Guest editorial

Citation

Welford, J. (2022), "Guest editorial", Housing, Care and Support, Vol. 25 No. 3/4, pp. 125-126. https://doi.org/10.1108/HCS-12-2022-050

Supporting people experiencing multiple disadvantage: evidence from the Fulfilling Lives programme

This special issue shares learning and insights from the Fulfilling Lives programme, an eight-year, voluntary sector-led programme to improve the lives of people experiencing multiple disadvantage. Articles in this issue have a very practical focus, sharing lessons learned, what worked well and less well for this group and highlight the challenging systemic environment that the programme worked within.

People with experience of multiple disadvantage are amongst the most marginalised in society today. Experience of homelessness, mental ill health, substance misuse and the criminal justice system are inter-related and often mutually reinforcing. Yet public services often engage with problems in isolation. Failing to recognise and address the complexity of people’s experiences results in a substantial cost to the public purse and, more significantly, a tragic waste of human life and potential.

The Fulfilling Lives programme aimed to address these issues. The National Lottery Community Fund (one of the distributors of funds raised by the UK National Lottery) invested a total of £112m in 12 voluntary sector-led partnerships in England to support people experiencing multiple disadvantage. Partnerships began in 2014 and ran for between five and eight years. The programme had three intended outcomes:

• People experiencing multiple disadvantage manage their lives better through access to person centred and co-ordinated services.

• Services are tailored and better connected, with service users able to fully take part in effective service design and delivery.

• Shared learning and the improved measurement of outcomes will demonstrate the impact of service models to key stakeholders and influence future programme design by local services.

In total, over 4,000 people were directly supported by Fulfilling Lives. In identifying the current system of support as fragmented, siloed and in many cases not designed to meet the needs of those experiencing multiple forms of disadvantage, Fulfilling Lives partnerships strived to change the system for the better.

The programme differed from usual practice in that partnerships were not tied to externally set targets; instead, they were encouraged to test and learn, to try new approaches and be innovative with an acceptance that not everything would work. They were encouraged to be flexible, to adapt in response to changing circumstances and share learning. One volunteer with lived experience of multiple disadvantage summed up the approach nicely: “There are no mistakes, there’s just learning.”

Evaluation and learning were a key part of Fulfilling Lives. The programme was evaluated nationally by CFE Research, an independent non-profit research agency, and The University of Sheffield. In addition, partnership undertook or commissioned local-level research and evaluation. Overall, a substantial amount of evidence has been generated, helping to understand the failings of the current local and national system and what works in supporting people experiencing multiple disadvantage. This special issue brings together research, evaluation and learning from evaluators and practitioners from across the Fulfilling Lives programme.

The special issue opens with a discussion of the growth of policy interest in severe and multiple disadvantage (SMD); although this is a recently coined concept, there has been long-standing political interest in this group of people. Alice Lemkes reviews the recent policy context and demonstrates how a particular definition of SMD has come to dominate. Whilst marginalising other interpretations, this definition has at least given the UK Government a concept to focus policy attention on.

Rachel Moreton and colleagues from the national evaluation team explore some of the barriers to accessing mental health support faced by people experiencing multiple disadvantage. This paper also shares encouraging approaches to meeting these challenges from across Fulfilling Lives partnerships.

The remainder of the papers highlight impact, learning and novel approaches adopted by specific partnerships to improve services for people experiencing multiple disadvantage in their area. Lauren Bennett and Phillipa Iwinicki report on work to improve employability outcomes at Inspiring Change Manchester, with peer researchers co-producing the project. Team Around Me is a model of case conferencing designed specifically for complex cases. Scarlett Stock and colleagues from Fulfilling Lives Islington and Camden discuss their experiences in developing and using this model and propose why they have found it to be beneficial for people experiencing multiple disadvantage.

Continuing the theme of person-centred support, Karen Randall and colleagues describe a co-produced project at Fulfilling Lives Lambeth, Southwark and Lewisham to create a gender-informed drug and alcohol treatment service using appreciative inquiry. Anna Tickle from Opportunity Nottingham reflects on the value of psychologically informed environments for people experiencing multiple disadvantage and shares learning gained through adopting this approach.

The final four papers further explore the ways in which Fulfilling Lives partnerships have challenged ways of working in their localities to enact systems change. Konstantinos Spyropoulos and colleagues use a situational analysis to consider the impact of the Stoke-on-Trent Fulfilling Lives partnership (VOICES) on three key areas of work: improving access to services, improving housing outcomes through a Housing First project and making service users leaders in service design and commissioning. The role people with lived experience can play in systems change is further outlined by Chris Pawson and colleagues from Bristol Golden Key with a case study on the development of Independent Futures, a group that enabled the voice of lived experience to be heard at the programme, city-wide and national levels.

Charlotte Cooke and colleagues from Fulfilling Lives South East describe the role of the East Sussex Temporary Accommodation Action Group in creating a multi-agency, collaborative space to improve unsupported temporary accommodation. The final paper from Beth Fouracre and colleagues from Bristol Golden Key describes their systems change journey and provides practical recommendations for activating change.