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Catch 22
Published 01 November 2023
These assessments are failing the test for vulnerable people, writes Graham Sharp
NowMedical’s reports on whether or not someone is ‘vulnerable’ are standardised and formulaic, and based on what can best be described as a Catch 22 approach.
So, if a homeless person with mental health problems is not admitted to psychiatric hospital, this is presumed to mean their condition is not severe enough to confer vulnerability. But if someone is discharged from psychiatric hospital, this cannot confer vulnerability either, because discharge from a psychiatric ward can only indicate recovery. Likewise, a GP’s decision not to prescribe medication must mean the condition is not severe, whereas if medication has been prescribed, this must mean the condition is under control.
These assessments, which can also be used to decide whether someone is intentionally homeless or whether housing is suitable, appear to take place in a perfect world where decisions are never resource-driven and solutions to complex problems work in perfect harmony. In NowMedical’s world, a decision not to admit a patient to hospital could never be due to a shortage of acute services.
The reports seem based on a hierarchical view of illnesses and conditions. NowMedical tends to a dismissive view of drug and alcohol addiction, post-traumatic stress disorder, positive HIV status, learning difficulties, depression, self-harm and attempted suicide.
Addiction and unsuccessful attempts at self-medication – so often a response to traumatic life experiences – can be dismissed as ‘behaviours of choice’. Once characterised as a ‘behaviour of choice’, the solution to an addiction problem is presented as abstention: there is no need for tailored support that would include the provision of social housing.
These assessments are rarely based on any direct contact with the homeless applicant, their GP, consultant or other specialist. Selective quoting from reports by GPs, consultants and other experts is not unknown, and reports sometimes contradict specialists who have had longstanding contact with the patient or client. But local authorities often give greater weight to NowMedical’s opinions.
It is hard to accept that NowMedical’s assessments are objective – as it claims – given that its clients are under such pressure to arrive at ‘not vulnerable’ decisions. The company’s advice has been central to the way many local authorities have responded to the 2002 additions to the priority need categories and government pressure to reduce homelessness acceptances by raising the vulnerability threshold.
NowMedical’s intervention is contributing to the distortion and medicalisation of the vulnerability test. The test should involve a detailed impartial assessment of how an applicant or family members will cope with homelessness. Instead, it is increasingly a second-hand opinion based on a superficial snapshot of someone’s medical history.
For years, critics of NowMedical (including local authority staff) have been hopeful that case law would address the worst aspects of bad practice. Although the recent Shala v Birmingham City Council case offers some hope, it remains the responsibility of senior council officers, councillors and the Department for Communities to question the role of companies involved in homelessness assessments. Until then, public money is being used to fund a crude method of social exclusion.
