Ruth Robin: Ask and Act - are we ready for prevention at scale?

The Housing (Scotland) Act has the potential to help Scotland sustain its position as a leader in progressive housing legislation and practice. At its heart is a shift many of us have argued for over years: identifying people at risk of homelessness earlier and intervening before crisis hits. That ambition echoes the Christie Commission’s call for public services to move upstream, with prevention and early intervention becoming the default rather than the exception.

But as we begin to test what Ask and Act looks like in the real world, we need to be honest about what it demands. Do relevant bodies have capacity to undertake these new duties? It is a practical question for every relevant body: are we equipped to ask the right questions, at the right time, and, crucially, improve outcomes for people?

I have worked in NHS Scotland for the past eight years, most recently as organisational Lead for Housing and Homelessness within Healthcare Improvement Scotland. From inside the system, I see both the opportunity of prevention and the operational reality of implementing new duties in clinical environments under sustained pressure.

The scale of NHS demands every day is enormous. Across primary and acute care, there are hundreds of thousands of patient interactions. Within that volume, people at risk of homelessness will represent a relatively small proportion. This matters because the challenge is not simply awareness; it is about identification, knowing when to enquire, how to do it safely, and how to avoid unintended harm, inefficiency, or poor experience for people and the workforce.

Health and homelessness are deeply connected. Engagement with health services often peaks around the point of a first homelessness assessment. This reflects what many practitioners already know: homelessness damages health, and health issues can contribute to homelessness. If Ask and Act is to deliver on its promise, we need approaches that are clinically appropriate and operationally realistic—especially in busy settings where time, trust and continuity of care are already stretched.

This is why readiness cannot be reduced to “knowing about the duty”. It requires:

• Confidence and skills to recognise risk in clinical contexts
• Time and space to ask sensitively and safely
• Shared language and accountability across health, housing and social care
• Clarity of responsibility so staff know what to do next
• Reliable pathways so action is timely, consistent and effective

For NHS colleagues, the question is rarely whether homelessness matters. The question is: how do we recognise risk appropriately, take proportionate action, and do so without compromising safe, trusted care?

And that brings us to my central point, the real test of Ask and Act is the “Act”. Identification is only meaningful if there is capacity, coordination and accountability to respond. If we ask more people about housing insecurity without strengthening what happens next, we risk creating frustration for staff and false reassurance for people in need.

Locally, the housing emergency is felt acutely. Pressure on temporary accommodation, constrained supply, and the challenge of securing permanent, affordable homes all place real strain on teams. Introducing additional duties, however well-intentioned, must be matched with careful joint planning across local authorities, health and social care, so the whole system can adopt new practices without destabilising a system already under pressure.

Ask and Act is an opportunity to move beyond pockets of effective joint working and hard-wire prevention into Scotland’s public services. But prevention at scale will not happen through isolated effort. It must be owned collectively, with health, housing and local government sharing responsibility not just for identification, but for outcomes. That is the cultural change Ask and Act truly demands.

As I launch ROOTS for People, my aim is to support housing organisations and partners to develop and test practical solutions that sit between sectors—grounded, proportionate and aligned with real-world delivery. Drawing on my experience across housing, health and social care, I want to help organisations innovate with confidence in complex system environments.

If you’d benefit from my experience in driving people-led change, system insight, developing your innovative ideas or exploring the design of solutions to wicked problems, please do get in touch.