Reviewing previous reforms to public services for socially excluded groups, this report makes the case for a locally-led and coordinated programme to support people with multiple and complex needs.

While successive governments have promised to tackle the ‘root causes’ of social and economic disadvantage, public spending on individuals experiencing problems such as addiction, homelessness, offending and poor mental health is still largely reactive – funding expensive crisis care services rather than coordinated and preventative support.

At a time when rising numbers of people are becoming socially excluded, the government is committed to finding ways to reduce the estimated £4.3 billion spent on ‘troubled individuals’ struggling with homelessness, addiction and mental health problem. The taxpayer is indeed meeting unnecessary costs as the result of spending that is focussed on expensive crisis care services, rather than on coordinated and preventative support that would deliver better results as well as value for money. Savings cannot be made, and outcomes cannot be improved, unless action is taken to reform the services that vulnerable and disadvantaged people rely on.

Because services are set up to deal with single issues such as drug or alcohol misuse, homelessness or mental health, rather than addressing the various needs of the individual, multiple professionals are often working with the same person. The successful Troubled Families programme was developed precisely to address this problem. However, there is no framework for disadvantaged adults who do not meet the programme’s criteria.

In this report we examine what lessons can be learned from the successes and failures of previous attempts to reform public services for disadvantaged individuals. We review several decades' worth of reform to provide a range of insights to learn from and build on in formulating new policy approaches. Based on these lessons, we recommend that at the next spending review, the government chooses multiple and complex needs as one of a small number of priority issues for investment in local integration and service transformation. A new 'Troubled Lives' programme, based on the Troubled Families model of centrally driven but locally led reform for vulnerable groups, should be established, focussed on approximately a quarter of a million individuals who experience two or more of the following problems: homelessness, substance misuse and offending.