Individuals with Complex Needs

Description

This contract is a Direct Award made under the Provider Selection Regime (PSR) - Direct Award process A. The Service is to address inequalities and sustaining targeted interventions for high-risk cohorts. The service model reflects a whole-system, integrated approach, bringing together clinical expertise and social care-led coordination to address both the immediate healthcare needs and the wider determinants of health. This includes a strong emphasis on outreach, relationship-building, and person-centred support to re-engage individuals with mainstream services. The service is designed to address gaps in provision, enhance system integration, and support a coordinated approach to improving health outcomes for some of the most vulnerable residents in the borough. The target cohort for this service includes individuals who experience overlapping and inter-related challenges, including but not limited to: • Drug and alcohol dependence • Mental ill health and co-occurring conditions • Homelessness or insecure housing • Social exclusion and financial hardship • Safeguarding concerns, including self-neglect • Poor engagement with primary care and preventative services