Developing services that can
address the needs of people with
multiple, complex health and social
care needs is a challenge. Very
often, people with such needs
range from those who are ‘hard to
reach’ and do not engage with services, to those
who are already heavy users of services but who
experience inappropriate service responses due
to the challenging, intense or ‘revolving door’
nature of their needs.
Developing services that meet the needs of
people with multiple and complex needs is an
important issue for all service providers. However,
ensuring the sustainability of such services is also
important if they are to be effective in promoting
health and wellbeing in the longer term.
Evidence suggests that a partnership approach
between health, social care, voluntary and other
relevant agencies is the best means of providing
the type of services needed by people with
multiple and complex needs (1, 2). The continuing
development of Community Health Partnerships
(CHPs) in Scotland is expected to provide greater
opportunity for collaboration between the NHS,
social care, voluntary sector and other partners to
identify and address local need. This should provide
good opportunities for the NHS and its partners to
develop local services that are responsive to the
needs of people with multiple and complex needs.
However, what does this mean in practice? This
chapter describes the approach being taken by the
Partnerships for Access to Health (PATH) project in
the Lothian and Highland areas to explore this issue.
What is the PATH project?
The PATH project is part of the Scottish
Government’s Multiple and Complex Needs
Initiative. PATH is hosted by NHS Lothian and
undertaken in partnership with NHS Highland.
The aim of PATH is to:
“Explore how health, social care, community
justice and voluntary sector partners in local
Community Health Partnerships can work together
to develop services responsive to a wide variety of
users with multiple and complex needs.”
PATH is working with three Community
Health Partnerships (CHPs) in Lothian and
Highland, chosen to represent a range of urban
and rural areas:
Urban: Edinburgh CHP
Rural but not remote: East Lothian CHP
Rural and remote: Mid Highland CHP
PATH focuses on developing existing,
sustainable practice, not on developing new
services. While PATH is a time-limited project,
the learning from PATH will be shared with other
CHPs and service providers.
Developing services responsive to local needs
The development of services for those with
multiple and complex needs should be based
upon an awareness and understanding of
what service users want from services and the
interventions and approaches which work. PATH
has therefore reviewed the literature to answer the
What do people with multiple and complex needs want from services?
What can service providers do to improve access to services? What works and why?
We found that people with multiple and complex
needs want the following from services: simple,
quick access; a single point of access; cultural
sensitivity; a flexible approach; information
about services; support with the practicalities
of everyday life; peer support; involvement in
decision making; effective joint working and
communication between services; and greater
employment of staff from black and minority
Also identified, was the importance of
funding arrangements, training and support
for staff and addressing the disadvantages
of targets for services. The full findings of the
literature reviews are available at
PATH will be developing toolkits as a resource
for CHPs elsewhere who may wish to use the
lessons learnt from PATH to develop their own
local services. The toolkits will be available on the
PATH website from autumn 2008 onwards.
Building on existing good practice
Service development should be sustainable.
Part of the PATH process to date has involved
undertaking a rapid appraisal in each study CHP
area to identify examples of local good practice
and explore the elements of services that promote
engagement with clients who have multiple and
complex needs. The features of services that
improve engagement are summarised in Box 1.
The CHPs taking part in PATH are developing
their practice in response to locally identified
needs. Box 2 describes the approach being taken
by Edinburgh CHP to improve access to services
for those people with multiple and complex needs
who are leaving prison or are on community
disposals. These are early days for the project,
but already links are being made which, if
nothing else, have improved inter-agency
communication and understanding.
Projects to develop sustainable practice in
East Lothan and Highland will come on-stream
Addressing the needs of people with
multiple, complex health and social care
needs is a challenge for many services. To
do so in a sustainable way requires focus
on developing existing practice rather than
simply creating new services.
The development of Community Health
Partnerships in Scotland provides a good
opportunity for the NHS to work with local
partners to develop sustainable practice
within existing services that are responsive
to the needs of this client group.
The Partnerships for Access to Health
project is exploring how health, social
care, community justice and voluntary
sector partners in local CHPs can work
together to develop services that are
responsive to a wide variety of users with
multiple and complex needs. The lessons
learnt will be shared with CHPs and
service providers elsewhere.