Flawed Medical Assessments by For-Profit Contractor Led UK Councils to Wrongly Deny Housing Support to Severely Sick and Disabled Clients

by Vins
Published: Updated:

The UK’s Islington Council of London has decided to terminate its contract with NowMedical, a private firm used to provide confidential medical assessments. An investigation by The Independent and the Bureau of Investigative Journalism revealed that, due to NowMedical’s “flawed” assessments, sick and disabled people were wrongly denied housing support. The private company was cited for determining that sick people were “fit” to be homeless, without ever meeting them. Both the Islington Council of London and the Southwark Council were reported to be cutting ties with NowMedical after numerous faulty decisions were exposed.

The Islington Council provides low-income, sick, and disabled residents with accessible, high-quality legal advice to challenge the effects of poverty, ultimately linked to homelessness. Due to years of budget cuts, the Council has no in-house medical experts to consult, therefore medical assessments were outsourced to NowMedical, which was contracted to provide recommendations about whether people were eligible for housing support based on their medical evaluations.

NowMedical claims to provide confidential medical assessments made by doctors, medical specialists, and occupational therapists, but the investigation revealed that NowMedical assessed hundreds of people a week for councils and the Home Office purely on paper. The investigation exposed that the sick and disabled applying for housing support were wrongly denied on the basis of NowMedical’s distorted assessments and qualifications. At least 118 councils across England were reported to have used NowMedical’s assessments, spending over £2m of taxpayers’ money since the start of 2014.

The investigation, which became public after an article was written by Maeve McCleneghan titled “How a Doctor Who Has Never Seen You Can Say You’re Fit Enough To Sleep On The Streets”, published by The Independent, revealed that while a six-person team, led by Dr. John Keen of NowMedical, provided an estimated 14,000 assessments to councils per year—an average of 55 a day—none were based on actually seeing or speaking to those being assessed. In some cases, the Bureau documented NowMedical advising on applicants who lived more than 250 miles away.

McClenaghan reported that in one case, a mother named Susan and her 22-year-old daughter Leah, who is taking seven medications for autism and several health issues, was denied housing support four times by council after NowMedical determined that their case was not a “priority need” and that the daughter was no more vulnerable than “an ordinary person if homeless.” The investigation also cited the cases of a suicidal refugee from Mauritania who had been subjected to slavery and human trafficking; torture victims from Mexico and Iran, including a man who had been beaten so badly he still suffered pain in his feet; and an alcoholic man with epilepsy, psychotic episodes and depression, who after being rejected for homelessness support ended up living in a shed. A 59-year-old woman recovering from breast cancer, and receiving chemotherapy, was also reported to have been assessed by NowMedical and found not to be “priority need.”

The investigation also faulted the councils, stating that in all instances, decisions to deny housing to applicants are made by the council. Simon Mullings, a housing law case worker, said “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.”

While some councils do not use NowMedical for assessments, many councils across the country do so. Southwark Council paid £51,000, and Tower Hamlets council, which used to spend £110,000 a year for in-house medical expertise, chose to pay half that, and paid £42,000, to NowMedical in the past year.

Diarmaid Ward, the councillor in charge of housing and development, told the Bureau of Investigation that councillors had been shocked to discover that NowMedical’s assessments differed from experts, or those of the applicants’ own doctors, and were made without ever physically meeting with these highly vulnerable people, and instead made assessments based solely on paperwork. In response to concerns, Ward confirmed that medical assessments will now be made, where possible, by an in-house occupational therapist, without commissioning advice from NowMedical.


Maeve McClenaghan,  “Islington to Drop NowMedical over Homelessness Assessment Fears,” Bureau of Investigative Journalism, January 15, 2020, https://www.thebureauinvestigates.com/stories/2020-01-15/islington-council-to-drop-nowmedical-over-homelessness-assessment-fears.

Maeve McClenaghan, “How a Doctor Who Has Never Seen You Can Say You’re Fit Enough to Sleep on the Streets,” Bureau of Investigative Journalism, February 24, 2020, https://www.thebureauinvestigates.com/stories/2019-12-18/how-a-doctor-who-has-never-seen -you-can-say-youre-fit-enough-to-sleep-on-the-streets.

Josh Salisbury, “‘NowMedical: Concern over Outsourced Medical Assessments Used to Decide Homelessness Support by Southwark Council,” Southwark News, January 24, 2020, https://www.southwarknews.co.uk/news/nowmedical-outsourced-medical-assessments-south wark/.

May Bulman and Maeve McClenaghan. “‘There Is Something Very Wrong with This System’: Stories of Sick People Assessed by Doctor They Never Met,” The Independent, March 5, 2020, https://www.independent.co.uk/news/uk/home-news/housing-medical-assessments-health-ho me-office-london-nowmedical-a9250231.html.

Clare Sambrook, “‘Fit to Fly?’ Woman Awaiting Spinal Surgery Is Fit to Be Deported, Controversial Doctor Tells UK Home Office,” OpenDemocracy, November 28, 2019, https://www.opendemocracy.net/en/shine-a-light/fit-to-fly-woman-awaiting-spinal-surgery-is-fit-to-be-deported-controversial-doctor-tells-uk-home-office/.

Student Researcher: Perry Kindel (College of Marin)

Faculty Evaluator: Susan Rahman (College of Marin)