Summary: Ms B complained that the Council failed to properly consider her medical assessment in connection with her application for alternative housing. We have found fault in the actions of the Council. The Council has agreed to apologise to Ms B, pay her £250 and invite her to submit another medical assessment. It has also agreed to give training to staff on dealing with medical assessments.

The complaint

1. Ms B complained that the London Borough of Hounslow (the Council) failed to properly consider her medical assessment in connection with her housing application. It has adopted the view of the medical adviser without explaining why it has discounted the evidence she provided to support her view that her son requires a separate bedroom and enclosed garden. Furthermore, it appears to have accepted the medical adviser’s view that the living room can be used as a bedroom when this is not specified in the allocations policy. This has caused and continues to cause Ms B significant distress and inconvenience as she has to share a bedroom with her son which adversely affects her sleep and wellbeing.

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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(i), as amended)

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How I considered this complaint

4. I have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. Ms 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

Council’s allocation policy

5. This policy states that a family with two children require a two-bedroom property. It does not say that living rooms count as bedrooms
6. It also specifies that the housing assessment team should make the decision on an application, taking into account the view of the medical adviser and all other available information.

LGSCO Guide for Practitioners: Medical assessments for housing applications (July 2024)

7. Our guidance says that we expect to see the council has:
• considered all the medical evidence provided as well as the independent medical adviser.
• kept a proper record to show how it considered the evidence in the context of its allocation scheme and how it weighed any conflicting evidence.
• made its own decision and made this clear in the decision letter.
• explained the reasons for its decision in the decision letter and in the case of refusal it should explain why the medical or other evidence was discounted, or was insufficient to award priority.

What happened

8. Ms B lives in a two bedroom property with her two children. Her younger son (aged 6) has medical conditions and extra needs. He shares a bedroom with Ms B because he cannot share with his older sibling who is an adult.
9. In August 2023 she applied to join the council’s housing register and completed the medical assessment form. She said her son had challenging behaviour and sleep issues and she had anxiety and depression. She said he had no outside space to release excess energy and spent most days inside the flat. She said he needed a separate bedroom to play and calm down so he would not be so aggressive and loud. She has to remove the light bulbs from the bedroom at night otherwise he will turn on the lights. He also has screaming fits and will not allow her to have a cover on her in bed. Because they share a room, he goes to sleep very late which does not help his behaviour.
10. She enclosed an assessment and housing needs report from a council occupational therapist completed in August 2023. The report detailed the child’s challenging behaviour and said he sleeps for a maximum of two hours at a time before waking and disturbing the rest of the household. Medication had been tried but did not help. The report said he had no safety awareness and when Ms B took him to the park or other community space he will punch and display other aggressive behaviour. The report recommended that he needed his own bedroom and an enclosed garden area.
11. The Council sent the application to the medical adviser. They did not consider any medical priority was applicable saying:

“The applicant already resides in accommodation with access to normal facilities. They do have three rooms available for their use (one living, two bedrooms) and can configure to maximally use this space at night. Medical priority doesn't apply.”

12. The Council sent an email to Ms B on 17 August 2023 saying she was ineligible to join the housing register because she was adequately housed. It included the medical adviser’s comments.
13. Ms B disputed the decision saying that the decision did not refer to the age gap between her two children. She requested a review and submitted the occupational therapist’s assessment and report. The Council forwarded these to the medical adviser. The medical adviser replied on 18 August 2023:

“My previous advice remains applicable. The applicant’s son is only 6, and I don’t think an exclusive bedroom is essential at that age. I recommend use of public outdoor space, parks.”

14. The Council sent an email to Ms B the same day confirming that the medical adviser’s view had not changed and no medical priority was given. The Council repeated the medical adviser’s view but said nothing further. It gave her a right of review against the decision.
15. The Council sent Ms B its review decision on 13 October 2023. It said it was satisfied that her full circumstances had been taken into account and she was not eligible to join the housing register. It acknowledged her son’s medical conditions and receipt of the occupational therapist’s report. It was satisfied that the decision had been properly made. In respect of the medical assessment it said:

“I have considered that you stated that you require accommodation with a garden. There was no medical priority awarded to your case. I am satisfied that you can take [your son] to nearby Gardens to your accommodation…you can rearrange your space to suit your housing needs. The medical condition has not attracted an additional room.”

16. Ms B complained to us in March 2024. She also made another housing application around this time, which the Council later refused. I have not investigated this issue as Ms B has a right of review against the refusal. The Council said that, despite a request Ms B did not submit any further medical evidence in support of her application. She had previously submitted a letter of support from her son’s social worker and school supporting the request for an extra bedroom and outdoor space.

Analysis

17. The Council’s first decision to Ms B dated 17 August 2023 simply repeated the medical adviser’s view verbatim and confirmed that no medical priority had been given. This was fault as it was not clear that the decision was made by the Council rather than the medical adviser.
18. The medical adviser did not comment on the age gap between the children, the younger son’s medical conditions, the impact of his medical conditions on his behaviour at home during the day and night or the impact on Ms B’s mental health. It merely said the family could utilise the living room and medical priority did not apply. This was fault for several reasons:
• The medical adviser’s role is to make recommendations on medical priority, not make the decision. The email reads as if they have made the decision which was then repeated by the Council.
• The medical adviser has implied the household can utilise the living room to resolve the sleeping issues but has given no reason why this is viable or appropriate given that the allocation policy does not count living rooms as bedrooms.
• The medical adviser has not commented on the child’s medical conditions at all or their impact on the household.
19. The Council’s second decision dated 18 August 2023 again was very brief and simply quoted the medical adviser’s view that ‘medical priority was not applicable’ without giving any reasons. Again, this is fault as it appears the medical adviser has made the decision, not the Council. The decision also fails to give any reasons why the medical adviser’s view has been accepted and why Ms B’s evidence has been discounted.
20. The medical adviser’s input is also inadequate and is fault:
• They only refer to the child’s age as the reasons why he does not need a separate bedroom and not his medical conditions or how they affect him.
• They have not referred to the occupational therapist’s report at all or explained why they have discounted it completely.
• They have failed to explain why Ms B can take her son to local parks when the occupational therapist and Ms B have explained in detail why this is not possible due to his aggressive and uncontrolled behaviour, combined with his lack of safety awareness.
• They have made a decision on medical priority, not a recommendation.
21. The review decision sent in October 2023 was also inadequate as it did not contain a clear reasoned decision on the points Ms B had raised. It did not address whether either an extra bedroom or garden were needed on medical grounds. It concluded the family were adequately housed but did not explain how the living and bedroom spaces are sufficient to address the difficulties with the child’s behaviour and interaction with Ms B. Neither does the decision explain why the Council discounted the recommendation of its own occupational therapist, that the child needs their own bedroom and an enclosed garden because it is too dangerous to take them to the park.
22. The Council in responding to my draft decision said it considered the occupational therapist’s report was based on hearsay and anecdote and was not evidence of a medical condition or need. I consider the occupational therapist expressed their professional view of the impact of the child’s medical needs on the household in their current accommodation and what would improve the situation to make the accommodation suitable for their needs. The Council and its medical adviser should have explained why it was discounting the evidence from another health professional.
23. This is fault which has caused Ms B frustration and uncertainty as to whether the Council has made the correct decision and whether she has missed an opportunity to obtain more suitable housing.

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Agreed action

24. In recognition of the injustice caused to Ms B, I recommended the Council, within one month of the date of my final decision:
• apologises to Ms B in line with our guidance and pays her £250 for her distress and inconvenience;
• invites Ms B to submit a further housing application with any more supporting evidence she has relating to her son’s medical needs, including (but not limited to) any letters from his consultant and his Education, Health and Care Plan; and
• on receipt of the evidence the Council should decide whether to ask for more evidence from the child’s occupational therapist and social worker. It should then decide whether to refer the case the medical adviser and reach a decision on the application within eight weeks.
• If the decision is favourable the Council should backdate the effective date of the application to August 2023 and consider if Ms B has missed out on the opportunity to successfully bid on any more suitable properties. If so, it should make a symbolic payment to her in line with our guidance for the injustice arising from the failure to properly consider her application in August 2023.
25. I also recommended that within three months the Council should:
• circulate our ‘Guide for Practitioners: Medical assessments for housing applications (July 2024)’ to all staff involved in making decisions on medical priority;
• arrange a training session to those staff on the content of the guidance to ensure the Council:
1. makes its own decisions on medical priority and does not simply adopt the medical adviser’s view;
2. considers all the evidence submitted in reaching its decision; and
3. provides clear reasons why a person does not qualify and why their evidence has been discounted.
• remind medical advisers that their role is to make a recommendation (not a decision) on medical priority based on the evidence provided with clear and relevant reasons.
26. The Council has agreed to my recommendations and should provide us with evidence it has complied with the above actions.

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Final decision

27. I consider this is a proportionate way of putting right the injustice caused to Ms B and I have completed my investigation on this basis.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman