London council cuts ties with private firm that assesses sick homeless people without meeting them

Islington Council decides not to renew contract with NowMedical after The Independent revealed it has been paid millions of pounds in public money to produce reports on homeless individuals solely on basis of paper records

May Bulman
Social Affairs Correspondent
Wednesday 15 January 2020 17:39 GMT
Islington Council said it planned to bring the assessments in-house and employ a specialist occupational therapist to carry out the majority of health checks
Islington Council said it planned to bring the assessments in-house and employ a specialist occupational therapist to carry out the majority of health checks

A London council is set to stop outsourcing medical assessments to a private firm that assesses the vulnerability of homeless people “fit” without ever meeting them after The Independent exposed the practice.

Islington Council has decided not to renew its contract with NowMedical, which has been paid millions of pounds in public money by local authorities across the country to produce reports on homeless individuals, based solely on paper records.

Diarmaid Ward, the chief housing councillor, said the council planned to bring the medical assessments in-house by employing a specialist occupational therapist, saying this would give the council “more control” and help to deliver a better service for homeless applicants, as well as potentially saving money in the long term.

The council’s decision comes weeks after an investigation by The Independent and the Bureau of Investigative Journalism revealed that sick and disabled people were being wrongly denied housing support on the basis of NowMedical’s ”flawed” assessments.

In recent years, 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.

Lawyers and charities have also 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.

Despite the criticisms, the firm has been paid £2.2m by at least 118 councils to carry out assessments of housing needs since the start of 2014.

Mr Ward told The Independent: “We understand there were concerns about this, and your article highlighted those concerns, so with the opportunity and the budget we want to try something different.

“It will cost us more, but we know there are concerns about this, and we want to deliver an excellent service. Making a homeless application can be daunting. This will give us more control over how these applications are dealt with. The person doing it will be working for us. And perhaps this could actually save the council money in the long term.”

He said the plans had been laid out in the council’s draft budget, which also proposes an additional £280,000 to prevent homelessness. If the proposals pass into the finalised budget, the new systems will begin in April.

Since 2010, the council has been trying to bring services in-house where possible in order to provide a better service for residents, with £400m worth of contracts insourced back into the council over the last eight years, bringing in £14m worth of savings, Mr Ward said.

In one case that highlights shortcomings in NowMedical’s service, a suicidal refugee from Mauritania who had been subjected to human trafficking was refused housing by Islington Council after the firm deemed that he did not “meet the threshold for being more significantly vulnerable than an ordinary person if homeless”.

On the same day, his GP noted that the man was “traumatised” by his suicidal thoughts, in a “terrible condition” and that “there is no doubt being homeless would trigger an exacerbation of his current conditions”. But NowMedical maintained its assessment.

The decision to refuse the man’s housing request was overturned by a judge in 2018, who ruled that he was indeed vulnerable because of his mental illness and physical disability.

Sue Lukes, vice-chair of housing scrutiny at Islington Council, said last month that the council “shouldn’t be outsourcing services for the most vulnerable”, adding: “Every council is strapped for cash, but we have to be really careful with public money. We need to find cost-effective solutions, but they do need to be based on good-quality medical knowledge.”

She recommended that other local authorities did so as well, saying: “The more that do, we can share resources and make it a better and better service. I’m hoping that’s what we’re going to do.”​

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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