When we first began working on the Fulfilling Lives: Supporting people with multiple needs evaluation, a question we asked was ‘how many people are affected by multiple and complex needs?’ It seemed like a simple enough starting point. Two years on we’ve learnt very little is simple in trying to address issues that are inter-related and mutually reinforcing, particularly when the service response is too often inflexible and designed to address single issues only. The disconnected nature of support is reflected in the data which can provide an indication of levels of homelessness, offending etc, but not how these commonly related issues overlap. However, a recently published report from Lankelly Chase Foundation goes some way to addressing this and helping to answer that first, not so simple question.
This ground breaking research, carried out by Heriot Watt University, combines administrative data from various sources to come up with figures for those who are in contact with substance misuse, offender and homelessness services*. There are an estimated 58,000 people in England each year with experience of all three services. Of course, this is likely to be an under-estimate because not all people with complex needs are in touch with all the services they need. The report also gives figures for those who are in touch with two (164,000), or just one of the services (364,000).
While this provides an answer to our original question, there is so much more of interest in the report. The Big Lottery Fund’s Fulfilling Lives: Supporting people with multiple needs initiative focuses on 12 localities across England. The Hard Edges report provides a local authority level break-down of the prevalence of multiple and complex needs. There are great disparities in numbers of people affected between areas. There are particular concentrations of people in contact with the three services in northern former manufacturing towns and cities, some seaside resorts and former port cities and central London boroughs. Nine of the 12 areas funded through the Big Lottery Fund initiative are in the top 24 authorities with the highest prevalence. But importantly, no local authority in England has no people with multiple and complex needs; this is an issue that affects all areas to some extent.
Much of the current political discourse on tackling multiple needs focuses on the financial costs of supporting people and families, the efficiencies of the current system and opportunities to save money through system and service redesign. The report estimates a person with multiple disadvantage costs on average £19,000 per year in public services, compared to £4,600 per adult in the general population for the same range of services. While the cost-savings argument is a powerful one to make, it also overlooks the personal experiences and individual tragedy of failing to tackling multiple and complex needs effectively.
* Mental ill health, the fourth domain of multiple and complex needs as defined by Big Lottery Fund, was not factored into the equation due to the lack of useful national data on this domain.
Read the report here: http://www.lankellychase.org.uk/our_work/policy_research/hard_edges
Research Manager, CFE Research