And the crisis shows no sign of easing, with NHS board data revealing around 120 further patients were discharged with nowhere to go in just the first four months of 2025/26, maintaining the same grim pace.
Scotland’s homelessness prevention duty known as Ask and Act which requires public bodies to ask people about their housing situation and take action to prevent homelessness where risks was identified was committed to by the Scottish Government at the end of 2023.
The principle of ‘ask and act’ had become a recommendation of the Prevention Review Group (PRG), a Scottish Government-established advisory body, nearly five years ago saying “no one should be discharged from institutions without anywhere to sleep that night”.
But the policy has yet to be fully implemented, with worries that delays leave vulnerable patients slipping through the cracks.
The international charitable organisation and church, the Salvation Army, has raised serious concerns about the scale of hospital discharges to no fixed abode and is calling on ministers to put Ask and Act into force as a matter of urgency.
The charity, which has been tracking the record of the NHS boards raised further worries that 52% of discharges from hospitals in Scotland occurred outside standard working hours between 9am and 5pm.
Some 19% were at weekends, when housing support is less easy to access.
The Salvation Army in Scotland have called for swift action over the numbers who are discharged from hospital with nowhere to live (Image: Salvation Army)
Helen Murdoch, The Salvation Army’s homelessness lead for Scotland, said: “No one should leave hospital without somewhere safe to go. Discharging someone when they have no secure accommodation does not only put them at risk of sleeping rough, it puts their health and recovery in jeopardy.”
The group say their own records show that 30% of people who come into their homelessness services in Scotland are not registered with a GP, suggesting many are using hospital A&E departments for minor injuries.
Ms Murdoch added: “When people have nowhere safe to stay they are far more likely to relapse, become unwell or end up back in hospital.
“We would like to see the Ask and Act requirement in the new Housing Bill fully implemented as soon as possible. “We have a critical opportunity here to prevent homelessness and to save the NHS money.”
The Ask and Act approach aimed to embed homelessness prevention duties across public services including health, justice and social care. The aim was to shift Scotland’s system away from emergency responses and towards early intervention.
Under Ask and Act, frontline workers — such as NHS staff, social workers or prison services — are expected to identify housing risk as part of routine contact, rather than waiting until someone presents as homeless. Where a risk is identified, action should be taken within existing powers, or a referral made so preventative support can be put in place.
The policy is underpinned by legislation contained in the Housing (Scotland) Bill, which strengthens duties on local authorities and creates a wider legal framework for homelessness prevention.
The Bill extends the point at which councils must intervene from two months before homelessness to up to six months, and allows referrals from public bodies to trigger formal prevention duties.
The Scottish Government declared a national housing emergency in May, 2024 (Image: PA)
However, despite being politically sanctioned and legislated for, Ask and Act has yet to be fully implemented in practice.
Rather than an immediate nationwide rollout, ministers opted for a phased approach, launching a Homelessness Prevention Pilot Fund to test how Ask and Act would operate on the ground.
These pilots involve local authorities working alongside NHS boards, housing associations and third-sector organisations to trial early-intervention models and share learning.
Charities and housing organisations have broadly welcomed the ambition behind Ask and Act but are raising concerns about the pace of delivery. Critics argue that delays mean frontline services — including hospitals — are still operating without a clear, enforceable duty to resolve housing issues before people are discharged or released from care.
Ministers have said the staged rollout is intended to ensure the policy works effectively across complex services, with further regulations and statutory guidance expected to follow pilot evaluations. The pilot fund which opened in September was due to go live last month.
Housing secretary Màiri McAllan said in promoting the fund: “We are determined to end homelessness – and the best way to do this is to prevent homelessness in the first place. This investment in prevention pilots will help us test and scale up innovative approaches to help people stay in their homes.”
Housing secretary Màiri McAllan promoted the Ask and Act pilots fund (Image: PA)
But there are concerns that Scots local authorities are widely failing in their legal obligation under the Housing (Scotland) Act 1987 to offer at the very least temporary accommodation when they assess a person or household as unintentionally homeless, with thousands of breaches every year.
The Housing (Scotland) Act 2025 introduces the legal duty to Ask and Act. If informed that someone is homeless or at risk, it must take appropriate action — whether that be to remove the threat where possible, or make a homelessness application to the local authority, with the person’s consent, if action cannot be taken directly.
For NHS boards, it would mean taking on formal role in preventing homelessness, rather than treating housing as an issue to be dealt with only after discharge. In practice, NHS staff would be required to ask patients about their housing situation at key points of contact. This could include admission to hospital, discharge planning, outpatient appointments, mental health services, addiction services, and Accident and Emergency (A&E) attendances where housing insecurity is suspected. The duty does not require staff to solve housing problems themselves, but to identify risk and trigger support.
If a patient is found to be homeless or at risk of homelessness, the NHS board would then be required to take “reasonable action”. That action could involve adjusting discharge plans, delaying discharge where clinically appropriate, or — crucially — making a referral to the local authority housing team, with the patient’s consent, before a crisis occurs.
For patients leaving hospital, housing risk would be treated in the same way as mobility needs, medication, or follow-up care — as a core part of safe discharge.
Helen Murdoch, The Salvation Army’s homelessness lead for Scotland, said: “No one should leave hospital without somewhere safe to go.” (Image: Salvation Army)
The Scottish Government, which declared a housing emergency in May, last year, has argued that the intervention will reduce pressure on hospitals and A&E departments by preventing repeat admissions linked to homelessness, poor recovery, or untreated conditions.
Evidence from charities suggests people without stable housing are more likely to relapse or return to hospital, increasing costs for the NHS.
But analysis of council returns described as “shocking” by campaigners shows that Scots local authorities have incurred nearly 40,000 violations of the law giving the homeless the right to a roof over their heads over the last eight years with nearly half in the past year – and without penalty.
There were 16,485 breaches in 2024/25 alone, more than the previous five years combined as violations have rocketed in a housing emergency declared by ministers in May last year.
A Scottish Government spokesman said: “We know that there’s a strong relationship between homelessness and health in Scotland and clear evidence of a relationship between repeat homelessness, drugs, alcohol and mental health.
“Homelessness is about much more than housing, and homelessness prevention will be most effective when it is recognised as a priority for a range of public services, particularly health services. We have recently passed new homelessness prevention laws which will support more people to avoid homelessness through earlier intervention and shared responsibility.
“We are committed to ensuring ask and act is successfully implemented, and £4 million has been invested in pilots to ensure robust implementation of these duties. These prevention pilots have commenced, and learning will be gathered throughout 2026.”