“Thirty-odd years ago, it would have been very unusual for somebody to come to me with a major housing issue,” says Dr John Montgomery.

When they did, it was “relatively straightforward” for GPs like Dr Montgomery to get in touch with the relevant authorities to negotiate a solution for patients whose health was being put at risk by insecure or substandard accommodation.

Today, the situation is one of gridlock.

“Councils and housing associations have been swamped with these requests, and they can’t remotely cope with demand,” said Dr Montgomery, whose David Elder Medical Practice is located in the Govan area of Glasgow – one of Scotland’s most deprived communities.

“It raises people’s stress levels, and that’s why they are coming to us - and they’re doing so on a far more regular basis than they ever did before.

“You feel quite helpless. It’s not that the council or the housing associations don’t want to help – it’s simply that the properties are not there.”

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In primary care, housing problems are being manifested in a range of ailments from insomnia, depression and anxiety, to rashes and respiratory issues such as poorly-controlled asthma or COPD – a chronic lung condition – aggravated by damp or mould.

Dr Montgomery added: “We’ll see infestations of rats and mice in families with young children, and exacerbations of skin conditions like eczema - again because of household infestations.

“And with the overcrowding issue, which is a real problem, you’re seeing the easy transmission of infections.

"You’re seeing TB coming back, which had gone away for decades.

“When the pandemic was in full flow, Covid disproportionately affected these deprived communities where overcrowding was a major factor.

“A lot of the reasons can be traced back to Margaret Thatcher – the whole buy your council house thing – which reduced the housing stock. That hasn’t ever really been replaced.

“And here in Govan, they’re knocking down the high-rise flats but they haven’t replaced that level of accommodation like-for-like on the lower level.”

Dr Montgomery said they were seeing more patients than ever whose health is being affected by housing issuesDr Montgomery said they were seeing more patients than ever whose health is being affected by housing issues (Image: Pics: Robert Perry)

As one of Scotland’s ‘Deep End’ GP practices, Dr Montgomery’s surgery provides medical care to a relatively large number of refugees and asylum seekers – including those fleeing Ukraine and the Middle East.

Many end up in desperately unsuitable housing.

Dr Montgomery said: “We’ve got a 43-year-old woman from Syria who has four children and she’s got breast and bowel cancer.

“They’re all in this two-bedroom house and the 20-year-old girl has to share a bedroom with her younger brothers, and the mum has her hospital bed stuck in the tiniest possible room.”


Issues with housing are “far and away” the most common reason for the surgery’s GPs to refer patients onto its Community Links Practitioner (CLP) – a specialist member of staff dedicated to resolving non-medical problems which are impacting on people's health and wellbeing.

Emma Macdonald, who is employed by Alliance Scotland but has been embedded at the David Elder practice for the past three years, says that most of the people she deals with are in unsuitable social housing.

She said: “All I can really do is draft up a letter to say why, medically, it would be better for somebody to move.

“It could be overcrowding, or damage to the property. There’s quite a lot of damp and mould issues, and then people are getting respiratory problems.

“Some people are sharing rooms. I had wee girl who is sleeping in with her Mum because it’s the only room that doesn’t have mould in it.

“I’ve got another lady whose windows don’t open and she’s stuffed around them with cotton wool to try to keep the draught out.”

Emma Macdonald, a community links practitioner, said she was regularly dealing with patients living in crowded, mouldy, or run-down properties in need of repair - but problems are rarely resolved quicklyEmma Macdonald, a community links practitioner, said she was regularly dealing with patients living in crowded, mouldy, or run-down properties in need of repair - but problems are rarely resolved quickly (Image: Pics: Robert Perry)

'Disrepair'

Sometimes Ms Macdonald will go to housing associations on behalf of patients if nothing is done, but she admits that even then “it can be quite tricky to get hold of somebody”.

She said: “We don’t always get to speak to the right person, and even then it doesn’t tend to result in them getting a transfer quickly.

“If it’s damp and mould or windows falling in, what can really be done that doesn’t cost a lot of money?

“There just isn’t the housing stock. We don’t have enough, and a lot of what we do have has fallen into disrepair.”

According to recent research carried out in Scotland by the charity, Asthma and Lung UK Scotland, one in five people with a lung condition say it is being aggravated because their home is cold, damp, or both.

Among these individuals, three quarters (74%) said their condition has negatively impacted on their working life, and 41% said they have required emergency care in the past year.

An inquest blamed the death of Awaab Ishak on exposure to mould in the family home An inquest blamed the death of Awaab Ishak on exposure to mould in the family home (Image: PA)

The links between housing and health have been brought into sharp focus by the surge in gas and electricity, which left many sick, elderly, and disabled people struggling to adequately heat their homes, as well as by high-profile tragedies such as the death in December 2020 of two-year-old Awaab Ishak.

An inquest blamed exposure to mould – which had spread through the family’s home in Rochdale, Manchester as a result of untreated damp - and criticised the housing association for its “dismissive” and “unsympathetic” treatment of residents.

Joseph Carter, head of devolved nations for Asthma + Lung UK, said: “A lot of the time when the Scottish Government and councils are declaring emergencies, it’s about the sheer shortage of housing rather than the quality of it.

“But we are seeing the consequences of disinvestment in our homes, whether it’s in the private sector or even the social landlord sector, and this is impacting on people’s health – on their lung health.

“We’ve seen this in our patient surveys when we engage with people across Scotland – about 21% of people tell us that dampness in their homes or coldness in their homes is a major contributing factor to their lung condition.

“That might lead them to have an asthma attack or an exacerbation in their COPD, and it might mean a very scary and very avoidable trip to hospital.

"It’s all intrinsically linked and it all comes down to us having a lack of housing, but also a lack of decent quality housing.”

Joseph Carter, of charity Asthma + Lung UK, said queries about damp had increasingly become a reason for patients to contact its helplineJoseph Carter, of charity Asthma + Lung UK, said queries about damp had increasingly become a reason for patients to contact its helpline (Image: Pics: Tete and Tete Photo)

Mr Carter added that the charity has only added questions about damp to its patient surveys in the past few years, in response to an increasing number of calls to its helpline about the problem.

He said targeted initiatives such as a trial to “prescribe” heating to people with lung conditions – initially piloted in Gloucestershire and later trialled with 330 patients in Aberdeenshire in the winter of 2022/23 – had been useful.

The UK Government-funded scheme paid money directly into vulnerable households' energy accounts to ensure they could keep a bedroom and main living area heated to between 18-21°C throughout the winter.

Mr Carter added that while charities like his own would welcome increased investment in respiratory care, it was important to be “mindful of the role that good housing plays”.

He added: “Some of questions being asked of all the party manifestos [before the election] was ‘well, if everyone is talking about prioritising the NHS, is there a risk you’ll have to cut back on other things?’.

“And some of those might be things like good quality housing and open space that contribute to overall wellbeing.

“Do you risk public health and prevention by throwing everything at treatment?”

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In Edinburgh, hospital doctors have been working with their local branch of the homeless charity, Cyrenians, over the past four years in a bid to tackle the revolving door of re-admissions among those sleeping rough.

Part of the problem is the huge healthcare need among this population.

Many rough sleepers aged in their 30s or 40s present with cardiac, respiratory, and mobility problems more commonly seen among people in their 70s, as well as complications such as wound infections from drug use.

However, many were ending up back on the street after being discharged from hospital.

Mike Wright, a senior service manager at Cyrenians, said: “They were maybe being sent off in a taxi or given advice about how to access their local housing office.

“The health professionals had no idea that the people they were directing to housing in good faith were maybe being turned away and forced into staying with friends, or sleeping outside, and didn’t understand that why they’d be coming back [to hospital] so quickly.”

Mike Wright, of the Cyrenians homeless charity, has been working with hospitals in Edinburgh to reduce the number of patients being discharged into homelessnessMike Wright, of the Cyrenians homeless charity, has been working with hospitals in Edinburgh to reduce the number of patients being discharged into homelessness (Image: Pics: Duncan McGlynn)

Working with doctors at the Royal Infirmary of Edinburgh and the Western General, the charity devised an algorithm to quickly identify homeless patients on admission and then acted as a “bridge”, linking them directly with the capital’s housing services.

An 18-month pilot, which ran from late 2020 into 2022, achieved remarkable results: 100% of “roofless” patients were discharged into accommodation, and the hospital re-admission rate for these individuals was slashed by 68%.

The scheme, mostly funded by Edinburgh City Council, was expanded in April this year to include the Royal Edinburgh Hospital – a psychiatric facility.

However, Mr Wright concedes that the capital’s scarce housing resources are making it harder to ensure that homeless patients end up somewhere safe.

In the first six months after the pilot phase ended, the charity counted eight patients whose destination was “uncertain”; in the first three months of 2024, this has risen to six.

“It’s certainly become a lot more difficult,” said Mr Wright, adding that the situation boils down to a lack of available accommodation.

'They're feeling forced to choose between their health or having a house'

Social rented homes account for just 14% of Edinburgh’s housing stock, compared to an average of 23% nationally.

"The council is in a really difficult position - it’s not like they can just magic up extra accommodation," said Mr Wright.

"They do go to some lengths to secure what’s not normally within their housing stock, but even that at times isn’t always great for the people we support.

“Quite often, when the council run out of accommodation, they'll use a Travelodge.

"But most of these are on the outskirts of the city, so if you've got mobility issues and you're expected to pick up medication on a daily basis somewhere in the centre of the city, it can leave you quite stranded.

"The council are doing their best, but you’re almost setting them up to fail and no doubt they will end up back in hospital much quicker.”


Mr Wright added that housing shortages are now so extreme that some sick homeless people are too scared to risk being admitted to hospital in case they forfeit their temporary accommodation.   

He said: “The situation is so grave that some people are making a choice between ‘if I’ve got an accommodation placement, do I go to hospital and have resolution to my treatment, with the risk that I might lose accommodation because it will be closed while I’m inside, or do I just keep going?'.

"They're feeling forced to choose between their health or having a house."

In Paisley, Cor Hutton is “constantly” grappling with housing emergencies for people who have lost limbs to injuries or medical amputations.

Ms Hutton, a quadruple amputee who lost her legs and hands to sepsis in 2013, established the charity Finding Your Feet to support patients across Scotland.

She said: “We’ve always got one or two crisis situations on the go for people who really need housing.

"Eventually they get the help, but it shouldn’t have to be as hard as it is.

“Yes, housing shortages are a generic problem nationwide, but because what we need is quite specific - often it’s a ground floor or a single floor premises that’s accessible for wheelchairs - it can be quite difficult.”

Finding Your Feet founder, Cor Hutton (right), with Tracey Whiteside - who has been waiting years for a ground floor flatFinding Your Feet founder, Cor Hutton (right), with Tracey Whiteside - who has been waiting years for a ground floor flat (Image: Gordon Terris/Herald&Times)

In recent months, Ms Hutton has been lobbying Renfrewshire council on behalf of Scott McQuade, a quadruple amputee sepsis survivor whose case was reported by the Herald after he was left to fundraise to pay for alterations to his home.

Ms Hutton has also been working with Tracey Whiteside – a 48-year-old from Linwood whose left leg was amputated in 2020.

After nearly five years on the council waiting list, she will finally move to a ground-floor flat in Paisley with her husband and daughter later this month.

Ms Hutton said: "Tracey has lost one leg, she’s at threat of losing the other, she’s wheelchair-bound, doesn’t wear a prosthetic and she's in a first-floor flat in Linwood.

"The only way of accessing it is by crawling up the close stairs. It’s awful.

“With Scott, it wasn’t that [the council] wouldn’t pay, it was that they would only put money into what they wanted to do – and the things they were suggesting weren't going to help him.

“And the thing is, if they can get you into a situation that you can cope with, then you’re nobody’s problem anymore.

"It makes sense, logically, to help people adapt their house, or move.

"But I do accept that we’re in a housing crisis.”