Homelessness

Today someone will become homeless. Tonight, someone will sleep rough for the first time. It will be cold, uncomfortable, lonely and potentially life threatening. They may face abuse or violence.

We can all do something to help.

You can use the MECC approach to help someone that you are concerned about who is either experiencing homelessness or may be threatened with homelessness.

Duty to Refer

Duty to Refer Form

Some Public authorities have a ‘Duty to refer’ someone who is homeless, or may be threatened with homelessness, to a local authority for assistance.

The Homelessness Reduction Act 2017 significantly reformed England’s homelessness legislation by placing duties on local housing authorities to intervene at earlier stages to prevent homelessness in their areas, and to provide homelessness services to all those who are eligible. Additionally, the Act introduced a duty on specified public authorities to refer service users who they think may be homeless or threatened with homelessness to local authority homelessness/housing options teams of the service user’s choice.

Public authorities with a duty to refer in England are:

• prisons
• young offender institutions
• secure training centres
• secure colleges
• youth offending teams
• probation services (including community rehabilitation companies)
• Jobcentres in England
• social service authorities (both adult and children’s)
• emergency departments
• urgent treatment centres
• hospitals in their function of providing inpatient care
• Secretary of State for defence in relation to members of the regular armed forces

Other organisations not subject to the duty can also refer someone to a local authority.

People experiencing homelessness often have additional support needs, including both physical and mental health problems. People with additional needs will likely benefit from direct support to help them approach a local housing authority, rather than only making a referral.

The service user must consent to the referral being made. The consent can be made in writing or verbally, although the person referring should follow the agreed processes set out in their agency’s internal guidance, if applicable. In situations where it is necessary to safeguard a child or vulnerable adult you can make a referral without the person’s consent.

A person is considered homeless if:

• they do not have any accommodation which is available for them which they have a legal right to occupy; or,
• it is not reasonable for the person to occupy their current accommodation, for example, because they would be at risk of domestic abuse.

Someone is defined as being threatened with homelessness where they are likely to become homeless within 56 days, or have been served with a valid notice under section 21 of the Housing Act 1988 by their landlord, which expires within 56 days.

Shelter's homelessness referral checker can help you identify whether someone is homeless and whether to make a referral.

Not sure which local authority area to choose? If you know a postcode you can check which local authority area here.

Supporting access to GP and primary care

Homelessness is associated with extreme health inequity and premature death. Both long-term physical and mental health problems and urgent and acute health needs are much more common compared to the general population.

Research has highlighted both inequality in access to health care and negative experiences for people trying use of mainstream services. They are often asked for proof of address and photo identification to register or are simply refused for no reason by reception staff. This is unacceptable and contrary to NHS guidance.

GP practices have a responsibility to register people who are homeless or have no fixed abode. There is no requirement to produce identification or proof of address to register with a GP and immigration status does not matter.

Address: GP practices can use the practice address, a hostel, day centre or other service that supports someone experiencing homeless to register patients.

Contacting patients: GP practices can consent patients to contact them through other health and social care professionals who are supporting a person experiencing homelessness.

Very Brief Intervention

Ask

It can often be hard to know what to say to someone experiencing homelessness and we may feel awkward. It’s OK to explain that you don’t have anything to give, most people just want to be acknowledged and talked to - it doesn’t matter what it’s about.

If you’re unsure what to say, just ask

Are you alright? Do you need any help? Have you got a safe place to go to?

Anyone can advise someone experiencing homelessness of their right to access GP and Primary Care services. Surveys have shown that while homeless people commonly report being registered with a GP practice, in many cases the service is geographically inaccessible or is unwelcoming.

Ask the person if they are registered, if they can access the service and if not, are they aware of their right to register with a local GP practice.

Assist

You can assist someone who is homeless or may be threatened with homelessness to apply to a local authority in the following ways: -

  1. Direct referral by employees of Public Authorities with a legal duty to refer.
  2. Supported referral for people with additional needs who may struggle to access and complete an application to a Local Authority housing office. This is often the quickest and most effective option.
  3. Individuals and employees of other organisations not subject to the duty can also make direct or supported referrals.

Act

If you think the person you are concerned about is in immediate danger or needs urgent care, please call 999.

Whilst there are some amazing national services available, we recommend a local first approach. A list of local services can be found at the foot of this text.

Not sure which local authority area to choose? If you know a postcode you can check which local authority area here.

Street Link is a national service which can be used by members of the public if they see people sleeping rough. Referrals can be made online or via telephone (0300 500 0914).

Supporting access to primary care

Groundswell have produced and widely circulated small, plastic, credit card-style cards called ‘My Right to Healthcare’. These cards emphasise the person’s right to register and highlight that they may need assistance to complete forms and help with reading and understanding. The cards can be used to remind GP receptionists and other practice staff of the national patient registration guidance from NHS England. The cards are freely available and can be downloaded and printed locally.

Local Support and Contact Details