In the jurisdictions visited by the author, the needs of populations are changing. There is an increasing number of people who have multiple, complex, and long-term conditions, and systems that were established to focus on singular issues or needs do not adequately respond to this complexity. Demand is also increasing, and there is a growing desire that services and supports are more person-centred. A consistent story is that services and supports do not respond to the reality of people’s lives, particularly those experiencing multiple and complex needs. Many of these challenges are similar to those faced by people in Victoria.

This report chronicles several approaches, structures, and ways of working that will provide valuable lessons for the Better, Connected Care reform, Victorian systems more broadly, and other Australian jurisdictions. The intention is that the findings from the United Kingdom and Canada can inform efforts to better respond to people with multiple and complex needs in Victoria and Australia.

Key findings:

• The evidence base for service integration is still emerging: While benefits of integration are promising, there are areas where the evidence is weak or inconclusive. Most studies have focused on short-term outcomes, making it difficult to assess the long-term benefits and sustainability of integrated care models. A focus on service integration can be helpful in aligning professionals, local services, and policy makers around a common goal, and strengthens the case for more collaborative ways of working.
• Establishing clear authorisation and governance arrangements for social service integration is important. However, this is only one building block for improved integration. Allowance for flexibility and creativity at regional levels, so system managers can drive improvements informed by the local context is critical. Genuine collaboration between local system actors was a consistent theme across effective initiatives. Given the complexity of systems change, structural and cultural differences between systems need to be factored into any integration efforts, and this is a long-term task. Progress will be slow without accompanying resources and support.
• Service design and social innovation approaches that have a whole of systems change objective are required. Strong service design approaches, which focus on understanding the problem before proposing solutions are key. Deep engagement with people and communities is essential in major change or reform processes. Pilots are valuable for testing different approaches to respond to people with multiple and complex needs. Where the problem is particularly complex, social innovation approaches should be considered, especially where there are supportive environments to enable social innovation to succeed.
• Responding to people with multiple needs is complex and systemic. A complexity lens allows for appreciation of the multiple, diverse, and interconnected elements that operate in complex systems. Human Learning Systems is an approach that creates space for continuous learning and adaptation and recognises the importance of human actors and their relationships within systems.
• Connection to community provides fulfilment outside of service systems. Some people require ongoing services or support, others may only need episodic help. But fulfillment comes from things outside of the service system, such as participation in communities and social connection. Whole of systems change approaches that promote broader community connection are required.