Complex and severe needs

Introduction

The population of adult social care users is changing. Advances in medicine are enabling more children with life-threatening conditions to live into adulthood, more adults to survive major injuries or illnesses with on-going needs, and growing numbers of older people to live longer, often with long-term conditions. These developments present new challenges for adult social care and require new responses.

Objectives

This study aimed to scope the evidence on good practice in social care for disabled and older people with severe and complex needs, and to find out what this group consider to be key features of good support. The study also aimed to identify examples of potential good practice and make recommendations for future evaluation.

Methods

The study was conducted between June 2010 and February 2012 and had three stages:

1. Consultation with people with severe and complex needs, their carers and members of specialist organisations
2. Identification of service examples that demonstrate key features of good practice
3. A scoping review of the UK literature (published and ‘grey’) available since 1997 on good practice in social care for people with severe and complex needs. Studies were grouped by quality.

Findings

• People with complex needs (and those close to them) emphasise the importance of individually tailored support and value a range of person-centred approaches to social care. Good support requires staff to have the time, and services the flexibility, to respond to each individual’s unique needs and preferences. Support should be holistic, addressing social and emotional, not just personal care, needs
• People with complex needs value support through the way services are organised as well as at an individual level. There were strong arguments, for example, in favour of dedicated
  key workers and case managers to facilitate access to disparate services and coordinate support across sectors and boundaries. Participants wanted key workers to have expert knowledge and the skills to navigate complex service and funding systems
• A scoping review of UK literature found many publications advocating person-centred support, covering a wide range of approaches, but no robust evidence to support any specific model
• Some promising evidence was found on the effectiveness of four ways of organizing services for people with complex needs: multidisciplinary specialist teams; intensive case management; specialist social work; and inter-professional training
• Overall, the review found a dearth of evidence about the outcomes and costs of models of social care considered to be good practice for people with complex needs
• Several examples of services and support arrangements were identified that appeared to illustrate key features of good practice, but none of these had been formally evaluated
• There is an urgent need for rigorous evaluation of models of support for people with severe and complex needs.