How life-changing assessments are farmed out to private firms

The move towards privatisation in a bid to cut costs has seeped into the state’s responsibility to care for vulnerable people, says May Bulman

Our investigation has prompted calls for a wider review into outsourcing

When a suicidal refugee and victim of modern slavery is deemed “no more vulnerable than an ordinary person”, something is clearly wrong. When this conclusion is relied upon as the basis for denying him housing support when he falls homeless, that decision-making process is surely flawed. When a judge rules against the local council that made the decision, saying the man is indeed vulnerable and overturning the refusal for housing support, the system is clearly failing.

Yet this system is widespread, as has been revealed by a joint investigation by The Independent and the Bureau of Investigative Journalism, on Wednesday. Our report showed that NowMedical, a private medical firm based in West London, has been paid millions of pounds in public money by councils and the Home Office to produce assessments on homeless individuals and asylum seekers, based solely on paper records.

This is despite the fact that, as far back as 2006, judges have warned councils against relying on the firm’s advice and overturned decisions determined by its reports, calling them “irrational” and criticising the company for not taking the time to meet or speak to those they are assessing.

The real-life examples speak for themselves: a wheelchair bound asylum seeker with “immense health problems” deemed fit to fly; an epileptic told he can “fend for himself” when rough sleeping; a disabled woman who struggles to wash herself not considered too vulnerable to be made homeless. Each of these decisions – all based on NowMedical’s assessments – were later overturned in court or on review.

Beyond the tragic individual cases lies a wider problem. Our investigation has prompted calls for a wider review into the outsourcing of medical advice and care of vulnerable people by the state – not only the Home Office and local councils, but also, among others, the welfare system, prisons and immigration detention. Just look at the money being thrown at companies Atos and Maximus for testing disability benefits with what is widely regarded as a “flawed” medical assessment process. Beneath it are vulnerable people often unable to speak up when they get it wrong.

The move towards privatisation in a bid to cut costs has seeped into the state’s responsibility to care for vulnerable people – placing profit-driven companies in charge of life-changing decisions. A re-think is crucial – but whether it happens is another matter.

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.