Adult Social Care Glossary, v 0.6

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.

You may have complex needs if you require a high level of support with many aspects of your daily life and rely on a range of health and social care services. This may be because of illness, disability or loss of sight or hearing - or a combination of these. Complex needs may be present from birth, or may develop following illness or injury or as people get older.

People with multiple needs are often described as having complex needs when in fact the needs aren't complex but are multiple and often severe. The label complexity may be wrongly applied because the individual is hard to reach.

Words that blame: Complex

Complex cases. Complex individuals. Complex health conditions. Complex lives.

Real lives are complex. Messy. Rainbow coloured crayon scribbles on crinkled and torn pages. Stuff happens – or doesn’t. Too much. Not enough. Stops. Starts. Loops back. Dead ends. Creeping, miniscule shifts. Rapid, devastating changes. Balancing. Juggling. Waving. Falling. Drowning.

Real lives don’t fit the straight lines of our ‘system’, the black and white boxes on our forms. Our processes and pathways require a single label at the start. One ‘primary support reason’. One ‘service user group’. Go.

Too many labels = too many boxes ticked = too many pathways = too many professionals = too many conversations = too many options = too much time = not enough time = not enough options = ‘complex’.

And then often, ‘too complex’.

Of course, ‘complex needs’ is the classic. We’ve even built complexity into the term ‘complex needs’, as the multiple references in the Care Act statutory guidance illustrate. “Multiple and complex needs”. “Highly specialised and complex needs”. “Less complex needs”. “More complex needs”. “Particularly complex needs”. “Higher or more complex needs”. “Complex ongoing healthcare needs”. “The most complex needs”. “Multiple complex needs”. “Complex SEN and care needs”. “Complex health and care needs”. “Complex care needs”. [6]

The guidance contains several case studies, including ‘Isabelle’ who ‘is 15 years old with complex needs’ and Maureen who “is 72 years old.. with complex care needs’. We don’t find out what their needs are, just that they are ‘complex’.

Like ‘challenging’ and ‘vulnerable’, ‘complex’ is a meaningless term – used repeatedly to convey – well, what exactly? Yes, people’s lives may be complicated, but people’s basic needs are simple. Somewhere to call home and to belong. Someone to love, and to be loved in return. Something to do. Something to look forward to.

Stop using labels as excuses.