Applyingsituationalanalysistoexamine theimpactofVOICESonpeople
experiencingmultipledisadvantage
KonstantinosSpyropoulos,ChristopherJamesGidlow,FionaMcCormack,AndyMeakin,
RacheleHine and SophiaFedorowicz
Abstract
Purpose – Thispaperreportstheuseofsituationalanalysisasasystemsmethodologytoevaluatethe voicesofindependencechangeandempowermentintheStoke-on-Trent(VOICES)partnershipproject.
Design/methodology/approach – Usingsituationalanalysisanddrawingonarangeofsecondarydata sources,athree-stageconceptualmappingprocessprovidedadetailedpictureofboththenon-linear interlinkageandcomplexityofthelocalsystemthatVOICESwasworkingtoinfluence,aswellasthe processesthatshapedtheexperiencesofthosewhoactwithinthesituation.
Findings – DatahighlightedthesystemicchallengesfacingVOICEScustomers(e.g.stigmaand marginalisationandlackoflegalliteracy),progressmadebyVOICESineachoftheirpriorityareasandan overarchingthemeofVOICESpromotingequity(ratherthanequality)toaddressfailuredemandinthe systemofsupportforpeoplewithmultipleneedsanddisadvantage.
Originality/value – Theauthorspresentthenovelapplicationofsituationalanalysistodemonstratea substantialimpactofVOICESwhiledemonstratingthevalueofthismethodologyforcomplexsystems thinkingresearchandevaluation.
Keywords Multipledisadvantage,Situationalanalysis,Fairaccess,HousingFirst,Systemsthinking, Failuredemand
Papertype Researchpaper
Introduction
Multipledisadvantage
Multipledisadvantagehasbeendefinedas“experienceoftwoormoreofhomelessness, offending,substancemisuseandmentalillhealth”(Lamb etal.,2019,p.5).Similartoterms suchas“severeandmultipledisadvantage”(Bramley etal.,2015)or“multipleandcomplex needs”(Harland etal.,2022),multipledisadvantageisusedtodescribeapopulationatthe extrememarginsofsocialdisadvantage(Bramley etal.,2015).Underthesecircumstances, peopletendtohavemuchworsehealthandqualityoflifecomparedwithotherlow-income andvulnerablepeopleandcanplacedisproportionatedemandsoncertainpublicservices (e.g.emergencyhealthcareandthecriminaljusticesystem),withconsiderablesocietal costs.
AkeyfocusoftheNationalFulfillingLivesprogrammewasonchangingsystemsthatcan enablesustainableimprovementsinthelivesofpeopleexperiencingmultiple disadvantage.Thesesystemscanbeconsideredacomplexnon-centrallycontrolled systemofinterdependent,autonomouspartsthatareexpectedto(butoftendonot) functionasacoherentwhole(Rutter etal.,2017).Throughtakingasystemsfocus,Fulfilling Livesrecognisedthatmultipledisadvantageislessaproductofanindividual’sbeliefsand
KonstantinosSpyropoulos, ChristopherJamesGidlow andFionaMcCormackare allbasedattheSchoolof Health,Scienceand Wellbeing(CHAD), StaffordshireUniversity, Stoke-on-Trent,UK.
AndyMeakinisbasedat theVOICESStoke-on-Trent, Stoke-on-Trent,UK.
RacheleHineisbasedat theExpertCitizensCIC, Stoke-on-Trent,UK. SophiaFedorowiczis basedattheSchoolof Health,Scienceand Wellbeing(CHAD), StaffordshireUniversity, Stoke-on-Trent,UK.
Received1February2022
Revised22April2022
Accepted27May2022
Thisresearchwasfundedby TheNationalLottery CommunityFundthrough VOICES.Theauthorswouldlike toacknowledgeallthosewho contributeddirectlyor indirectly,including:Sharon Sharmanandothermembersof theVOICESteamfortheir support;ExpertCitizens;the evaluationSteeringGroup members;VOICESPartnership Board;andotherlocal stakeholdersandindividuals whocontributedtotheprojects andactivitiesthatwere consideredhere.
attitudesandmoreafunctionofthesystemthatshouldsupportthem,i.e.behaviourof institutions,policydecisions,publicattitudesandculturalnormsperpetuatesocial problemsthatkeeppeopleinastateofdireneed(Abercrombie etal.,2015).
Systemschangehasbeendescribedasthe“intentionalprocessdesignedtoalterthe statusquobyshiftingandrealigningtheformandfunctionofatargetedsystem”(FosterFishman etal.,2007,p.197).Socialsystemsareoftencomplexandcomprisemany componentsofdifferenttypes(e.g.people,services,policiesandpractices).Therefore,to effectlastingchangerequiresalteringunderlyingstructuresandmechanismsthatmakethe systemoperateinacertainway(e.g.policies,practices,relationships,resources,power structuresandvalues)(Abercrombie etal.,2015).Thisdemandsactionandsupportfrom differentsectorsandorganisationswithinthelocalsupportsystem(NicholsandDoberstein, 2016),ultimately,improvingthecircumstancesandlivesofthosewithmultiple disadvantage(Fowler etal.,2019).
Setting
Thispaperpresentsasituationalanalysisundertakenaspartofasummativeevaluationof voicesofindependencechangeandempowermentinStoke-on-Trent(VOICES),aneightyearlocalimplementationoffulfillinglives(2014–2022).VOICEStargetedsystemschange effortsinthreepriorityareas:
1. Ensuringfairaccesstoservices – inadditiontocaseworkandservicecoordinationto facilitateaccesstoservicesforVOICEScustomers,arangeofVOICESactivitieswithin thisworkstreamaimedtoaddresssystemicbarrierstocustomersreceivingthesupport theyneeded.TheyincludedtheMulti-agencyResolutionGroup(MaRG),embedding specialistwelfareadvisorsinfrontlineservicestohelpcustomersaccessthebenefitsto whichtheywereentitledandconductingresearchtobetterunderstandcommon barriers,suchasdifficultyregisteringwithaGP,aswellaspooroutcomesfollowing prisonreleaseorhospitaldischarge.
2. HousingFirst – followingthetrialofahousing-ledintervention2014–2018(similarto HousingFirst),VOICESworkedtoembedaHousingFirstprogramme,whichadhered totheprogrammeprinciples(HomelessLink,2016),throughapilotimplementation (2018–2022).VOICESsupportedthroughvariousroles:ServiceCoordinator,Landlord LiaisonOfficerandTenancySustainmentOfficer,inadditiontofundinga12-month extension(2021–2022)andanindependentprogrammeevaluation(Gidlow etal., 2021a, 2021b).
3. Makingserviceusersleadersinservicedesignandcommissioning – VOICESworked withandsupportedExpertCitizens,puttingcoproductionwithlivedexperienceatthe heartofitsactivitiesandhelpingwithExpertCitizens’developmenttobecomean independentcommunityinterestcompany(CIC).
Situationalanalysis
Advancedmethodologiesarerequiredtostudythistypeofcomplexsystemchange,where traditionalapproachesgroundedinlinearmodelsofcauseandeffectareinappropriate (Martin etal.,2016; Rutter etal.,2017).Weneededamethodologythatembraced fragmentation,instability,diversity,contextandpositionalities,suchassituationalanalysis (Clarke etal.,2018),whichisdesignedtounpickknowledgefromcomplexinquiries(Wulff, 2008).
SituationalAnalysiswaswell-suitedtoexploringhowandtowhatextentVOICEShad impactedthe“situation”ofthewidersystemofsupportforpeopleexperiencingmultiple disadvantageinStoke-on-Trent,forseveralreasons.Firstly,itisaniterativeanddata-driven methodology.Thiswasappropriateaswedidnothavepredefinedhypothesesandwere
guidedbythedatatounderstandthecomplexityofthesituation(Clarke etal.,2018; Meadows,2008).Asdetailedsubsequently,discoursesandissuesidentifiedwerefurther exploredthroughrevisitingmaterialsorseekingconfirmationorclarificationthrough alternativesources;thus,allowingkeydiscoursestodevelop.Secondly,situationalanalysis isaflexiblemethodologythatcanaccommodatearangeofsecondaryandprimarydata sources,suchasreports,interviews,fieldnotesandminutes,givingequalcredenceto writtenandverbalevidence(Clarke etal.,2018).Thisenableduseofthewealthofexisting evaluations,reportsandotherexistingdataaccumulatedthroughoutVOICES,withfollowupworkshopstoverifyemergentthemes.Thirdly,situationalanalysisisoneofthefew methodologiesthatputscontext(“situation”)attheheartoftheinvestigation(Clarke,2005). Here,thesituationwasthewidersystemofservicesandsupportforpeopleexperiencing multipledisadvantageinthecity,whichisdistinctfromothersettingsandpopulationtypes andneededtobefullyunderstood.
Someresearchershavesuggestedthatthesekeypropertiesalignsituationalanalysiswith complexityinquiryandsystemsthinking(Martin etal.,2016).Thepresentstudytakesthis alignmentastepfurther,usingsituationalanalysisasanevaluationtooltoidentifysystemic barriersthatpreventpeoplewithmultipledisadvantagefromaccessingsupportiveservices andhowVOICESworkedtoaddressthem.
Method Design
Acasestudydesignwasused,whichdefinedtheboundariesofthesituationofinquiry:the widersystemofsupportforpeopleinStoke-on-Trentwhoexperiencemultiple disadvantage.Thethree-stageprocessofsituationalanalysis’conceptualmappingwas applied,asoutlinedbelow.Thisaimedtoprovideadetailedpictureofboththenon-linear interlinkageandcomplexityofthelocalsupportsystemstructures,aswellastheprocesses thatshapedtheexperiencesofthosewhoactwithinthesituation(Martin etal.,2016).
Data
Datasourceswereprimarilyexistingmaterials,includingcompletedandongoingVOICES reportsandprojectsandassociatedevidence(includinginterviewsandcasestudies),field notesandminutesofmeetings(Appendix),withadditionalcontextualinformationfrom stakeholderworkshopstoexplorespecificdiscourses.
Threestagesofsituationalanalysis
Thefirststageinvolvedthecollationanddetailedreviewofallmaterials,todevelop situationalmapsthatidentifiedall-importanthumanandnonhumanelementsofthesituation (e.g.keyindividuals,technologies),includingkeydiscoursesorissues.Inthesecond stage,socialworlds/arenasmapsweredevelopedtolocateandanalysethecollective actionoforganisationsintheir“socialworlds”andtheirrolewithrespecttothekey discoursesinthesituation(arena).Inthethirdstage,positionalmapsunpackedall positionsthatemergedfromdatarelatingtokeydiscoursesorissuesthatwererelevantto eachofVOICES’threepriorityareas.PositionalmapswereintheformofCartesianmaps, oneforeachmajordiscourse/issue,whereaxespresenttheissuesofconcernor controversy(Clarke,2005).
Assituationalanalysisdictatesnothingwastakenforgranted,especiallyonissuesthat seem“normal”withinthesituationand,therefore,havebecomeinvisible.Minordiscourses orissuesweregivenequalconsiderationtomoreprominentissuesbecauserelative prominencecanbeindicativeofpowerimbalances.Deviationsfromthenormwerenot treatedasexceptionsbutasboundariesofthesituation.Finally,athoroughinvestigation
wasusedtoidentifyallrelevantactors/actants,includingthoseusuallyhidden,silencedor onlytangentiallypresent,astheycanhelptoimproveourunderstandingofthesituation (Clarke,2005).
Findings
Thissectionpresentsthefindingsfromeachstageofsituationalanalysis.Positionalmaps fromStage3representthemaindiscoursesandissuesinrelationtoeachVOICESpriority areaforsystemschange.OutcomesfromStages1and2arepresentedtoshowthe process,whichisreportedinmoredetailelsewhere(Gidlow etal.,2022).
Stage1:situationalmaps
Processessetoutby Clarke etal. (2018) werefollowed.Afterthoroughlyreadingand memoingallwrittenmaterials,“messy”mapswereproduced,followedbyaseriesof orderedmaps,whichsetoutallhumanandnon-humanelementsofthesituation.Wealso begantoidentifymajorissuesanddiscoursessuchasthe“stigmaandmarginalization”and “equityissuesinhealthcareprovision”,whichlateron,wereusedtofocusthesituational analysis.Thefinaloutcomeofthisstageofanalysiswasthecreationofthreesituational relationalmaps,oneforeachofthethreeVOICES’priorities,toillustraterelationships betweentheelementsofinterestandotherelementsinthesituation,inasystematicand coherentway.
Stage2:socialworlds/arenasmaps
Therelationalmapsgeneratedquestionsthatwerefurtherexploredthroughthree workshops(oneforeachpriorityarea)thateventuallyledtothenextphaseofsituational analysisandthecreationofthesocialworlds/arenasmap(Figure1).Thismaprepresents thekeysocialactiveplayers(socialworlds)andthefield(arena)inwhichtheyinteract.As Clarke etal. (2018,p.150)stressed,itmapsthe“relationalecologicalformoforganizational analysisdealingwithhowmeaningmaking,andcommitmentsareorganizedand reorganizedagainandagainovertime”.
FivedifferentsocialworldscomprisedtheVOICESpartnership:thirdsectorhousing associationsthatsupporthousingneeds;voluntarysectorchampionswhosupportthose whorequireandusehealthcareservices;localpublicsectoragencies,mostlylocal authority(e.g.housingandMaRG)andtheNHS;legaladvisers’socialworld,whichwas dominatedbythethirdsectorwelfareadvisers;ExpertCitizens,whoactedasambassadors oflocalpeoplewithlivedexperienceofmultipleneedsanddisadvantage.
TheremainingsocialworldsalignedcloselywithVOICESobjectives(whilenotbeingpartof theVOICESpartnership)suchaslegislation,thecriminaljusticesystem,healthcaresector andacademia.ThisvisualrepresentationoftheVOICESpartnershipshowsthecomplexity ofthesituation,butalsoillustrateshowVOICESprovidedthecommongroundformany organisationstotacklemultipledisadvantage.Thishelpedtoovercomecompetitive attitudesandpracticesfrompartnershipsofvoluntaryandpublicsectors.
Althoughthemainfindingsarepresentedinpositionalmaps(Stage3),someaspectsthat emergedfromthesocialworld/arenasmapareworthnotinghere.Followingthe“likewith like”approach(Clarke etal.,2018),agreeablerelationshipsbetweenorganisationsare representedbyputtingthembesideoneanother,whereasconflictingorganisationsare opposing. Figure1 depictsthepower-seekingrelationshipofExpertCitizensCIC,a pinnacleachievementofVOICESlegacy,relativetotheotherVOICESpartnership organisations.BypositioningExpertCitizensopposingotherpartnershiporganisations, indicatestheirmovetoindependenceinfuturedecision-makingprocessesregardingthe localmultipledisadvantagedpopulation.
Moresubtly,thoughimportant,istheroleofacademia.Asawiderworkforcethatsupported VOICESefforts,academiawasplacedasanadjunctofthepartnership’sorganisation. Specifically,throughitsconsultancyandevaluatorrole,academiasupportedrigorous independentresearchandevaluationtoguidepracticeandpolicy(e.g.evidenceofprimary caregatekeeping;evidenceofineffectivehospitaldischargeprocessesforpeople experiencinghomelessness).
Finally,severalhumanelementshadanindirectroleinthesituation(referredtoas implicatedactors)butcriticallydidnotappeartohavedonesobeforeVOICES.For
example,generalpractitionerswererelevantthroughlegalobligation,butapparently resistanttosupportingpeopleexperiencinghomelessness,whichhasimplicationsforcrisis healthcareservices.Privatelandlordsandlettingagentswereimplicatedactorsthrough fillingthegapinhousingprovisioninHousingFirst,insomecases,creatingissuesin accommodationqualityandmaintenance.
Stage3:positionalmaps
Drawingonthewealthofmaterialconsidered,thefinalstageofanalysiselucidatedthe variouspositionstakenwithrespecttotheemergingdiscourses/issuesforthethree prioritiesunderinvestigation.Undereachofthesepriorityareas,thediscoursesreflectkey systemicissuesand/orhowVOICESwastryingtoaffectsystemschange.
Fairaccesstolocalsupportservicesofpeoplewithmultipleneedsand disadvantage
Threepositionalmapsarepresentedtohighlightthemajordiscourses/issuesthatcreated barrierstofairaccessandhowVOICES’workattemptedtoaddressthem[othermaps illustratinglessprominentdiscoursecanbefoundelsewhere(Gidlow etal.,2022)].
Stigmaandmarginalisation
Stigmaandmarginalisationamongsomepersonnelinpublicsectorsupportservices emergedasafundamentalbarriertopeoplewithmultipledisadvantageaccessing services(Figure2).Describedbyonestakeholder,as“theelephantintheroom” (McCormack etal.,2019),whendiscussinghospitaldischargeprocessesforpeople experiencinghomelessness,itwasrecognisedthatstigmacanvarywiththeneeds/ situationoftheindividual(e.g.substancemisusevshomelessvsoffendinghistory).This createdproblemsforthoseseekingcareorsupport,aswellasthestaffwholackthe knowledgeandexperiencetodealeffectivelywithpotentiallychallengingbehaviouror situations.
PositionCin Figure2 illustratesVOICES’worktoaddressthis.VOICESproducedlegally informedmaterialsandrecommendationstoraiseawarenessofthetopicandroles/ responsibilities(e.g.toavoidgatekeepinginprimarycare).Theyco-producedproducts, oftenwithpeoplewithlivedexperience,thatchallengestigmaandmarginalisation,such asVOICESandExpertCitizen’smethodologies(e.g.INSIGHT)andtoolkits(e.g.Care Acttoolkit)toempowerfrontlinestafftounderstandpeopleexperiencingmultiple disadvantageandempoweredthemtochallengeunjustdecisions/processes.Also, thelearningprogrammethattrainedpublicsectorprofessionalstoacknowledgethe importanceoflivedexperienceasbasiccomponentoftheirownprofessional development.
Responsibilityandaccountabilitygaps
Gapsinresponsibilityandaccountabilitycanresultfromfragmentedsystemsandsilo working(Gidlow etal.,2022).As Figure3 illustrates,forpeoplewithmultipledisadvantage, thiswasevidentinthecontextofpeopleexitingcrisisservices(e.g.accidentand emergencytothelocalauthority),situationsthatdemandaclearunderstandingofthelegal responsibilitiesofeachorganisations(andassociatedstaff)toensureeffectivetransitions betweensettingsandcontinuityofcareorsupport.
VOICEShaveshownthelargegapsinprovision,particularlybetweenhealthandother services. Figure3 illustratessomeconflictingpositionsonthisissue,that:thoseleaving healthcarearetheresponsibilityofsocialcare(PositionA);thatthethirdsectorworks beyonditsremittocoverthisgap,whichcanmasktheshortcomingsofthesystem
(PositionC).However,sustainablesolutionswerelessclear,asidefromtheaddressingthe misunderstandingamongdifferentsettingsandsectorsregardingthemeaningof“multiple needs”,whichcouldavoidmisperceptionsthatindividual’sneedsdidnotfallwithintheir remit(e.g.thathomelessnesswasahealthissue,notonlyahousingissue;PositionB).
Legalliteracy
Dataindicatedthatlackoflegalliteracywasacommonfailureofthesystem,whichwas largelyunchallengedbeforeVOICES.Asrepresentedin Figure4,alackofknowledgeof someimportantlegislation(HomelessnessReductionAct 2017; CareAct 2014)inthepublic sector,createsseriousbarriersforpeoplewithmultipledisadvantageinaccessingthe servicestheyneedandtowhichtheyareentitled.Weobservedthepositionthatmanagers andfrontlinestaffworkingwithinsufficientknowledgeormisunderstandingsaround policies,passon“myths”andmisunderstandingstocolleagues,which,inturn,become enactedaspolicy(PositionA).Thisisa‘negativefeedbackloop’,inwhichorganisations lacktheincentivetoaddresstheproblemasdoingsocouldmeanhavingtodealwithmore situationsandpotentiallycomplexcases.
VOICEShelpedtoaddressthisproblemthroughdevelopingtoolkits(e.g.CareActtoolkit) andmodels(e.g.WelfareBenefitsLeadingandLearning[WBLL])andthelearning programmetofacilitatethedevelopmentofrelatedknowledgeandskillsinfrontlinestaff (PositionB).
Figure3 Positionalmapforresponsibilityandaccountabilitygapsasabarriertoaccessing services
HousingFirst Availabilityofsuitablehousing
ThemajorissuewithHousingFirstinStoke-on-Trentwasthelimitedavailabilityofsuitable housing.Asshownin Figure5,therewereseveralrelatedpositionsinthedata,twoofwhich appearedtoreflectanissuethatpre-datedtheintroductionofHousingFirst(PositionsA andB)andjeopardiseditsprinciplesandeffectiveness:housingdemandexceeding supply,leadingtodelaysinHousingFirstcustomerssecuringtenancies(PositionB); inconsistentsupplyofsocialandcouncilproperties(PositionA).Thisresultedinareliance onprivatelandlordsandlettingagents,whichhadcreatedsomeissuesaround accommodationqualityandmaintenance(PositionC).
Finally,somestakeholderssuggestedthatunrealisticcustomerexpectationscouldbe barrierstoHousingFirst,citingexamplesofcustomersrefusingaccommodationoffers (PositionD).ThisneitherviolatesHousingFirstprinciplesnorsuggestsamainstream behaviourofHousingFirstcustomers.Thesolutiondoesnotnecessarilylieinaddressing thosecustomerexpectations.Rather,thispositionpointstoaneedtoaddressstakeholder
perceptionsoftheHousingFirstmodel.Again,itrelatestoalimitedsupplyofappropriate properties(primarilysingleoccupancy)thatleadstocompromise,wherebycustomershave tochoosebetweenaccommodationthatisunsuitable(basedonqualityorlocation)orwait (perhapsinthehosteloronthestreet).
SustainabilityofHousingFirstinStoke-on-Trent
Figure6 illustratespositionsregardingthefutureofHousingFirstasasustainablelocalstrategy totacklechronichomelessness.TheirargumentpresentedHousingFirstasacostlyintervention witharelativelysmallnumberofbeneficiaries,andadvocatedforalessintense,housing-led intervention,whichdeviatesfromHousingFirstprinciples(e.g.finitesupport,tenancyconditional onengagementwithsupportservices;PositionA).Opposingthiswastheperceivedneedto maintainHousingFirstasthekeylocalstrategy,whichwasapparentlyendorsedthroughlocal approvaltoextendtheprogrammefor12monthsusingVOICESfunding(PositionB).Here,the costofHousingFirstwasrecognizedbutwithacounter-argumentthatnumerousothersupport servicesthatareevenmoreexpensive,andwitharelatedargument(PositionC)thatinaction costsmorethandoingsomething,especiallyasaneffectiveinterventionhaswiderbenefits throughavoidingthecostsofdealingwiththeconsequencesofinaction[e.g.incarceration, emergencyhospitalcareand24/7socialcareservices(Gidlow etal.,2021a, 2021b)].
Figure5 PositionalmapforavailabilityofsuitablehousingasabarriertoHousingFirst
Makingserviceusersleadersinservicedesignandcommissioning
ThethirdVOICESpriorityareaconcernedthegreaterroleforpeoplewithlivedexperience, who,throughVOICES,hadbecomeestablishedwithinthepoliticalagendaandcanbe consideredakeyrequirementforsystemschangeapproach.Twopositionalmapsare presentedtoillustratekeydiscourses/issuesforthistheme.
DevelopmentofExpertCitizenscommunityinterestcompany
ThedevelopmentofExpertCitizensCICwasrecognisedasacornerstoneachievementof VOICES(PositionA),thepinnacleofco-productionbetweenVOICESpartnershipandlocal
peoplewithlivedexperience(Figure7).Despitethisco-productionandsubstantial contributionExpertCitizens,therewasasuggestionthatnotalltheirideas/suggestionshad beentakenintoseriousconsiderationoractionedbyVOICES(PositionB).
Peermentoring
Peermentorswereindividualswithlivedexperienceofmultipleneedsanddisadvantage, whohadjoinedExpertCitizens,receivedtrainingandwerewillingtobeexemplarsto supportcurrentcustomers.TheywereusedprimarilyforHousingFirst.Therewasaposition thatpeersmentoringwasbeneficialforHousingFirstcustomers,helpingtobuildinformal relationshipswithcustomersandsupportwithactivitiesofdailylife,whileacknowledging thecomplexitiesandthatsuchsupportisnotarequirementofHousingFirstprinciples (PositionA).Therewasconcurrentconcernregardingthepotentialnegativeimpactonpeer mentors(PositionB);e.g.peermentorsfeelingobligedtoactbeyondtheremitoftheirrole
orfeelingoverburdened,withriskstopeermentors’mentalhealthandrecoveryprocesses (theirsandthecustomers’).Cautionandregularmonitoringwereproposedasonefeasible solution(Figure8).
Discussion
WereportevidencefromsituationalanalysisoftheVOICESpartnershipimpactonthewider systemofsupportforpeopleinStoke-on-Trentwhoexperiencemultipledisadvantage, acknowledgingthepostmodernconceptualalignmentofsituationalanalysismethodology tosystemsthinkingapproaches(Martin etal.,2016)
Throughtheconceptualcartographicmappingprocessforeachofthethreepriority areasinwhichVOICESaimedtoaffectsystemschange,situationalanalysismadetwo importantcontributions.Firstly,situationalanalysismaps,asother systemthinking approaches( Egan etal.,2019),suggestedanewtypeoflanguagethatshiftsnarration fromitsrelianceonthelinearandlogicalformationofwords(Meadows,2008)towards thedisplayofthediversepositionalitiesofthephenomenaunderinvestigation(Mathar, 2008).Secondly,theyprovokeasystemsthinkingexplanation,whichisnecessaryfor complexityinquiry(Martin etal.,2016 )andpermitresearcherstoembracethe heterogeneityofthesituation,whichisusuallyhiddenbypositivistmethodologiesof cause-and-effect( Williams etal.,2018)orevenexcludedby“whatworks”interventions (Abercrombie etal. ,2015).
Thus,despitebeinga“thickanalysis”methodology,situationalanalysis,alsoembraces abductionthinking(Clarke etal.,2018)thatpermitstheidentificationofahigherand abstractlevelofexplanation(thoughgroundedinthedata)ofthenon-linearrelationshipsof thesituationofinterest(Chapman,2004).
Thissectionprovidesexactlythat,areflectiononthelearningfromtheabovefindings, expandingonevidenceofVOICES’effortstoaddressthelocalsystem’sfailuredemand [“demandcausedbyafailuretodosomethingordosomethingrightforthecustomer” (Seddon,2003,p.26)]insupportingthosewithmultipledisadvantageandneeds. VOICESmadeconsiderableeffortstosupportlocalpeoplewithmultipledisadvantageand makepositivechangestoasystemthatoftenshiftsblametotheindividualfornonengagement/non-compliancewithtypicalprocesses.ThroughstudyingtheworkofVOICES withinthe‘situation’ofthesupportsystemsforthisgroup,itwaspossibletoidentifyseveral differentialpositionsbetweenthepartnershipandthepublicsector.Theseunderpinned manyoftheobservedfindingsandcanbeexplainedinthecontextoftheirdifferenttargets relatingtoequalityorequity,andtheirroleinsystem’sfailuredemand.Equalityapproaches fairnessastheprovisionofthesametreatment/supportopportunitiestoall(Takeuchi etal., 2018),whereasequityacknowledgesthepotentiallydifferentneedsandabilitiestoaccess servicesprovided.Thus,forequity,treatment/supportisallocatedproportionally(Duclos, 2006).Thisconceptualdifferencecanhavesubstantialimplicationsforthesupportthatthe peoplewithmultipleneedsanddisadvantagereceive(Chang,2002).Moreover,this providesanappropriatebasistoconsiderdifferencesinthissystemandresultingsupport beforeandduringVOICES(i.e.thedifferenceVOICESmade).
Accordingtotheevidenceconsideredinsituationalanalysis,supportservicesmorealigned withequalityweremostlythoseofthepublicsector.Thisisperhapsnotsurprisingasthe
commondeliveryfocusiscitywideandbasedonpopulationneeds,ratherthanbeing targetedortailoredtothosewiththemostextremedisadvantageandneeds(McCormack etal.,2019).However,inthissituation,itappearstohaveledtofailuredemand, exacerbatingsocialandhealthinequitiesbetweenthelocalgeneralpopulationandthose withmultipledisadvantage(Wilson etal.,2016).AseriesofexamplesfromVOICESwork showshowpeoplewithmultipledisadvantageandneedshavebeenexcludedfrom services,despitebeingeligibleandentitledtosupport.Forexample,theobservedlackof legalliteracyandmisinterpretationofthelegislation’sinclinationtowardsequityaffects manyservices,ultimately,excludingtheVOICEScustomergroupfromsocial,healthand financialservices.Inturn,thelackofresponsibility-takinginthepublicsectorforthosewith multipleneedsanddisadvantage,alongsidethereactiveanduntargetednatureofsome provision(e.g.prisonreleaseplans,hospitaldischarge),illustratedthecausesofthe revolvingdoorissue,wherebythosewiththegreatestneedsarecontinuallyin/outofthe samelocalsupportservice(oftenincrisis).Finally,theperpetuationofthetraditional treatmentfirstortemporaryhostelaccommodationpolicyisanotherindicationoffailure demandregardinghowchronichomelessnesshasbeenaddressedlocally.
Furthermore,theequalityprincipleandpoliciesfavourthosewithbettersocial,physicaland mentalhealth,ratherthanpeoplewithmultipleneedsanddisadvantageresultinginthe “competitiveexclusionprinciple”;agravitationalforcethatkeepspeoplewithmultiple needsanddisadvantageinthesamevulnerableposition(Chapman,2004).Eventually, whentheproblematicsituationbecomesunmanageableandoverburdensthesystem(in whatiscalleda“feedbackdelay”),theneedtoturntomoresystemsthinkingsolutionsis acknowledged(Meadows,2008).Inthiscase,suchsolutionswereattemptedthrough FulfillingLivesandVOICES.
VOICES’actionsreflectedaneedtofocusonequityasthemaintargetfortacklingthe socialgradient,inlinewithwhatMarmotcalledproportionateuniversalism,wherebythe intensityofthesupportwasproportionatetotheextremeneedofVOICEScustomers (Marmot,2010).Tothisend,VOICESaddressedsocialorhealthinequalityissues(e.g. appealsforbenefitclaimsorgatekeepingfromprimarycare)identifiedinsupportive services.Firstly,byinterveningandinitiating“verticalequity”;i.e.workingspecificallyto accommodateortailortheservicetoaVOICEScustomer’sneeds,and,secondlyby securing“horizontalequity”,bytailoringtheservicetoVOICEScustomerbase(Duclos, 2006).
Specifically,toapproachequityviasystemicthinking,VOICESimplementedaseriesof changestothesituationunderinquiry.Initially,theemergenceofExpertCitizensas ambassadorsforpeoplewithmultipleneedsanddisadvantageredirectedthefocusofthe localsupportsystem.Accordingtosystemthinking,changingoneelementcannot drasticallytransformthewholesystem.However,itcancausearedirectionofprioritiesifthe changeisaccompaniedbyanalogouschangesinnestedsystemicrelationships (Chapman,2004).Forexample,thiswasachievedthroughsupportingExpertCitizensnot onlytobecomeanindependentCICbutalsobyacknowledgingtheneedforskilful personnelwhoareaccreditedandtrainedtoparticipateequallyasco-designers(i.e.Care Acttoolkit),co-researchers(i.e.interviewingandcollectingdataatvariousVOICESreports) andco-evaluators(i.e.INSIGHT).Thisisexpectedtoprovidelong-lastingchangethatwill continuetohelptransformthefaceofthelocalsupportsystem.
Inparallel,VOICESgraduallyturnedintoatotallyco-producedproject,aninnovative, diverseandautonomouspartnershipandtookanevolutionarylearningapproach,which acknowledgedthecomplexityofthesupportsystemforpeoplewithmultipleneedsand disadvantage(i.e.thesituation).Forexample,thelearningprogrammeaimedtopromote workforcedevelopmentformoreeffectiveworkingwiththispopulation;WBLLaimedto improvelegalliteracy;researchandevaluationwerecommissionedtoinformpractice. Thesemeasuresalsoaimedtoovercomeprofessionals’assumptionsofwhoknowsbest,
acknowledgingtheimportanceoflivedexperienceasabasiccomponentoftheirown learningprocessandbeingopentoconstructivecriticismasopportunitiestolearnand adapt.
Finally,VOICESaimedtoeffectchangesinlocalsupportsystemforpeoplewithmultiple needsanddisadvantage.Thiswasattemptedthroughtheeffortstoreinstatelegislation’s inclinationtowardsequity,eitherbyraisingawarenessthroughlegallyinformed documentation(i.e.Gatekeepingreport;CareActtoolkit)orbyinterveningintheinternal structureoforganisationsviathemodel(s)ofspecialistwelfareAdviserandWBLLmodelto thefrontlineteamsorthroughthepilotHousingFirstprogrammeforimmediate,permanent andunconditionaltenanciesforcustomers,regardlessofcompliancewithservices (BrethertonandPleace,2016).
Conclusion
Thisnovelapplicationofsituationalanalysishighlightedanumberofissuesinthesystemof supportforpeoplewithmultipleneedsanddisadvantagesandthewaysinwhichVOICES hadimpactedthatsystem.DuringtheeightyearsofVOICES,therewasevidenceof progressagainstallthreepriorityareasforsystemschange,primarilytacklingthesocial andhealthinequities.Whereshortcomingsorfailurestomakealastingimpactwere observed,VOICES,commitmenttolearningandevaluationhasallowedthenew programmestosupportpeoplewithmultipledisadvantage,particularlyChangingFutures (DLUHCandMHCLG,2021),toincludemeasuresthatcanaddresstheproblems encountered.
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Appendix.Resourcesforsituationalanalysis
Reports
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Rice,B.(2020) VOICES – VoicesofIndependenceChangeandEmpowermentin
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Websites
www.voicesofstoke.org.uk/ www.brighter-futures.org.uk/ www.fulfillinglivesevaluation.org/about/the-partnerships/voices-stoke-on-trent/ www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/pip/appeals/ mandatory-reconsideration/ www.healthwatchstokeontrent.co.uk/about-us/ www.keele.ac.uk/socialinclusion/ourpartnerships/ www.expertcitizens.org.uk/ www.chadresearch.co.uk/
Minutesandpapersfrommeetingsof
VOICESLegacySteeringGroup
HousingFirstSteeringGroup
Correspondingauthor
KonstantinosSpyropouloscanbecontactedat: konstantinos.spyropoulos@staffs.ac.uk
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