1. Introduction

Conclusion 1. Introduction

VOICES has had a substantial impact on the system of support for people in Stoke-on-Trent who are experiencing multiple disadvantage. During the eight years of VOICES, there has been progress against all three priority areas for systems change, which should now be built on through the Changing Futures funding (2-3 years funding to deliver improvements for adults experiencing multiple disadvantage at the individual, service, and system level). Learning from VOICES has shaped the Changing Futures approach; successful components are included e.g.

Case coordination

Multi-Agency Resolution Group (MARG)

CRM

Welfare Benefits Leading and

Learning (WBLL)

Centre of Excellence (Citywide

Learning Programme) Where VOICES was unable to effect change the learning from VOICES commitment to research and evaluation has informed alternative approaches.

1.1 Multiple disadvantage

This report presents a summative evaluation of the VOICES programme, which was the Stokeon-Trent implementation of the national Fulfilling Lives: supporting people experiencing multiple disadvantage. Fulfilling Lives was established by the National Lottery Community Fund (formerly Big Lottery), investing £112 million across 12 areas of England that had high concentrations of people experiencing multiple disadvantage. The aim was that each area develop partnerships with local people with lived experiences, service providers and commissioners, to design, test and implement different approaches to improving the lives of people experiencing multiple disadvantage. Despite variation in terms used to describe those who would be target beneficiaries of the programme, including multiple needs and complex needs, we will use the term ‘multiple disadvantage’, which has been defined as: Common to the concept of severe and multiple disadvantage (SMD) offered by Lankelly Chase, we use this to refer to those at the ‘extreme margins of social disadvantage’ [2, p11] who tend to have much worse health and quality of life compared to many other low income and vulnerable people, and can create a substantial cost for the rest of society, particularly with respect to disproportionate use of certain public services (e.g., emergency health care, criminal justice system). Fulfilling Lives aimed to improve the lives of this group by:

Providing learning which can be used to create system change

Addressing the combination of factors that can affect the person, in a way that is simple and straightforward for individuals to navigate, with a single access point

Assuming that people can improve their own circumstances and life chances with the right support

Engaging people with lived experience of multiple disadvantage in the design and delivery of services.

“Experience of two or more

of homelessness, offending, substance misuse and

mental ill health”

[1,pg 5]

(Voices of Independence Change and Empowerment in Stoke-on-Trent)

VOICES was an eight-year partnership (2014-2022) project that sought to empower people experiencing multiple disadvantage to change their lives and to influence the services on which they depend [3]. VOICES customers (i.e., those experiencing multiple disadvantage) are people whose lives have been seriously affected by events and conditions over a prolonged period. To improve their lives, health and wellbeing, requires action and support from a system of different sectors and organisations [4] .

To affect sustainable changes, VOICES has taken a whole systems change approach

A core function of VOICES was casework and service coordination to ensure people experiencing multiple disadvantage are supported. It was delivered by an operational team that coordinated a range of services and stakeholders around people currently experiencing multiple disadvantage. Part of its mission is to change systems through casework and assertive advocacy to help people access appropriate services. Even within the partnership this is not always easy. Work needs to be done to understand the drivers behind these barriers, which may be, for example, skills-based, culturally constructed, or process driven. Central to all the work undertaken are the voices of those with lived experience. The Expert Citizens, supported by VOICES have formed their own Community Interest Company and are central to the progress of change in the city and the legacy of the VOICES project. The VOICES work has included a wide range of discrete projects, evaluations, and development work to influence various parts of the system, aligned with three priority areas:

Housing First

Ensuring fair access to services

Making service users leaders in service design and commissioning Evaluations to date around many aspects of this work have indicated important impact of VOICES work on VOICES customers, partner organisations and how they work together (i.e., some evidence of systems change). However, a sustainable legacy of VOICES beyond the life of the project is contingent on changes that mean people who experience multiple disadvantage are supported through a better functioning and coherent system when the VOICESfunded activity is no longer there. This evaluation employed a systems methodology. The wider system within which VOICES has been operating and trying affect, can be considered as a complex non-centrally controlled system of interdependent, autonomous parts that are expected to (but often do not) function as a coherent whole to improve the circumstances and lives of those experiencing multiple disadvantage[5]. The complexity of understanding the impact of VOICES’ work and its potential legacy means that traditional research methods grounded in linear models of cause and effect, are unsuitable [6]. A shift toward methods that focus on complexity theory and systems change approaches is necessary to evaluate both VOICES impact on promoting health and health equity in the multiple disadvantage population, and for generating knowledge about the processes implemented for building the VOICES legacy [7] .

This summative evaluation examined what has changed as a result of VOICES work and the potential legacy post-March 2022. It drew on learning from the discrete projects and evaluations, including an overall Hard Edges evaluation, and took a qualitative approach (with systems lens) to examine the wider systems change. Expert Citizens’ lived experience provided ongoing insight and validation of findings.

The overarching aim of this evaluation was to understand the impact of the VOICES partnership and its legacy. This was addressed through a series of objectives:

Draw key learning from discrete evaluations

Use Situational Analysis to explore the role of VOICES in effecting systems change for each of the VOICES priority areas

Embed lived experience in the evaluation through

Expert Citizens

Get Talking training to add to the legacy through further professional development

Consider the VOICES legacy in the context of the city’s ongoing plans around support for people experiencing multiple disadvantage.

As summarised in Figure 1, the approach drew on learning from discrete projects, which are summarised to provide a standalone record of the legacy of VOICES projects and the associated learning from research/evaluation.

1.3 Evaluation aims and objectives

1.4 Evaluation outline

These reports, a range of other data sources (e.g., project reports, partner organisation websites, minutes from meetings, project proposals), and additional discussions/workshops with key stakeholders, fed into an overarching systems analysis, using Situational Analysis[8] . As detailed in Section 4, Situational Analysis was well suited for this purpose because: the situation (i.e. the system of support for people experiencing multiple disadvantage in Stoke-on-Trent) is complex and methods to study linear models of cause and effect were inappropriate; it can use data gathered using various methods; it is iterative and data driven (not for hypothesis testing); it is one of the few complex systems methodologies that places the importance of context at the heart of its investigation[9] . Situational Analysis results in a series of maps that show different positions around key issues or discourses. These offered a useful means of considering the problems that VOICES were trying to address, the previous or current conflicting positions to change, and the progress made by VOICES. Concurrent work using Get Talking training was included to allow members of the research team and Expert Citizens to collaborate and reflect on the contribution of VOICES, whilst providing further professional development and accredited learning to Expert Citizens in the Get Talking approach. Finally, and critically, this provided a panel of individuals with lived experience of multiple disadvantage and VOICES to have input on various parts of this summative evaluation (e.g., Situational Analysis, interpretation of data, implications). After considering the strengths and weaknesses of this summative evaluation, we conclude by considering the implications: what is the legacy of VOICES in the context of the city’s plans for supporting people with multiple disadvantage postMarch 2022.