1. Multiple needs: meeting the challenge
A mid-point review of Opportunity Nottingham

2. Three challenges… The Beneficiary challenge The system challenge
How far have we got in transforming the lives of people with multiple and complex needs?
The system challenge
How far has the system changed in response?
The legacy challenge
What will Opportunity Nottingham bequeath to future generations?

3. What are the benefits of engagement?
343 Beneficiaries by March 2018 (233)
10% have left no longer needing support (6%)
19% have disengaged (15%)
Of Beneficiaries recruited since June 2016;
32% women (24%)
28% BME (19%)
73% with improved Outcomes Star score (63%)
Beneficiaries still engaged at the end of 2017 had made more progress than those who had disengaged.

4. What makes for successful engagement?
Those who make most progress are;
Consistently willing to work with their PDCs
Motivated by the desire to recover lost relationships
Motivated by opportunities to give something back.
The PDC model that works involves;
Persistence, commitment and not giving up in the face of repeated set-backs
I think it’s being persistent with them. If they disengage with you for a few weeks, then not giving up, because a lot of other services would have breached them or discharged them, given up on them. But we’re like, OK I’ll speak to you in a week. Don’t get rid of us very easily.
Motivating Beneficiaries through positive reinforcement
Start providing that positive reassurance … So for example if somebody is trying to re-engage with substance misuse services, if you sit with them and get them to make that appointment with them. … Reiterate the fact that you’ve done really well making that first step in trying to address the issues. It’s that positive reinforcing their goal and making sure they are doing well.

5. What are the financial benefits (1)?
Beneficiaries leaving the project with a positive outcome achieved an average cost saving of £12,185

6. What are the financial benefits (2)?

7. How are Beneficiaries further empowered (1)?
Peer Research
Steering Group membership
Interviewing
Transcript analysis
Presentation of findings.
Peer mentoring
Average Outcomes Star scores increased by 34
Access to positive social networks
Combatting social isolation
Sharing the effects of lived experience
Better engagement with services.

8. How are Beneficiaries further empowered (2)?
The Expert Citizens Group have;
Expressed a ‘user voice’ to national policy-makers through the National ECG
Participated in training workshops
Raised awareness around multiple needs
Influenced system change through the development of ‘The Pledge’ and ‘Facts About Me’ form.
The ECG has given Beneficiaries;
New opportunities (Peer Research)
Peer support
A sense of being heard by policy-makers.

9. How do we become more inclusive?
Barriers to BME engagement:
Fear of not being understood
Stigma and shame within BME communities
Unfamiliarity with the language of MCN.
BME recruitment increased from 19% to 28%
The key to AWAAZ’s success;
Assertive Outreach Workers familiar with different cultures to build links and rapport
Person directed assessments
Provision of a safe place free of institutional racism.

10. How do we plan for system change?
Of 64 actions, only a quarter fully achieved, with half partially completed
Austerity has impeded access, especially for those outside pre-defined categories
Agencies unwilling to cede control of information systems
Some progress towards person-centred services through adoption of The Pledge.
The revised system change plan includes five challenges;
The system works as one
Services are welcoming
The system is service user led or informed
Building resilience in service users and the workforce
Multiple needs are recognised and understood.

11. Do partners work together?
How well is collaboration working at commissioning level?
No enthusiasm for shared risk taking in a climate of austerity
Poor sharing of data.
But Opportunity Nottingham can…
Set an example in outcome based commissioning
Be at the table in inter-agency forums
Maximise knowledge sharing through the PDU.

12. Does the system work for persistent rough sleepers?
Persistent rough sleepers who are Beneficiaries make slower progress in their Outcomes Star scores and are more likely to have;
All four complex needs (66% cf 53%)
Spent at least two weeks in prison (32% cf 17%)
Experienced at least one eviction (42% cf 25%)
Been excluded from a service (42% cf 16%)
Systemic factors, for example;
Lack of affordable housing
Prison discharge to NFA
Homelessness regulations
Beneficiaries with support from MNTS show more extensive progress than rough sleepers generally

13. Does the system work for prisoners?
Beneficiaries who have spent time in prison show more limited progress, with an Outcomes Star score that is 11 points less.
Beneficiaries reported violence, self-harm and worsening drug and mental health problems through being in prison.
Release was frequently unplanned, resulting in discharge to ‘no fixed abode’, with housing services unable to help.
However, with a PDC, Beneficiaries were;
Visited in prison
Sometimes met on discharge
With pre-arranged accommodation.

14. Does the system work for people with mental health problems (1)?
Three quarters of the single homeless population have a mental health condition (cf a sixth)
One fifth have been sectioned under the Mental Health Act (cf 0.1%)
Correlation with offending and substance misuse makes them an MCN population
Half this population did not receive the assessment, treatment or support they need;
Lengthy waiting lists for appointments
Exclusion for drug and alcohol use
Failure to meet rising access thresholds.

15. Does the system work for people with mental health problems (2)?

16. Does the system work for people with drug problems?
In 2017, 33% of current Beneficiaries were users of ‘new psychoactive substances’. They were;
3 times as likely to be arrested
2½ times as likely to attend A&E
2½ times as likely to attend community mental health services
Made less progress by Outcome Star scores.
Systemic issues with NPS use;
Poor service engagement due to effects of NPS
Drug services good in providing information
Active support more limited.

17. What will Opportunity Nottingham’s legacy be?
The Practice Development Unit.
Of workshop participants;
76% more confident addressing topic discussed
59% planning to share learning with colleagues
Many already making changes to working practices
78% of participants from the voluntary sector.
The Wellbeing Hub

18. Some questions remain…
What will happen to Beneficiaries still on the project at the end of year eight?
What support will be available when Opportunity Nottingham stops taking referrals?
How can there be investment in ‘what works’ at a time of austerity?
If the City invests in successor support, what will the resulting service look like?