Publication - Advice and guidance

Health and Homelessness standards

Published: 3 Mar 2005
Part of:
Health and social care

Standards and performance requirements for NHS Boards in support of the planning and provision of services for homeless people.

Health and Homelessness standards
Page 10

Health and Homelessness standards

Section 8:
Annexes and References
Annex A:
Homelessness Task Force - Health Recommendations

The Homelessness Task Force, in its final report Homelessness: An Action Plan for Prevention and Effective Response (Scottish Executive 2002), made a number of recommendations which were intended to have a positive impact on the health of homeless people. Some of these are aimed at the statutory sector as a whole, others directly at the NHS and others are for the attention of the Scottish Executive. The recommendations are listed below for ease of reference and numbered as they appear in the report, cross referenced by the paragraph in which they appear where additional contextual information may be found.

The delivery of the health recommendations will be monitored through the self-assessment reporting framework for the Health and Homelessness Standards.


(26) Those responsible for prisoners, looked after children, long-stay hospital patients and the armed forces should develop high quality housing and homelessness advice services with support from Communities Scotland. Standards for these advice services should be set and monitored within the appropriate regulatory regime for each type of institution. Local Authorities should ensure that appropriate linkages are being made between services in institutions and services in the community (paragraph 62).

(33) All service providers, statutory and voluntary, should ensure that they are promoting values, attitudes and behaviour which deliver responsive and personalised services. They should ensure that staff are supported and trained in serving people affected by homelessness. Training should cover, as appropriate, the definition of homelessness, risk assessment techniques to help "first-to-know" agencies respond effectively, joint working with other agencies, support packages, consultation techniques and how to help and empower people experiencing homelessness to find appropriate solutions. Joint training approaches should be pursued. The training programmes run by the Scottish Training on Alcohol and Drug Abuse (STRADA) partnership should include coverage on serving homeless people (paragraphs 76-77).

(42) A high priority should be placed upon monitoring of quality and delivery of Health and Homelessness Action Plans. The Health Department's Primary Care Modernisation Group should set out how the primary care needs of homeless people would best be met (paragraph 99(i)).

(43) All Local Authorities should record information about the GP registration of all those who register as homeless, and should offer information about local health services to homeless people rehoused out-with their existing GP area (paragraph 99(i)).

(44) NHS Boards should ensure their strategic planning embraces the current and future service needs of homeless people. Drug and Alcohol Action Teams should include, in their planning priorities, the service requirements of homeless people relating to substance misuse. Monitoring of the effectiveness of such processes should be undertaken through the Scottish Executive's assessment of Local Health Plans and Corporate Action Plans on Substance Misuse (paragraph 99(ii)).

(45) NHS Boards should ensure that all children in homeless families are able to access the full range of universal health services for children; and the Health and Homelessness Co-ordinator should monitor this action (paragraph 99(iii)).

(46) NHS Boards should address the provision of mental health services to homeless people to minimise the barriers to access. Being free from substance-misuse should not be an automatic pre-condition for access to services (paragraph 99(iv)).

(47) Actions within the national drugs and alcohol plans which will prevent addictions contributing to homelessness and which will tackle substance misuse amongst homeless people should be given high priority. The recommendations of the Glasgow Street Homelessness Team in relation to the development and provision of drug and alcohol services to hostel dwellers should be more widely applied. Local action to tackle substance misuse and homelessness in parallel should be developed through homelessness strategies and Drug and Alcohol Action Team plans. The results of Scottish Executive work on effective interventions in tackling substance misuse should be disseminated to support commissioners and purchasers of services and service providers in both homelessness and drugs and alcohol agencies (paragraph 99(v)).

(48) In the case of primary care services, specialist provision should be seen as transitional for all but a small number of homeless people. It should provide planned support over a reasonable period of time until individuals are re-housed and settled with access to their local GP practice and primary health care team. The general approach should be to support homeless people to maintain their current health networks or to establish new regular contact with mainstream health services (paragraph 99(vii)).

(49) The Health and Homelessness Co-ordinator, whose remit includes setting standards for homelessness training programmes, should support training on homelessness for health professionals and ancillary staff (paragraph 99 (viii)).

(52) Public sector employers should also examine ways of creating and expanding work opportunities for homeless people. New public sector initiatives should strive to employ homeless people in the provision of their services (paragraph 108).

Annex B:
Homelessness Task Force - Definition of Homelessness

The Homelessness Task Force identified a range of housing situations that defined the meaning of homelessness for the purposes of their work. This definition embraces the following categories, which are not mutually exclusive, but all have been specified in the interests of clarity. It is this definition that should be used in applying the Health and Homelessness Standards.

1. Persons defined in current legislation as homeless persons and persons threatened with homelessness, i.e. those:

  • Without any accommodation in which they can live with their families.

  • Who cannot gain access to their accommodation or would risk domestic violence by living there.

  • Whose accommodation is "unreasonable", or is overcrowded and a danger to health.

  • Whose accommodation is a caravan or boat and they have nowhere to park it.

2. Those persons experiencing one or more of the following situations, even if these situations are not covered by the legislation:

  • Roofless: those persons without shelter of any kind. This includes people who are sleeping rough, victims of fire and flood, and newly-arrived immigrants.

  • Houseless: those persons living in emergency and temporary accommodation provided for homeless people. Examples of such accommodation are night shelters, hostels and refuges.

  • Households residing in accommodation, such as Bed & Breakfast premises, which is unsuitable as long-stay accommodation because they have no where else to stay.

  • Those persons staying in institutions only because they have nowhere else to stay.

  • Insecure accommodation: those persons in accommodation that is insecure in reality rather than simply, or necessarily, held on an impermanent tenure. This group includes:

    • Tenants or owner-occupiers likely to be evicted (whether lawfully or unlawfully).

    • Persons with no legal rights or permission to remain in accommodation, such as squatters or young people asked to leave the family home.

    • Persons with only a short-term permission to stay, such as those moving around friends' and relatives' houses with no stable base.

    • Involuntary Sharing of Housing in Unreasonable Circumstances: those persons who are involuntarily sharing accommodation with another household on a long-term basis in housing circumstances deemed to be unreasonable.

The Task Force's full report can be found at

Annex C:
Health and Homelessness Steering Group: Membership

Health and Homelessness Steering Group: Membership

Catriona Renfrew, Chair, Director of Planning and Community Care, NHS Greater Glasgow
Sue Irving, Health and Homelessness Co-ordinator, Scottish Executive
Robert Aldridge, Director, Scottish Council for Single Homeless
Julia Egan, Consultant in Public Health Nursing, NHS Tayside
Gary Wilson, Programme Manager - Young People, NHS Health Scotland
Rosemary Robertson, Health and Homelessness Co-ordinator, NHS Lanarkshire
Colin Brown, Branch Head, Primary Care Division, Scottish Executive
Frances Wood, Branch Head, Health Improvement Policy, Scottish Executive
Kim Fellows, Head of Health Improvement Strategy Division, Scottish Executive
Pippa Goldschmidt, Branch Head, Homelessness Team, Scottish Executive
Wendy Hayhurst, Associate Director, DTZ Pieda
Convention of Scottish Local Authorities


Fitzpatrick, S., Pleace, N., and Jones, A. (2005), The support needs of homeless families: an audit of provision for families with children affected by homelessness in Scotland, University of York
HMSO (1987), Housing (Scotland) Act 1987
HMSO (2003), Homelessness etc. (Scotland) Act
HMSO (2001), Housing (Scotland) Act 2001,
Kershaw, A., Singleton, N. and Meltzer, H. (2000), Survey of the health and well-being of homeless people in Glasgow, Office for National Statistics
Love J., (2002), Health and Homelessness in Aberdeen: a study of the experiences and views of homeless people in Aberdeen, The Robert Gordon University
NFO System Three and MORI (2002), Scottish Household Survey Bulletin No. 8, Scottish Executive
NHS Argyll and Clyde (2002), Health and Homelessness Needs
NHS Lothian (2004), Improving Care: Investing in
NHSScotland, Performance Assessment
Quilgars D. and Pleace N. (2003), Delivering Health Care to Homeless People: An Effectiveness Review, University of York
Robinson J. and Elkan R. (1996), Health needs assessment: theory and practice, Churchill Livingstone
Scottish Executive (2000), Our National Health: A plan for action, a plan for
Scottish Executive (2001), Health and Homelessness
Scottish Executive (2002), Closing the Opportunity
Scottish Executive (2002), Homelessness: An Action Plan for Prevention and Effective
Scottish Executive (2003), Improving Health in Scotland - The
Scottish Executive (2003), Partnership for Care: Scotland's Health White
Scottish Executive (2004), Statistical Bulletin, Housing Series, Operation of the Homeless Persons Legislation in Scotland: National and Local Authority Analyses
Scottish Executive (2005), Equality and Diversity Toolkit
Wright J. (2001), Assessing health needs, in Oxford Handbook of Public Health Practice, Pencheon D., Guest C., Melzer D., Muir Gray J. A. (Eds), Oxford University Press