Systems Change for people with multiple and complex needs in Birmingham

The Birmingham Changing Futures Together (BCFT) programme is funded by National Lottery  Community Fund’s Fulfilling Lives initiative and is led locally by BVSC.

The programme works with service users and organisations to shape how services are delivered to people with multiple and complex needs. The project focuses on long-term service and system change to support individuals to lead fulfilled lives and to ensure that successful models and approaches pioneered through this project become mainstream. With a strong focus on working in partnership with ‘experts by experience’, the project aims to develop the collaboration and integration of agencies to improve the client journey.

There are several streams of work within the BCFT programme. These include direct delivery by BVSC and sub-contracted delivery led by partners across the programme.

Over the past five years of the programme we have explored what is important to our service users, tested models of working together as well as gathered a great deal of learning that will inform our continued journey towards systems change.

We are proud of how Experts by Experience have shaped the programme to the point that they are an integral part of everything we do; their voice can be heard clearly in our services, in decision making and in how we approach our daily work.

‘Experts by Experience are integral to the Programme.

The Lead Worker Peer Mentor programme, delivered by our partners Shelter, Birmingham Mind and SIFA Fireside, has led the way in service delivery for people with complex needs and this model is now being adopted by partners across sectors including criminal justice, health and housing.

In March 2019 we launched a refreshed Systems Change Action Plan which will inform our work for the final three years of the programme:

Birmingham Changing Futures System Change Priorities

The Principles

As part of the development of our Quality Framework, BCFT have agreed a set of principles which under-pin delivery of services for people with multiple and complex support needs. These same principles will under-pin and drive our key priorities over the coming years.


Cross Cutting Theme

Co-production and involvement of people with lived experience

We believe that service users and people with lived experience are integral to the design, delivery and evaluation of everything we do.
Therefore rather than making this a separate priority we have treated co-design, co-production and the active involvement of people with lived experience as a cross-cutting theme.

Lead Worker, Peer Mentor Service

The Lead Worker Peer Mentor service has supported 320 service users, of which 56% needed help with all four complex needs (Homelessness, problematic substance misuse, mental ill health and risk of offending)

55% of service users had improved their Outcome Star total score.

Read the full report

“I got involved with Every Step of the Way on the advice of a friend. She said I would find good support and get access to opportunities that would help me develop as well as having the chance to give something back. She was right. I have volunteered elsewhere but Every Step of the Way is different. I’m part of a community. I feel connected, with the people who run it as well as with my colleagues.

Read the evaluation report

“Referrals come from all sorts of sources including the Probation Service, West Midlands Police, the Rough Sleepers Team or the drugs services, the first thing we do is meet the client to assess if they match the criteria. Then we get to work. The support we offer is client-led. If their priority is somewhere to live, we concentrate on housing. If it is a prescription for methadone, we sort it as soon as possible. If there are multiple, urgent needs, we tackle them concurrently. The client has to be fully engaged. Peer Mentors get the client’s trust, which means we can quickly build the positive relationship we need. Peer Mentors draw on their lived experience to connect to the client. Honest and open about their own life experiences, they inspire the same in the client.”

Read the full case study: ‘Working hand-in-hand to save lives’

“The Paid Mentors’ history means they truly understand the experience of the individual and so can quickly build the trust based relationship needed for change. Their perspective makes them powerful advocates on behalf of the service user; having been through the system and struggled with its complexities and challenges, they now know how to get things done.”

Read the full case study: ‘Birmingham and Solihull Mental Health Foundation Trust’s Liaison & Diversion (L&D) integrates Peer Mentors into service provision’

“It’s not like they are doing a job that’s just like mundane. They actually engage, and actually will not turn you away until you go away yourself thinking there’s someone there on your shoulder.”

(Service user, link to Revolving Doors Evaluation)

Key Delivery Partners

No Wrong Door Partners:
Anawim – support for women with complex needs
Asirt – asylum support and immigration.
Birmingham Mind– Floating Support for single homeless
Birmingham & Solihull Mental Health Foundation – Liaison and Diversion Team
Change Grow Live  – Drugs and alcohol
Crisis – homelessness/ courses to support development
Meridian Housing – accommodation
Midland Heart – accommodation
Pegasus Supported Housing Ltd – supported housing
Re-think – mental health support
RRP Community Rehabilitation Company
West Midlands Police
Shelter – navigator service
Swanswell – Floating Support for single homeless
SIFA Fireside – Homeless support
The Big Issue – Homeless self-help support

Core Group Partners
Birmingham City Council
Birmingham Mind
Birmingham and Solihull Mental Health NHS Foundation Trust
NHS Birmingham and Solihul Clinical Commissioning Group
Change Grow Live
Midland Heart
SIFA Fireside
Probation Service
West Midlands Combined Authority
West Midlands Police

Find out more about Birmingham Changing Futures Together at