Breaking boundaries: Towards a ‘Troubled Lives’ programme for people facing multiple and complex needs
Successive governments have promised to tackle the ‘root causes’ of social and economic disadvantage. Yet public spending on individuals experiencing problems
such as addiction, homelessness, offending and poor mental health is still largely reactive, funding expensive crisis care services rather than coordinated and preventative support.
In its final budget statement in 2015, the Coalition government committed to carrying out an assessment of how to reduce the estimated £4.3 billion spent on ‘troubled individuals’ struggling with homelessness, addiction and mental health problems, ahead of the next spending review (HM Treasury 2015a). The new Conservative government is now actively considering the case for extending the Troubled Families programme to these individuals as part of their preparations for that spending review.
The Troubled Families programme has been successful in pioneering integrated support and in producing savings by reducing demand for crisis-led services, for example in Greater Manchester and Oldham. A relatively small pot of central funding has generated additional financial commitments from local areas and galvanised agencies to set up local ‘invest to save’ partnerships.
However, there are several aspects of the model that could be improved. Specifically, the programme relies upon an individual-based payment-by-results (PbR) scheme to reward success. Evidence suggests that the effectiveness of PbR schemes is mixed for those with multiple and complex needs, although this could be mediated by using incremental area-based outcomes. In addition, nationally defined criteria could be made more flexible to allow for local areas to define their target groups in order to ensure that no individuals are left behind.
We recommend that, alongside an expanded Troubled Families programme, the government should create a new ‘Troubled Lives’ programme, based upon similar principles. While the Troubled Families programme is aimed at coordinating support for workless families with problems of crime and antisocial behaviour and truancy, Troubled Lives would be targeted at approximately a quarter of a million individuals who experience two or more of the following problems: homelessness, substance misuse and reoffending. Instead of the PbR element of the programme being linked to achieving individual-level outcomes, it should be linked to area-level outcomes: upper-tier local authorities should be required to show reduced demand for expensive crisis care services after one year of the programme. This approach would
help to improve the lives of some of the most excluded people in society, support the integration of local services, and reform poorly targeted spending.