For paramedics and ambulance crews: referring patients in housing disrepair

Paramedics and ambulance crews enter people's homes in situations that no other health professional sees: sudden illness, falls, mental health crises, cardiac events. The home environment is part of the clinical picture, and the conditions you observe during a callout are often the first professional observation of a housing situation that has been deteriorating unreported. Below, we cover when a housing disrepair referral is appropriate and how to make one.

What paramedics see that other professionals miss

A paramedic called to a patient in their home sees the real conditions, unfiltered, unannounced, in the state the patient actually lives in. In calls involving older patients, patients with chronic conditions, or patients in deprived areas, you will regularly see:

Cold homes: A patient who has had a fall at 7am in a bedroom that is 10°C tells a clinical story about their living conditions, not just their balance. Cold bedrooms cause or worsen a range of conditions, hypothermia in vulnerable patients, increased cardiac risk, worsening of arthritis and joint conditions that impair mobility and increase falls risk.

Damp and mould: Black mould on bedroom walls, visible damp, a smell of mildew. For a patient presenting with breathlessness, wheeze, or a chest infection, the presence of mould in the bedroom is clinically relevant.

Structural hazards: A loose carpet, a broken step, a wet floor from a leaking pipe, these are often the direct cause or contributing factor in a fall. If you are attending a fall in the home, note any environmental factors that contributed.

Heating failure in winter: A call to a patient who is cold, confused, or unwell in a property where the heating has clearly not been working is a housing disrepair observation as well as a clinical presentation.

What you can do

Document your observations in your patient record: You can note housing conditions as environmental factors relevant to the presentation. Your patient record is a contemporaneous, professional document, observations made in it have evidential value.

Refer to the council's social services or environmental health: Many ambulance services have protocols for referring concerns about housing conditions to the council. If you are attending an elderly or vulnerable patient in unsafe housing conditions, a referral to adult social care or the council's housing team may be appropriate.

Signpost the patient to Support for Tenants: If the patient is a tenant and there is clear disrepair, you can mention that free legal advice is available for tenants living with disrepair. The most practical step is to pass on our freephone number.

How to refer to Support for Tenants

Give the patient (or a family member present) our freephone number: 0800 030 4669. We work on a no win, no fee basis, there is no cost to the patient.

A patient is likely eligible if:

• They rent their home, council, housing association, or private landlord
• There is disrepair: broken heating, damp, mould, structural hazards
• They have told their landlord and it has not been fixed

If the patient is not in a position to call themselves, a family member, carer, or other professional can call on their behalf with consent.

Consent and documentation

Referrals of patient information require consent. You can signpost the patient verbally without sharing their data. If you are making a safeguarding referral through your trust's established protocols, those consent and data sharing rules apply.

Free materials

We provide free leaflets for health settings. To request materials, call 0800 030 4669 or see /help-centre/order-free-leaflets-and-posters-for-your-service.

Sources

• Section 11, Landlord and Tenant Act 1985 (legislation.gov.uk)
• Housing Health and Safety Rating System (HHSRS) guidance (GOV.UK)

Related articles

• How to refer a patient to Support for Tenants
• Signs of disrepair, a quick checklist for professionals
• My home is too cold, excess cold
• Consent and confidentiality when referring to us