Guidance

Guidance for NHS trusts and foundation trusts providing emergency departments, urgent treatment centres and inpatient services

Updated 22 November 2018

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This publication is available at https://www.gov.uk/government/publications/homelessness-duty-to-refer-for-nhs-staff/guidance-for-nhs-trusts-and-foundation-trusts-providing-emergency-departments-urgent-treatment-centres-and-inpatient-services

Who this guidance is for

This guidance is for staff or clinical teams who meet and assess patients.

The ‘duty to refer’

Specified public services now have a legal duty to refer service users they consider may be homeless or threatened with homelessness to a local housing authority. For health services the impact will be on NHS trusts and foundation trusts in the provision of any of the following NHS health services:

  • accident and emergency services in a hospital
  • urgent treatment centres
  • in-patient treatment (of any kind)

The referring service must have the person’s consent. The service user will need to decide which local housing authority they are referred to, mirroring the way people choose which local housing authority to seek help from when approaching directly for housing assistance.

Health services already support and refer individuals who are homeless or at risk of homelessness, as part of their safeguarding responsibilities and normal daily work. The duty to refer seeks to extend the good practice that already exists in many local areas across England and aims to ensure services are working together to prevent homelessness.

Individuals who could potentially be homeless

The following factors would indicate that an individual may be threatened with homelessness and should be enquired about:

  • problems with debt, particularly rent or mortgage arrears
  • problems with a landlord, being threatened with eviction or served notice to leave
  • being a victim of domestic abuse, or other forms of violence, threats or intimidation
  • approaching discharge from hospital, armed forces or release from custody, with no accommodation available
  • having previously been in care, the armed forces or in prison

Priority need for accommodation

The following categories have a priority need for accommodation:

  • a pregnant woman or a person with whom she resides or might reasonably be expected to reside
  • a person with whom dependent children reside or might reasonably be expected to reside
  • a person who is vulnerable because of old age, mental illness, learning disability or physical disability or other special reason, or with whom such a person resides or might reasonably be expected to reside
  • a person aged 16 or 17 who is not a ‘relevant child’ or a child in need to whom a local authority owes a duty
  • a person under 21 who was (but is no longer) looked after, accommodated or fostered between the ages of 16 and 18 (except a person who is a ‘relevant student’)
  • a person aged 21 or more who is vulnerable because of having been looked after, accommodated or fostered (except a person who is a ‘relevant student’)
  • a person who is vulnerable because of having been a member of His Majesty’s regular naval, military or air forces
  • a person who is vulnerable because of:
    • having served a custodial sentence
    • having been committed for contempt of court or any other kindred offence
    • having been remanded in custody
  • a person who is vulnerable because of ceasing to occupy accommodation because of violence from another person or threats of violence from another person that are likely to be carried out
  • a person who is homeless, or threatened with homelessness, as a result of an emergency such as flood, fire or other disaster

Service users choosing which local housing authority they are referred to

The duty allows service users to choose which local housing authority they are referred to. However, when discussing the referral and offering guidance to the service user, it is important to be aware that local housing authorities owe more duties towards homeless applicants who have a local connection with their area.

If a person asks to be referred to an area they do not have a local connection to, the local housing authority might subsequently refer them on to another local housing authority to which they do have a local connection.

Process for referrals

The Faculty for Homeless and Inclusion Health in consultation with health providers have developed a downloadable example referral form for hospitals to use. This should be used alongside the duty to refer health services checklist.

Local housing authorities should work with NHS trusts and foundation trusts in their area to design effective referral mechanisms that meet their local circumstances. Local housing authorities should place information on their websites explaining what their referral mechanisms are.

However, NHS trusts and foundation trusts may make a referral to a local housing authority in any manner they wish providing they include the minimum information required by law: contact details, consent and agreed reason for referral. Where a local housing authority has not established referral mechanisms or not provided information about their mechanisms, or if the referral is coming from another part of the country, a simple form is available that can be used by public authorities to make a referral.

Local housing authorities have been asked to provide a standard email address that duty to refer referrals can be sent to: dutytorefer@[insertlocalauthorityname].gov.uk.

What happens when someone is referred

When a referral is received by the local housing authority they will contact the service user, using the contact details provided. They should provide a receipt of referral, which may be in the form of an automatic email reply. If this is not received, please contact the local housing authority.

If you think the referral has not been acted upon, you will need to contact the housing authority.

Referrals without consent may be made to safeguard children or vulnerable adults, in accordance with safeguarding procedures.

Homelessness Reduction Act 2017

The Homelessness Reduction Act 2017 (the Act), which introduced the duty to refer, came into force 3 April 2018 and introduced new duties for local housing authorities to help prevent the homelessness of all families and single people, regardless of priority need. Under the new duties in the Act, local housing authorities will now offer individuals who are homeless or threatened with homelessness a greater package of advice and support. The Act should mean more people get the help they need earlier, to prevent them from becoming homeless in the first place.

Changes in how local authorities respond to housing referrals

The Act introduced new duties for local housing authorities (LHAs), which changes the way they respond to housing referrals.

The Act introduces an enhanced prevention duty, which requires LHAs to take reasonable steps for 56 days to help prevent any eligible person who is at risk of homelessness from becoming homeless. This means either helping them to stay in their current accommodation or helping them to find a new place to live.

Where an eligible person has sought help from the LHA when they are already homeless or if homelessness prevention work has not been successful, they will be owed a new 56-day relief duty. The relief duty requires LHAs to take reasonable steps to help secure accommodation for any eligible person who is homeless.

The new homelessness prevention and relief duties are owed to all eligible applicants, regardless of whether they have a priority need or would be found to be intentionally homeless.

This means that on receipt of a health sector referral the local authority will contact the person and confirm their circumstances, which in most cases will trigger a homeless application and provision of help to prevent them being homeless. The Act should ensure interventions begin earlier, to help address problems that might lead to homelessness.

Who the duty to refer applies to

If a specified service considers that a service user may be homeless or threatened with homelessness or if the service user made a positive disclosure to a member of staff that they were homeless or at risk of homelessness, the service would be required to ask the individual if they would like to be referred to an LHA.

Service users may be patients, or other individuals for whom the health service exercises a function.

The Act defines an individual as threatened with homelessness if they are likely to become homeless within 56 days. However, the Department of Health and Social Care encourages health services to refer individuals that may be at risk of homelessness as early as possible to maximise the opportunities to prevent homelessness.

What a referral needs to include

We hope the duty will encourage all health services who come into contact with people who are homeless or at risk of homelessness to renew their efforts to identify them and to refer them; confident that this will help that patient access the support they need.

Local housing authorities will be capturing data on applicants and referral sources. Future amendments to the regulations have not been ruled out, if a need is identified.

The basic legal requirement for a referral is the inclusion of:

  • the individual’s contact details
  • the individual’s consent
  • the agreed reason for the referral (that they are homeless or threatened with homelessness)

Non-fufilment of the duty to refer

There is no sanction specified in the Act. A breach of the duty could be subject to judicial review and a failure to comply with the duty could also be addressed through contractual means where a provider’s contract requires a contract holder to comply with all their legal duties.

Will the duty introduce new bureaucracy?

The new legal duty is not intended to be onerous nor to add an administrative burden to health services. There are no extra data collection requirements specified in the Act. Applying the legal duty only to selected functions within NHS trusts and foundation trusts aims to avoid the need for new data systems to track referrals.

Public Health England publishes best practice guidance to service providers and commissioners.

The Faculty for Homeless and Inclusion Health have updated their standards for commissioners and service providers.

Data protection

The use of emails to convey personal information has been raised as a concern. The gov.uk email address is considered sufficiently secure. However, if in doubt, please check with the trust’s data protection officer.

Other services

The Act was a private member’s bill. Therefore, only limited health services were considered for specification in the regulations.

Help and resources

How to feedback on the duty to refer in health

The Department of Health and Social Care would welcome feedback. Please contact homelessness@dhsc.gov.uk with views and any feedback.

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