Wednesday, December 18, 2019

"First, do no harm"

Vulnerable 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. Lawyers and charities criticised NowMedical, 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. 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.
 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. 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.
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.
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 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”.
Councils have also paid the company to advise on whether housing is suitable. In one case, NowMedical said a first floor flat with a balcony was suitable for the family of a six-year-old girl with severe autism, despite the fact that she had climbed up on the balcony and put herself at immediate risk, saying a fall from that height was “unlikely to be fatal”.

Victoria Pogge von Strandmann, a public law solicitor 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.“

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