6. Implications

This final section summarises the main implications from the VOICES legacy, in particular taking in to account the Changing Futures programme. Briefly, Stoke-onTrent was one of 15 areas in England to be awarded funds from central government and the National Lottery Community Fund to deliver improvements for adults experiencing multiple disadvantage at the individual, service, and system level: stabilise and then improve the life situation of adults who face multiple disadvantage transform local services to provide a person-centred approach and to reduce crisis demand to test a different approach to funding, accountability and engagement between local commissioners and services, and between central government and local areas The Stoke-on-Trent Changing Futures approach builds on the approach and learning from VOICES, intervening system, service and individual levels, which interact as described in the Changing Futures proposal: The legacy of VOICES in this proposal is clear. Changing Futures has effectively provided resource to build on VOICES’ work, and the VOICES Director played a central role in the successful bid (which can be considered an additional, considerable part of the VOICES legacy beyond March 2022). We suggest some main implications, in the context of Changing Futures, listed under each of the VOICES priority areas.

“At the system level, we

will reconnect systems design and commissioning to the lived experience of practitioners and beneficiaries through a CRM with access to live quantitative and qualitative data. Learning will be captured and disseminated at the service level through a community of practice and workforce development function informed by lived experience. This will equip practitioners at the individual level across the whole system with the up-to-date knowledge and skills required to work more effectively and empathise with people experiencing multiple disadvantage, promoting a person-centred and trauma-informed culture. A Case Coordination Team and Multi-agency Resolution Group will triage and escalate the most problematic frontline situations for analysis, resource allocation, information and risk sharing, and to act as a bridge to connect the frontline, management, strategic oversight, and

commissioning functions”

6.1 Fair access to services

CRM, MARG, silo working and system fragmentation

Changing Futures is a multi-agency partnership (as was VOICES), will use a multi-agency CRM (like VOICES) and includes the MARG (which VOICES has helped to develop/shape after it was initiated by the Local Authority). These factors aim to address issues of silo working and system fragmentation observed through VOICES work and which VOICES tried to address. The legacy of VOICES in these parts of the Changing Futures model are clear. First, the multi-agency partnership of VOICES was clearly important for raising awareness and engaging organisations from the public and third sector in efforts to support the customer group. The Changing Futures partnership will build on this at the system level, with an even broader partnership.

Second, VOICES CRM provided a powerful data source that, through Hard Edges reports (Section 2.2), demonstrated benefits of intensive support to reduce demand on crisis services by the customer group. Again, at the system level, the ‘Shared Multiple Disadvantage CRM’ in Changing Futures will be a shared data resource to help ‘resolve the disconnect and inertia between the system, service, and individual levels by rapidly generating management information based on live data’. Through giving partners this access and feedback, the various agencies and sectors should be able to observe the benefits of effectively supporting those experiencing extreme disadvantage, thus work more cooperatively towards a common goal (thus mitigating silo working and fragmentation). Third, at the service level MARG will continue with resources for an independent chair, to deal with exceptional cases. The prominent role of VOICES staff in helping to chair, organise and shape the development of this group, in addition to the value of the MARG among stakeholders evident from the VOICES-commissioned evaluation (Section 2.14), again demonstrates that this can be considered part of a legacy. Fourth, at the individual level, Changing Futures includes Case Coordinators who, much like the VOICES Service Coordinators will be the key workers for individuals. The difference to VOICES, and based on learning regarding parts of the system where continuity of care fails and individuals can be lost, is that these posts will be employed by key services at these ‘pinch-points’ in the system, e.g., hospital discharge teams, primary care outreach, substance misuse, women’s services, or prison release.

Engagement with health care

As a direct response to failure of VOICES to consistently engage with, and be heard by, the local health care system, the Changing Futures Project Board will report to the Health & Wellbeing Board. This could prove to be a fundamental system-level shift towards recognition that the needs of this population group are a health concern, not only a social concern.

Ongoing development of legal literacy for benefit claims

Funds have been allocated to support the ongoing implementation of WBLL as part of the Changing Futures approach. Through the specialist advisor and WBLL approaches (see Sections 2.11 and 2.12), VOICES started to improve the local system through developing legal literacy among frontline staff in key organisations. However, the challenges of changing practice within these partner organisations were apparent. Given the substantial impact on individuals experiencing multiple disadvantage and need of receiving the benefits to which they are entitled, the continuation and evolution of WBLL is another important part of VOICES’ legacy.

Workforce development and resources

The Learning Programme in VOICES reached many local staff from a range of organisations to develop knowledge and skills around supporting those experiencing multiple disadvantage. In addition to this observed benefits of this work (see Section 2.8), Changing Futures will build on this through the Centre of Excellence, a ‘workforce development group to develop a learning programme for frontline workers, volunteers, and people with lived experience’. VOICES also developed a range of materials and toolkits as a legacy that can be used beyond the VOICES period.

Hospital Discharge and Homelessness

A specific legacy with potential that has not yet been realised relates to proposed changes to hospital discharge processes for people experiencing homelessness. Recommendations from this work (see Section 2.6) were used to develop and plan to improve the discharge process, but due to changes in personnel in the hospital, were not implemented at the time. Through Changing Futures, efforts to progress this have reinitiated and, if successful, would make an important difference to continuity of care and re-admission risk for the city’s homeless.

Prison Release

Changing Futures also includes programme review, design and prototyping of prison release plans to mitigate the shortcomings of the present processes that VOICES highlighted. Although these were not addressed during the lifetime of VOICES, the legacy of this work is through its inclusion in the Changing Futures workstream.

Housing First Extension

The clear legacy of VOICES is the establishment and extension of Housing First in Stoke-on-Trent (funded by VOICES). Without this investment, Housing First would not have outlasted the VOICES period.

Housing First Sustainability

The longer-term sustainability of Housing First is less certain. Changing Futures does not include a specific Housing First funding allocation. Therefore, the questions around the programme’s future discussed in the context of the positions discussed in 4.5.2 remain. Through VOICES, there is legacy of an evidence base to support the programme (see Section 2.13) and recommendations for the future service specification that have been presented to the local authority (by the programme managers). Ultimately, at the present time, the culture shift needed to accept the principles and ethos of Housing First and to mainstream the programme, was not evident (although the 2022-2027 Housing Strategy had not been released at the time of writing). According to the evidence considered in Situational Analysis, support services more aligned with equality were mostly those of the public sector. This is perhaps not surprising as the common delivery focus is citywide and based on population needs,

6.2 Housing First 6.3 Making service users leaders in service design and commissioning

Expert Citizens CIC independence

The primary VOICES legacy under this priority is establishment of VOICES as an independent CIC, who at the time of writing, have set up in new offices and will continue to function autonomously post-VOICES. This evaluation is focused on the legacy of VOICES. Expert Citizens are discussed in that context, while recognising that they operate as an independent, autonomous group who no longer rely on VOICES funding. Their establishment as a CIC and growing prominence is a considerable achievement in changing how the city perceives and works to support those experiencing multiple disadvantage. Expert Citizens have also gained national recognition for their work and innovation around lived experience.

Expert Citizens CIC as key partner in Changing Futures

Expert Citizens are embedded through the Changing Futures plan at each level: - system level, to ‘involve people with lived experience in all aspects of Changing Futures systems change activity as cocreators and producers including recommendations for commissioning’ - service level, for ‘Development and maintenance of a network of people with lived experience to participate in Communities of Practice and the co-design / codelivery of learning opportunities through the Centre of Excellence’. - individual level, the ‘Project Board will commission periodic evaluations of services by people with lived experience using

the INSIGHT Service Standards developed by Expert Citizens, to test and report on the nature of the beneficiary experience’. This cements Expert Citizens’ position in the city’s plans to improve the lives of those experiencing multiple disadvantage.

Expert Citizens CIC growth in other areas

Expert Citizens have partnered with academic teams for various projects. For example, they have partnered with CHAD on projects including City Centre Rough Sleeping and Street Activity [12, 13], Housing First evaluation [24], an exploration of local women’s support services [32] and this summative VOICES legacy evaluation. They have partnered with Keele University on work around primary care gatekeeping (see Section 2.5) and applying INSIGHT evaluation to health care settings. This demonstrates two important additional features of Expert Citizens as a legacy: they have developed experience of academia to allow this work and other partnerships to develop; their lived experience expertise is now being applied beyond the context of multiple disadvantage into other settings (i.e., health). Such efforts will increase sustainability post-March 2022.

6.4 Summary

In summary, VOICES has made a substantial impact on the system of support for people in Stokeon-Trent experiencing multiple disadvantage. During the eight years of VOICES, there has been progress against all three priority areas for systems change. Where shortcomings or failures to make lasting impact have been observed, the commitment to learning and evaluation throughout VOICES has allowed the Changing Futures plans to include measures that should address the problems encountered.