Developing more effective services for people facing multiple and complex needs
With significant cuts to public sector budgets set to continue into the next parliament, local leaders must look to redesign how services work for the most excluded to achieve better outcomes and reduce demand in the long term. Highlighting some of the latest research, Shane Britton, policy manager at charity the Revolving Doors Agency, looks at how local areas can develop and fund a more effective approach for people facing multiple and complex needs.
People facing multiple and complex needs are among the most disadvantaged and excluded in our society. They live chaotic lives and experience a combination of problems at once, including mental ill-health, substance misuse, homelessness and offending.
Recent research by the LankellyChase Foundation found there are a minimum of 58,000 people experiencing three or more of these problems at once in England. An average local authority can expect 1,470 cases of people facing severe and multiple disadvantage each year.
A priority for local leaders
This relatively small group of people have a disproportionate impact locally. Our public services, focusing on one problem at a time, struggle to respond to the complexity of their need. They see the same people repeatedly as they fall into a negative cycle of crisis and crime, causing damage to themselves, their communities and driving significant costs to the public purse.
There is a growing political consensus that something needs to be done, with the Government committing in the Autumn Statement to extend the principles of the Troubled Families approach to other groups of people with multiple needs.
However, this change will need to be locally led.
Building on our research for a series of briefings for local leaders, I want to highlight three key aspects of developing a more effective approach:
1. Start with service users
Firstly, it is crucial that any approach starts with the service users themselves. It is only by involving people with direct experience, and speaking with them about what is important, that effective services can be developed.
Our new report A Good Life: ExploringWhat Matters to People Facing Multiple and Complex Needs presents findings from research with members of our National Service User Forum. Participants predominantly wanted fairly simple things: stability; a decent and secure home; and services that were compassionate, responsive and treated them without stigma and prejudice.
They also stressed the importance of relationships outside of traditional service provision, including links with family and peer support networks. However, a key finding was the complex and highly personal nature of people's journey towards recovery. The report concluded that services must provide genuinely personalised support, involving services users in setting their priorities and the outcomes services are measured by.
2. Understanding what works
Secondly, local leaders should look at the growing evidence base of what works as they seek to develop a more effective approach.
Our recent briefing Comprehensive Services for Complex Needs: A Summary of the Evidence found that many of the principles of effective services for this group reflect what service users are asking for. The three service models reviewed adopt:
- A flexible approach.
- Work intensively with service users.
- Build positive relationships.
- Build on client's strengths.
- Involve them throughout the process.
- Work holistically.
- Ensure a range of key outcomes are addressed and the client's priorities are respected.
While further research is needed in some cases, there is promising evidence that this provides better outcomes, including reduced reoffending and improved mental wellbeing. It also generates savings through reduced demand on services in the long-run - two recent studies of the "link worker" model suggest monthly savings per client of between £347 and £958 to local services.
3. Funding positive outcomes
Finally, local commissioners - and local authorities - have a crucial role in working together across different sectors to fund services that deliver these positive outcomes. In doing so, they must also ensure that the outcomes they prioritise reflect what people want and need, and funding mechanisms used do not hinder effective service delivery.
Outcome-based approaches such as payment by results (PbR) may seem attractive in a time of shrinking budgets. In theory, they can share the risk of funding preventative work and create efficiency by tying funding to "results" achieved. However, as our recent report Adding Value?: Reflections on Payment by Results for People With Multiple and Complex Needs shows, PbR poses significant challenges for this group.
While commissioners should be encouraged to be outcomes-focused, this does not necessarily mean adopting a PbR model. It is important to recognise that savings come from pooling funds, reducing duplication and working together to provide more effective and responsive services, rather than processing people towards unrealistic and oversimplified outcomes more effectively. Outcomes should be set in conjunction with service users, reflecting their priorities and needs.
The case for change
Recent research conservatively estimates that multiple needs cost £10.1bn a year nationally. The need for a more effective approach to this problem in a time of significant cuts to local services is clear. While there are no easy solutions, by starting with the service users themselves, looking at the evidence of what works and working together to at a local level to fund services that deliver what service users need and want, local leaders could achieve that holy grail of reform: driving savings while improving outcomes for people in need.
Revolving Doors Agency’s publications for local leaders are available here.