Vision for the Future
Part One: The Context
May 22nd, 2021
A1 Members from Keep Our NHS Public, the Socialist Health Association, National Pensioners Convention, the Labour Party, the Green Party and other activists, under the umbrella of Health Campaigns Together (HCT), came together to organise the Reclaim Social Care Conference in Birmingham on Saturday 17th November 2018. Reclaim Social Care (RSC), initially a subcommittee of HCT, emerged as a separate organisation following the conference and it has built a coalition involving disabled people, carers, trade unionists, activists, academics and health and social care professionals and workers campaigning for all social support, independent living and care services to be brought back into public ownership and out of the market economy.
A.2 Over the last two years RSC through meetings, discussions, and papers, has sought to understand the crisis within Social Care and consider various perspectives. The last year in particular has seen a marked change in the social and political landscape which prompted the RSC committee into considering the direction of travel the organisation was on. The conclusion was reached that a new and radical change vision was required that reached beyond the current thinking within the majority of existing campaigns.
A.3 A change vision usually simply means what the organization will look like after the specific changes have occurred. A change vision is the picture of the desired state the change will bring to the organisation. The concept helps to connect essential steps and actions that are needed to happen and assist us to make the outcomes we are seeking a reality. Our change vision should combine together what we intend doing, how we intend to carry this out, and identify short-, medium-, and long-term desired outcomes.
A.4 Creating and communicating the vision requires us to ensure our audience, that is our members, supporters, and wider public are able to see the relevancy for the proposed changes and that the process of going from the current state of the organisation to the proposed state makes sense. We want people to feel optimistic and excited about the vision and understand why we believe it will help us move forward.
A.5 A preliminary draft discussion paper was circulated and presented to a members’ meeting. Resulting from the discussions the Vision for the Future has been updated and divided into two parts. The first part outlines the thinking behind the new vision and the second part considers how the organisation can work towards having it realised.
B. Why we need a New Vision?
• B.1 Since the General Election we have been up against a Conservative Government with a confident majority who have a clear agenda to shrink the state, are not interested in addressing and reducing inequalities and have already signalled a return to even more oppressive austerity policies as we begin to come out of at least the worst of the pandemic.
• B.2 The publication of the White Paper on Health and Social Care (Integration and innovation: working together to improve health and social care for all) cements the plans to enable NHS England to implement Integrated Care Systems and lays the groundwork for later legislation which could see Social Care hoovered up into the ICS where it will be expected to act as handmaiden to Health.
• B.3 The pandemic has made clear the callous disregard of older and disabled people in residential care, those living in their own homes, the poor pay and conditions of staff and the fact that relatives and friends have had almost no say in decisions made. This has opened up at least a small space to get ideas across about disablism and ageism, inclusion and independent living, community not individual “solutions” This radical vision is one which we are in a strong position to promote as an alliance of disabled people, informal carers, trade unionists et al. Indeed, it is vital that we do so as most other organisations won’t. The pandemic has prompted 57 varieties of solutions to solving the “Crisis within Social Care’ but most of these are at best partial and at worst cosmetic rather than transformative.
• B.4 The launch of a campaign for a National Care, Support and Independent Living Service (NaCSILS) and our involvement in helping to shape and develop that campaign requires us to reassess the role of Reclaim Social Care so the two bodies can sit alongside and complement each other.
• B.5 Reclaim Social Care has attracted significant new support, partly perhaps because of the impact of the pandemic, the fact that Zoom has made our meetings more accessible, we have picked up some interest from the launch of NaCSILS and we have had some very pertinent webinars on key topics – examining what is “Care” and coproduction – which have attracted substantial interest. These have also helped move our collective thinking forward on what a radical vision might look like. It has also meant that we now have within the group a wide range of talent and experience which we need to be harnessing to the full to take the organisation forward. We have recently had 5 or 6 people coming forward to offer to do more and they are already getting stuck in!
• B.6 We needed to resolve increasing dissatisfaction with our name which many people believe suggests that we want to return to some ‘good old days’ that never existed and hope that clarifying our vision and a framework for action has helped us all to come up with a name that better reflects our mission. The Annual General Meeting voted on 22nd May, 2021 to adopt the name: Act 4 Inclusion.
C. What is wrong with the current framework for Social Care?
C.1 Our need to address a new vision is underpinned by the way society is currently encouraged to view what Social Care is and the groups of people framed as ‘in need’ of it. The selection of descriptions below are loaded with social constructions that assist to determine the existing oppressive relations between the State and sections of society on the receiving end of its “care”. Look at the nature of the language employed.
“Social care in England is defined as the provision of social work, personal care, protection or social support services to children or adults in need or at risk, or adults with needs arising from illness, disability, old age or poverty. The main legal definitions flow from the National Health Service and Community Care Act 1990 with other provisions covering responsibilities to informal carers.” (1)
“Social care has revamped the standard of living for those threatened or vulnerable to society offering support for the elderly, support for people with mental health needs, support for those with learning and physical disabilities, support for those suffering from alcohol and substance abuse problems, the homeless, victims of domestic abuse” (2)
“‘Care and support’ is the term used to describe the help some adults need to live as well as possible with any illness or disability they may have. It can include help with things like: getting out of bed, washing, dressing, cooking meals, eating, getting to work, seeing friends, caring for families, being part of the community.
It might also include emotional support at a time of difficulty and stress, helping people who are caring for an adult family member or friend or even giving others a lift to a social event. Care and support includes the help given by family and friends, as well as any provided by the council or other organisations.” (3)
C.2 All these descriptions focus on ‘what is “wrong” with individuals’ rather than address the social conditions which impact on their lives and lifestyles. It is important for us to also factor in other groups of people, such as those within description two, into our new vision as they are often forgotten or neglected. Peter Beresford’s Shaping Our Lives could be a useful reference point for us.
D. Creating a new Vision
D.1 It might be useful to start from what we say about ourselves in our Constitution.
RSC (now Act 4 Inclusion) is a coalition of individual members and affiliated organisations campaigning for all social support, independent living, and care services to be:
• Free at the point of use
• Fully funded through progressive taxation
• Subject to national standards based on article 19 of the United Nations Convention on the Rights of Disabled People, addressing people’s aspirations and choices and with robust safeguarding procedures.
• Publicly and democratically run, designed, and delivered locally and co-productively involving Local Authorities, the NHS and service users, disabled people and carers.
• Underpinned by a workforce who have appropriate training, qualifications, career structure, pay and conditions.
• Committed to giving informal carers the rights and support they need.
D.2 This is fine as a set of demands, but do they really conjure up and excite people about what a truly transformative vision might look like? A transformative vision is looking beyond trying to prop up the old system and making it work better, our transformative vision points to a very different system, a new vision. We believe is difficult to reach such a vision through incremental improvement in what already exists. Our vision sees a new national service as being the core element of this new system.
What we are striving for can best be described as a community based eco-social system of supported living that suits people’s life choices
D.2 At the moment this an unfamiliar idea to most people, but in essence it is simply recognising the need for us to build coordinated, sustainable communities which are inclusive and engaging. The development of a new national service framed by a community based eco–social system needs to work for all disabled people, of all ages, with all types of impairment, but also for everyone in society.
D.3 A community based eco–social system would take an intersectional approach towards policy making, considering the differential impact of universal and targeted policies across the diversity of disabled people (e.g. people with different types of impairment, older people, disabled women, and younger disabled people). A crucial part of its function would be making physical environments, transport and information technologies more accessible alongside ensuring health care, personal support and the right to full and effective participation and inclusion in society.
E. Developing the future vision
Could Independent Living be developed into a community based eco–social system for ensuring civil and human rights?
E.1 Here are two crucial ideas we are working with:
The definition of ecological is “…of or relating to the environments of living things or to the relationships between living things and their environments. It can include the need for sustainability.” We are using the word social to mean “…relating to society or its organisation.”
E.2 The social interpretation of disability (social model) was developed from the experiences and priorities of disabled people and their organisations and is now an established norm basis for policy discussions. From this perspective, services should aim to identify disabling barriers or other social restrictions and prioritise actions for their removal. Independent Living recognises that disability is a form of discrimination that is institutionalised throughout society, impacting on disabled people collectively as well as individually.
E.3 Independent living is possible through the combination of various environmental and individual factors that allow disabled people to have control over their own lives. This includes the opportunity to make real choices and decisions regarding where to live, with whom to live and how to live. This is where the social interpretation of disability can combine with Ecological Systems Theory.
E.4 Ecological Systems Theory conceptualizes the environment as an open system with individuals at its centre surrounded by the interacting environmental layers. Proposing an eco-social approach would keep the individual or groups embedded in their chosen lifestyle or experiences and provide a more transactive way of addressing social inclusion. Ecological system theory identifies three systems which impact upon the ability to exercise choice and control. The first system consists of the immediate environment that an individual operates within e.g. their home. This could involve family members, partners, etc. The second system consists of the place of daily activities, community, and neighbourhood. The third system consists of the cultural contexts, legal and social policies that may influence what an individual or group could do. [Fig.1]
F. Why would striving towards a community based eco-social system be transformative?
F.1 Using a community based eco-social approach for understanding the basic relationships between service users and their environments moves away from traditional need-led assessment procedures towards addressing how to create inclusive participation in both local communities and wider society. Having support to make decisions, exercising choice and control are all aspects of inclusive participation. Effective inclusive participation enables individuals and communities to work together to build capacity in shaping and engaging in decision-making processes through coproduction and the development of confidence, skills, knowledge, and experience.
F.2 Drawing from several eco-social models we can identify some of the characteristics conducive to the transformative changes we are seeking, including:
• F.3 Adopting a holistic worldview which perceives every aspect of life as interconnected within a much larger system, as reflected in Indigenous perspectives.
• F.4 Fostering inclusive practice and coproduction, which reflects an appreciation for cultural diversity within contributions made to community living.
• F.5 Adopting fundamental ecological values within the development of community-based services, which requires challenging dominant ideologies that accept growth as an unquestionable goal rather than looking at sustainability and de-growth.
• F.6 Reconceptualising an understanding of well-being to embrace holistic, environmental, and relational attributes. It can’t just be about individual wellbeing. Consideration about personal, individual, collective, community and political dimensions of wellbeing need to be considered within planning, developing, and delivering service.
• F.7 Acknowledging ‘supported living’ or independent living requires a holistic approach capable of identifying ways of addressing restrictions to participation within communities and wider society.
• F.8 Community work has a vital role to play in supporting the development of community-based service provision.
G. We want all people to:-
Ø G.1 Be able to live in the community as equals, to be fully included and fully able to participate in community life.
Ø G.2 Have the opportunity to choose their place of residence and where and with whom they live, on an equal basis with others, without being obliged to adopt a particular living arrangement.
Ø G.3 Have access to a range of in-home, residential, and other community support services, including personal assistance necessary to support living and inclusion in the community, and to prevent isolation or segregation.
Ø G.3 Be able to use the services and facilities provided to the general population, which should have the flexibility to respond to all access requirements.
Ø G.4 Creating the new service along these lines will require us to take everyone on a journey both in terms of people’s thinking, but also in terms of our campaigning initiatives.
H.1 In order for the vision to be realised, Act 4 Inclusion needs to promote the idea of striving towards a community based eco-social system through its campaigning, educational work and development of policy and practice.
4. Boetto H. Bowles W. (2017) ‘Eco-social transition: Exploring the wisdom of our elders’, in Matthies A. Närhi K. (eds), Ecosocial Transition of Societies: Contribution of Social Work and Social Policy, Abingdon, Surrey, Routledge, pp. 190–205.
Developing Our Strategy
Part Two – The Strategic Framework
1.1 Having outlined the context of the new vision, it is necessary to give consideration to a framework capable of taking the vision forward. Within Part Two we offer a strategic framework to enable us to coproduce a multi-pronged strategy with short and longer term objectives. The vision we have for a new system and national service is ambitious and will not be realised in the short-term, therefore, we need to work to build resistance to further attacks on service provision, pay and conditions, safeguard the interests of those who require daily living support, and begin to coproduce the foundations upon which a new system could be established.
1.2 The strategic framework considers both what needs to be done and the organisational changes required to implement what we want to do.
1.3 Although the Government’s handling of the Coronavirus epidemic has presented us with more opportunities to get our core messages across, it has also deepened the crisis within Social Care, limited our powers to mount effective opposition and may speed up the Government bringing forward proposed “solutions”, which are bound to run in the opposite direction from the way we need to go.
This means that we need to have a multi-pronged strategy with short and longer term objectives which will:-
• Build resistance to the erosion of budgets, service provision, and standards.
• Insist on safeguarding disabled and older people and pursuing better pay and conditions for care and support staff.
• Challenge moves to ‘integrate’ health and social care i.e. subsume social care into health!
• Campaign for free, universal access to support and getting the market out of Social Care.
• Call out disablism and ageism and promote our radical vision to build inclusive communities through genuine coproduction, as well as ensuring that the vision informs the way we do everything else.
2. What needs to be done to further our vision?
A. Strengthening the resistance to cuts that:-
• Harm people’s health and wellbeing.
• Segregate and isolate people from and within their communities by maintaining social exclusion e.g. cuts to transport, libraries, education, arts and sports as well as health and welfare services.
• Make people feel unsafe in their communities.
• Undermine the right to self-determination, choice, and control.
• Restrict people making contributions to our communities, and public life.
All resistance struggles should be based on coproduction with the users of the service under attack at the fore, along with families, friends, front line workers and the local community.
2.b Where Local authorities move in to take over private care homes facing collapse or seek to bring domiciliary care back under Local Authority control, we should in the first instance initiate debate around who runs local services and demand all service redesign should be based on coproduction (see below).
B. Safeguarding and deinstitutionalisation
2.c The crisis within Social Care and the Covid-19 pandemic has brought home a whole series of safeguarding issues for residents and service users, staff members, family, and friends. The current situation has also highlighted the fact that residents in care homes, their family, and friends as well as care and support workers have little or no say over what happens in largely unaccountable, privatised residential homes. The reliance on market forces within this sector also raise serious safeguarding issues, but also feeds into why deinstitutionalisation has to be a central part of any strategy to safeguard people and improve lifestyles.
2.d We support the relatives and friends campaigning not just for visiting rights to their loved ones in residential care but also to be regarded as valuable partners for care workers.
• We campaign for residents of all ages in residential care to be given choice and control over their day to day living.
• We seek to ensure that disabled people living in their own homes have the financial support and resources needed to keep them safe and promote their wellbeing.
2.e We want the transform the entire sector from market based to community based:-
• We campaign to get the market out of Social Care as the need to maximise profit rather than meet people’s needs dominates service design and provision. The market results in wages and conditions are forced down, produces staff turnover around 30% per annum and homes are highly unstable because they will close down if they fail to make a profit. Private homes have no accountability to the electorate and there is some evidence to link large homes run by big private companies with increased risk of Covid-19 due to shifting staff between buildings. Many have no sick pay scheme which is a disincentive to staff to take time off when necessary.
• We support care and support workers campaigning for better pay and conditions and want to see a radical revaluation of care and support work to recognise its importance, the high level of skills required, its contribution to the economy and huge potential to generate green and purple jobs. (1)
• We also support the end of Social Care charges as services should be free at the point of delivery. Charging undermines human and civil rights.
2.f Challenge all moves to “integrate” Health and Social Care
The current Health White Paper lays the groundwork for “integration” with the threat of a new Social Care Bill coming down the line at some stage to complete this structural and ideological shift.
2.g Integration, as the Government means it, would inevitably result in subsuming ‘care’ and support into Health and into the Health dominated Integrated Care Systems. This runs directly contrary to our perspective and would roll back years of struggle within the Disabled People’s movement to promote the social model of disability, to get out from under a medical gaze and away from individualised “solutions”. It will act as a break; undermining the need for community and societal change which would move away from being “done to” approach towards genuine coproduction – nothing about us without us.
2.h Campaign for a new national service to replace Social Care which would be universal and free at the point of access.
We will campaign alongside other groups and organisations which may not share our radical vision but nonetheless support the NaCSILS’ seven demands (see appendix). We will seek to work with them in order to generate public support for a transformative change in service delivery and to push our demands up through political systems while holding firm to our broader platform and vision. We will maintain our principles in any alliances we join or discussions we enter into with other campaign bodies and political organisations.
2.i Promote our radical vision to build inclusive communities and services through genuine coproduction.
It is necessary to expose institutional ageism and disablism and also acknowledge existing services often contain inequalities in power relations, knowledge and practices, including a lack of inclusivity. In order to foster a culture of support delivered through community-based services these types of inequalities will need to be addressed. Coproduction should involve all areas and decision-making processes. We would subscribe to how Boyle and Harris define coproduction:
Coproduction means delivering public services in an equal and reciprocal relationship between professionals, front-line workers, people using services, their families, friends and their neighbours. (2)
2.j We want to:-
• Further disabled and older people’s Human Rights by supporting the integration of the Convention of the Rights of Disabled People into UK law. The CRDP promotes deinstitutionalisation and advocates for disabled people to be given the support they need to live in a range of settings within local communities.
• Work with others to develop practices and methods constituting genuine coproduction as a basis for transformative planning, developing, and delivering.
• Champion existing and potential local initiatives seeking to develop genuine coproduction, share and spread good practice.
3. Changing the organisation’s name
3.a There are people inside and outside the organisation who remain unsure as to what our name means; take the existing system back into public ownership alone is not a solution nor does it address the oppressive nature of the system itself. People subjected to Social Care (sic) residents, service users, workers, etc. all deserve better than what is currently on offer. The Committee believes it is time the organisation’s name conveyed the direction of travel the vision outlines and is therefore capable of speaking to both our members and audience.
4. The internal structure of the organisation
4.a Currently, the organisation has a simplistic internal structure which consists of meetings where members and supporters can attend and business conducted; day-to-day issues conducted by officers via email. This is in line with the existing constitution. In practical terms it is an inadequate structure: cumbersome, stifles discussion, delays decisions, unnecessarily time consuming and places much responsibility on a small group of elected officers. It does not support local groups or encourage or support campaigning and organisational development. The need to further RSC has led to organised meetings via Zoom of officers and co-opted members to plan and organise meetings and other activities. The successful meetings on ‘Care’ and ‘Coproduction’ were possible as a result of having a ‘steering committee’. We support the idea of having a steering committee that facilitates the organisation and we recommend this body is written into the constitution.
4.b In line with this thinking, we would support organisational and constitutional changes whereby the officer positions of Chair and Vice Chair would be replaced by having a Facilitator and an Engagement Officer.
4.c The officers would be empowered to set up the Organisation’s Steering Committee to assist in the administration of Reclaim Social Care consisting of the Officers and representatives of the Support Teams.
4.d The Organisation’s Steering Committee will be empowered to convene Support Teams to support the Engagement Officer, Secretary and Treasurer The Support Teams made up of volunteer members will fulfil administration and organisational roles. The Support Teams will assist in the facilitation of Reclaim Social Care’s agreed subgroups. The members’ meetings would establish subgroups and agree their remits and where appropriate timescales.
5.1 Neither the vision nor the strategic framework is written in stone. The membership will determine how the organisation campaigns and the manner in which it will develop its work around 2.a through to 2.j. The vision is a living document and the strategic framework will adapt accordingly.
Glossary of words, terms and concepts
A change vision:-
A change vision is the picture of the desired state the change will bring to the organisation. The concept helps to connect essential steps and actions that are need to happen and assist us to make the outcomes we are seeking a reality.
Discriminatory, oppressive or abusive behaviour arising from the belief that disabled people are inferior to others.
Prejudice or discrimination on the grounds of a person’s age.
A way of working whereby citizens and decision makers, or people who use services, family carers and service providers work together to create a decision or service which works for them all. The approach is value driven and built on the principle that those who use a service are best placed to help design it.
Preparing or causing a radical and typically positive change in outlook, character, form, or condition.
Ecological theory is fundamentally concerned with the interaction and interdependence of organisms and their environment. Likewise, within social contexts there is an acknowledgement that individuals, families, groups and communities interact with their environments and are shaped by them. Individuals do not operate in isolation but are influenced by their physical and social environments in which they live and interact.
A community based eco-social system:-
A community-based eco-social system of support and independent living would require systems to see older and disabled people’s lifestyles in relation to their homes, existing relationships, and neighbourhoods, etc. from an asset perspective, and then to identify the appropriate services and support needed to overcome barriers to living in these familiar surroundings.
Social interpretation of disability:-
“[Disability] ….results from the interaction between a person’s characteristics and their unsuitable environment – not their medical condition. An environment filled with barriers will create a significant difference in experience for a large number of disabled people. Conversely, an inclusive environment will offer the minimum level of intrusion for the experiences of all but enable disabled people to live their lives equally. To improve the experiences of disabled people, you don’t need to medically ‘fix’ everyone, but to think practically about what the goals are and removing environmental barriers. Put simply, disability is the experience of being a square peg in a round-hole world. And the world is changeable.” F. Perry
“….we cannot understand or deal with disability without dealing with the essential nature of society itself. To do this disabled people must find ways of engaging in the class struggle where the historical direction of society is fought, won or lost. It is in this arena that the boundaries of knowledge that have put disabled people aside from the ‘normal’ can and have to be openly questioned. For me repossessing the social model of disability means searching for openings in the structures of society where we might effectively contribute with others in the restructuring of society so that it is neither competitive nor disabling for all people.” V. Finkelstein
“Using the generic term [disabled people] does not mean that I do not recognise differences in experience within the group but that in exploring this we should start from the ways oppression differentially impacts on different groups of people rather than with differences in experience among individuals with different impairments.” Oliver, M (1994)
Independent Living shifts the focus away from the ‘needs based assessment’ approach, which centres upon loss of functionality and an individual’s incapacity, towards a human rights approach which seeks to identify and address the barriers preventing Disabled people living lifestyles of choice. Independent Living is not about being the same as non-disabled people, but rather to have the right and opportunity to participate in the life of their community and/or mainstream social activities.
12 Pillars of Independent Living:-
The 12 Pillars of Independent Living set out addressing barriers to independent living:
• Accessible information
• Enough money to live on
• Accessible health and social support
• Fully accessible transport
• Full access to the environment
• Aids and equipment
• Accessible housing
• Personal Assistance
• Inclusive education and training
• Equal opportunities for employment
• Independent advocacy and self-advocacy
• Peer counselling.
1. Green jobs are central to sustainable development and respond to the global challenges of environmental protection, economic development, and social inclusion. Purple jobs are considered traditional women’s employment and many of these jobs were done by women in the home. When they are brought into the labour market, women are still predominantly employed in them; calling for purple jobs creation means demanding an increase in these jobs and government investment to create more of them i.e. caring, nursing, nursery jobs. There is no reason why men cannot do them of course, but we want them taken out of the home where women do this as unpaid labour. By socialising this labour women are freed from doing them at home if they don’t want to do them and so we increase government investment so that they do not have to do it as unpaid labour. It has been clearly demonstrated that the private sector is incapable of organising this work and providing the quantity and quality of the work needed in society.
2. Boyle D and Harris M (2009) The challenge of co-production: how equal partnerships between professionals and the public are crucial to improving public services, London: Nesta
Campaign for a National Care, Support and Independent Living Service (NaCSILS)
1. National Care Support and Independent Living Service (NaCSILS)
The Government shall have responsibility for and duty to provide a National Care and Supported Living Service to provide care, independent and supported living, adopting into English Law Articles from the UN Convention on rights of disabled people that establish choice and control, dignity and respect, at the heart of person-centred planning.
2. Fully funded through government investment and progressive taxation, free at the point of need and fully available to everyone living in this country.
3. Publicly provided and publicly accountable:
The NaCSILS will have overall responsibility for publicly provided residential homes and service providers and, where appropriate, for the supervision of not-for-profit organisations and user-led cooperatives funded through grants allocated by the NaCSILS. A long-term strategy would place an emphasis on de-institutionalisation and community-based independent and supported living. All provision will deliver to NaCSILS national standards. There will be no place for profiteering and the market in social care will be brought to an end.
4. Mandated nationally, locally delivered:
The Government will be responsible for developing within the principles of co-production, a nationally mandated set of services that will be democratically run, designed, and delivered locally.
Local partnerships would be led by stakeholders who are delivering, monitoring, referring to or receiving supported services or budgets, e.g. organisations representing disabled people (DPOs), older people, and people who use mental health and other services, in partnership with local authorities and the NHS.
5. Identify and address needs of informal carers, family and friends providing personal support:
The NaCSILS will ensure a comprehensive level of support freeing up family members from personal and/or social support tasks so that the needs of those offering informal support, e.g. family and friends, are acknowledged in ways which value each person’s lifestyles, interests, and contributions.
6. National NaCSILS employee strategy fit for purpose:
The NaCSILS standards for independent and supported living will be underpinned by care and support staff or personal assistants who have appropriate training, qualifications, career structure, pay and conditions to reflect the skills required to provide support services worthy of a decent society.
7. Support the formation of a taskforce on independent and supported living with a meaningful influence, led by those who require independent living support, from all demographic backgrounds and regions. This would also make recommendations to address wider changes in public policy.