As part of the Public Sector Reform Component of the Devolution Deal, there is a desire amongst partners within the North East of England to understand what can be done to support people with multiple and complex needs (MCNs). This highly vulnerable population is generally defined by their experience of several overlapping problems, such as mental ill-health, homelessness or very poor housing, substance misuse, domestic abuse, and involvement with the criminal justice system. They tend to fall through gaps between services because no-one takes overall responsibility for helping to break the cycle they are in. People with MCNs can find themselves in a downward spiral and experience poverty, stigma, discrimination, early morbidity and mortality. This significant individual impact is exacerbated by impacts on family, friends, communities and services.

People with MCNs rely heavily on reactive services and responses, such as crisis welfare support, temporary housing, emergency care, neighbourhood policing, safeguarding response and social care. These responses are rarely co-ordinated or designed to work with an individual collectively, moving them to a more stable situation. People with MCNs may also have needs below the threshold for support from key agencies, meaning that sustained and personalised support is not available. The project described in this report arose from a desire to identify evidence-based solutions to these problems. The aim was to provide answers to the following questions:

• How can we clearly define MCNs?

• What is the best evidence available on the effectiveness and cost-effectiveness of approaches to working with people with MCNs in the UK?

• How might this evidence be used to inform efforts within the North East region to work differently in order to better meet the needs of people with MCNs?

These questions have been answered primarily through a scoping review of published and grey literature on interventions, programmes, services or approaches to working with people with MCNs. Local policy, practice and academic partners were also consulted (through an online survey and one-to-one conversations) as part of efforts to identify relevant literature and develop a shared understanding of the term ‘multiple and complex needs’. The outcomes of these activities are detailed in the remainder of this report.