In 2015, it was estimated that 363,000 adults in England were facing multiple disadvantage. Approximately 85% had experienced significant trauma in their childhood.

In 2019, it was estimated that over 5.000 of Nottingham City's residents were facing Severe and Multiple Disadvantage (SMD); a combination of issues including homelessness, mental ill health, substance misuse, offending and domestic abuse.

For people facing such issues, accessing help can be very difficult. A lack of signposting or dedicated services, combined with the trauma of having to retell their story to each organisation they attempt to access for support, means many people fall through the gaps in the system, becoming more unwell, and more entrenched in their circumstance.

Co-occurring conditions such as mental ill health and addiction are often dealt with separately, usually with an expectation that a person stops or reduces their substance misuse before accessing mental health services. For those leaving prison, a lack of accommodation and support often results in a repeat cycle of arrest and time in prison; which can go on for decades. For those who are homeless, finding suitable accommodation can be difficult, with many people choosing to sleep on the streets as opposed to in hostels, where drugs are often readily available.

The system needs to change, so that it is focused on supporting people facing SMD to live a fulfilled life, as opposed to setting them up to fail.

Since 2014 we have worked at a strategic level across Nottingham City to influence system change. Using evidence and learnings from our project, we have worked with key delivery and commissioning organisations to identify the need for collaboration and joined up services. This work has included;

  • Continuous research, sharing and application of learnings
  • Driving positive change in the way services are commissioned, including the direct commissioning of some services
  • Ensuring the SMD agenda is represented at a strategic and policy-setting level in Nottingham City
  • Participation and input in national strategy and policy-setting in relation to SMD.

People who have direct experience of Severe and Multiple Disadvantage (SMD) in Nottingham City, have been fully involved in this work at all times.  

In September 2019, our Evaluation Team penned a Joint Strategic Needs Assessment (JSNA) regarding SMD in Nottingham City. This assessment considers unmet needs and gaps in the system, and includes recommendations for Commissioners. It provides a clear roadmap for system change in Nottingham City, and can be read in full here.

Further information and reports regarding Severe and Multiple Disadvantage (SMD) and system change, can be viewed here.