Getting started – partnership, co-production and defining the problem
Haringey became a MEAM area in November 2018. This was prompted by a significant increase in deaths affecting homeless and vulnerably housed people in the first six months of 2018. Enquiries began into the gaps, costs, and opportunities of working differently with the small cohort of people in Haringey whose lives are affected by severe and multiple complex needs.
The MEAM steering group pulled together key strategic partners from across the borough and asked for a commitment to work differently and to develop and adopt a coordinated, borough-wide approach to addressing the complex and multiple needs of vulnerable and homeless adults in Haringey. Specifically, to address the interconnected harms and costs of homelessness, mental ill health, substance misuse and offending behaviour.
The MEAM Systems Navigator post was created to create a bridge between frontline practice and strategic decision-making. With a focus on testing, refining and advocating for ‘systems flex’, this role coordinates the MEAM interventions without ‘providing a service’. Our hope is that what we develop during our three years as a MEAM adoption area can continue afterwards embedded within the practice of the organisations who’ve committed to the project.
An area for development and priority in our Year 2 is co-production. Our aim is to focus on co-producing solutions to some of the barriers identified in our work so far – access to services, eligibility and flexibility. To do this we plan to hold a number of workshops, 1:1 interviews and bring together an Peer Advisory Panel who will work with us throughout the year on this work. We hope that as part of this work we will be able to bring people with lived experience into the Strategic Board as regular members in a meaningful and not a tokenistic way.
Designing your intervention
Our intervention has no one single shape and is better framed as a commitment to ‘doing whatever it takes’ to help someone achieve the things they want in life and then learning from it. Whilst this doesn’t seem very radical, often the changes people need are not. The MEAM Practitioners Group are committed to person-centred practice, finding creative solutions and reducing/removing the barriers people often face when trying to access services they need.
The Strategic Board is made up of senior leaders and decision makers from across the system. Their role is to take proposals, ideas and challenges from the Practitioners Group and use their authority and decision-making power to address these and embed them within their services and organisations. One aim of the Board is to seek opportunities for joint commissioning and shared decision-making across statutory organisations in particular, but inclusive of the full range of stakeholders in the borough.
This year our priority is to create a Peer Advisory Panel, made up of people with lived experience of homelessness, incarceration, inpatient mental health services and addiction/dependency. The Panel will work with us to co-produce new ways of working, to address problematic processes and deliver training and knowledge sharing sessions with practitioners and Board.
Sustainability and system change
We hope to make the MEAM approach sustainable in Haringey by developing a new culture within the system around people facing severe and multiple disadvantage. To do this we want to get comfortable asking difficult questions, developing confidence around trying (and stopping) things and by developing the narrative and understanding of what it means when we say ‘a system’.
The purpose of designing our MEAM intervention as a three year action-learning project is so that the changes and new practices developed can be absorbed and adopted by the system of services, organisations and individuals ‘in action’, rather than being lost when ‘the service’ ends after three years.
Tracking the MEAM30 for this period will help us to understand more about individual journeys into, through and out of services and statutory systems, recognising there is learning and opportunities for change both when things are not going well and when they are. We will test new ways of working with the people in this group, recognising the urgency of their need and the complexity of their involvement with the system as valuable sites of systems flex as well as improving individual outcomes and experiences.