First Anniversary of the Duty to Refer

 Helen Donovan 19 Sep 2019

How much do you know about the Homeless Reduction Act (HRA) and the duty to refer where a risk of homelessness has been identified? – It’s time to find out…

This blog has been co-written with Jane Cook, RCN member and Health & Homelessness Adviser (Rough Sleeping Adviser, MHCLG).

The HRA came into legislation in 2017 and has been the biggest change in Housing legislation for 15 years. The Act brings a duty on Local authorities to prevent the homelessness of those threatened with homelessness within 56 days, regardless of priority.  

It also introduced a new legal duty. A duty to refer, which came into force 1st October 2018 on specified public services to refer service users they consider may be homeless or threatened with homelessness to a local housing authority. This duty includes health and care services and nursing colleagues.

The data on the numbers actually reported under this duty is collected by the Ministry of Housing Communities and Local Government; Homelessness Case Level Information Collection (H-CLIC). The numbers are low at the moment, because the duty is a new and awareness and uptake has been patchy.

It is important that nursing staff are aware of the legislation and the duty it imposes. Act now to understand what is happening in your local area and improve referrals for vulnerable individuals. Local authorities have developed specific protocols to fit with local needs. They need information to them to help to prevent homelessness.

For health services the action is on NHS Trusts and Foundation Trusts:

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

The following basic legal requirement for a referral, includes the individual’s:

  • contact details,
  • consent,
  • the agreed reason for the referral (i.e. that they are homeless or threatened with homelessness).

What does this mean?

If there’s reason to believe someone is homeless or at risk of homelessness, staff must notify the Local Authority of the individual’s choice, with the individual's consent.  The local housing authority should make contact within approximately 72 hours to carry out an assessment and agree a Personal Housing Plan with the individual.

Evidence suggests the best placed team to act is often the hospital discharge team.  Local housing authorities are keen to build relationships with hospitals in their area and often attend meetings with hospital teams to help establish jointly working together, to assess risk and housing needs for those who may be homeless or at risk of homelessness and refer them to the most appropriate support agencies.

What are the benefits?

Opportunity for working collaboratively to explore housing status and housing options in a timely, appropriate environment towards a planned discharge to help the person resolve their homelessness.

Prevent admission/re-admission to NHS Trust wards, where housing is a patient’s primary need and their care can be managed within the community:

  • Sharing of intelligence
  • Safeguarding vulnerable people
  • Managing risk
  • Patients and where appropriate their families are empowered.

How to make a referral?

With the patient’s consent a downloadable example referral form for hospitals  can be used. This should be used alongside the duty to refer health services checklist and sent to the Local Housing Authority of the patient’s choice (a list of email addresses can be found here).

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.

If the patient is not admitted to hospital, staff can make a referral, by completing the form and asking the patient where they will be bedding down for the night and passing the details onto the local housing authority, or staff can contact StreetLink.

Helen Donovan

Helen Donovan

RCN Professional Lead for Public Health


Helen has wide nursing experience working within the NHS and in local authority public health teams, as well as in health protection. She has a special interest in immunisation.

Page last updated - 19/09/2019