Guidance

Appendix 2: Stakeholder action summaries to support vaccination for people experiencing homelessness

Published 1 October 2026

ICBs and commissioners

Actions ICBs and commissioners can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• convene and support multi-agency partnerships • ensure people with lived experience are involved in service design, delivery and evaluation • establish governance arrangements and shared objectives  • embed vaccination for people experiencing homelessness within wider inclusion health, health inequalities and homelessness strategies • align commissioning with local homelessness and inclusion health priorities • support sustainable funding mechanisms and evaluation
Understanding local vaccination needs	• use local intelligence to inform decisions about planning and commissioning targeted vaccination services • include vaccination status on local homeless health audits to enable monitoring of uptake • triangulate service data with data sources from other organisations, where possible • support development of inclusion health data flows
Finding and engaging people	• consider commissioning services that enable proactive identification, eligibility assessment and invitation across multiple settings (for example, outreach, in-reach, and integrated models) • ensure service specifications include expectations for proactive identification and opportunistic assessment of eligibility, as well as follow-up of eligible individuals
Promoting vaccination	• ensure communication and engagement are considered within service specifications • ensure organisations delivering services to people experiencing homelessness are aware of and can access co-produced vaccine promotional materials • support the involvement of trusted community organisations and peer advocates • promote workforce development and training in trauma-informed and culturally competent communication
Delivering accessible services	• commission and support delivery models that improve access for people experiencing homelessness considering outreach, in-reach and vaccination in non-traditional settings  • commission integrated models that combine vaccination with wider health and social support services (for example, neighbourhood health hubs) • ensure local vaccination service providers are aware of new vaccine eligibility criteria • ensure appropriate arrangements are in place for workforce, vaccine supply, clinical governance, reimbursement, data recording and evaluation • monitor uptake and identify gaps in service provision

Local authorities

Public health teams

Actions local authority public health teams can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• work together with the local authority housing team to tackle homelessness and access to healthcare • coordinate partnership working across organisations • support monitoring and evaluation activities
Understanding local vaccination needs	• collate and interpret local data on people experiencing homelessness from multiple sources • include vaccination status on local homeless health audits to enable monitoring of uptake • produce local needs assessments for people experiencing homelessness to inform vaccination delivery • provide intelligence to commissioners and providers • identify underserved groups and priority locations for targeted vaccination activity • incorporate lived experience and community insight into local needs assessments
Finding and engaging people	• provide intelligence on individuals and groups experiencing homelessness  • support linkage between housing data and health services, in line with information governance • work with healthcare providers, accommodation services and outreach teams to develop local signposting and invitation pathways
Promoting vaccination	• support development of locally tailored communication approaches informed by community insight and behavioural evidence • facilitate engagement with voluntary, community and social enterprise (VCSE) organisations and people with lived experience  • support the use of behavioural and community insight to inform communication and engagement approaches
Delivering accessible services	• work with providers to identify suitable locations and populations for targeted vaccination activity • ensure commissioning arrangements for drug and sexual health services include access to vaccination • support local coordination of outreach initiatives  • facilitate links between vaccination providers, housing services and VCSE organisations  • alert health partners to outbreaks or increased infectious disease risk within accommodation settings

Housing teams

Actions local authority housing teams can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• working together with the local authority public health team to tackle homelessness and access to healthcare • support external links between housing, homelessness and health services • facilitate engagement with accommodation providers and outreach teams
Understanding local vaccination needs	• provide data on rough sleeping and temporary accommodation • support mapping of local population and service use
Finding and engaging people	• provide intelligence on individuals and groups experiencing homelessness (for example, rough sleeping lists, temporary accommodation data) • support linkage between housing data and health services, in line with information governance • work with healthcare providers, accommodation services and outreach teams to develop local signposting and invitation pathways • identify residents who may be eligible for vaccination and facilitate signposting
Promoting vaccination	• share vaccination information through housing, homelessness and rough sleeping services • support accommodation providers to promote vaccination and encourage uptake among residents • support communication with residents about upcoming vaccination sessions
Delivering accessible services	• facilitate access to hostels, temporary accommodation and other housing settings for vaccination delivery • identify suitable venues for outreach and in-reach vaccination clinics • support coordination between accommodation providers, outreach teams and vaccination providers • embed vaccination opportunities within wider housing support and resettlement activities where possible • alert health partners to outbreaks or increased infectious disease risk within accommodation settings

Healthcare providers

Primary care

Actions primary care (GPs and primary care networks (PCNs)) can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• participate in local partnerships • contribute frontline intelligence • develop and support collaborative approaches to engagement
Understanding local vaccination needs	• use patient records and coding to estimate the size and make-up of the patient cohort experiencing homelessness • maintain inclusion health registers and undertake searches to identify unmet vaccination need • share insights on population needs and gaps in coverage • record and maintain homelessness status using appropriate SNOMED codes
Finding and engaging people	• use clinical systems and coding to proactively identify patients experiencing homelessness • support GP registration for people experiencing homelessness • take a pragmatic approach to eligibility where vaccination history or risk factors are uncertain • work with outreach and accommodation providers to identify and register individuals not currently engaged with primary care • establish recall and follow-up systems for multi-dose vaccination schedules
Promoting vaccination	• provide clear and accessible information about vaccination • display promotional posters and provide leaflets or pocket guides in areas of high need • use trusted and ongoing relationships to build confidence and support informed decision-making • offer opportunistic conversations about vaccination
Delivering accessible services	• provide vaccination through routine and specialist services, where appropriate • provide accessible walk-in vaccination opportunities, where commissioned • support opportunistic vaccination (for example, through specialist nurses) • support co-administration of vaccines where appropriate • undertake outreach or in-reach activity where commissioned • develop links with outreach teams and accommodation providers • signpost individuals to vaccination services as required • ensure vaccinations are accurately recorded and follow-up doses arranged where required

Secondary care

Actions secondary care (including accident and emergency (A&E)) can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• participate in local partnerships • contribute frontline intelligence on barriers to vaccination, uptake and service access among people experiencing homelessness • develop and support collaborative approaches to engagement with primary care, outreach teams, accommodation providers and VCSE organisations
Understanding local vaccination needs	• identify and record housing status during admission, discharge and outpatient contacts where appropriate • use information from hospital attendances to identify unmet vaccination need and gaps in access • share intelligence on vaccination coverage gaps, vaccine-preventable disease (VPD) presentations and emerging issues with local partners • contribute data and insights to local needs assessments and service planning
Finding and engaging people	• incorporate vaccination eligibility checks into routine assessments where feasible (for example, alerts) • signpost eligible individuals to appropriate vaccination services or deliver opportunistic vaccination where pathways exist • reinforce invitations and support onward engagement with primary care, outreach, pharmacy or community vaccination providers • take a pragmatic approach where vaccination history is uncertain, in line with national guidance
Promoting vaccination	• provide clear and accessible information about vaccination • use trusted clinical relationships to build confidence and support informed decision-making • offer opportunistic conversations about vaccination during admissions, outpatient appointments and emergency attendances where appropriate • make a strong recommendation for vaccination where clinically indicated • address concerns and misinformation using evidence-based, non-judgemental approaches
Delivering accessible services	• provide vaccination through routine and specialist services where appropriate and commissioned • support opportunistic vaccination during inpatient stays, outpatient appointments (for example, midwife appointments at antenatal clinics) and other healthcare contacts • consider vaccination before discharge where clinically appropriate and local pathways exist • develop links with outreach teams, accommodation providers and community services to facilitate follow-up • ensure vaccinations are accurately recorded and communicated to the individual’s GP or usual healthcare provider • support continuity of care across healthcare settings, particularly for individuals with complex needs or unstable accommodation

Community pharmacies

Actions community pharmacies can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• participate in local partnerships • contribute frontline intelligence on barriers to vaccination, uptake and service access among people experiencing homelessness • develop and support collaborative approaches to engagement with primary care, outreach teams, accommodation providers, substance misuse services and VCSE organisations • support coordinated approaches to signposting, vaccination and follow-up across local systems
Understanding local vaccination needs	• share insights on local service users, emerging needs and access barriers • identify patterns of unmet need among people accessing pharmacy services, including those who are not registered with a GP • contribute intelligence to local needs assessments and service planning
Finding and engaging people	• identify individuals opportunistically during medicine supply, needle and syringe programme contacts, supervised consumption, consultations or advice-seeking interactions • ask simple eligibility questions and offer vaccination or signpost to vaccination services as appropriate • work with needle and syringe programmes and other inclusion health services to identify eligible individuals • support identification of individuals who are not engaged with mainstream healthcare services • signpost people to GP registration and wider healthcare services where needed
Promoting vaccination	• provide clear and accessible information about vaccination • display promotional posters and provide leaflets or pocket guides in areas of high need • use trusted and ongoing relationships to build confidence and support informed decision-making • offer opportunistic conversations about vaccination during routine contacts • provide strong recommendations for vaccination where clinically appropriate • address concerns and misinformation using evidence-based, non-judgemental approaches • ensure information is accessible and responsive to communication needs
Delivering accessible services	• provide vaccination through routine and specialist services where appropriate and commissioned, without requiring the need for proof of homelessness or address • provide accessible walk-in vaccination opportunities where commissioned • support opportunistic vaccination during routine pharmacy contacts • support co-administration of vaccines where appropriate • support outreach or off-site vaccination delivery where commissioned • develop links with outreach teams, accommodation providers and other services supporting people experiencing homelessness • signpost individuals to vaccination services as required • provide advice on vaccine side effects and follow-up doses • ensure vaccinations are accurately recorded and communicated to relevant healthcare providers • support follow-up and completion of multi-dose vaccination schedules where required

Other service providers

Outreach and mobile health teams

Actions outreach and mobile health teams (including hepatitis C outreach teams) can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• participate in local multi-agency partnerships and planning groups • develop collaborative working arrangements with primary care, community pharmacy, housing teams, accommodation providers, substance misuse services and VCSE organisations • support coordination of outreach activity to maximise reach and avoid duplication • act as a bridge between people experiencing homelessness and mainstream healthcare services
Understanding local vaccination needs	• gather real-time intelligence on people not engaged with mainstream services • identify changes in local patterns of homelessness, population movement and emerging health needs • identify locations and settings where people experiencing homelessness can be reached • provide feedback to commissioners, providers and public health teams on barriers to vaccination and service accessibility • contribute intelligence to local needs assessments, service planning and evaluation activities
Finding and engaging people	• identify individuals during street outreach, encampment visits, accommodation visits and engagement activities who may not appear in healthcare records • undertake brief eligibility screening (for example, homelessness status, known risk factors or likely incomplete vaccination history) • provide face-to-face vaccination invitations and facilitate access to services • where possible, work with or employ people with lived experience of homelessness to promote engagement • support GP registration and access to wider healthcare services • use every contact as an opportunity to assess vaccination need and eligibility • support identification of individuals who are not engaged with healthcare services • revisit vaccination offers over time where individuals initially decline vaccination • facilitate signposting into vaccination, primary care and other health services
Promoting vaccination	• use trusted relationships to promote vaccination and discuss concerns • support ongoing conversations over multiple contacts where individuals are undecided • provide clear, accessible and tailored information about vaccination • support distribution of vaccination promotion materials to partners and directly to people experiencing homelessness • share consistent vaccination messages across outreach contacts and partner organisations • help address misinformation and vaccine concerns using evidence-based, non-judgemental approaches • encourage informed decision-making and support vaccine confidence • work alongside peer advocates and trusted community organisations to promote vaccination
Delivering accessible services	• deliver vaccination in community settings, accommodation services and outreach locations where commissioned to do so • support follow-up of multi-dose vaccination schedules • facilitate access to wider health and support services where needed • accompany or support individuals to attend vaccination appointments where appropriate • identify and communicate practical barriers to uptake, such as transport, communication difficulties or competing priorities • share learning with local partners to improve service accessibility and responsiveness • support delivery of opportunistic vaccination through outreach and in-reach models • help ensure continuity of care by linking individuals with appropriate follow-up services • support accurate recording of vaccinations delivered through outreach settings

Substance misuse services

Actions substance misuse services can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• participate in local multi-agency partnerships and planning groups • develop collaborative working arrangements with vaccination providers, primary care, outreach teams, housing services, mental health services and VCSE organisations • support integrated approaches that combine vaccination with wider health and wellbeing interventions
Understanding local vaccination needs	• share intelligence on service users’ health needs, risk factors and barriers to vaccination • identify groups at increased risk of VPD, including people who inject drugs, people with liver disease and people with blood-borne virus infections • contribute information to local needs assessments and service planning • identify gaps in vaccination uptake and completion among service users • highlight emerging infectious disease risks and outbreak concerns affecting service users
Finding and engaging people	• routinely assess vaccination eligibility as part of clinical, recovery and support contacts • identify individuals with blood-borne virus risk factors who may benefit from vaccination • undertake opportunistic discussions about vaccination during routine appointments • identify individuals who are not engaged with primary care or other healthcare services • facilitate signposting to vaccination services • support GP registration and wider healthcare engagement where appropriate • use every contact as an opportunity to assess vaccination need and eligibility • support follow-up of individuals who may have missed appointments or vaccine doses
Promoting vaccination	• reinforce vaccination messages through ongoing therapeutic and support relationships • provide clear, accessible and evidence-based information about vaccination • use trusted relationships to build vaccine confidence and support informed decision-making • address concerns and misinformation using non-judgemental and trauma-informed approaches • provide strong recommendations for vaccination where appropriate • support repeated conversations about vaccination over time, recognising that trust and confidence may take time to develop • work with peers and people with lived experience to promote vaccination
Delivering accessible services	• integrate vaccination into existing service delivery where feasible and commissioned to do so (for example, hepatitis A and B) • support completion of multi-dose vaccination schedules (hepatitis B vaccination) • identify opportunities for opportunistic vaccination and signposting • support attendance at vaccination appointments, including through practical assistance where appropriate • facilitate vaccination delivery alongside blood-borne virus testing, harm reduction services and wider healthcare interventions • support accurate recording and follow-up of vaccinations • help coordinate care for service users requiring additional vaccine doses or ongoing healthcare support

VCSE organisations

Actions VCSE organisations can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• participate in local multi-agency partnerships and planning groups • provide community insight and lived experience perspectives throughout planning, delivery and evaluation • support meaningful community engagement • help shape communication, service design and evaluation approaches • act as trusted connectors between communities and system partners • facilitate relationships between healthcare providers, housing services, accommodation providers and people experiencing homelessness • advocate for the needs and perspectives of people experiencing homelessness within local systems
Understanding local vaccination needs	• share knowledge of service users and local population dynamics • identify barriers, facilitators and emerging issues affecting vaccination uptake • provide insight into local communities that may not be visible through routine data sources • identify underserved groups and individuals who may not be engaged with healthcare services • contribute community intelligence to local needs assessments, service planning and evaluation • identify changes in local need, service access barriers and emerging concerns • contribute to data collection on vaccination uptake (for example, by including vaccination status on local homeless health audits to enable monitoring of uptake)
Finding and engaging people	• use knowledge of service users to identify individuals likely to be eligible for vaccination, including those not engaged with healthcare services • provide direct invitations through trusted relationships • share information with healthcare partners, where appropriate, and support signposting • support appointment attendance and access for outreach or in-reach vaccination sessions • support GP registration and wider healthcare engagement where appropriate • identify individuals who may have missed vaccinations or follow-up doses • provide practical support to help people navigate vaccination pathways • use routine contacts as opportunities to identify vaccination need and encourage uptake
Promoting vaccination	• deliver and reinforce vaccination messages through trusted relationships and familiar settings • help ensure information is accessible, relevant and culturally appropriate • support co-production of communication materials and approaches • identify emerging concerns or misinformation within communities • identify opportunities to display and disseminate accessible vaccination resources in homelessness services and community settings • train staff and volunteers to provide accurate vaccination information and signposting • support informed decision-making through ongoing conversations and relationship-based approaches • use trusted community networks to raise awareness of vaccination opportunities • support peer-led communication and engagement approaches
Delivering accessible services	• facilitate vaccination sessions in familiar and trusted settings • help reduce practical barriers to attendance • assist with follow-up and engagement for subsequent doses where required • facilitate follow-up and recall for subsequent vaccine doses where appropriate • link with venues and community spaces for vaccination clinics where feasible • support outreach and in-reach vaccination delivery • accompany individuals to appointments or support transport arrangements where appropriate • support completion of multi-dose vaccination schedules • identify barriers to access and provide feedback to service providers and commissioners • facilitate access to wider health, housing and support services alongside vaccination

Accommodation providers

Actions accommodation providers can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• participate in local multi-agency partnerships and planning groups • work collaboratively with healthcare providers, housing teams, outreach services and VCSE organisations to support vaccination activity • provide insight into the needs and experiences of residents • support co-production and service improvement activities with residents and people with lived experience
Understanding local vaccination needs	• share knowledge of residents, local population dynamics and patterns of service use • support identification of residents who may be eligible for vaccination • provide information on accommodation occupancy, turnover and population movements to support service planning • identify barriers and facilitators to vaccination among residents • highlight emerging health concerns, clusters of illness or infectious disease risks within accommodation settings • contribute intelligence to local needs assessments and planning exercises
Finding and engaging people	• use knowledge of residents to identify individuals who may be eligible for vaccination, including those not engaged with healthcare services • provide direct invitations through trusted relationships • support signposting • support appointment attendance and access for outreach or in-reach vaccination sessions • identify new arrivals who may benefit from vaccination assessment • support GP registration and wider healthcare engagement where appropriate • encourage residents to discuss vaccination needs with healthcare professionals • support identification and follow-up of residents who have missed appointments or vaccine doses
Promoting vaccination	• reinforce vaccination messages through routine contact with residents • identify opportunities to display and disseminate accessible vaccination resources within accommodation settings • support healthcare providers and outreach teams to promote vaccination activities • help ensure information is accessible, relevant and culturally appropriate • identify emerging concerns, rumours or misinformation and share these with healthcare partners • facilitate informal conversations about vaccination in familiar and trusted environments • support peer-led promotion and engagement initiatives where available • raise awareness of upcoming vaccination sessions and opportunities
Delivering accessible services	• facilitate access for healthcare providers and outreach teams to accommodation settings • provide suitable space for outreach, in-reach and mobile vaccination clinics, as needed • support coordination between accommodation providers, outreach teams and vaccination providers • assist with follow-up and engagement for subsequent doses where required • support completion of multi-dose vaccination schedules • help residents access vaccination appointments through reminders and practical support • identify and communicate barriers to access to healthcare partners • support access to wider health, housing and social support services alongside vaccination activity

Peer advocates and people with lived experience

Actions peer advocates and people with lived experience can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	• provide community insight and lived experience perspectives throughout planning, delivery and evaluation • participate in co-design and co-production of vaccination services, pathways and interventions • contribute to governance groups, partnership meetings and service improvement activities • support meaningful community engagement and help ensure services reflect the needs and priorities of people experiencing homelessness • contribute to evaluation activities and interpretation of findings • advocate for the needs and experiences of people experiencing homelessness within local systems
Understanding local vaccination needs	• provide insight into local barriers to healthcare access and vaccination uptake • identify emerging concerns, service gaps and unmet needs within communities • share intelligence on the experiences of people who may not be visible through routine data sources • help interpret quantitative data by providing lived experience context • highlight practical, cultural and behavioural factors that may influence vaccination uptake • support identification of underserved groups and individuals
Finding and engaging people	• provide informal reminders and support engagement with vaccination services • assist individuals to attend appointments or outreach sessions where appropriate • support outreach and engagement activities in settings used by people experiencing homelessness • help connect people who are not engaged with services to healthcare providers • facilitate conversations about vaccination with individuals who may be hesitant or distrustful of services • support follow-up and re-engagement where individuals have missed appointments or vaccine doses
Promoting vaccination	• encourage discussion about vaccination status, health conditions and risk factors • share lived experience of vaccination and healthcare services • act as vaccine ambassadors or champions within communities • help build trust and challenge myths and misinformation • support outreach, engagement and communication activities • advise on the development, co-design and testing of communication materials and key messages • contribute to workforce training by sharing lived experience perspectives • provide reassurance and support informed decision-making through trusted peer relationships • support delivery of consistent, accessible and culturally appropriate vaccination messages
Delivering accessible services	• accompany individuals to appointments where appropriate • support engagement with outreach and vaccination services • identify practical barriers to uptake and provide feedback on service accessibility • encourage completion of vaccination courses and follow-up appointments • support navigation of health and care services before and after vaccination • assist with reminders and follow-up for multi-dose vaccination schedules • help services understand and address barriers to attendance and completion • contribute to peer-led outreach and vaccination initiatives • where appropriately trained and commissioned, support peer-led vaccination delivery models and wider vaccination programmes

UK Health Security Agency (UKHSA)

Actions UKHSA can consider to support vaccination for people experiencing homelessness.

Priorities	Actions to consider
Building partnerships	•provide evidence, clinical and public health expertise and national guidance to support local vaccination programmes • support system partners to identify and address immunisation inequities • promote collaboration between national, regional and local stakeholders working with people experiencing homelessness • share examples of effective local practice and emerging evidence • support dissemination of learning, evaluation findings and best practice • engage with stakeholders across health, housing, local government, academia and the voluntary sector to inform policy and programme development
Understanding local vaccination needs	• analyse local and national data on VPD among people experiencing homelessness where available • analyse local data on VPD outbreaks among people experiencing homelessness (Field Service) • analyse enhanced surveillance data where homelessness status is recorded • interrogate surveillance data to support understanding of vaccine uptake, coverage and disease burden where possible • work with system partners to improve recording of homelessness and vaccination data within health systems • identify emerging epidemiological trends, risks and outbreaks • develop and share evidence reviews, needs assessment resources and intelligence products • support local partners to interpret data and use evidence to inform planning and prioritisation
Finding and engaging people	• develop and disseminate national guidance and resources to support identification and engagement of underserved populations • share examples of effective approaches for identifying and engaging people experiencing homelessness • support national work to improve recording of homelessness status within healthcare systems • provide advice on inclusive approaches to vaccination delivery and access
Promoting vaccination	• co-develop accurate and accessible vaccination resources and communication materials • develop and maintain resources, toolkits and training materials to support vaccination delivery • provide evidence-based information to support vaccine confidence and informed decision-making • support the development of communication approaches that address vaccine inequities • promote good practice in community engagement, co-production and working with people with lived experience • disseminate learning from behavioural, communications and engagement initiatives
Delivering accessible services	• provide clinical and public health guidance on vaccination delivery, training, governance and vaccine administration • provide advice during outbreaks involving people experiencing homelessness and other inclusion health populations • support evaluation of interventions aimed at improving vaccination uptake • produce template Patient Group Directions (PGDs), Programme Group Directions and Vaccine Group Directions • support implementation of national immunisation policy and programme changes • provide expert advice on operational, clinical and public health issues relating to vaccination programmes • support continuous improvement through publication of guidance, quality standards and best practice resources