The National Institute of Health and Care Excellence (NICE) is currently consulting on standards to improve people’s experience of adult social care.
Developing our message to government on multiple needs: prevention
It sets out the scale of the challenge around multiple needs and the action that government must take in response. In the first of three blogs, MEAM’s Policy and Practice Officer Laura Greason reflects on the nationwide consultation that helped to shape it.
We wanted our new publication to be shaped by the insight of people with lived experience of multiple needs and those who support them. Over the summer, we asked a range of our local partners for their views and several themes emerged. The first was the importance of prevention, an issue which is also acknowledged and verified by academic research.
Across the country, people told us that preventative work around multiple needs is severely lacking and that where it is occurring, it’s not happening early enough. For example, they explained how the current system requires a perverse scenario in which their situation has to be very severe before services will intervene.
“Now you have to meet a very high criteria for services. If you can’t meet it, you get sent away and you stay in the cycle of revolving doors until you become so bad that you meet the criteria.”
For some, steps towards prevention could have been taken in childhood and especially at key transition points in their life, such as moving from child to adult mental health services.
Looking at the research
Recent analysis of the British Cohort Study by Professor Suzanne Fitzpatrick and Professor Glen Bramley at Heriot-Watt University supports this argument, showing that experiences in childhood and early adulthood can too often predict future outcomes. In particular, they find that homelessness is not something that happens by chance, but is the result of a combination of systemic factors, suggesting that targeted prevention should be possible.
Based on their analysis, they compare predicted outcomes for two individuals: a mixed-ethnicity lone mother who experienced childhood poverty was renting at the age of 26 and has experienced unemployment, has a predicted probability of homelessness of 71.2% by the age of 30. In contrast, for a white male university graduate from a relatively affluent background in the rural south of England, living with his parents at age 26, the figure is only 0.6%.
According to research by Centrepoint in From Care to Where? if that lone mother also happened to be a care leaver, the outcome would likely be worse. Of the care leavers surveyed, 26 percent had sofa surfed and 14 percent had slept rough since leaving care. The later a young person enters the care system, the poorer their long-term outcomes including homelessness are likely to be.
Preventing what, and when?
But that leaves us with an important question: what do we mean by prevention, and at what point should we intervene?
At the Homeless Link conference in July, Suzanne Fitzpatrick discussed three distinct types of prevention. Structural (i.e. housing supply and welfare eligibility), upstream (i.e. addressing childhood poverty and adverse teenage experiences) and systemic. It’s on the last of the three – how public services work together to identify and support people at risk – where our work is increasingly focusing and where consultation participants focused their attention as well.
We know that the key to helping people with multiple needs is a well-coordinated response from public services. But it is now clear that a well-coordinated response can happen much earlier on, and before an individual develops complex and multiple needs. While local areas are attempting to address this issue, they cannot provide the complete solution. Our publication sets out four steps that national government should take on multiple needs. Two of these asks have been particularly shaped by the thinking on prevention arising from the consultation:
- To publicly commit to supporting people who are at risk of developing multiple needs; and
- To collaborate across government departments, acknowledging that prevention can take place at key points in people’s lives when they are interacting with different functions of government.
As a coalition, we hope to further explore the role of prevention with the help of people with lived experience. Later this week, we will be publishing research on this issue in collaboration with the University of Sheffield. To share your thoughts on the issues raised here or to find out more about the MEAM coalition, please visit www.meam.org.uk or contact email@example.com.
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Policy manager for the MEAM coalition
Laura is policy manager for the Making Every Adult Matter coalition, working with a team across Clinks, Homeless Link and Mind. Laura works to strengthen the link between the policy and practice elements of the coalition ensuring that our national policy is informed by the work of local MEAM Approach areas and the experiences of people with multiple needs.
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