Thank you & farewell from FLSE

Here we are, at the end of the eight year Fulfilling Lives South East Project, and what an incredible journey it’s been.

The project has involved many people and we have learned and achieved so much. I remember speaking at the project’s launch event in 2014 looking forward into an unprecedented eight years of funding with a brief to change individuals lives, improve services and influence systems. I believe we have made an impact at all three levels.

We have forged new partnerships and connected with like-minded people right across Brighton & Hove and East Sussex. We have developed innovative projects, forged a model of co-production that others wish to emulate, we have influenced national policy, informed new governance arrangements locally, and advocated so that individuals experiencing multiple disadvantage have been recognised locally as a strategic priority. We have hosted learning events and conferences, engaged in national debates, participated in local partnerships, facilitated new networks, used data to shine a spotlight on people’s needs and case studies to celebrate their achievements but most of all we have ensured that individuals facing multiple disadvantage are not ignored, othered, labelled or given up on.

Although we have achieved a lot the work is not over. There is still much to do. Still shocking inequalities experienced, individuals let down by services and facing early death, stigma and discrimination. It is now time to hand over the baton to you to continue the work to effect positive change. The next chapter for multiple disadvantage has already started with the government’s Changing Futures programme, which arguably would not have come about had it not been for the work of Fulfilling Lives.
Thank you to everyone who has been with us on this journey. To our host organisation BHT Sussex, who have trusted the project to act with autonomy yet offered ongoing support and stable leadership. To every single person who has worked or volunteered on the project since 2014. To our clients who bravely shared their stories and inspired us to continue this work, even on the tough days. 
Thanks to our partner agencies and delivery partners who helped us to shape best practice, model trauma-informed, assertive yet compassionate case coordination and crush the myth of ‘non engagement’. To our national partners across the country, sources of peer support and inspiration. Finally, to our great colleagues at the National Lottery Community Fund, without whom none of this would have been possible. To be trusted to try new things without fear of failure has been a rare gift which has been cherished.
From 1st July, Fulfilling Lives South East as a project will cease to exist, as team members join past colleagues in moving onto other roles and opportunities. The team has evolved over the years and people have joined and left along the way but what has remained has been a consistent thread of collaboration, compassion and hope that we can make a difference and that things can change for the better. We sincerely hope that Fulfilling Lives as an ethos and repository of ideas will live on. BHT Sussex will be the custodians of the learning resources we have developed and they will curate the Fulfilling Lives webpages for the next period.
For the next phase of change it is up to you, and to us.
From Fulfilling Lives, this is thank you and good bye, and please remember you can be the change you wish to see.

Over and out 😊

Co-production: Definition is in the detail

“Co-production is a high level of such participation that involves sharing control with those using (or who have used) a service, and ensures they have equal influence over the design, delivery and commissioning of any service that affects them.”

The above quoted text is the official Fulfilling Lives definition of co-production in the context of working with people who have experience of multiple and complex needs, as shown on our website.  It isn’t dissimilar to other definitions which can be found by searching for the term online.  The idea is simple and speaks for itself, yet when considering working in this way, this definition and many others can become increasingly vague.  It is a way of working that can be applied to a wide variety of activities and projects within differing organisations.  These projects and organisations will have their own ethos, goals, values, management structure, rules, regulations, policies, guidelines, and other restrictions on flexibility that need to be considered when deciding to co-produce.  Furthermore, there isn’t one way to approach co-production.  The same task can be divided a multitude of different ways.  It is up to you (all) to decide on the best approach to meet your goals, while considering who you are working with, the skills and interests they possess, and the various regulations previously mentioned that may restrict choice and freedom.

At Fulfilling Lives, we aimed to co-produce from day one of the project being in operation.  As well as a systems change project, we are an experimental one.  We have learned about co-production along the way and evolved our practices accordingly to fit our purposes.  It is through trial and error, continuous reflective practice, regular analysis of how we operate, and regular feedback from those we are co-producing with that has helped us to see the challenges and nuances of the co-production process.  From this, we are better able to foresee potential sticking-points or areas of conflict that may emerge.

An example in practice:

As an example, consider co-producing in the following scenario:

Co-ordinated by a member of staff, a service user group decide to produce an information brochure to help others navigating social services’ childcare proceedings.

Questions or dilemmas that might arise during the process:

  • Are we being inclusive and accessible?
  • Do people feel confident and knowledgeable enough to meaningfully contribute?
  • Who has personal experience of childcare proceedings?
  • How might taking part impact service users? – discuss with them.  What emotional support might they need and is this available?
  • Have you asked service users what they will need to complete their task e.g. regular check-ins with their mentor? Do they feel they can reach out for help if they need it?
  • If someone wants to drop out, do they feel they can let us know so the work can be undertaken by someone else and completed before any deadlines?
  • Is there a member of staff who would need to authorise the content and design?
  • Are there branding guidelines that need to be followed?
  • Does anyone have design experience?
  • What is the division of workload?
  • Who can commit?
  • Do the group want to work on the whole brochure collectively, or would people prefer to own sections from start to finish?
  • Should people have specific roles based on personal experience and interests?
  • Should someone be responsible for ensuring the writing flows consistently throughout the final document?
  • If someone can’t make a session, are they happy for someone else or the group to take on their work?
  • Should people be appointed the power to override decisions based on their expertise or experience?
  • What if there is a conflict over content or design?
  • Does the final product have to be of professional quality?

This is not an exhaustive list of potential questions that may come up, but it serves to illustrate the intricacies of power sharing and the nature or working in a co-produced way.  Thinking about the questions and challenges that may arise has several benefits; firstly, it demystifies the unknown.  When you can visualise what’s up ahead, it’s less intimidating getting started.  Secondly, it will help avoid or manage potential conflict while minimising occasions when you may have to explain why a suggestion may not be possible.  Saying ‘no’ highlights a power difference, can result in people feeling rejected, and can shake trust in the relationship and faith in the process.  Like any members of staff, service users need as much clarity and transparency on their role and the work they are taking part in right from the start.

What Co-Production is NOT ….

Exploring questions around barriers and restrictions is one way of gaining clarity when co-producing.  Another, is to think about areas of uncertainty around what does and does not count as co-production: 

  • Co-production is not about individual agendas  
  • Co-production does not mean an equal share of the workload 
  • Co-production does not mean all group members need to commit an equal amount of time 
  • Co-production does not mean equal accountability and responsibility 
  • Co-production does not preclude the project group having a leader/manager/coordinator 
  • The co-production process in not free from rules and limitations 
  • Ideas and opinions shared when co-producing a piece of work does not mean they are all equally considered by default.  It is important to remember that there is a common goal as defined by the objective, and that ideas should be considered on their merit and relevance  
  • Co-production is not assuming everyone will want to be involved 
  • Co-production should not be tokenistic  
  • Co-production is not consultation 
  • Co-production does not mean an individual must be part of the process from start to finish 

Connecting all the pieces for your project ….

Through curiosity about the process and discussions with service users, over time you’ll gain a more complete picture of what co-production will look like in the project you are taking part in, like piecing together a jigsaw puzzle.  We would suggest starting with the vital things that need to be in place – how will you co-produce in a trauma-informed way that keeps people safe, enables them to make informed choices, work collaboratively, build on relationships of trust, and honour everyone’s voice? There may always be elements of unpredictability and uncertainty when compared to the standard role-based hierarchical management structure, and it is important to be transparent about these from the start, as far as possible, with everyone taking part.


Ian Harrison, Engagement and Co-production Worker

Vikki, Engagement and Co-production Worker

For further information about Fulfilling Lives work in this area, please contact:, Co-production and Engagement Lead:

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Common Ambition and Fulfilling Lives South East- a flourishing partnership

In this blog we reflect on a productive partnership that has helped nurture systems change. We look at what elements most contributed to this relationship and the role coproduction can play in catalysing change.

Common Ambition and Fulfilling Lives South East (FLSE)

The Brighton and Hove Common Ambition project works with people who have lived experience of homelessness, frontline providers and commissioners in order to improve health services and outcomes for people experiencing homelessness in Brighton & Hove. This is done through co-production. Common Ambition is funded by Health Foundation and is run in partnership between ARCH Healthcare, Justlife, University of Brighton, Brighton and Hove CCG and Brighton and Hove City Council Public Health Department. Funding was secured in 2021 and the project is guided by a passionate steering group of experts by experience.

The FLSE project, based at BHT Sussex, is one of 12 partnerships funded by the National Lottery Community Fund to provide intensive support for people experiencing multiple and complex needs, involve people with lived experience at all levels and challenge and change systems that negatively affect people facing MCN. While this eight-year project will soon be coming to an end, we recognised the potential of collaborating with Common Ambition.

At FLSE, we were keen to collaborate with the Common Ambition team from the start; we saw a real opportunity to share our learning while amplifying our voices to champion for changes in healthcare services and systems to improve outcomes for people experiencing homelessness.

What we did together

Ever since early 2021, monthly catch ups between staff members helped facilitate a collaborative approach, providing a regular space for exchange. Nicky Pyper, Project Manager of Common Ambition, says ‘The support Fulfilling Lives has given Common Ambition since the very beginning of the project has been invaluable. Always on hand to discuss arising issues, share learnings and make connections, we would not be where we are now without them. The monthly catch ups have been really useful as a place to share best practice, look at how we can work together and ask for advice. Then knowing the team were always willing to share their knowledge or could point us in the right direction for help when we were designing the project, bringing our lived experience groups together and then carrying out research was such a support to the project.’

We invited Common Ambition to internal Project Group meetings about promoting changes to address health inequalities, shared our reports and blogs and invited the Common Ambition team to our Action Group to get first-hand accounts of service experiences from FLSE volunteers with lived experience.

Both FLSE and Common Ambition teams share a commitment to co-production and this was an important part of our partnership work. FLSE has worked for eight years to test lots of ways to bring co-production to life and have learnt useful ways to align co-production and systems change efforts. We wanted to share the FLSE approach and learning of facilitating co-production in practical systems’ change projects to support the Common Ambition team shape and set up their co-production approaches.

Co-producing with partners and people with lived experience weaves authenticity and integrity into the fabric of systems change.  It makes sense to involve the people who will be using services in their design, delivery, and evaluation, and to work closely with those who know them best to ensure a safe, accessible working environment.  Furthermore, the professional relationship that develops as a result of inclusive, equitable collaboration is different in quality to one that does not prioritise these approaches.  When all invested parties work together towards a common goal, without rivalry or a defensive position, the partnership becomes supportive in nature; with the attitude that we are helping each other to achieve a common goal.  This mutual trust is the foundation for a respectful, strong, supportive, and effective partnership.

Sharing learning – a deeper dive

One of the highlights of this collaboration was FLSE’s Service User Engagement team creating and facilitating custom-made training sessions for Common Ambition’s Steering Group members. The sessions focussed on topics such as confidentiality, professional boundaries, mutual respect, effective communication, active listening as well as what real co-production looks like in practice and how it is different from other forms of engagement.
Our team adopted a trauma-informed lens while co-designing the sessions. Prior to the training, our team visited a steering group meeting to familiarise themselves with the members of the group and find out what their expectations and asks were for the content of the sessions – what and what not to include. Then, we invited the staff from the Project to review and feedback on the training to account for any sensitivities or requirements and ensure that we enhanced the group’s ongoing learning. This was a successful strategy because it allowed us to build an open and trusting relationship from the very beginning and develop a sense of psychological safety for the group members. This was also reflected in the feedback we received from the participants, with all of them giving us a 10/10 score to the question whether they would recommend us to a friend or colleague.

For us, these are the three tips to consider when facilitating workshops for service user groups:

  1. Get to know your audience and use a trauma-informed approach based on principles of safety, trust and transparency, choice, collaboration, and voice.
  2. Address barriers to inclusion which can be thought of in terms of making language accessible, accounting for any mobility/disability issues for example.
  3. The topic you present on may be entirely new to your group, so be prepared to tailor your session and change tack if any tricky situations arise.

Nicky Pyper commented about the training that “We can’t thank the Fulfilling Lives team enough for the fantastic training you delivered. It was exactly what the group wanted and was thoroughly sensitive to the group’s needs throughout. It was the perfect mix of presenting, group work, activities and discussion. The group all commented on how great the trainers were, in particular noting their down to earth and caring approach. It didn’t feel like we were in a classroom setting, rather that the whole group was going on the journey together. Group members commented that they felt like they learnt a lot. We will be building on the work Fulfilling Lives did with us and making sure we revisit our learnings regularly.

Looking to the future

As FLSE is now reaching the final stage of the project, we are proud to know that Common Ambition will continue influencing the system to make primary healthcare more accessible to and impactful for people experiencing multiple and complex needs.

Michaela Rossmann from the FLSE team reflected that “being open and proactive in partnerships is key when trying to influence systems. For me, sharing learning and supporting each other, finding commonalities and focussing on the positives are what makes the partnership with Common Ambition so unique. It’s built on trust, mutual respect and understanding. Common Ambition has been an ally for FLSE from the start and it’s been great to see the project go from strength to strength.”

Nicky Pyper reflected that “Common Ambition will carry on the FLSE legacy of putting the voice of those with lived experience at the heart of system and service change and will continue to advocate for co-production. We will also be continuing to shine a light on ‘Bright Spots’ and raising awareness around the challenges people experiencing MCN face when accessing and using healthcare services. Areas that our lived experience groups have found particularly interesting are the implementation of frailty scores for people experiencing MCN and treatment in A&E, we hope to continue to explore this.”

For more information about FLSE’s systems change work to address health inequalities please read our Ripple Effect impact report

For more information about the Common Ambition project, please visit their website


Michaela Rossmann, Systems Change Officer:

Aditi Bhonagiri, Engagement and Co-production Worker

Ian Harrison, Engagement and Co-production Worker

Rebecca Rieley, System Change Lead

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

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How Multiagency Meetings Can Join Up Support

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


Alan Wallace, Systems Change Officer

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

Alan Wallace, Systems Change Officer:  

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How Multiagency Forums Can Influence Systems

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.


Alan Wallace, Systems Change Officer

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

Rebecca Rieley, Systems Change Lead:  

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

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.”


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.


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


Eve McCallum, Systems Change Officer

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

Rebecca Rieley, Systems Change Lead:  

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Reflecting on women’s health on International Women’s Day  

Working alongside clients with multiple and complex needs (MCN) / multiple disadvantage has shown us that the vast majority have a physical health problem or problems. Many have a combination of long-term chronic conditions such as liver cirrhosis, hepatitis C, diabetes and circulatory diseases. The female clients we have worked with have more complex and chronic conditions compared to men. A number of factors contribute to this, including the impact of domestic abuse and violence, as well as the stress on the body from rough sleeping. The average life expectancy nationally of homeless people is low – for men this is 47 years of age, for women this is 43 years of age.

Our recent research into the deaths of people facing multiple disadvantage who were supported by Fulfilling Lives South East (FLSE) over the past seven years, supported national research findings that individuals facing multiple disadvantage are more likely to experience premature death compared with the general population (Aldridge, 2018). With some of the most complex cases, FLSE had the highest mortality rate across the national programme. Restricted access to healthcare is a recurring theme in our casework.

This recent research captured in our How can we avoid treatable or preventable deaths of people facing multiple disadvantage? found that:

• Of all the Fulfilling Lives South East clients who died in hospital of preventable or treatable conditions; 75% were women (6 clients), compared with 25% who were men (one client).

• Of all the FLSE female clients who died, 100% were from preventable or treatable causes in hospital, without inquest or further investigation.

• The average age when clients died was slightly higher for women (42 years), compared with men (41 years)

What does this mean about healthcare for women who face multiple disadvantage? As women, do they experience additional levels of health inequalities?

Our project believes that women facing multiple disadvantage are more likely to have more complex health issues and are more at risk of premature death. Our client work suggests the healthcare system struggles to meet their needs even more so than men facing multiple disadvantage. Our case studies highlight the complex trauma experienced by women who received support from across FLSE, culminating in very complex health needs. This evidence clearly illustrates why women’s specific healthcare services are paramount and could ultimately reduce or prevent premature deaths of women facing multiple disadvantage.

The National Women’s Health Strategy

In June 2021 FLSE fed into the government’s ‘Women’s Health Strategy Review’. It was recognised by the Secretary of State for Health and Social Care that, “For generations, women have lived with a health and care system that is mostly designed by men, for men.”

In response, we recommended support for:

• Women only spaces in healthcare settings, such as sexual health clinics.

• Specialised healthcare services for women with MCN.

• Making appointments should be flexible (not only online or phone) and offer walk-in clinics.

• The frailty score should be used for women (and men) with MCN to offer healthcare services more quickly, using the ‘Edmonton Frail Scale’ (Rolfson et al., 2000).

• Making trauma-informed approaches training compulsory to all healthcare professionals.

• Improved coordination of support services for those with comorbid mental health and substance misuse conditions.

We have further fed into the discussion about the future Women’s Health Strategy. At the end of 2021, the Government released details of its Vision for the Women’s Health Strategy for England, informed by feedback received in the call for evidence.

We have reflected on this Vision as a team and welcome some of its strategic intentions, particularly to shape services by taking a ‘life course approach’. However, there are some areas we feel need strengthening to better meet the needs of women with MCN. We have shared these reflections with the Maria Caulfield MP for Lewes who is leading the development of the Women’s Health Strategy.

Key reflections on the Vision for Women’s Health Strategy include:

Women’s Voices: 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.

Healthcare Policies and Services: 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.

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. We would like to see training on trauma informed approaches to promote shared language and approach to healthcare services that could enable a less siloed approach between physical and mental health as well as the wider NHS services, adult social care and the third sector.

Health in the workplace: We would encourage greater attention on supporting the health and wellbeing of those with experiences of MCN 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.

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 MCN 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 as such are often missed out of policies and strategies.

Our best hopes for women’s health  

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 recent contribution to the call for evidence for the Women’s Health Strategy will contribute to a better system for women experiencing MCN.

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

  • MCN 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.


Rebecca Rieley, Systems Change Lead

Michaela Rossmann, Systems Change Officer

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

Rebecca Rieley, Systems Change Lead:  

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Finding Bright Spots in Primary Healthcare 

Our clients’ journeys and experts by experience have highlighted that access points to the primary healthcare system are challenging for people with multiple and complex needs (MCN). These challenges grew for many during the start of the Covid-19 pandemic and at Fulfilling Lives South East (FLSE) we could also see the stresses and strains the system was trying to manage during 2020-21. 

As a project, we knew that there are amazing healthcare services out there supporting people with MCN but we didn’t know exactly what separates those services from the mainstream ones. We wanted to better understand what enables people with MCN to access primary healthcare, and what constitutes as ‘good’.

So, we created a sub-group across our internal teams and experts by experience. Together, we developed our criteria for services that could be described as ‘good’ in enabling people with MCN to access primary healthcare services and engage with healthcare support. These criteria helped us decide who to interview and who we could learn from.  

The criteria were:

  • Flexibility 
  • A caring attitude 
  • Professionalism 
  • Continuity, consistency and collaboration 
  • Trauma-informed practice 
  • Psychologically informed environments 

The group then identified the following four services across Sussex that [IH1] [MR2] encompass these criteria – these became our ‘Bright Spots’ in the system.

The FLSE sub-group was keen to follow robust research processes to better understand and learn from these four services.  That is why we used the Positive Deviance model as our main approach and the Appreciative Enquiry model to conduct our four separate interviews.

The interviews we conducted with ARCH Healthcare, Seaview, St. John Ambulance and the Rough Sleeper Initiative made it clear that there are recurrent issues across the healthcare services in Sussex. Some of them include lack of flexibility, being siloed and under-resourced. Our four Bright Spots services have also identified common practices that enable community and healthcare services to be efficient and effective for people experiencing MCN. Organisations, no matter how big or small they are, need to collaborate with each other, provide multi-disciplinary teams and put people they support at the centre of everything they do.

The Bright Spots

The four Bright Spots had shared views on the top three ways to improve health services for people with MCN:

1) bring the services to them in a flexible way;
‘We really recognise that it’s not the easiest thing for clients to attend booked appointments. So, we are trying to make it as flexible as possible for them. Our day centre is also open on weekends when other services are closed.’ Dave Perry, Chief Officer, Seaview.

2) a collaborative approach between services (not just signposting);
‘Multi-disciplinary drop-ins have allowed the team to work informally with individuals and to engage with historically hard-to-reach groups on their own terms.’ Becky Jackson, County Coordinator, RSI.

3) invest in staff, training and resources
For Roger Nutall at St.John’s ‘both, debriefing and training, is to make sure that the team has time and space for reflections in order to learn from each other, find solutions as well as gain new skills.’ Gary Bishop from ARCH Healthcare agrees and says that ‘(we) understand the importance of recruiting the right people for the job. (Our) workforce receives coaching, mentoring and supervision.’

At FLSE, we strongly believe in the power of partnership. We also believe that the role of commissioners is to nurture systems change and help services develop more accessible, responsive, flexible and coordinated approaches for those with the most complex needs. 

We understand that due to Covid-19 and resource constraints, the health system is currently overburdened and treatment waiting times are increasing. 


We do think though that there are quick wins which could be implemented in the short term by commissioners and healthcare providers to improve access to primary healthcare for people with MCN. These have been informed by our Bright Spots learning and are shared below in a  set of recommendations: 

  1. Investing in existing services with long term funding 

We already have four very different Bright Spot services in Sussex and think that the first step is to expand and replicate services which are already working well for our clients. Continuity is a crucial element for our clients to start trusting services and only long-term funding and investing in staff members can help with that.

2. Putting people first 

We need a cultural shift towards a trauma-informed system for patients, volunteers, experts by experience and staff members. This approach in turn will help facilitate more agile, multi-disciplinary collaborations.

3. Building relationships 

Building trust, taking time to invest in relationships and connecting with patients, agencies and teams can improve care for patients. It’s about creating a community of best practice, learning from each other and sharing information. With this in mind, we advocate for the concept and practice of co-production  to be introduced in primary healthcare settings to inform service design and delivery. 

4. Offering choices 

Our Bright Spots have identified that for people with MCN, a mix of contact-points is needed which include in-person appointments, phone calls, texting, outreach, mobile healthcare support out in the community, and access at weekends.
We would like current and future services to include a variety of engagement options as a standard way of working with people experiencing MCN, led by staff teams that are enabled to offer support in flexible ways. 

Therefore, we would like to call on commissioners and decision makers to include the above set of recommendations in any future funded service that aims to improve the health and wellbeing of people with MCN.

Read the full report here: ‘Bright Spots’: What enables people with multiple and complex needs to access primary healthcare?


Michaela Rossmann, Systems Change Officer

Ian Harrison, Engagement and Coproduction Worker

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

Rebecca Rieley, Systems Change Lead:  

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Empowering staff in Temporary Accommodation to best support people with Multiple Complex Needs 

The crisis in housing supply and growing numbers of people becoming homeless, has resulted in increased pressure on local authorities to source and provide temporary accommodation. Higher numbers of people with multiple and complex needs are being placed in unsupported temporary accommodation (TA) and in turn TA staff have become a key part of peoples’ journey out of homelessness.

Fulfilling Lives’ research shows that from our clients in TA, 57% of placements broke down due to behaviour or failure to comply with their accommodation provider’s licence agreement and expectations. With staff not trained to work with people with multiple and complex needs (MCN), behaviours that arise as a result of trauma can be seen as too challenging for the environment. As a result, clients can be evicted quickly and find themselves back at square one, in need of accommodation.

“We have experienced multiple situations where a TA resident has displayed progressive changes in their behaviour which have ultimately resulted in cancellation of their booking. Examples might include failure to maintain medication, depression or relapses into substance abuse. We are keen to find solutions to reduce the frequent cycles in TA and support progress towards stable living.”

TA Provider

As identified in FLSE’s Manifesto for Change, establishing acceptable minimum standards of training and quality for temporary accommodation providers is essential if local authorities are to use them in providing TA for people with MCN.

Over the past three years, Fulfilling Lives has facilitated training sessions for providers of temporary accommodation on how to better support people with multiple and complex needs. These sessions were led by members of the Service User Engagement team and client facing workers and gave insight into the experience of people with MCN and offered practical tools on how staff can support this group.

The sessions:

This training took place in a number of temporary accommodations across East Sussex and explored topics such as Stigma, Psychologically Informed Environments and Trauma, in the context of working with people with multiple and complex needs.

The training sessions were led by the FLSE team, and set out the following aims:

  • To introduce the learners to the concepts of – Multiple and complex needs (MCN), the impact of trauma on MCN clients, brief introduction to trauma-informed approaches (including psychologically informed environments PIE) and establishing professional boundaries with the client group. 
  • Share with learners the experiences of people with lived experience, including the impact of stigma, with a view to promoting increased empathy and understanding.  
  • The hope is that staff will feel more confident in working with people multiple and complex needs who are placed in temporary accommodation, and that these clients will have better outcomes such as increased ability to sustain a placement and better relationships with the staff. 

Feedback gathered from learners before and after the sessions highlights the positive impact training has on the understanding and confidence of staff. Learners gained knowledge around the impact of trauma and how this can present itself in the clients they work with.

“Trauma is not the event, it’s the person.”

Another learner said they would go away and particularly consider the impact of first impressions when working with MCN clients –

“The impact of first impressions on someone that is likely to be in a chaotic or stressed state. Their ability to retain information will be reduced as a result.”

A particularly valuable element of the training that was mentioned again and again in feedback was the opportunity to hear about the lived experience of temporary accommodation from the FLSE Project Consultant.

“I was really impressed with [the Project Consultant’s] story as having a real person’s account makes it more relatable”

The session received a net promoter score of 100, meaning that it was rated ‘excellent’ by attendees. Respondents valued the real-world insight gained on working with complex trauma and with multiple and complex needs.


It is clear that adequate training empowers staff to best support people with multiple and complex needs and establishes a greater understanding of the impact of trauma and challenging behaviours.

In line with our commitment for change, set out in our Manifesto, and based on the positive feedback from Fulfilling Lives’ training sessions, we recommend the following:

  • The adoption of minimum standards as documented in The Emergency Accommodation Charter, which requires TA providers to train their staff with a focus on safeguarding, Multiple Complex Needs awareness and trauma informed care (TIC) and Psychologically Informed Environments (PIE) approaches.
  • For local authorities to embed Fulfilling Lives’ multiple and complex needs training videos within their online induction resources and for these videos to make up part of the mandatory training for staff in temporary accommodation.

For residents in temporary accommodation to be asked for regular feedback on their accommodation, including a section on staff conduct and adherence to trauma-informed principles.


Eve McCallum

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

Rebecca Rieley, Systems Change Lead:  

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Mental Health Act review- the Government’s responses and our feedback

In April 2021, the Fulfilling Lives South East (FLSE) team responded to the government’s Mental Health Act review and published a blog detailing our responses and thoughts.

We called for:

  1. A commitment to invest in local mental health support services.
  2. The Advance Choice Document to include a Nominated Person instead of next of kin.
  3. To offer more advocacy support, ideally peer led, to help patients’ voices be heard.
  4. The new guiding principles of choice and autonomy, least restriction, therapeutic benefit and the person as an individual to be integrated in day-to-day work.
  5. Trauma informed practice training to be introduced to all staff members.
  6. MCN and co-existing conditions to be recognised as a specific category.

1,700 organisations and individuals UK wide submitted their responses to the government, and it is reassuring to see that the majority of responses reflect our recommendations and suggestions.

The government reflected on how this wide-scale review had generated useful learning: ‘In 2017 the government asked for an independent review of the Mental Health Act 1983 (MHA), to look at how it’s used and to suggest ways to improve it. The review’s final report said that the MHA does not always work as well as it should for patients, their families and their carers. We’re now proposing a wide range of changes to rebalance the MHA, to put patients at the centre of decisions about their own care and ensure everyone is treated equally.’

Matt Hancock, Health and Social Care Secretary from January 2021 said in an oral statement to Parliament that ‘(…) this programme of transformation is ambitious and as we support mental health services now, so we must bring up to date the legislative framework also for the long term. The Mental Health Act was created so people who have severe mental illnesses and present a risk to themselves, or others, can be detained and treated. For their protection and the protection of those around them. But so much has changed since the act was put in place, nearly 40 years ago.’

Following the Consultation on the Bill between January and April 2021, the revised Act was released in October 2021.

Our Reflections

The FLSE team has since reviewed and reflected on this new content and would like to share our reflections below.

  • We welcome the introduction of the Advance Choice Document which focuses on facilitating patients’ recovery and patients with capacity to be able to refuse treatment, for their wishes to be respected and for the Mental Health Tribunal judge to give orders for treatments not to be given.  
    As set out in the White Paper, the government will take forward legislative changes to replace the Nearest Relative role with the Nominated Person role so that individuals can choose who represents them. 
  • Co-production and working with service users and carers is critical to the quality of advocacy services. 
    As set out in the White Paper, the government will take forward legislative changes to extend eligibility of Independent MH Advocate (IMHA) services to all mental health inpatients which means that their voices are being heard.
    The government will further explore with stakeholders the best way to improve the quality of IMHA services, whether through enhanced standards, accreditation, regulation, or increased training requirements. The government will continue to prioritise the development of culturally appropriate advocacy and work with stakeholders to ensure that ethnic minority backgrounds are considered as the reforms are implemented. 
  • The government is reviewing their position on the proposed time requirement for health and local authorities to deliver on directions made by the MHT, as a five-week timeframe might not be sufficient for those patients who require a complex care package. 
    We agree that there needs to be a focus on services in local communities (statutory and third sector alike) and for them to collaborate.
  • It is the government’s intention to take forward the proposals to increase the frequency of automatic referrals to the Tribunal as there have been concerns that some patients may never have access to a Tribunal hearing if automatic referrals are removed and that some patients “falling through the cracks.” 

There has been an acknowledgement that further development of the White Paper is needed when it comes to people with learning disabilities and autistic people and a commitment to discuss this further with an expert group. The need for appropriate community services was a common theme across responses to all of the learning disability and autism proposals. 

There are a number of areas that we believe remain unaddressed in the Act’s revisions:

  • We would very much like to get clarification on the type of training staff members will receive and how co-production is ensured across the system, not just advocacy services.
  • We are disappointed that ‘multiple and complex needs’ or ‘multiple disadvantages’ are not named and seen as a separate category in the MH Act.
  • It is also unclear what the commitment is to extra resources, funding and a timeline to implement these changes.


There is a commitment from the government to take the proposed changes further, which includes stakeholder engagement and individuals with lived experience saying that ‘The proposals made in the White Paper represent once in a generation reforms to the Mental Health Act (…). Our job is now to continue to develop a new Bill to reform the Mental Health Act. We have listened, we will continue to listen, and we will deliver on enacting mental health legislation fit for the 21st century – legislation which will provide for the protections and support for people with severe mental health needs, which will strengthen their voice, choice and rights, support the increased use of community alternatives to hospital, will limit the use of the Act for people with learning difficulties or autistic people, will improve support for offenders with acute mental disorders, and which will aim to address the racial disparities that have too long been part of the way the Act has been used.’

The Rt Hon Sajid Javid MP Secretary of State for Health and Social Care
The Rt Hon Robert Buckland MP Secretary of State for Justice

As it stands, there is no fixed timeline or secured funding to implement said changes, saying that ‘We intend to bring forward a Mental Health Bill, which will give effect to many of the changes we wish to make, when parliamentary time allows.’  We look forward to hearing more about concrete implementations of the White Paper soon.

The full government responses can be found here: 

Reforming the Mental Health Act – GOV.UK (


Ian Harrison, Engagement and Coproduction Worker

Michaela Rossmann, Systems Change Officer

Rebecca Rieley, Systems Change Lead

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

Rebecca Rieley, Systems Change Lead:  

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