Identifying the extent and nature of multiple complex needs in Coventry poster presentation to the West Midlands Public Health Excellence (WMPHE) Conference, March 2017 and the ESRC Centre for Knowledge, Information, Technology and Enterprise (ESRC) Seminar Series, April 2017 by Si Chun Lam, Coventry City Council.

1. Using anonymised local data from agencies,we were able to add local data to the estimates
from Hard Edges,building a better understanding of groups who may be at-risk of MCN.
In addition,anonymised row-level local data enabled us to build a picture of the risk factors
associated with MCN,for instance,locations/incidents frequently attended by the police;and the
risk factors associated with offenders.
Finally,anonymised data also allow us to create overlay maps that make visible local levels
of need and demand for services.We have mapped data from the police*,fire*,probation*;
households affected by welfare reform*;as well as the English indices of deprivation and local life
expectancy.This enables the MCN Board and partners to,for the first time,see correlations and
patterns in the need and demand for different services. *shownbelow
Si Chun Lam
Our starting point was a literature review of existing
studies locally and nationally,in particular Hard Edges:
mapping severe and multiple disadvantage by
LankellyChase Foundation & Heriot-Watt University.
Estimates from Hard Edges suggest that Coventry has
6,601 people facing severe and multiple disadvantage at
any one point,including…
We wanted to go into more detail,and understand the
local Coventry population better.To do so,we gathered
anonymised data from agencies working across the city
to understand the characteristics of people facing
MCN and gathered case studies about the lives and
experiences of people facing MCN.
Supporting People
via
1,005
Homeless
OASys
via
1,393
Offending
1,530
Substance misuse
1,211
Offend+
Subst
457
Homeless+
Subst
297
Homeless+
Offend
891 (SP)
SMD3
480 (OA)
6,601
SMD1-3
West Midlands Ambulance Service
NHS Foundation Trust
Coventry and Rugby
Clinical Commissioning Group
University Hospital
Coventry and Warwickshire
NHS Trust
120
(Sep 2016)
7,030
call-outs (Sep 2016)
1,657
(Dec 2016)
150
Aquarius(2016)
2,000
AddAction (2016)
60
older people accessing
floating support
(2016)
150
Compass (2016)
8,000
CAMHS (2016)
200
16-24 supported accommodation
(2016)
100
CAF (Sep 2016)
653
children’s social care contacts
(Apr-Sep 2016)
400
accessing
tenancy support
(2016)
311
statutorily homeless
(Apr-Sep 2016)
500
homelessness
prevented
(Apr-Sep 2016)
1,695
homelessness clients
(2015/16,up 25%)
Using a range of case studies (children's social care,
housing,fire,substance misuse,citizens advice) we are
able to map out the lives and experiences of people
facing MCN.For example,the timeline below sets out
the contacts that a couple had contact with over the
period of two years -- that is,24 different agencies.
Case studiesCharacteristics of multiple complex needs
We adopted a collaborative approach that was
iterative (findings feed into work as we go along),
minimised reporting (use of visual outputs),data-
driven (informed by but not constrained by data),hub-
and-spoke (partners undertake/lead different aspects
of work),continual sense checking of findings with
key stakeholders,and reflective (capturing and sharing
experiences).
People being supported by NPS Midlands (Coventry)
Current cases on OASys end-September 2016
Offending-related needs
The most common needs are…
needs
six
category
thinking &
behaviour
20% 99%
Frequency of needs
thinking & behaviour 119
lifestyle & associations 103
attitudes 91
relationships 83
alcohol misuse 77
Coventry Multiple Complex Needs
n=120
Low
18%
Medium
45%
High
1%
Unknown
36%
People being supported by SWM Community Rehabilitation Company
Current cases on OASys December 2016
Offending-related risks
Risk of serious harm
Coventry Multiple Complex Needs
n=1,657
OASys General reoffending Predictor
Low
29%
Medium
17%High
7%
Very High
2%
Unknown
45%
Coventry repeat demand data from West Midlands Police
Incidents recorded and police call-outs in September 2016
Frequent callers
Coventry Multiple Complex Needs
n=7,030
5,372 incidents with phone numbers
52 numbers responsible for five or
more calls totalling 419 calls
12 numbers responsible for ten or
more calls totalling 177 calls
54 calls from
four homes
37 calls from
the Council
16 calls from
the bus garage
⛽38 calls about
bilkings
28 from homes
for children
10 calls from a
special school
What we did
In 2016,Coventry’s health and wellbeing board made
improving outcomes for individual facing multiple
complex needs one of its three priorities for 2016-19.In
addition,troubled individuals became part of the public
sector reform programme for theWest Midlands
CombinedAuthority.We established a multi-agency
multiple complex needs board in Coventry.The board is
identifying the extent and nature of MCN in the city and
modelling costs and outcomes (research work stream)
and looking at how services and support can be
redesigned around the needs of people at risk of and/or
facing MCN (transformation work stream).
Background
Individuals facing multiple complex needs (MCN) are
people who experience several problems at the same
time,often face ineffective contact with services,and live
chaotic lives.This can be a combination of offending
behaviour/violence,homelessness,substance misuse,
mental ill-health,or adverse childhood experiences.
What are multiple complex needs? How we did it
Despite the disproportionate time and resources spent
across different services such as social care,housing and
homelessness,police,fire,NHS,criminal justice,
probation and substance misuse services,outcomes for
people facing MCN are poor.To services,they are a
significant source of repeat demand for public services
and are amongst the‘hardest to help’.To improve
outcomes for people facing MCN,we need to
understand the what,who,where,when,how and why.
By understanding the issues,we can manage it better
and see the problem through a different lens to achieve
a common understanding and a shared solution.
The case for change
SiChunLam· InsightTeam ·Coventry City Council
April2017·SiChun.Lam@coventry.gov.uk
We now have a range of data about the characteristics
of people facing multiple complex needs,and case
studies about the lives and experiences of people facing
MCN.With this,we have gained a more granular and
comprehensive understanding of the lives and
experiences of people facing MCN in Coventry.In
addition,data and maps enable us to illustrate how risk
factors correlate and relate to each other.
Our intention now is to combine data and case studies
to build stories about the lives and experiences of
people facing MCN.We will do so by jointly identifying
people,and locations that disproportionate affect our
services where a different model could save us all time,
money and resources to improve outcomes for this
group of people – and use this as a basis for improving
the whole system.
So what? Next steps…
11/17/14 2/25/15 6/5/15 9/13/15 12/22/15 3/31/16 7/9/16 10/17/16
Sherbourne Fields– Training/Public
Evolution 3– Training/Voluntary
Hospital/GP/NHS– Health/Public
West Midlands Police– Police/Public
West Midlands Fire Service– Fire/Public
Foodbank– Food/Voluntary
Cyrenians– Housing/Voluntary
Valley House– Housing/Voluntary
Placements Team– Housing/Public
Salvation Army Lifehouse– Housing/Voluntary
The Foyer– Housing/Voluntary
St Basil– Housing/Voluntary
Whitefriars Housing/Caradoc Court– Housing/Public
Housing Benefits– Housing/Public
Social Care (Children's, Adults, All Ages Disability, MASH, CLDT)– Social/Public
Newfield Trust– Money/Voluntary
Concentrix– Money/Private
Royal Bank of Scotland– Money/Private
Severn Trent Water Big Difference Scheme– Money/Voluntary
Justice System (Courts)– Money/Public
DWP / Job Centre Plus (Benefits including JSA, ESA, IS, PIP)– Money/Public
Coventry Law Centre– Advice/Voluntary
Grapevine– Advice/Voluntary
Citizens Advice Bureau (CAB)– Advice/Voluntary
2014 2016
AGENCIES
Identifying the extent and nature of multiple complex needs in Coventry
www.coventry.gov.uk/hwbb/