Families with Complex Needs – An Introduction

In the UK public services are facing unprecedented demand in a period of financial and political upheaval. A growing realisation across public services is the need to engage with families with complex needs, those presenting with profound and enduring health and social needs, the often named ‘high cost’ families.

For the past few years successive government initiatives have attempted to address this issue with varying degrees of success, the latest incarnation is the coalition’s flagship Community Budgets.

All of these governmental approaches have tried to reduce the costs associated with families with complex needs whilst at the same time improving outcomes for them.  This cost reduction and outcome improvement is achieved through a ‘joining up’ of services locally, mapping of resource to reduce duplication, increased efficiencies and where possible, the pooling of budgets and resources.

The current experience of social care services is that families with more than one vulnerability are the norm rather than the exception. These vulnerabilities or problems may include but are not exclusive to:  drug and alcohol misuse, mental health, involvement with the criminal justice system and domestic abuse. These vulnerabilities lead to not only poor outcomes for the adults in the family but also for their children. Where more than one vulnerability exists it does not butt up neatly against the other, it is the overlapping nature of these vulnerabilities and the co-dependency between them that causes the complex social problems that successive governments and successive interventions have tried to address.

These attempts have all been in reaction to the realisation that these so called high cost families can cost the taxpayer anywhere from £250,000 to £350,000 a year to manage, in real terms however the true cost is much higher. If we were to include educational costs and general services, or the reduction in taxation and NI from worklessness the quoted figure would increase exponentially.  Also, this figure doesn’t take into consideration the fact that often no perceptible improvement in outcomes for these families can be measured over the long term, effectively £250,000 to £350,000 of investment for no measurable return.

With the renewed focus on initiatives to support these high cost families local authorities are tasked to have full roll out of community budgets by 2013. This presents major challenges to commissioners, providers and local authorities in a time of cuts to public spending at every level.

The challenge for local authorities and commissioners cannot be underestimated, tasked as they are with finding ways to improve outcomes for these families, interpret and deliver effective interventions as part of community budgets, effectively evaluate these programmes, reduce cost and pool budgets across localities.  The need for effective support from specialist providers with experience of these approaches at a local and central governmental level will be vital to ensure successful delivery.

What we can be sure of is the need for co-ordinated approaches to ensure that community budgets can achieve its fundamental aim, the reduction in reliance on the state by complex families.

Mark Bowles

The Training Effect