The Vision Project

THE
VISION
PROJECT

THIS BOOK HAS BEEN KINDLY PART-FUNDED BY
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3
THE VISION PROJECT

CONTENTS
FOREWORD
pg 5
FROM RAT PARK TO HOUSING FIRST: WHY MASLOW
STILL MATTERS
pg 6-7
THE BENEFITS SYSTEM IS PERFECT JUST AS IT IS
AND NOBODY SHOULD PANIC; IT’S FINE
pg 8-9
WORDS MATTER - THE ROLE OF LITERACY IN
COMBATTING SOCIAL EXCLUSION
pg 10-11
DRUG RELATED DEATHS: A PUBLIC HEALTH
EMERGENCY
pg 12-13
HOW WE CAN END HOMELESSNESS
pg 15-16
WHERE HAVE ALL THE ACTIVISTS GONE?
pg 17-18
CONSERVATIVE SOLUTIONS TO THE HOUSING CRISIS
pg 19-20
FAMILIES, DRUGS, ALCOHOL AND SOCIAL EXCLUSION
pg 22-23
SOCIAL EXCLUSION: ADDRESSING THE CAUSES NOT
JUST THE SYMPTOMS
pg 24-25
JUST SAY IT! YOUNG PEOPLE SPEAK OUT
pg 26-29
A VISION FOR PRIVATE RENTED HOUSING
pg 30-31
TACKLING THE PERMANENT SOCIAL EXCLUSION
OF SEX WORKERS
pg 34-35
TAKING BACK CONTROL?
pg 36-37
BUILDING BRISTOL AS AN INCLUSIVE CITY OF
HOPE
pg 38-39
HOW DO WE HELP TODAY’S YOUNG PEOPLE
WITH SUBSTANCE MISUSE?
pg 41-42
SOCIAL CARE: A POSITIVE OPTION
pg 43-44
FROM CRUELTY TO CARE: DRUG POLICY THAT
PROMOTES SOCIAL INCLUSION
pg 45-46
HOW SHOULD WE BE HOUSING PEOPLE IN LATER
LIFE?
pg 48-49
HOW DO WE STOP TODAY’S YOUTH FROM
BECOMING TOMORROW’S SOCIALLY EXCLUDED
ADULTS?
pg 50-51
LOOKING TO THE FUTURE
pg 52-53
CRIMINAL JUSTICE AND SOCIAL EXCLUSION: A
PLACE FOR SOCIAL JUSTICE?
pg 54-55
HOW YOU CAN HELP TURN LIVES AROUND
pg 56
NO ONE LEFT BEHIND: TACKLING SOCIAL EXCLUSION
IN LGBT COMMUNITIES
pg 32-33
DEVELOPING HEALTH & INDEPENDENCE
5

Rosie Phillips
DHI Chief Executive

FOREWORD
WRITTEN BY ROSIE PHILLIPS
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
symptoms.
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.
DEVELOPING HEALTH & INDEPENDENCE
7

FROM RAT PARK TO
HOUSING FIRST
WHY MASLOW STILL MATTERS
WRITTEN BY ROSIE PHILLIPS
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
London...
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
impact.
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
available.
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.
8
THE VISION PROJECT

“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.”
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!
DEVELOPING HEALTH & INDEPENDENCE
9

THE BENEFITS SYSTEM IS
PERFECT JUST AS IT IS
AND NOBODY SHOULD PANIC; IT’S FINE
WRITTEN BY EMMA KERNAHAN
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
1601.
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
toilets.
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
assessed.
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.
Celebrated.
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.
10
THE VISION PROJECT

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.”
DEVELOPING HEALTH & INDEPENDENCE
11

WORDS MATTER
THE ROLE OF LITERACY IN COMBATTING SOCIAL EXCLUSION
WRITTEN BY JONATHAN DOUGLAS
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
language.
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
country.
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.
12
THE VISION PROJECT

“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
improved.
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
inclusion.
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.
DEVELOPING HEALTH & INDEPENDENCE
13

DRUG
RELATED
DEATHS
A PUBLIC HEALTH
EMERGENCY
WRITTEN BY JODY CLARK
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.

“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.”
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
stop.
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.
DEVELOPING HEALTH & INDEPENDENCE
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.
15

Luckily I got in touch with
DHI, who gave me a stable
roof over my head and the
support I needed.
Simon

HOW WE
CAN END
HOMELESSNESS
WRITTEN BY JON SPARKES
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.
DEVELOPING HEALTH & INDEPENDENCE
17

“THE QUICK OFFER OF A PERMANENT
HOME IS THE MOST EFFECTIVE MEANS
OF ENDING HOMELESSNESS, SIMPLE AS
THAT MIGHT SOUND.”
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
lives.
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
that.
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
happen.
18
THE VISION PROJECT

WHERE HAVE ALL
THE ACTIVISTS
GONE?
WRITTEN BY NICK WILSON
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.

A PERFECT STORM.
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
component.
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
again.
20
THE VISION PROJECT

CONSERVATIVE
SOLUTIONS TO
THE HOUSING
CRISIS
WRITTEN BY JACOB REES MOGG
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
homeless.
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
building.
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.
Mary

FAMILIES,
DRUGS,
ALCOHOL
AND
SOCIAL
EXCLUSION
WRITTEN BY VIVIENNE EVANS
Vivienne is the Chief Executive of Adfam, a national charity working to improve life for families affected by
drugs or alcohol.
“The public
perception
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.
24
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
excluded.
“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.
THE VISION PROJECT

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
isolated.
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
group.
DEVELOPING HEALTH & INDEPENDENCE
25

SOCIAL
EXCLUSION:
ADDRESSING THE
CAUSES NOT JUST
THE SYMPTOMS
WRITTEN BY JOHN TIZARD
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.
26
THE VISION PROJECT

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.
DEVELOPING HEALTH & INDEPENDENCE
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
few.”
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
activists.
27

JUST SAY IT!
YOUNG PEOPLE
SPEAK OUT
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
executives.
On the night, 4 key questions related
to social exclusion were asked by young
people:
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
18?
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 problems...it’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
differently?
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
honestly’.
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.”
CONCLUSIONS
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
problems.
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
relationships.
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.
29
THE VISION PROJECT

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.
www.whitestardesign.co.uk
www.bathbc.com

A VISION
FOR PRIVATE
RENTED
HOUSING
WRITTEN BY NICK BALLARD
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
option.
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.
32
THE VISION PROJECT

“The right to housing is
fundamentally about life
chances.”
DEVELOPING HEALTH & INDEPENDENCE
33

NO ONE LEFT
BEHIND
TACKLING SOCIAL EXCLUSION IN LGBT
COMMUNITIES
WRITTEN BY JOSH BRADLOW
Josh is Policy Manager of Stonewall, Europe’s largest LGBT rights
organisation.
This year’s Pride month comes at a
critical point in our journey towards
lesbian, gay, bi and trans (LGBT)
equality...
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
themselves.
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
treatment.
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
potential.
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
themselves.
DEVELOPING HEALTH & INDEPENDENCE
35

TACKLING THE
PERMANENT SOCIAL
EXCLUSION OF SEX
WORKERS
WRITTEN BY SARAH TALBOT-WILLIAMS
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
harsher.
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.
36
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.
THE VISION PROJECT

TAKING
BACK
CONTROL?
WRITTEN BY JEFF MITCHELL
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.
38
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
person.
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
control.
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
more.”
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.
THE VISION PROJECT

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
responsibility.
DEVELOPING HEALTH & INDEPENDENCE
39

BUILDING BRISTOL
AS AN INCLUSIVE CITY OF HOPE
WRITTEN BY MARVIN REES
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
potential.
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.
40
THE VISION PROJECT

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
people.
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.
DEVELOPING HEALTH & INDEPENDENCE
41

It was only by engaging
with DHI that I began to
turn my life around.
Kaine

HOW DO WE HELP
TODAY’S YOUNG PEOPLE
WITH SUBSTANCE
MISUSE?
WRITTEN BY PHIL HARRIS
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
neighbourhoods...
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.
DEVELOPING HEALTH & INDEPENDENCE
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.
43

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
Cornwall.
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.
44
THE VISION PROJECT

SOCIAL CARE:
A POSITIVE
OPTION
BY AMANDA DEEKS
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
hands.
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
customer.
DEVELOPING HEALTH & INDEPENDENCE
45

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
choice.
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.
46
THE VISION PROJECT

FROM CRUELTY
TO CARE
DRUG POLICY THAT PROMOTES SOCIAL
INCLUSION
WRITTEN BY DANNY KUSHLICK
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.
DEVELOPING HEALTH & INDEPENDENCE
47

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
Drugs.
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.
48
THE VISION PROJECT

DHI has been like a
parachute on my back; if
I feel myself freefalling, I
can pull that cord.
Jon

HOW
SHOULD
WE BE
HOUSING
PEOPLE
IN LATER
LIFE?
50
WRITTEN BY KEVAN FORDE
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
beyond?
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?
THE VISION PROJECT

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
themselves.
DEVELOPING HEALTH & INDEPENDENCE
51

HOW DO WE STOP TODAY’S
YOUTH FROM BECOMING
TOMORROW’S SOCIALLY
EXCLUDED ADULTS?
WRITTEN BY SANDY HORE-RUTHVEN
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
excluded.
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
brains.
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
lives.
52
THE VISION PROJECT

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
yet.
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
themselves.
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.
DEVELOPING HEALTH & INDEPENDENCE
53

LOOKING TO
THE FUTURE
WRITTEN BY STEPHEN ROBERTSON
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
decline.
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.
54
THE VISION PROJECT

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
term.
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
down.

CRIMINAL JUSTICE
AND SOCIAL
EXCLUSION
A PLACE FOR SOCIAL JUSTICE?
WRITTEN BY DR IAN WALMSLEY
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
groups...
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.
56
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
environment.
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.”
THE VISION PROJECT

HOW YOU CAN
HELP TURN LIVES
AROUND
“I skydived for my friend who lost her only child to
substance abuse”
Sadhana
DONATE
VOLUNTEER
FUNDRAISE
Although DHI receives some funding from the
state, we need additional donations to help us to
provide the best and most innovative services to
our clients to help them turn their lives around.
For example, your donations could help us offer
more tenancy support training to disadvantaged
clients new to living in their own home, help a
vulnerable young person build their resilience
and keep services such as our breakfast club and
gardening club flourishing.
You can donate online at localgiving.org/dhi or you
can send a cheque made out to ‘DHI’ to our office
at 15-16 Milsom Street, Bath, BA1 1DE.
58
Our volunteers add real value and help us to
deliver more effective services for people who are
marginalised, vulnerable or socially excluded. With
volunteers, we are able to offer more personalised
support and help turn even more lives around.
Whether you want to work for an hour or a day a
week with us, we appreciate what our volunteers
do for our service users.
We provide full training for all our volunteers and
we are able to cover some expenses.
Check out our website for details of current
opportunities.
Fundraising for DHI helps us to turn around more
lives and help people to live independently.
By fundraising, you will not only raise vital funds
so that we can help more people in a more
personalised way, but you will also raise the profile
of our services.
Email fundraising@dhi-online.org.uk to let us know
your idea for a fundraising activity.
LEAVE A LEGACY
By remembering DHI in your will, you can help
people turn their lives around long into the future.
If you’d like to discuss how you can do this, please
call us on 01225 478730.
www.dhi-online.org.uk/help-us
THE VISION PROJECT

Developing Health & Independence
15-16 Milsom Street
Bath BA1 1DE
www.dhi-online.org.uk
info@dhi-online.org.uk
01225 478730
twitter: @dhi_online
facebook.com/DevelopingHealthIndependence
Charity No. 1078154 Company No. 3830311