Care and support for people with complex and severe needs: innovations and practice. A scoping study

Project: Research project (funded)Research

Project Details


This scoping study identified:
- key features of the service and support arrangements desired by different groups of disabled adults and older people with severe and complex needs
- evidence of initiatives to deliver support to disabled people with complex and severe needs that had the desired features and the potential to constitute examples of ‘good practice’. Methods

The study involved:
- interviews and focus groups with key stakeholders, including people with complex needs and their carers, on the desired features of good support and service arrangements
- a review of recent published and grey research on relevant service developments and initiatives
- case studies of ten examples of good practice in service provision or commissioning, identified through the above two stages.

The study aimed to generate evidence to inform social care practice in commissioning and providing support to people with complex and severe needs, in accordance with those service features that are highly valued by users and carers themselves. There was a particular focus on the role of social care in co-ordinating or collaborating with other providers over the commissioning, organisation and delivery of services; and on identifying examples of good practice that have the potential to be transferable to other similar groups of service users. Summaries of the study findings were disseminated widely to all English adult social care departments, NHS primary care trusts and relevant voluntary sector organisations. The results of the study were also disseminated through NIHR School for Social Care Research knowledge transfer activities.

Research findings
This project is now complete and publications from it are available on the SPRU website

Layman's description

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. We also identified examples
of potential good practice and make recommendations
for future evaluation.

Key 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.

Short titleGood support for people with complex needs
Effective start/end date1/06/1029/02/12


  • H Social Sciences (General)