Author: Fulfilling Lives South East

Employing People with Lived Experience of Multiple and Complex Needs

Fulfilling Lives South East

We would like the knowledge our toolkit contains to travel far and wide, making its way into the hearts and minds of organisations across the country, and for employers to recognise the benefits of employing people who have been through hardship and continue to fight for themselves.

A toolkit for employers

Fulfilling Lives South East (FLSE) has been running for eight years.  Eight years is a long time.  Over the course of the project, a lot has changed.  We have tried, tested, adapted, won some, and lost some.  Through all this experimentation, we have learnt a lot about the ‘system’, and a lot about people.  As the project draws to a close, we want to share what we have learned along the way

A major feature of the FLSE project was its employment program, the purpose of which was to employ people with lived experience of multiple and complex needs (MCN) and support them through their recovery from a work-centred perspective.  Those employed were titled Project consultants (PC) and attached to the Service User Involvement (SUI) team.  Their lived experiences varied in combinations and intensities across the spectrums of substance misuse, mental health, repeat offending and homelessness, while their duties were similar, their skillsets differed.  Those occupying the role came from a variety of backgrounds, including but not limited to design, research, psychology, biological sciences. They were also tasked with mentoring lived experience volunteers whose experiences ranged from students to city workers.

In the eight years, the project has seen many lived experience team members come and go.  The majority successfully moved on to other employment, either directly from FLSE, or within six months of leaving the project, while others were not quite at the right stage of their recovery to complete their contract.  Throughout this time, the managers and supervisors have evolved their support practices as they’ve learned what helps (and what doesn’t help) staff with experiences of MCN.  More than that, they’ve helped those staff members to harness their own skills to drive systems change forward. 

Inclusive, supportive workplaces for all

In 2021, we decided to develop a toolkit aimed at employers to consolidate what we have learned about employing people with experience of MCN.  The more we discussed the idea, the larger in scope it became.  In essence, it is a guide to help organisations foster a culture where lived experience of MCN is not only supported but valued.  It’s about creating an inclusive, supportive workplace culture that benefits employers and employees, regardless of whether they have experience of MCN or are just going through a difficult time.  Our toolkit exists to support organisations in creating that culture by providing tools, approaches and practices that help them to help their employees thrive and be successful so that they, in turn, can give their best in their working roles.

So, what does that support look like?  Having seen 41 Project consultants pass through FLSE, all with different life experience, we have a wealth of knowledge to share.  Our toolkit distils down to the overarching support themes that – although written for people with lived experience of MCN – can be applied to all employees.  Its foundation is three principles: Psychologically Informed Environments, Co-production, and Trauma-informed Practice.  Together, these concepts underpin the way people work together, how they treat each other, and how the working environment respects and reflects the (sometimes) difficult life experiences of its employees.  On the surface, they are simple to understand, but require consideration when put into practice.  It is a culture-change, so that means staff need to be on board at all levels, and it takes time and diligence to overwrite old habits, thought processes, and ways of relating.  These three principles should be applied throughout the recruitment process, supervisions, and day-to-day working practice. 

The toolkit also highlights the benefits that people with these life experiences can bring to organisations and the people working within them.  The chances are high that there are multiple people in any organisation who have personal experience or know someone close to them who has experienced addiction, mental ill-health, offending behaviour, or has either been homeless or close to being homeless.  Having someone relate to these circumstances can help with feelings of isolation and shame.  This alone can build stronger, more trusting relationships, while reducing stigma and improving wellbeing within organisations and teams.

The British Medical Association reported in their July 2016 publication (that alcohol use is prevalent among those who work, more so than those who are unemployed, and that it is a growing concern for employers.  The Office for National Statistics reported on their website that in the UK in 2020, 11.6% of absences from work were due to mental ill-health.  Criminal behaviour is not uncommon in wider society.  Violence and substance use are daily occurrences.  These intertwined issues are not confined to people with MCN histories; they apply to people from all walks of life in any profession.  Although our toolkit is designed for supporting people who have combinations of adverse experiences, it can be just as useful for people who are struggling for a single reason.  

Sharing our knowledge

We would like the knowledge it contains to travel far and wide, making its way into the hearts and minds of organisations across the country, and for employers to recognise the benefits of employing people who have been through hardship and continue to fight for themselves.

If you are an employer and would like to discuss this further or have some support around employing people with lived experience of MCN and how to do it well, then please get in touch at the contact email below by 1st June 2022. We’d be more than happy to help!

Click here to open our Toolkit for Employers

Author:

Ian Harrison, Engagement and Co-production Worker

For further information about Fulfilling Lives work in this area, please contact:

Andree Ralph, Co-production and Engagement Lead:

andree.ralph@sefulfillinglives.org.uk  

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How Multiagency Meetings Can Join Up Support

Fulfilling Lives South East

Reflecting on the impact of joint working protocols and how they can build bridges between mental health substance misuse services

Joint working protocol

In 2017, Fulfilling Lives South East (FLSE) developed and implemented a joint working protocol between Hastings mental health and substance misuse services to improve experiences for clients who need access to both services. The protocol aimed to meet clients’ needs as a whole, through a combined approach, rather than separating mental health and substance misuse as distinct issues and was shaped and informed by representatives from both services.

In the intervening years the Joint Working Agreement has grown and evolved. There is now a wider multiagency meeting called the Co-occurring Substance Use and Mental Health (COSUMH) Conditions forums held monthly in both Hastings and Eastbourne that has helped further strengthen joint working and shared client support planning.

These forums are an opportunity for agencies to discuss any of their clients who have mental health needs, are using substances and whose current situations are felt to be particularly high risk. The aim is to work across agencies to ensure the client does not fall between the gaps and for the group participants to agree who will do what tasks and lead in what areas to best support the client, and further joint working approaches.

A range of agencies attend the forums including Adult Social Care, CGL, Housing, SWIFT, Staying Well, FLSE, Oasis, Optivo, Health in Mind, Probation, UCL, Psych liaison, Rapid Response, Rehab Pathway, Assessment & Treatment Service, and Crisis Resolution Home Treatment Team (CRHT).

How did the Joint Working Agreement start?

The Joint Working Agreement was the product of collaboration between CGL Star (The East Sussex Drug & Alcohol Recovery Service), East Sussex Mental Health services and the local Hastings FLSE team. First raised at the Hastings Dual Diagnosis meeting in 2016 (now the Co-existing Conditions Steering Group), the initial idea was to organise joint training sessions between the two services, so that workers would become more aware of how the other service worked.

It quickly became clear that ambitions for the partnership and the Joint Working Agreement went beyond training and that both services wanted to find a way to offer clients with co-existing conditions a better pathway to treatment; one which was person-centered and holistic.

What was included in the Joint Working Agreement?

The initial Joint Working Agreement included the following three aims:

  • Improve the experience of people who need to access both Mental Health and Substance Misuse services.
  • Enable clients to have their needs met, through a combined approach, which is informed by the expertise of both services.
  • Ensure that the client is treated as a whole person with overlapping support needs.

The Joint Working Agreement also set out detail of how agencies would address three key areas of joint client working: consent, assessment, and communication.

  • The Joint Working Agreement considered it to be good practice for workers conducting assessments to gain client consent to share information at the first opportunity. And that consent should be used purposely in a task-specific manner to ensure that information is shared between services when needed. Information sharing should be proportionate to risks and needs, ensuring that safe and appropriate treatment is provided.
  • The Joint Working Agreement recognised assessingclients who have enduring mental health problems, while also using substances, would take more time. To gather a full picture of who the person is and who they might wish to become an active, collaborative, engaging process was used. While acknowledging that recording the details of co-occurring mental health and substance misuse presentations would need to take place at separate meetings, each led by a specialist practitioner. Attempting to address problems in each of these areas required different models of treatment and different styles of engagement, enabling services to learn from each other by observing one another’s professional practice.
  • The Joint Working Agreement anticipated that mental health and substance misuse provision would need to be co-ordinated across services with one agency taking the lead, and that the lead agency might change as the client progresses through treatment. Good communication would be a pre-requisite between practitioners from both services so cases could be regularly reviewed and updated.  

When multiagency planning can work well

The Joint Working Agreement aims, and objectives have evolved and the COSUMH Forum is now a valued junction point in the support system, providing a space for joint working, joint problem solving and a place to plan support for people who have coexisting substance use and mental health needs.

Recent feedback from Forum participants has shown that staff working across services in East Sussex value the forum for the following:

‘The forum has been a fantastic help in raising the profile of our project and clients’ needs/role, as well as in getting to meet all the right people. We know this has helped us to get referrals, so in that sense, there’s a very clear benefit to us as a project and to the people who are getting support that they didn’t have before.  I like the presentations and I’m really grateful to the forum – for welcoming and including us – it’s hugely appreciated. Getting a holistic view of individuals we talk about is invaluable, the way everyone talks about things at the forum is very different – it doesn’t have formality of case meetings – and the willingness of professionals to be open, share thoughts and bounce ideas around in a caring and safe environment is very rare, refreshing and much valued.  There are so many people with different knowledge and skills and the way it is set up is very effective.’

(Quote from an attending professional)

However, the group remains ambitious and want to develop the Forum further. The Forum chair shared their thoughts on what they would like to see happen next for the meeting:

‘I enjoy having the opportunity to develop and maintain positive relationships across services in East Sussex through the COSUMH conditions forum network. The forums have strengthened understanding between partner agencies and their roles in supporting recovery, this happens not only through the forum presentations, but also during the referral discussions. We have a core group of professionals from SWIFT, Adfam, Oasis, SPFT and Probation who attend every forum. I would like to see this replicated across all agencies so that we have passionate advocates for our clients living with COSUMH conditions in every service across the county. I am delighted that the forums have been recognised as good practice and am now working with West Sussex to set up something similar.’

(Susi Whittome, Forum Chair)

Reflecting on the importance of multi-agency meeting spaces in support systems

AT FLSE, we believe that fostering new collaborations and creating new meeting spaces is a way to foster systems change.

This method of systems change involves creating new connection points to bring together previously unconnected representatives of agencies who hold the power to change the way the system is structured and operates. The process for this can include mapping existing multi-agency meetings and identifying gaps where it would be beneficial to bring unconnected stakeholders together in a new forum.

These new forums should nurture collaboration and foster learning and result in tangible positive actions that impact on the recipients of support systems. The COSUMH Forums are a good example of this in action locally.

Challenges of this method include the time and resilience needed for the new forum to become an effective catalyst for change, an initial over-reliance on key individuals to engage and breaking down barriers to sharing information that may be traditionally viewed as commercially sensitive.

However, the benefit of this approach includes increased cross-agency partnership working; increased access across the system to new skills and knowledge; and a shared access point for raising gaps and barriers in systems and joint problem solving. This is particularly useful when responding to new systemic challenges that are unlikely to have existing forums for conversations and nurturing collective action.

To read more about how multi-agency meetings can foster systems change, please read our blog on the Brighton & Hove and East Sussex Coexisting Conditions Steering Groups here

Author:

Alan Wallace, Systems Change Officer

For further information about Fulfilling Lives work in this area, please contact:

Alan Wallace, Systems Change Officer:

alan.wallace@sefulfillinglives.org.uk  

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Journeys towards a Psychologically Informed Environment (PIE)

Fulfilling Lives South East

There is a growing interest in the support sector to operate Psychologically Informed Environments (PIE) and to adopt trauma informed practice, but this is hard to do. In this blog we reflect on Brighton & Hove City Council’s (BHCC) PIE journey that Fulfilling Lives South East (FLSE) supported with experts in this field and what we learnt from the experience.

What sparks collaborations?

After conversations between the FLSE team and BHCC about changes to language and policy seemed to stall in the face of detailed revisions and large authorisation processes, the FLSE team decided to re-group and re-evaluate priorities. We reflected that we actually wanted to support larger-scale changes beyond the immediate policy in question and that we were passionate about encouraging PIE and trauma informed practices across the service.

We shared these reflections openly with the BHCC managers and this unlocked a different mode of conversation. We were able to discuss broader principles and values of the department and we found this was a much more open dialogue, welcomed by both ourselves and the BHCC team.

What happened in the journey – ‘How about a mystery shop?’

In a meeting that followed sharing our reflections, a volunteer said: ‘how about we do a mystery shop?’ He reassured the groups that this was a learning opportunity, with an established process which had been carried out in the Hastings Housing Department to support their service development too. The BHCC Managers embraced this opportunity and a month later we were training up volunteers to carry out a mystery shop and conduct environment assessments of the housing customer service centre.

To find out more about mystery shopping please read our toolkit here. The learning from these activities was shared at both a managers’ level and with the whole department. These meetings and presentations were co-produced and co-delivered with people who have lived experiences of multiple and complex needs (MCN) and we highlighted positives as well as areas we felt could be developed. Paired with this, BHCC housing managers made time for staff to reflect on the learning and share hopes and aspirations for the Department. They wanted staff to have space for de-brief and dialogue.

The BHCC Housing Department was starting to shape its vision and plans for the future using the learning from the mystery shop and environment assessment paired with staff feedback.

Following this, the Department reached out to Dr Peter Cockersell to support with staff training in PIE and trauma informed approaches. Peter is a leading expert in this field and one of the co-authors of the national guidance on PIE. Peter worked in collaboration with FLSE, partnering with volunteers and experts by experience to design the training which was then delivered by the team. This programme saw over 100 staff participate in training across the whole of the BHCC Housing Department.

Following this, in late 2020/early 2021, the Department released its revised strategy, which included a commitment to becoming a department that operates as a PIE.

Covid-19 has obviously put all housing departments under huge strains, and we hope that as the world takes steps to recover from the pandemic that the BHCC team can have space to revisit this work and time for non-crisis activity.

What impact did this have?

Having the mystery shopping exercise and environment assessment as the foundation for this partnership, centred the voice of lived experience and helped to shape BHCC’s plans for the future around the service-user.

One volunteer who was key to shaping FLSE’s involvement in the partnership shared their reflections on this work:

“So my interest in the work was to do with the fact that the first time I was homeless I went through the system, and it was decided that they had no duty of care. So I just wanted to see if the system had changed or not.

I do think that the majority of the staff [at the council] were very open minded.  The few staff members who did object at first did eventually came around after we managed to convince them that the work was about testing the system and not them.

I don’t know about all the staff, but I do remember one lady who said that as a result of the mystery shops that she had re-evaluated the way she worked, and that after it, when she was meeting with people she made sure that she had some water and tissues in case they were needed.”

Learning

Based on the learning and values of the Project, there are golden threads that run through all of our systems change work. We share these below as useful starting point for anyone looking to spark or support a journey of change similar to the one we reflect on above.

  • Drivers for change: At FLSE we have found it useful to reflect on and write down what drives all our efforts and partnership work. These are a useful reminder on a challenging day about why you do the work. 
  • Guiding principles: We have worked to certain values, principles and practices and this has helped shape what we do as much as how we do it. For FLSE, these have been:
    • Co-production
    • Trauma-informed practice
    • Naming Multiple and Complex Needs (and multiple disadvantage)
    • Using project management tools to guide activity
  • Building trust: Making concerted efforts to build trust between all stakeholders who need to be involved in a PIE journey or further systems change activity is crucial.  We’ve learnt that this is a bedrock of all good partnership working and when we have built trust effectively, this has led to the most impactful outcomes.

Author:

Rebecca Rieley, Systems Change Lead

For further information about Fulfilling Lives work in this area, please contact:

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

For more information sign up to our newsletter:

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Health Inequalities: Contributing to national and local consultations

Fulfilling Lives South East

Contributing to national and local consultations

For Fulfilling Lives South East (FLSE), engaging in formal consultations is a way of influencing systems change and connecting with key decision makers.

Engaging in consultations provides a way of informing and influencing the development and delivery of a project or programme, the commissioning or delivery of a service, or the development of a strategy or policy. Consultations offer the opportunity to engage with national Governmental agencies and public bodies, Local Authorities and Commissioners, in a dialogue to help them better understand your needs and opinions, which they will consider when developing policy and delivering services. Engagement in formal consultation provides one of the greatest opportunities for marginalised communities and voices to be heard in spaces which are not traditionally accessible.

The Kings’ Fund advocates that ‘people and communities using health and care services are best placed to understand what they need, what is working and what could be improved.’ Formal consultations provide an opportunity for those using services to have their say. 

The FLSE team has used opportunities to participate in consultations for this reason; to promote the voices, experiences and views of people with experiences of multiple and complex needs (MCN). In our work to tackle health inequalities, we participated in and contributed to the following four health-related consultations nationally and locally:

We have welcomed the opportunity to address and highlight inequalities for people experiencing MCN and feel that these consultations are symptomatic of a system that is ready for change and looking to listen to lived experiences. 

This blog contains an overview and summary of our responses, our messages and reflections on how the system can continue to improve. We also share our way of engaging with health-related consultations to encourage more agencies to engage in these opportunities as a way to champion the views of, and improvements for, the people they support.

Co-production and consultations

For all our responses to consultations, we have worked with the Service User and Engagement Team, volunteers and experts by experience, to build and shape our messages and recommendations. We think it incredibly important to represent our clients and amplify their voices when feeding into consultations and help tell their stories to demonstrate what impact (positive or negative) current local and national policies are having on their lives.

Louise Patmore, Programme Lead Participation Mental Health Collaborative with Sussex Health and Care Partnership, who we have closely worked with says that

‘‘Co production is so important in the transformation and development of our services in health. For many years we have had a “doing to” way of working and people have not been able to have effective choice or control over their health care. It is recognised that health seems to have a very specific problem about providing patient needs versus organisational want, be that financial saving or accommodating new services. Co production enables – or should – enable us to be able to hear from those that actively use services and its impact. We need to be open hearted and minded to the voice of people, especially those that have specific needs. Society is always judged on the way it treats the less able. We need to be able to think differently and using coproduction to be able to shine a light on our issues, become more transparent about them and work together in a diverse way to find solutions can only help to improve our services and provide better, more efficient ways of supporting people and reducing pressures on the system and making sure that people get the right type of treatment at the right time. It will help us with efficiency and economy but only if we truly coproduce and share power.

The people who participate benefit from inclusivity and services are known to become better the more involvement there is. It helps us to grow a listening culture and a more empathic culture that also supports staff wellbeing.’’

Similar sentiments have been expressed by Ian Harrison, our Coproduction and Engagement worker:

“Co-producing consultations with people with lived experience is a must.  Our review of the Mental Health Act would not have been as in depth or as targeted without the contribution of one our volunteers.  The breadth of knowledge from their personal experience and their past work with people of this cohort surpassed our own by a large margin in particular areas.  Without their expertise and detailed knowledge of specific parts of the system and its effects on those it is designed to help, valuable information during a pivotal moment could have been lost, and the opportunity to affect change in a key area would have been missed.”

1. The Mental Health Act- review

Since our submissions and previous blog post, the government responded to the Mental Health Act (MHA) review and we are happy to see an acknowledgement that the MHA doesn’t always work for patients, their families and carers. Our full blog to comment on the government’s next steps can be found here. We welcome the new guiding principles of choice and autonomy, least restriction, therapeutic benefit and the person as an individual in the Mental Health Act Review as the focus is now shifting to a more person-centred approach. 

However, we are uncertain how the proposed changes in the MHA can lead to increased funding into services and equity in place-based mental health care provisions and hope the Government can clarify this during 2022. 

2. The East Sussex Mental Health Inpatient Consultation

The FLSE team was keen to participate as we know that over 75% of FLSE clients have a self-identified disability, of which 84% had a mental health problem. We contributed extensively to the East Sussex Mental Health Inpatient-consultation and our suggestions and recommendations have been incorporated into the future service design plans for a new inpatient facility that will be built in Bexhill by 2024.

After multiple consultations and workshops throughout 2021 with the East Sussex Mental Health Inpatient Consultation team, we had representation from volunteers and experts by experience, the full report has been published.

”In best practice public consultation, understanding the potential impacts of proposed changes to public services on vulnerable individuals and groups is vital. While every effort is made to reach out to these groups during consultation and engagement, there are often challenges and barriers to hearing first-hand feedback; this is perhaps particularly the case for those with multiple complex needs who may be experiencing crises or difficult personal circumstances.

In this context, the support and input of organisations like Fulfilling Lives South-East are invaluable; in a recent consultation around inpatient mental health services, the FLSE team took the time to take part in an interview with Opinion Research Services (ORS) researchers and a workshop for stakeholder organisations, and to prepare and submit a detailed response for inclusion in the final feedback report. The combination of professional expertise and lived experience that FLSE were able to bring to bear meant that the insights they provided via ORS contributed valuable evidence for conscientious consideration by senior leaders and decision makers in the NHS.”

Charlie Wilson, ORS Senior Researcher and Public Consultation Lead, sharing his reflections on the impact of the FLSE engagement with the consultation.

3. The Women’s Health Strategy

Throughout 2021, there was a call for evidence to inform a new national Women’s Health Strategy. This call for evidence has now closed and the government has published its Vision for the Strategy in late December 2021.
The Vision document identifies six key areas of improvement: 

  • Menstrual health and gynaecological conditions
  • Fertility, pregnancy, pregnancy loss and postnatal support
  • The menopause
  • Healthy ageing and long-term conditions
  • Mental Health
  • The health impact of violence against women and girls

The full Strategy will be published in spring 2022 but in the meantime, we have written a letter to Maria Caulfield MP to share our reflections and recommendations to improve the health of women with MCN for, namely:

  • Women experiencing MCN are underrepresented in consultations;
  • We are concerned that women experiencing MCN have not been named as a separate category in the strategy;
  • We would like to see training on trauma informed approaches and a less siloed approach between physical and mental health throughout the NHS, adult social care and the third sector.

4. B&H Mental Health Crisis House Service- survey

In August 2021 we contributed to the B&H Mental Health Crisis House Service survey organised by the Brighton & Hove Clinical Commissioning Group. This service aims to provide short-term intensive support and care (e.g. 7 days) to patients to avoid hospitalisation.

Following the survey, the Council has put together an ambitious specification and contract for the new Crisis House service and commissioners are now in the process of reviewing applications from the tender.

Looking through the service specification, we are happy to see Multiple and Complex Needs defined in a similar way to FLSE’s definition; as people who experience several problems at the same time, such as mental ill health, homelessness, drug and alcohol misuse, offending and family breakdown.

However, we noted that the new service will predominantly take referrals from the existing mental health trust services (SPFT). We would have liked to see the referral pathway to be widened beyond the SPFT Mental Health Urgent Care Services, with GPs and third sector organisations also being able to refer into the service. The service will have single rooms with en-suite bathrooms and we welcome this and included a recommendation on this as part of our feedback in August, However, we are concerned that there are no female only spaces required in the new specification. The Contract refers to specific patient cohorts who will be a priority for improving access to mental health crisis services, but MCN is not one of them.

On a positive note, there is a commitment for the service to provide support, which is Psychosocial and Trauma Informed, and includes a comprehensive training package for staff on trauma informed care and dual diagnosis. (p.22) We support these approaches as our work highlights how valuable this approach is to building trusting and supportive relationships with people who have MCN.

We are also pleased to see that it is part of the acceptance and inclusion criteria that people can access this service if they are ‘ready to engage with the Recovery Model and have consented to stay at the Service’ (page 17), so that people with a co-existing substance use and mental health needs aren’t excluded. And that the service will link patients with other statutory and voluntary sector services to support a patient’s health, substance misuse, mental health and social care.

Key messages for the healthcare system

Chief Medical Officer, Prof. Chris Whitty, is calling for a national strategy for public health as well as an increased investment in prevention and spending that supports population health to improve the health and wellbeing of coastal communities. The Kings Fund is also calling for a cross-governmental strategy to reduce health inequalities for people with MCN.

FLSE supports both of these national developments and calls locally for:

  1. MCN, or multiple disadvantage, to be named in local and national healthcare policies, strategies, and service contracts and paired with an expressed commitment to meeting the needs of this group. Due to the stark health inequalities faced by people with MCN, their needs must be factored into local Equalities Impact Assessments and given the same profile as other protected characteristics.
  2. Setting up a local review process to monitor deaths of people experiencing MCN and assess progress in improving health inequalities for this group.
  3. Offering choice to patients with MCN as crucial to increasing access to primary healthcare. We call for increased community-based primary care that enables engagement through walk-in clinics and drop-ins as well as healthcare professionals providing outreach into communities to build relationships and deliver care outside of traditional spaces. This can be enabled by scaling up existing good practices as suggested in the FLSE Bright Spots report.
  4. Integrating frailty scores as a routine clinical assessment tool with rapid access clinics to respond to these high frailty scores. This will enable the coordination of care for complex conditions for people with MCN.
  5.  A dedicated funding stream within Sussex’s new Integrated Care System to support the needs of people experiencing multiple disadvantage. This would be a vehicle to promote the commissioning of a cohesive, joined up healthcare response to meet the needs of this distinct group of people. 
  6.  Trauma-informed practice training to be delivered to all healthcare staff members to help improve communication with and service approaches for people experiencing MCN.

Reflections on the benefits and limitations of consultations

FLSE is aware that consultations provide an excellent opportunity for changing and influencing key decision makers. We have however noticed that the way they are being advertised for is inconsistent, irregular and at short notice. It can take the form of completing online questionnaires and surveys, and drafting reports in response to calls for evidence.

We understand that some organisations don’t have the resources or capacity to participate in the consultation process. Nevertheless, engagement in formal consultation provides one of the greatest opportunities for marginalised communities and voices to be heard in spaces which are not traditionally accessible.

Authors:

Michaela Rossmann, Systems Change Officer

For further information about Fulfilling Lives work in this area, please contact:

Michaela Rossmann, Systems Change Officer

michaela.rossmann@sefulfillinglives.org.uk

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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The Intermediate Care ‘Step Away’ model

Fulfilling Lives South East

A holistic community support approach with testing of frailty score-based interventions

Sharing learning

In 2021, the Brighton Homeless and Inclusion Health Specialist Service with Sussex Community NHS Foundation Trust secured funding from the Department for Levelling Up, Housing and Communities and Brighton & Hove City Council to deliver an Intermediate Care ‘Step Away’ programme. This required a multi-agency approach between medical experts, nursing and other allied health professionals to provide support for homeless and insecurely housed patients in the community after being discharged from hospital.

Fulfilling Lives South East (FLSE) is committed to improving systems and services locally for people experiencing multiple and complex needs and a partnership has been formed between our teams to share learning with the wider system by establishing a Steering Group for the agencies involved in the ‘Step Away’ service.

Our data collection gives an overview of the patients supported by the ‘Step Away’ service:

  • Between May 2021 and January 2022 a total of new 33 patients have been referred.
  • Most patients were aged 40 to 59.
  • Two thirds were male.
  • 55% of patients had further support needs such as drug and alcohol dependency and mental health issues.
  • Most patients lived in hostels, temporary accommodation, emergency accommodation or sleeping rough.

FRAILTY

One element in particular has stood out in the Step Away service data:.  patients were a lot more frail than the average population in the same age category. The Step Away team and FLSE started to focus our attention to this element of the service and build up a better picture of the patients.

The Edmonton Frail Scale, has been used as the chosen assessment tool for frailty and anyone trained is able to use it not just healthcare professionals. The Edmonton Frail Scale covers cognition, general health status, functional independent, social support, medical use, nutrition, mood, continence and functional performance.

Our findings were worrying – more than half the patients had moderate and severe frailty.

OUR LEARNING

We have shared our learning from the ‘Step Away’ service at the Pathways from Homelessness Conference in March 2022 to a wide audience.

We know that a small group of complex patients have more intensive support and care needs. The frailty score is a key tool to identify people’s level of support and care needs, incl. poly-pharmacy issues and raising concerns around personal care needs and mobility.

It is a tool to communicate well the health and care needs of another person to different parts of the wider support system, such as housing and adult social care teams, without too much clinical language. This makes it more accessible across professional teams sitting in different parts of the system. It also helps younger patients to better understand their own frailty and the implications this may have on their lives.

WHAT WE WOULD LIKE TO SEE NEXT

  1. Frailty scores need to be integrated into housing options assessment tools to help allocate care and support 
  2. Investment in a one-stop-shop clinic to respond to the moderate and severe frailty scores (especially for patients with multiple and complex needs) – this will improve accessibility to services and lead to better diagnosis and clinical investigations 
  3. Long term substance use to be seen as a chronic health condition – this impacts on frailty of patients. We support the recent Dame Carol Black review where she called on the government and society to recognise addiction as a chronic health condition

The full presentation the team delivered at the Pathways from Homeless conference 2022 can be found here.

Authors:

Michaela Rossman and Rebecca Rieley

For further information about Fulfilling Lives work in this area, please contact:

System Change Officer

michaela.rossmann@sefulfillinglives.org.uk

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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Training for future Social Workers

Fulfilling Lives South East

Positive Partnerships towards a Trauma-Informed Workforce

In autumn 2020, the Fulfilling Lives South East (FLSE) Area Lead, together with the Systems Change Officer reached out to Lucy Basterra, Senior Lecturer in Social Work at the University of Brighton, to offer training sessions around working with people experiencing multiple and complex needs (MCN) and experiences of repeat child protection processes. The idea was to influence social workers’ attitudes and behaviours before they start practising social work as their profession.

Issues faced

FLSE understands that Social Workers play a key role in providing support to people experiencing multiple disadvantages and MCN. Following our research and front line experience, we developed a Manifesto for Change, with emerging themes and commitments. One of which is about supporting women through repeat removals of children. Our commitment states: For women with MCN to not suffer stigmatising practice (e.g. from antenatal and post-natal healthcare providers, courts, police, GP and Social Services).

In our previous blogs on this theme, we have explored the gaps women with multiple and complex needs often fall through and the issues that arise when the working practices of social services don’t respond flexibly and creatively to these needs.

Women often feel disempowered throughout the process of working with social services, not understanding their rights or having a firm grasp of what is happening at each stage. Many women have also had negative experiences of social services in the past, often as children themselves, leading to a distrust and disengagement from services. Our clients have reported that they felt like passive recipients of a process that is making permanent decisions about their own lives and those of their children. 

Quote from our client

“I feel like everything is going to come crashing down around me.  I feel I haven’t been given enough time to turn my life around it’s just not fair. How can I be expected to just stop using and attend all these appointments without any period of lapse?  I’m not perfect.” 

What we did

Our partnership with the University of Brighton, has provided us with a platform to reach future social workers and provide an enhanced understanding of multiple disadvantage, encouraging the students to consider the intersecting issues faced by their future clients and to respond in ways that are adaptive to the complex needs and informed by experiences of trauma.

FLSE delivered two guest lectures on the subject of ‘Trauma Informed Practice (TIP) and working with people experiencing multiple and complex needs (MCN)’ in November 2020 and January 2021. These sessions were co-produced with front line staff, project consultants, volunteers, experts by experience, the learning and impact team as well as the systems change team. Following their success, FLSE were invited to deliver the lectures again to the next year’s cohort of students. In January and February 2022, two guest lectures were held, one online and one in-person, which again received overwhelmingly positive feedback, highlighting the importance of teaching students about trauma informed practices, and working with people experiencing MCN.

Student feedback on the training sessions

“I found this session really useful and was really comfortable to engage with the facilitators. I found this session to be a safe place to ask questions, be curious and think outside my box”.

“I found the information provided about MCN and trauma very useful and will definitely look more into this and take it into the future. Also information around women and repeated pregnancies interesting, as it was topic I was debating recently”.

“I really enjoyed the session, especially the way that each breakout group had an assigned practitioner as it allowed for a detailed group discussion. I was also really impressed with the passion each of the workers showed”.

“The practice examples were really interesting, and I learnt some important skills for building relationships with service users who have experienced trauma”.

“The need for trauma informed practice and unconditional positive regard for the client. Be strength and person focused. Work as part of a team around the person and celebrate small wins for the client. The need for long term approach”.

“I have learnt about the importance of considering language used (terms such as label) and how this can impact on the clients we work with.  Thus, learnt to challenge the use of such terms”.

“Thank you for the training. I am working with a mum who has had 2 children removed and has a learning disability, ADHD and poor mental health. I have often had tense, difficult conversations with her, and I think I may have been dismissive at times. Your presentation has opened my eyes and made me realise what she has gone through.  I feel better able to support her and her children. Thank you”!

“In social work we focus on the children and keep them at the centre of our practice.  This has helped me consider the wider impact on the parents”.

Feedback from Lucy Basterra, Senior Lecturer in Social Work at the University of Brighton

“It has been a pleasure collaborating with the Fulfilling Lives team, and it is clear from the feedback that the team’s expertise and passion has made a positive impact on students’ learning.  From my perspective, as a lecturer in social work with a practice background in working with people experiencing multiple disadvantages, it is vital that we bring the voices of an often-marginalised group of people into the teaching and training of social workers.  Fulfilling Lives were able to do this by putting together a session which kept service users at the heart of the content, while also offering expert knowledge from a practitioner perspective.  Linking the themes that were covered with broader concepts of trauma-informed care means that the learning is applicable to any setting our students go on to practice in. The resources and case studies that Fulfilling Lives have shared will continue to be put to good use across our programmes where applicable and will add depth and insight into the experiences of people with complex needs as well as the practice tools and approaches best-placed to support practitioners in their work”.

Reflections from the facilitators

“Participating as a facilitator in the training as a volunteer with FL has been an invaluable experience that I am proud I was part of. An important part of healing and growing is the ability to use past experiences, good and bad ones, in order to help and support others, but that’s not always easy. I thought taking part in this training would help me gain some confidence and trust in myself.  I’m really grateful I got to do that in a very professional and human environment, working alongside staff members while being supported step by step.

I think the training was a highlight for everybody involved, and it was great to read the feedback left by students, it made me realise what a great achievement to have been part of shaping, through our efforts, a next generation of a trauma-informed social workers”. – Linda, FL Volunteer

“As a member of the Service User Involvement team with lived experience of MCN it has been extremely rewarding to play a role in the development and delivery of training for social work students. In addition, mentoring volunteers to develop new skills they are interested in, and working together on them achieving each step to get to where they want to be, is a part of my role I feel really privileged to be doing.

Linda has worked with Fulfilling Lives as a dedicated volunteer for a year and a half and seeing her get to the stage of presenting slides in training to a room of people is testament to how hard she has worked. People with lived experience can bring a unique and valuable insight to our work, but beyond that learn and bring skills that have really supported our project in achieving its own goals. I would like to thank the volunteer involved for being part of our team and congratulate her on her achievements.

This training has been a great example of co-production in action. Bringing together the expertise of frontline staff, diverse lived experience voices, and knowledge from our systems change work. It’s great to hear the feedback that the training was valuable to the students.” – Vikki, FL Engagement and Coproduction Worker

Legacy

One of the main objectives of Fulfilling Lives nationally and locally is to work in partnership with organisations and institutions to nurture system change to help with the development of accessible, responsive, flexible and coordinated approaches for those with the most complex needs.

We are conscious that social workers and social work students are key to how social services are being delivered and perceived from a service user point of view. We are keen to help develop skills and approaches for future professionals.

The positive impact of the collaboration between FLSE and the University of Brighton has resulted in a commitment to continued use of Fulfilling Lives resources on MCN, Trauma and the repeat removal of children into care. Having these key resources being integrated into educating our future workforce is a legacy we are proud of and shows the importance of collaboration. 

Authors:

Eve McCallam, Systems Change Officer

For further information about Fulfilling Lives work in this area, please contact:

Systems Change Officer

eve.mccallam@sefulfillinglives.org.uk

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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Building inclusive goals in Sussex  

Fulfilling Lives South East

Engaging in the development of a Pan-Sussex Strategy for Domestic Abuse Accommodation and Support

Setting the scene

Part 4 of the Domestic Abuse Act, which achieved royal assent in April 2021, placed a new statuatory duty on local authorities to assess the need and commission support to victims of domestic abuse (DA) and their children in safe accommodation services in their areas. Local Authorities were required to conduct a local needs assessment and prepare and publish a strategy for the provision of such support, and to monitor and evaluate the effectiveness of this strategy.

At Fulfilling Lives South East (FLSE), we know that women who have multiple and complex needs (MCN) are disproportionately affected by DA yet are often felt to be the most challenging to reach for consultation activity and service design and as such, are most at risk of not having their voices heard and needs met. This is a group that services most struggle to build trusting relationships with, and as a result often fail to provide appropriate, person-centred, empathetic support. This is why FLSE is passionate about sharing these women’s voices through coproduction.

What we did

In August 2021, FLSE submitted a report to the Sussex Local Authority Project Team in the Office of Sussex Police and Crime Commissioner (OSPCC), which focused on the needs of women with MCN, to support the development of the Brighton and Hove City Council, East Sussex County Council and West Sussex County Councils, Pan Sussex Accommodation Based Support Needs Assessment. When writing this report, we adopted a co-produced approach by including staff and volunteers with lived experience of complex needs and domestic abuse in the process, including attending and participating in planning meetings, in-depth research of our case study database and in writing the final report. The evidence presented was gathered from our client work and FLSE volunteers and staff to express both the needs of this group of women as well as their reflections on how the wider housing and support system can be developed.

Members of the FLSE team also attended an online market engagement event to consult on specialist refuge accommodation for those with MCN, hosted by East and West Sussex County Councils. We reflected on the needs of women with MCN who experience domestic abuse and facilitated discussions on the various operating models for refuge provision and the factors that need to be considered when designing these services.

Upon the release of the draft Pan-Sussex strategy for domestic abuse accommodation and support in October 2021, the FLSE project group presented a subsequent report to the OSPCC, to support their public consultation. This expressed our impressions of the draft strategy, identifying what we were pleased to see and areas for improvement. Project group members also completed the online survey conducted by the County Councils to share feedback on behalf of our organisation.

Measuring our Impact

Within our contribution to the Sussex needs assessment, FLSE made a specific recommendation for women with MCN to be named and considered in the strategy. We are delighted to see ‘Responsive to Multiple Disadvantage’ listed as one of six key strategic priorities in the finalised strategy published in January 2022. This priority establishes the need for specialist provision to support victim/survivors with MCN, and makes recommendations for Sussex local authorities, specialist domestic abuse accommodation providers and support services to holistically support those with MCN, whilst ensuring accessibility of services

We also raised concerns around limited and unsuitable move-on options for victims/survivors with MCN. We highlighted the benefits of adopting a ‘Housing First’ model paired with specialist DA wrap-around support, in ensuring accommodation is appropriate to MCN and simultaneously provides a long-term housing solution. As a result, the strategy commits to exploring accommodation and support options appropriate for the needs of survivors with MCN including short-term respite facilities, specialist housing, move-on pathways, and long-term floating support.

Reflections and Recommendations

Engaging and consulting in the development of the Pan-Sussex strategy for domestic abuse accommodation and support provided space for FLSE to have an open channel with local commissioners to share our learning and support the commissioning teams to engage with discussions about the needs of those who experience domestic abuse as one of several complex and intersecting needs. We believe that this was best achieved by giving prominence to the voice of those with lived experience:

‘’The contribution and time invested by the team in providing Sussex with the lived experience work demonstrated to us and further strengthened the importance of ensuring better support is provided to survivors with MCN…by being given the opportunity to corroborate our findings with lived experience feedback was invaluable and helped provide a more meaningful evidence base for our recommendations’’ – Commissioning Project Manager, OSPCC

With the strategic goals in place, we are hopeful that many women with MCN experiencing domestic abuse will have improved opportunities to access appropriate safe accommodations and would be more likely to reach out for help and support. However, in order to break down current barriers experienced by those women with MCN, local authorities, commissioned services and the wider support system must develop tangible action plans that will operationalise the commitments made within the strategy and bring the voices of experts by experience to the forefront.  

Authors:

Emily Page, Systems Change Project Assistant

For further information about Fulfilling Lives work in this area, please contact:

Systems Change Project Assistant

emily.page@sefulfillinglives.org.uk

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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How Multiagency Forums Can Influence Systems

Fulfilling Lives South East1 Comment

The Fulfilling Lives South East’s (FLSE) ‘Perspectives Project’ researched what good psychological support can look like for people with co-existing mental ill-health and substance use, prior to accessing formal substance misuse treatment. The aim was to identify new ways of working through learning from professionals who support individuals experiencing multiple and complex needs (MCN), providers or commissioners of substance misuse and mental health services, and sector leaders.

Many contributors stressed the importance and urgency of linking mental health and substance misuse provision more coherently, with one person reflecting.

“I fundamentally believe that joined up working should be an absolute minimum… Operational teams shouldn’t be reliant on building good relationships with other agencies, collaboration needs to be built into service design.“

The objectives of both Brighton & Hove, and East Sussex Coexisting Conditions Steering Groups, echo The Perspective Project research findings and seek to strengthen working relations between mental health and substance misuse services at both operational and strategic or system level. In this blog we explore the journey of these Groups and reflect on their potential to positively impact the system in the future.

The Coexisting Conditions Steering Groups – formerly the dual diagnosis steering groups – in Brighton & Hove and East Sussex, are chaired by FLSE. The membership includes both statutory and non-statutory organisations including local commissioners, as well as leaders from mental health and substance misuse services and representatives from housing and the criminal justice system. The groups aim to be a source of learning and development to improve services for those who have coexisting conditions. The strategic overview that members of the groups have places a strong emphasis on deepening collaboration and partnership working across sectors. Through its membership the group promotes and shares relevant information, learning and best practice with the aim of increasing the knowledge and confidence of staff working with people who have coexisting conditions. As well as information sharing an important role of the group is to map the prevalence of coexisting conditions across Brighton & Hove and East Sussex. This involves working towards improving the identification and monitoring of coexisting conditions, leading to a better understanding of the gaps and barriers in our local areas and informing improved service responses.   

Prior to these forums, there was no dedicated space to discuss co-existing conditions in a multi-disciplinary setting.

As part of the group’s evolution, FLSE is supporting commissioners and group members to consider how these groups could sit within more formal local healthcare governance structures. FLSE believe the work of the current Coexisting Conditions Steering Groups should be integrated into local governance structures to enable coexisting conditions to be addressed more strategically.

What can the Co-existing Conditions Steering Groups offer the system?

We think there are three areas where the expertise and established relationships within the Coexisting Conditions Steering Groups in both Brighton & Hove and East Sussex can contribute to furthering the aims of a more co-ordinated approach to working with individuals experiencing multiple and complex needs. With the ending of Fulfilling Lives there is a need to find capacity within the local system to support and evolve this work.

Firstly, we think a local strategic plan is required to advocate for the needs of individuals experiencing MCN. The newly formed Integrated Care System, Sussex Health, and Care Partnership (SHCP) could lead on devising this plan. The Changing Futures Programme for Sussex is  well placed to provide additional resources to advise the ICS on policy requirements needed to realise the Black Review’s recommendations on re-establishing local partnerships.  The Coexisting Conditions steering groups could provide the space for such planning and reviewing the effectiveness of these plans.

Secondly, we think Multiple and Complex Needs (MCN) and Multiple Disadvantage should be clearly named in local healthcare policies, strategies, and service contracts and paired with clear commitments to meet the needs of this distinct group. Due to the stark health inequalities faced by people with MCN, their needs should be factored into local Equalities Impact Assessments and given the same profile as other protected characteristics. The Coexisting Conditions steering groups can advise on how these assessments could be accrued out and what would most need to be considered.

Thirdly, building on positive commissioning efforts dedicated Coexisting Conditions roles have been created in both substance misuse and mental health services across Sussex.  We call on the leaders of these teams and commissioners to consider co-location of these individuals. This would enable a more joined-up service response, pave the way for further development of joint working protocols and explore potential for a jointly commissioned service in the future. The Coexisting Conditions steering groups could help review the impact of these teams and guide future developments.

The Coexisting Conditions Steering Groups are a good illustration of the value local multiagency groups can play in championing continuous improvement and change. However, it is only when these groups become fully integrated into local governance structures that more systemic change for those experiencing co-existing conditions can be achieved.

In our next blog exploring coexisting conditions and multiagency forums, we will take a closer look at the ‘Coexisting Conditions’ operational forums held monthly in Hastings and in Eastbourne. These were set up to support operational developments and we will look at the impact they are having in shaping the system, promoting cross-sector collaboration and strengthening client support plans.

Author:

Alan Wallace, Systems Change Officer

For further information about Fulfilling Lives work in this area, please contact:

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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Open letter to MP Maria Caulfield re. The ‘Women’s Health Strategy: Our Vision’

Fulfilling Lives South East1 Comment

In 2021, the government called for input on the Women’s Health Strategy with the following key themes:

We fed into this consultation with experts by experience, front line workers, the service user engagement team as well as the systems change team.

In January 2022, the new Vision for the Women’s Health Strategy has been published and we are pleased to see a local Member of Parliament- MP Maria Caulfield, leading this initiative.

We now are keen to share our reflections on the recent Vision for the Women’s Health Strategy for England by publishing the letter we have sent to MP Maria Caulfield in response to the publication on the 7th March 2022. And we hope to get an opportunity to discuss this further.

Open letter from Fulfilling Lives South East to the ‘Women’s Health Strategy: Our Vision’ publication

Subject: Women’s Health Strategy: Our Vision 

Date: 07/03/2022

Contributors:
Kate Jones, Engagement and Co-production Worker
MichaelaRossmann, Systems Change Officer michaela.rossmann@sefulfillinglives.org.uk
Rebecca Rieley, Systems Change Lead- rebecca.rieley@sefulfillinglives.org.uk

Sue Westwood, Expert by Experience
Victoria Hensley, Engagement and Co-production Worker
Contact details: Rebecca Rieley & Michaela Rossmann, Fulfilling Lives South East – BHT Sussex,144 London Road, Brighton, Sussex, BN1 4PH

Dear Maria Caulfield,

We are a local charitable project who are keen to share our reflections on the recent Women’s Health Strategy and are pleased to see a local Member of Parliament leading this initiative.

  1. OVERVIEW OF FULFILLING LIVES SOUTH EAST PARTNERSHIP

The Fulfilling Lives South East (FLSE) Project started in 2014 and is funded until July 2022 by the National Lottery Community Fund, and operates in Brighton and Hove and East Sussex, as one of 12 projects across England. 

We are funded to:   

(a) provide intensive support for people experiencing multiple disadvantage,   

(b) involve people with lived experience of multiple disadvantage at all levels and,   

(c) challenge and change systems that negatively affect people facing multiple disadvantage.  

We have highlighted six themes that have arisen from our work to date and within each theme we have further identified several Commitments for Change – changes that we believe will help improve support systems and services for people with multiple and complex needs.    

One of our core themes of our  Manifesto for Change is addressing Health Inequalities. 

  1. MULTIPLE AND COMPLEX NEEDS (‘MCN’)

Multiple and complex needs (MCN) are persistent, problematic and interrelated health and social care needs which impact an individual’s life and their ability to function in society.  They are likely to include; repeat street homelessness, mental, psychological and physical health problems, drug and/or alcohol dependency, and offending behaviour. People with MCN are more likely to experience violence and abuse, including domestic violence, live in poverty and have experienced trauma in childhood and throughout their lives.

  1. OUR RECOMMENDATIONS

How we are feeding into the Women’s Health Strategy- Consultation: 

FLSE has fed into the open call for evidence for the Women’s Health Strategy as a collaboration between the Systems Change Team and the Service User Involvement team. Together, we have used case studies, experts by experience and data from our project to inform the below recommendations:

A) Women’s Voices:

FLSE would like to see the healthcare system change to a more inclusive, trauma informed and collaborative system, where women don’t feel stigmatised when seeing professionals. Ideally, specific women’s only spaces are created so that taboos (such as sex work) and re-traumatising experiences are minimised. We would also like to be given a choice of being seen by female professionals instead of male professionals.

Our experts by experience feel that being listened to by a professional is crucial, but there’s a difference between being listened to and actually being heard.

Women experiencing MCN feel underrepresented and sometimes ignored or belittled. There are currently lots of gaps and barriers when trying to provide a person-centred health service. 

In contrast to the 96.9% of women who shared their own experience via the online consultation, our client group also faces digital exclusion and we feel that their voice has been left out.

We are happy to see the acknowledgement of stigma and taboo in the new Vision document but we strongly feel that trauma informed training needs to be rolled out across the healthcare system, not only in connection with Violence Against Women and Girls specific services/aspects of the healthcare system.

B) Healthcare Policies and Services:

Our clients and experts by experience would like to see a more flexible appointment system and walk-in clinics for women experiencing MCN. One of our experts points out that ‘GP surgeries should ditch using Covid as an excuse for failing of health services. We need a new approach and start again.’ The real issue for our clients is accessibility. This can’t be overlooked. If you can’t get through the GP’s door, then health outcomes won’t be improved.

We appreciate that ‘Ensuring equitable access to services and reducing disparities in health outcomes’ between women is now on the government’s radar and geographic disparity and women with disabilities are mentioned.

We are, however, concerned that women experiencing MCN, or multiple disadvantages, have not been named as a population category itself. It is often difficult for our clients to make appointments with GP surgeries by a certain time and day, which is exacerbated by feelings of not deserving help. In our experience, especially in Eastbourne since the closure of the walk-in clinic, it is extremely difficult to get through to GP surgeries, and if so, many of our experts by experience report difficulties ‘getting past’ receptionists who can appear to act as gatekeepers.

We welcome the life course approach of the vision document but feel that links between services are missing, especially when it comes to some of the potential links between the Mental Health Act, Mental Capacity Act, the VAWG Strategy and the Women’s Health strategy. We would like to see resource being directed to link us these strategies at a national level.

Our recently published mortality report shows that our clients experience on average at least 7 long-term health conditions which can lead to early deaths. We need policies that are fit for purpose and interconnected. We also call for a joined-up approach between support services within primary and secondary healthcare but also the third sector.

C) Information and Education

In our experience, women experiencing MCN are linked in with a variety of systems and services: the prison system, alcohol and substance misuse services, adult social care, domestic abuse and the physical and mental health services. The one commonality though is women are left feeling that these systems operate in isolation and information is not being shared.

This is two-fold:

  • Information about the clients is not being shared across services effectively and our clients need to consistently repeat their stories which can be re-traumatising;
  • Health information is not being shared between services and systems. Trusted relationships, such as key workers, might be outside of the clinical healthcare system but are crucial to provide support, information and education to clients.

We appreciate that there is an acknowledgement of education and training for healthcare professionals on specific physical and mental health issues being needed in the Vision, but we would also like to see training on trauma informed approached and a less siloed approach between physical and mental health as well as the wider NHS services, adult social care and the third sector.

D) Health in the workplace

FLSE has employed a total of 41 individuals with lived experience of MCN, through its employment programme. You can read our findings from the employees’ perspective here and the employers’ point of view here.  

We would encourage greater attention on supporting the health and wellbeing of those with experiences of multiple and complex needs in the workplace and see this support as an enabling factor, helping people with lived experiences re-enter the workplace as well as supporting their health and wellbeing.

E) Research, evidence and data

Due to the high complexity of clients, we call for an open-ended, tailored and individualised approach. We believe that the healthcare system unfortunately is not always prepared to support women who experience multiple and complex needs or reach out and include them in research studies. FLSE would welcome a new, more collaborative and inclusive way of working to enhance the reach of research because historically women experiencing MCN have been under-represented in data and research.

Our project’s Research and Evaluation Officer has produced a toolkit to support researchers with practical advice and tips on applying the principles of trauma-informed practice to their research activities, specifically running focus groups, one-to-one interviews, and service observations. It is suitable for evaluators, researchers, service leads, commissioners, or anyone who would like to find out more about the experiences of people who may have been affected by trauma. This can be found here.

  1. OUR CONCLUSION AND BEST HOPES

In our experience, the key to providing better healthcare to women experiencing MCN is accessibility and flexibility. This is also supported by the King’s Fund ‘Interventions to tackle health inequalities need to reflect the complexity of how health inequalities are created and perpetuated, otherwise they could be ineffective or even counterproductive.’

FLSE is based in Brighton and East Sussex which means that our clients have worse health outcomes due to coastal inequalities, than in other areas as explained by Chief Medical Officer Prof.Chris Whitty’s annual report 2021.

Nonetheless, we hope that our contribution to the call for evidence for the Women’s Health Strategy will contribute to a better system for women experiencing multiple and complex needs.

That is why our best hopes for the Women’s Health Strategy are that:

  • Multiple and complex needs is recognised as a population category in itself, alongside disabilities and minorities.
  • There is recognition that some of the listed priorities (such as gynaecological health) can be traumatising or re-traumatising for women who have experienced certain forms of abuse and women experiencing/who have experienced MCN. As a result, high quality trauma informed training needs to be provided to all healthcare staff (incl.GP receptionists) and that the training includes the voices of lived experience.
  • The different strategies (such as VAWG, Mental Health Act, Mental Capacity Act) are linked together and find a systemic way to collaborate more efficiently.
  • The life course approach to include social determinants of health, as well as more joined up working, so that we move away from a focus on singular health issues, towards more joined up approaches to complex health conditions such as coexisting conditions mental ill health and substance use.

With kind regards,

The Fulfilling Lives South East team

Authors:

Michaela Rossmann, Systems Change Officer

Rebecca Rieley, Systems Change Lead

For further information about Fulfilling Lives work in this area, please contact:

rebecca.rieley@sefulfillinglives.org.uk  

michaela.rossmann@sefulfillinglives.org.uk

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Stronger Together – How Temporary Accommodation Action Groups are achieving Systems Change

Fulfilling Lives South East

Improving unsupported temporary accommodation and the experience of those with multiple and complex needs living in this type of accommodation has been a focal point of Fulfilling Lives’ work over the past 8 years. With the use of Temporary Accommodation (TA) at an almost two-decade high  identifying the most effective ways to find solutions to the issues faced by those in TA is increasingly important. In this blog, we will tell the story of the East Sussex Temporary Accommodation Action Group (TAAG) and explore the successes of the TAAGs more widely in creating real change in this area.

“A Temporary Accommodation Action Group (TAAG) is a local initiative that brings together the key temporary accommodation stakeholders in the city to collaborate to improve the lives of those without a home.”

Justlife

Through our casework with people experiencing multiple and complex needs (MCN) placed in unsupported TA by Eastbourne and Hastings Borough Councils, we found there were recurring issues that were leading to repeat cycles of homelessness. These included a lack of support for specific needs, and lack of staff understanding of how past trauma can affect behaviour often leading to evictions.

Discussions with representatives across the sector, including support services, local housing authorities and TA providers culminated in a local learning event which highlighted the importance of partnership working and taking a local systems change approach to the problem.

The consensus was that forming a multi-stakeholder group would be welcomed and so a few months after the event, the first East Sussex TAAG was held. This has now developed into a regular, well-attended action group chaired by the Chief Executive Officer of Eastbourne Citizens Advice. 

Fulfilling Lives’ approach to systems change recognises that change is rarely something we can do in isolation and through our work locally we knew that there were individuals within the system who were demonstrating person-centred and trauma-informed practices. As a project we wanted to listen to that wisdom from within the system and help to build on positive behaviours to create change.    

By taking a collaborative and democratic approach, a common set of values and shared purpose was established within the group. A space was provided for members to raise concerns and build group-led solutions to the challenges associated with unsupported TA. The TAAG is also  a forum for learning and connecting, to reduce siloed working and identify opportunities for further collaboration. With Fulfilling Lives’ scope spanning across East Sussex and Brighton & Hove, we have been involved in the TAAGs in both areas and have used this position to utilise our learning widely.

A significant initiative arising from the East Sussex TAAG was the Temporary Accommodation Charter, which was developed from research carried out in 2018 by Eastbourne Citizens Advice into people’s experiences of living in TA. The Charter sets out a reasonable standard of emergency accommodation and provides an established agreement between the local authority and TA providers to help residents break away from homelessness. Building on the work of Eastbourne Citizens Advice and the East Sussex TAAG, Fulfilling Lives collaborated with Justlife in Brighton & Hove to develop a similar charter and after working closely with local TAAGs, it was agreed by Brighton & Hove City Council to include the higher quality of standards in their contracts with TA providers. With Eastbourne due to release its new Service Level Agreements (SLAs) for Temporary Accommodation providers, we hope to see the embedding of the Charter standards within these contracts too.

Reflections

The dedicated commitment of support services to the TAAG has continued to centre the client in the thinking and actions of the group and has led to an increased awareness of the issues faced by those at the intersection of multiple disadvantage. From this consolidated place, the TAAG has been able to think strategically about change at both a local and national level.

The newly formed All Party Parliamentary Group on Households in Temporary Accommodation, functions as a national forum with support from either end of the political spectrum to address the issues in TA. This presents an opportunity for the TAAGs to share their learning gained at a local level to influence and enact changes to national policy.

While striving for long-term solutions to the housing crisis continues to be necessary, it is important to acknowledge that for now, the use of emergency and temporary accommodation is only set to increase. Despite its prevalence, the hidden nature of temporary accommodation means it is largely excluded from strategic conversations around tackling homeless, further emphasising the value of the TAAG as a dedicated space for improving standards in TA. With this in mind, Fulfilling Lives encourages the increased use of TAAGs and the sustained and proactive involvement of local authorities and temporary accommodation providers in these groups. Local TAAGs should also be utilised in the evaluation and gathering of feedback on the standards in temporary accommodation. We recommend that, in line with the monitoring and evaluation standards as set of out in the Charter for Temporary Accommodation that “a person with lived experience of emergency accommodation and a representative with learned experience from a voluntary sector group on behalf on the Temporary Accommodation Action Group (TAAG) should take part in inspections, contract meetings and gathering feedback from residents. This should all be reported back to the TAAG.”

To learn more about our Systems Change approach and work with TAAGs, read our article for the academic journal Housing, Care and Support due to be published this Spring.  

‘If you are interested in setting up a TAAG, click here

Authors:

Eve McCallum, Systems Change Officer

For further information about Fulfilling Lives work in this area, please contact:

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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