A lived experience team has helped to highlight the changes that need to take place to improve outcomes for more than 3,000 people experiencing multiple disadvantage in Surrey. Surrey County Council has published the latest Joint Strategic Needs Assessment (JSNA) chapter, which focuses on addressing multiple disadvantage across the county. JSNA chapters serve as a tool to help key decision-makers and commissioners to understand the current and future health and social care needs of a population group.
The chapter, which was supervised by myself, has been co-produced with the Surrey LERO and reveals how vulnerable individuals face all kinds of barriers when accessing support. It also highlights their stories, as well as the experiences of the frontline staff supporting them.
Values and approach
Multiple disadvantage is where an individual is experiencing a combination of challenges including homelessness, substance use, domestic abuse, mental ill health and contact with the criminal justice system. Eleanor Levy is part of the lived experience team and has faced challenges including childhood deprivation and trauma, which led her into addiction and homelessness.
‘The multiple disadvantage JSNA chapter represents the values and approach of the Changing Futures programme,’ she said. ‘We worked with curiosity, hope, and without judgment to gather evidence, involving many agencies, groups, and individuals. Together we designed, created, and carried out interviews, and the participants responded honestly and openly.’
The project was ‘built on generosity’, she continued. ‘Instead of focusing only on Changing Futures, we aimed to better understand the root causes of multiple disadvantage. The Changing Futures programme in Surrey has not only benefited individuals but also improved how agencies work together. However, this work helps us develop strategies for prevention, early intervention, and more effective support for those affected.’
Multiple disadvantage continues to worsen health and wellbeing inequalities ‘in our communities and beyond’, she stated. ‘Unlike past efforts that didn’t lead to lasting impact, this work is different. It has resulted in a co-produced strategy that embeds our learnings and sets a clear direction for service improvements going forward.’
System change
The LERO was formed at the inception of Surrey’s Changing Futures programme in 2021 and they have recently re-named themselves RAGS (Recovery Action Group Surrey). Now a member of the national CLERO (College of Lived Experience Recovery Organisations), their ambition for the future is for autonomy beyond the Changing Futures programme.
The group’s objectives include seeking system change for residents experiencing multiple disadvantage, and it’s their ambition to partner in the governance in Surrey – providing peer research and being a critical friend to system partners, including the local combatting drugs partnership board.
Lived experience team member Steve Saunders says his background of alcohol addiction has enabled him to see where gaps exist in current services. ‘I approached the co-production of the JSNA chapter with an open mind, unsure of what we might achieve,’ he said. ‘But as I began to understand the JSNA’s objectives, I realised they aligned perfectly with how I envisioned addressing the needs of people facing multiple disadvantage. From that moment, I was hooked.’
What immediately drew him in was the ‘sense of community and the passionate individuals working toward a shared goal,’ he said. ‘There was a clear enthusiasm to turn the findings into actionable change. Being part of the JSNA process taught me some invaluable lessons – it became clear that there are significant barriers we must overcome, and the path isn’t as straightforward as I initially thought. Organisations and individuals are starting to see the benefit of working alongside people with lived experience.’
Despite some roadblocks along the way, the experience was ‘overwhelmingly positive,’ he said. ‘When I helped present the findings to Surrey’s Health and Wellbeing Board, their response was encouraging. Most attendees were supportive, and it was inspiring to hear local leaders express their willingness to take bold steps forward. Their comments were a testament to the potential we have to effect meaningful change.’
Findings from the JSNA chapter show that investment is needed in systems and initiatives to reduce multiple disadvantage for residents of Surrey. Funding also needs to be redistributed to ensure more accessible and person-centred services. Steve said the next step would see them presenting these findings to stakeholders in a collaborative workshop, and together they will aim to co-produce system-wide governance arrangements for addressing multiple disadvantage. This step is key to ensuring sustainable, lasting change.
‘The JSNA chapter’s findings have been a springboard for identifying where change is needed,’ he said. ‘By turning recommendations into action we can create a future that ensures everyone has access to the best support and services, no matter what their circumstance are. While obstacles remain, we’re gaining strength and momentum. The road may be challenging, but our vision remains clear and hopeful.’
Rebuilding lives
Nat Adams is also in the lived experienced team after an online gambling addiction affected her mental health, family relationships and left her homeless.
‘One of the highlights of the JSNA research for me was interviewing stakeholders and service providers,’ she said. ‘It was eye-opening to hear their struggles and perspectives, which made their challenges more relatable. This helped us better understand the situation rather than feeling completely dismissed. It was admitted that poor housing remains a major issue, and without stable housing it’s hard to have good health outcomes.
‘I also enjoyed being part of the co-production team,’ she continued. ‘It was helpful to connect with people who’ve faced similar struggles – it gave us a sense of community and purpose. While the findings weren’t surprising to me, they’re important for stakeholders. commissioners and policymakers to see. They highlight the need for better support to help people improve lives, overcome addiction, and truly recover. The project showed how vital support is for rebuilding lives.’
Other recommendations from the JSNA report include establishing strong governance for multiple disadvantage which includes developing a five-year strategy with measurable objectives. Also, ensuring that health and care services are commissioned in a way that promotes partnership and integration through the adoption of best practices for people experiencing multiple disadvantage.
Visionary roadmap
Ella Turner, programme manager of the Health Determinants Research Collaborative (HDRC) at Surrey County Council, said that the JSNA chapter on multiple disadvantage ‘signals a shift towards a more integrated, empathetic, and effective approach to support those facing complex challenges.
Lived experience, stakeholder engagement, and data analysis have been the foundation of our recommendations, ensuring that those most affected are at the heart of the solution.’
The chapter offers a visionary roadmap for reshaping how support systems function. By drawing on expertise from lived experience contributors, the chapter focuses on how services must be person-centred, with a trauma-informed approach.
‘The JSNA chapter highlights significant barriers within the current system, including services that can be restrictive and a lack of flexibility,’ said Ella. ‘Our aim is to address these challenges with an actionable set of recommendations to ensure a system-wide cultural shift.’
This report represents a call to action for a more equitable and compassionate future for our communities. Following these findings Surrey’s Changing Futures programme will continue focusing on prevention and reducing health inequalities across Surrey.
Lisa Byrne is Changing Futures programme manager
Read the JSNA on multiple disadvantage here