Scores of people have their health assessed every day by NowMedical, which has been paid millions of pounds by local authorities and the Home Office. The reports from the private firm are used to determine whether homeless people qualify for housing support and whether failed asylum seekers are fit to be removed from the country. But decisions that can plunge people into hardship are made without even speaking to them – often even without their knowledge – and instead rely on paper records.

Needing spinal surgery – but signed off to sit on a 15-hour flight

Ekhalas Yousif, 55, suffers severe pain in her back and upper legs due to spondylitis, sciatica, and lumbar spinal stenosis, which gets particularly excruciating if she sits for long periods of time. She needs spinal surgery, yet has been deemed fit to board removal flight to Sudan – a journey that takes 12 to 15 hours.

“How can they say that when they have never seen me?” she says of Dr John Keen, the owner of NowMedical, which advised the Home Office that she was able to leave the UK. Less than 24 hours after being asked to assess her, the doctor who evaluated her case responded via email stating that he did not believe her condition precluded her leaving the UK as long as she took regular exercise during the flight by “walking around the cabin”.

“It gave me a shock. He’s never seen me. If he spoke to my GP he would know,” says Ekhalas, who came to Britain in 2012 with her two sons after fleeing religious persecution. “I can’t even make a three-hour journey to Liverpool to sign on with the Home Office. How can I sit for 15 hours to Sudan?”

UK news in pictures Show all 50 1 /50 UK news in pictures UK news in pictures 18 September 2020 A model presents a creation during the Bora Aksu catwalk show at London Fashion Week 2020 Reuters UK news in pictures 17 September 2020 World kickboxing champion Carl Thomas during his attempt to run a marathon while pulling a plane at Elvington Airfield near York. 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PA UK news in pictures 16 August Wasp players take a knee as Northampton Saints stand prior to kick-off in their Premiership match at Franklin's Gardens PA UK news in pictures 15 August Piper Colour Sergeant Lil Bahadur Gurung attends the VJ Day National Remembrance event, held at the National Memorial Arboretum in Staffordshire, Britain Reuters UK news in pictures 14 August People including students hold placards on Whitehall outside Downing Street as they protest against the downgrading of A-level results. The government faced criticism after education officials downgraded more than a third of pupils' final grades in a system devised after the coronavirus pandemic led to cancelled exams yes AFP via Getty UK news in pictures 13 August Benita Stipp (centre) and Mimi Ferguson (left) react as students at Norwich School receive their A-Level results PA UK news in pictures 12 August 2020 A train derailment near Stonehaven has left three people dead. Driver Brett McCullough, conductor Donald Dinnie, and a passenger were killed when the 6.38am Aberdeen to Glasgow Queen Street service crashed amid heavy rain and flooding BBC UK news in pictures 11 August 2020 A woman hydrates in the sun after open water swimming at the West Reservoir Centre in north London Tolga Akmen/AFP via Getty UK news in pictures 10 August 2020 Prime Minister Boris Johnson takes part in an archery session as he visits Premier Education Summer Camp at Sacred Heart of Mary Girls' in Upminster Reuters UK news in pictures 9 August 2020 People cycle through Cambridge as the heatwave continues in Britain EPA UK news in pictures 8 August 2020 Healthcare workers take part in a protest in London over pay conditions in the NHS Getty UK news in pictures 7 August 2020 Emergency services make their way along the seafront on Bournemouth beach in Dorset on one of the hottest days of the year PA UK news in pictures 6 August 2020 Alison Murphy poses for a picture by husband Peter as she walks through a field of sunflowers in Altrincham, Cheshire PA UK news in pictures 5 August 2020 Pakistan's Abid Ali being bowled by England's Jofra Archer during day one of the First Test match at the Emirates Old Trafford, Manchester PA UK news in pictures 4 August 2020 The 'Timbuktu tumblers' from Kenya perform their balancing act on the Southsea waterfront as Zippos Circus reopens in Portsmouth Rex UK news in pictures 3 August 2020 Pelicans interact with a visitor in St James's Park in London PA UK news in pictures 2 August 2020 Lewis Hamilton drives with a puncture towards the finish line to win the Formula One British Grand Prix at Silverstone POOL/AFP via Getty UK news in pictures 1 August 2020 Arsenal's Pierre-Emerick Aubameyang celebrates with the trophy and teammates after winning the FA Cup, as play resumes behind closed doors following the outbreak of the coronavirus disease Pool via Reuters UK news in pictures 31 July 2020 People enjoy the sunny weather at a Bournemouth Beach Reuters

Made homeless despite psychiatrist’s warning it would be a ‘disaster’

Susan* was told she and her severely disabled daughter Leah*, 22, had to move out of their temporary accommodation just five days before Christmas this year. Leah, who has autism and several mental health issues, has been ruled not fit to work while a psychiatrist concluded she was “extremely debilitated”, with suicidal thoughts and hands raw from obsessively washing. “It would be a disaster for [Leah] to be homeless, given her current mental state,” they concluded.

Yet Bexley Council in southeast London said it would not house them because they were not in priority need, telling Susan and Leah they would be able to manage as well as “an ordinary person” even if “homelessness were to result in you having to sleep rough occasionally or in the longer term”, after NowMedical found Leah was no more vulnerable “than an ordinary person if homeless”.

After a legal battle, the council conceded Susan and Leah were in priority need but offered them a private sector flat that was unaffordable and unsuitable. Susan said she had no choice but to turn it down. “How have they come to this decision, when they have never met my daughter?” she asks. “There’s something very, very wrong with this system. It is unjust.”​

After intervention from Susan’s lawyers, Bexley Council said they could stay in their flat over Christmas and that it is reviewing whether it was right to offer Susan only a private rental flat, but in the meantime it has told her to prove that she is searching for a place of her own every week.

Housebound with ‘immense health problems’… but fit to fly

A woman who was housebound and in a wheelchair due to significant disabilities following a stroke lost her asylum support after NowMedical deemed her fit to fly. A report by the firm accepted that there were difficulties but said these were “not insurmountable” and that assistance could be provided to her during the flight. An immigration judge later said they “preferred the evidence of her treating specialist [..] to that of NowMedical, and overturned the decision that the woman was fit to fly.

Suicidal slavery victim ruled ‘not more vulnerable than an ordinary person’

A suicidal refugee from Mauritania who had been subjected to human trafficking was refused housing by Islington Council after NowMedical deemed that he did not “meet the threshold for being more significantly vulnerable than an ordinary person if homeless”. On the same day, his GP noted Mr Mohammed was “traumatised” by his suicidal thoughts, in a “terrible condition” and that “there is no doubt being homeless would trigger an exacerbation of his current conditions”.

A second report by NowMedical stated that his depression was reported to have worsened and that he had been experiencing suicidal thoughts, but that there was “nothing to suggest any current suicidal risk or intent”. The decision to refuse his housing request was overturned by a judge in 2018, who ruled that he was indeed vulnerable owing to his mental illness and physical disability.

Great difficulty with eating, washing and dressing… but not too vulnerable to be made homeless

A woman who suffered from upper limb weakness and severe muscle wasting in her shoulders, meaning she could not lift her arms above chest level, as well as post-traumatic stress disorder, anxiety and depression, was not deemed not to be in priority housing need after NowMedical said she was “able to fend for herself”. A report signed off by Dr Keen advised that he didn’t think her mental illness was “severe or substantially disabling”. A review of the decision was successful.

Epileptic told he can can ‘fend for himself’ when rough sleeping

Daniel*, who suffers from epilepsy, as well as post-traumatic stress syndrome and depression, fell homeless after he was denied temporary accommodation by Harrow Council following NowMedical’s assessment that he couldn’t “find anything to prevent him from fending for himself”.

While on the streets he had seizures most days, he was attended by paramedics at least four times and admitted to hospital twice. He often had to go without eating he could not always take his medication. Daniel’s GP wrote to council reporting that he was vulnerable and that homelessness was both detrimental to his physical and mental health.

At this point, the council sought further advice from NowMedical’s doctors, whose response was: “I note that he has experienced recent seizures, but this seems due to non-compliance with his medication only which is his own volition. I can’t see a particular reason why homelessness prevents him taking medication. I can’t find anything to prevent him fending for himself.” The council decided again that he was not in priority need.

The Stats: Homelessness in the UK Show all 10 1 /10 The Stats: Homelessness in the UK The Stats: Homelessness in the UK Sleeping rough up 165% from 2010 The total number of people counted or estimated to be sleeping rough on a single night in autumn 2018 was 4,677, up 2,909 people or 165% from the 2010 total of 1,768 Getty The Stats: Homelessness in the UK London rough sleepers up 13% The number of people sleeping rough increased by 146 or 13% in London since 2017 AFP/Getty The Stats: Homelessness in the UK London accounted for 27% of people sleeping rough in England London accounted for 27% of the total number of people sleeping rough in England. This is up from 24% of the England total in 2017 Getty The Stats: Homelessness in the UK 64% of rough sleeps UK nationals 64% were UK nationals, compared to 71% in 2017 AFP/Getty The Stats: Homelessness in the UK 14% of rough sleepers are women 14% of the people recorded sleeping rough were women, the same as in 2017 Getty The Stats: Homelessness in the UK 6% were aged 25 years or under, compared to 8% in 2017 AFP/Getty The Stats: Homelessness in the UK Thousands of families staying in temporary housing Almost 79,000 families were staying in temporary housing in the last three months of 2017 because they didn't have a permanent home, compared with 48,010 in the same period eight years before Getty The Stats: Homelessness in the UK Reduction in families living in temporary housing before Coalition government There had been a significant reduction in families living in such conditions before the Coalition government came into power, with the number having fallen by 52 per cent between 2004 and 2010 under the Labour government AFP/Getty The Stats: Homelessness in the UK Families staying in temporary has risen since But the figure has crept up in each of the past seven years, from 69,140 in the last quarter of 2015, to 75,740 in the same period in 2016 and 78,930 at the end of last year Getty The Stats: Homelessness in the UK Nearly 58,000 families accepted as homeless (2018) Nearly 58,000 families have been accepted as homeless by their local council in the past year (as of March 2018), equating to an increase of 8 per cent over the last five years Getty

Harrow Law Centre requested a review of the decision and obtained further medical evidence from his GP which said he was very vulnerable and that it was quite conceivable that his life span would be significantly reduced by remaining homeless. The council quashed the decision and Daniel was allocated permanent council accommodation.

A Home Office spokesperson said: “The Home Office procured the services of NowMedical to provide independent medical advice, which is required to assist case workers making decisions on the suitability of accommodation and ability to travel. This advice is considered alongside the medical evidence provided by applicants and all other factors. We are committed to providing support which meets the needs of asylum seekers and their dependants in line with current legislation.”

NowMedical and Harrow Council have been approached for comment.

*Some names have been changed

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.