Improving Outcomes for People with Multiple Disadvantages

Healthcare services, police, local authorities, and a multitude of other agencies and services provide care for a variety of individuals.

Often, these services are focused on a sole issue, making the issue of helping people with multiple disadvantages challenging.

Doncaster Council’s Pat Hagan and Debbie McKinney spoke to us about the big vision for Doncaster Town Centre, the importance of ‘people and place’ to achieving this, and the Complex Lives Alliance integrated delivery model.

Doncaster Facing the Challenges of our Times

Doncaster faces challenges recurrent throughout many towns and cities in the UK, with a growing homeless population, long waiting lists for social housing, and city centres in need of renewal.[1]

The past three years have seen the growth of other major challenges, such as addiction, begging, and crime and anti-social behaviour.[1]

The Complex Lives Alliance and within that, the Complex Lives Team has attempted to tie their work to the redevelopment of the city centre, as many people seeking help are drawn towards this area.

When examining who was leading this project and providing services to those with multiple disadvantages and complex needs, the team established that the lack of an obvious answer was the crux of the issue.

The multitude of commissioners and different points of access make getting the most from the services very difficult for people with multiple disadvantages.

The commissioning across service providers in Doncaster consists of:

• Doncaster CCG (Mental Health, Physical Health, Primary Care)
• DMBC Adults (Housing Support, Social Care)
• DMBC Public Health (Drug & Alcohol Services)
• Doncaster Children’s Trust (Care Leavers)
• Central Government (Community Rehabilitation, Probation, Prisons) [1]

The effects of having such fragmented commissioning include having no clear governance or mandates to operate in certain cases, and often no grip on the reality of an individual’s circumstances.[1]

To take rough sleeping as an example of a growing challenge, it is crucial to integrate the management of the plan to tackle rough sleeping alongside the plans for the development of the town centre.

One reason for this is to manage concerns from those with a people-side brief, such as charities, and those with a business focus, such as the high street shop owners.

The Complex Lives Alliance

To support rough sleepers, The Complex Lives Alliance has employed a core integrated team to work alongside major partners.

The core integrated team is made up of:

• Service Manager
• Senior Case Worker
• 6 Intensive Support Workers
• 6 Navigators
• Specialist Drug & Alcohol Worker
• The Assertive Street Outreach Team
• Trauma Worker
• Department for Work and Pensions (DWP) worker
• St Leger Homes Single Point of Access worker

The Intensive Support Workers are part of the Make Every Adult Matter (MEAM) team, and their focus is on the most intense cases. This generally means the individuals who are supported by the most services.

The St Leger Homes Single Point of Access worker is primarily concerned with processing people for housing, and judging the suitability of specific housing for individual cases.

The Specialist Drug & Alcohol Worker also works for a service that aims to get those struggling with addiction the correct kind of care for them.

The Assertive Street Outreach Team look for those who are rough sleeping, speak to businesses and communities to find out where those who are out on the street are and try and get them into care.

The Trauma Worker aims to help those experiencing and suffering from trauma to understand that there is a way out of it, even if they’re not ready to take a step into counselling at that point, it can be beneficial to have them onboard early on in the process.

The DWP Worker prevents homelessness by ensuring people have access to the correct benefits and funds.

Alongside these, the Core Integrated Team is also made up of:

• Housing Benefits Officer
• Amber Outreach Workers
• CRISIS Skylight Support Workers
• Positive Pathways Worker
• NACRO Worker

The Housing Benefits Officer works closely alongside the DWP representative to try and limit evictions and ensure past arrears are met.

Amber Outreach workers support sex workers on the streets and also do work around trauma to try and help people exit sex work.

CRISIS Skylight Support workers offer a range of courses ranging from cooking to tenancy support and benefits.

Positive Pathways are attempting to bring in the faith sector to help reach out to more people and give them positive tasks to do whether that be directly related to the church or helping out in the community.

NACRO workers are also involved in the accommodation process, as well as ensuring prison release dates run smoothly and that people have a place to go when they leave prison.

The team work closely alongside the South Yorkshire Police, Town Centre Officers, Housing/Hostel Providers, and Primary Care Doncaster.

This complex, multi-agency effort is driven by a wide-ranging skillset and a shared moral purpose. Debbie described the team as proactive, and with the ability to think outside the box to provide unique care solutions.[1]

The Results of this Approach

The multi-agency approach to multiple disadvantages has resulted in a large impact on the number of people rough sleeping, but there is still a steady stream of new rough sleepers that continues to provide challenges.

At the time of writing, the case numbers were as follows:

• 103 people directly case managed by the team, all of whom were originally rough sleeping.
• 92 of those are now in settled accommodation and receiving support.
• During the summer spike there 67 rough sleepers in the town centre.
• This number is now down to 7, with the goal still being 0.[1]

However, Debbie was keen to highlight that this is not ‘task and finish work’, with an estimated 8 new rough sleepers per week, and 158 known to be at risk of rough sleeping due to unstable housing situations.[1]

These results have been successful enough to be the centre-piece for the new Integrated Health and Social Care and NHS Long Term Plan.

The plan includes a bigger emphasis on the significance of childhood trauma and psychologically informed delivery environments, including PTSD training.

A key part of the NHS’ Long Term Plan is to ‘support people to age well’.[2]

Under this goal falls the following targets:

• increasing funding for primary and community care by at least £4.5bn
• bringing together different professionals to coordinate care better
• helping more people to live independently at home for longer
• developing more rapid community response teams to prevent unnecessary hospital spells, and speed up discharges home.
• upgrading NHS staff support to people living in care homes.
• improving the recognition of carers and support they receive
• making further progress on care for people with dementia
• giving more people more say about the care they receive and where they receive it, particularly towards the end of their lives.

Continuing the collaboration between agencies is vital, with growing prevalence for Prison Health Care to ensure people aren’t trapped in a vicious cycle of being released from prison only to go back into a difficult situation of rough sleeping and criminality.

Also, whilst focusing on those accessing care remains the priority, ensuring staff and frontline workers have adequate wellbeing services themselves is also vital to delivering high quality and sustainable service.

[1] Hagan, Pat. McKinney, Debbie. 2021. Doncaster Council. Supporting People with Multiple Disadvantages: Improving Outcomes Through a Multi-Agency Approach.

[2] Longtermplan.NHS.UK. 2021. NHS Long Term Plan: A summary.