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 8

Health and Homelessness standards

Section 6: Standard Statements and
Performance Requirements

Standard 1


The objective of this Standard is to enable Boards to demonstrate corporate buy-in and support for the policy, and to ensure that implementation is being driven at senior management level.

Why this Standard?

It is vital that health and homelessness planning is embedded in the Board's corporate thinking, and that this is integral to its duty to continuously improve services. Experience has shown that the most effective approach to this policy is where an official at Director level or above has responsibility for guaranteeing that the Board is fully aware of the strategic approach to improving the health of homeless people. In so doing it can be ensured that related activities are appropriately resourced (not simply in financial terms, but also personnel and support), and that health and homelessness is considered in strategies such as substance misuse, health inequalities, Public Focus Patient Involvement, mental health, children's services, domestic violence and health improvement. Good practice suggests that effective joint working at Director level across agencies is beneficial.

As Community Health Partnerships will inform and deliver much of the health and homelessness activity it is critical that accountability procedures with CHPs include service delivery to homeless people. CHPs need to pro-actively inform all service planning for homeless people and agree the appropriate models of care to be delivered locally.

Health and homelessness is also an aspect of overall health inequalities strategies. Action to secure better health outcomes for homeless people is a component of the overall strategy to reduce health inequalities by securing a faster rate of improvement for those who are the most disadvantaged.

Performance Requirements

1.1 The Board can evidence that responsibility for health and homelessness is taken at Director level or above.

1.2 The health needs of homeless people are incorporated into the Board's Health Inequalities Strategy and all other relevant strategic planning frameworks, which also reflect the common aims of the Health and Homelessness Action Plan.

1.3 In the financial planning framework, and in other matters relating to resources, the Board can demonstrate that it has taken account of the priorities agreed in the Health and Homelessness Action Plan.

1.4 The Board is able to fully report against the health and homelessness Performance Assessment Framework indicator and other relevant health inequalities indicators.

1.5 The Board has in place appropriate involvement and accountability procedures to enable it to ensure that Community Health Partnerships are effective in planning and delivering the health and homelessness priorities, linked to the Health Inequalities Strategy.

1.6 The Board regularly reviews its health and homelessness activities to continuously improve services.

Standard 2


The objective of this Standard is to demonstrate that NHS Boards are working with, and learning from, those agencies that also have important
roles in the lives of homeless people.

Why this Standard?

Health and homelessness activity is part of the holistic approach to preventing and alleviating homelessness promoted by the Scottish Executive. Local Authorities' Homelessness Strategies also form part of this framework. NHS Boards are expected to lead activity on health and homelessness in their area but not to undertake all activities themselves, though frontline health care workers have an important role in preventing homelessness. Boards should be proactive and work as part of a multi-agency partnership where all partners are involved in planning and delivering services. Boards are also expected to involve homeless people in helping to shape services. Effective partnership activity will ensure that Homelessness Strategies and Health and Homelessness Action Plans are complementary and reflect common themes and priorities. This will also ensure that Community Planning Partnerships and Community Health Partnerships take account of this activity in their planning processes.

Performance Requirements

2.1 The Board plays a leading role in a partnership group comprising voluntary and statutory sector partners, focussed around Community Health Partnerships, which drives the Board's activities in relation to health and homelessness.

2.2 The Board supports partnership working by ensuring that such an approach is appropriately resourced.

2.3 Service users are a key partner in the Board's health and homelessness activities, and more widely are fully involved and consulted.

2.4 The Board supports partner organisations in the voluntary, statutory and private sectors to improve the health of homeless people.

2.5 The Board's partnership activity ensures that the Health and Homelessness Action Plan and Homelessness Strategies are complementary, reflecting common issues and aims, and reflecting Community Health Partnerships' local service plans.

2.6 The Board is effectively engaged in the implementation and delivery of the Local Authority(ies) Homelessness Strategy(ies).

2.7 Where a Board covers more than one Local Authority activities relate to all Local Authorities in the area. In addition, where a Board shares Local Authorities with other NHS Boards there is evidence of joined up working to meet the needs of homeless people.

Standard 3


The objective of this Standard is for NHS Boards to develop and maintain an evolving body of knowledge in the health and homelessness area. This knowledge will help to ensure that services evolve in ways that will be most responsive to the health needs of homeless people, which may change over time.

Why this Standard?

In preparing their initial Health and Homelessness Action Plans, NHS Boards were required to assess the profile and needs of homeless people in the area. It is important that Boards maintain an up-to-date evidence base on the health needs of the homeless population. The evidence must remain current as new homelessness legislation is implemented, Health and Homelessness Action Plans rolled out, and in the light of the social and economic changes that will occur. It is vital to use a range of means of identifying needs, including reports relating to critical incidents involving homeless people, and service users' views. Awareness of the profile and needs should not be concentrated at Board level, but all relevant personnel, especially those in front line services, should be trained to ensure they deliver services to homeless people effectively and equitably.

Performance Requirements

3.1 The Board has assessed the health needs of homeless people and, working with Community Health Partnerships, regularly reviews this information and uses it to shape services.

3.2 The Board makes active use of service user views in shaping its services.

3.3 The Board uses critical incident reporting and complaints procedures to inform policy and practice towards homeless people.

3.4 The Board maintains an up-to-date knowledge base on health and homelessness issues, including relevant research, which informs its services and Health and Homelessness Action Plan.

3.5 The Board, in partnership, ensures that staff at the front line of service delivery have the relevant competencies to work effectively with homeless people and supports them in acquiring further competencies as required.

Standard 4


The objective of this Standard is to break down the barriers which prevent homeless people from having their health needs met. Barriers may be structural, policy based or attitudinal.

Why this Standard?

Homeless people have more difficulty in accessing services than the general population. In order to gain access to services homeless people must first know that they exist, have details about the services and know how to access them. Local NHS service providers should be aware of the needs of homeless people in their area in order to ensure services are accessible and meeting those needs. For example, homeless people may be living in temporary accommodation away from their local community, with a distance to travel.

Understanding which services are used or not used by homeless people may lead Boards to consider whether these are accessible to homeless people or to remodel services to overcome such problems. Barriers may be structural (for example an inflexible appointments system), policy based (for example that a homeless person must have a permanent address to access a service), or may be related to attitudes towards homeless people. Mainstream services should be systematically audited to ensure they are designed in ways which improve reach for the most disadvantaged groups and which identify and overcome barriers.

Performance Requirements

4.1 The Board ensures the information needs of homeless people are assessed in order to ensure access to services and an appropriate response for those who need to use them.

4.2 The Board ensures partner agencies have appropriate information on access to health services for homeless people.

4.3 The Board ensures that being alcohol- or drug-free is not a prerequisite of accessing services.

4.4 The Board provides information to primary care and acute sector practitioners about homelessness in their area.

4.5 In ensuring equitable access to all its services the Board takes account of the needs and lifestyles of homeless people, including literacy and numeracy.

4.6 The Board monitors and evaluates which services are used/not used by homeless people and uses this information to refine and improve services.

4.7 The Board ensures that the attitudes of those providing health and well-being services for homeless people do not create barriers to accessing services.

4.8 In the development of Single Shared Assessments the needs of homeless people are taken into account.

Standard 5


The objective of this Standard is to assist NHS Boards to understand the ways in which services can operate with the greatest positive impact on the health of homeless people.

Why this Standard?

Homeless people are entitled to receive the same range of health and well-being services as the general population, though their circumstances may make it more difficult to participate equally in a range of health-related programmes, or to receive the continuity of care experienced by the housed population. Specialist services may be appropriate for homeless people for a period of time, but the existence of such services should not mean that everyone who is homeless is automatically channelled through this route; the aim must be to incorporate homeless people within mainstream services and to ensure these services are designed in ways which meets their needs.

It can also be very difficult for homeless people to plan and wait for services (such as detoxification) so it is important that Boards take lifestyles into consideration and where appropriate consider fast tracking into services. Admission and discharge procedures should also take account of the patient's housing status and ensure that no one with a planned discharge leaves to a homeless situation. This holistic approach to combating homelessness means that health workers should be equipped to sign-post homeless people to other appropriate agencies to prevent a continuation of their unsettled lives.

Performance Requirements

5.1 The Board can evidence that homeless people are able to use the full range of health and wellbeing services, and can report on outcomes.

5.2 Where waiting lists for health services exist, the Board takes account of the needs and lifestyles of homeless people in determining priorities.

5.3 Where specialist health services for homeless people exist, the Board can demonstrate that moving on to mainstream services is integral to their activities.

5.4 Where specialist health services exist, the Board can demonstrate that homeless people are not restricted to such services.

5.5 The Board's procedures ensure that no one who is subject to a planned discharge is discharged into a situation of homelessness. This will necessitate good joint working with other agencies.

5.6 The Board ensures homeless people receive appropriate continuity of care which takes account of their circumstances.

5.7 The Board can demonstrate that relevant front-line staff have the skills and knowledge to assist homeless people and are trained accordingly.

Standard 6


The objective of this Standard is to formalise the ongoing use of the Health and Homelessness Action Plan as the main planning tool for local health and homelessness activity.

Why this Standard?

Health and Homelessness Action Plans are the driving force behind health and homelessness activities for the Board. They should form part of the Board's Health Inequalities Action Plan in its Local Health Plan, and feed into Community Planning Partnership Health Inequalities Strategies, expressed in Joint Health Improvement Plans. Community Health Partnerships will be responsible for the delivery of much of the activity so Boards must be able to account for their progress against the Plan. The Action Plan must be an up-to-date document, regularly reviewed and monitored to ensure it remains relevant. It must not exist or be implemented in isolation, and appropriate resources will be required. The Plan also forms part of the broader framework to combat homelessness in Scotland; as such it relates to the recommendations of the Homelessness Task Force, and to the Health and Homelessness Guidance (Scottish Executive, 2001). The Action Plan should also be congruent with the Health Inequalities Action Plan.

Performance Requirements

6.1 The Board can demonstrate that the Action Plan is revised and updated on at least an annual basis.

6.2 The Action Plan is driven, delivered and monitored through a multi-agency steering group.

6.3 There is a clear reporting structure within the Board for the monitoring of the Action Plan.

6.4 The Action Plan is both deliverable and measurable and is built around SMART objectives.

6.5 The Action Plan has a level of resources appropriate to its aims.

6.6 The Action Plan reflects the principles of the Health and Homelessness Guidance.

6.7 The Action Plan addresses the health recommendations of the Homelessness Task Force.

6.8 The Action Plan is reflected in the Local Health Plan and the Joint Health Improvement Plan.

6.9 The Board has mechanisms in place to ensure Community Health Partnerships are delivering the Action Plan.