This article will look at how best to frame multiple disadvantages, why the current system is failing, and examine some practical steps that can be taken to improve the services provided.

Ollie Hilbery, Director of the Making Every Adult Matter Coalition, spoke to us about the importance of understanding multiple disadvantages as a complex problem, requiring a systemic response.

Challenges in Delivering Services

Many of the services involved in the process of helping those with multiple disadvantages are often designed, commissioned, and delivered in silos.[1]

The services involved in helping those in need.[1]

The design of the services means that they often originate from a single government department focusing on a single issue, which then runs through the commissioning systems down into how the services are delivered at a local level.

This has created a system where services are built and centred around one particular issue, which can limit their remit when dealing with someone with multiple disadvantages.

The historic lack of communication and cooperation between these services has also led to difficulties in being truly responsive to people’s complex needs.

Due to the nature of the services, they often focus on a person’s deficits rather than strengths, which can lead to more negativity in their lives which doesn’t help their situation.

Ollie also claims the services lack a person-centred and trauma-informed approach, and they can be side-tracked by overly rigid processes.[1]

As a result of these challenges, many multiple disadvantaged individuals have suffered a string of failures and find themselves ‘bounced about the system’ which ultimately adds to, rather than solves, their problems.

Ollie added it’s important to treat multiple disadvantages as a systemic issue, rather than placing blame on individuals. It’s often ineffective contact with services that lead to more chaotic lives for those in need.[1]

Not only do the individuals suffer, it also leaves staff frustrated and inhibits them from providing the best service possible; as well as costing more than it should.[1]

Multiple Disadvantage is a Complex Problem

Ollie divides problems into three categories; simple, complicated, and complex.

Simple and complicated problems are often linear and mechanistic, with a clear solution. They can be diagnosed and fixed if there is the knowledge available to do so.[1]

Examples would be a car or a jumbo jet. One is simple, the other complicated, but both are fully understandable systems where problems and solutions can be identified and solved in a methodical way.

Complex problems however have no clear, identifiable ‘problem and solution’ dynamic. Many problems will be interrelated and will be unresponsive to standard problem-solving.

If complex problems are treated as simple, or complicated, there is a large risk that they will be made worse.

Ollie quoted American systems scientist Peter Senge to succinctly capture why oversimplification is an issue:

“From an early age, we are taught to break apart problems, to fragment the world. This apparently makes complex tasks and subjects more manageable, but we pay a hidden, enormous price.”

“We can no longer see the consequences of our actions: we lose our intrinsic sense of connection to a large whole.”[2]

The system surrounding a person with multiple disadvantages is made up of a range of different dynamics, organisations, individuals, and societal impacts.

The immediate circle is often family, friends, co-workers, local shopkeepers, and neighbours.

Then there are the local services the person may use, and the local commissioning structures and policies they’ll engage with.

Beyond that is the national policy structures informing the commissioning environment and dictating how care and services are delivered.

The societal factors that have impacted a person, their education, wealth, race, social mobility amongst a range of other contributing factors also form the ‘system’ around someone.

Systems are made up of a complex web of interconnected but individual parts.[1]

These parts interact in unpredictable ways, and from these interactions, a collective culture emerges.

While the systems are built with explicit intentions, they often contain implicit assumptions and possibly vested interests, which leads them to fail.[1]

Taking a systemic approach to multiple disadvantages can help us better understand where and why these failures emerge and ultimately provide better care to those who need it.

What Can be Done?

Ollie offered five ways that care providers and other services can help tackle multiple disadvantages.

  1. Build Partnerships

Working alone is not a plausible approach when dealing with someone with complex needs.

Questions to ask when dealing with an individual facing multiple disadvantages include:

  • Who else is working on this locally?
  • Who shares an interest in this?
  • Who could have an interesting or different point of view?

Asking these questions can create space for operational and strategic discussions to take place, and strengthen the links between service providers.

Finding a senior ‘home’ to sponsor and oversee a case could also prove useful, allowing the partnership to have a clear space to operate.

2. Make Partnerships Effective

The partnership should be equal, both in statutory terms but also the time is given to the case should be shared evenly.

There should be opportunities to get to know and understand each member of the partnership, strengthening the service side of the approach.

There should be a broad range of members, who through such discussions and sessions come to an agreed definition of the multiple disadvantages.

Agreeing on an ultimate shared vision and common purpose is also important to constantly remind everyone what they are trying to achieve.

Another beneficial aspect of a partnership is creating a culture comfortable with uncertainty, where members feel confident to challenge and ask questions, to learn and reflect.

3. Explore the System and Prioritise

It’s necessary to gain a good understanding of the system around people as it allows you to prioritise your actions accordingly.

Some good questions to ask include:

  • What does the system look and feel like locally?
  • What do people experience in the system?
  • What is good and bad about it?
  • What needs to change?

Things such as cultures, perceptions, funding opportunities and constraints, risks, and policy should all come under consideration in this part of the process.

Once the system has been explored and potential problem areas highlighted, it should be clear which actions need to be prioritised, and how best to coordinate the response.

4. Learn, Reflect, Iterate

The cycle of learning, actioning and reflecting.[1]

After executing the action plan, it’s important to reflect on what has happened and learn from the changes made.

Ollie recommends being inquisitive about what the evidence is indicating, don’t be afraid to challenge the status quo, and trying to reach a consensus on what to do to move the situation to the next stage.

5. Focus on System Thinking Behaviours

The thought processes influencing decisions should be those highlighted in green, rather than red.[1]

By framing multiple disadvantages in this way, throughout the entire process, will enable the service providers to offer person-centred and holistic care.

Moving from siloed services focusing on one part of the problem, through a constantly iterative learning process, will ultimately improve the complex lives people lead and give them a better chance at overcoming the complex issues they are facing.

[1Hilbery, Ollie. 2021. Director, Making Every Adult Matter. Tackling Multiple Disadvantages.

[2]Senge, Peter. 1992. The Fifth Discipline.

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This article will look at how best to frame multiple disadvantage, why the current system is failing, and examine some practical steps that can be taken to improve the services provided.

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