Housing & Homelessness

Ask and Act Duties:

Housing is an important determinant of health.  Poor or insecure housing conditions can cause or exacerbate many physical and mental health conditions.  It can also create barriers to accessing services and maintaining treatment regimes.

The best way to end homelessness is to prevent it from happening in the first place

The Housing (Scotland) Bill (passed Stage 3 in September 2025, awaiting Royal Assent) introduces groundbreaking "Ask and Act" legal duties requiring public bodies, including NHS Tayside, to:

1.       Ask about housing situations during routine contacts.

2.       Act to prevent homelessness by making referrals and connections.

3.       Extend prevention window from 2 months to 6 months before potential homelessness.

The primary goal of Act and Ask duties is to reduce homelessness, by ensuring individuals receive the necessary support before reaching crisis point.

Ask

Questions to guide conversation

Conversations about housing can be integrated into all routine appointments e.g. GP, Dental, Pharmacy, outpatient, mental health and substance use services.  Housing conversations are an important consideration during discharge planning and other key transition points.

Red Flags: Healthcare staff should be vigilant to health & behaviour  cues/indicators, which may identify a potential or real homelessness risk for service users:

·         Health indicators:

o   Deteriorating physical or mental health without clear medical cause.

o   Untreated chronic conditions.

o   Substance use issues.

o   Hygiene or clothing suggesting rough sleeping.

• Behavioural indicators:

o   Frequent missed appointments or difficulty attending regularly.

o   Poor medication adherence without clear explanation.

o   Presenting at A&E for non-emergency issues.

o   Multiple changes of address or use of temporary addresses.

How to Ask – use simple and direct opening questions such as:

·         “How are things with your housing at the moment?"

·         "Do you have any concerns about your housing situation?"

·         “Is your housing stable for the next 6 months”

·         "Is there anything about your housing that's affecting your health

Act

If you believe that the person is at immediate risk of homelessness (within 2 weeks) an urgent referral to emergency housing services should be made.

If the person is at risk of homelessness in the next 6 months, they should be encouraged to access support now.

Dundee – Housing Support Services:

Perth & Kinross – Housing Support Services:

Angus – Housing Support Services:

Further Information

(links to websites, local support etc.)

Key Messages for Health Professionals:

·         Housing IS Health - poor housing directly causes illness.

·         You Have a Role - under Ask and Act duties, asking about housing is YOUR responsibility.

·         Early Intervention Works - Perth & Kinross proves prevention reduces homelessness (88 days vs 278 nationally)

·         It's a Simple Conversation - you just need to ask and refer

·         Help Exists - comprehensive support services are available across all three Tayside areas

·         Every Contact Counts - a 2-minute conversation could prevent someone becoming homeless

Common Myths Debunked:

Myth: "Housing isn't my job"

Reality: Housing is a social determinant of health. Addressing housing IS treating the patient.

Myth: "Patients need to be homeless first"

Reality: Prevention support is available up to 6 months before potential homelessness.

Myth: "I don't know enough about housing"

Reality: You don't need to be a housing expert. Just ask, recognize warning signs, and make referrals.

Myth: "It takes too much time"

Reality: The conversation takes 2-5 minutes. Compare this to time spent managing health deterioration from housing instability.

Myth: "Patients won't want to talk about it"

Reality: Many patients are waiting for someone to ask. By asking, you give them permission to share.