UofG Centre for Public Policy

7 October 2026: Professor Andrea Williamson welcomes the publication of ‘The Level’, led by Homeless Network Scotland, a delivery protocol to close the health equity gap and ensure people with severe and multiple disadvantage backgrounds thrive. She writes that change needs to ensure practitioners have the time and support to enact it.

Blog by Professor Andrea Williamson

As a GP working in Inclusion Health settings when the English Hard Edges research was published back in 2015 it was a lightbulb moment. I had been working in homelessness health and alcohol and drug recovery services for about 15 years. It articulated what I understood from working with patients; that the challenges people face – called ‘Severe and Multiple Disadvantage’ (SMD) - are overlapping and come from the same roots of poverty and psychological trauma.

Working in this setting also brought into sharp relief the challenges patients had in using a health service that was not designed for them. Being involved in GPs at the Deep End helped me understand that this was an issue way beyond Inclusion Health. Research about ‘missingness’ in healthcare followed - defined as ‘the repeated tendency not to take up offers of care such that it has a negative impact on the person and their life chances’.

Ensuring health services actively consider and adapt what they do to ensure people are brought back into care - what we call ‘applying a missingness lens’ gives us a tangible means within the NHS - and arguably within wider public services - to ensure all people have a fair opportunity to reach their full health potential.

The opportunity for positive progress for people with SMD backgrounds, and to stop children having that experience, has just had an enormous boost with the publication of The Level: Raising the Floor for No Wrong Door by Homeless Network Scotland along with many partners, including the Centre for Public Policy.

It is a delivery protocol aimed at frontline practitioners, commissioners and policy makers to make the changes needed so that health, social care, housing, criminal justice, and all the many parts of our public care system that support people are doing what is needed to ensure people with SMD backgrounds thrive. This is rooted in a human rights-based approach to health and a ‘minimum standard of considering the whole person, human connection, early help and brave action’ in what is done to bring about change.

It has something in it for professionals working in every context and refreshingly is explicit about the brave action that is often needed to support a person with an SMD background to navigate the (labyrinthine) system of care. At its heart is the call to have every person with an SMD background have a ‘lead professional’ who is ‘a trusted practitioner who holds the whole picture’ with the person having a say in who that should be. The lead professional has an ‘early coordination’ role grounded in ‘consistency and trust’ with ‘advocacy and navigation’ a key part of that.

Practitioners are asked to do ‘level checks with people’ framed around ‘housing and home, health and recovery, financial security and justice, relationships and safety, purpose and growth, and attitudes and discrimination’.

For me the vital question is what national funding streams, Health Boards and Local Authorities will do in response to the delivery protocol.

Supportive rhetoric from Government is important and many more frontline practitioners are now doing a lot better by people with SMD backgrounds day to day. However, we need changes in systems of care and resource allocation to ensure practitioners have the time and managerial support to take these steps to raise the level for no wrong door.

Author

Andrea E Williamson is Professor of General Practice and Inclusion Health in the School of Health and Wellbeing, University of Glasgow where she combines research, teaching and clinical practice. Andrea is a Centre for Public Policy Affiliated Researcher.

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First published: 7 October 2026