North Yorkshire Council
Care & Independence Overview & Scrutiny Committee
20th April 2026
Complex Care Update
Report of the Corporate Director for Health & Adult Services
1.0 Purpose of Report
1.1 To provide an update on three major programmes of work within Health & Adult Services: Complex Decision-Making Research, Trauma Informed Practice, and Multiple Disadvantage.
2.0 Summary
2.1 This report summarises progress across three interconnected areas of service transformation:
i. A collaborative research project focused on improving complex decision-making,
ii. The directorate-wide Trauma Informed Practice program
iii. The development of new support models for people experiencing multiple disadvantages.
3.0 Background
3.1 North Yorkshire Council continues to develop strategic programmes to strengthen practice, improve decision-making, and support people with complex needs. These programmes reflect national priorities and local commitments to improving outcomes for adults with care and support needs.
4.0 Complex Decision-Making Research
4.1 North Yorkshire Council, University of Surrey and King’s College London are together completing a collaborative research project. The purpose is to develop North Yorkshire Council policy and principles on working with complexity, identified as a key priority improvement area for adult social care. The research project started in Autumn 2024 and is due to be completed by Autumn 2026. It involves North Yorkshire Council adult social care policymakers and practitioners including but not limited to registered social workers. Cognitive psychology and legal expertise are provided by the University of Surrey, King’s College London and 39 Essex Chambers.
4.2 Multiple workshops have been held with practitioners, both in-person and online to develop a tool which strengthens practitioners’ ability to make complex decisions. The tool, which includes legal prompts, helps practitioners when need to manage complex situations where there are conflicting perspectives and high risks. A pilot group is currently using and testing the tool, with a training programme commencing in April 2026 for the next cohort of Advanced Practitioners and Practice Leads to use the tool. The tool should be ready to launch for the adult social care workforce to use in September 2026. There is regional and national interest from other Local Authorities to adopt the tool to support their complex decision-making.
5.0 Trauma Informed Practice
5.1 Health and Adult Services made a formal commitment in 2024 to become a trauma‑informed organisation, recognising this as a key approach to reducing the long‑term negative impacts of trauma across the life course. HAS has since initiated a transformational programme, working in partnership with colleagues in Housing and Community Safety, to embed trauma‑informed principles across all directorates involved.
5.2 Collectively the services have adopted the UK Government’s working definition of trauma‑informed practice and have proactively engaged with neighbouring councils, joined both local and national networks, and established collaborative partnerships with colleagues in Health. These activities are enabling us to deepen our understanding and shape the actions required to progress this work effectively.
5.3 The organisation is also learning from and sharing best practice with our colleagues in Children and Young People’s Services, across both social care and the NHS. Our programme is informed and inspired by the Children and Young People’s Trauma Informed Care Programme, part of the Humber and North Yorkshire Health and Care Partnership.
5.4 The transformational programme is structured around four progressive stages:
i. Trauma Aware
ii. Trauma Sensitive
iii. Trauma Responsive
iv. Trauma Informed
5.5 It is anticipated that achieving full trauma‑informed status will take approximately eight years. This timeline reflects the breadth and depth of change required, as becoming trauma‑informed influences every aspect of service delivery, including approaches to supporting both the workforce and the people who access services.
5.6 Significant progress has already been made in Phase 1 of the implementation journey, and preparations are underway to transition into Phase 2. A dedicated delivery group has been established to lead and coordinate this work. Representatives from Health and Adult Services, Housing, Community Safety, and Training and Learning meet monthly to review progress, agree priorities, and coordinate actions.
5.7 Phase 1 has focused on delivering Trauma‑Aware Leadership and Management training, which has been in place since April 2025. To date, approximately 200 leaders and managers have either completed or booked onto the in‑person, two‑half‑day training sessions. The objective is for all leaders and managers to complete the programme by September 2026. In addition, the entire workforce has been encouraged to access the eight‑minute e‑learning module, *Opening Doors: Trauma‑Informed Practice*, which provides an introduction to trauma‑informed approaches.
5.8 A key next step involves rolling out broader training to all Health and Adult Services staff. This programme is scheduled to begin in Autumn 2026 and is expected to take approximately three years to complete, reflecting the size and diversity of the workforce.
5.9 Operational teams have also reviewed the trauma‑informed toolkit and completed the Phase 1 self‑assessment. This process highlights current strengths and identifies areas for further development. The completed self‑assessments have been collated and analysed to inform action plans that will support teams as they move into Phase 2. These assessments will be reviewed annually to track progress and demonstrate the emerging impact of trauma‑informed practice.
5.10 A central element of this programme is the prevention of vicarious trauma, compassion fatigue, and burnout among the workforce, ensuring staff are appropriately supported. Staff continue to be encouraged to access support through the Employee Assist Programme, and future action plans will incorporate practical measures to mitigate burnout, alongside opportunities for reflection and mutual support through supervision and team discussions.
6.0 Multiple Disadvantages
6.1 The new Intensive Support Team (IST) was launched on 5 January 2026 within Health and Adult Services. The IST provides support to individuals with high levels of need who are experiencing multiple disadvantage, co‑occurring wellbeing needs and who require specialist, intensive intervention. Identification of the cohort is based on presenting need rather than diagnosis. In addition, the team offers long‑arm supervision, guidance and support to other teams working with individuals who require specialist preventative intervention to avoid crisis, or who are already experiencing crisis.
6.2 The IST operates across the areas of crisis intervention, emotional distress, substance use, homelessness, forensics, learning disability and mental health. Since its launch, social workers within the IST have been actively supporting individuals facing multiple disadvantage, working jointly with partners such as Housing, North Yorkshire Horizons, Harrogate Homeless Project and REACH. The next stage of development will see Multi‑Disadvantage Outreach Model (MDOM) workers join the team across both Harrogate and Scarborough from April 2026.
6.3 Health and Adult Services has identified the need for a robust multi‑disciplinary and multi‑agency meeting framework to ensure effective support for people with complex needs and multiple disadvantages. A “Team Around the Person” approach has been explored. In 2024, research and a dedicated workshop were undertaken to review existing arrangements across North Yorkshire, as well as regional and national best practice, in order to develop Terms of Reference for Multi‑Agency Team Around the Person (MATAP) meetings. MATAPs are senior‑led multi‑agency meetings in which representatives from each organisation with the authority to commit resources participate in coordinated safety planning and decision‑making for individuals with complex needs and multiple disadvantages.
6.4 Learning from this work identified opportunities to improve consistency. It was acknowledged that a range of single‑agency and multi‑agency forums already operate across North Yorkshire, including Multi‑Agency Problem Solving (MAPS) meetings. As the programme and organisational understanding have progressed, the project group has begun exploring whether MAPS meetings could be adapted to meet the identified need. This work is ongoing, with the intention of establishing a finalised model by Autumn 2026.
6.5 An outcome of the 2024 workshop was an agreement that North Yorkshire Council should apply to join the MEAM (Making Every Adult Matter) network. MEAM is a national charity that supports practitioners, policymakers and people with lived experience to transform systems and services for individuals facing multiple disadvantage. Established as a coalition of Homeless Link, Clinks, Collective Voice and Mind, MEAM works across sectors and government, partnering with local areas to strengthen responses to multiple disadvantage and improve outcomes for the people affected. North Yorkshire became a MEAM Network Partner for the period 2024–2026.
6.6 The MEAM Approach provides a framework to help local areas design and deliver more effectively coordinated services for people experiencing multiple disadvantage. This framework is underpinned by seven core principles of service design and operational delivery that have been associated with successful transformation in MEAM‑supported areas:
· A strategic coordinator responsible for system alignment, operational oversight and evaluation.
· A clearly defined cohort of individuals who will receive support.
· Small caseloads to enable meaningful, sustained engagement.
· An assertive outreach model** that meets people where they are, rather than requiring access through standard service points.
· A relational, person‑centred approach that prioritises the individual's needs over organisational structures.
· A flexible service offer that is not dependent on compliance, attendance or other traditional engagement requirements.
· Co‑production with people with lived and living experience, ensuring their voice is central to shaping policy, commissioning and service delivery. People with experience of multiple disadvantage are recognised as the most influential advocates for system change.
· Governance arrangements that support a learning system, ensuring insights inform both specialist provision and mainstream services.
6.7 The development, evolution and long‑term sustainability of an effective offer for people experiencing multiple disadvantage depend on shared resources, shared risk and realistic timescales across all partner organisations.
6.8 Partners are currently testing the MEAM approach in Harrogate with the aim to achieve:
· A co-ordinated system of services that facilitates the following for people who experience multiple disadvantage:
· A ‘connection’ with a service or services.
· A single plan based around the person’s own strengths, agency, needs and goals.
· A home.
· Harm reduction – avoidance of an acute health event and prevention of death.
7.0 Consultation Undertaken and Responses
71 Engagement has occurred across adult social care, partner agencies, academic partners, frontline practitioners and people with lived and living experiences.
8.0 Contribution to Council Priorities
8.1 These programmes support prevention, early intervention, safeguarding, and workforce development.
8.2 The programmes of work also support the council’s key themes:
i. support thriving places and empowered communities that live, work, visit and do business in North Yorkshire
ii. develop more sustainable and connected places across North Yorkshire
iii. ensure the people of North Yorkshire are safe, healthy and living well
iv. maximise the potential of North Yorkshire’s people and communities
8.3 All three aspects of the work algin with the council plan
· Customers programme
· Way we will work programme
· Reducing demand programme
· HAS priority areas for HAS 2030, and key priority areas.
9.0 Impact on Other Services / Organisations
9.1 The programmes involve multi-agency working and will strengthen collaboration across sectors.
10.0 Implications
10.1 Financial - Activities are being delivered within existing programme budgets; further financial planning will align with rollout phases.
10.2 if successfully delivered the programmes should show value for money and potential return on investment.
10.3 Legal - The decision-making tool incorporates legal prompts to support compliance with statutory duties. Legal are involved in the design and implementation.
10.4 Equalities - All programmes aim to improve equity of access and outcomes for people with complex needs.
10.5 Climate Change - No direct environment impacts identified, although could have a slight positive implication as services will be closer to home therefore less travel for residents.
10.6 Performance - These programmes are expected to improve consistency and quality of practice. The programmes performance will be managed through the national outcome frameworks for Multiple Disadvantage, Mental Health and Substance use framework and the trauma informed programme.
10.7 Policy Implications - The research project will inform new policy on complex decision-making
10.8 Risk Management - Improved decision-making processes reduce organisational risk.
10.9 Human Resources - Significant workforce training commitments are planned across multiple years; resources have already been allocated through the transformation projects.
10.10 ICT - Digital support will be required for training delivery and tool implementation.
10.11 Community Safety - The IST and MATAP models improve safeguarding for people with complex risks.
11.0 Conclusion
11.1 Significant progress is being achieved across all programmes, with further key milestones planned for 2026. New opportunities continue to emerge that will support people to live well in North Yorkshire with good mental health and wellbeing. Our focus remains on aligning this work with existing local initiatives and national programmes, while developing new approaches where they add clear value and make sense for our communities.
12.0 Reasons for Recommendations
12.1 To ensure the Committee is fully informed of ongoing transformational work to improve outcomes for people with complex needs.
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13.0 |
RECOMMENDATIONS
The Committee is asked to: |
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i) Note the progress made across the three programme areas. ii) Support continued development and implementation of the programmes into 2026 and beyond.
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Abigail Barron HAS Corporate Director
County Hall
Northallerton
Report Author
Natalie Smith, Head of HAS planning, (Service Development and Public Health),
Elaine Hewitt, Head of Mental Health Specialist services (HAS)
Ruth Austen, Practice Development Officer (HAS Mental Health Team)
Presenter of Report – Natalie Smith Head of HAS planning
Note: Members are invited to contact the author in advance of the meeting with any detailed queries or questions.