Quality statement 6: Accommodation

Quality statement

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

Rationale

Rates of active TB are high in people who are homeless. They also have a higher risk of delayed diagnosis, drug resistance, onward transmission and poor treatment outcomes. Providing accommodation for people who are homeless 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

Structure

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

Data source: Local data collection.

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

Data source: Local data collection.

Process

Proportion of people with active pulmonary TB who are homeless 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 homeless.

Data source: Local data collection.

Outcome

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

Data source: Local data collection. 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 Public Health England's TB Strategy monitoring indicators.

b) TB prevalence rates.

Data source: Local data collection.

c) TB incidence in homeless people.

Data source: Local data collection. National and regional data on TB incidence in England is collected in Public Health England's 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 homeless 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 homeless has accommodation for the duration of their treatment.

Commissioners (local government and clinical commissioning groups) fund accommodation for people who are homeless and 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 homeless, 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

Tuberculosis (2016) NICE guideline NG33, recommendations 1.8.11.1, 1.8.11.2 and 1.8.11.3

Definitions of terms used in this quality statement

Homeless

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' section 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 homeless with accommodation for the duration of their treatment in order to prevent their homelessness from being a barrier to accessing services and completing treatment. Providing accommodation helps to remove the inequality between people who are homeless and people with secure accommodation.