Agenda item

This paper outlines the draft recommendations of the developing multiple disadvantage JSNA chapter in recognition of the impact that the experience of multiple disadvantage has on some of the most vulnerable persons in our county. The production of this JSNA chapter has been led by our local lived experience group.

Witnesses:

Ruth Hutchinson, Director of Public Health, SCC

Lisa Byrne, Changing Futures Programme Delivery Manager, SCC

Steve Saunders, Expert by Experience, Lived Experience Recovery Organisation (LERO)

Ella Turner, Programme Manager - Health Determinants Research Collaborative (HDRC), SCC

Key points raised in the discussion:

1.    The Director of Public Health (SCC) highlighted the key overarching priority of the Health and Well-Being Strategy: to reduce health inequalities so no one is left behind. Commended all for their hard work to understand the breadth and depth of the challenges faced by those with Multiple Disadvantage. Noted that the chapter and draft recommendations should be read in conjunction with other JSNA chapters on: mental health, substance misuse and housing. The Board should consider its collective action to implement the draft recommendations which needed time to embed, she encouraged participation in the discussion events.

2.    The Changing Futures Programme Delivery Manager (SCC) explained that Multiple Disadvantage was where people faced concurrent and compounding challenges: mental health needs, substance use, homelessness, domestic abuse and contact with the Criminal Justice System. In 2015, there were approximately 336,000 adults in England experiencing Multiple Disadvantage, the findings in the JSNA chapter estimated that there were 3,000 Surrey residents experiencing it. The findings came from extensive stakeholder engagement, data analysis and collaboration across sectors, co-produced with the LERO set up in 2023.

3.    The Expert by Experience (LERO) noted his background of Multiple Disadvantage due to substance use and he was a SMART Recovery facilitator. He noted that it was vital to highlight lived experiences at decision-making forums and was working to ensure co-production was included. Essex, Middlesbrough and Sheffield had good representation of lived experience people on boards. He called for action on the draft recommendations to put the hard work into practice.

4.    The Changing Futures Programme Delivery Manager (SCC) explained that a mixed methods approach was taken and included cross-cutting representation from a range of stakeholders across the system. The chapter was awaiting final sign-off from the JSNA Oversight Group, the full document would be available on Surrey-i in the coming weeks and a summary version would be produced. 

5.    The Programme Manager - HDRC (SCC) outlined the six key findings:

·      ways of working: fragmented care was identified from siloed working across the system, statutory services were often equipped to assess and treat only what they considered to be an individual's primary need.

·      feeling abandoned: identified gaps and unmet needs in service provision, the impact of limited access to mental health services often intensified mental health challenges. Explored how the housing and accommodation support system could be better designed.

·      misheard and misunderstood: commonly experienced stigma and judgement often due to the lack of understanding around Multiple Disadvantage. A culture change was needed and understanding around trauma and psychologically informed approaches.

·      one size does not fit all: identified a need for bespoke support that recognises the interconnected nature of Multiple Disadvantage, to focus on relational rather than medical models of support, it should be outcomes led.

·      overcoming hurdles: numerous barriers that prevent people from accessing services, thresholds and eligibility criteria risked excluding people.

·      under pressure: strategic challenges could create disruption and discord, current commissioning structures did not always foster flexibility, choice and innovation. Considered how funding could be redistributed or restructured to create service stability and support longer-term strategic planning.

6.    The Programme Manager - HDRC (SCC) thanked the Experts by Experience and those involved in the primary research and detailed the draft recommendations:

·      recommendation 1: a refresh of current governance arrangements was needed and the Partnership Board would have representation from local partners co-producing with people with lived experience and would agree a system-wide Multiple Disadvantage definition.

·      recommendation 2: the recommendations would form the basis of a five-year iterative strategy, used to achieve sustained change at all levels.

·      recommendation 3: to address the gaps in data a Population Health Management approach should be adopted, identifying people at risk for priority action and prevention planning.

·      recommendation 4: ensuring the full involvement of people with lived experience of Multiple Disadvantage or impacted by it, to be integral to decision-making. A shift in power towards a service user led system.

·      recommendation 5: improving intervention and prevention approaches at all stages was crucial to reducing the incidence and impacts, the prevention of Multiple Disadvantage must be a whole system responsibility.

·      recommendation 6: embedding a trauma informed approach required collective system-wide cultural change.

·      recommendation 7: commissioning models were vital to addressing Multiple Disadvantage as those determined the type and way that services were delivered, work must be done at pace to embed innovative best practice.

·      recommendation 8: identified that there were major barriers to accessing care, progressive models should be provided focusing on relational support.

·      recommendation 9: to undertake a review in 2025/26 of substance use services to ensure the transparency of funding availability and find ways to redistribute and restructure funding streams to maximise outcomes.

·      recommendation 10: the limited availability, accessibility, and flexibility of mental health support intensified mental health challenges. Offering a diverse range of mental health services would help to reduce barriers in access.

·      recommendation 11: the lack of housing nationally and locally meant many people experiencing Multiple Disadvantage were homeless or living in inappropriate and unsuitable accommodation. Housing should be considered as a primary need, improved planning for winter provision and investment in rough sleeping solutions was needed.

7.    The Vice-Chair commended the co-design approach with those with lived experience which should be a blueprint for each JSNA chapter. Suggested that the draft recommendations be reviewed in detail outside of the meeting as per the report’s first recommendation.

8.    The Chair asked whether there was a Multiple Disadvantage Co-Production and Insight Group bringing together various groups and stakeholders. The Programme Manager - HDRC (SCC) explained that there were pockets of co-production underway and the LERO was specific to Multiple Disadvantage.

9.    A Board member noted that the draft recommendations included a lot of commissioning language as opposed to co-production language of getting people responsible for delivering services working alongside people who use those services to formulate a new vision and ensuring accessibility.

10.   A Board member referred to draft recommendations 7 and 8 noting their implementation would be evidence of real partnership working across the system for those requiring support. Noted the importance of having a five-year strategy and consideration of how the finances are distributed from shared pools to fund the work. Noted that the majority of PCNs in Surrey Heartlands had signed up to the Veteran Friendly Accreditation scheme and it was important for veterans to be considered in the work as roughly 5% of the homeless population were veterans.

11.   A Board member referred to recommendation 5 regarding prevention and intervention noting that it would be interesting to understand the circumstances that led people to experience Multiple Disadvantage, to understand what would have helped at the right time to stop that route. Called for access to services to be improved and made simpler. Noted that some of the wording needed simplifying. The Programme Manager - HDRC (SCC) explained that the JSNA chapter focused on adults, to be followed up through work with children, young people and families focusing on early intervention and prevention and the transition period between 18 and 25. The discussion events would showcase more case studies.

12.   A Board member noted that statutory organisations tended to overlay new ideas and ways of working on the old and made a plea to stop doing some of the things being replaced; to avoid building complicated networks of change delivery.

13.   The P3 Sponsor referred to recommendation 11 around accommodation and highlighted that the lack of accommodation for many was horrendous. Asked for early engagement with the Surrey Chief Housing Officer Group to get a constructive response, as services were under significant pressure. The Programme Manager - HDRC (SCC) noted that engagement had been done with that Group throughout the primary research and was factored in.

14.   The Chair thanked all for their work on the JSNA chapter, noting the synergy between chapters and other areas of work.

RESOLVED:

1.    Would consider how the headline draft recommendations are relevant to their own organisations and what actions can be taken to support progress to be made.

2.    Once the final chapter is published would support dissemination of the chapter’s findings and recommendations within their own organisations and networks.

Actions/further information to be provided:

1.    The Board will review in detail and consider how the headline draft recommendations are relevant to their own organisations and what actions can be taken to support progress to be made.

2.    The Board will be invited to the discussion events on the JSNA chapter.

Helen Coombes, Jason Gaskell, Paul Farthingleft the meeting at 4.04 pm.