Case study

Tuberculosis (TB) and homelessness in City of London and Hackney

Homerton hospital is working with City of London and Hackney local authorities to house homeless people with TB during treatment.

Photo of homeless camp on Hackney marshes
Homeless Camp found by Homerton Hospital TB team on Hackney Marshes (Image courtesy of Homerton Hospital TB team)


Homelessness is a risk factor for TB, but it is also a risk factor for failure to treat and cure TB, leading to an increase in suffering and expense, reduced accessibility to services and a higher risk of community transmission.

Homerton hospital, working with City of London and Hackney local authorities, has developed a service level agreement (SLA) to house homeless TB patients with no recourse to public funds (NRPF), for the duration of their TB treatment.

What was involved

In 2008 the Homerton hospital TB team reviewed their lost to follow up (LTFU) patients and found that common factors were lack of housing and lack of eligibility for state benefits. Without the stability of accommodation, these patients’ lives can be chaotic with their health needs quite low in their daily priorities.

The TB team held a series of meetings with the London Borough of Hackney’s Homeless Persons Unit and developed an SLA to accommodate homeless TB patients, with NRPF, in temporary housing.

All patients under the SLA were on Directly Observed Therapy (DOT) and given monthly bus passes to attend their clinic-based DOT session as well as food and help with health, psychological and social problems, benefit and asylum applications and various other needs. Non-adherence to treatment resulted in eviction.

What works well

Housing homeless TB patients creates a vital opportunity for them to complete treatment, gain social and psychological support from the TB case worker and prevent onward transmission of the disease.

Since it started the SLA has housed 35 patients from 21 different countries (together with partners and children when necessary) and every patient housed has completed treatment and neither City of London nor Hackney local authorities have had an LTFU patient since 2008.

Next steps

The original SLA was originally set up and funded during the lifetime of the local primary care trust but is now funded by City of London and Hackney local authorities.

Housing a homeless person for the duration of their TB treatment gives the individual the same chance of cure as someone who is already housed and prevents the spread of TB to others as well as giving dignity to the patient.

In recognition of their ground breaking work, Homerton hospital TB team were winners of the 2015 Sir John Crofton Prize for TB Nursing.

Further information

Dr Susan Collinson, Department of Respiratory Medicine, Homerton University Hospital. Email

Published 20 October 2016