I don’t usually provide commentary on a Chancellor’s Budget. Yet, buried in the budget fine print lie important paragraphs; these inspire confidence for all those who, like us, have been trying to address the long-standing challenges faced by the 60,000 adults who experience multiple and overlapping problems of mental ill health, substance use, homelessness (and often a record of offending) and for whom the services provided – at significant cost – rarely meet their needs.
We are all understandably pleased that the Government found space in its budget to show how it intends to provide the sort of national leadership on these issues that the Foundation and those we have been working with in the Making Every Adult Matter (MEAM) coalition have been calling for.
For five years, the Foundation was the sole funder of the MEAM programme and we are pleased that others have joined us in sustaining it. We always knew that one big challenge would lie in thinking through an “end game” – one in which the only long-term option for taking our necessarily limited interventions to every area would require both national leadership and funding at a level which is only really the preserve of central government (or the Big Lottery Fund). We lobbied the Big Lottery Fund hard when our colleagues there were designing their Fulfilling Lives programme but we failed to persuade them to scale up the MEAM approach instead securing a welcome support contract which connects MEAM to the Big Lottery’s programme and provides a small surplus for MEAM to help meet core costs which were always tight.
The Government’s Troubled Families initiative was always going to be a useful comparator: a national programme, delivered locally, with significant resources dedicated to addressing an entrenched problem with the potential of cost savings down the line. Politicians needed to be persuaded of the potential for a similar approach being applied to troubled individuals. Examples of other models for stimulating change in an environment in which decisions are largely devolved to local authorities lie in the Better Care Fund or the Prime Minister’s Challenge Fund on Dementia.
In times of austerity, we needed to make the case in cost benefit terms, which the evaluation of the pilot projects (to our relief) delivered. At the same time, the Lankellychase Foundation published its study into quantifying the problem, concluding that the numbers we are talking about are indeed the 58,000 that we had initially assumed. A failure to support these individuals effectively costs the taxpayer between £1.1bn and £2.1bn a year while recent research by MEAM has shown that better coordinated services in local areas can reduce costs by about almost a quarter.
A key recommendation lay in the IPPR’s report: The Condition of Britain, which the Foundation supported. It concluded that a future government should extend the Troubled Families programme to individual adults with multiple needs under the brand of Troubled Lives. At the same time, the Public Service Transformation had been doing its work looking at service integration and a debate in the House of Lords on the Government’s Social Justice Strategy, secured by Baroness Tyler who chairs the MEAM programme board, provided additional profile for MEAM’s work.
Building awareness at policy level has been important in exercising influence when the opportunity presented itself. And it did in the Autumn Statement in 2014 in which the government committed itself to look at the issues faced by the most vulnerable people. We seized the opportunity swiftly making contact with officials in various government departments whom we had been courting for a little while. One on one interviews with officials were conducted and a single position paper circulated setting out: the case and the learning from the MEAM approach. We hosted a dinner for these officials and further meetings with Treasury officials in particular followed. We were advised to expect a more detailed commitment in the Budget, which was published last week.
The Budget announced that the government is exploring options to integrate spending around vulnerable groups of people to improve outcomes and reduce costs. It particularly cited individuals struggling with homelessness, addiction and mental health problems and is exploring the cost effectiveness of options to integrate spending around some of the most vulnerable groups of people and designing a more integrated, multi-agency approach. We have been asked to advise the Treasury on developing options and a business case for a new Government to consider after 5 May.
So, we are poised for breakthrough as the government machine goes into purdah and officials examines the various funding models and delivery options we are presenting to them. We have yet to reach the finishing line but this has been a case study in how foundations can work with others to drive change. And the lessons have been instructive for us generally.