'Adults with complex needs' is not a defined clinical group but encompasses any adult needing a high level of support with many aspects of their daily life who relies on a range of health and social care services. These needs for support may result from illness, disability, broader life circumstances or any combination of these. Complex needs may be present from birth or may develop over the course of a person's life and may fluctuate. The nature of these needs, and the way society is organised to respond to them, means adults with complex needs often face multiple challenges to living as they would wish and accessing support when it is needed. They are consequently vulnerable to preventable secondary conditions and premature mortality.
Social workers are one of the main professional groups who support adults with complex needs. They do this in a range of settings, on a long- or short-term basis. Their responsibilities include facilitating the local authority's duty to conduct needs assessments under the Care Act 2014. They also work with individuals and families to address identified needs, effect change and organise support. Social workers can help people with practical, social and interpersonal difficulties, and promote human rights and wellbeing.
There are about 100,000 social workers registered in England in 2021, according to the Social work in England: emerging themes report by Social Work England. Most commonly they are employed in local authority social care settings, but also in health and voluntary sector services. As well as providing care directly, social workers have a key role in organising support from the wider social care sector and other agencies. They work in a challenging context. The King's Fund Social care 360 report in 2021 describes a rising demand for social care, but a reduction in how many people are receiving care, and that social care funding levels have only just returned to 2010 to 2011 levels, after a decade of lower real-terms investment. The Care Quality Commission State of Care report for 2019/20 reports that the quality of social care received by most people was good overall. However, it noted regional variation in access to and quality of care, the need for better integration and joined-up care between services, and that the COVID-19 pandemic is 'having a disproportionate effect on some groups of people, and is shining a light on existing inequality in the health and social care system'.
In this context, it is vital that the organisation and delivery of social work is informed by the best available evidence about effective ways of working. The Chief Social Worker for Adults' annual report: 2018 to 2019 acknowledges evidence gaps for social work, setting as priorities knowing what works and developing a better evidence base for social work practice.
This guideline was commissioned by the Department of Health and Social Care to meet this need and develop evidence-based recommendations for social work for adults with complex needs. The guideline was developed by a guideline committee following a detailed review of the evidence. It covers assessment and care management or support which is delivered by or led by social workers. It seeks to provide recommendations which are generalisable to the whole population of adults with complex needs. This guideline is for social workers, and organisations which employ social workers or commission social work services. It is also relevant for adults with complex needs and their involved family and informal carers, and for other professionals who work with social workers in supporting adults with complex needs.
Adults with complex needs are defined as people aged 18 or over who need a high level of support with many aspects of their daily life, and relying on a range of health and social care services. This may be because of illness, disability, broader life circumstances or a combination of these. Complex needs may be present from birth or develop over the course of a person's life, and may fluctuate. Unless otherwise specified, when a recommendation refers to 'people' or 'the person', this is the adult with complex needs.
This guideline does not replace statutory duties and good practice as set out in relevant legislation and guidance, including:
This guideline aims to complement legislation and guidance by providing evidence-based recommendations about how social work interventions including assessment, care management and support for adults with complex needs could be improved. Actions already required by law, or recommended in statutory guidance, are not replicated here unless there was evidence to suggest that these are not implemented consistently in practice, or there was a need to emphasise specific points relevant to social work interventions including assessment, care management and support for adults with complex needs. NICE guidelines cover health and care in England and therefore focus on English legislation. Other UK countries have to follow legislation from the Welsh Government, Scottish Government, and Northern Ireland Executive.