Islington Council is “looking for alternatives” to a controversial private firm that concluded a homeless refugee who had been tortured was not vulnerable and did not qualify as being in “priority need” for housing.
NowMedical receives thousands of pounds a year to advise council officers on whether housing claimants are vulnerable, using existing medical reports about those making housing applications. Officers then have the final say.
Last year a Central London County Court judge overturned an Islington Council decision, informed by advice from NowMedical, that an Iranian refugee who had been tortured, suffered from PTSD and could not speak English was not vulnerable.
Now councillors on the housing scrutiny committee have called for a review of this arrangement, saying GPs and in-house medical experts may be better placed to advise on a patient’s medical needs.
Islington currently has no expert in-house medical staff.
Committee vice chair Cllr Sue Lukes (Lab, Highbury East) told a meeting on Tuesday last week: “My concern is we are outsourcing our medical assessments in Islington.”
Cllr Una O’Halloran (Lab, Caledonian) said she and her colleagues were “committed to looking at how long we have got with them because we are a bit horrified” by allegations that had been made to them about NowMedical not meeting claimants face-to-face, and rarely concluding that they qualified for priority housing. The Gazette has repeatedly asked NowMedical to comment on the truth of these claims.
The refugee at the heart of the court case was a 37-year-old man who had been imprisoned and tortured in Iran and fled to the UK in 2015. He was granted Indefinite Leave to Remain (a right to permanent residence in the UK) the following year.
In keeping with government policy, the Home Office stopped housing him under its National Asylum Support Service once his case was concluded.
He then moved into a one-bed property with his brother, sister-in-law and their baby boy.
But his brother found the arrangement made family life “really difficult” and asked him to moved out by February 2017, which he did.
The man notified Islington Council he was homeless on March 28, 2017.
An accompanying report said he had: “Depression, severe PTSD [Post Traumatic Stress Disorder] as a result of torture in his home country [and] no English. Needs support.” He also suffered from urinary incontinence and pain in his feet linked to beatings while in Iran.
But in a report dated April 25, 2017, NowMedical’s psychiatric adviser Dr Wilson told Islington Council: “Overall the applicant appears to have some deficits in his activities of his daily living as a result of his mental health problems but he has consistent predictable support available to him from two siblings, and I think on this basis he does not meet the threshold for being more significantly vulnerable than an ordinary person if homeless.”
On May 5, 2017, Islington told the man he was not in priority need for housing under Section 184 of the Housing Act 1996.
The Act defines someone in need of priority accommodation as: “A person who is vulnerable as a result of old age, mental illness or handicap or physical disability or other special reason, or with whom such a person resides or might reasonably be expected to reside.”
His lawyer requested a review of this decision on May 9, supported by a letter by his GP Dr K Vranakis that read: “Due to his back pain and neck pain, his mobility is reduced and he has difficulty walking and standing. He also finds it very hard to concentrate due to Post Traumatic Stress Disorder, anxiety and depression.
“He has low mood and is having difficulty sleeping with constant nightmares. All of the above are affecting his quality of life.”
The man’s sister also submitted a letter saying she would “help him to the best of my ability” but that she was a carer and full-time student with two children, and that she was getting treatment for her own illnesses including depression, meaning she could not realistically support him.
In a second report sent by NowMedical to Islington Council on May 12, medical adviser Dr Brickley said: “The applicant suffers from mental health problems described as PTSD, depression and anxiety.
“His depression is reported to have worsened and I note mention that he has been experiencing suicidal thoughts. However, there is nothing to suggest any current suicidal risk or intent.”
Despite this he was subsequently referred to Barnet’s crisis team, who sent him on to the Brent Crisis Centre on May 17 because he was at “significant risk of self harm”.
On the same day Dr K Vranakis noted Mr Mohammed 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”. He concluded “the patient is more at risk than the average patient”.
Consultant psychiatrist Dr Freedman backed this assessment up with her own report dated June 27, where she said: “Mr Raufi is significantly more vulnerable than an ordinary person made homeless.”
Islington again referred the medical notes to NowMedical for advice.
An excerpt from Dr Wilson’s response reads: “Based on the information submitted, I would have concerns that he may deteriorate if he does not have consistent and predictable support available to him.
“I would therefore remain of the view that if such support is not available, then he would meet the threshold for being vulnerable given the concerns raised regarding his depression and suicidality.
“I therefore recommend that the local authority investigates and confirms whether he has support available to him from his friend and whether he has adequately been able to secure accommodation. This would appear to be the key matter upon which the decision regarding vulnerability hinges.”
Islington Council eventually sent Mr Mohammed a letter claiming he was wasn’t vulnerable enough to meet the threshold for priority accommodation on December 12.
It stated: “Whilst it is clear that the threat of homelessness has exacerbated your anxiety, I am satisfied that your mental and physical health issues do not render you at risk of more harm in a significant way, and you are therefore not significantly more vulnerable.”
But this decision was overturned by Judge Roberts on April 6, 2018, who found Mr Raufi was indeed vulnerable owing to his mental illness and physical disability. Homeless people with children are almost guaranteed to be in “priority need”, but the Gazette understands it is less straightforward for cash-strapped councils to decide whether it has the same duty of care to people with mental health issues.
Islington’s housing boss Cllr Diarmaid Ward told this paper: “I absolutely understand the concerns and we are actively looking for alternatives [to NowMedical.”
The council couldn’t disclose how long its contact with NowMedical runs for, but public records show it paid the company £17,525 in the 12 months to November 2018.
It is not known how many applications NowMedical has dealt with for Islington but, based on rates displayed on its website, it is likely to have been upwards of 350 in those 12 months.
NowMedical states it is the “UK’s leading provider of medical housing services [...] advising over 150 local authorities, housing associations and organisations across the UK, providing prompt and professional medical and psychiatric advice on housing applications.”
It also claims its “services are highly cost-effective – for example, reducing time spent in temporary accommodation, and [resulting in] more efficient use of housing stock”.
It charges £35 per case plus VAT for advise on a case that will be returned within a working day. But it costs £50 plus VAT for advise from NowMedical psychiatrists, with a 5-day response time.
The director of NowMedical Ltd, which was set up in 1995, is Dr John Keen.
Dr Keen and NowMedical have repeatedly been approached for comment.
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