Social work with adults experiencing complex needs

Resource impact summary report

This guideline covers the planning, delivery and review of social work interventions for adults who have complex needs. It promotes ways for social workers, allied health professionals and people with complex needs to work together to make decisions about care and support. It includes recommendations on needs and risk assessments, escalation of need, future planning, individual and family casework and helping people with complex needs to connect with their communities.

The guideline recommendations reflect current legislation and/or current best practice and aim to make best practice more consistent across the country. However, experts suggest that various aspects of the guideline recommendations do not reflect current practice in some local areas across the country.

The Care Quality Commission’s State of Care Report 2019/20, the Care Quality Commission’s State of Care Report 2020/21 and The King’s Fund Social Care 360 report in 2021 also highlighted the following issues:

• regional variation in access to and quality of care, and a need for better integration and joined up care between services
• local systems and providers facing rising vacancy rates, recruitment and staff retention problems
• rising demand for social care, coupled with historical reductions to social care funding levels.

These issues may have resulted in services being stretched and not meeting current legislation and/or current best practice levels.

The following may require additional resources and result in additional costs:

• establishing integrated and joined up multidisciplinary care teams between services through shared formal agreements (including budgets and information sharing)
• developing simplified referral processes and pathways to ensure, for example, a single point of access for people with complex needs who are accessing services
• additional social workers or staff time to effectively plan, conduct and manage assessments and caseloads
• ensuring services have effective supervision structures to improve and maintain the quality of service and support to adults with complex needs
• additional social worker time to undertake continuous professional development (CPD) and interdisciplinary training, including CPD for equality and diversity issues, and multi-agency training.

The Care Quality Commission’s State of Care Report 2020/21 also highlighted that the government made a £500 million investment to support adult social care workforce where there are rising vacancy rates as social care providers struggle to attract and retain staff.

Implementation of the guideline may help to:

• reduce variation in access to care and improve quality of life for adults with complex needs
• reduce the need for ongoing support and the associated costs
• prevent expensive interventions downstream such as hospitalisation by supporting preventive community services. This would in turn create capacity benefits for secondary care.

Social work services to support adults experiencing complex needs are generally commissioned but not exclusively by local authorities. Providers are local authorities, NHS organisations and third sector organisations such as charities and community organisations.