On 30th November 2016 a veritable horde of Opportunity Nottingham crew members and partners (ok – ten of us) descended on the University of Birmingham to deliver a presentation on the importance of engagement in working with people with multiple and complex needs (MCN).
People with multiple and complex needs experience at least two of the following:
- substance misuse;
- mental ill-health;
- offending (including victims of domestic violence).
People with MCN can bounce from one service to another, as providers typically focus on single aspects of a person, often offering conflicting views. For instance, in ‘dual diagnosis’ cases, mental health services may refuse to work with someone until they have ceased using substances, whilst substance-misuse services refuse to work with them until they have engaged with mental health services.
Opportunity Nottingham (ON) is a partnership of voluntary and statutory services which is aiming to approach this problem differently. Its key objectives are to empower and support people with multiple and complex needs, to make front line services more effective by listening to what beneficiaries want; and to generate positive ‘system change’ at strategic and commissioning level.
System change is a long and difficult process, and one at the very core of Opportunity Nottingham’s ‘Fulfilling Lives’ programme. It operates on the premise that incorporating potential service users’ views at every level of service creation and delivery ensures a more person-centred outcome, and encourages people to engage more willingly over time. Country-wide (and perhaps one day, world-wide) services can achieve better outcomes over time through a ‘bottom up’ change process.
Opportunity Nottingham places a huge emphasis on the importance of constant and persistent engagement with beneficiaries, over an extended period, on the beneficiaries’ terms and at their own pace, with positive results. We do this in a variety of ways.
At the start of the project, ON focussed on going to where potential beneficiaries might be found, including hostels and day centres. Over time we adopted a gently persistent approach, also respecting some individuals’ wishes not to be involved. We developed structures for engagement, including ‘Expert Citizens’ who have been beneficiaries of the service and are in a place of stability, where they can feed back; ‘Beneficiary Ambassadors’, who have lived experience of MCN, and are heavily involved in helping to deliver system change; Personal Development Co-ordinators, the frontline staff working with beneficiaries to help them achieve their goals; and SEA (Services for Empowerment and Advocacy), a partner agency who have been integral to the design and development of Opportunity Nottingham.
Empirical evidence, two years into the project, shows that beneficiaries’ quality of life has improved. The “distance travelled” by beneficiaries is measured on an ‘outcomes star’, using a scale of 1 to 10 in ten key areas of life (a high score is good). This process is completed every 6 months, facilitated by a member of staff. Whilst some months there is no progress, or even regression, overall the project has recorded positive changes. Additionally costs to services (court, emergency services etc.) have decreased.
Sandra, one of our Beneficiary Ambassadors used her own life story as a powerful example. Having been a service user at the start of the project, she is now employed full-time, and has spoken to the House of Lords on the importance of system change. Former beneficiaries of Opportunity Nottingham have also spoken to managers and chairs of boards about their first-hand experiences of services, and what works or does not work.
So, why is it important we discuss the benefits of engagement with as many people as possible?
It shows a different way of working – services have typically been inflexible, expecting service users to engage at a set pace, for a set period of time, and within the boundaries of that service’s rules. Opportunity Nottingham recognises that there is no ‘one-size-fits-all’ approach when working with individuals, and does not place a time limit on engaging with beneficiaries. We also aim to raise the profile of people with MCN, an excluded group that rarely feature in public policy.
We had some excellent input and feedback from INLOGOV students throughout, who really seemed to value the chance to talk to people with lived experience, and to compare the theory of engagement with the reality. Many thanks to the University of Birmingham for letting us run our session for the INLOGOV Public Policy module – we hope to have planted the seed of system change and bottom-up co-production into the minds of those who’ll be involved in shaping public policy for many years to come!
Suzie Tanney is a Personal Development Co-ordinator at Opportunity Nottingham and has been working with people who have multiple and complex needs for 3 years.