Turning the Tide: A Vision Paper for multiple needs and exclusions

Abstract

PurposeThis article seeks to summarise the recent publication, Turning the Tide: A Vision Paper for multiple needs and exclusions by Revolving Doors and Making Every Adult Matter. It addresses the significant financial and social costs of society's failure to support the 60,000 adults facing multiple needs and exclusions in England today and how this damage can be prevented.Design/methodology/approachIn total, six qualitative evidence seminars and a series of individual meetings were held, with 60 stakeholders consulted. The paper draws on the expertise of member agencies, partners, and the members of Revolving Doors' service user forum who have direct experience of multiple needs and exclusions.FindingsPeople facing multiple needs and exclusions experience several problems simultaneusly, have ineffective contact with services and, as a result, live chaotic lives. They are a small group but impose disproportionate costs on themselves, families, communities and the public purse. The paper sets out the vision that in every local area people facing multiple needs are supported by effective coordinated services. It argues that to achieve this, a new approach is needed from national government. Five building blocks to achieving the vision are examined in detail.Originality/valueDrawing on a wide evidence base, the paper shows how politicians, local leaders, and commissioners can act to make coordinated services for people facing multiple needs and exclusions the norm. It is of relevance to service managers/providers who can act now to tackle multiple needs by building partnerships, taking proposals to commissioners, and supporting elected members to develop new approaches.

Changing homelessness services: revanchism, ‘professionalisation’ and resistance

“…In support of this, it was clear that the big players, and perhaps some of the smaller players too, mainly operated a keyworker model, in the sense envisaged by Page and Hilbery () and Cattell et al . (), i.e.…”

“…In support of this, it was clear that the big players, and perhaps some of the smaller players too, mainly operated a keyworker model, in the sense envisaged by Page and Hilbery (2011) and Cattell et al (2011), i.e. a worker who advocates between service users and local services to ensure that they access the right services at the right times.…”

“…and decides what action to take. This illustrates how agencies can come together with a common purpose by focusing greater attention on the needs of people sleeping rough, thus achieving the targeted and co‐ordinated services envisaged by MEAM, with Brighter Futures, by virtue of its responsibility for the Rough Sleepers Team, acting as the co‐ordinator (Page & Hilbery , p. 3). Although the trigger for action was political, the motivation for forming and maintaining the Group appeared to come from within the agencies themselves.…”

“…Even when services are successfully co‐ordinated, people more entrenched in homelessness become ‘routinely excluded from effective contact with services they need’ (MEAM, , p. 9) – because their needs are not deemed to require support or are not formally diagnosed, or the services cannot cope with them or take responsibility for them. In the United Kingdom, four major national charities working with homeless people (Homeless Link, Clinks, DrugScope and Mind) formed the Making Every Adult Matter (MEAM) coalition to address this failure to meet the needs of an estimated 60,000 people in the United Kingdom whom it described as having ‘multiple problems’, ‘ineffective contact’ with services and ‘chaotic lives’ (Page & Hilbery , p. 13). This coalition recommended that a named individual should be responsible in every local area for ensuring the support required and that the public be given a ‘right of inquiry’ to ask that individual to provide information about the level of support given to someone with multiple needs.…”

Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

“…They experience feelings of inadequacy and lack of professional con dence and display an unwelcoming attitude toward patients. (13,(26)(27)(28)(30)(31)(32)(33)(34) As a result, patients do not feel comfortable and choose not to seek care at an appropriate time (eg seeking care early from a GP before a condition gets worse and acute care is needed). (13,26,31,(35)(36)(37) The outcome of not seeking care when the care environment is not welcoming becomes a new context which leaves patients instead to seek care only when the need is emergent and out of desperation, and at a later stage than ideal and at a setting that is available (such as the ED).…”