Quality standard

Quality statement 6: Accommodation

Quality statement 6: Accommodation

Quality statement

People with active pulmonary tuberculosis (TB) who are experiencing homelessness are offered accommodation for the duration of their treatment.

Rationale

Rates of active TB are high in people who are experiencing homelessness. They also have a higher risk of delayed diagnosis, drug resistance, onward transmission and poor treatment outcomes. Providing accommodation for people who are experiencing homelessness who have active TB helps to ensure they are not lost to follow-up for their TB care, promotes treatment adherence and completion of therapy, and reduces the probability that antimicrobial drug resistance will occur in the TB bacteria. It also helps them to have social stability and space to recover from their disease and to care for themselves.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to ensure that people diagnosed with active pulmonary TB who are experiencing homelessness are identified.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

b) Evidence of local arrangements to ensure that people diagnosed with active pulmonary TB who are experiencing homelessness are offered accommodation for the duration of their treatment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

Process

Proportion of people with active pulmonary TB who are experiencing homelessness who are provided with accommodation for the duration of their treatment.

Numerator – the number in the denominator who are provided with accommodation for the duration of their treatment.

Denominator – the number of people with active pulmonary TB who are experiencing homelessness.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

a) TB treatment completion rates for people with active pulmonary TB who are experiencing homelessness at the time of diagnosis.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. National and regional data on the proportion of people with drug-sensitive TB and at least 1 social risk factor who completed treatment within 12 months are collected in the Office for Health Improvement and Disparities' TB strategy monitoring indicators.

b) TB prevalence rates.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

c) TB incidence in people experiencing homelessness.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. National and regional data on TB incidence in England is collected in the Office for Health Improvement and Disparities' TB strategy monitoring indicators.

What the quality statement means for different audiences

Service providers (secondary care services) have systems in place to identify people with active pulmonary TB who are experiencing homelessness and ensure that they are provided with accommodation for the duration of their treatment.

Health and social care practitioners (TB multidisciplinary teams) assess the living circumstances of people with active pulmonary TB. If there is a housing need, they work with allied agencies to ensure that the person who is experiencing homelessness has accommodation for the duration of their treatment.

Commissioners (local government, integrated care systems and clinical commissioning groups) fund accommodation for people experiencing homelessness who are diagnosed with active pulmonary TB, using health and public health resources, in line with the Care Act 2014.

People with active pulmonary TB who are experiencing homelessness, or living in overcrowded accommodation with people at high risk of undetected TB, are given somewhere to live while they are receiving treatment for TB.

Source guidance

Definitions of terms used in this quality statement

People experiencing homelessness

For the purposes of TB control, a broad and inclusive definition of homelessness has been adopted that incorporates overcrowded and substandard accommodation. It includes people:

  • who share an enclosed air space with people at high risk of undetected active pulmonary TB (that is, people with a history of rough sleeping, hostel residence or substance misuse)

  • who are ineligible for state-funded accommodation

  • without the means to securely store prescribed medication

  • without secure accommodation for the full duration of planned treatment.

[Adapted from NICE's guideline on tuberculosis, terms used in this guideline and recommendation 1.8.11.3]

Accommodation

A secure, self-contained single-room environment that is adequately heated and has facilities for bathing and for preparing food.

[Expert opinion]

Equality and diversity considerations

It is important to provide people who are experiencing homelessness with accommodation for the duration of their treatment in order to prevent homelessness from being a barrier to accessing services and completing treatment. Providing accommodation helps to remove the inequality between people who are experiencing homelessness and people with secure accommodation.