Bringing legal advice into healthcare to tackle homelessness, ill health and inequality

Our Homeless Patients Legal Advocacy Service is an innovative partnership between Southwark Law Centre and the Homeless Team at Guy’s and St Thomas’ NHS Foundation Trust.

The project brings specialist legal expertise into the healthcare system, helping homeless and highly vulnerable patients resolve the legal problems that can prevent them from recovering safely or moving on from hospital.

It began in 2020 and is still running today. What started as an innovative pilot has developed into an established partnership between health and legal services, demonstrating the difference that access to legal advice can make to both people’s lives and their health.

Why Legal Advice Belongs in Healthcare

For people experiencing homelessness, poor health rarely exists in isolation.

Patients may be medically ready to leave hospital but have nowhere safe to go. Others may be unable to access housing or benefits because of their immigration status or face several interconnected legal problems at the same time.

These are legal problems, but they are also health problems.

Our partnership enables hospital staff to identify these issues and connect patients directly with specialist legal support. It reaches people with complex health and social needs who may otherwise have little or no contact with advice services.

How the Partnership Works

A Southwark Law Centre solicitor works closely with the hospital’s specialist homelessness team. The model combines three different forms of support:

  • Direct legal advice and representation for patients with complex housing, immigration and welfare benefits problems.
  • Second-tier legal advice for healthcare professionals, enabling hospital staff to get specialist advice about an individual patient’s situation and, in many cases, resolve a problem without needing to make a full legal referral.
  • Training for hospital staff, building their knowledge of areas including homelessness, immigration, welfare benefits, migrant accommodation and related legal rights.

This integrated approach means that legal and medical professionals can work together. The Law Centre can draw on detailed medical evidence from clinical teams, while health professionals have access to legal expertise when a patient’s housing, immigration or financial circumstances are affecting their health or preventing a safe discharge.

An Innovative Model of Legal Support

The project turns the traditional model of legal advice on its head.

Rather than waiting for someone in crisis to find their way to a Law Centre, we work with the professionals who are already supporting them. Legal advice becomes part of the wider response to a person’s health and homelessness.

The second-tier element is particularly important. Hospital staff can seek advice from our solicitor about a patient’s legal position and use that knowledge in their own advocacy. This can resolve problems quickly without every patient needing to become a Law Centre client.

As the partnership has developed, hospital staff have become increasingly confident in identifying legal issues and making detailed referrals. In 2025 alone, we provided 78 pieces of second-tier advice, significantly exceeding the project’s target of 50.

The Impact

The project has produced powerful evidence of what can happen when health and legal services work together.

Independent evaluation found that patients were able to access legal advice they would otherwise have struggled to obtain, housing outcomes improved and the hospital Homeless Team was able to support patients more effectively.

The evaluation also found a striking reduction in hospital use. In the second year, patients experienced an 81% reduction in hospital bed days in the six months following referral. Earlier evaluation had found the same 81% reduction, suggesting that the first year’s results were not a one-off.

Housing outcomes matter too. By the second year of the project, no patients referred to the service were discharged from hospital to sleep rough

Continuing to Deliver Results

Six years after the project began, it continues to deliver specialist support to some of the most vulnerable patients in the hospital system.

In 2025, the Law Centre worked on 30 complex cases, provided 78 pieces of second-tier legal advice to hospital staff and delivered four training sessions.

The outcomes included grants of refugee status and leave to remain, access to public funds, accommodation and acceptance of a local authority homelessness duty. All applications decided during the year were successful, with the project report highlighting the importance of the detailed medical evidence made possible by close collaboration with hospital staff.

Building Knowledge as Well as Resolving Cases

The project’s impact goes beyond the individual patients represented by the Law Centre.

Regular training and access to second-tier advice have increased the ability of healthcare professionals to recognise legal problems and advocate effectively for their patients. This creates a multiplier effect: legal expertise strengthens the wider health team rather than being confined to the cases taken on by the Law Centre.

The project has also adapted in response to what hospital staff tell us they need. For example, where a need for community care expertise was identified, we developed closer working with a specialist organisation to bring additional knowledge into the partnership.

From Innovation to an Established Partnership

The project was originally supported with two years of pilot funding. Following successful evaluation, Guy’s and St Thomas’ NHS Foundation Trust moved to continuation funding on a rolling basis.

The model has also influenced work beyond the original Southwark partnership. The approach was subsequently expanded to Lewisham Hospitals, demonstrating the potential for health justice partnerships to be replicated elsewhere.

For us, the project demonstrates a simple but important principle: sometimes the most effective place to provide legal help is alongside the services people already trust and use.

Case study: Legal and healthcare teams working together

When J, a young person undergoing treatment for cancer, was referred to Southwark Law Centre by his oncology team at Guy’s and St Thomas’, his health, immigration status and housing situation had become dangerously intertwined.

Mr J had fled civil war as a child and grown up in a refugee camp. He later came to the UK to work under an exploitative contract. When he became too ill to continue working during chemotherapy, his employer threatened to cancel his work visa and he faced losing his accommodation. His medical team believed that becoming street homeless while undergoing treatment would pose a grave risk to his health.

Through our Health Justice partnership, the hospital was able to refer J directly to our specialist solicitor. We helped him apply for refugee status and for Home Office accommodation while his application was considered.

When the Home Office initially refused to provide accommodation, we represented him at the Asylum Support Tribunal and successfully overturned the decision, securing somewhere safe for him to live while receiving treatment.

J was subsequently granted humanitarian protection with access to public funds and was able to move into local authority accommodation. When an error later appeared on his immigration record suggesting that his leave had been cancelled, we reopened his case and successfully challenged the mistake.

The partnership also allowed us to look beyond the immediate legal problem. We referred J for specialist employment advice about the exploitative contract so that, when his health allows him to return to work, he will be able to do so on a more secure footing.