Survey reveals impact of welfare and commissioning reforms on people with multiple needs

DrugScope – together with its partners in the Making Every Adult Matter coalition, Clinks, Homeless Link and Mind – is running a two-year project called Voices from the Frontline. It starts with a theory and a conviction. 

The theory is that people experiencing multiple needs and exclusions – those who have a combination of problems including mental health, substance misuse, homelessness and offending – may be disproportionately affected by reforms to welfare and the commissioning of public services. 

To test this, over the last month we surveyed members of the MEAM coalition partners. Over 140 organisations participated, between them representing as many as 70,000 individuals. The results provide strong evidence that people with multiple needs are losing out from recent reforms. However, they can only give us a partial picture of what’s happening. 

This brings me to the conviction. If we want to understand the problems that people with multiple needs are facing, we need to involve them in that discussion. That also goes for the practitioners who support them, who can help us link local circumstances with the national picture. Voices from the Frontline aims to make this happen and this data is helping map out the territory. 

So, what did we find – and what does it suggest should be on the agenda? 

Welfare reforms are having an overwhelmingly negative effect on people with multiple needs.

This doesn’t come as much of a surprise – there’s plenty of evidence that welfare reforms have hit the most vulnerable hardest – but our data provides useful detail. We asked services to assess how many of their clients with multiple needs are affected by various changes to the welfare system:

Clearly, of all the reforms to welfare, strengthening of sanctions has had the biggest impact on people with multiple needs. Since 2012, heavier penalties have been placed on those claiming Jobseeker’s Allowance (JSA) and Employment Support Allowance (ESA) (which supports people unable to work due to illness or disability). Four out of five services reported that more than half of their clients with multiple needs had been affected by the new regime. This reinforces evidence from Homeless Link that sanctions are having a serious affect on people with complex problems. Changes to Work Capability Assessments – which determine eligibility for ESA – are also having a widespread impact.

Alongside this, cuts to legal aid and advice are heavily affecting people with multiple needs. Breaking this down by sector, services working on criminal justice and homelessness issues reported more of their clients with multiple needs being affected. It may be that reduced access to legal support complicates difficulties caused by other reforms – for instance, appeals against benefits decisions – and this is something we want to look at more closely.

Changes to commissioning structures are having a mixed and uncertain impact.

We also asked services to assess the effect that various changes to commissioning – the processes through which they access public funding – were having on multiple needs clients. The clearest finding was that the end of ring-fenced funding for Supporting People is having an overwhelmingly negative impact on people with multiple needs:

Supporting People is a national programme of funding for housing-related support, aimed at helping people live independently. Since 2012, local authorities have been able to spend this allocation as they wish, and many have opted to cut services that had previously been funded from it. These decisions – taken against the advice of the then Housing Minister Grant Shapps – are clearly disadvantaging people with multiple needs.

In general, though, commissioning changes present a mixed picture. For instance, services were guardedly positive about the introduction of Police and Crime Commissioners and Health and Wellbeing Boards. On other reforms yet to take hold – Transforming Rehabilitation, for example, which is reforming the management and rehabilitation of offenders – they reserved judgment. And when asked about the cumulative impact of all the recent reforms, their responses were negative, but not overwhelmingly so:

What does this all add up to?

This ambivalence about the impact of the (often very complex) changes to commissioning structures highlights a wider truth about these results. Although we should be concerned about the impact of individual reforms, it’s more important to understand how they interact. People with multiple needs present a challenge for policymakers, because their problems tend to cut across different services, making them particularly vulnerable to the combined effects of reform.

We’ll be publishing a full report on the survey results next month – and over the next year, we’ll use these findings as the basis of discussions with service users and practitioners across the country. We’re confident that their insights can help policymakers to design systems that improve and don’t disadvantage, the people who need them most.

Sam Thomas is the programme manager for Voices from the Frontline, leading a joint team across Clinks, DrugScope, Homeless Link and Mind. If you’re interested in being part of this work, or would like to find out more, email samt@drugscope.org.uk.