Sick and disabled people being assessed by doctors who have never spoken to them

Exclusive: Medical firm paid millions of pounds in public money by councils and the Home Office to carry out assessments on homeless individuals and asylum seekers, based solely on paper records

May Bulman
Social Affairs Correspondent
,Maeve McClenaghan
Wednesday 18 December 2019 01:01
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In one case, the company deemed a homeless man who was at risk for self-harm and suicide as not needing housing support because he was 'no more vulnerable than an ordinary person'
In one case, the company deemed a homeless man who was at risk for self-harm and suicide as not needing housing support because he was 'no more vulnerable than an ordinary person'

Sick and disabled people are being wrongly denied housing support and threatened with removal from the UK on the basis of medical assessments by doctors who have never met or spoken to them.

NowMedical has been paid millions of pounds in public money by councils and the Home Office to produce reports on homeless individuals and asylum seekers, based solely on paper records.

But judges have warned councils against relying on the firm’s advice and overturned decisions determined by its assessments, calling them “irrational” and criticising the firm for not taking the time to meet or speak to those they are assessing.

In one case, the company deemed a homeless man who was at risk for self-harm and suicide as not needing housing support because he was “no more vulnerable than an ordinary person”. In another, a woman who was housebound due to significant disabilities following a stroke was deemed fit to board a removal flight. In both cases, the decisions made on the basis of these assessments were overturned by the courts.

Lawyers and charities criticised the firm, which is owned by Dr John Keen, for “churning out findings very quickly” and in some instances “diminishing or downplaying” the severity of applicants’ conditions, sometimes in contradiction to the opinion of their treating doctors.

A joint investigation by The Independent and the Bureau of Investigative Journalism can reveal that the firm has been paid £2.2m by at least 118 councils to carry out housing needs assessments since the start of 2014.

The amount paid to the company by the Home Office is unknown, but lawyers said the department regularly commissioned NowMedical to assess whether asylum seekers had certain housing needs due to medical conditions or whether those whose claims have been refused were fit to be removed from the country.

However, criticism from judges of the firm's assessments has been long-standing. In 2006, Mr Justice Leveson criticised Ealing Council and NowMedical over the case of a woman suffering post-traumatic stress disorder following rape, torture and imprisonment in Iran. He said NowMedical's assessment of her case was “irrational” and that the council's view was “tainted” for having relied upon these reports.​

In another case a year later, the Court of Appeal overturned a decision to reject a priority-needs claim by a homeless refugee family, made on the grounds that the mother suffered depression and post-traumatic stress disorder, after NowMedical had concluded there was “nothing to suggest her condition [is] of particular severity”.

Overturning the decision, Lord Justice Smedley said Birmingham Council had not considered all available medical evidence and that the handling of the case displayed “a want of fair-mindedness”. He warned that “care has to be taken by local authorities not to appear to be using professional medical advisers simply to provide reasons for a refusal”.

In a more recent example in 2016, an immigration judge rejected a decision by the Home Office to issue removal notice to a woman who was housebound due to significant disabilities following a stroke, after NowMedical deemed her fit to fly. A report by the firm had stated that difficulties she faced were “not insurmountable” and that assistance could be provided to her during the flight.

Tribunal judge Paulene Ganhdi allowed the woman's appeal to the decision, saying she “preferred the evidence of her treating specialist who has specifically addressed her ability to travel in light of his detailed knowledge of her medical conditions to that of NowMedical".

In 2017, a county court judge allowed the appeal of a homeless woman who was refused housing support by Lambeth Council after being deemed by not to be “significantly more vulnerable than an ordinary person” by NowMedical, despite her GP stating that she was suicidal and would “not cope with being homeless”.

Judge Parfitt said the council’s approach, “formed directly from the NowMedical opinions”, was “fundamentally flawed”, adding that it “might have helped” had someone from the medical firm “taken the time to see the appellant or indeed considered her medical records”.

NowMedical , which is based in west London, charges local authorities £35 plus VAT for a basic report on whether someone is medically vulnerable enough to get long-term support to prevent or alleviate their homelessness, and is believed to charge the Home Office the same rate to medically assess asylum seekers.

Many councils do not have their own medical experts in-house and, while some rely on applicants’ GPs or other medical records, scores across the country opt for using NowMedical’s service. Southwark council paid the company £51,000 last year, while Hackney spent £46,000.

Councils have also paid the company to advise on whether housing is suitable. In one case, NowMedical advised that a six-year-old child with severe autism was ‘in medical need’ and that her was home unsuitable, after she had climbed onto the balcony of her first-floor flat and put herself at risk. NowMedical suggested that ‘a ground floor property would be optimum’ for the family, but acknowledged that the availability of ground floor properties may be ‘so scarce as to potentially delay a relocation’. To enable the family to move as quickly as possible from their current first-floor accommodation, NowMedical advised that a different first-floor flat could be an ‘acceptable alternative’, as a fall from a first floor ‘is unlikely to be fatal’.

Housing lawyers said they feared cash-strapped councils were using the advice of the company as a way of outsourcing tough decisions at a time when low availability of local authority housing meant they were having to place a growing number of homeless people in costly temporary accommodation.

Simon Mullings, a housing law case worker, described the system as “terribly flawed”, adding: “It is obviously a kind of gatekeeping exercise for councils. And it is a very useful, arms-length, quick and cheap way to protect your case workers from the trauma of having to make these decisions on people’s lives.”

Victoria Pogge von Strandmann, a public law solicitor at Simpson Millar, said there was a similar system in the Home Office, and that despite the “limitations” of NowMedical's reports, the department “just seems to follow it blindly”, regardless of what other evidence there might be.

She also raised concern that the Home Office did not always provide Dr Keen with all of the relevant medical records for the person being assessed, saying that she had seen cases where “crucial evidence” had not been given to him.

“NowMedical’s assessments are pretty cursory in my experience. They are short, amounting to a page or two, they don’t go into massive detail,“ she added. ”They don’t particularly caveat their opinions in the way you would expect when a medical professionals who has been asked to give an opinion only on the papers should do. And the way the Home Office then deals with that information is flawed in my opinion.“

Nicholas Nicol, a barrister who has successfully challenged council decisions based on NowMedical assessments, suggested that the apparent frequency at which the firm deemed applicants not to be vulnerable could make the service more attractive to councils.

“I am not saying there is any conscious bias, but if they continually said this person is vulnerable, well, they just would not be used. In my opinion, they are delivering, in the broadest terms, the advice that their customers want to hear,” he said.

Stephen Hale, chief executive of Refugee Action, said it was “vital” that the health and wellbeing of vulnerable people were properly evaluated before important decisions were made about their future, adding: “It’s appalling to see the consequences of vulnerable pesople being let down by the current system.”

A Home Office spokesperson said: “The Home Office procured the services of NowMedical to provide independent medical advice, which is required to assist case workers making decisions on the suitability of accommodation and ability to travel. This advice is considered alongside the medical evidence provided by applicants and all other factors. We are committed to providing support which meets the needs of asylum seekers and their dependants in line with current legislation.”

NowMedical has been approached for comment.

UPDATE (05.03.20) Now Medical provides hundreds of thousands of opinions, the vast majority of which lead to decisions which are not challenged. NowMedical’s assessments have been praised by some judges. Now Medical does not make decisions in relation to individuals; it provides opinions to local authorities and government agencies, who consider those opinions as part of the application as a whole.​

UPDATE (26.03.20) A spokesperson for NowMedical said “Local authorities have the legal responsibility to make decisions on priority need. We simply provide medical opinions to assist the local authority to understand the medical records and make its decision. The law uses the comparators of “vulnerable person” and “ordinary person”. Our reports use this language. Opinions we give to the UK Border Agency consider the statutory test of whether an individual is “unable to leave the UK”. This is not an opinion on whether an individual is “fit to fly” on a specific day. No such language is used in NowMedical reports.

NowMedical’s registered doctors and psychiatrists are not required to physically examine patients in order to provide the opinion that the local authority/UKBA has asked for. This approach is one which the Courts and General Medical Council have accepted to be correct.

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