Inspiring initiative transforming lives of vulnerable people recognised For excellence

A pioneering initiative transforming the lives of the most vulnerable people in Nottingham as well as reducing pressure on emergency health services is up for a major award.

An estimated 8,000 people in Nottingham experience severe and multiple disadvantage (SMD) - a combination of homelessness, substance use, mental illness, domestic and sexual violence, victimisation and offending. This vulnerable population has an increased risk of chronic health problems, reduced healthy life expectancy and early death. 

Now the Nottingham City Place Based Partnership - a place based approach to improving health outcomes and reducing healthcare demand - has been shortlisted for the Integrated Care Initiative of the Year at the prestigious Health Service Journal Awards. 

The partnership offers targeted provision of intensive wrap-around support to people with the highest level of need removing the barriers that prevent access to services such as mental health or substance use treatment, and ensuring different service providers work together. 

Since July 2022, 486 people with the highest level of need have received compassionate, person-centred support. Additionally, 150 people have received coordinated support from a specialist multi-disciplinary team reserved for people in crisis, often providing lifesaving care. 

While the outcomes can be truly transformational for individuals, the return on investment for the system is also substantial. Savings in the reduction in emergency attendances and non-elective bed days alone are estimated at £4,609 per person per annum. 

People with lived experience of these complex needs are at the centre of the design and delivery of the holistic model of support. The programme has been successful in stopping the revolving door of the same services spinning for hundreds of people, helping them to recover, sustain tenancies and rebuild their lives, and reducing their reliance on emergency healthcare.

The collaborative approach continues to grow from strength to strength, with 15 statutory and voluntary sector organisations across primary, secondary, community and mental health NHS services, adult social care, housing and criminal justice involved. 

Framework is one of the original members of the Nottingham City Place-Based Partnership and plays a central role in the SMD workstream. 

Framework’s Director of Health and Social Care Apollos Clifton-Brown, who is also chair of the partnership’s SMD group, said: “There are around 8000 people experiencing severe and multiple disadvantage within Nottingham city.

"That means there are more people in Nottingham with SMD than have dementia but, until now, severe and multiple disadvantage has received far less focus as a major contributor to negative health outcomes. This is remarkable when you consider that the average life expectancy for people experiencing SMD is 45 for men and 44 for women, compared to a national average life expectancy of around 82 years.
 
“Framework is delighted to see this coordinated effort by a wide range of agencies and organisations on issues that matter most to the people we support – people with the highest levels of need, including homelessness.    
 
“The nomination of Nottingham’s Place-Based Partnership for this prestigious award is in recognition of the partnership’s commitment to tackle severe and multiple disadvantage and to adopt innovative ways of working. It has shown how things can be done differently and more effectively when system partners come together.

"Everyone involved is committed to doing things differently, giving things a try, and working outside of the normal commissioned boundaries. Crucially we start with the needs of individuals rather than expecting people with complex needs to navigate complex systems; in this approach we involve people with lived experience in the design of services and ensure that services talk to each other, so people don’t have to be continually reassessed by each agency offering support.
 
“As a registered charity delivering major public sector contracts, Framework has had an important role in bringing together statutory agencies to work alongside specialist voluntary organisations.
 
“This work on severe and multiple disadvantage has been revolutionary. We are grateful to all partners for engaging and continuing to do so. It has already had a significant impact on people’s lives, with the potential to see considerable long term benefits.

"The Nottingham SMD partnership is now county-wide, and this model of integrated working can be picked up and applied anywhere. We hope that other areas across the country will consider this learning when designing services for vulnerable people."

This innovative work is delivered primarily through the Changing Futures programme. 

Bobby Lowen, Programme Director of Changing Futures, shared his pride in the partnership. He said: “We are delighted that Nottingham’s Place Based Partnership has been recognised in the HSJ Awards for a second year running. This recognition celebrates our collaborative effort to improve how colleagues and services across the city work together to better meet the needs of people experiencing multiple disadvantage. 

“Many vulnerable and stigmatised people across communities up and down the country can be left without help that works for them when they need it the most. We are proud to be working together as a team in Nottingham to break down these barriers to make a real difference for our community.” 

The overall winner of the Integrated Care Initiative of the Year - which attracts more than 1,000 entries - will be announced at the national HSJ awards on 20th November.