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Health and Homelessness in Scotland

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Overview

This large-scale study showed for the first time the link between homelessness and health at a national level.

Published in June 2018, the work revealed the extent of homelessness in Scotland and the potential to help prevent homelessness, through closer working relationships between health boards and local authorities.

The work linked six health datasets, death records and homelessness data for the first time across Scotland.

Who was involved?

Scottish Government led the work —  it also involved National Records Scotland and local health boards.

The study contained data from over 1.3 million people. Of these, 435,853 people had been in households assessed as homeless or threatened with homelessness between June 2001 and November 2016. These households had been assessed by Scottish Local Authorities under section 28 of the Housing (Scotland) Act 1987. These people formed the Ever Homeless Cohort (EHC).

Each person in the EHC was matched on age and sex to a non-homeless individual from the 20% least deprived areas of Scotland, and a non-homeless individual from the 20% most deprived areas of Scotland.

This formed two control cohorts — the Least Deprived Cohort (LDC) and the Most Deprived Cohort (MDC). Each cohort had the same number of people and the same age–sex distribution. In total, the study contained over 1.3 million people.

What data was used?

The study contained six health datasets from NHS National Service Scotland covering Accident and Emergency attendances (A&E2), Inpatient admissions (SMR01), Outpatient appointments (SMR00), Prescriptions (PIS), the Scottish Drugs Misuse Database (SDMD) and Mental Health admissions (SMR04), together with information about deaths from National Records of Scotland.

There was a particular focus on mental-health, drug-related health conditions and alcohol-related health conditions.

Homelessness data came from Scottish Local Authorities.  

What have they found, and how did this research help inform policies and improve lives?


Homelessness affects a sizable minority of people in Scotland - at least 8% of the population as of 30 June 2015 had experienced homelessness at some point in their lives. This will be an under-estimate as the homeless assessments in the study only covered around three quarters of all Scottish homelessness assessments for the study period.

Of the EHC people, 29% of males and 26% of females had been in households assessed as homeless on multiple occasions during the study period. Following their first homelessness assessment, people included in the EHC cumulatively spent 9.7% of their time for males (9.2% for females) in open homelessness cases, before local authorities had discharged their duties under the homelessness legislation.

The EHC people tended to be younger than the Scottish population. The proportion of people in the EHC at around 20–30 years was higher for females than for males.

In this case, data linkage helped joint working across government social policy and through improve service design a trial of a homelessness prevention service was held in NHS Fife. This found by coordinating health and housing services this helped to:

• Reduce the prospect of people at risk of being homeless being admitted to hospital or admitted for a long stay

• Health economists identified the intervention project provided an average cost saving of £2,422 per person in acute resource

• Managing patients to have their housing requirements addressed while they accessed health services reduced the number of people being discharged with no fixed address or into street homelessness

• Coordinating health and housing expertise within a hospital setting can support patients to have their health and wider support needs met – for example, providing access to recovery from substance-abuse programmes.

The work showed that an increase in interactions with health services preceded people becoming homeless, and this was often many years before the first homelessness episode. As a result, the work showed a clear opportunity for health services to help prevent homelessness from occurring. It also identifies the valuable use of data, connected across different public sector services, for identifying cause/effect, designing preventative interventions, and in monitoring and evaluating their effectiveness.

Research Data Scotland’s impact

This study was designed and completed before RDS existed however there are valuable lessons to draw. The most important one is the realisation data has a role to help stimulate research.

RDS exists to make the flow of data faster and simpler for those applying to access it – we want to make the cycles of innovations faster.

Through the Researcher Access Service, we enable streamlined access to data for research in the public benefit, reducing the time and resources required to undertake projects that can provide evidence to improve social policy for the benefit of society. Launched in April 2024, the service initially enables access to nine of Public Health Scotland’s most frequently requested datasets through a streamlined pathway, where previously complex approvals and information governance processes are standardised using the Five Safes framework.

Another important lesson is how data linkage enables new insights. Data linkage is a driver in understanding root causes, which in turn helps our understanding of consequences and uncover what interventions might have the most impact.

Find out more

Read the publish report - Health and homelessness in Scotland: research

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