Hard to reach systems

In 2006, the UK government produced a report, called "Reaching out: an action plan on social inclusion", which argued that a large part of the problem of so-called 'hard to reach' people with 'complex needs' was as much to do with the inflexibility of services, which allow many people to simply slip out of reach.

Overly rigid procedures, eligibility criteria or commissioning focussed too narrowly on particular needs, can mean that those with more complex needs are then more at risk of falling through the safety nets, drifting or crashing into exclusion.

This report, along with the thinking behind it, other programmes in similar vein (such as Supporting People), and the programmes that it led to (such as the National Social Inclusion Programme for mental health, or 'NSIP') , have been identified as some of the more significant developments in the history and the origins of the PIE approach.


(NB: It has been argued that the demand for 'evidence based' treatments, especially in the health services,  had unwittingly tended to exacerbate this tendency, in giving precedence to mainstream-able and standardisable treatments. The convincingly large datasets required for such evidence tend to exclude the more marginalised and cannot recognise the very person-centred interventions often needed for these groups.)

Further reading, listening and viewing

PIElink pages

A PIE of pathways : HERE

'Navigators' and 'system brokers' : HERE

A single framework : HERE

Gaps and barriers (case studies) : HERE

(PIE Abacus for) Local practice networks and service ecosystems : HERE


Library items

"Reaching out: an action plan on social inclusion" UK Cabinet Office: : HERE

A very brief history of PIEs : HERE

"Theory of Change: a summary":Lankelly Chase : : HERE

"On Behaving Like a System" Lankelly Chase : HERE

"10 Strategies to End Chronic Homelessness" United State Interagency Council on Homelessness  : HERE  (NB: the details here are US-centred, but the overall approach is relevant elsewhere)

"Exploring effective systems responses to homelessness": Naomi Nichols & Carrie Doberstein (for The Homeless Hub) : HERE

"Do 'complex needs need 'complex needs services'? Part Two"   Robin Johnson: HERE

The importance of relationships in knowledge translation and implementation (CHI Impact festival webinar): HERE

Big Lottery Fulfilling Lives' Complex needs' programme: HERE

"System change brokers" (an interview with Alex Smith and Ray Middleton) : HERE