom property with his mother and sister. The Council assessed him in 2022 as having band 3 medical priority. That was due to the impact of his accommodation on his autism and learning difficulties.
14. Mr B applied for band 2 medical priority in 2023. Mr B said he experienced regular conflict with his sister which affected his wellbeing. Mr B said he stayed in his room most of the day. Mr B provided a letter from his mother’s support worker. That letter said Mr B having separate accommodation would benefit his and his mother’s wellbeing. Mr B provided medical evidence from his psychiatrist. The psychiatrist said she believed Mr B warranted band 1 priority as he suffers with a serious medical problem which is adversely affected by his current housing situation and he is at high risk of further deterioration. The psychiatrist referred to the risk of domestic violence towards Mr B from his sister who lives in the same property and has mental health difficulties. The psychiatrist went on to say Mr B’s symptoms were exacerbated by the volatile environment at home with his sister and he had resorted to staying in his room.
15. The Council referred that application to its medical adviser. The medical adviser said matters of social disharmony were not medical matters, although she noted the additional mental health diagnoses. The medical adviser therefore did not recommend additional medical priority. The Council wrote to Mr B to tell him the medical evidence he had provided did not meet the threshold to award priority on medical grounds and that his medical conditions were not seriously adversely affected by him remaining in the property.
16. Mr B asked the Council to review that decision. By the time that review took place Mr B’s sister had moved out of the property. Mr B provided the Council with further medical evidence from his psychiatrist. The psychiatrist letter referred to the fact Mr B was volatile at home and abusive towards his mother. The psychiatrist noted Mr B’s sister living in the property aggravated the situation and there was not enough space. The psychiatrist said that made Mr B’s mental health problems worse. The psychiatrist said Mr B’s mental health condition was quite severe and evidenced by obsessive behaviour and temper outbursts. The psychiatrist said Mr B tended to stay in his room most of the day and was withdrawn. The psychiatrist concluded the current accommodation was unsuitable as the crowded circumstances were aggravating Mr B’s condition. The psychiatrist also said the situation of Mr B living with his mother was untenable and impacting on Mr B’s already vulnerable mental state.
17. The Council reviewed its decision and decided not to increase Mr B’s medical priority. The letter telling Mr B about the decision referenced the fact the psychiatrist had referred to Mr B’s mental health condition as ‘quite severe’. The letter recorded this did not indicate Mr B’s mental health condition was severe or serious. The letter explained the Council’s decision was not to award additional medical priority given the property was not overcrowded and Mr B’s sister had left the property which meant the psychiatrist’s representations about the impact of that was no longer of any significance.

Analysis

18. Mr B says the Council failed to properly consider his medical needs and the medical information he provided when it gave him band 3 priority. Mr B believes the banding should be 2.
19. I am satisfied Mr B had his case assessed twice in 2023. I am satisfied on both occasions Mr B provided medical evidence to support his application. For the first decision in May 2023 I have some concerns about how the Council considered the case. Although the decision letter says the Council considered Mr B’s medical evidence it provides no explanation about why the Council did not consider that warranted additional medical priority. That is fault. I recommend the Council remind officers dealing with medical assessments of the need to explain the reasoning for decisions when writing to the person that has applied for medical priority. I also recommend the Council apologise to Mr B.
20. I am satisfied though when considering Mr B’s request for review the Council properly set out its decision fully. However, the review decision states the officer’s interpretation of part of the medical supporting evidence. That causes me concern. In the decision letter the officer referred to the fact the psychiatrist’s letter referred to Mr B’s mental health condition as ‘quite severe’, recording that it does not state severe or serious. The implication is including the word ‘quite’ reduces the severity of the condition. However, it is equally possible by adding the word ‘quite’ the psychiatrist was intending to strengthen the severity. Had the Council relied solely on that description of Mr B’s mental health condition and the impact his accommodation was having on it I would have had concerns about the decision. That is because the Council cannot have known what the psychiatrist’s intent was in using those words. The Ombudsman would expect the Council to take the wording on its simple reading and on a simple reading ‘quite severe’ is still severe.
21. I am satisfied though the officer also took into account the fact Mr B’s sister no longer lived in the property and it was not overcrowded. Those were relevant facts for the Council to take into account because Mr B’s application for additional priority is largely built around the difficulties between him and his sister. Mr B’s supporting medical evidence is also built around the difficulties caused by him and his sister living in the property. I am therefore satisfied the description of Mr B’s mental health condition was not the only reason the Council decided not to award additional priority.
22. I have considered whether to recommend the Council to complete a further assessment of whether Mr B requires additional medical priority given the way it has interpreted part of the psychiatrist’s letter. However, the Council would be reviewing the decision based on the evidence it has already received. That evidence is related mainly to how living in accommodation with his sister is impacting on Mr B’s mental health. I therefore do not consider it likely, on the balance of probability, if I asked the Council to review the case it would result in a different outcome for Mr B given his sister has moved out.
23. It is clear from my discussion with Mr B’s representative though that there are also issues between Mr B and his mother which are exacerbating Mr B’s mental health issues. It is clear this is having a significant impact on both Mr B and his mother. As it stands though I have seen no medical evidence assessing how the accommodation is impacting on Mr B now that he and his mother are the only two sharing the accommodation. If Mr B feels his mental health is affected due to living with his mother in the property he will need to submit a further application for medical priority with medical evidence concentrating on the current situation at home. As the Council does not have any medical evidence relating to the difficulties Mr B has sharing the accommodation only with his mother I do not recommend a further review of the existing application. That is because it is unlikely the outcome would be different without additional medical evidence.

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Agreed action

24. Within one month of my decision the Council should:
• apologise to Mr B for the frustration he experienced due to the faults identified in this decision. The Council may want to refer to the Ombudsman’s updated guidance on remedies, which sets out the standards we expect apologies to meet;
• send a reminder to officers dealing with medical assessments to ensure they are aware of the need to explain the reasoning for decisions on medical priority and that any medical evidence should be taken on its simple reading rather than interpreted.

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Final decision

25. I have completed my investigation and found fault by the Council in part of the complaint which caused Mr B an injustice. I am satisfied the action the Council will take is sufficient to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman