WIDER POLICIES
Scottish Health Policy

Key Policies: 

• Health and Homelessness Action Plans
• National Health and Homelessness Standards

Health policy is fully devolved to the Scottish Executive.

There has been concern about the health of homeless people in Scotland for some time.  For example, additional funding was made available to the health element of the Rough Sleepers Initiative in 1999.  This concern is part of a more general concern about health inequalities.

The Homelessness Task Force sets the agenda for improving health among homeless people.  Its starting point is that the range of health needs of the homeless population is not being met by the current health services.  As a result of its proposals, all local Health Boards have been required to produce Health and Homelessness Action Plans and a set of National Health and Homelessness Standards has been developed.

As in England, Scotland offers Personal Medical Services contracts to its GPs to provide a service to a particular group of people in their area, including homeless people (see English Health Policy section). 

Health and Homelessness Action Plans

In 2001, Scottish Executive Guidance issued to NHS Boards placed a requirement on them to produce health and homelessness action plans, to be in place by 2002.  These plans set out the actions that Boards will take to address the health needs of homeless people in the area.  It is understood that some of these plans have led to the development of new services for homeless people, such as joint training, hospital discharge protocols to prevent homelessness, service user involvement, health improvement initiatives and raising awareness of health issues.

The plans were required to be linked to the local mental health and drug and alcohol strategies.  Although the Homelessness Task Force has highlighted the importance of addressing drug and alcohol problems for homeless people, and Drug and Alcohol Action Teams (DAATs) are supposed to consider the service requirements of homeless people relating to substance misuse, the corporate action plan of DAATs on substance misuse did not mention homelessness.  Each DAAT has now been asked specifically to identify the way in which it will address the substance misuse aims of the NHS Boards Health and Homelessness Action Plan, and provide evidence of the way in which it has taken notice of the substance misuse recommendations of the Homelessness Task Force.^[1]

The plans were also required to be linked to the plans for childrens' services, specifically to ensure that children in homeless families are able to access the full range of healthcare services. Feedback has suggested that, where families are moving around in temporary accommodation, there are still problems with access.  In 2005 The Scottish Executive commissioned research into support needs for homeless families.

Some Health Boards and local authorities, such as Fife, run training programmes on health and homelessness.^[2]

The Scottish Executive appointed a Health and Homelessness Co-ordinator to support the work of the Boards.  It also set up a Health and Homelessness Steering Group, consisting of the Executive, health and voluntary sector to oversee the implementation and make recommendations.  Their work led to the development of the Health and Homelessness Standards.

Health and Homelessness Standards

The Health and Homelessness Standards, which were launched in March 2005, set out what the NHS Boards must achieve in terms of corporate support, partnership working, needs assessment, access to services and service responses, and the delivery of Health and Homelessness Action Plans.  Their overall aim is to raise the standard of health and homelessness planning and to ensure that homeless people have the same level of health services across Scotland, as the rest of the community.  The performance of the Boards in relation to the standards will be monitored by the Scottish Executive Health Department via the NHS Scotland Performance Assessment Framework.

Primary care services

The overall approach is to ensure that homeless people use mainstream services as soon as possible, rather than remaining in specialist services.

Asin England, Scotland offers Personal Medical Services contracts to its GPs to provide a service to a particular group of people in their area, including the homeless.  These began in 2001 (see English Health Policy section)

The Homelessness Task Force recommended that all local authorities should record information about the GP registration of all those who register as homeless, and should offer information about local health services to homeless people re-housed outside their existing GP area.  Such information is recorded within the local authority homelessness strategies.  A recent assessment of the strategies, however, showed that few local authorities had in fact implemented the recommendation.  This was fed back to local authorities, and progress will be monitored in the next review of homelessness strategies.

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End notes

[1] These are: DAATs should, in their planning priorities, include the service requirements of homeless people relating to substance misuse; DAATs should give actions to tackle substance misuse a high priority. Back to text

[2] The Fife programme covers needs assessment, mental health, substance misuse, health and homelessness  It is included as a model of best practice in the Health and Homelessness Standards. Back to text

Page last modified on 22/06/2006 at 11:56