1. Fulfilling Lives: Supporting people with multiple needs
Laura Furness
Head of Funding
27th April 2017

2. England Strategic Investments
A Better Start
HeadStart
Talent Match
Multiple Needs
Ageing Better
Supporting around 50 partnerships with over £550m of strategic funding for preventative, evidence based systemic change within tough social policy issues over the next 5-10 years.
In addition to our open funding programmes Awards for All and Reaching Communities, we are investing over £500 million in England, over the long term, to tackle some of society’s most entrenched social problems in preventative and innovative ways. All these investments have been designed and are being delivered working closely with beneficiaries. They each require organisations from different sectors to work together, using an approach focused on individuals and prevention rather than cure.
As well as the MN programme, we have;
Through A Better Start we aim to offer early intervention in first years, improving outcomes for 10,000 of the most vulnerable babies and families in England, using a £215 million investment over 8-10 years in up to five areas.
Headstart. £75m to give young people support and skills to cope with adversity and do well at school and in life. The investment will equip young people to cope better with difficult circumstances in their lives, so as to prevent them experiencing common mental health problems before they become serious issues.
21 areas in England implement the £100 million five-year Talent Match programme designed to help young people furthest from the labour market back into training, education and jobs.
And Ageing Better which invests £50 million to look at what works in helping people have a rewarding older age, and a £70 million investment will address social isolation among older people.
Key to all these schemes is learning. We want to learn what works – and what doesn’t – and share our findings widely as we go along, shedding light on ways to both save money and deliver better results for vulnerable people.

3. Fulfilling Lives - Our vision
Supporting people with multiple needs
People with multiple needs are able to better manage their lives through access to person centred and co-ordinated services
Services are more tailored and better connected and will empower users to take full part in effective service design and delivery.
Shared learning and the improved measurement of outcomes for people with multiple needs will demonstrate the impact of service models to key stakeholders.
We want to improve the lives of people with multiple and complex needs through projects which will better co-ordinate the relevant services around individuals with multiple needs. It is estimated that there are 60,000 adults at any one time facing multiple needs and exclusions in England. People facing multiple needs and exclusions are more likely to end up in the criminal justice system, attend A&E frequently and experience poor mental and physical health. Good practice shows that tackling these needs through more effective co-ordination of services, leads to better outcomes for individuals and reduced use of high cost emergency services.
The overarching aims for the programme are to ensure that people with MN are better able to manage their lives, that services are better connected, and that learning is shared to improve outcomes and can be used by other funders, policy and decision makers. Our vision is that the programme with develop to create, and leave, a legacy based on evidence as to the best approaches to commissioning. In a nutshell, we aim to change lives, change systems and involve beneficiaries.

4. National picture 2,195 individuals (so far)
Highest presentations for substance use
44% individuals presented with all 4 needs
Most individuals are male, British and aged between 30 and 39
All areas reducing risk
2195 (not including counterfactual areas) beneficiaries so far with 1,089 leaving the programme. Most are due to disengagement however we have unfortunately had 89 people who have died.
Substance use accounted for 84% of presentations followed by mental health at 80%, offending at 74% and homelessness at 62%
44% presented with all 4 needs, 38% with 3 needs, 4% with 2 and 13% unknown. Pleased to say the ‘unknown’ is decreasing – we need data to gather and provide evidence.
Most aged between 30 and 39, male and British, not disabled, unable to work with literacy not an issue for them (self reported) The proportion of beneficiaries with a disability is almost twice that of the general population. We do not know the age of 503 beneficiaries so cannot argue for age specific delivery.
Lack of date collected means we are unable to provide data on some demographics eg literacy issues had 873 missing records (33%) . Lack of data make it more difficult to influence policy.
All areas reducing risk, with risk from others being the most pronounced concern (according to NDT scores)

5. Early impact Successfully reaching out to women
Individuals are making progress and engaging better with services.
The involvement of people with lived experience has resulted in quicker relationships forming due to their shared experiences and understanding.
The flexible, holistic and well-resourced approach appears to be helping key workers to engage and support individuals better.
To date, the initiative is successfully engaging those with the most complex needs
The initiative appears to be successfully reaching out to women with multiple needs.
Assessment scores show that beneficiaries are making progress, beginning to accept help and engaging better with services.
Projects using individuals with lived experience on the frontline has resulted in quicker relationships forming with beneficiaries due to their shared experiences and understanding.
The flexible, holistic and well-resourced approach of Fulfilling Lives (Multiple Needs) appears to be helping key workers to engage and support beneficiaries better.
To date, the initiative is successfully engaging those with the most complex needs

6. Interesting learning
Average of six and half months on the programme before move on
Addressing alcohol and drugs misuse appears to be harder other issues and may occur later in beneficiaries’ journeys
After a year engaged, a larger proportion are in supported accommodation
Moving people from rough sleeping to more secure accommodation remains a challenge
Beneficiaries who successfully move on spend an average of six and half months on the programme, although length of time on programme varies from less than a month to over a year. This on the surface is slightly skewed however as we know most services work intensively with people for between 18 and 21 months.
Addressing alcohol and drugs misuse appears to be harder than some other issues and may occur later in beneficiaries’ journeys.
By the time beneficiaries have been engaged for a year on projects, a larger proportion are spending most of their time in supported accommodation.
Moving people from rough sleeping to more secure forms of accommodation remains a challenge.

7. Interesting learning continued….
After 12 months, beneficiaries reporting incomes from unsafe or insecure sources (begging, borrowing, illegal activity) increases slightly initially
Commonly cited barriers are lack of/inappropriate housing and information sharing
Frontline staff are vital!!
Of those who have remained engaged on programmes for at least 12 months, the proportion of beneficiaries who report incomes from unsafe or insecure sources (begging, borrowing, illegal activity) actually increases slightly initially. We’re unsure if this is due to people starting to engage in unsafe activity or due to a more trusting and honest relationship being built
Where there are cited barriers, we should proactively establish ways to break these down. Housing is often expressed as a block to accessing support, and we have seen that closer working with local authority services and private landlords can ease this, particularly for individuals wanting to move to another LA area. Further to this, information sharing (both lack of and inappropriate) cause concerns for beneficiaries. A lack of information sharing reduces the likelihood that individuals will be given seamless and tailored interventions, whereas inappropriate information sharing may lead to conversations which have a wider impact e.g. With the potential for benefits being adversely affected.
Frontline staff are vital!! They not only navigating the system, but open up access to new services and facilitate improvements in how beneficiaries are treated.

8. West Yorkshire have had 460 beneficiaries so far and the NDT scores, which are assessments of risk made by workers (rather than self assessments) show a reduction of 12 points – both the highest risk score at initial monitoring and the greatest reduction in risk shown across the 12 areas. Data we collect doesn’t give us any further information on this so we look to the project and local evaluation as to why this may be

9. The outcome star measures how a persons self assessment of where they think they are on a number of items such as offending, social networks, drug and alcohol misuse, emotional and mental health and managing tenancy and accommodation. Self assessments are completed at various points of a person working with the project to determine how well someone feels they are doing.
West Yorks is showing improvements in all areas assessed by the outcomes star, with improvements to physical, mental and emotional health showing the least progress, and motivation and taking responsibility showing the most progress.

10. In comparison to other funded areas, individuals in WY are not showing as much improvement as other areas however there can be many reasons for this and more investigation would be needed to put this into context.

11. WY-FI and systems change
Building foundations
Multi Agency Review Boards
Locality Plans
Training and Practice Development Group
Co-production
WY-FI have spent the couple of years building up the foundations for systems change to take place - engaging with people so that they are receptive to change and new ideas, everyone from commissioners, service leaders, service users, and those workers at the sharp end(?) of delivery.
The Multi Agency Review Boards (MARBs) are seen as an increasingly valuable tool in many localities to help get people into the right services with the right support
The development of Locality plans which are relevant to local policies and practices, which is now being supported by the overarching WY-FI SCAN group
The training and practice development groups designed to deliver that ‘on the ground change’ with over 100 people from 28 different organisations participating – creating a more effective and empathetic workforce/sector
Ongoing development of the WY-FI Network, a voracious group working to instil the value of the user voice in everything that you do, championing co-production as well as being role models for others
Challenge is sustainability – how do WY ensure that learning continues beyond the life of the programme? How do WY ensure learning is shared beyond the named partners to influence policy elsewhere? We want to see more on systems change to understand impact.

12. Recommendations Focus on assets
Services need to be flexible and responsive to individual need
Services should work together to address barriers and offer more effective support
Proactive and genuine beneficiary engagement and involvement at every stage, by all stakeholders, is vital
Workforces must be actively supported and developed
To change the commissioning and delivery culture, we should focus on the assets the individuals have rather than the problems they face, identifying and developing the capital that every individual has.
Levels of need across the beneficiary group vary, and the service provision must recognise that through tailored definitions, eligibility criteria and approaches to individuals. The PIE Approach is achieving positive results across partnerships, reflecting the need to work collaboratively with beneficiaries in a way that recognises individual needs.
There should be a greater collaboration across partnerships with successes, barriers and learning being shared across the 12 areas and beyond to ensure the overall programme provides the collective legacy of the work being completed individually.
Those with lived experience should be involved from the identification of need, design of a service/project, application, set up, management and delivery.
Success is built on people and therefore everyone working in a service should be supported to deal with the emotional and professional pressures of the reality of the work.

13. WY-FI is funded for 6 years, so we are nearly halfway through
WY-FI is funded for 6 years, so we are nearly halfway through. Our focus is on the legacy of the funding, which is about how we ensure systems are better, peoples lives are better, and people are more involved, within West Yorkshire. The spirit of this is our general focus for the programme and so its vital we are considering how we ensure systems change actually happens. It is important that locally and nationally, there is a common understanding of what ‘systems change’ means in order to have an action plan to work to
This is then taken forward in two ways;
Nationally – evaluations are being carried out, shared and developed in order to provide the basis for a legacy. This is not something that we can do alone, nor is something we should do in the final years. This is something we (as a programme ) and local areas need to be doing now. The SCAN, local and national evaluations are being used to build links with policy makers and beyond in order to achieve a long lasting impact. Its too early to determine the success of this however needs to be adopted by everyone within partnerships, within delivery and within the programme in order to lead to better opportunities for people with multiple needs in the future.
Locally, areas are expected to develop systems change plans which should aim to go beyond the funding life. Sustainability of changes which are made now is crucial. So what does it mean to you? Whats your part in bringing about this change? Who can you bring on this journey? And this is where I will leave it – with a challenge to you all to consider how you can support WY-FI to make things better to achieve our overriding ambitions to change lives, change systems and involve people,