The Vision Project


Throughout 2019, Developing Health & Independence (DHI), have been marking their 20th anniversary as a charity by looking to the future. Through articles, events and podcasts, they've asked people to answer the question of how we can achieve their vision of ending social exclusion. This collection of articles includes the contributions of experts from across public life and the political spectrum.







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Rosie Phillips

DHI Chief Executive



DHI’s founder and Chief Executive

How do we achieve our vision to end social exclusion by ensuring that everyone

has their basic needs met and is able to thrive by contributing to the richness and

wellbeing of their community?

That was the question we put to people this year,

to mark DHI’s 20th anniversary. I’ve had the great

pleasure, while writing this foreword, of reading all

the articles contained in this book again, and I am

grateful to all the people who have written them;

for sharing their wisdom and experience with us,

our supporters and the public.

If social exclusion is defined as exclusion from the

prevailing social system, its rights and privileges,

Viv Evans from Adfam wrote movingly about

the social exclusion families experience through

the stigmatising effect attitudes in society have

on people affected by someone else’s substance

misuse, and the devastating effect of stress in

everyday situations. That this is still taboo is

something we must strive to change.

When considering the issue of meeting people’s

basic needs, it’s impossible to ignore the fact

that many people in Britain today live in poverty.

Emma Kernahan offers a vision where we have a

generous redistributive social security system, one

based on respect and trust, not one underpinned

by the Poor Laws of 1601. While on the third

anniversary of the EU referendum, Jeff Mitchell

from Clean Slate Ltd. also considered social

security, work, and how he believes inequality was

a major factor in the vote to leave.

Another impact of inequality, according to Ian

Walmsley, are higher crime rates. His article

explores how our criminal justice system can be

reformed since it currently causes and entrenches

social exclusion. Social, as well as economic

inequality, were written about by One25’s Sarah

Talbot-Williams in her article about sex work for

International Women’s Day and by Stonewall’s

Josh Bradlow, whose article for Pride Month

showed how far we still are from LGBT people

being treated equally by society.

Apart from money, the other basic need that

people really emphasised was housing. Jon

Sparkes from Crisis laid out their ambitious plan

to end homelessness; Stephen Robertson from

The Big Issue Foundation articulated their ethos

of giving people a hand up and helping them

think about the future; and Nick Ballard of Acorn

wrote practically about the changes that need to

take place in the private rented sector to make

it a more accessible and stable option. At the

other end of the spectrum though, Jacob Rees-

Mogg warned about the ‘balance shifting too

far’ in terms of regulations and the possibility of

landlords being put off letting their properties, but

also stressed the desperate need for more homes

to be built. Kevan Forde from Anchor-Hanover

also considered the issue of housing, but with a

particular focus on housing people in later life,

the challenges they face around isolation and

loneliness, and the need to co-produce solutions.

At the other end of the age spectrum, Sandy

Hore-Ruthven from Creative Youth Network drew

attention to the need to build relationships with

young people and move away from the quickfix

results driven culture we are in. Children who

start school without the literacy, language and

communication skills they need to learn and

flourish will have their futures cut short before

they’ve even started, argued Jonathan Douglas,

Chief Executive of the National Literacy Trust,

while Phil Harris wrote a fascinating article about

the widening opportunity gap for young people

and how treatment services must get better at

reflecting underlying social functioning levels

curtailed through drug use.

Others writing about drugs focused on reducing

the harm done to the individual and society by

them. Danny Kushlick from Transform made a

case for the legal regulation of drugs as one route

to ending social exclusion, while Nick Wilson

from Exchange Supplies sent out a call for people

to become harm reduction activists again at a

time when drug-related deaths are at a record

high. John Tizard also made a plea for people

to become activists in his article encouraging

the voluntary sector to raise their heads above

the parapet and more openly discuss the causes

of social exclusion, not just dealing with the


DHI’s own Jody Clark wrote about preventing

people from dying as a result of using drugs,

including a more holistic view of public sector

spending. Amanda Deeks made a similar

argument, advocating for early intervention as

well as the need for councils and the NHS to

invest in infrastructure and consider their shared

commissioning strategies. Funding silos remain as

much a problem today as 20 years ago.

Finally, as Marvin Rees says in his article, ‘the

mantra of inclusion is easy to preach and hard to

practice’. However, whether it’s by tackling poverty

through ensuring adequate supply of affordable

housing, ensuring real opportunities for our most

disadvantaged young people through a focus

on literacy, or through overcoming stigma and

discrimination, we can ill-afford to do nothing.

We very much hope this

collection of articles will help

stimulate debate, but more

importantly create real change

for the better.

Thank you.







Rosie is the Chief Executive and founder of Developing Health & Independence (DHI)

‘Oh, the craic was good in Cricklewood,

And they wouldn’t leave the Crown,

With glasses flying and Biddy’s crying,

Sure Paddy was going to town.’

McAlpines Fusiliers, The Dubliners, 1966

In 1990, as a fresh faced graduate working for a

London PR consultancy, every morning I would

walk down Cricklewood Broadway, past the then

infamous Crown, and the men waiting for the

vans to take them to work. But the craic was not

so good in Cricklewood by then. The building

boom, that had offered opportunity for many

disadvantaged Irish men, had collapsed, and

their world unravelled at alarming speed. Living in

insecure crowded rented accommodation without

purpose, family or friends, most drank to overcome

boredom, disappointment or pain, and soon

swelled a rapidly growing homeless population in


So I started volunteering at Cricklewood Homeless

Concern at weekends. I eventually got a paid job,

initially by raising enough money to cover my

own salary! I worked there for seven years. Mostly

we gave out food and clothing, we tried to find

housing, or repatriate people back to Ireland, but

as the evidence now clearly shows, the longer a

person is on the street, the more entrenched that

lifestyle becomes. Having mostly arrived because

of the Troubles, intolerance or lack of opportunity

back home, too many then drank themselves to

death when the financial crash signalled the end

of industry’s need for their labour. Productive one

day, expendable the next.

Eventually I became tired of the sticking plaster we

offered, and of the perverse effect the segregation

of services and funding led to. So when I saw

the opportunity to run a project called the Drugs

and Homeless Initiative in Bath, setting up a dry

house that sought to bridge the gap between drug

treatment and housing, I jumped at it.

I was then fortunate to be given free rein to

broaden its scope. And so began DHI in 1999,

a charity that seeks to turn around the lives of

those who face multiple disadvantage, by focusing

on the clustering of serious social harms such as

homelessness, substance misuse, mental ill health,

violence, abuse and poverty. Not catchy, appealing

or an easy ‘brand’ to sell, such is the interlocking

nature of these issues, and their cumulative


20 years on and where are we? Treating drug

addiction will always be an uphill battle while they

remain illegal, since the law is by nature always

one step behind the criminals that supply, market

and sell it. Drug related deaths are sadly heading

upwards, and the young, the vulnerable and the

poor are those most likely to be caught up at the

rough end. Yet, whatever your view of drug policy

or current funding, treatment is in a much better

place than it was: better understood, better funded

and more joined up. Having shifted the paradigm

from viewing addiction as a moral failing, to the

disease model of the 70s, this too was challenged,

largely thanks to the insights of psychologist Bruce

Alexander and an experiment called ‘Rat Park’.

When the disease model was first gaining ground,

evidence was thought to come from the fact

that rats, given unlimited access to cocaine,

would take it relentlessly, sometimes foregoing

food and water even to the point of death.

What explanation could there be for an animal

neglecting basic needs? The answer seemed to be

that drugs were so powerful they could override

evolutionary instinct. But rats are highly social

animals like us. Wondering why no one thought

it noteworthy that the disease model was based

on experiments with rats that had been removed

from their family groups and kept isolated for

the course of the experiment in small cages, with

nothing but cocaine, Alexander constructed his

own experiment: Rat Park.

Alexander took morphine dependent rats out of

their isolated cages and put them in rat park, a

naturalistic setting where rats were able to cohabit

and reproduce. His overwhelming finding, since

corroborated, was that if given a choice between

drugs and either sugar, saccharine or same sex

snuggling, the rats addicted to drugs chose the

sugar, saccharine or snuggling over the morphine.

Rats in the isolated cages took cocaine until

they died, because without it, there was nothing

but suffering in that environment. In rat park,

the morphine dependent rats stopped taking

the morphine as there were other alternatives


Of course, people are not rats, but the basic

lessons still apply. Fortunately, treatment services

no longer view those struggling as morally

bankrupt or helpless addicts, or ignore the wider

determinants of a person’s drink or drug use.

For the men on Cricklewood Broadway, lacking

opportunity to prove their self-worth through work,

and without family or love, the alcohol served to

anesthetise the pain.

To really understand and treat addiction, we

need to understand what drugs do for people in

general, and in particular when they are suffering,

where the alternatives are of limited help. Don’t

just blame the drugs – look at how people feel,

what opportunities they have and what’s wrong

in our world. People need self-worth and a sense

of purpose in order to want to change, to seek to

achieve their potential, and this requires a basic

level of material and financial security. Talk to

any of DHI’s staff today, and you’ll hear that

housing is the single biggest barrier our clients

face in attempts to turn their lives around. For the

majority, this is not the street homelessness of the

headlines (no, that is the canary in the mine; and

worryingly on the rise), it is the daily grind of living

insecurely, be that on a friend’s sofa, in a hostel

or just through the weekly struggle to make ends

meet to pay the rent.



“But this isn’t

about houses –

it’s about people.

For a home is not

just a physical

space: it provides

roots, identity,

security, a sense

of belonging and a

place of emotional


In light of this, the relentless physical and mental

battle of living in poverty must be tackled if we

are to address social exclusion. Universal credit

may be well intentioned – with its aims to simplify

a complex system and make work pay - but the

process is stressful, starts and ends with the

presumption that everyone is work ready, IT literate,

robust and capable, and doesn’t take account of

people’s vulnerabilities. Moreover, it pushes people

into debt. Meanwhile, the biggest single cost

pressure for the vast majority of us – housing - is

simply not affordable for far too many people.

But this isn’t about houses – it’s about people.

For a home is not just a physical space: it provides

roots, identity, security, a sense of belonging and

a place of emotional wellbeing. Lack of affordable

housing, including housing to rent at benefit

levels, creates inequality, stress and ill health. It

impoverishes, excludes and increases the pressure

on our precious public services when we can ill

afford to do so.

Housing First has recently been put forward as a

model of good practice in the UK in helping rough

sleepers fully move away from a street lifestyle

by providing stable housing as a platform from

which to begin recovery. It holds to the principle

that housing is a basic human right. But there is

nothing new in this. Way back in 1943, Abraham

Maslow offered a way of looking at human

needs: Maslow’s Hierarchy of Needs. At its heart

Maslow’s hierarchy is both simple and profound.

It states that all people must have their basic

needs for food, warmth and shelter met in order to

be able to address other higher needs effectively.

Only then can they achieve their potential. Poor

physical and mental health, substance misuse,

domestic abuse, lack of educational attainment

and poor employment prospects – these are all

closely associated with poverty, and housing sits

at the heart of this. To end social exclusion in 20

years’ time, we must make sure everyone can

afford a decent place to live and be able to put

down the foundations for achieving their potential.

Secure affordable housing may not be the end

game, but it is most certainly the entry ticket!







Emma is a blogger and writer from Gloucestershire who works in the third sector.

She can be found on Twitter @crappyliving.

I’m a Support Worker. I help people

to access social security and move on

positively in their lives. This is an easy

job, because government benefits are

generous and easy to access and social

security is highly valued, as are the

people who receive it...

The government invests heavily in services to

make sure they lift people out of poverty, even if

doing so goes against individual, donor or party

interests. Doing that is what they are known for,

because it’s their job. When they have agreed

work commitments, they stick to them.

The system has been designed by people who

have received social security themselves, and

used it to progress into training and well-paid

government jobs. They work in offices that provide

flexible working, and on-site childcare. There are a

few people who work as policy makers who have

no experience of living on a low income, and that’s

great for diversity.

I have a case load of five people - not 30, and not

90 if I work in London. I work with five people

intensively to ensure they have enough money to

control their own lives, and to connect them to

other well-funded and effective services, because

this is literally the only thing that works. Nobody

needs to have a local connection to use essential

services, because that’s a system that underpinned

the Elizabethan Poor Laws of 1601, and it is not


Today I’m meeting Kate. Kate has a three-yearold

son and is seven months pregnant. Kate is

funny and clever and wants to be a journalist. Her

ex-partner is abusive, and even though she doesn’t

have family nearby, Kate was able to leave that

situation because high quality social housing is

plentiful and easy to access. She and her son have

never been housed in one room above a boardedup

pub, in a remote area with no public transport.

Her son does not have chronic respiratory illnesses

caused by damp living conditions, because that

would be unacceptable for any child growing up in

the fifth largest economy in the world.

We are meeting at the social security office. The

social security office is a bright and welcoming

place in a nice part of town, because that’s how

much we value the people who use it. Their success

benefits everyone. They are allowed to use the


We are meeting there because Kate has debts.

These debts are not a result of having been

unlawfully fired from a poorly paid job in the care

industry because she was pregnant. Nor are they

the result of three months with absolutely no

income while her eligibility for state benefits was


Kate has rent arrears because for years her partner

controlled her finances. He made unreasonable

demands of her in exchange for small amounts of

money. Sometimes, he withheld money from her

for long periods without explanation or redress,

trapping her in her relationship and making her

physically and mentally ill. This was humiliating

and abusive. The government does not do this.

Instead it provides Kate with a Basic Income. The

Basic Income is paid straight away, fortnightly and

in advance. It is not means tested and it covers

all of her needs, including those of her children,

however many children she has. It allows a little

extra to save, cover unexpected costs and make

long term plans, because being unable to do this

would make poverty inescapable. No government

would set out to make poverty inescapable for a

large proportion of the electorate, or to benefit

from that process in any way.

At the office, Kate is Kate. She is not a customer, a

client, a scrounger or a cheat, she is not bone idle

or playing the system. She’s also not in the library,

because that’s a place for borrowing books, not

for people in crisis to discuss the details of their

personal life with strangers, even in a glass booth

that is called a pod.

Kate, like all people claiming social security, is working

a little harder to get by than others who have been

luckier in their circumstances. This takes skill and

resourcefulness and she is actively celebrated for it.

Not vilified, not tolerated. Not even simply supported.


On the wall is a reminder that every person is

entitled to the realisation of the economic, social

and cultural rights indispensable for their dignity

and the free development of their personality. It

does not feature a list of reasons the police may be

called and sixteen posters about chlamydia.

Together, we speak to Kate’s regular adviser

in person, and call a debt specialist on a single

Freephone number. We spend one minute on hold,

not 90, which means everyone still actively enjoys

hearing Vivaldi, and Kate does not miss any of

the university course that she attends for free. Her

son has had free access to an excellent nursery

since his first birthday, so she will soon be able to

complete her journalism studies and find well-paid,

secure work.

Her rent arrears are cleared with a grant, and debt

does not stop her and her children from having a

home, or from heating it. As survivors of domestic

abuse, Kate and her son receive regular, high

quality care, often in their own home. So does the

perpetrator of the abuse. She is not put on a six

month waiting list for counselling, or given a leaflet

for the anger management hotline with the wrong

number printed on it, or offered a series of free

shiatsu sessions, at the library.

This is done because everyone wants Kate to fulfil

her enormous potential. They know that a good

social security system does not mean a budgeting

sheet and a lecture about ready meals. It does not

mean food bank vouchers, or calling a sick note

a ‘fit note’, or disguising funding cuts with words

like ‘empowerment’. It does not cut holes in the

welfare safety net, and then briskly toss people into

it. Also, nobody knows what the benefits cap is, but

it sounds terrible.

A good benefits system is fundamentally

redistributive. And what it redistributes is value,

making those at the bottom as important as those

at the top. It means a huge number of highly

trained staff, a well-connected infrastructure and

a clear and transparent line of responsibility, so

that nobody sinks beneath the weight of poor and

unjust decisions.



It means free and easily accessible legal services

to hold both employers and the government to

account – no ifs, no buts. It means understanding

people’s choices and opinions, and respecting

them. It means a rich bedrock of support services,

from early years to mental health to housing.

It also means money. Money changes things.

Money. No strings, no judgement, easily accessible

- money.

Within such a system, Kate takes control of her life

and moves on positively. She believes herself to

be funny and clever and with unlimited options,

because this is what she is told, in a hundred

different ways, every day. And also, because she is.

In 15 years of highly paid front-line work, nobody

I support has had their child removed from their

care because they are poor. Nobody has died of

exposure in the doorway of Marks and Spencer,

and nobody I work with has ever taken their own

life. It is a good system.

“A good benefits system is

fundamentally redistributive.

And what it redistributes

is value, making those at

the bottom as important as

those at the top.”






Jonathan is the Chief Executive of the National Literacy Trust, an independent charity working with

schools and communities to give disadvantaged children the literacy skills to succeed in life.

Children who start school without the

literacy, language and communication

skills they need to learn and flourish

will have their futures cut short before

they’ve even started. As children they

won’t be able to succeed at school, as

young adults they will be locked out

of the job market, and as parents they

won’t be able to support their own child’s

learning – putting social inclusion, and

the chance to live in a fairer society, out

of reach for generations of children...

To achieve social inclusion, children, young people

and adults must have the literacy skills they need

to be able to make sense of the world around

them and their place in it. Yet 7.1 million adults in

England don’t have the literacy skills they need to

read a newspaper, understand a utility bill, make

sense of the instructions on their medicine, fill out

a job application form or navigate the internet.

Lacking vital literacy skills puts people at extreme

risk of social exclusion. Indeed, extensive research

shows that people with poor literacy skills are

significantly more likely to experience poverty, live

in poor quality housing, be unemployed, become a

perpetrator or victim of crime, have poor physical

and mental health, and even lead shorter lives.

Research also shows that the majority of literacy

problems experienced in adulthood can be traced

back to the early years. Children who have poor

language skills at the age of five are six times

more likely to fail to reach the expected standard

in English at age 11, three times more likely to

experience mental health problems as adults, and

twice as likely to be unemployed aged 34.

The scale of the challenge we are facing is

immense. Last year in England, more than 180,000

five-year-olds started primary school without the

language, literacy and communication skills they

need to learn, make friends and flourish.

This picture doesn’t improve as children grow

up – in fact, it gets worse – with a quarter (25%)

of 11-year-olds leaving primary school last year

unable to read well and a third (36%) of 16-yearolds

failing to get a good grade in GCSE English


For children from the poorest backgrounds, this

challenge is even more acute. We know that

children and young people from the poorest

backgrounds are most at risk of falling behind

when it comes to developing the literacy skills they

need to succeed in life. In fact, the link between

poverty, educational attainment and basic skills is

stronger in England than in any other developed


To tackle the UK’s literacy challenge and give every

child the literacy skills they need to reach their

potential, regardless of their background, we must

target our work in the places where we can make

the biggest difference to children’s lives.



“While there is no silver bullet, the message is clear:

if we focus tightly on the areas where the literacy

challenge is sharpest, we can make a meaningful

difference to children’s lives.”

Working with Experian, we’ve been able to pinpoint

the nation’s literacy cold spots – communities

where as many as a third of the adult population

is functionally illiterate, child poverty is rife, social

mobility has stagnated and life expectancy hasn’t


Using this analysis, we have established 12

Literacy Hubs and campaigns in towns, cities and

regions where low levels of literacy and poverty

are seriously impacting people’s lives, including

Middlesbrough, Bradford, Stoke-on-Trent and the

North East.

In our Literacy Hubs, we bring together multiple

local stakeholders, including businesses, education,

community, health and cultural organisations,

to galvanise the whole community, its skills and

assets in decade-long campaigns to improve

local literacy levels and drive social mobility and


Our approach is different in each place we work

because every community has different needs and

this is the best way to create long-lasting change.

And we are starting to see evidence that placebased

approaches can move the dial on literacy in

the nation’s most disadvantaged communities.

When we began working with local partners

in Middlesbrough, children from the town

were starting school with some of the lowest

communication, language and literacy skills in the

country. Five years on and the attainment gap

with the national average has halved.

During this time, we have delivered a range of

interventions through our local partnerships, each

with the aim of improving the early language skills

of disadvantaged children in Middlesbrough.

For example, we delivered targeted literacy

interventions in nurseries, ran a town-wide

advertising campaign with the local council to

encourage parents to chat, play and read with

their child every day, and worked with health

visitors to provide new parents with information

and advice on the importance of reading with their

baby from day one.

Place-based working enables us to tackle

intergenerational low literacy in areas of

concentrated deprivation and give some of the

most disadvantaged children and young people

in our society the literacy skills they need to take

control of their futures.

While there is no silver bullet, the message is clear:

if we focus tightly on the areas where the literacy

challenge is sharpest, we can make a meaningful

difference to children’s and families’ lives and help

them to become informed, empowered and active

members of their communities and society.









Jody is the Associate Director of DHI, writing this

article in a personal capacity.

They say that for every complex social

problem there is always a solution that is

clear, simple and wrong and nowhere is

this truer than for drug-related deaths...

The accepted wisdom is that to reduce drugrelated

deaths people simply need to stop using

drugs - no drug use, no overdoses, no deaths.

Simple, done, move on to proper social problems.

After all, this has been Government policy since

2010 and if it wasn’t for UK citizens refusing to

comply with this clear and simple directive, deaths

would have all but disappeared.

The only problem is that people seem to want to

use drugs. Whether it’s the legal variety or those

for which possession is prohibited, substance use

remains a familiar part of the human experience.

People who use drugs do so for a broad spectrum

of reasons, be it for pleasure, relaxation or

experimentation, some to enhance experiences,

increase social connectedness and empathy and,

of course, those who use drugs to deal with a life

of pain and trauma. Often it’s a mix of reasons

but whether we like it or not, people who use drugs

derive a benefit from doing so – regardless of

whether it looks from outside that there is only a

negative impact or whether we judge the risk as

too high.

All overdose deaths are tragedies, whether it’s a

teenager dying after using MDMA at a festival or

a middle-aged man from a heroin overdose in a

hostel. It’s understandable that the media widely

covers the loss of young people dying from MDMA

use, despite these only making up a small number

of the overall fatalities.

Children dying before they reach their prime is

heart-breaking and the coverage of these deaths

is increasingly sensitive and often seeks to capture

the essence of the person who has been lost to us.

Families and friends have been able to share their

memories and reflect on the futures that are no

longer possible.






Unfortunately, the same is not true of heroinrelated

deaths. Media articles, if any even appear,

remain full of stigmatising language, usually

referring to the “addict” that has died, focusing

on the drug use and the failure of the individual

to have stopped. Rarely, if ever, do articles look

at the person, their history, what they may have

had to overcome in their lives - just one less junkie

being a drain on society. We’ve got an increasing

understanding of the role of trauma and adverse

childhood experiences that underpin many

people’s heroin use but the media continue to

push stories that paint the deceased as merely

lacking the necessary willpower or moral fibre to


Deaths from MDMA and other club drugs have

been mainly due to very high purity putting people

at risk of taking an unknowingly dangerous dose.

Without legally regulated production and supply

of these substances, it is left to organisations such

as The Loop to offer drug testing facilities to give

individuals an opportunity to better understand

what it is they have bought and to sit with a

health professional to better understand the risks

and allow informed choices to be made.

These measures, while still underfunded and

under-supported by local and central government,

have been widely accepted as a public good,

and are relatively uncontroversial. However, the

response to reducing opiate deaths has so far

been much more lacklustre. Naloxone, the opiate

overdose reversal drug, should now be easily

available through drug services and has been

saving lives up and down the country. Whilst

naloxone doesn’t prevent overdoses, just reduces

the risk of them being fatal, without it there

would be far more deaths. However, it is crucial we

don’t solely rely on the supply of this emergency

medication to prevent people from dying.


To reduce opiate deaths, there are things we can

do right now: prioritise access to and retention

in treatment, ensure people aren’t booted out of

treatment for relatively minor non-compliance,

provide decent doses of substitute medication

for a decent length of time, as well as increasing

availability of naloxone wherever people are using

opiates. Improvements to these alone would

save a significant number of lives.If drug-related

deaths continue along the same trend that we’ve

seen since 2009, we would expect 90,000+ deaths

attributed to drug misuse over the next 20 years,

with opiates making up the bulk of these. At some

point you’d hope this would be recognised as

the public health emergency it already is. There

are things that could be introduced very quickly

that would further reduce the rate of deaths. Just

like drug safety testing first took place on the

continent before the UK, other initiatives provided

in Europe and elsewhere have been proven to

reduce the number of deaths related to opiate

use and we should adopt them where there is the

need to.

Heroin-assisted treatment (HAT) is the provision

of pharmaceutical grade heroin for use in a

clinical environment under medical supervision.

HAT is available in Switzerland, Germany, the

Netherlands, Canada and Denmark to reduce the

harms associated with heroin use. Ironically, it’s

based on the old “British System” of prescribing

heroin and other controlled drugs to the middle

class, which all but ceased decades ago.

Deaths, crime and anti-social behaviour have

all reduced where HAT has been introduced and

is far more effective than the mainstream drug

treatment currently available. Foundations drug

service in Middlesbrough will be the first service to

(re)introduce this approach in the UK but hopefully

not the last.

Drug consumption rooms (DCRs) have been

around for the last 30 years and are currently

operational in several countries in Europe, North

America and Australia. Similar to HAT, DCRs

are clinical environments where heroin can

be administered under medical supervision –

although in the case of DCRs the heroin is bought

on the illicit market by the individual using it rather

than being prescribed.

Whether these types of initiative are made

available across the country depends on two main

issues. HAT and DCRs have been shown to be

cost effective. Unfortunately, due to how budgets

are managed in England it is hard to make these

arguments as the one spending the money will not

be the one making the savings. Local authorities

are responsible for funding drug treatment but

nearly all savings will be in the NHS, police, courts

and prisons.

With little to no savings for local authorities

and billions of pounds cut from council budgets

following a decade of austerity, it will require

a shift to a more holistic view of public sector

spending, and for those civil institutions to work

together more closely.

Secondly, if we’re serious about reducing drug

deaths then something more fundamental will

need to take place. We will need to move beyond

just seeing the behaviour and start seeing the

people behind it. We will need society, and in

particular those with the ability to bring about

change, to see those at risk of death as deserving

of public services - without caveat. People who use

drugs have a right to life, to be safely and securely

housed, to have their health needs met. Rather

than changes to drug use being a precondition

for support, people should be able to benefit

from society’s rights, opportunities and resources

as freely as those who don’t (openly) use drugs.

Eliminating social exclusion is likely to have more

impact on the number of deaths than anything

else we may be able to achieve.

The solution to reducing drug-related deaths isn’t

clear and simple but we can’t let it continue to be

wrong. If we value the tens of thousands of lives

we’ll lose over the coming years we can’t keep on

following the same well-trodden path and expect

drug-related deaths to suddenly stop.


Luckily I got in touch with

DHI, who gave me a stable

roof over my head and the

support I needed.






Jon is the Chief Executive of Crisis, a national charity that works directly with thousands of

homeless people every year.

Right now in Great Britain there

are 170,000 individuals or families

experiencing the worst forms of

homelessness – rough sleeping,

sleeping in places not meant for human

habitation, staying in homeless hostels

or emergency Bed and Breakfast (B&B)

accommodation or sofa-surfing with

people they may not even know...

At Crisis we don’t think that this is necessary,

neither do we believe it to be inevitable. We believe

that homelessness can be ended but to do this

we need to stop making plans which aspire only

to show how homelessness can be managed or at

best contained.

There are many reasons for people becoming

homeless. Some people become homeless when

they leave prison or the care system; others when

their relationship breaks down, when their landlord

wishes to put up the rent or when they deal with

difficulties by turning to drink, or because they

have been the victim of domestic abuse.

Experiencing one or more of these things can be

extremely stressful, and the pressure of dealing

with this can quickly build up, often culminating in

long term homelessness.

Not all of us however would follow this path

to losing our homes, and if we did experience

homelessness it might be brief rather than long

term. The claim that we are all two or three pay

cheques away from homelessness simply isn’t true.

Many of us facing one of the challenges above

would still have access to a home, or the support

necessary to get back into new homes of our own

as soon as possible.

What leads to these situations making someone

homeless, and keeping them homeless, is the lack

of a safe, affordable home of their own to move

into and the support needed to make it work.

However, we do not have enough homes

available to stop people becoming homeless. We

haven’t built enough social homes, so people are

more reliant on private renting.

This often results in homelessness strategies

which set out how much temporary

accommodation is needed year-on-year,

stretching into the future with long-term

commissioning plans focusing on procuring

B&B placements and accommodation available

on a night-by-night basis. These strategies,

however, rarely set out how we can go beyond

that, to a point where rather than just managing

homelessness, at great financial and individual

cost, we set about ending it.







In 2018 we produced our Plan to End

Homelessness, which was the result of 12 months

of extensive consultation with our partners in the

sector, key academics, and crucially people with

lived experience of homelessness. A key finding

from the Plan is that that out of the 170,000

people and families experiencing the worst forms

of homelessness about 152,000 just need a

home and the means to pay for it. They don’t

need support beyond that; they just need rapidly

rehousing and then they can get on with their


Private renting is more and more unaffordable

as rents go up, and the benefits freeze means

that benefits which are intended to help find and

secure decent accommodation do not cover the

cost of rent. The supply of suitable housing isn’t

adequate, but we have also compounded this

by not traditionally recognising that the quick

offer of a permanent home is the most effective

means of ending homelessness, simple as that

might sound. In addition to this, the way local

authorities determine how many homes should

be built in their area has not historically sought

to identify how many homes are needed to end

homelessness. Because of this the local authority

Housing Strategy and Homelessness Strategy are

too often separate documents written in isolation

from one another.

The recognition of the role this ‘rapid rehousing’

must play has been realised and championed in

Scotland. I chaired the Scottish Government’s

Homelessness & Rough Sleeping Action Group

that made recommendations which are now

embedded in the Scottish Government’s ‘Ending

Homelessness Together’ plan.

As part of the plan, every local authority has

now written a ‘Rapid Rehousing Transition Plan’

setting out over five years how they will make

quickly rehousing people in mainstream housing

the default of their system. The plans identify

the numbers of homes needed to end the use of

temporary and emergency accommodation and

propose solutions for getting there. It’s an exciting

time in Scotland. Homelessness is being tackled in

a way that works, and this approach is setting the

bar for the rest of Great Britain.

The figures identified in our plan are at a national

level but, unlike Scotland, in England we don’t have

a clear picture of real local housing need. Housing

registers have been superficially reduced in recent

years and the accuracy of the homelessness

statistics in England being called into question by

the government’s own statistics authority.

We need to adopt the lessons from Scotland to

ensure our decisions about housing supply mean

we provide for everyone who needs a home, not

just those who can afford to buy one.

I mentioned above the 152,000 of the 170,000

households need rapid rehousing, but that still

leaves around 18,000 people needing more than


For these people we know the overwhelming

pressure of homelessness has in some cases

caused, but in all cases exacerbated, their poor

mental health, their addictions and destructive

behaviours. For these people the very worst place

for them, but the place they inevitably will be

found, will be the streets, or revolving around

hostels and B&Bs. The solution here is Housing

First. Encouragingly the term is now widely used,

and the huge evidence base supporting it is

recognised across Great Britain. However, we still

do not operate Housing First at the scale needed

for all who would benefit from it.

We know from studies we have undertaken that

the system without Housing First and rapid

rehousing is about 15% effective in ending

someone’s homelessness. 85% of people are still

unable to find a settled home two years after

first becoming homeless. With Housing First, the

extensive evidence tells us to expect effectiveness

to be at 80-90%.

Transitioning to a system which is housing-led

cannot take place overnight. We can’t simply

switch off one system, which so many people are

reliant on, and turn on another. The transition

needs to be properly resourced so that the two

systems can run in parallel, which is why we so

welcomed the announcement of £28 million of

funding for the three Housing First pilots in the

Liverpool City Region, Greater Manchester and the

West Midlands.

We need to learn and take inspiration from these

pilots and by the other projects supported and

promoted through Housing First England, our

partnership with Homeless Link. We need to be

bold and follow the evidence. Our commissioning

and services need to be driven by what we know

ends homelessness, rather than a need to maintain

and honour historic investment in existing services

and buildings.

Homelessness is ended when everyone has a home

and the support available to make it so, we need

to challenge ourselves and our own practice to

make sure we are doing all we can to make that








Nick works for Exchange Supplies, a unique social enterprise — established to supply products,

information, and services to improve and prolong the lives of people who inject drugs.

The UK’s well-deserved reputation for

developing gold standard harm reduction

services were the envy of many countries

around the world...

From modest beginnings in the 80’s and an

extraordinarily passionate and committed harm

reduction community, was crafted the level of

activism which ultimately brought harm reduction

into the UK’s healthcare mainstream. Credit must

also be given to the UK government who at this

time and faced with the emerging ‘AIDS epidemic’

committed protected funding to support the growth

and roll out of harm reduction services, most notably

the provision of needles and syringes for people who

inject drugs. Rates of HIV in the UK today (about

1% of people who inject drugs) is one of the lowest

in the world and testament to this partnership of

activism and political pragmatism.

From the late 1980s the UK began to refine

effective skills around engagement and

interventions to reduce harm among people

who inject drugs. The four cornerstones of

harm reduction – needle and syringe provision,

substitution therapy and methadone, treatment

for Hepatitis-C and HIV and the prevention and

reversal of overdose – established our role as

agents of behaviour change within this inclusive,

non-judgemental, low-threshold environment.

However, despite achieving the inclusion of harm

reduction within mainstream healthcare, the

attitudes of the public have not changed towards

people who inject drugs. Look beneath the thin

veneer of acceptability for harm reduction in

our communities and there remains the same

pernicious and ignorant views about drug use

which are ill-informed but ensure that people who

use drugs remain some of the most marginalised

people in our society.

This is due in part due to UK government’s

insistence that drugs and drug use remain illegal

and the fear and ignorance within our society that

leads many to believe people who use drugs should

be locked up rather than helped. Society does not

see them as worthy of compassion and healthcare

and resent ‘their taxes being spent’ on injecting

equipment and treatment. It’s also due to the

failure of a truly representative and sustainable

model of a service user involvement movement

which would have helped ensure service users’

views and rights were central to the planning,

funding and commissioning process at both the

political and service delivery level.

We have been effective at reducing the risks

associated with injecting drug use and developing

interventions which deliver some of the most

cost-effective health interventions of any kind.

It is estimated that for every £1 spent on harm

reduction, £4 is delivered in return in health

and social gain. This was achieved by tenacity,

commitment, compassion and years of activism

at a time when our communities would rather see

people who inject drugs locked up rather than

understood, treated and supported.


Sadly, since 2010, England has systematically

disinvested in harm reduction. The political

firestorm debate of 2008 saw the abstinence

model of intervention win out over harm reduction.

The Government’s new drug policy in 2010 saw

a political shift away from harm reduction. This

occurred at the same time as a move in the

commissioning responsibility for drug services from

the then primary care trusts to local authorities,

just as the authorities ran out of money. The

ring-fencing of funding for HIV, which supported

drug services disappeared and harm reduction had

to start competing for funding against a range of

other worthy causes within public health.

There is no doubt that many people have benefitted

beyond their hopes from the opportunities delivered

by the recovery model, but many people who use

drugs are so much worse off. In the UK we are

experiencing an increase in homelessness and drug

related deaths which are greater than they have ever

been. We have now also had the first major outbreak

of HIV in our history, a fact which outside of Scotland

hardly anyone knows or talks about.

Many harm reduction services who traditionally

provided a front door into treatment services and

no less importantly a safety net for people who

couldn’t manage the treatment options on offer,

now provide little more than the distribution of

injecting equipment. The systematic disinvestment

in harm reduction in England has left many people

alone, isolated and vulnerable, without skilled

harm reduction workers to do what they always

have. Engage, support and save lives.

A recent exchange on social media described a

triage discussion with a new client registering

at a needle and syringe programme provided

by a large national charity. This is a quote from

the discussion; ‘whilst going through the triage

paperwork to register he was asked his preference

regarding administration of substances. He told

the worker he was an IV user. The worker didn’t

know what that was, so he expanded saying he

was an intravenous user. The worker still didn’t

know what that meant.’

Does this represent what happens in most drug

services? Of course not, but it does happen and

it absolutely should not. So many drug services

now have staff covering the needle and syringe

programme who do not have the required

knowledge, skills or even in some cases the

appropriate attitudes to engage with some of

the most marginalised and vulnerable people in

our society. In this environment, good quality

harm reduction cannot happen and we have

little hope of reducing or ending the harms and

social isolation of drug users, until there is enough

political will to develop a drug policy which truly

reflects the value of human life. Naloxone (the

opioid overdose reversal drug) is not the answer

to saving the lives of people who use drugs, harm

reduction is, of which naloxone is one important


We must celebrate the commitment and

compassion of those who work in our field and

properly educate, train, mentor and support

them. This doesn’t have to cost the earth, it’s not

a financial issue, it’s a cultural one. In a world

increasingly dominated by pharmacy provision

of syringes, we appear to have forgotten how to

like and respect people who use drugs. If we lack

positive enthusiasm and optimism, what right do

we have to expect this in others?

Services must properly support our amazing

colleagues to once again create the culture of

acceptance and engagement, save more lives and

improve the health of people who inject drugs.

We need to reimagine how harm reduction can

work in this austere climate and, yes, maybe this

also means we need to rediscover a new style

of activism to once again make a difference by

keeping people who inject drugs alive and well.

We must also engage with our communities in

a way that encourages them to reframe their

understanding of drugs and the people who

use them. We have to challenge attitudes and

break down the barriers which prevent society

from feeling compassion, understanding and

acceptance for people who make life choices that

can carry risk.

We accept people who make life choices that lead

to heart disease, diabetes, respiratory disease and

cancer, yet condemn people who inject drugs for

‘wasting precious health resources’ because of

their life choices. This health inequality is perverse

and is perpetuated by a political policy which

continues to classify people who inject drugs as

criminals, fails to support harm reduction and does

nothing to challenge society’s perpetual exclusion

of people with genuine health needs.

In the absence of any political will to address this,

our only hope is that the field can become activists

once more and bring about the change we need.

We did it before; we can do it









Jacob has been the MP for North East Somerset since 2010 and is the current

Leader of the House of Commons and Lord President of the Council.

It is an honour to be asked to write an article

for DHI’s 20th anniversary. Its vision, to “end

social exclusion by ensuring that everyone has

their basic needs met and is able to thrive by

contributing to the richness and wellbeing of

their community” is laudable...

Housing is an issue which I have long felt has not

been given enough prominence and is particularly

relevant to the debate on social exclusion. There

are few things more socially excluding than being


Currently in the UK we have a housing shortage.

This affects a wide range of people in society but

principally the young and the less well-off. Owning

their own home is a distant dream for many but

this should not be the case. On the contrary, it

should be the norm, something that everyone

can aspire to and achieve. There are so many

advantages, security, sustainability and social

benefits and there are also significant financial

advantages. A study last year found that owning

a home is cheaper than renting in every part of

the UK. Unfortunately, the major hurdle of saving

enough money for a deposit stands in the way.

So how have we got to this situation

where there are, quite simply, not

enough houses to go round?

On 3rd October 1980 the Conservative

Government, under Prime Minister Margaret

Thatcher, introduced the policy of ‘Right to Buy’,

which, subject to certain conditions, allowed

people living in council houses to purchase them

at discount rates. This was an excellent policy.

Enabling people to have the ability to improve

their situation is at the heart of Conservatism.

However, this policy turned social housing into

private housing. This loss of social housing

should have been fixed by building more. This

is something that successive governments,

Conservative, Labour and the Conservative / Lib

Dem coalition, have failed to do.

In addition, several new countries joined the

EU, meaning that anyone from those countries

could come to live in the UK. The result was that

immigration jumped from an average of 30,000

per year to 300,000 per year.

Now let us be clear. Immigrants provide an

undoubted benefit to our country and to our

economy. However, anyone coming to this country

naturally needs somewhere to live. This means you

need to build enough houses to accommodate

the increase in population. This is something that,

again, successive governments have failed to do.

The current Government is finally addressing the

problem. There is now significantly more house

building taking place but it will be some time

before we get close to resolving the issue. We need

to keep building houses and we must not stop.

It is worth noting at this point, that any house

building helps everyone affected by the housing

crisis. If a four-bedroom home is built, it is likely

that the family who buys it will be upgrading from

a three-bedroom home. This house will then be

freed up for people upgrading from a two-bedroom

home and so on. Nevertheless, it is important that

a range of properties, including social housing, are

provided when new housing is built. My preference

is for houses with gardens. Studies have repeatedly

shown that this is where people want to live. Most

people do not want to live in tower blocks. The

other vital point is that house building must be

accompanied by the necessary infrastructure –

new schools, shops, surgeries and roads.

Two things then happened in the early 2000s. The

Labour Government relaxed the immigration rules,

making it much easier for people from outside the

European Union to come here to live.

This need to build more houses must be accepted

by all. It is not always a popular topic when I visit

local Conservative Associations. We must put aside

any tendencies to “nimbyism”. We cannot say “yes

we need more houses” but also “just not where we

live”. For the sake of our young people and future

generations, we must support and embrace house


There are other things that the Government could

and should be doing. There are some laws and

regulations that make building new homes more

complicated and difficult than necessary. These

should be simplified where possible. However,

this must not allow house builders to cut corners.

I have recently been asked for help by several

constituents who have moved into a new-build

home only to find significant problems with its

construction. House building companies must do

better at quality control and also at helping people

who encounter such problems.

As well as making it easier to build, the

Government should be doing everything it can to

make it easier to buy. The ‘Help to Buy’ scheme

has enabled many people to get on the housing

ladder but more needs to be done. One simple

solution would be to reduce Stamp Duty. It is

often the case in such situations that lowering tax

encourages more activity so the Government ends

up raising more money.

Another issue that my constituents write to me

about is high rental costs. This is another serious

problem. Recent figures from the Department

for Work and Pensions showed that rising rents

were the main cause of poverty for many families.

The Government has recently passed legislation

to improve the rights of tenants but we must be

careful that the balance does not shift too far,

otherwise landlords will be put off. This would only

exacerbate the problem. Fundamentally, this is the

same issue as above, there are not enough houses

to go round. Rental costs and mortgages will only

start to come down when supply begins to catch

up with demand. We must build more houses and

we must do so quickly.

DHI couldn’t change the

situation, but they helped

me be the best I could at

that time.









Vivienne is the Chief Executive of Adfam, a national charity working to improve life for families affected by

drugs or alcohol.

The public


of families

affected by drug

and alcohol

use requires a

cultural shift.”

Adfam has been listening to the

experiences of families affected by

substance misuse for over 30 years. Over

and over, we have heard stories of the

stress, anxiety, physical ill health and

financial burdens that caring for – or

just being in the orbit – of someone with

an addiction can cause for a so-called

‘affected other’...

‘When I was a young mother I never thought I

would spend 35 years of my life fighting dealers

and the drugs, lying to my neighbours, stripped of

my dignity, having lost everything.’

Research bears out this personal evidence: the

impact of living with a family member who has a

drug/alcohol problem can be devastating.

There is a social side to this too; family

celebrations can be a nightmare – the fear of

embarrassment and humiliation because of a

loved one’s inappropriate behaviour – or the stress

of avoiding or having to answer difficult questions

– is ever present.


And then there is social exclusion. This is a term

defined as exclusion from the prevailing social

system and its rights and privileges, typically

as a result of poverty or the fact of belonging

to a minority social group. But family members

affected by substance misuse are not members

of a minority social group. In fact, UK Drug Policy

Commission research suggests a minimum of 1.5

million people are affected by someone else’s drug

use. Other studies have indicated this number is up

to 8 million.

The social exclusion which families experience

is rooted in the stigmatising effect attitudes in

society can have on people affected by someone

else’s substance misuse. The definition of stigma

is a mark of disgrace or infamy; a sign of severe

censure or condemnation, regarded as impressed

on a person or thing; a ‘brand’. Culture and

language – often displayed in the media – can

define a user, rather than the addiction itself and

this can apply to family members too, resulting

in them not speaking about their situations, not

seeking help and support for themselves, and

consequentially feeling isolated and socially


“Stigma for me meant being treated differently

once people knew of my son’s drug use.”

“...because there’s a drug user or an alcoholic

in the family, a lot of services think the whole

family’s the same so you’re all judged on that

person’s behaviour or that person’s lifestyle.”

Stigma and drug use have been associated for

a long time. They have also been popular topics

of debate in recent years and the focus of a

growing body of research. But in the same way

that families have often been absent in other drug

policy discussions, their perspective on stigma is

much less widely researched. Often, regardless

of their own behaviour, families find themselves

defined by the ‘addict’ label attributed to their

drug using relatives.

Those affected by someone else’s addiction are

living double lives; they live in a silent struggle that

very few know about for fear of being judged.

As well as this externally imposed ‘stigma by

association’, the high levels of guilt and selfblame

experienced by the families of drug and

alcohol users, particularly parents who believe that

the upbringing they provided is responsible for

the substance misuse, mean that some families

effectively stigmatise themselves through feelings

of guilt and low self-worth.

Stigma can cause social exclusion, and so can

poverty. Many families experience financial

hardship due to supporting a loved one with an

addiction. This can be particularly true for kin

carers – family members who take on the care

of children because their birth parents have a

substance misuse problem. There are an estimated

200,000 children and young people in kinship

care and over 50% of these cases are as a result

of substance misuse. These kin carers receive a

negligible amount of allowances and benefits in

comparison to foster carers, something we are

supporting a campaign to change.


In an era of austerity, budgetary constraints

have resulted in a reduction, and often the

disappearance, of many family support groups.

Yet the need to support families affected by

substance misuse is as acute as ever. We know

from our supporters that many of them suffer not

just from the effects of addiction, but of multiple

and complex needs, including domestic abuse

and mental ill health. Treatment services can

fail to prioritise family support because of a lack

of finance, and those families which do receive

support are those whose loved ones are accessing

treatment, a small proportion of the number of

families affected. This lack of support provision

means that families are further excluded and


It’s time to end the social exclusion experienced

by families. Austerity and its consequences

require political and economic change; the public

perception of families affected by drug and alcohol

use requires a cultural shift. I believe that the best

way to combat stigma, and the resulting social

exclusion, with the resources we have currently

available to us, is to take the issues out in the open,

not hide them away.

That’s why we have launched our

#StigmaMakesMeFeel campaign. We want people

to think about how families experience stigma,

and tell us how that makes them feel. This includes

family members with lived experience, professionals

supporting these families but also those without

direct experience - so we can put stigma on the

agenda and start an open and honest discussion.

By talking about this issue candidly, I hope that

we can create a groundswell that counters the

blame and guilt – and social exclusion – weighing

so many families down, adding to the stress and

distress that caring for, and about, a loved one

with an addiction can bring. I also hope it can

persuade decision makers of the crucial need to

provide services and support for this neglected










John is a strategic adviser and commentator on public policy, governance, leadership and public services.

He is a social activist and serves as chair and trustee on several charity and CIC boards.

If we are serious about reducing and

ideally eliminating social exclusion, we

need to understand what causes it...

We should be prepared to tackle these causes and

only not provide some mitigation to its impact. Too

often civil society and voluntary and community

sector (VCS) organisations do a remarkable job

at dealing with the symptoms, offering relief and

hope, while they shy away from openly discussing

the causes; let alone the politics that usually

underly these causes.

Poverty, inequality, lack of decent and accessible

public services, inadequate public transport, the

welfare and benefits system and lack of good

housing are some of the major contributors

to social exclusion. Austerity has fuelled social

inequality and social exclusion in many ways.

Sometimes the political system fails to address

social exclusion and reinforce it. Too few socially

excluded people are politically active and cynical

politicians may feel that they can ignore them.

This is simply unacceptable.

I believe most activists in the VCS and wider civil

society are passionate about equality, fairness

and equity. They celebrate diversity. They wish to

address and usually to eradicate social exclusion,

but they fall short of challenging public policy,

fiscal and tax policy and the structural contributors

to social exclusion. This is a mistake.

Social action is driven by compassion and a desire

to secure better outcomes, and often better

opportunities and a better society. Compassion is a

great motivator for social activists and those active

in the voluntary and community sector, and almost

everyone I meet in the sector demonstrates such,

in as much as they display their passion for social

justice, equality and fairness.

This is fantastic, but the hard fact is that

compassion is not enough on its own if we are to

offer support and opportunities to communities.

Equally, passion is a fabulous attribute and

essential for anyone seeking to secure change and

to motivate others. Yet it does not automatically

translate into practical action and, again, on its own

will not address need, inequality and injustice.

Social activism has contributed to

addressing some major injustices over

the centuries.

Indeed, social activists have frequently been

instrumental in securing change for the better,

sometimes massive change at the national or even

international level, but more often achieved in

neighbourhoods and localities.

However, to make an impact, social activism

must take the form of action. This might involve

stepping in and providing services to those with

unmet needs and those who are socially excluded.

It can take the form of advocacy (for an individual

or community) to ensure that they receive what

they are entitled to. It might manifest itself in

campaigning for changes in public policy or

legislation. And it could have a local, regional,

national or international focus.

The challenge to the VCS and the wider civil society

at all territorial levels is that they must be ready to

address both the symptoms and the causes of social

and economic injustice and exclusion.

Often, the sector is at its best when it adopts

a two-strand approach. For example, the food

bank movement has been a practical response to

need, while at the same time challenging public

policies such as the Universal Credit five-week

delay and the horror of in-work poverty: action on

two levels. The VCS must be careful not to give

cover for poor and inadequate public services

and appalling damaging public policy through

its provision of ameliorating services. This is both

unsustainable and allows those in power to avoid

their responsibilities and accountabilities.

The sector must not simply pass on the other

side when there are gaps to be filled or policies

requiring challenge, or structural inequalities to be

overturned. Compassion, passion and, above all,

action can combine to make a difference in the

immediate and the long term.

Many voluntary and community groups, and other

charities, were created to respond to injustice and

need. We should be proud of this inheritance and

live its values today.



VCS organisations and social activists must also be

clear about what they will do and what they will

not do. They must never compromise their values

and mission. The sector can complement but

should not be a substitute for the state, however

tempting this might be in the short term.

Voluntary collectivism can and should both

complement and augment state collectivism.

Collectivism is key to addressing social exclusion

and its causes. Collective social action can and

should seek to shape the collectivism of the state.

The voluntary and community sector and social

activists should find their voice to fight all that is

inappropriate and harmful. They should promote

alternative policies. They champion social justice

and fairness; and must be ready to challenge

government and engage in the political debate –

charities of course must avoid being partisan.


They should say loudly and continually that, in the

fifth richest economy in the world, there should

be much reduced levels of homelessness, poverty,

inequality and austerity. The sector cannot be silent

on such issues if it is going to be true to its mission,

values and beneficiaries.

It cannot simply argue for its communities at

the expense of others. It must avoid being drawn

into false choices. If there is a need for greater

public spending, it has to be ready to argue where

expenditure can be reduced or more likely to make

the case for greater progressive taxation. It has to

argue for the redistribution of wealth and incomes

between individuals and between regions and

places if it is going to make a coherent case for

addressing social exclusion just as much as it will

have to be willing to challenge poorly regulated

markets and market based social conditions.

Social exclusion in its many forms will be consigned

to history when we have an economy and society

that are fair, are inclusive and deliver opportunities

for everyone irrespective of their class, their

ethnicity, their gender or sexual orientation,

and their opinions – provided that these are not

contrary to equality and fairness.

Equality, not just equality of opportunity, is

essential. As Martin Luther King Jr said:

“This will be the day when we shall

bring into full realization the dream

of American democracy - a dream yet

unfulfilled. A dream of equality of

opportunity, of privilege and property

widely distributed; a dream of a land

where men will not the take necessities

from the many to give luxuries to the


Addressing social exclusion and the causes of social

exclusion should surely be a priority for civil society,

the voluntary and community sector and for social






On 26 March, young people aged 14-21

from across Bath & North East Somerset

and Wiltshire gathered at The Egg

Theatre for Just Say It.

The event provided a platform for young people

to share their thoughts and ideas – because DHI

believes that in order to respond to the biggest

challenges of tomorrow, it is vital to hear the voices

of young people today.

Helping to guide the conversation was MC Greg

Ingham from Media Clash, and an expert panel,

including: Victor da Cunha (Curo), Sergeant Jon

Raisey (Avon & Somerset Police), Sandy Hore-

Ruthven (Creative Youth Network), Richard King

(Children in Need), Niall Bowen (B&NES Member

of the Youth Parliament), Caryl Thomas (Wales

international rugby player), Jahnene Green and

Mike Grizzell (DHI). Listening carefully in the upper

galleries were a range of key local decision makers,

including councillors, commissioners and charity


On the night, 4 key questions related

to social exclusion were asked by young


How do we make sure no one is homeless

in 20 years’ time?

The discussion revealed the extent of the crisis

in housing supply and subsequent rising prices

for those leaving home. Victor Da Cunha, Chief

Executive of Curo, painted a gloomy national

picture: a chronic under-supply of housing is

placing an over-emphasis on the private sector.

And there is no quick fix solution: large scale

municipal building programmes are required, and

higher levels of funding to support people with

complex needs in the short term.

But increasingly, even renting seems out of reach.

Alice, aged 19, had recently moved into her own

flat. But she and her partner had had to use

credit cards to cover the upfront costs of £2,000 -

pushing her into debt, even with a good job. And

while the rising costs of renting mean it’s now

common to live with your parents well into your

twenties. Jasmine asked - what if you don’t have

a family home to stay in while you save? What

solutions are there for those leaving foster care at


What can we do to help people feel safe

without carrying a knife ‘for protection’?

Young people showed courage in sharing their

stories about knife crime, speaking honestly about

what it means to live in fear of stabbings, and of

reprisals for going to the police. The relatively small

numbers of reported crimes were challenged by

those with real life experience of the issue, who

made it clear that many incidents go unreported.

Mike Grizzell from Motiv8 (DHI’s young people’s

drug and alcohol service in Wiltshire) added

that three young people have been stabbed in

Trowbridge alone since January - and even one

incident has devastating effects for those involved.

Theo, aged 18, and the designer of a stab proof

garment, summed up the response of most young

people at the event: ‘It’s too simplistic to point to

a single cause for knife crime. It sits within a wide

range of’s a soup’ and ‘people just

don’t understand the effect it has on your mental

health - to walk down the road and not feel safe’

In response to the police assurance that knives

were rarely carried in B&NES, one young person

said ‘that over 1000 knives have been handed in

(to ‘sin bins’ in Somerset police stations) shows

just how many people are actually carrying knives.’

Another young person, Charlie, questioned the

police on their sin bin locations, suggesting that

they be placed in neutral locations instead so that

people would find it easier to hand knives in.

Richard King, Children in Need, said: ‘There is too

much tough rhetoric, and it isn’t effective. You

need to look at the broader issues, and see knife

crime as a community health issue.’

How do we reduce the pressure on young

people to appear perfect on social media?

When it came to debating the effect of social

media on mental health, it was clear that it is a

problem for many, and highly addictive, with one

person saying that they checked their phone every

15 minutes. It is also taking up a lot of mental

space for people from very early on in their lives -

for some as young as seven years old. The effects

of filtered and edited celebrity posts on Instagram,

and the pressure of constant comparison is

resulting in new levels of stress and anxiety for

young people.

While young people are often blamed for issues

such as knife crime or reliance on social media, the

impact of cuts to services across the board needs

to be acknowledged and understood.

A clear point was made by one young person

about the lack of alternatives available: ‘There is

nothing else to do that doesn’t cost money - more

free activities for young people are needed’.

Some people have been permanently

excluded from school because they have

used drugs. Could schools do anything


Haydn spoke about being immediately excluded

from school after an incident involving drugs,

despite having a previously unblemished record.

Instead of exclusion, he said, he badly needed

more support. Others spoke up, saying that

adults often know about the issue, but turned a

blind eye, or don’t know how to tackle it before

it becomes a serious problem. The fear of facing

serious consequences was silencing many young

people from voicing concerns.

One young person got straight to the heart of

the problem: ‘We just aren’t able to have safe

conversations with adults, where we can talk


Those delivering front line services supported

this: Project 28 (DHI’s young people’s drug and

alcohol service in Bath & North East Somerset)

pointed out that if services are to be involved,

they need to be preventative - and that this

requires both long term planning, and investment.

“While young people are often

spoken about, especially in the

media, for most it was a new

experience to be given space to

do the talking themselves.”


While young people are often spoken about,

especially in the media, for most it was a new

experience to be given space to do the talking

themselves. Those attending came from a wide

range of backgrounds - but the one thing everyone

agreed on was that they had few places to voice

their opinions - to tell their stories to people with

influence, who would listen, without judgement.

Despite the huge challenges outlined, young

people made difficult and nuanced points about

the importance of context - making it clear that

you just cannot provide simple answers to complex


What was clear from this event was that, far from

the image sometimes portrayed in the media,

young people are active and resourceful members

of their community, finding creative ways to

support each other to overcome what can seem

like huge obstacles. Throughout the evening,

positive ideas and solutions bounced around the

audience: from placing ‘sin bins’ in neutral spaces,

to encourage people to hand knives in; to group

sessions in schools from drugs services like Project

28 and Motiv8 or youth groups to facilitate those

vital conversations; and other ways to challenge

the received wisdom about ‘how things are done’.

Across all areas discussed it was felt that the only

way young people have power to make change is

by speaking up, collaborating and having trusted


All of the issues discussed were complex, and

nobody had quick or easy solutions. But by the end

of the evening, one thing was clear: when given

a platform to speak, young people demonstrate

insight, resilience and hope. And it is only when

we truly listen to them that we have the chance to

change the future.



Following Just Say It, DHI are continuing

the conversation with young people.

We are touring an exhibition stand around our

region, which illustrates some of the conversations

that were had at the event, and inviting more

young people to have their say.

The exhibition was designed by David Rolls of

White Star Design and the production of it was

sponsored by Bath Business Club.






Nick is the National Organiser of ACORN, a community union focusing

on the housing crisis and tenants’ rights.

For nearly two decades we have seen

the private rented sector (PRS) develop

at a rapid pace. The decline in social

housing, increasing gap between the LHA

rate and ‘affordable’ rents, stagnating

wages and rising housing prices has

increasingly forced tenants into the

PRS. Private tenants now include the

most economically deprived in society,

students, professionals, families and

pensioners from every demographic...

Having a home is at the core of meeting

anybody’s basic needs, yet we’re seeing more and

more people being made homeless due to the

end of their assured shorthold tenancies. The PRS

is inaccessible to many due to the high rents and

extortionate letting fees attached to any tenancy,

with many landlords rejecting people receiving

benefits. Tenants’ health is being decimated by

poor housing conditions across the UK, with the

most vulnerable relying on housing that is often

damp, cramped and overpriced.

This may be viewed as a worst-case scenario but

we have seen these conditions in member defence

cases across the country, with rogue landlords

taking advantage of people who have no other


The right to housing is fundamentally about life

chances, providing shelter and a secure place for

people to live, confident in the knowledge that

they can build a home.

We need to see an end to a private rented sector in

which landlords and tenants are not fully informed

and able to act on their rights and responsibilities.

We’ve seen some positive moves towards reducing

the costs associated with living in the PRS with the

Letting Fees ban, and additional security for residents

with the government’s promise to end Section

21. However, more needs to be done to improve

the conditions in the PRS, make the sector more

affordable for those who need it most, and allowing

people to make their private rented houses homes,

not “property investment opportunities”.

Only then can people truly put down roots, stop

living day to day worrying about the precarity of

their housing situation, and thrive by becoming

fully involved in a community where they know

they can afford to stay without fear of eviction or

deteriorating health.



The right to housing is

fundamentally about life









Josh is Policy Manager of Stonewall, Europe’s largest LGBT rights


This year’s Pride month comes at a

critical point in our journey towards

lesbian, gay, bi and trans (LGBT)


In recent decades, we’ve made significant progress

in many areas. Equal marriage is now a reality for

many. Same-sex couples can adopt, and LGBT role

models are more visible than ever on our screens,

in our newspapers and in our workplaces

But while progress has been made, we know

that many LGBT people still face harassment,

discrimination and prejudice simply for being


The biphobic and homophobic attack against

two women on a London bus earlier this month is

a stark reminder that we cannot be complacent

in the fight for equality. Trans communities also

continue to face a relentless onslaught of antitrans

coverage in the media and online. We know

that our work cannot stop until every LGBT person

is accepted for who they are, wherever they live,

learn, work, play sport and pray.

Stonewall is Britain’s largest organisation

campaigning for LGBT equality. Through our

state-of-the-nation LGBT in Britain research series

with YouGov, we know that many LGBT people

continue to face multiple barriers to participating

fully in our society. Nowhere is this clearer than

in our research into LGBT people’s experiences of

homelessness, and poor mental health.

Having a safe and stable home is crucial for all

of us. But nearly one in five LGBT people have

experienced homelessness at some point in their

lives – with trans people, LGBT disabled people and

socio-economically disadvantaged LGBT people at

particular risk.

The situation is particularly tough for many LGBT

young people. Research by the Albert Kennedy

Trust, who work to support homeless LGBT young

people, estimates that a quarter of the youth

homeless population is LGBT. Of those, the

majority had experienced familial rejection, abuse

and violence. And when accessing homelessness

support services, many respondents said that

providers often lack understanding of their

specific needs – which can lead to discriminatory


It is essential that homelessness services monitor

the sexual orientation and gender identity of their

service users to ensure they can understand the

needs and experiences of LGBT homeless people.

It’s also vital that all staff receive training on

meeting the needs of LGBT service users.

At the same time, growing up in a society that still

doesn’t fully accept LGBT people – from bullying at

school, to workplace discrimination, to harassment

on the street -can also have a profound impact on

many LGBT people’s health and wellbeing.

Rates of poor mental health are incredibly high

within the LGBT community. Stonewall’s School

Report (2017), with the University of Cambridge

looked into the experiences of over 3,700 LGBT

people and found that nearly half of trans young

people have tried to take their own life, as have

one in five lesbian, gay and bi young people who

aren’t trans. Within this group, LGBT young people

who are disabled, or who are eligible for free school

meals, are at particular risk.

Among adults, our LGBT in Britain series found

that half of LGBT people said they’d experienced

depression in the last year – with Black, Asian and

minority ethnic LGBT people, trans people and

LGBT disabled people experiencing particularly

high rates of poor mental health.

While a growing number of mental health services

are meeting the needs of LGBT people, many

LGBT people continue to face barriers to accessing

support, with experiences of discrimination

remaining commonplace. For these services too,

monitoring sexual orientation and gender identity,

and providing staff with high-quality training on

LGBT inclusion, is essential in meeting the needs of

the community.

But while the challenges are great, we know that

there are growing efforts to address them. As part

of the Government’s 2018 LGBT Action Plan, new

research is being undertaken into the needs and

experiences of LGBT homeless people – research

that will be essential in helping us to understand

how national and local Government can help meet

these needs.

And through our Diversity Champions programme,

we now work with over 50 national and local

health and social care organisations across the

country, including mental health services, to help

them provide inclusive support to LGBT patients

and service users.

But we need to do more. We need to reach deeper

into our communities. We need to provide better

support on the ground to the most vulnerable

people in our communities. And we need to tackle

these challenges at their root, too, to ensure that

every young person is supported to reach their full


Pride is a time for celebration. But it’s also a time

to reflect on how far we’ve come, and how much

further we have to go. Now is the time for us

to come together, to renew our efforts to bring

forward the day when true equality for LGBT

people is a reality.

Our work will not be done

until every single LGBT person,

everywhere, is free to be









Sarah is the former Chair of Trustees at DHI, and past Chief Executive of Bristol’s NHS Charity, Above &

Beyond. She is now a charity strategy and governance consultant, a non-executive director and a trustee

for a number of charities including One25.

I am told regularly, normally by men,

that women have gained equality. But in

so many ways I know they are wrong...

You don’t have to look further than Caroline

Criado Perez’s book “Invisible Women” published

yesterday. It gives example after example of the

gender data gap. Did you know that most offices

are five degrees too cold for women? It is because

the formula to determine their temperature was

developed in the 1960s based on the metabolic

resting rate of a 40-year-old 70kg man; women’s

metabolisms are slower. Or that women, here in

the UK, are 50% more likely to be misdiagnosed

following a heart attack? Heart failure trials

generally use male participants. You might not be

surprised that cars are designed around the body

of “reference man”. The impact is that, although

men are more likely to crash, women involved

in collisions are nearly 50% more likely to be

seriously hurt.

Let’s look a little deeper into our communities

where the impact of inequality is stark and much


This really shows us how far we haven’t come.

I don’t claim to highlight all the issues which

challenge us in society but I want to highlight just

a few examples of where women are excluded

from our society and our systems – where they

struggle in our society to be heard, helped

or acknowledged; where they are vulnerable,

forgotten, hidden and ignored.


320,000 people were counted as homeless in

2018, a 4% rise from 2017, which is the equivalent

of 36 new people a day. But this is just the tip of

the iceberg, some say more than 62% of single

homeless people are hidden and do not show

up in official figures. And many of these people

are women. Women make up at least 20% of

the estimated homeless population, hidden

from the statistics because the dangers on the

streets drive them to literally hide in gardens and

parks to avoid violence or because they are not

officially homeless, as they are forced to live under

a roof in uncertain, violent and abusive housing

– often being made to undertake sex work. With

no money, no support networks and often an

addiction, they will stay in a “home” where there

is sexual exploitation and domestic abuse rather

than sleep rough. What kind of choice is that? It is

no “home” at all.

Bristol charity, One25, who work with vulnerable

women who are involved in street sex work, report

that more than 80% of the women are homeless.

Lack of housing is one of the biggest obstacles for

these women to move on and move into more safe

and secure environments. Without a safe place to

stay, women will struggle not to go back into the

cycle of abusive ex-partners, into their addictions,

into being pimped into street sex work, and often

end up in prison again.

Although buying and selling sex is not illegal in the

UK, some of the associated practices are – such as

loitering and soliciting to sell sex on the street. And

even here we see such inequity and gender bias.

Figures show that between 1984-2016, there were

138,947 convictions of women soliciting to sell sex,

while only 125 convictions of men soliciting to buy.

Women are deemed responsible for prostitution in

spite of the fact that the women are often there

through male coercion in the first place. That also

doesn’t take account of the large numbers of

women who have received ASBOs and other orders

and have been further criminalised for breaching

them, often through little fault of their own. And

if you believed that our society and our criminal

justice system was committed to driving people

away from re-offending, think again.

Prison sentences for soliciting to sell sex ended

in 1982 in favour of fines. Far from fines having

a deterrent effect, many women simply return

to selling sex in order to pay the fines. This puts

women at further danger of being rearrested and

could leave them being trapped in a continuous

cycle of fines and prostitution. The accumulation

of fines can also result in women having extensive

financial problems, posing another obstacle to exit

street sex work.

And even when women are able to restart their

lives away from street sex work and addiction,

their lives are overshadowed by the fact that their

‘sexual offences’ will follow them throughout

their lives. When a woman who has left sex work

is trying to get employment that requires a DBS

check (Disclosure and Barring Service), their ‘sexual

offence’ is shared with prospective employers,

often leading to rejection. And this will continue

to impact their family life too. I often hear that

women don’t take part in school activity with their

children because they have to have a DBS check

and can’t risk their past coming out into their

children’s lives. Imagine your child’s school being

aware of the fact that you had a caution or fine for

soliciting to sell sex in your past.

So our world, our society still holds fast to prejudice,

discrimination and inequality for women. We can

of course see it all around us. But I hope that this

small focus on the more vulnerable women in our

communities makes us all think and feel outraged

that women who are often abused as a child –

not their fault; who are trafficked or coerced into

prostitution – not their fault; who have suffered such

trauma mainly at the hands of men – their family,

their pimp, their punters; who are hidden from our

homelessness statistics and most of our services; are

made to live each day for their rest of their lives with

the stigma which will never cease which comes with

their criminal record.






Jeff is Managing Director of Clean Slate Training & Employment CIC and the Social Publishing Project. He

is a former Managing Director of The Big Issue and author of I’m Ready – 7 Signs That Show You’re Right

For The Job.


Social exclusion is, I now realise, a source

of daily celebration around the globe. A

bit like with #metoo, once you see it, you

can’t stop seeing it in social interactions

every day...

Social exclusion has been rightly described as the

injustice that holds people back. It’s the thing that

DHI and my own organisation Clean Slate Training

& Employment tackles, often effectively, person by


We cannot eradicate social exclusion this way,

however. We need something societal in scale. But

I don’t believe social exclusion is part of a system

we live within. It is the system and we have to take


In the UK we’re split. Brexit is just the start of it.

And when you take the ideology and politics out of

it, it’s just symbolic of what happens when people

do choose to take control. But our biggest divide is

by wealth. Social exclusion is a chasm between the

lives of the Haves and Have Nots. Social exclusion

had a large part in the Brexit vote and the Have

Nots lashed out at the Haves because, let’s face it,

austerity only affected those with least and they

want change. They may want out of Europe but to

what end? A better life, surely.

What the Have Nots know is that during austerity,

only the poor got poorer. Meanwhile the super-rich

have increased their wealth (there’s now a growing

divide among the Haves too, just as in Victorian

days). As the BBC recently reported, the richest

one percent tripled their ‘worth’. And as Professor

Sir Angus Deaton said, they did so by ‘taking, not

making’ their money.

“Our fightback against social

exclusion starts with helping

consumers find ways to spend less,

earn more, borrow less and save


I am a social entrepreneur. I run a not-for-profit,

all-for-social-purpose enterprise that helps people

on low incomes become better off. We help them

manage and stretch their budgets, find work or

better paid work, and get online. It’s a business

because when they do better, we all do better:

Rent is paid so housing is occupied and there are

fewer people sleeping in shop doorways.

Jobs are filled (when there are fewer migrants

to fill them) so we don’t have to wait so long

for a cappuccino. Mental health services are less

stretched so it only takes six months to access

them. And, of course, the benefit bill goes down so

taxes can stay comfortably low for the Haves.

I’m being facetious but I’m describing a business

case that means we get commissioned to help

make society work better.

My epiphany came after launching a money skills

programme in 2018. I’ve run Quids In!, a money

guidance magazine, website and email service, for

ten years but this was the first time we took it into

the room and shared the ideas with real people.

Unemployed people. People out of work because

of mental health issues. Mums who are working

but still turning to a foodbank. Essentially, the

Have Nots.

We talked about how if we don’t keep a tight hand

on our wallet, someone else has their fingers in

it. That includes banks built on people straying

into overdraft as much as it does payday loans

companies and other legal loan sharks peddling

unaffordable credit. It includes weekly payment

stores targeting young, stay-at-home mums and

discretely charging through the nose. And coffee

shops offering online discounts while people

without a loyalty card subsidise them. But while

new regulations are announced daily to protect

customers, there’s more we can do by taking

control. Our fightback against social exclusion

starts with helping consumers find ways to spend

less, earn more, borrow less and save more. And

cut the profits to the fat cats.


Now every day I see how, in every way, the Haves

keep the Have Nots at bay. Pubs that used to be

community hubs for workers clocking off have

either closed or ‘gone gastro’ selling pints for

over a fiver and meals costing two hours on the

minimum wage.

The spirit of capitalism is at full flight and the

Haves celebrate it each time they say: ‘Yes, I’ll pay

that! Not because it’s worth it but because I can.’

And each time we do, another wedge goes into the

class divide. We say ‘Cheers’ to this exclusivity and

don’t even notice that it’s social exclusion we’re

raising a glass to.

Like for my business, there are opportunities in all

this madness. There are pub chains where a pint or

a roast battery-farmed chicken costs just half an

hour at minimum wage. In retail, jumpers made

by juvenile Asian fingers can help low-income

mums keep their kids dressed. Maybe it’s little

coincidence Wetherspoons have led the charge

promoting Brexit.

It is with a growing sense of shame for me that

we, my friends, are the Haves. Privilege is always,

always at the expense of the Have Nots. And as

one class gets better off while the other loses out,

social exclusion continues. And if you believe that

when the Have Nots vote, they’re voting against

the country’s interests, ask whose interests we are

really talking about?

For all this talk of shame, the one thing I’m

enormously proud of is my small team, past

and present, over the past ten years. They’ve

provided around 3,000 people on low incomes

with the means to become better off. To this end,

everything we do is about helping them Take

Back Control. But if the rest of us really want to

see an end to social exclusion, we all have to take







Marvin is the Mayor of Bristol, and has been re-selected to stand as Labour’s candidate for that role again in 2020.

My vision as Mayor of Bristol is clear: to

help build an inclusive city where no-one

is left behind. It’s a vision that underpins

our Corporate Strategy as a Local

Authority, as well as wider city strategies

such as the One City Plan...

I want Bristol to be a place in which everyone’s

hopes and aspirations can be made real. To do this,

we need to ensure that people are not held back

by poverty and that our collective successes are

fairly shared. But the mantra of inclusion is easy to

preach and hard to practice. So what does it mean

for Bristol and how are we trying to make it real?

The first thing to say about inclusion is that it

can only be achieved when we have a mindset

that sees people as assets and not burdens. It’s

easy and all too common to see leaders and

organisations take a ‘deficit approach’ and focus

only on people’s needs and disadvantages. But we

will only become a truly inclusive city if we focus

on the contributions that everyone can bring, and

then set about creating the structures and systems

that enable those contributions.

The second principle that underlies our inclusive

approach is that progress can only be achieved

through collaboration. Inclusion is everyone’s

responsibility, and cannot simply be delivered by

a Local Authority or any other organisation or

group acting alone. That’s why the we’ve adopted

what we call the One City Approach, seeking to

bring together different actors in the city and

catalyse greater collaboration and alignment. This

is happening through the One City Plan which

sets a collective vision for the city all the way to

2050, the City Office which is providing a hub for

collaboration and engagement, and the City Funds

which is pooling financial resources in order to

make systemic gains.

With these principles in mind, we can focus on

the contents of inclusion, which for me consists

of four key elements which all need to be held

together. They are access, outcomes, belonging

and influence. Access means making sure that

everyone in the city is able to benefit from and

contribute to services and activities. There is of

course a physical element to this, which involves

making sure our city is as physically accessible to

everyone as possible.

But there is also a cultural element which involves

breaking down the less visible barriers which hold

people back from being able to engage with

services and other activities. We were proud last

year to become the first Local Authority in the

UK to ‘Ban the Box’ and no longer use a tick box

in our job applications asking people about their

criminal record. We took this step because we

believe that everyone applying for a job at the

council should be given the same encouragement

and opportunity irrespective of their background.

Bristol is a place where the opportunities to share

in the city’s success are not evenly distributed and

barriers exist that prevent some from fulfilling their


Our aim is to remove one of those barriers and

send a message that we’re interested in getting

to know the person applying for the job first and

begin our conversation there.



The second dimension of inclusion is about working

towards fair outcomes for everyone. Our city is

currently blighted by huge inequalities in areas such

as education, health and employment, and in many

contexts we need to take positive action to address

these often historic and entrenched injustices. One

of many examples of this work is in seeking to help

refugees get into employment. We are proud to be

a City of Sanctuary, but across the UK only 51% of

refugees are in work compared to 73% of UK-born


Refugees have a huge range of skills and talents to

bring to our community, and so we’ve been working

with an innovative tech start up called SkillLab to

trial new software which can map people’s skills

and help match them to local job markets. The

app has been designed specifically with refugees

in mind but if successful could also htave benefits

for all of our residents looking to get into work or

progress their careers.

The third dimension of inclusion is about ensuring

that everyone feels that they belong in Bristol,

and encouraging and enabling people to build

relationships across difference. This is partly

about the narrative of the city, and ensuring

that the message projected by city leaders and

institutions is one that embraces diversity in all its

forms. It is also about practical opportunities for

different individuals and groups to meet and build

relationships, working against cultural and social

barriers and segregation in all its forms.

And finally it is about ensuring that hate crime

and discrimination in all its forms is vigorously

opposed. In the last two years we have been one

of six cities in the UK taking part in the Inclusive

Cities project run by Oxford University, and one

element of this has been a focus on narrative. This

has led to a strategic communications campaign

which will launch this summer and help spark

a conversation about all the things we hold in

common as Bristolians and how we can break

down barriers through relationships.

The fourth and final element of inclusion is about

enabling everyone to have the opportunity to

influence and shape the future of the city. True

inclusion is not about one group creating a system

which is fair to everyone, but rather about a

system which recognises the unique contribution

of every person. Inherent in this is a belief that

everyone should have the ability to influence the

decisions that affect them, and that the city’s

power structures should be representative of the

diversity of its communities. That’s why we’ve

invested nearly £400,000 over three years into

Bristol’s Voice and Influence Partnership, making

sure that individuals, groups and communities

whose voices aren’t always heard are listened to,

and are part of shaping Bristol’s future.

Creating an inclusive city isn’t something that

happens overnight, and we still have a long way to

go in Bristol to reach our ambitions. But I believe

that the work that we are doing, and the level of

commitment we are investing, means that the

theme of inclusion will be at the heart of this city’s

common life for much longer than the lifetime of

any Local Authority administration.



It was only by engaging

with DHI that I began to

turn my life around.







Phil has worked in the community services field for over 25 years as a practitioner, trainer and manager.

If you were born in 1999, your life course

would have traversed the most seismic

shifts in the UK’s drug culture. Back

then, familiar drugs were distributed

through stable networks in renowned


Few predicted the proliferation of new

psychoactive substances - legal highs - that were

developed faster than could be tested. Skunk, a

rarity back then, is now a UK net export. Buying

drugs on the ‘Dark Net’ has challenged old

monopolies of established dealing. It has also

meant that drug distribution follows rapidly

changing neighbourhood-based patterns of

use, rather than a stable national pattern of

consumption. Cross county lines dealing has

extended city-style dealing into rural corners.

Despite these changes, drug and alcohol use has

been in decline in young people. Young people

are now more screen time dependent that drug

dependent. Ironically social media has reinvented

an old social pressure related to intoxication

that had been lost. When we drank in local pubs,

unacceptable threshold of consumption was

observed by family and neighbours. The move

to anonymous city bars and clubs removed this

informal social pressure on consumption. Now,

Snapchat and Instagram have recreated these old

social pressures, where image conscious youth now

fear their least flattering moments of intoxication

can be shared with the whole world forever. In

‘real’ worlds, wider enriching experiences such as

travel, high performance sports, outdoor pursuits

and novel challenges compete for time, money

and interest. And cultural knowledge of the impact

of substance use has diverted many young people

away from experimentation.


These shifting currents have revealed an

interesting washout effect. As casual drug use

has declined it has revealed a more clearly

identifiable pattern of problematic use. For

example, increasing access to legal highs did not

create ‘new’ treatment populations. Instead,

the same high risk groups diversified. Likewise,

decriminalisation of cannabis in the US has also

identified that greater access to the drug was

only problematic for those who already had high

levels of use prior to legalisation. Young people

do not have problems with drugs and alcohol;

certain young people have problems with drugs

and alcohol.

Research has shone a deeper light into patterns

of problematic use. The evolution of drug and

alcohol problems is multi-causal, with risk factors

emanating from both the biological, psychological

and environmental domains. These risk factors

are accumulative - meaning that they snowball.

So just by the accident of your birth, in-utero

experience, genes, post-code and the established

patterns of family use have already given the child

a stacked hand. These risks are then activated

by initiation factors like positive expectations of

use, peer norms and impatience for adulthood

that open up more risk. Continued involvement

brings new confidence, new contacts and new

drugs. Alienation and lack of opportunity allows

use to fulfil the meaning gap in people’s lives.

And as consequences of use increase, so does

consumption as a form of stress compensation.

Risk factors chain together link by link.

Furthermore, the underlying risks in young people’s

lives cluster, creating highly predictable pathways

of involvement. This includes an early onset group

whose lives are characterised by transgenerational

poverty, poor parental support and poor impulse

control such as ADHD and Conduct disorders. A

mid-onset initiation group occurs alongside a huge

spike in mental health diagnosis: 50% cent of all

mental health diagnosis in the UK is made on 14

year olds. 75% of diagnosis is made by the age 20

as young people experience a peak in internalised

disorders such as depression, anxiety and selfharm.

Our later onset groups are ‘peer involved’

young people who initiate use after the age of 14.

These are largely stable-background youths who

enter into peer driven use. And then finally there

are ‘Fling’ users, these are students who are the

highest drug and alcohol consumers but for short

intense periods of time.

Research also shows that the onset of first use

predicts the length of a users’ career. The Montreal

Longitudinal and Experimental Study of over

1,000 males from impoverished neighbourhoods in

Canada examined drug and alcohol use at age 17,

20 and 28. The results confirmed that the younger

they started smoking cannabis, the more likely

they had a drug problem later. Those who started

before age 15 were at higher risk of problematic

use, regardless of how often they consumed drugs

at this age.

The Dunedin studies in New Zealand followed

over 1,000 people born in 1972. This study found

that just 20 per cent of the sample accounted for

81 per cent of criminal convictions, 66 per cent

of welfare benefits, 78 per cent of prescription

fills and 40 per cent of excess obese kilograms.

They grew up in socioeconomically deprived

environments, experienced maltreatment and

exhibited low childhood self-control. This research

has been augmented by Adverse Childhood

Experiences (ACEs) studies in the US, which again

have found high correlations between early

deprivation and trauma with later health, mental

health, domestic violence, suicide and substance

misuse patterns in adulthood.


Social policy and the substance misuse field in

general has been slow to understand and respond

to the implications of this research. A recent

large scale meta-analysis of 453 Randomised

Control Trials involving 31,933 participants

that spans 53 years found the effectiveness of

youth interventions remained stagnant during

this time. Specifically, treatment effectiveness

increased non-significantly for Anxiety. Treatment

effectiveness has decreased non-significantly for

ADHD whilst the effectiveness of treatment for

Depression and Conduct problems has worsened

over the last 50 years.

So whilst the number of young people presenting

for help has decreased, the complexity levels of

those who do present has increased. Those in

the field of youth work must recognise that we

are now operating in a realm of need beyond

social education and befriending but one of

more acute mental health needs in a grossly

underfunded sector. There is reticence in the field

to identify young people’s needs specifically for

fear of “labelling” young people. However, there

is no evidence that diagnosis worsens young

people’s conditions. Failure to better calibrate

young people’s needs, and tailor their treatment

accordingly, may be contributing to worsening

outcomes for the most vulnerable young people.

The improvement of treatment outcomes for

young people demands better understanding

of their pathways and profiles. Interventions

must begin to take better account of the specific

drivers and profiles of use within each pathway.

The inability to control impulsive behaviours is

a different therapeutic challenge to Depression.

Treatment intensity must also better reflect the

underlying social functioning levels of young

people that have become curtailed through

substance involvement.

This should be combined with new approaches

to interventions. For example, real time feedback

processes to track and inform young people’s

progress in treatment. Technology offers new

a new world of opportunity in adapting and

developing specific interventions matched to

neural systems implicit in young people’s clinical

profiles. This is not treatment as usual that is

simply delivered online via the internet. Computer

games like Go-Stop Tasks have improved impulse

control in young people, Erickson’s Flanker Test

improves concentration, Working Memory tests

reduce cravings, Emotional Recognition Challenges

improve depression and virtual reality holds

promise to reduce anxiety. These games ‘work’

brain systems that improve their functioning and

reduce presenting symptoms with practice. These

approaches are often more attractive to screensavvy

youth. The introduction of such procedures

has helped double to triple young people’s

expected outcome in projects across Wales and


All too often young people are regarded by adults

as a blank screen to project what they feel is

wrong with the world or what they feel should

be right in the world. At worse this has led to the

politicisation of youth work whilst at its best we

have simply drawn down adult models for the

not yet adult. The history of effectiveness of

young people’s services does not support either

position. Instead we need to draw upon the

increasing weight of research that illuminates

what it is to be young and translate this into

more developmentally informed approaches. This

requires the profound acceptance of one central

fact: we cannot make young people us but we can

help young people become themselves.







Amanda was Chief Executive of South Gloucestershire Council, a role she

held for 14 years until she retired in 2019.

An item on the radio about social care:

Cue sad piano music, presenter’s gloomy

voice and a story of service failure,

loneliness and isolation...

Cut to real life:

• My neighbours’ twin teenage sons with severe

learning difficulties. I’ve watched them grow

through school, college and into supported

living in a home shared with friends. They

have busy days, a great social life and holidays

abroad. They are happy, healthy young men

living without being dependent on my now

ageing neighbours.

• A recently visited elderly friend who was being

supported to die at home. Not much money in

the family, but a warm, clean and welcoming

home as always. Family able to drop by and

a constant stream of friends and neighbours.

All made possible by a fantastic district nurse

working with two great home care workers,

supported by the GP and palliative care

services. My last memory of him was lots of

love and laughter.

• A friend whose grandson who was born

prematurely and has severe physical and

learning difficulties. He lives at the heart

of a loving home, adapted for his needs,

surrounded by his boisterous siblings. He

attends an amazing school with the help of

specialist transport and support. A happy and

loving little boy.

• A close relative’s mother has a degenerative

illness and her husband of 64 years was

struggling to cope. She is now happily settled

in a local care home a short bus ride from

her husband. He can visit every day and they

spend the afternoon together, still holding


Lovely stories of social care at its best. So, what’s

the problem? When I asked these families, the

issue always comes back to funding and the often

complex, confusing and sometime adversarial

process of securing the services needed.

Amazing advances in healthcare mean that

many more people can now survive for longer

with increasingly complex conditions. Our current

system does not adequately recognise these

changes in demographics, nor does it recognise

the changing social context.

Institutional care is no longer an acceptable

model. Quality care must recognise the needs of

the individual and that the burden of care and cost

should no longer fall on the family.

The majority would agree with this, but there has

been no recognition of the costs involved. So, what

are the implications of an underfunded social care

system? There are a number of factors which are in

themselves problems, but together can sometimes

lead to disaster.

Costs have been driven out of the care system to

a point where pay rates are no longer competitive

and some care home and home care providers

sometimes struggle to maintain staffing levels.

Society rightly expects quality services, but a drive

to the bottom can only result in service failure and

failures in quality. Often employers rely on agency

staff, this can be a positive, filling short term gaps

and sometimes bringing in experienced staff.

Agency work can also offer the freedom to the

individual worker, which may mean the difference

between keeping good colleagues in the sector

or losing their skills and expertise. However, if

overused and badly managed, use of too many

agency staff can lead to situations which may

be sub-optimal and occasionally unsafe for the




Often, low pay is synonymous with jobs that are

seen as low value and lead to negative perceptions

of care work, which has its challenges but can be

some of the most rewarding work going. There is a

wider issue than just pay rates. Lack of investment

often leads to a lack of training and development,

the very issue which will attract and retain a care

workforce in the longer term. Indeed, the lowest

paid in the sector are often expected to pay for, or

contribute to, their own training and development.

The implications for professional working in the

system have also been significant, leading to a

potentially damaging change in emphasis which

has contributed to less job satisfaction for those

working across the system. Individuals aspire to

become social workers or occupational therapists

or any of the professional and caring roles within

the system because of a desire to support the most

vulnerable in our society, to make a difference and

to add value.

Increasingly their roles are as gatekeepers to

resources which has led to already stressful jobs

becoming harder and less satisfying. Work feels

more adversarial and about denying care rather

than the creative, supportive and sustaining

roles individuals joined for. This must contribute

to burnout and staff looking for other ways to

take back control, of which agency work must

be a prime example. The serious risk lies in staff

becoming negative about already difficult roles

when cost becomes the driving factor. This can

lead to untold damage to staff and the very

individuals they joined the professions to support.

The best care happens where there is trust and

a shared commitment to the same vision and

values for all players in the system. Social Care,

wider Council services, the NHS, education and the

voluntary sector working together in an integrated

system can wrap support around the individual

and their family, to maximise independence and


Financial pressures across the system cause

disagreements around funding thresholds and can

be the cause of deteriorating relationships and

a lack of trust between staff and organisations,

potentially contributing to a dysfunctional system.

In children’s services this may lead to unfair

pressure on schools unable to support children with

additional needs; and in adults’ services, perverse

decisions about care settings, which can lead to

additional costs in the longer term. A particular

example may be a reluctance to fund early

intervention and prevention, with mental health

services and services for vulnerable adolescents

being particularly vulnerable.

Current thinking recognises the vital role of the

community and voluntary sector in keeping

individuals in their own home and providing vital

support to parents or carers. Funding specific

services is not enough. Councils and the NHS

must invest in voluntary sector infrastructure and

consider their shared commissioning strategies if

they expect the voluntary sector to be available

when needed.

One of the most distressing impacts of a lack

of funding is the way parents or carers have to

fight, sometimes for years, to get the services

and support their child or loved one needs and

deserves. This sometimes leads to a destructive

and adversarial relationship between parents or

carers and the very staff who are there to provide

services and support. This is a terrible consequence

for all concerned, valuable time, money and

energy is wasted, when it should be focused on

the individual who should be at the heart of all

our care.

So, our request to have a properly funded social

care system is about preventing the frustrating

consequences of underfunding that reduce the

effectiveness of the resources already available.

More funding will have a major and beneficial

impact. That the system functions as it does, is

testament to the parents, carers and staff who

work so hard, in spite of the circumstances, to

provide safe and high quality care for so many. But

we can do so much better for the most vulnerable

in our community.








Danny is the founder of Transform Drug Policy Foundation. His experience as a drugs worker in the criminal

justice system led him to set up Transform in the mid-90s to campaign for an end to prohibition.

“Recognizing that addiction to narcotic

drugs constitutes a serious evil for the

individual and is fraught with social and

economic danger to mankind. Conscious

of their duty to prevent and combat this

evil.” - United Nations Single Convention on

Narcotic Drugs 1961

“Recalling ... that the enjoyment of the highest

attainable standard of health is one of the

fundamental rights of every human being without

distinction of race, religion, political belief,

economic or social condition.

Determined to promote measures of tobacco

control based on current and relevant scientific,

technical and economic considerations.” - WHO

Framework Convention on Tobacco Control 2003

In the mid-90s I began working as a drug

counsellor with clients on probation and in prison.

In my first couple of weeks in the job a strong

batch of heroin hit Bristol and five of our clients

died in one week. Heroin users, accustomed to a

less pure product, injected too much, overdosed,

and died. An acute overdose like this (out of

ignorance of toxicity) rarely happens with alcohol,

because it’s regulated and carries a purity guide.

It’s the equivalent of accidentally drinking spirits

in the same quantity you might ordinarily drink

beer. And, put quite simply, that is one major

reason why we need to regulate any drug supply

for which there is a high level of demand.

But drug control policies tend to be implemented

at the extremes. Whilst for example, both alcohol

and smokable nicotine are legally regulated,

the level of regulation for those drugs is too low,

and policy makers remain excessively under the

influence of the respective industries. Both drugs

are sold from newsagents - alcohol doesn’t carry

a health warning, an ingredients list or a calorie

guide. Tobacco products are sold without a license

or an ingredients list from inappropriate outlets. At

the other end of the policy spectrum, production

and supply of cannabis, heroin, cocaine, ecstasy

and many more are gifted to organised criminals

and unregulated dealers.



Again, they are all sold without any information or

quality assurance. The job of policy makers should

be to aim toward the ‘sweet spot’ in the graphic

above, where the level of public protection is

highest, and harms are at their lowest.

Worse though, people who use drugs that are

prohibited are demonised to one degree or another

- and in fact, that demonisation is literally written

in to the UN drugs treaty. The preamble to the

Single Convention on Drugs states that ‘addiction’

to the drugs included in the treaty constitutes a

‘serious evil’ (the inclusion of the term is a result

of the influence of the Vatican at the UN, when

the treaty was drafted). And it isn’t a big step

from defining ‘addiction’ as evil, to identifying

people who use drugs as evil. Drugs identified for

prohibition are often described as a ‘scourge’ and

a ‘menace’, and it is all too easy to identify ‘users’

as the ‘menace’, as they so often are - treated

somewhat akin to the threat of cancer or a virulent

disease that requires elimination. And this is a big

part of the reason that the deaths of over 3,500

people each year, mainly opiate users, are treated

with such apparent disdain by policy makers across

the political spectrum. That’s ten deaths a day, 70

a week, 280 a month.

The Framework Convention on Tobacco Control

(FCTC), on the other hand – and also held in place

at the UN – is based on the right to health, not

the demonisation of people who smoke tobacco.

It is important to note that the FCTC was a

belated attempt to fetter the worst tendencies of

Big Tobacco, but its principles are fundamentally

different to those of the Single Convention on


And those principles play out very differently for

those people from deprived and marginalised

communities. Criminalisation, and the

demonisation that accompanies it, serves only to

further marginalise and exclude those who need

to be included the most. In my work with people

who were caught up in the criminal justice system

(CJS), middle-class users were notably absent. The

CJS is not even-handed when it comes to issues of

class and inequality.

The senior executives at HSBC who were

responsible for the failure to notice the laundering

of $881 million of Mexican drug money weren’t

even arrested, let alone charged, after a formal

intervention from the then Chancellor, George

Osborne, claiming that criminal proceedings

could cause a “global financial disaster”. The Old

Boys’ Network will not intervene for the tens of

thousands of ordinary people who are prosecuted

in the UK each year.

People from disadvantaged and from BAME

communities, those who are street homeless,

those who are already broken by a system that

discriminates against them are the ones who

bear the brunt of criminalisation. And it is up

to those of us in the drug sector to stand up for

those people who make use of our services. We

must call out the cruel system that punishes those

using drugs to relieve their personal pain and the

impacts of social inequality.

That is why the Royal Society for Public Health

called for the decriminalisation of people who

use drugs in 2016 (it is worthy of note that the

only flak that the Royal Society took in the media

came from The Times, who, in their editorial, called

on them to go further and legalise and regulate

drug supply). It is why Westminster Drugs Project,

Blenheim CDP and Kaleidoscope have all taken

organisational positions supporting reform.

There is now support for reform on Labour and

Conservative back benches, while the Liberal

Democrats and Green Party already support legal

regulation of cannabis and decriminalisation of

personal use of other drugs, and supporters of

reform will be meeting MPs at a mass lobby of

parliament on 25 June this year. Now is the time to

call out a cruel policy that causes and exacerbates

social exclusion and speak out for policy reform

that supports inclusion and care for those who

need it most.



DHI has been like a

parachute on my back; if

I feel myself freefalling, I

can pull that cord.











Kevan is the Head of Innovation at Anchor

Hanover, the largest provider of specialist housing

and care for people in later life in England.

It’s widely recognised that increasing

numbers of older people in society

bring exciting opportunities but also

challenges. On the one hand more older

people are occupied with childcare for

their grandchildren, or are retiring later

and thus keeping their skills in the

workforce for longer. On the other people

are living longer but with more conditions

that can limit their activities and mean

that they need more care and support...

More attention to older people has also meant

that there’s been greater media attention given

to how they live. Only seven percent of older

people live in housing that’s specifically designed

for them; many live in housing that may not

be suitable, but for those who live in specialist

accommodation the model is one that hasn’t

changed significantly for decades. Is this the sort

of housing that’s suitable for the 21st century and


Along with many others I’d say that we need to

urgently look at whether it’s fit for the future.

We now have examples from both this country

and abroad of different models which challenge

our approach. For example, Channel 4’s series on

a nursery set in a St Monica’s Trust retirement

village is one of the latest examples of how intergenerational

initiatives can benefit everyone who

takes part.

The programme demonstrates great benefits

to both their mental and physical health for

older people from spending time with nursery

age children, surprising even the participants. In

Europe older people have been encouraged to

live in town centres so that they effectively act as

community guardians while people of working age

are away at work – they can take in parcels during

the day and keep an eye on the neighbourhood.

And there are also initiatives such as Shared Lives

Plus, which match older people and younger

people so that the younger person can live with

the older person in return for carrying out some

basic tasks. Examples like this have set me thinking

about our own model of retirement housing for

people over 55. What are we doing already that

works and what should we be changing?


Organisations like mine work locally with schools

on projects around, for example, digital inclusion,

but we do still operate a model which puts older

people on the same estate living together and to

some extent expect them to get on, even though

the only thing that they may have in common is

the fact that they’re over 55.

Our youngest resident is 52 and our oldest 107, an

age range equivalent to a 3-year-old and someone

who’s 58. Within that age range there are many

people who are physically fit and strong at 80 and

some who are frail at 65. A particular problem for

some older people, particularly older men, can be

isolation, widely quoted as shortening an older

person’s life as much as smoking 15 cigarettes

a day. As we all know, loneliness and isolation

have become the subject of a national campaign

because they are so important.

But if you look at the model widely referred to as

sheltered or retirement housing, one question is

how much support neighbours give to each other.

This is an area that needs to be examined further:

does physical proximity – living on an estate with

other older people – mean that it’s more likely that

they will socialise and, more importantly, support

each other? We’re living in an environment

where local authorities are having to cut budgets,

and those include support for older people – for

example, day centres facing closure and local

housing support budgets being axed. In practice

this means that housing providers like us need

and want to do more to help the wellbeing of our

residents, but the question is: how?

Intervening directly into someone else’s life can be

seen as paternalistic when the intention is to work

with people to help their wellbeing. In surveys,

residents have been clear with us that they see

our responsibility as maintaining their homes and

helping them to live independently. Where are

the boundaries in intervening? Survey results have

demonstrated that residents can understandably

be resistant to being organised. Many estates have

arrangements where neighbours look out for each

other without any interference from us.

Surveys also tell us that residents want us to get

the basics right before we get involved in other

areas such as wellbeing. Yet as a responsible

specialist social landlord we have a duty to make

sure that our estates are good places to live.

We believe the answer lies in co-producing

solutions with our residents, working with them to

design projects which work locally but also piloting

different approaches so that we can learn from

them and get better. We have to remember that

many of the people moving on to our estates now

are baby boomers, who are used to more choices

than the previous generation and rightly don’t like

being talked down to. Many are perfectly capable

of organising activities on their estate themselves,

but we need to continue to help those that want

help. We also need to be more robust in evaluating

the results of interventions and learn from what

others are doing.

As older people become a larger part of the

general population there are already great

examples we can learn from – but we just need

to make sure that we’re co-creating solutions by

working together and not imposing what we think

is a good idea on people who have a wealth of

life experience and can teach us a thing or two









Sandy is the Chief Executive of Creative Youth

Network, Chair of Voscur and Green Party

candidate for Mayor of Bristol in 2020.

Liam is a young man with dyspraxia,

dyslexia and mild learning difficulties. His

problems started to become more serious

later on during primary school. He fell

behind with reading and his dyspraxia

meant he was ‘disorganised’; never

having the right pencil or the right book

and rummaging around in his bag for 10

minutes before he could get started...

Occasionally this would lead to a fractious

argument with a teacher who couldn’t start the

lesson until he had got himself sorted. During

primary school this was manageable but when

he went to secondary school things became

worse. The pressure to achieve grew, as did the

complexity of lesson timetables, homework and

the need to be generally prepared. His poor

reading skills meant he fell behind in most of his

subjects. He began to get into more trouble and

became violent – partly as a way to avoid being

shown up or made to feel ridiculous. He hung in

there for a couple of years but soon started to

play truant more regularly until eventually he left

mainstream school in year 9.

This example is important because truancy

from school is the single most reliable indicator

that a young person is going to become socially


Social exclusion can take many forms – at its

simplest, it’s not having the money to take part in

things that our peers do. But at its deepest it can

be caused by serious trauma and the problems

can affect our very personalities. The causes might

be anything from serious physical or sexual abuse

to neglect. Or, it may be caused by bullying, a

disability (sometimes simply a personality that

doesn’t fit with the mainstream) or low resilience

to the ‘slings and arrows’ that life throws at us.

We know too that those who are in a minority

are more likely to suffer – for example those who

are BAME or LGBT are more likely to experience

exclusion. At its most extreme, it changes our


We know that neglect and abuse changes the

neural pathways we develop as we grow. It can

lead to things like anxiety or hyper-vigilance. If we

are anxious we see danger everywhere and act

accordingly. Panic, aggression, fear or passivity

above and beyond what is ‘normal’ can cripple a

person’s development leading to lack of friendships

or ‘bad’ behaviours. We can, in turn, resort to drugs,

alcohol or other behaviour that ‘treats’ the problem

in the short term but of course, in the long run,

does more damage. Many young people hang out

with the ‘wrong crowd’ because they are looking to

belong and will forgo their own wellbeing, getting

involved in crime or sexual exploitation at worst.

But let’s start with the reality – most young people

don’t become socially excluded adults. Most young

people, including some who suffer from serious

trauma or troubles in their early years, go on to live

fulfilling lives. So, we are discussing a minority of

young people, those whose trauma is so great that

it affects their lives irrevocably.

But if we are to work out and answer the question

we need to look further at those who do lead

fulfilling lives. Study after study highlights that the

single most important factor, when successfully

dealing with difficulty in life, is the relationships

we have around us. This might be family, friends

or professionals. Having people around you to help

you through problems and make sense of them.

This in turn allows us to moderate our behaviour as

we recover. Good relationships also allow problems

to be spotted early reducing the damage they do

in the first place.

Liam became a carpenter. His mother and father

sent him to a special school where he thrived. Now

19, he is supported by his parents to find the right

course for him and is now ‘on his way in life’.

The second thing is time. Recovering never takes

a few days or weeks. We have to process it,

understand how it has affected us. Our experience

at Creative Youth Network tells us that young

people have to go on a journey of discovery. It has

ups and downs, successes and failures, so people

must have the time to work out how to live their




Jacob went into foster care aged three and

while he was perfectly able with his reading and

writing, he began to struggle at school. Going into

foster care only happens when there has been

significant trauma or neglect and so, as he entered

his teenage years, the trauma led to him losing

his confidence, getting into trouble and starting

to ‘misbehave’ at school. He enjoyed it there

but ultimately the school couldn’t help him with

his behaviour. Despite entreaties from his foster

carers, they did not provide him with the support

he needed and he was excluded at the end of year

8. He disengaged even from the Pupil Referral Unit

and became homeless for a period. The education

system had failed him, but persistence from his

carers meant that aged 16 he contacted them to

ask for help getting a job. He returned to college,

got a one-day-a-week job that has now (aged 18)

turned into a full time apprenticeship. This journey

has been 15 years in the making and is not over


So, what do we need to do differently for

those who are at risk of exclusion?

First and foremost, we must build relationships

with young people, spending time getting to know

them, not just responding to their behaviour. When

we have a good relationship and understanding,

we often see a different way of resolving a

problem. It might be something as simple as

getting them involved in a positive activity where

they find their self-confidence or new friends. It

might be they need long term counselling or even

foster care. But too often stressed professionals do

not have or take the time to see the real problems

under the surface.

Secondly, we must walk the journey with them.

Relationships only work when they are for the

long term. Success is not guaranteed, but walking

the long journey and taking time with young

people can help them to recover, come to terms

with problems, and start to build a new life for


Yet, as a society and as professionals we don’t

yet structure our support for young people for the

long term. The short term intervention is king! We

measure ‘outcomes’ like returning to school or

entering training when we know well that a tick in

the box is not the end of the journey. Three-year

contracts and grants ‘demand’ results for knife

crime, obesity or isolation when those facing such

problems have no positive relationships and will

take years to recover from their experiences.

If we are truly to stop our young people becoming

tomorrow’s socially excluded adults, then we

need to look hard at the very structure of our

society; what we value and resource. Where a

young person does not have the support of family

or friends, for whatever reason, then we must

structure support and allow professionals the time

to build relationships with young people in the

long term.

It is these long term relationships that help our

young people to thrive, to grow and to overcome

any difficulties they face. In that way they are like

all of us – we need friends along the way to help us

be the best we can be.






Stephen has been the Chief Executive of The Big Issue Foundation since 2007.

‘Staying in the moment’ or ‘stuck in the

moment’? Short-termism and self-denial

are not the qualities of a ‘mindful’

approach to modern living. Will we regret

tomorrow what we did or did not do

today and, today, does tomorrow seem

just a little too far away?

Social and economic exclusion most frequently

wander hand-in-hand along the path of social

ill-justice. To bring about an end to exclusion we

are really talking about achieving sustainable

decreases and the eradication of the chronic

outputs that are symbols of inequality within our

society; be that homelessness, gender or ethnicitybased

discrimination or inequality of access to

labour markets for example.

Of course, these are not sudden overnight

manifestations of short-term problems writ large.

History can teach us lessons if we are curious

to look and open to being taught. What are the

positive social behaviours we can understand

from history? How have these evolved, mutated or

ceased to exist and why?

Society is made of people and social and economic

exclusion can act like a disease, infecting, adapting

and spreading as it multiplies and expands.

Individual and collective responsibility should be

accepted, and positive action taken; action that is

informed by insight and history.

Some societal challenges are the unintended

consequences of action elsewhere; when a library

is closed it is often true that more people end up

in the local A&E department as a result. We should

be attempting to predict if what we intend to do

now will lead us to a more positive future, a future

that we seek to design.

Many of the young people we encounter in our

work are in hardship and on the streets in-part

because of problems that can be traced back

generations. Poverty inherited and maintained

by their parents, and their parents before them,

breeds family conflict and breakdown. The trauma

of losing the family home (however meagre),

and the support system that it provides, spins

young people into a downward spiral that’s often

impossible to climb out of.

Feelings of hopelessness can quickly amplify across

everyday behaviours. At a time when they crave

family members to nurture self-reliance, negative

experiences can start to reinforce the isolation and

inadequacy that many young people experience.

The lack of confidence that can result ensures that

the easiest way to deal with life’s challenges is

to run away. To run away from responsibility, run

away from the opportunity for education and run

away from the chance of getting a job. Missed

basic needs, at a young age, can be handed down

and passed on from generation to generation.

People need ongoing support to help them cope

with the trauma of poverty and homelessness.

At the Big Issue we give people experiencing

financial and social exclusion the opportunity to

earn money by becoming vendors. Their primary

motivation may be cash, but in the process, they

gain retail skills, resilience and self-worth. They

figure out how to be part of society again, to own

and tackle their exclusion.

Our way isn’t for everyone, and it’s not the

only way. For others, bursaries may be more

appropriate so that they can benefit from an

education that leads to a career and a long life of

contributing to society rather than a short life at

the mercy of society.

To enable this, we need a shift in public perception,

we should encourage the public to recognise

that people are homeless because of wider social

problems, not just housing. Social ills that only

a genuinely benevolent society can address and

we, the well-intended, should never play a role in

promoting the stereotypes that re-enforce the

idea that homelessness is an inevitability. That in

the main, people are the architects of their own


When people become homeless we need to

act quickly to reverse their fortunes. The many

organisations in this space must work more

collaboratively (and there is much to say about

the real value of collaboration going forward),

creatively developing solutions with permanence

at their heart, rather than applying individual

sticking plasters. And, if an idea works, let’s give it

the space, time and money to succeed – Housing

First works so implement it properly.

We need our Government, of whatever political

persuasion, to implement a welfare regime that is

sufficiently robust and generous to ensure that our

citizens are not held down or held back by things that

we can control or correct. Monetary poverty leads

to poverty of opportunity, so we must help families

to obtain a better future, rather than just fund the

status quo.

Earlier this year the Environment Agency warned

that England’s flood planners must prepare for

the worst of climate change. Its chairwoman,

Emma Howard Boyd said, on current trends, global

temperature could rise between 2C and 4C by

2100 and £1bn a year would need to be spent on

flood management. She went on to say that some

communities may even need to move because of

the risk of floods.

Climate change and the emergence and public

mobilisation of movements by, for example,

Extinction Rebellion do demonstrate that there

is power in collective endeavour. Citizenship and

democratic action here look beyond the normal

timeframes to re-write a future history that has yet

to happen and a future that many may not even

be alive to witness. Thinking, planning and acting

for tomorrow is a critical component to ensuring

that we live in the present and thrive not just in

the short-term moment.

So, what has history taught us with The Big Issue

magazine? How has something so simple had such

a profound effect on so many and for so long?

At the very core is the concept of self-help and

responsibility. Many who we first meet live a

life that extends 60 to 90 minutes ahead, the

immediacy of their situation preventing any

thought about tomorrow, with little or no capital

to support the next day. For those who return

the next day with some cash from the sale of

the free magazines we provide each new vendor,

then another 23 hours have been added on to

a persons’ experience. They have engaged with

themselves and saved something from that for

another day. They are thinking about tomorrow

and that is where the window of opportunity is

opened. Self-determination, personal effort and an

eye for the opportunities that tomorrow can bring.

That’s where this all starts.



Since entering the House of Lords, Big Issue

Founder and Editor-in-Chief Lord John Bird has

been thinking about the future and the steps

needed to ensure we do not repeat the mistakes

of history.

Further inspired by the Well-being of Future

Generations (Wales) Act 2015, Lord Bird intends

to introduce his Future Generations Bill in the new

Parliament and campaign for its enactment. Public

bodies, including the UK Government, should

be legally required to balance the needs of the

present with the needs of the future, and to work

preventatively, with a long-term focus that spans

longer than the implicit self-interest of an electoral


We should embrace a new framework to

encourage decision-makers to think differently

about the importance of preventing problems,

long-term thinking and accounting for the wellbeing

of future generations as a matter of law.

Embedding long-termism, prevention and the

interests of future generations at the heart of UK

policymaking should aim to tackle the climate

crisis, poverty and health inequalities head on.

We need to ensure that the paths we wander

lead towards positive choices and destinations.

We should accept that a short stroll might lead to

a hard climb, but a future generations principle

will ensure that the needs of the present are

met without compromising the ability of future

generations to meet their own needs.

This is a path worth walking







Ian is Senior Lecture in Criminology at the University of the West of England.

In the Spirit Level, Wilkinson and Pickett

make a persuasive argument that

national crime rates strongly correlate to

levels of social inequality. Criminologists,

furthermore, have observed that certain

types of crime, acquisitive crimes in

particular, are concentrated among

socially marginalised and excluded


Tackling the link between social exclusion and

involvement in crime is not straightforward when

we consider that social disadvantage has been

deeply embedded within the structures and

institutions of British society for many decades.

This entrenchment is arguably worsened by the

institutions of the criminal justice system and

policies that glorify individual responsibility

while at the same time downplaying or silencing

collective and social responsibilities. Part of the

problem can be traced to our narrow conception

of justice and the unintended consequences

of the type of justice we are delivering. The

solution I want to propose is that the exercise of

criminal justice should be widened to include a

consideration of social justice.

The links between social exclusion and crime

have been well-recognised but how might the

day-to-day workings of the institutions of the

criminal justice system contribute to this link?

I am not suggesting that the criminal justice

system reproduces this link intentionally. Part of

the problem, it can be suggested, is related to

the narrow conception of justice that underpins

the decisions and actions of the criminal justice

system. Criminal justice in this respect, directs

the disciplinary apparatus of the state towards

correcting the individual rather than recognising

the structural influences on individual behaviour.

In practice, the search for justice inevitably

becomes entangled with punishment, retribution

or questions regarding the types of punishment

that can most successfully and efficiently deliver

justice for society. The exercise of punishment

aims to deter crime generally, rehabilitate

offenders and discourage them from committing

crimes in the future. Importantly, in the last

few decades the pursuit of criminal justice has

increasingly become fixated on prison as the

method of punishment best suited to achieve

these aims.


The number of men and women sent to prison

has almost doubled in the last two decades with

Government figures for September 2019 reporting

82,384 prisoners in England and Wales, compared

to 44,975 in 1989. Furthermore, since 2010 the

growth in the prison population in England has

surpassed the increase in the general population

by 10%. Paradoxically, actual crime rates had been

falling long before the prison came to hold this

privileged positon in the exercise of juridical power.

Nevertheless, this move towards incarceration has

unsurprisingly silenced, on the one hand, the link

between social exclusion and crime and on the

other, the collective responsibilities necessary to

reduce the social causes of some crimes.

The All Party Parliamentary Group for Ending

Homelessness acknowledged that 15% of newly

sentenced prisoners reported being homeless

before entering prison and a third of rough

sleepers in London had served time in prison. Such

living conditions can have serious implications for

there is convincing evidence that those who were

homeless prior to their imprisonment are more

likely to be reconvicted upon release compared

with those that report living in other types of

accommodation. In essence, those caught in

the revolving door of the criminal justice system

are more likely to come from economically and

socially disadvantaged backgrounds. Arguably,

the continued use of an underfunded and

overpopulated prison system risks producing

hostile and criminogenic environments that

will inevitably impact upon communities in the

form of more crime, victimisation and human

misery. The prison disturbances, rising levels of

violence against prison staff and prisoner on

prisoner violence is recent evidence of this type of


Where do we go from here? We can never imprison

our way to a safer and more equal society. A

solution to this problem, I would argue, can be

found in the concept of social justice. Criminal

justice is limited in its valorisation of individual

choice and responsibility and neglect of collective

responsibilities. In contrast, social justice promotes

fair and just relations between the individual

and society. It supports an imagination of the

individual as always embedded and affected

by the social environment. This understanding

of justice as a collective or social good draws

attention to the economic and social inequalities

of those that find themselves caught within the

revolving door of the criminal justice system. It

moves beyond the idea that individuals alone

have the capacity and responsibility to become

more socially included and recognises that with

the fair and equal distribution of opportunities

and access to a wider range of resources, such

as appropriate housing upon release from

prison, desistance from crime is an achievable

reality. From this perspective, rehabilitation of

an individual offender should always carefully

consider the bigger picture as well as its influence

on the individual.

Practically, the inclusion of social justice into

the criminal justice system might involve

increasing the use of community alternatives to

imprisonment and strengthening the position

of social policy in efforts to reduce crime and

rehabilitate offenders. Either way, there is much

value in understanding the criminal justice system

as an important mechanism for achieving social

justice and something that we can all benefit from.

“We can never imprison

our way to a safer and

more equal society.”





“I skydived for my friend who lost her only child to

substance abuse”





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Developing Health & Independence

15-16 Milsom Street

Bath BA1 1DE

01225 478730

twitter: @dhi_online

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