New data maps the reality of complex need

At the launch of the Lankelly Chase report Hard Edges: Mapping severe and multiple disadvantage, there was a strange mix of emotions. Initially I was intrigued. As someone who has been working on the rehabilitation of offenders since 2006, first in the Cabinet Office and then as chief executive of Kent Probation, we had long awaited data beyond that available from the 2002 social exclusion unit which, while excellent at the time, only viewed needs through the prism of offending.

Practice-led work on reducing reoffending had continued to evolve but the data to back up strong professional opinion was lacking. Could this report look at the overlap between needs in a way the 2002 report didn’t?

Then, there was excitement. The research provided some fantastic datasets which both backed up what we thought we knew and provided a level of detail enabling segmentation both geographically and demographically (the geographer in me couldn’t contain herself!).  If you haven’t read it, you really must or, for a taster, try Julian Corner’s blog.

But then, I felt a surprising sense of being overwhelmed, daunted even, by what we were hearing.  The multiplicity and complexity of needs it reveals will require a fundamentally different approach from the highly segmented group of services, agencies and individuals we currently have. It needs something far more than ‘partnership working’, but systems approaches at their most sophisticated are, as we know, difficult, messy and uncomfortable.

However, before we descend into a pit of despair I wanted to pull out some beacons of hope and consider how to bring different perspectives together in order to apply this excellent research to real places with real people.

So, three perspectives:

• Systems thinking continues to inspire change management thinking and practice in the public services but its focus is often organisational and it can dehumanise individual interaction and collaborative practice in attempting to account for cause and effect at an aggregate level
• Co-production techniques for complex and multiple needs increasingly draw on a growing evidence base supporting outcomes and preventative cost reduction.  But they remain difficult to scale and are marginal practice for many local authorities or government agencies seeking to control cost through big contract negotiation and competition
• The value of collaboration across public service silos and sectors is a matter of consensus, but anecdotal evidence suggests that practice is often undermined by a lack of awareness of opportunities and system drawbacks – to the extent that even well thought through innovation and system disruption can fail in the medium term.

How can we address these limitations and understand how to sustain ecosystems of support for individuals with multiple and severe disadvantage?

At Collaborate, we believe the answer lies in some rather more practical steps, which we are working on with collaborative-minded individuals, organisations and systems up and down the country. These are:

1. Joining up national, upper and lower tier government around the experience of the individual or family.  The layers of government are not only costly but they are confusing for those navigating systems: putting aside the devolution debate there is much more to do to make systems such as the welfare more seamless for those receiving it. We are currently working with Suffolk Council, Ipswich Council and the Department of Work and Pensions to explore what can be done to improve the experience of disabled people receiving benefits and support from those three arms of government and to make that provision more sustainable. We are also working with acute trusts and future health leaders to consider how staff, patients, carers and the community can be better drawn into co-creating more integrated models of care.
2. Working hard to create a shared purpose, then aligning behaviour with governance, data and commissioning. An example is the ‘commissioning clusters’ developed by public service and social economy partners in Oldham, or ‘intelligence hub’-led commissioning in Sunderland. Both have the potential to build investment propositions that are bottom up and cross-sector. We are also exploring how different organisational forms such as mutuals can help support this alignment by looking at the limits of Foundation Trust status for acute trusts, and considering what’s next for the future leaders of public health care.
3. Developing a more collaborative model of local growth where public spending is seen as a driver of economic inclusion and productivity. Organisations like Cles are active in this area and, building on the work of the Joseph Rowntree Foundation in Leeds, Collaborate will be co-hosting a workshop on collaboration across the skills, employment and business sectors in the city. This will be asking what changes in culture and behaviour are needed to encourage better collaboration on behalf of marginalized citizens particularly those who are Neet. This is all about building the future social spine of our towns and cities, a task which requires responsibility and risk-taking from all sectors.

Of course looking at each of these strands alone doesn’t achieve the multiplicity that Lankelly’s report calls for.  That is why they have commissioned Collaborate to do a piece of work in Coventry looking at collaboration, complex needs and system change which will consider the issues above, focusing particularly on those with severe and multiple disadvantage.

This will allow us, in collaboration with those delivering and commissioning services in Coventry, to take the rich data from the Hard Edges report and consider what it means in a real place with real people.  It will involve building a broad picture of what the local ecosystem looks like for those with complex needs; producing a map of public, private and social institutions and the networks of support and influence.

From his we can begin to understand the interaction between the individual, the place and the many agencies that might support them and assess the readiness of that system to collaborate.