Stonewater and Fulfilling Lives South East- Supporting Women experiencing Multiple Disadvantage in Refuge

In this blog we reflect on how effective partnership working can support new outcomes.


Stonewater and Fulfilling Lives South East (FLSE)

In 2021 Stonewater was awarded the new contract to provide refuge accommodation for women and children experiencing domestic abuse in Brighton and Hove

Stonewater is:

“…a leading social housing provider, with a mission to deliver good quality, affordable homes to people who need them most. We manage around 34,500 homes in England for over 76,000 customers, including affordable properties for general rent, shared ownership and sale, alongside specialist accommodation such as retirement and supported living schemes for older and vulnerable people, domestic abuse refuges, a dedicated LGBTQ+ Safe Space, and young people’s foyers.”

(source: https://www.stonewater.org/about-us/)    

The FLSE project, hosted by 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 (MCN), 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 value of collaborating with Stonewater.

At FLSE, we were keen to collaborate with the Stonewater team as we saw a real opportunity, when they were awarded the new refuge contract, to work together to share our learning of working in a trauma-informed way with women facing MCN and domestic abuse to help this particular group of women to better access and sustain their stay in refuge.

The importance of defining MCN or multiple disadvantage

There is much disagreement in this sector about the merits of having a unified definition of MCN or multiple disadvantage. There are concerns in some quarters around the negative effects of labelling on people experiencing multiple disadvantage. At FLSE we understand and respect this viewpoint. However, from eight years of learning, when it comes to the design and commissioning of services for this client group, we know that there is more risk in not naming multiple disadvantage than providing a clear definition. We feel this is important so that services are designed with the specific needs of this group, who are often excluded from services, in mind. For women experiencing intersecting needs including homelessness, mental ill health, substance or alcohol use, repeat contact with the criminal justice system and the repeat removal of children, when domestic abuse is added to this complex array of issues, it is vital that services are equipped to work with these women, who will all have experienced trauma and require an appropriate response.

Recently, FLSE worked alongside the Sussex Police and Crime Commissioner’s Office that led on the Needs Assessment – a requirement of the DA Bill – to assess the need for safe accommodation and support for victims/survivors of domestic abuse across Sussex. We coproduced a written submission detailing the specific needs of women fleeing domestic abuse using case examples from our client-facing work. We were delighted to read in the final Pan-Sussex Strategy for Safe Accommodation and Support for Victims/Survivors of Domestic Abuse that FLSE’s definition of multiple disadvantage was included and responsive to multiple disadvantages’ was cited as a key priority in the Strategy. We recommend that all agencies in Sussex use this definition when commissioning or designing domestic abuse services and safe accommodation options:

Multiple Complex Needs (MCN) has a variety of meanings in services and third sector organisations, depending on the needs of the client group. In general, MCN includes people on the edges of society who are often excluded from or who cannot access who is experiencing 3 out of 4 of the following:

What we did together

The FLSE team and Stonewater managers discussed ways we could work together to support improved outcomes for women with MCN.

In April and May 2022 the FLSE team delivered two training sessions for refuge staff. The first session focussed on complex trauma; its causes and how it manifests in behaviours and tools to manage potentially difficult situations and was informed by the refuge team feedback in a pre-training survey.

The second session focussed on deepening conversations around:

  • The window of tolerance.
  • Dissociation – being the most misunderstood responses and the most common in women and children experiencing domestic abuse and how to recognise and work with it.
  • Practising some grounding techniques and tools.
  • The working together tool.
  • Further reading and training that staff can access.

Impact

Following the two training sessions, the Stonewater refuge team felt they had a better understanding of:

  • The meaning of MCN.
  • What women experiencing MCN and domestic abuse might need.
  • Different trauma-related responses.
  • How to take a different approach to clients affected by alcohol and substances, including ways to organise a multi-agency meeting involving clients.
  • A number of staff reported feeling confident creating and using a Working Agreement.
  • All staff reported that they felt ‘completely comfortable’ now with using grounding techniques.

The Stonewater team felt that the collaboration and sharing learning had a positive impact on their work, with one staff member sharing:

“The training was absolutely excellent, I felt as though I learnt a lot and I have already used the working together agreement and the window of tolerance work sheets in my case work sessions”.

Looking to the future

As FLSE is now reaching the final stage of the project, we are proud to know that Stonewater will continue influencing the system to make refuge accommodation more accessible to, and impactful for, women experiencing MCN.

Sandra Sylvester from the FLSE team reflected that “it is so positive to see what can be achieved when working in a strengths-based way with a partner such as Stonewater, who have been open to learning from our 8 years’ experience to develop the tools they need to successfully accommodate women with complex intersecting needs, but also how to give the amazing staff the space to reflect on the difficult work and to provide opportunities to attend relevant training. It has been an honour to be part of this project.”

Wendy Sheehan from Stonewater, shared how enthusiastic the staff were to attend the two training sessions and how they really appreciated them being in person.

“The support and training that the Refuge team have received from Fulfilling Lives has been invaluable. The training was tailored to the specific needs of the team and was based on real life case studies.  The feedback from the team has been extremely positive and has improved their confidence with supporting women with MCN’s.  This will ensure that we can support more women with MCN a group that is often excluded from accessing many refuge services.”

Sarah Pugh, also from Stonewater, is in the process of developing the organisation’s training package and is using the learning from the training and partnership to inform the content of this framework.

“Refuge has to be more than just bricks and mortar and the practical and therapeutic support survivors, including children, receive is crucial to their recovery.   Stonewater are dedicated to ensuring that refuge staff have the opportunity for continual professional development and are equipped with specialist knowledge and confidence to support the multiple and complex needs that residents present with.  The feedback from staff who attended this training is overwhelmingly positive and has whet their appetite for more!  Learning in the field of domestic abuse and its radiating impact on all aspects of its survivors lives is continuous and we’re working on a Domestic Abuse training plan for all Stonewater employees, incorporating what we’ve learnt so far and utilising all the resources you have provided.  Knowledge is power, and effective training results in knowledgeable, skilled staff resulting in improved outcomes for survivors.   Thank you Fulfilling Lives, for your time and energy!”


Authors:

Sandra Sylvester, 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

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Co-Production……because it’s worth it! 

In our previous blog posts and on our website, we’ve talked in great detail about the how, the when, the who and the what of Co-producing with people with lived experience.  We’ve also shared our learning around the potential challenges, how to overcome them and how to be creative when co-producing.  In our final blog, we’ll look at what is probably the most important piece of the co-production jigsaw puzzle… the why. 


So, why is it better for a service to change from their established way of working to co-producing with service users?  

Firstly, it’s worth stating that the purpose of any service is to deliver that service to those who need it.  It should be accessible to everyone from any demographic.  In the context of our work, we are referring to housing, substance misuse, mental health, domestic abuse, and those related to prison release.  It can be difficult enough for someone to access any of these services even if they are experiencing a single complex need, and accessibility is a fundamental aspect of an effective service.  Service users are best placed to inform how the services aren’t accessible for them, either individually, or connectedly.  If they aren’t accessible for them, then the service hasn’t been designed for others in similar circumstances.  Working closely with the people who understand the needs of those falling through the cracks is the best way understand the service’s design flaws so the cracks can be filled.  They can tell you what needs to change and what they feel they needed from the service at that time in order to access the support on offer.  With every additional complex need, it becomes more difficult for someone to access a service on its terms.  Genuinely co-producing with people with lived experience of multiple and complex needs can help the service reach those in the most chaotic circumstances. 

If a service is co-produced from the start, it will be designed to be more efficient while making the best use of the resources available.  There will be fewer missed appointments due to improved accessibility, thus less wasted time and money while reaching more service users and increasing the chance of better outcomes. 

A service can be inaccessible even before attending an appointment.  The service’s reputation can help or hinder the staff who are offering support.  It may be that before someone walks through the front door and meets their support or key worker for the first time, they will have expectations that may be positive or negative based on word of mouth or service reputation.   If a service has been co-produced with those who use it, this will help to increase trust amongst the community it serves, leading to better relationships between workers and service users, and a greater chance for positive outcomes. 

Co-production can benefit service users not just by improving service provision.  Through the process of involvement, service users will be empowered with the opportunity to harness their experiences and direct them in a way that benefits others, providing purpose and a sense of belonging.  Furthermore, services who show trust and value in the co-production process can have a strong impact on the self-esteem, self-worth and confidence of the people taking part, while concurrently helping them to gain skills and experience.  This involvement can be a significant step in someone’s recovery journey.  It also represents a cultural shift in the way society views those with the most complex needs, paving the way for less stigmatising beliefs. 

There is a growing emphasis amongst funders to incorporate co-production into service design.   It is encouraged by procurement regulations and favoured by commissioners, so its value has been recognised.  Bids are likely to be seen more favourably when co-production is part of the service operation.  In these cases, it’s important that co-production is well understood so it can be implemented effectively. 

And finally, people have the right to be involved in their own care; professionals and service users working together to find the best path forward.  When someone is living in chaos, they may not feel they have much control over their own circumstances.  Working with someone in this way provides a sense of agency which can have positive knock-on effects in other areas of their life. 

Key Messages:

So, to summarise, co-producing with people with lived experience of multiple and complex needs is beneficial to the service and service user because: 

  • It is more efficient in the long run as the service will be set up to cater for the needs of all its users, with fewer wasted resources 
  • Outcomes will be better for service users and more sustainable 
  • Co-producing can lead to creative solutions to difficult, long-standing problems 
  • Involving people in their own care is the right thing to do and offers some control over their lives which may be lacking 
  • Service users gain skills and experience that can help prepare them for work 
  • Co-producing provides service users numerous psychological benefits such as a sense of belonging, purpose, and achievement, while building self-esteem, self-worth and confidence 

Below are some quotes from volunteers on co-producing pieces of work with Fulfilling Lives: 

“We had a voice, made me feel I’m not the only one who had experiences like I did at [service] as heard other people’s experiences doing this project, builds confidence. Not very often you have a voice. Hopefully speaking for people who don’t have a voice. We were trusted to do this – self-esteem, not being judged on our past” Service User Involvement Volunteer – FLSE 

 

“Possibility to have a voice. Feeling valid. Being given agency. It felt good to take difficult experiences and turn them into something productive and taking the chance to step into a more active role, after a long time of feeling powerless and hidden”  Service User Involvement Volunteer – FLSE 

— 

“Everybody should be part of decisions and making a change. Lived experience brings unique perspective, emotional intelligence. Can’t learn it from a textbook. Think that trying to heal and overcome hard times is a difficult and long journey but it also gives incredible insights into yourself and the world, for better and for worse. When the experiences of hard times collide with social services police and other systems, I think that insight and emotional intelligence is particularly valuable if not essential as a window into the client base”  Service User Involvement Volunteer – FLSE 

The only question that remains then is “When are you getting started?” 


Author: Ian Harrison – Co-Production and Engagement Worker

Thanks to colleagues & volunteers at FLSE: 

Vikki Hensley – Co-Production and Engagement Worker

Aditi Bhonagiri – Co-Production and Engagement Worker

Kate Jones – Co-Production and Engagement Worker

Andree Ralph – Engagement and Co-Production Lead

Service User Involvement Team Volunteers

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

ian.harrison@fbht.org.uk

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Clinical Supervision and how it can support the work of non – specialist client facing workers


What is clinical supervision?

Clinical supervision isn’t new, having been used for many years in a variety of healthcare settings, including mental health. Clinical supervision is a formal mechanism through which individual and professional development occurs by the worker reflecting and learning with the supervisor. People who receive clinical supervision have jobs that are emotionally demanding, in the case the of the Fulfilling Lives South East (FLSE) project supporting people with significant trauma histories and/or multiple and complex needs (MCN).  

A key piece of learning from the FLSE Perspectives Project and Perspectives Project: Part 2 work was how statutory mental health professionals could support non-specialist client-facing workers to safely hold high levels of risk. This blog shares learning and aims to illustrate the important role that clinical supervision can play, or could play, in providing a form of mental health specialist support via the worker to clients with a coexisting condition. In building confidence and knowledge in workers to understand the complex nature of this client group, develop appropriate methods for risk taking and sharing risk, managing worker wellbeing, and navigating complex systems when advocating for clients.

In what ways can clinical supervision help non-specialist frontline workers?

  • Feeling connected

Working in a role providing support to clients experiencing MCN on a one-to-one basis can be an isolating experience for the worker. The danger of vicarious trauma is more likely in this type of role when in your day-to-day work you are surrounded by complex trauma. Not having a space where you can discuss feelings and emotions that the work might be bringing up for you is an unsustainable approach that will lead to workers having to take time off sick. Clinical supervision offers a space for workers to process the emotional aspect of the work and understand the interplay in the client worker relationship. Being able to talk about what comes up when supporting clients to recognise transference and how this can conflict with your own attachment styles is vitally important.

  • Confidence and knowledge

Clinical supervision equips non-specialist client-facing workers with a framework of language that gives knowledge and confidence when adjusting to different audiences and situations. It can help workers advocate for clients using language that statutory mental health workers will recognise and listen to, as well more authoritative robust language to explain the risks and consequences of not responding to the needs of the client.

Additionally, clinical supervision supports workers to facilitate and lead multi-agency meetings that illustrate to partners trauma understanding and this helps other agencies work in the same way, modelling what good can look like when a multidisciplined team approach is adopted to working with complex needs clients.

Another way in which workers’ development of communication is important, is learning through clinical supervision how to interpret the client’s language as well as gauging what language is appropriate to use in response to a variety of situations that can and will arise when supporting MCN clients.

  • Innovative, flexible, new approaches

Services can be risk averse which stifles creative approaches to working with MCN clients. Working with this client group requires new approaches and time to build the vital relationships that set the foundations for positive support work to take place. Training staff to have the confidence, knowledge, and skills to work in this way is key to working in a trauma informed way. Non-specialist client-facing workers having the opportunity to discussion innovative ideas in clinical supervision where thinking can be refined, and potential risks can be identified, and mitigation strategies can be worked though. Is incredibly valuable and reassuring for a worker to know that a specialist is endorsing their case planning and now leaving the worker exposed to holding the risk alone.

  • Wellbeing and burnout

While clinical supervision is not therapy, it can be used for times when workers are triggered and to think about why that may be. Sometimes these discussions do not happen with managers until the worker has to go off sick and the reason for absence must be disclosed. Clinical supervision offers a regular slot in a worker’s diary where the focus won’t be frontline operational priorities, rather a time to talk with someone who isn’t part of their day-to-day working life. This protected time affords the worker safety to disclose issues and feelings resulting from the nature of the intense client work. Any sense of uneasiness around disclosing feelings that may be perceived as weakness or make the worker feel shame is diminished by the containing space provided through clinical supervision.

  • Feeling valued

One of the main impacts that clinical supervision has is it gives a message to staff that the organisation genuinely cares about them and their work. Staff are aware that clinical supervision is something that professionals with specialist qualifications receive, so it sends a signal that the organisation is treating the vital work they do with seriousness. There is often a sense that non-specialist frontline workers are regarded as professionals with a small ‘p’. This kind of investment in staff is validating making workers feel that their role in the support system and the contribution they make is being rewarded by the organisation looking after their wellbeing and professional development.

Why we need to protect our workers?  

The current headwinds buffeting third sector healthcare settings are some of the most difficult we have faced. The system is more stretched than ever, the number of people requiring support continues to grow as the level of complexity people are presenting with increases. Coupled with staff shortages and reduced funding the sector is producing a workforce that is stressed, under pressure and poorly supported. Of course, the Covid-19 pandemic has amplified these long-standing issues in the system, while at the same time creating an opportunity to embed clinical supervision in the sector. Giving meaningful professional support and development to non-specialist client-facing workers would be a decisive and welcome contribution to the system.

To read more about how clinical supervision can benefit client-facing workers providing intensive support to clients with MCN, please read ‘The effectiveness of clinical supervision for workers supporting people experiencing multiple disadvantage’. Written by Juliet Hough, and independent researcher, published on the FLSE website in January 2021, the research found that the provision of regular one-to-one clinical supervision was highly beneficial to workers and to the FLSE programme. It was critical to workers trauma informed practice, and in supporting their well-being in the following areas: Increased workers’ understanding and skills around providing trauma informed care, helped workers to successfully advocate for support from other services, helped to protect staff from burnout and compassion fatigue, reduced sickness absence and staff turnover, benefited the people being supported

For further reading about how clinical supervision can play a vital role in our wider communities, please read an academic paper, ‘Could clinical supervision help us to support increasingly complex needs in the community?’ The paper is a collaboration between Kerry Dowding, FLSE Research and Evaluation Officer, and, Juliet Hough, an independent researcher. First published online 15th February 2022, this paper presents qualitative research exploring the benefits of clinical supervision for workers supporting people experiencing multiple disadvantages. The paper illustrates how clinical supervision supported worker wellbeing, lessened compassion fatigue, and created space for workers to think creatively, manage risk and develop trauma-informed and reflective practice.

Locally, the FLSE team have taken a deep dive into the ways in which clinical supervision has supported our Practice Development team as they trial new ways to engage with people experiencing MCN. We wanted to see to what extent clinical supervision could provide a form of specialist mental health support to clients, via the practice development workers. Read more here https://www.bht.org.uk/wp-content/uploads/2022/06/PP_clinicalsup_FINAL_21062022.pdf


Authors:

Alan Wallace, Systems Change Officer

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

Alan.Wallace@bht.org.uk

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FLSE responds to the ‘Tackling Domestic Abuse Plan’

As Fulfilling Lives South East (FLSE) welcomes the government’s long-awaited Domestic Abuse Plan, we reflect on how far the measures go in meeting the needs of women with multiple and complex needs (MCN).


Specialist support in safe accommodation

Throughout our project work, FLSE have continuously advocated for access to appropriate housing options for those experiencing domestic abuse as one of several intersecting needs. We know that for those made homeless by domestic abuse, the path to stable accommodation is not easy, particularly for those experiencing MCN. Refuge referrals are frequently rejected on the grounds of clients’ mental health and substance use needs being too high. This results in women facing multiple disadvantage being excluded from accessing the current refuge service models, meaning many women are being forced to return to their partner and abuser or being placed in non-specialist accommodation settings.

We are particularly encouraged by the government’s commitment in the plan to provide funding for specialist support services in safe accommodation to ensure that vacancies are available to a greater number of victims and survivors, no matter how complex their needs. It is also heartening to see that the Ministry of Justice will look into introducing national commissioning standards across all victim support services and the Department for Levelling Up Housing and Communities’ Quality Standards for support in safe accommodation. This will ensure that the commissioning of support in safe accommodation for domestic abuse victims and survivors and their children will be subject to the same standards as all victim support services.

Training for non-specialist services

At a local level, FLSE have made specific recommendations for staff in non-specialist services supporting women with MCN to be equipped and trained to better respond to domestic abuse. We have evidenced the need for MCN specific domestic abuse training to be provided across Sussex, to ensure that police forces are more informed of the complexities facing women with complex needs experiencing domestic abuse.

As such, the provision of up to £3.3 million to fund the rollout of Domestic Abuse Matters training to forces which have yet to deliver it, or do not have their own specific domestic abuse training, is a welcome step. We also welcome the government’s commitment to provide £7.5 million to upskill healthcare professionals to identify and refer victims and survivors to support services and ensure that healthcare professionals are appropriately equipped to support those suffering trauma from abuse. We hope that these measures will be built upon, with the long-term view for all public services and non-specialist services to be able to respond appropriately to domestic abuse, with an intersectional understanding of the experience of women with MCN.

Collaboration and coordination across the sector

Women with MCN who are experiencing domestic abuse do not typically present at specialist domestic and sexual violence services. For example, they may present for help in the first instance at their Local Authority Housing Options Service, where clients can experience judgemental and stigmatising responses and unsatisfactory outcomes. Women frequently do not receive a service which reflects an understanding of the complexities, dynamics and risk issues of domestic abuse or receive a trauma-informed response.

As such, it is positive to see the importance of collaboration and coordination between and within statutory services in better supporting survivors recognised within the plan. We are hopeful that the government’s upcoming new Domestic Abuse Statutory Guidance, which will provide further details on the different types of abusive behaviours, will help to facilitate a common understanding of domestic abuse across the whole system, ensuring that women do not fall through the gaps in provision.  

The measures set out in the ‘Tackling Domestic Abuse Plan’ represents a positive step toward better coordinated and trauma-informed support services which can holistically meet the needs of the most marginalised women. The government must now bring lived experience voices to the forefront in decision-making forums when translating these objectives into practice and instigate the change that is truly imperative.


Authors:

Emily Page, Systems Change Project Assistant

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

emily.page@bht.org.uk

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Seeing the whole person: Reflections on a journey into employment

This blog post has been written by a colleague with lived experience of multiple disadvantage and is a personal reflection of the employment journey they travelled, including within their role at Fulfilling Lives South East. 


Citrus Ornge

My employment journey began over three years ago, when Rob Robinson who was working with me as part of the IPS (Individual Placement and Support) trial at a substance misuse service introduced me to Jason at Citrus Ornge. At the time I was volunteering, studying and taking part in wellbeing groups but I could not really visualise a pathway into employment for myself. Looking back, I realise I had internalised a lot of stigma and my self-esteem was quite low – I didn’t think anyone would believe in me enough to offer me paid employment. Many of my IPS meetings had been spent agonising over gaps on my C.V, which felt like a road block… something which even if I got to an interview I could be faced with trying to explain or apologise for. I felt I had wasted the career I had before.

Rob came with me to meet Jason informally. It took a while to absorb the fact I was in a room with a potential employer who was in recovery themselves and open about that, and that I was invited to be too. There was no need to explain gaps in my C.V or that my references would be from people I volunteered with rather than worked for. And so, I became the first employee of Citrus Ornge.

I had no media or business experience and did not even own a laptop, so Jason lent me one and I went to work one day a week. I was shown how to do what I needed to do – learning new skills in the process – and I did it. What I did know was that Citrus Ornge had a social mission that I admired and wanted to help with if I could.

Emotionally, it was a time of change and growth. Like many people in recovery, I had experienced trauma and feeling safe in different spaces was something I was working on. Sitting in an open office space surrounded by people with laptops from 9am to 5pm was something new, and I had to learn to be in that space. Facing anxiety and not letting it win, grounding myself in a place where I felt the acceptance of being with someone else in recovery. Continued regular IPS support was vital to keep me focussed on the positives, recognising my achievements and moving forward.

Jason introduced me to the idea that people in recovery have unique assets that should be valued by employers, and I learned from how open and honest he was about his own recovery that it is not something we should be ashamed of in professional spaces.  I wondered if other employers existed that thought about recovery this way.

Months on, Citrus Ornge had grown to a handful of employees. Someone at the service I was still volunteering with showed me an advert for a job at Fulfilling Lives. Having lived experience of multiple complex needs was a requirement for the role, much of my volunteering experience was relevant and I now had recent experience of employment. The project looked too interesting to let the opportunity pass by, so, I decided to apply for the role. I didn’t expect to get the job or even an interview and had prepared for that outcome with people in my support network but saw applying as a step in the right direction.

Fulfilling Lives

I started in a 3 day per week role at Fulfilling Lives and was then promoted to full time. I have been here 2 and a half years now. During my early months, I benefitted greatly from having regular supervisions where I could measure what I was learning against an induction checklist, raise any concerns and set goals. Having a list of what I was expected to achieve during my first six months was a reassuring, clear and objective way to look at my progress – this was important as I was tending to focus on my perceived failures and shortcomings at that time.

Like my experience at Citrus Ornge, I saw others being open about their lived experience but took time to feel I could start to do that myself. After building relationships of trust with my team, discussions in reflective practice sessions, and training about professional boundaries, I became more confident about judging what to share and when, knowing what I was comfortable with, how to speak from lived experience without sharing details I was not comfortable with, how to assert boundaries and making judgements about whether sharing something about myself would be of benefit to someone I was supporting or a piece of work. Over time I have started to make peace with my lived experience, integrate those experiences into my current identity, and rather than making a journey from a person in recovery to a professional, I have become a professional who is also in recovery.   

Monthly strengths-based, psychologically informed supervisions have facilitated development of my confidence and I am now able to recognise my own strengths and interests and more likely to take on new challenges at work. Being in an environment that genuinely supports me to perform at my best means I feel like my team are behind me even when I’m working as an individual. I know that if something is a challenge for me, I can view it as an area to work on rather than something I have failed at. As an example, the first time I had to stand up and speak in front of a room of people, I was so nervous I could not even stand up from my chair and a colleague delivered my part of the presentation. After working with my manager and development worker, and conversations with colleagues who were so non-judgemental and generous with their own stories of taking on challenges, I presented at a conference two weeks later. To date I have taken part in delivering training to hundreds of people.

This style of supervision has also positively influenced the way I mentor others within my role, by modelling a collaborative approach based on trust, building on and affirming strengths, supporting people to achieve their goals and creating safe strategies to cope with times resilience is tested.

I hope that anyone reading this gets a sense of how grateful I am for the IPS Trial, Citrus Ornge and Fulfilling Lives, and the impact they have had on my life. As I write this, I am about to start a new role and continue my employment journey – a journey I wasn’t sure would ever happen. We acknowledge the critical importance of believing in people whilst they are accessing support services and in the early stages of recovery, but recovery, learning, and growing never stop. Can we say we really believe in people if we only believe in them up to a certain point?

Learn more about employing people with lived experience of MCN

For those who are interested in Fulfilling Lives’ learning about employing people with lived experience of multiple complex needs such as my myself, we have created an employment toolkit which is available to download here:

For more information about Citrus Ornge and their social mission


Authors:

Anonymous Fulfilling Lives Team Member

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

Andree.Ralph@sefulfillinglives.org.uk, Co-production and Engagement Lead:

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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.


Authors:

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:

Andree.Ralph@sefulfillinglives.org.uk, Co-production and Engagement Lead:

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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.


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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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.”

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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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.

Authors:

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:

rebecca.rieley@sefulfillinglives.org.uk  

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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. 

Recommendations:

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?


Authors:

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:

rebecca.rieley@sefulfillinglives.org.uk  

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