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The benefits of good medical evidence

Research carried out by the University of York and Heriot-Watt University into how local authorities in England assess medical evidence when making a decision on the vulnerability of homeless applicants makes for interesting reading.

In the same way as Northern Ireland, applicants who apply for homelessness assistance in England have to satisfy the local authority that they meet a number of criteria i.e. they are homeless, eligible for assistance, in priority need and that they are not intentionally homeless.

The research, ‘You can judge them on how they look: Homelessness Officers, Medical Evidence and Decision-Making in England’, looked specifically at the priority need test and the importance of proper medical evidence in showing vulnerability.

In carrying out their research a number of interviews were held with Housing Options managers, homelessness officers and review officers. The researchers also held focus groups and examined case files.

Determining vulnerability

There is no legal definition of what ‘vulnerable’ means, but case law has indicated that a homeless applicant can show they are vulnerable if they are “less able to fend for himself than an ordinary homeless person so that injury or detriment to him will result where a less vulnerable man will be able to cope without harmful effects.”

Housing advisers will agree that medical evidence can often prove crucial in helping to show that an applicant is vulnerable. The research suggests that, certainly in England, there can often be a battle in deciding which medical evidence should be accepted by the local authority i.e. the medical evidence provided by the applicant or the medical evidence commissioned by the local authority from their own in-house medical experts.

Key findings

One of the key findings was that in many homelessness cases the decision on vulnerability was left quite open to the homelessness officers and that their initial impression of the applicant can have a significant influence on the decision that they make. This can lead to inconsistency in decision making between local authorities. However, this was balanced with a finding that homelessness officers generally looked for a rounded picture of what was going on with the applicant and that medical evidence which is as objective as possible can have a great influence on their decision-making.

In terms of the content of medical evidence, one lesson coming from the research was that medical evidence should focus on answering the four homelessness tests; particularly on what the impact of street homelessness would be on a person’s medical condition i.e. would the applicant’s medical condition be worsened by street homeless?

Recommended content of medical evidence

In conclusion, the research found that in order to be effective and helpful to homelessness officers in making their decisions, sample medical letters should:

  • Set out the capacity in which the applicant is known by the medical professional and the length of time they have known them.
  • Set out the applicant’s diagnosed medical conditions.
  • Set out the medication which has been prescribed to the applicant. This may also include information on why a particular drug or dosage has been prescribed.
  • Comment on the effect or likely impact of street homelessness on the applicant’s medical conditions. This should include an opinion on how the client’s medical condition would be worsened by street homelessness.

Advisers should bear these recommendations in mind when advising homeless applicants on what is required from their medical evidence; otherwise it may prove to be a meaningless exercise.

Adviser’s experience

Read a real example of how medical evidence can make all the difference in to a client’s housing status.

Further help

A copy of the research can be foundhere.


Tagged In

Welfare Reform, Equality

This article was written on 20 November 2013. It should not be relied on as a statement of the current law or policy position. For help with housing issues please contact our helpline on 028 9024 5640 or use our online chat service at www.housingadviceNI.org.