The devil is in the detail: policymakers must learn from experience to address complex needs

November 20, 2015

Claire Richmond works with Opportunity Nottingham – one of the 12 Big Lottery-funded Fulfilling Lives areas which MEAM supports. Ahead of the Spending Review, she reflects on the growing national interest in its work, and the vital role of lived experience. 

In his ‘smarter state’ speech in September, David Cameron reflected on the success of the Troubled Families programme, saying “…we need to do more to encourage departments, local authorities and charities to work together collaboratively”.  Support is growing for the next step, the development of a  national programme to support action on multiple and complex needs of individuals, with the MEAM Coalition, Revolving Doors Agency, Simple Change for Troubled Lives and IPPR all urging the Government to act ahead of this month’s Spending Review.

In this video, Claire talks about her work with people with lived experience of multiple needs

The debate alone is encouraging.  I work for a Big Lottery Fund-supported partnership called Opportunity Nottingham, aiming to improve services for local people with multiple needs – including mental ill-health, homelessness, substance misuse and contact with the criminal justice system. When I reviewed the policy landscape for the project last year, I found those with the most severe needs barely featured.

As commissioners, providers and beneficiaries, we have been thinking together about what a new national focus on multiple needs might mean for us.  We all want better outcomes for the people, but those with lived experience have highlighted issues that warrant a greater emphasis in the current policy debate.

Firstly, we can get weighed down by the complexity of process and structures, but the number one ask from beneficiaries is staggeringly simple: they call it ‘being human’.  They want services that recognise their individual needs, but also what they have to contribute.  For instance, Opportunity Nottingham has introduced ‘Facts About Me’ into its assessment process, where people share their strengths, interests and motivations. This is so important because it stops people being seen as a set of problems to solve, and instead recognises potential. As one person we’re working with told me: ‘we should be shouting the good stuff from the rooftops’.

Secondly, people want a system that supports their ambitions as well as meeting their needs. Commissioners are not sure that ‘social-care style’ personal budgets (as piloted with rough sleepers in Wales and London) are the right approach for Nottingham, but a modest ‘reward’ to fund positive activities that fill the void as negative behaviours cease is an important practical solution. And then there’s work: moving towards employment is a huge motivation, but it can take a long time. We need to ensure people are supported throughout their recovery – and that they aren’t penalised by welfare system when things don’t go well.

Finally, effective support for people with multiple needs depends on trust – but how do you build trust into a policy?  One way is to enable smaller community-based providers to play a leading role.  They know and understand the people they’re working with, which matters because many of those experiencing the most complex needs don’t show up on databases. This also means that pure payments-by-results models may not work for this group. The National Audit Office found that for programmes trying to achieve complex, long-term outcomes, it’s difficult to design a payment model based on individuals’ progress. What’s more, the financial risk involved in such investments can prevent smaller organisations that are trusted by beneficiaries from getting involved.

When it comes to any new national programme for people experiencing multiple needs, the devil will be in the detail. As they develop this work, policymakers can save time and energy by learning from the good practice that local services have already established. And, by ensuring that people with lived experience of multiple needs are involved from the start, they’ll help local areas and the individuals they’re supporting achieve things that are really worth shouting about.