How to make sure local hospitals are helping those facing homelessness

Some NHS services have a legal duty to alert their local housing authority if they identify someone who they believe is homeless or at risk of becoming so. Find out the questions you can ask your NHS to understand if they are meeting this duty.
Person holding shape of a home in their hands

Health and homelessness

Ill health can be both a cause and result of homelessness.

The health and wellbeing of people who experience homelessness are poorer than that of the general population. They often experience the most significant health inequalities. The longer a person experiences homelessness, the more likely their health and wellbeing will be at risk.

Role of professionals

Working with other services, NHS professionals can play an important role in helping to:

  • identify and prevent homelessness,
  • reduce the effect on health that homelessness can cause, and
  • make sure that poor health does prevent those who are experiencing homelessness moving on to a home of their own.

What is the Duty to Refer?

Since April 2018, public bodies - like hospitals, job centres and prisons - have had to tell a local housing authority if they identify someone who they believe is currently homeless or may be threatened with homelessness within 56 days. 

For the NHS, the Duty to Refer applies to all emergency departments, urgent treatment centres and hospitals providing inpatient care.

The notification, which requires the consent of an individual, aims to help people get access to homelessness services as soon as possible.

Find out more about the 'Duty to Refer'

Part of the Homelessness Reduction Act 2017, the Duty to Refer aims to help make sure that services are working together effectively to prevent homelessness by ensuring that peoples’ housing needs are considered when they come into contact with public authorities.

Although it is up to public bodies in a local area to decide how the duty will work in practice, Government guidance sets out further information about how referrals should work and the minimum information needed.

Find out more

Questions to ask your NHS

It is important that your NHS knows the steps they can take when they come into contact with someone who is homeless or is facing homelessness.

Here is a set of questions you can ask your NHS to help highlight the importance of tackling homelessness.

  1. Are you aware of the 'Duty to Refer' which came into force in October 2018?
  2. Are you aware of the need for certain health services to refer someone, with the patient’s permission, to the local authority housing team if they are experiencing homelessness or are at risk of becoming homeless in the next 56 days?
  3. Housing is as a key determinant of health. As part of a person-centred approach, what steps are you taking to understand your patients’ housing situation and to support recovery when their housing status is affecting their health?
  4. Do you discharge patients from inpatient services without a home or address to go to? If so, how do you monitor this and make sure plans are put in place before discharge to support recovery and reduce the risk of harm and readmission?
  5. How are the deaths of people sleeping rough investigated? Is this in the same way as any other unexpected death that happens elsewhere in the community or statutory services?
  6. How does your work with people experiencing homelessness safeguard them and reduce the risk of them experiencing abuse?
  7. Are you confident your staff are aware of the causes and impact of homelessness and their duties under homelessness legislation?
  8. What considerations have made in your policies and plans to help reduce homelessness and the impact of homelessness?

These questions were developed by Shared Ventures who, as part of the Keep Well Collaborative, have developed a fuller briefing for local Healthwatch to help you understand the role you can play in helping to tackle homelessness in your area.

Download the briefing

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