1. Securing strategic buy-in and alignment
This chapter describes how local Changing Futures projects improved strategic alignment, by highlighting some of the approaches that were more effective, as well as learning and considerations for future similar systems-change activity.
The Changing Futures programme aimed to improve the way that different sectors, organisations and services worked together to ensure effective support for people experiencing multiple disadvantage. Improving strategic alignment across the local system can create more favourable conditions for change, by:
1. Increasing the degree to which strategic leaders across the system understand multiple disadvantage, are committed to addressing it, and are factoring it into relevant strategic planning and decision-making.
2. Reducing the extent to which different local strategies, policies, processes and funding approaches pull commissioners and service providers in different directions, so that pathways and services can be made more efficient and effective.
3. Promoting a greater shared understanding of inefficiencies and systemic barriers that might be addressed through cross-sector or cross-organisational partnership working.
4. Setting the conditions for cross-sector partnerships at a strategic level, which might unlock different and better responses to multiple disadvantage (such as co-commissioning pooled budgets or introducing new service models and pathways).
This chapter describes how local Changing Futures projects improved strategic alignment, by highlighting some of the approaches that were more effective, as well as learning and considerations for future similar systems-change activity.
This chapter uses the terms strategic leads and strategic alignment. ‘Strategic leads’ refers to people in leadership roles who are responsible for planning and overseeing strategy development or other strategic functions, such as determining vision and priorities, governance, resource allocation, and commissioning decisions. ‘Strategic alignment’ refers to the goal of ensuring that the local strategies, policies and priorities that shape funding and delivery in a local area are coordinated and collectively respond to the issue of multiple disadvantage.
What do you want to change?
- What are the barriers in the local system that are preventing people from getting the support they need? Local needs assessments on multiple disadvantage, insights drawn from people with lived experience, and wider evidence on good practice, can help to identify barriers in the system..
- How does the change you seek align with other services’ priorities? Think about how better support for people experiencing multiple disadvantage will affect other services. For example, reducing crises through more relational support could help to reduce emergency service usage, which is important to police and NHS partners.
What is available to build on?
- What other programmes or initiatives exist locally, which have started to engage strategic leads? These might be initiatives explicitly focused on multiple disadvantage, such as the Making Every Adult Matter (MEAM) Approach, but other issues that relevant strategic leads are already addressing can also be a good place to start.
- What local networks or boards are in place? How could multiple disadvantage be incorporated within a local programme? This can be a good way to start putting multiple disadvantage on the agenda.
- Is there a need to create a new board or other strategic structure to focus on multiple disadvantage? A few Changing Futures areas created new structures that brought together all key organisations relevant to supporting people experiencing multiple disadvantage, in order to focus specifically on this group.
Who needs to be involved?
- Who is best placed to engage with strategic leads and effectively push for changes within the system? Who already has positive relationships with key decision-makers? Who has the passion, ability and credibility to build new relationships and influence at the strategic level?
- Who is missing from partnerships? Understanding the priority gaps in your local strategic partnerships can help you to focus your efforts on specific organisations and sectors.
- Who has the power to make and sustain change? Strategic leaders need to be involved to create organisational-level changes to policies and procedures. and to support different ways of working. Operational staff’s buy-in is needed, so that changes are implemented effectively.
- How can people with lived experience help to shape change? Meaningful involvement of people with lived experience at a strategic level is key to ensuring that people’s needs are addressed in the right ways, and it can help to reduce stigma.
Varied levels of understanding and commitment to multiple disadvantage
Local stakeholders indicated that before Changing Futures, the understanding and commitment to address multiple disadvantage varied significantly among strategic leaders across different organisations. Often, there were pockets of awareness of the issues faced by people experiencing multiple disadvantage, and some collaboration between organisations. However, not all organisations were well engaged, often due in part to competing organisational priorities. There was also variation in the extent to which organisations in different sectors recognised multiple disadvantage as being relevant to them.
Limited strategic ownership of multiple disadvantage
In many local areas (as well as nationally), there was no clear and widely recognised strategic home for multiple disadvantage, due to its multifaceted nature and overlap with different sectors. In addition, there were few strategic forums dedicated to multiple disadvantage, and limited visibility of the issues within cross-sector groups; this made it challenging to promote shared ownership or develop aligned responses.
A lot of the issues that we’re talking about here comes from the fact that we are talking about multiple disadvantage, and that those five disadvantages we’re talking about, generally silo off into funding streams…
Limited availability of data and insight to inform strategic decision-making
The limited availability and use of data and insight on multiple disadvantage has been a significant challenge to supporting effective cross-sector strategic planning and decision-making. In many areas, access to shared data is limited, which makes it difficult to build a full understanding of the needs of people experiencing multiple disadvantage, or to evaluate the impact of different interventions. This can hinder the development of coordinated, evidence-informed strategies across agencies. This issue is explored in more detail in the data and insight chapter.
Convening events to raise the profile of multiple disadvantage
An early step in creating strategic alignment has been to alert strategic leadership and commissioners to the problems within the system – in order to raise awareness and the profile of multiple disadvantage, and to highlight the benefits of working in more relational and trauma-informed ways.
Several areas hosted events and conferences that brought together a range of stakeholders, including strategic leads. Events were designed to be enjoyable and hook into stakeholders’ interests in their choice of topics. They showcased the work being carried out within the programme, to keep multiple disadvantage on people’s radar: for instance, in one case, staff used an event to share their plans for systems-change work, which enabled partners to shape their workstreams.
The conferences and the summits are really important. It’s probably why people buy into them actually, because they’re quite enjoyable. It gets people out and they meet new people and they go, ‘Well this is really interesting, why don’t we do more of this?’
Spotlight on: Lancashire – Using credible voices to build strategic buy-in
By working with supportive senior stakeholders, Changing Futures Lancashire generated opportunities to increase buy-in across those stakeholders’ sectors. For example, the Changing Futures team supported a Detective Chief Inspector and a Lead for Integrated Offender Management to discuss the Changing Futures approach and its impact at various events, with other senior stakeholders working in the criminal justice system.
Lancashire also hosted yearly conferences to engage a variety of stakeholders. At one, strategic stakeholders from organisations outside the Changing Futures team ran discussions within their relevant fields (such as mental health and policing). This encouraged participants to think about how they could do things differently within their specialism, to better meet the needs of people experiencing multiple disadvantage.
We’ve used those conferences to build collaboration at senior level, at strategic level, senior tactical level, operational level, in terms of operational management and then at the frontline.
Positioning multiple disadvantage within stakeholders’ priorities
Changing Futures teams also gained buy-in by demonstrating how better support and systems for people experiencing multiple disadvantage could contribute to achieving stakeholder priorities. Teams looked at partners’ strategic plans, objectives and actions, and identified areas of alignment with Changing Futures’ aims or achievements.
The quickest responses from people have been when I’ve gone out and looked at their strategic plans, and looked at their objectives and actions, and matched our evidence to that, and gone in and spoken their language.
To secure and maintain stakeholders’ engagement beyond the lifetime of the Changing Futures programme, one local area designed systems-change workstreams to reflect the interests of strategic boards.
So, the police, for example, I’m sure they’d be fascinated about pro-social, positive activities in the community. But what they’d care much more about is hospital discharge, because they are often the agency that is sectioning a lot of people that end up going into hospital. So, if there was an ask of senior colleagues: ‘We’re looking for multi-agency buy-in to deliver a hospital discharge team.’ You get that senior colleague on board because [they say], ‘Yes, I can see how that applies to me and my area.’
Demonstrating the potential cost savings
Many areas found it particularly persuasive to highlight the cost-effectiveness of the Changing Futures way of working, to create buy-in among strategic stakeholders and commissioners. Changing Futures teams demonstrated the high demand for and cost of emergency services due to ineffective support for people experiencing multiple disadvantage, and the costs that might be avoided by supporting people in a more relational way. For example, one area used data to show that people experiencing multiple disadvantage had high rates of readmission to hospital because of ineffective support. This area gained Integrated Care Board (ICB) funding to continue some elements of the Changing Futures service.
Spotlight on: Lancashire – Evidencing cost savings
The Changing Futures Lancashire team produced an analysis highlighting cost savings for partner services that resulted from the Changing Futures approach. Partnering with police, probation, substance misuse, hospital trusts, mental health, ambulance and housing services, they obtained service-use data on 92 beneficiaries (with beneficiary consent, and data protection impact assessments and information-sharing agreements with each service). By analysing service use before, during and after beneficiary engagement in the Changing Futures programme, they were able to evidence an average of £12,000 worth of system savings per person. The team held briefing sessions to highlight these findings, and presented them at public health collaborative meetings.
Shaping strategic conversations by bringing in people with lived experience
Enabling strategic leaders to hear directly from people with lived experience can be a powerful way to decrease some of the stigma around multiple disadvantage and improve the understanding of what needs to change. Most areas have created more opportunities to hear from and work with people with lived experience of multiple disadvantage.
Lived experience, and that’s really what’s brought a lot of our work to life, it’s helped to whet the appetite of some of our senior leaders about how lived experience can improve the quality of what we do, can provide insight into interventions, and how we go about delivering them, and what needs to change.
Some areas have encouraged the inclusion of people with lived experience on relevant strategic boards; this directly involves them in discussing and setting strategic agendas and plans. For example, from the outset of the programme, one area sought to help volunteers with lived experience gain positions on strategic boards, such as for drugs and alcohol support, safeguarding adults, and adult social care. This included working with the drugs and alcohol commissioning team to co-design, deliver and evaluate activities for adults in recovery.
In order to make this change, strategic spaces need to be adapted: simple changes to make meetings less formal and language more accessible can enable people with lived experience to participate comfortably. Changing Futures leads within all localities have been trialling approaches to make strategic meetings more inclusive, by asking people to remove lanyards, not introduce themselves using their titles, and avoid using acronyms. Another approach used was to enable people with lived experience to share their experiences and views through short videos. This may suit those who wish to be heard but do not want to attend meetings or engage directly with strategic leaders. Please see the chapter on Creating a learning culture for more on supporting people with lived experience to participate in systems change.
Spotlight on: Lancashire – Promoting the inclusion of people with lived experience in strategic settings
Changing Futures Lancashire has encouraged the involvement of people with lived experience in spaces across the system, including in strategic settings. There was initially pushback from some partners about sharing sensitive information with people with lived experience who were present. However, Changing Futures staff successfully challenged this, and it is now the norm for people with lived experience to attend, with partners proactively requesting their presence.
Workforce development for strategic leaders
Some Changing Futures areas targeted training at strategic and senior management roles. Delivering this to multi-agency groups was especially impactful in building inter-organisational relationships and ensuring that a critical mass of leaders was reached.
The training generally had one of two purposes. Some training aimed to improve the understanding of multiple disadvantage and of effective approaches to support people, such as trauma-informed support. For those in strategic roles, this helped to develop understanding and introduce a trauma-informed approach throughout organisations, rather than purely at an operational level (where this type of training is often focused). Often, those working at a strategic level are the ones with the power to create the environments, policies and procedures that better enable operational and frontline workers to work in a relational, flexible and trauma-informed way.
Other training aimed to support strategic leaders in developing the skills, confidence and awareness needed to drive forward systems change in their local areas. This was commissioned by organisations such as MEAM or Collaborate. To have the most impact, training needs to be followed up with further discussion and action, such as professional spaces for reflection. This is discussed further in the chapter on Creating a learning culture.
Another workforce development approach used was to set up networks or online resource hubs aimed at strategic-level staff, such as commissioners; this gives them a platform to come together to explore local issues, share learning, and access good practice. For example, one area hosts a quarterly in-person network for commissioners, bringing together commissioners of differing seniority and from across different disciplines – including the NHS, adult social care, criminal justice, and housing – to share information and learning, and solve problems. Meetings also include an external guest speaker who presents good practice and learning.
Using strategic partnerships and boards
Multi-agency partnerships, boards and networks bring together a variety of stakeholders across the system, and can therefore be used to keep the needs of people experiencing multiple disadvantage high on the local agenda. Changing Futures leadership teams attended and supported various boards and strategic groups which deal with the different issues that people experiencing multiple disadvantage might face.
Changing Futures teams assisted in developing new boards and networks focused specifically on multiple disadvantage, to ensure that progress would continue after the programme ended. At the same time, Changing Futures staff found that it can be more effective to bring multiple disadvantage into discussions on existing platforms, rather than creating new structures, which might duplicate work. One area created opportunities for practitioners, operational managers and strategic managers to meet separately to discuss opportunities and challenges related to selected themes. The thematic groups come together to coordinate a system-wide response, which contributes to shared accountability. For a discussion of developing boards, please see the Case study: Sussex.
Dedicated and skilled senior leaders are key
Teams with a dedicated capacity to work at a strategic level in Changing Futures areas were a key enabler in gaining strategic buy-in. Where Changing Futures teams included strategic leadership roles, these were instrumental in initiating and coordinating system-change work, influencing senior stakeholders, and bringing partners together in new ways.
To be most effective, teams needed to include role-holders with the authority, expertise and seniority to engage stakeholders and promote consensus across organisational boundaries. Having and being able to build positive relationships with key stakeholders has been key to improving strategic alignment on multiple disadvantage.
You need to be good at communicating, and you need to be the most influential person in the room, …if you’re confident in what you’re talking about, and passionate enough about it, you are the most influential person.
No need to ‘reinvent the wheel’
Systems change is inherently long-term and complex. To decide where best to focus resources and efforts, teams found it was important to first take stock of existing structures and relationships. For instance, some areas benefited from programmes such as Fulfilling Lives and the MEAM Approach, which had already created important foundations for change. Identifying what works, and building on prior programmes and related work, helps to maintain momentum and honours the learning already generated. Ignoring what is already working well can be counterproductive: for instance, one area alienated stakeholders by setting up a new multi-agency forum, when a well-regarded and -attended group already existed.
Bring operational and frontline staff with you
While buy-in at the strategic level is important, it is also vital to consider ways to engage staff at other levels, including operational managers and frontline staff. If they are not receptive to change, then strategically developed initiatives are unlikely to successfully translate into practice. For example, creating opportunities for frontline staff to feed back to management and to feel listened to can help ensure greater support and understanding across an organisation.
You’re creating a narrative within the middle seam of an organisation, as well as it coming in from the other structures that you’re talking around. So, when it lands, it’s like throwing seeds onto ploughed land, rather than just on concrete.
Ensure you provide the right kinds of support for senior leaders
Changing Futures teams pointed to the need to provide support for senior leaders, to help them move from awareness to action:
All of those senior leaders are aware of the regular barriers that we’re coming across. And they say the right things in terms of these things need to change. But then we don’t see any follow-through in some instances.
Changing Futures teams produced a wealth of reports, needs assessments and guidance documents, but teams were sometimes unsure what impact they had had. Some areas used communities of practice and working groups to good effect to facilitate the use of written resources. These activities can help strategic leaders explore ways to apply what they are learning.
This is discussed in greater detail in the chapter on Creating a learning culture.
Case study: Sussex – Developing structures that cross geographic and service boundaries
Before Changing Futures in Sussex, there were pockets of multi-agency partnership working, but governance structures mostly focused on single issues such as homelessness, drugs and alcohol, and domestic abuse. There were no structures dedicated to multiple disadvantage (referred to as ‘multiple compound needs’ in Sussex). Moreover, rather than having a Sussex-wide approach, work was often focused at district and borough level.
The Fulfilling Lives initiative and responses to the COVID pandemic sparked a greater impetus to work across sectors to improve support for people experiencing multiple disadvantage. The Sussex Changing Futures programme needed to benefit from this momentum, and work with the range of organisations that might be involved in commissioning and delivering support for people experiencing multiple disadvantage.
They championed the development of multiple compound needs (MCN) boards in three localities: Brighton & Hove, East Sussex and West Sussex. This had the potential to promote cross-sector strategic planning beyond the Changing Futures programme, because the MCN boards could be sustained in the longer term without Changing Futures input.
The three MCN boards were set up differently, to enable them to fit and function effectively within the governance and strategic landscape in each locality. The buy-in and involvement of senior leaders was key to pushing through the creation of the new boards. An important feature of the boards has been their inclusion of colleagues working in public health, which spans local authorities and health, and is therefore able to influence and engage a wider network of partners. For example, the chair of the East Sussex MCN Board is the Director of Public Health, who was involved in establishing and maintaining the Board.
Along the way we realised that they were really key, that if we could get public health on board, they would provide the influence to bring others along. And I think that’s why having the Director of Public Health as the chair of the Sussex MCN Board has been really, really important.
The remainder of this case study focuses on one of the three boards, the East Sussex MCN Board. Its establishment was driven in part by the recognition of a link between health, well-being and housing, and the need to do more to support people – as was highlighted by the Director of Public Health’s 2020 report. The NICE guidance on Integrating Health and Social Care for People Experiencing Homelessness was used to help take stock of how existing work could be progressed, and to make partners aware of some of the housing and health challenges within the system. This helped to inform a collaborative scoping workshop, which identified a gap in the oversight of programmes, along with shared priorities for improving support and systems. In response, the East Sussex MCN Board was developed. Its functions are to provide oversight and to be a point of escalation for programmes; to drive system change; and to provide leadership to address identified gaps in service delivery and redesign.
The East Sussex MCN Board is attended by a variety of local stakeholders from the voluntary and community sector and statutory agencies, including health and the local authority. It is key to have representation from all sectors involved in supporting people experiencing multiple compound needs (including housing and homelessness, mental health, domestic abuse, drugs and alcohol, and criminal justice), to ensure that all aspects of need are covered.
As attendance at the MCN Board is not a statutory requirement, it is important to maintain engagement with stakeholders, as consistent membership is needed to keep momentum. This is facilitated by ensuring that the aims of the Board have been jointly agreed, so that partners are bought in.
The East Sussex MCN Board has helped to enable cross-sector working, and is supporting a shared vision and accountability across the system. For example, the Board identified the need for and supported a large-scale public health needs assessment of multiple disadvantage in the area. It enabled access to data from multiple services, which was then linked to provide a clearer understanding of the level of need. This led to the development of actions and recommendations for how the local partnership could redesign services.
The boards have been a really good vehicle for pooling resources and thinking about this cohort specifically, rather than thinking about homeless people or people that are in contact with the criminal justice system, or people with mental health difficulties.
This chapter describes how Changing Futures teams were able to secure greater buy-in from senior stakeholders. Key to their success was understanding leaders’ priorities, and demonstrating how addressing multiple disadvantage aligned with these.
To do this well, Changing Futures teams needed to understand much more than who key stakeholders were.[footnote 1] They needed a detailed knowledge of what they wanted from a stakeholder, what a stakeholder could do or influence, and the stakeholder’s views, priorities, needs and challenges.
How detailed an understanding did they need? Enough to be able to choose among different options for what to say to and do with these stakeholders. For example, a Changing Futures team member commented that the police in their area cared much more about hospital discharge than positive community activities. Similarly, as shown in the Changing Futures Sussex case study, the team recognised that the NICE guidance on homelessness would be an impactful tool for engaging with public health colleagues.
Using stakeholder personas and empathy maps can help you to develop this understanding in your team, and more widely. A stakeholder persona is a profile of a small group of stakeholders – for example, senior leaders within an NHS trust, or senior leaders in the police – presented as a fictitious person. You can see some examples of personas in this blog post from Policy Lab.
Although a persona is not a real person, the data it is based on is neither fictitious nor founded on assumptions or speculation. It is information drawn from both formal and informal sources, including research (for example, a local stakeholder survey); from your and your colleagues’ direct contact with members of the stakeholder group; from documentation (for example, strategic plans, policy statements and press releases); and from other people in your network who work with these stakeholders.
Your persona should set out that stakeholder group’s priorities and responsibilities, what they believe or value, and what problems or challenges they face. You might also include the key places they go to for information and help, and the relationships that are important to them.
You can expand personas to include empathy maps. Empathy maps are somewhat more speculative; based on the data you have, they set out what a person from this group hears, sees, thinks, feels, and does in relation to an issue. They can help you think about how what your team is doing or saying will be received.
The persona is a way of pooling the information that you and your teammates hold about stakeholders, and keeping this updated. For example, you might revisit the persona after a series of meetings that provided additional feedback on how stakeholders’ priorities are changing.
Whether or not you use personas or another approach, it is important to check your decisions against what you know about local stakeholders, so that you are working with people and organisations as they are, rather than how you assume them to be. As a way of getting started, you and your colleagues could start building personas to see how much you understand about your stakeholders – and what you still need to find out.
NICE Guidelines (2022), Integrated health and social care for people experiencing homelessness. This set of guidelines is targeted at local authorities, commissioners and service providers, healthcare practitioners, and social care practitioners. It provides recommendations on ways to improve access to health and social care services for people experiencing homelessness, and advice on how agencies can work together to improve outcomes. The guidelines are referenced in the Sussex case study.
Fulfilling Lives South East Partnership, Ripple effect: The system change impacts of Fulfilling Lives South East project. This report outlines key learning on systems change from this partnership. It covers issues, what was done and what changed, including case studies.
Helen Bevan (2025), Ten things I’ve learned about making large scale change happen. This blog highlights ten key points of learning on how to create system change.
Golden Key Bristol (2021), The Importance of having a diverse board. This webinar recording discusses the value of including a diversity of experience on strategic boards, and explores ways to do this effectively.
MEAM (2025), Leveraging governance and strategic approaches: A blog. This blog outlines challenges for better strategy development and governance, and presents some solutions being trialled in Changing Futures areas.
Social Finance and Revolving Doors, Guide on making the case for change on multiple disadvantage locally. This document provides guidance for a variety of strategic stakeholders on how to make a case for change for people experiencing multiple disadvantage; it is informed by learning from Changing Futures areas and wider research.
NHS England (2023), A national framework for NHS – action on inclusion health. This framework outlines the five key principles for action on inclusion health, and provides a variety of resources to support thinking about a systems approach to inclusion health.
Greater Manchester Combined Authority has produced a model for cost benefit analysis to help demonstrate the fiscal, economic and social value of interventions. As well as guidance on using the model, there is a comprehensive database of unit costs for a range of public services and interactions covering areas such as crime, housing, health and social services. Many Changing Futures areas found this a valuable resource in demonstrating the cost of user interactions with public services.
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When considering the different stakeholders in your local area, there are a range of publicly available stakeholder mapping tools you can use. See, for example, the stakeholder analysis tools in The engagement toolkit, available from The Better Evaluation website. ↩