Sick and disabled people are being wrongly denied housing support and threatened with removal from the UK on the basis of medical assessments by doctors who have never met or spoken to them.

NowMedical has been paid millions of pounds in public money by councils and the Home Office to produce reports on homeless individuals and asylum seekers, based solely on paper records.

But judges have warned councils against relying on the firm’s advice and overturned decisions determined by its assessments, calling them “irrational” and criticising the firm for not taking the time to meet or speak to those they are assessing.

In one case, the company deemed a homeless man who was at risk for self-harm and suicide as not needing housing support because he was “no more vulnerable than an ordinary person”. In another, a woman who was housebound due to significant disabilities following a stroke was deemed fit to board a removal flight. In both cases, the decisions made on the basis of these assessments were overturned by the courts.

Lawyers and charities criticised the firm, which is owned by Dr John Keen, for “churning out findings very quickly” and in some instances “diminishing or downplaying” the severity of applicants’ conditions, sometimes in contradiction to the opinion of their treating doctors.

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. The attempt is raising funds for Ollie's Army Battling Against Battens, an organisation campaigning to raise GBP 250,000 to fund a clinical trial aimed at saving the sight of children with CNL2 Batten Disease PA UK news in pictures 16 September 2020 Labour deputy leader Angela Rayner speaking during Prime Minister's Questions UK Parliament/AFP/Getty UK news in pictures 15 September 2020 People enjoying the autumn sunshine as they punt along the River Cam in Cambridge PA UK news in pictures 14 September 2020 Early morning light bathes the skyscrapers of the City of London, at the start of a week in which the UK is expected to bask in temperatures of more than 30 degrees PA UK news in pictures 13 September 2020 England celebrate after they dismissed Australia's Alex Carey to win the second ODI match of the series at Emirates Old Trafford, Manchester PA UK news in pictures 12 September 2020 Protesters outside BBC Broadcasting House in central London, as marches and rallies form across the country calling for a 15% pay rise for NHS workers and an increase in NHS funding PA UK news in pictures 11 September 2020 An empty migrant dinghy floats off the beach at St Margaret's Bay after the occupants landed from France in Dover Getty UK news in pictures 10 September 2020 A view of small boats thought to be used in migrant crossings across the Channel at a storage facility in Dover, Kent PA UK news in pictures 9 September 2020 EU's chief negotiator Michel Barnier, left, arriving from the Eurostar with EU Ambassador to the UK, Portuguese diplomat Joao Vale de Almeida at St Pancras International railway station, London, for the latest round of the negotiations on a free trade deal between the EU and the UK PA UK news in pictures 8 September 2020 Dawn over Coquet Island, a small island off Amble on the Northumberland coast PA UK news in pictures 7 September 2020 A hovercraft arrives to Southsea, Hampshire from the Isle of Wight PA UK news in pictures 6 September 2020 Forensics officers near the scene of multiple reported stabbings in Birmingham Reuters UK news in pictures 5 September 2020 Anti-migrant protesters demonstrate in Dover against immigration and the journeys made by refugees crossing the Channel to Kent PA UK news in pictures 4 September 2020 Activists take part in a demonstration against the HS2 hi-speed rail line outside the Department of Transport AFP via Getty UK news in pictures 3 September 2020 Peter Baker, who plays Trigger in the musical version of Only Fools and Horses, sweeps the stage of the Theatre Royal Haymarket in London, after observing a 15 minute silence to show solidarity with those in the theatre industry that have lost their jobs due to the coronavirus pandemic PA UK news in pictures 2 September 2020 Kadie Lane, right, 11, and Brooke Howourth, 11, hug on their walk to Marden Bridge Middle School in Whitley Bay, Tyne and Wear, for their first day of term, as schools in England reopen to pupils following the coronavirus lockdown PA UK news in pictures 1 September 2020 Extinction Rebellion protesters sitting outside The Houses of Parliament in Westminster, London PA UK news in pictures 31 August Surfers at Long Sands Beach, Tynemouth PA UK news in pictures 30 August Black Lives Matter protesters march through Notting Hill in London in the first Million People March EPA UK news in pictures 29 August A protester reacts as she demonstrates against the lockdown and use of face masks, amid the coronavirus disease outbreak, outside Downing Street in London Reuters UK news in pictures 28 August Caribbean soca dancers display their costumes as they promote the first ever digital Notting Hill Carnival, following the cancellation of the normal Carnival festivities due to the continued spread of the coronavirus disease, in London Reuters UK news in pictures 27 August Father and son team Chris and Sam Milford from historic building conservation specialists WallWalkers begin restoration work on the spire of Norwich Cathedral, which stands at over 312ft high. The first known spire was completed in 1297 PA UK news in pictures 26 August Giant waves at Seaham in County Durham, as the bad weather continues PA UK news in pictures 25 August An assistant at the Wallace Monument cleans the case which houses the William Wallace sword in the Hall of Arms room at the monument near Stirling as they prepare to re-open PA UK news in pictures 24 August Restored World War Two landing craft LCT 7074 is transported from from the Naval Base in Portsmouth to its final resting place at the D-Day Story at Southsea PA UK news in pictures 23 August Jenny Nguyen and Tony Cao, from Vietnam, pose for wedding photos on Tower Bridge in London, as it remains closed to vehicles after it was stuck open on Saturday due to a "mechanical fault". The landmark's Twitter account confirmed only pedestrians and cyclists could use it on Sunday morning PA UK news in pictures 22 August England's Zak Crawley hit 267, joining the exclusive Double Hundred club, on day two of the Third Test match against Pakistan at the Ageas Bowl, Southampton PA UK news in pictures 21 August Harri Teale gathers lavender during the annual harvest on the Wolds Way Lavender farm near Malton in North Yorkshire PA UK news in pictures 20 August Parents and a student react after checking GCSE results at Ark Academy in London Reuters UK news in pictures 19 August Tate Modern workers hold a strike outside the gallery in London, to protest the institution's announcement that it would cut more than 300 jobs from its commercial arm, Tate Enterprises PA UK news in pictures 18 August Two rescued brown bear cubs, Mish (left) and Lucy, cool off in a pool after arriving at their new home with the wildlife conservation charity Wildwood Trust in Herne Bay, Kent. The orphaned pair, who have been living in a temporary home in Belgium since they were found abandoned and alone in a snowdrift in the Albanian mountains, will be acclimatised to their new life in the country before moving to a permanent home PA UK news in pictures 17 August A level students celebrate outside the Department for Education in London after it was confirmed that candidates in England will be given grades estimated by their teachers, rather than by an algorithm. The government U-turn comes just days after Education Secretary Gavin Williamson vowed there would be "no U-turn, no change. 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

A joint investigation by The Independent and the Bureau of Investigative Journalism can reveal that the firm has been paid £2.2m by at least 118 councils to carry out housing needs assessments since the start of 2014.

The amount paid to the company by the Home Office is unknown, but lawyers said the department regularly commissioned NowMedical to assess whether asylum seekers had certain housing needs due to medical conditions or whether those whose claims have been refused were fit to be removed from the country.

However, criticism from judges of the firm's assessments has been long-standing. In 2006, Mr Justice Leveson criticised Ealing Council and NowMedical over the case of a woman suffering post-traumatic stress disorder following rape, torture and imprisonment in Iran. He said NowMedical's assessment of her case was “irrational” and that the council's view was “tainted” for having relied upon these reports.​

In another case a year later, the Court of Appeal overturned a decision to reject a priority-needs claim by a homeless refugee family, made on the grounds that the mother suffered depression and post-traumatic stress disorder, after NowMedical had concluded there was “nothing to suggest her condition [is] of particular severity”.

Overturning the decision, Lord Justice Smedley said Birmingham Council had not considered all available medical evidence and that the handling of the case displayed “a want of fair-mindedness”. He warned that “care has to be taken by local authorities not to appear to be using professional medical advisers simply to provide reasons for a refusal”.

In a more recent example in 2016, an immigration judge rejected a decision by the Home Office to issue removal notice to a woman who was housebound due to significant disabilities following a stroke, after NowMedical deemed her fit to fly. A report by the firm had stated that difficulties she faced were “not insurmountable” and that assistance could be provided to her during the flight.

Tribunal judge Paulene Ganhdi allowed the woman's appeal to the decision, saying she “preferred the evidence of her treating specialist who has specifically addressed her ability to travel in light of his detailed knowledge of her medical conditions to that of NowMedical".

In 2017, a county court judge allowed the appeal of a homeless woman who was refused housing support by Lambeth Council after being deemed by not to be “significantly more vulnerable than an ordinary person” by NowMedical, despite her GP stating that she was suicidal and would “not cope with being homeless”.

Judge Parfitt said the council’s approach, “formed directly from the NowMedical opinions”, was “fundamentally flawed”, adding that it “might have helped” had someone from the medical firm “taken the time to see the appellant or indeed considered her medical records”.

NowMedical , which is based in west London, charges local authorities £35 plus VAT for a basic report on whether someone is medically vulnerable enough to get long-term support to prevent or alleviate their homelessness, and is believed to charge the Home Office the same rate to medically assess asylum seekers.

Many councils do not have their own medical experts in-house and, while some rely on applicants’ GPs or other medical records, scores across the country opt for using NowMedical’s service. Southwark council paid the company £51,000 last year, while Hackney spent £46,000.

Councils have also paid the company to advise on whether housing is suitable. In one case, NowMedical advised that a six-year-old child with severe autism was ‘in medical need’ and that her was home unsuitable, after she had climbed onto the balcony of her first-floor flat and put herself at risk. NowMedical suggested that ‘a ground floor property would be optimum’ for the family, but acknowledged that the availability of ground floor properties may be ‘so scarce as to potentially delay a relocation’. To enable the family to move as quickly as possible from their current first-floor accommodation, NowMedical advised that a different first-floor flat could be an ‘acceptable alternative’, as a fall from a first floor ‘is unlikely to be fatal’.

Housing lawyers said they feared cash-strapped councils were using the advice of the company as a way of outsourcing tough decisions at a time when low availability of local authority housing meant they were having to place a growing number of homeless people in costly temporary accommodation.

Simon Mullings, a housing law case worker, described the system as “terribly flawed”, adding: “It is obviously a kind of gatekeeping exercise for councils. And 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.”

Victoria Pogge von Strandmann, a public law solicitor at Simpson Millar, said there was a similar system in the Home Office, and that despite the “limitations” of NowMedical's reports, the department “just seems to follow it blindly”, regardless of what other evidence there might be.

She also raised concern that the Home Office did not always provide Dr Keen with all of the relevant medical records for the person being assessed, saying that she had seen cases where “crucial evidence” had not been given to him.

“NowMedical’s assessments are pretty cursory in my experience. They are short, amounting to a page or two, they don’t go into massive detail,“ she added. ”They don’t particularly caveat their opinions in the way you would expect when a medical professionals who has been asked to give an opinion only on the papers should do. And the way the Home Office then deals with that information is flawed in my opinion.“

Nicholas Nicol, a barrister who has successfully challenged council decisions based on NowMedical assessments, suggested that the apparent frequency at which the firm deemed applicants not to be vulnerable could make the service more attractive to councils.

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

“I am not saying there is any conscious bias, but if they continually said this person is vulnerable, well, they just would not be used. In my opinion, they are delivering, in the broadest terms, the advice that their customers want to hear,” he said.

Stephen Hale, chief executive of Refugee Action, said it was “vital” that the health and wellbeing of vulnerable people were properly evaluated before important decisions were made about their future, adding: “It’s appalling to see the consequences of vulnerable pesople being let down by the current system.”

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 has been approached for comment.

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.