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Purpose: This paper aims to remove the self-evidence of the concept of severe and multiple disadvantage (SMD) by drawing upon a historical as well as a critical perspective to show its contingency. Design/methodology/approach: This paper will introduce the concept of SMD by examining how it has come to be understood in the way that it has. This paper does so by exploring key texts which have informed the development of the concept as well as its conceptual near neighbours such as "multiple needs". This paper traces some advancements of the concept within practice and further research with a focus on the Fulfilling Lives programme and the Lankelly Chase Foundation. Finally, the author reflects critically upon the concept and the manner in which the concept has become operationalised. Findings: This analysis demonstrates how a particular definition of SMD has come to dominate over the past few years because of the research and practice of key organisations. On the one hand, this has further marginalised alternative definitions and ways of working, but on the other hand these stakeholders have been able to influence the way in which UK policy has taken up the concept within its governmental priorities. Originality/value: To date, research has taken the term SMD for granted which limits the ability to critique its definitions and applications. This is an important and timely contribution because concepts are all-too-often taken for granted and at a pivotal moment when SMD has become nationalised through policy, critique is a political, potentially transformative, act. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide a supply-side review of policies and practices that impact on the shortage of supply in the contemporary specialist housing market for older people in the UK.Design/methodology/approach The review is based on a review of academic literature, policy documents, reports and other sources.Findings There is a critical conflict between the key social purpose of specialist housing (i.e. living independent of socially provided care) and the values that underpin and ultimately limit the quantity of units in both the social and private sector. In the social sector, government policies prohibit rather than encourage local authorities and housing associations from increasing specialist housing stock. The nature of leasehold tenures in the private sector tends to commodify not only housing stock but also those who use it and therefore acts to instrumentalise housing supply in favour of the profit motive and the focus on the person and her or his needs is largely ignored.Originality/value While the shortage of specialist housing is well known, this paper is unique in that it provides a comprehensive and critical supply-side review of the factors that have created such conditions. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to illustrate realities of homeless people's lives during a time of significant change in UK public sector funding and welfare policy. Design/methodology/approach - A participatory research approach was used including working with two co-researchers; two people who have direct experience of homelessness. A sustainable livelihoods approach was adapted to provide a framework for analysis. The research was undertaken during May to October 2011. Findings - The paper interrogates five areas of assets held by people themselves that support sustainable livelihoods, an existing approach used in other research. Life journey narratives show that a connected range of services, operating through an empowerment model, promote human dignity. Research limitations/implications - Findings resonate with issues identified in larger studies; however, as the funding and policy context is rapidly changing it is recommended that additional local qualitative studies could be conducted during the next three years to illustrate impacts in people's lives. Practical implications - The paper suggests front-line services must include resettlement as well as crisis and stabilising services in order to ensure homeless people can successfully move from home to home. Social implications - The research identified negative attitudes towards homeless people. By illustrating homeless people's achievements the study provides evidence of the impact of, and the value of continuing to fund, homeless services. Originality/value - The paper suggests that people who have experienced homelessness achieve a successful life with support by drawing on their considerable life experience and personal talents. This message is important for practitioners, commissioners and policy makers working through a period of change for homeless services. [ABSTRACT FROM AUTHOR]

Purpose Professional partnerships between housing and health are not impossible, but they take time, commitment and dedicated strategic leadership. The language and culture of the two sectors are sometimes complex and do not always match. There can be issues understanding each other's motivation, ethics and terminology which can cause a barrier when working together. The purpose of this paper is to share the journey of how Wakefield District Housing (WDH) is working with the care and health sector to create sustainable partnerships that benefit both parties, getting to a stage where they could successfully integrate with healthcare providers in the Wakefield district.Design/methodology/approach The paper offers the reader an overview of how WDH's membership of the Wakefield Health and Wellbeing Board enabled improved partnership working with NHS and other members, including the establishment of a Housing, Health and Social Care Partnership, the employment of dedicated senior staff, co-located multi-disciplinary teams and joint design of new services.Findings WDH has demonstrated that the organisation understands the challenges facing NHS colleagues, has acknowledged the complexities of the system that their partners work in and looked for solutions alongside them. The opportunities within partnership working are boundless and, if successful, the outcomes for tenants and the wider Wakefield population could be in excess of those envisaged in planning the project. Partnerships will almost inevitably encounter challenges along the way but if all partners keep their own and shared visions in mind, further success is within reach and all parties will get there faster by not going alone.Practical implications The paper offers useful guidance and ideas for other housing organisations aiming to improve their contribution to local integrated healthcare.Originality/value This paper provides an original perspective from inside the programme, offering practical, comprehensive and deliverable initiatives to improve health outcomes for local communities. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to explore the operationalizing of a philosophy of humanization of hostel care and the challenge to such development presented by the proposed adoption of the "housing first" approach ("Chez Soi D'Abord") in Paris. Design/methodology/approach -- The paper is a translation of the transcript of an address given by the author to a symposium of psycho-analytic therapists working with the homelessness resettlement services in their quarter of Paris. It is a narrative of service development, described in some practical detail, with philosophical and psycho-analytic depths. Findings -- A philosophy of care and social education is replacing the philosophy of surveillance that had characterized earlier development of hostels. Psycho-analytic concepts, based on the writings of Lacan, help to understand the importance of addressing the profound psycho-social dislocation of individuals subject to the implicit violence of their situation. Originality/value -- This is the first known paper in print and in English to describe the development of a psychologically informed environment in homelessness resettlement in France. [ABSTRACT FROM AUTHOR]

Purpose -- Appropriate housing for the growing population of older adults is becoming an international concern. The purpose of this paper is to report on a review of UK and international literature carried out as part of a project exploring the commissioning and delivery of social care in housing with care settings. The paper also considers housing with care in the context of UK policy and practice. Design/methodology/approach -- The peer literature review process used a range of academic databases as well as government and third sector web sites, drawing on relevant material in English published from 1990 to 2012. Findings -- Findings are presented within three main themes: how care and support is provided; the role of the built environment; and the benefits for resident well-being. The review found a paucity of literature focusing specifically on care and support in housing with care settings, particularly in terms of how social care is delivered, but the evidence base suggests that housing with care is in a strong position to deliver on most if not all UK government aspirations. Practical implications -- Despite a growing literature both in the UK and internationally exploring the characteristics and benefits of housing with care for older people, substantial gaps remain in the research evidence. Originality/value -- This paper presents an up to date review of the housing with care literature in the context of current UK policy. [ABSTRACT FROM AUTHOR]

Purpose - The aim of this paper is to comment on current evolving UK policy in public health and social housing; and especially to outline 'blind spots' in conventional health research approaches that have tended to obscure the evidence and potential in collaborative working.Design/methodology/approach - The paper summarises policy developments, in the light of recent relevant research. Mental health is used as an example.Findings - Public health policy in the UK is new and rapidly developing; but the evidence base remains scattered across different disciplines and their various disparate communication channels. Any new public health strategy focussed on health inequalities needs to recognise the role that social housing already plays in supporting concentrations of the more vulnerable. Better recognition of the everyday social and especially mental health problems that social housing staff deal with illustrates the central role of housing management as the defining factor in social housing, and the potential for partnerships with public health.Originality/value - This paper offers a contemporary overview and comment; but it also introduces to the readership recent research findings that shed new light upon the potential in closer alignment of public health and social housing management practice. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an exploratory account of the links between devolution, homelessness and health in the UK. Specifically, it focusses on the policy context and governance structures that shape the systems of healthcare for homeless people in London, Scotland, Wales and Northern Ireland.Design/methodology/approach Empirically the paper draws on semi-structured interviews with a small sample of policy and practice actors from the devolved territories. Qualitative interviews were supplemented by a comparative policy analysis of the homelessness and health agenda within the devolved regions. Theoretically, it takes inspiration from Chaney’s concept of the “issue salience of homelessness” and explores the comparative character of healthcare as pertains to homeless people across the devolved territories.Findings The paper provides clear evidence of areas of divergence and convergence in policy and practice between the devolved regions. These features are shown to be strongly mediated by the interplay of two factors: first, the scope and scale of national and local homelessness prevention strategies; and second, intra-national variation in public health responses to homelessness.Originality/value The paper offers considerable insight from a comparative policy perspective into the nature of healthcare provision for homeless people in the devolved regions. [ABSTRACT FROM AUTHOR]

Purpose - The paper aims to explore current interest in the concept of well-being, and to trace, with examples, the growing use of design ideas in healthcare settings to reduce stress and maximise efficiency. Finally, it seeks to look at the relevance or transferability of such design principles and approaches to opportunities to enhance well-being through design in community settings. Design/methodology/approach - The potential in this approach is illustrated with some examples of design approaches applied in healthcare, teasing out the wider implications with ways to explore and arrange the patient journey, for example, or the "care pathway" for a vulnerable adult into a care or support service for maximum benefit. Findings - Thinking on enhancing well-being by design has been further advanced in applications in the health service, but a number of design concepts and approaches seem to promise similar benefits in community settings where issues in managing the health and well-being of vulnerable individuals are equally relevant. Originality/value - Design principles may be especially useful in current efforts towards creating dementia-friendly homes and communities, or "psychologically informed environments" in services for marginalized and excluded individuals. [ABSTRACT FROM AUTHOR]