It is, perhaps, self-evident that people with complex needs frequently require correspondingly multiple and complex responses…. wrote Henwood and Hudson in their 2009 CSCI study Keeping it personal. Now as Carers’ Week passes we have, in the Care Act, the strongest rights yet for carers. When put together with the duty of assessment for young carers, in the Children and Families Act, the legislative framework is suitably reflective of the very complexity identified for policy makers five years ago. It is a challenge for the Fulfilling Lives: supporting people with multiple needs evaluation to explore, understand and share how project investment resolves the problematic issues of real life complexity. Those involved in caring relationships shaped by homelessness, criminal behaviours, substance misuse and fragile mental health are potential benefiting contributors to making the most of that significant investment. The evaluation process has to identify both the benefits and contributions of carers to the success of Fulfilling Lives.

The Care Act refers to ‘individuals’ and so clearly covers both those with care needs and carers. It has a principle of well-being and includes duties to:
•    Reduce carers’ needs for support (prevention)
•    Provide information and advice (including financial advice)
•    Assess carers on the appearance of need and that they may benefit from prevention, information or other support
•    Apply eligibility criteria to carers’ services (yet to be defined in regulation)
•    Provide services to meet carers’ assessed needs based on an entitlement
•    Charge for carers’ support as applicable
•    Prepare a support plan with the carer and help them choose how it is met
•    Make sure there is no gap in services when people move home
•    Promote diversity and quality in provision of carers’ services
There are also important new legal provisions regarding transition, delegated duties and safeguarding. The children’s legislation ensures that young carers have the same rights as adult carers based on the appearance of need.

The complexity kicks in when seeking to pinpoint who exactly is the person in need and who the carer is. Where the needs assessment applies and where the carers assessment? People, families, relationships, households and, indeed, communities characterised by multiple and complex need do not neatly fit into binary boxes. Such is the stuff of ‘gift’ relationships on which much of the system is founded. In fact relationships ebb and flow between cared for and carer, dependent and independent, care-giver and recipient, child and young carer – at one moment symbiotic and then parasitic, sometimes mutually beneficial and at others potentially harmful. That fluidity is equally a necessary feature of the evaluation process.

Whole System
Each Big Lottery, Fulfilling Lives project is measuring how well it is achieving its objectives. In so doing there is the overarching objective of providing tailored or bespoke support services that are personalised and unique to the needs of each individual. Those people will meet the given definition of complex need. The individual support will address all the issues faced from within the funded partnership. Because the legislation is about ‘individuals’ those people may or may not be in a caring relationship – the important thing is supporting them to tackle the complex need. Clearly a whole system approach to support is needed and equally to evaluation. That whether support is provided as a person in need or carer in need diminishes in the face of ensuring that the support system is built, maintained and becomes self sustaining – making change real.

The legislation allows for this in its founding principle of wellbeing, in its emphasis on prevention and its recognition of the individual with ‘an appearance’ of need whoever they are. Similarly the evaluation allows for this in giving even weight to input, activity, output and outcome. It uses case studies and formative approaches to learning as well as the more quantitative techniques – both are important. The research logic chain refers to individuals with multiple and complex needs rather than service users; just like with people being cared for and carers, it is not an either/or when it comes to the Fulfilling Lives evaluation. It is about capturing what works, identifying why and how so that others may learn and replicate success.
Vic Citerella