Reaching the 15% with the Highest Needs

The shape of need

A core principle of social investment is taking a ‘customer focus’. This means adapting services to meet the long-term aspirations and daily realities of the people using them.

So what does that reality look like in New Zealand?  The picture below shows us something very important.

The Mason Curve was created using de-identified data from the Integrated Data Infrastructure, a linked data environment maintained by Statistics NZ that maps the journeys of most New Zealanders through many government services throughout their lives.

Each point on the line represents a person, and the height of the line shows the amount of interaction they have over their lifetime with social services funded by the government such as health, justice and welfare, in dollar terms. You can see that the 15% of New Zealanders with the highest support needs use 50% of government services (the blue area). The other 85% of New Zealanders use the other half.

These ~700,000 people are the biggest customers of our social services system. We were privileged to meet a few of them last week when we visited the Downtown City Ministry (DCM) in Wellington. DCM provide support to people who are experiencing homelessness in the city, who have no money, no food and no roof over their heads.

We’re learning something from providers like DCM that is obvious but critical: the most vulnerable New Zealanders face significantly more complex barriers to achieving their aspirations than other New Zealanders.

This is backed up by the public data.

For example, the Ministry of Social Development (MSD) recently found that the 13% most disadvantaged older people in New Zealand experience vulnerability across two or more of their health, housing, finances, social connection and access to transport, while 54% of older New Zealanders experience vulnerability in none of these areas.

Additionally, the pattern of need was mirrored in our recent 'Charitable Sector Insights' report co-produced with Jarden, that analysed the impact of 108 programmes measured through our GoodMeasure tool. The analysis showed that 13% of people, receive 73% of the investment. 

Complexity not only compounds, but it manifests uniquely for each person. On a given morning at DCM’s hub in Lukes Lane in central Wellington, clients might choose to engage with a mix of five or ten different services ranging from dental care, to food, to physiotherapy, depending on their specific circumstances. Sometimes, it may take a year of building a relationship with staff to engage with any services at all.

This increased complexity means that the mainstream social services that work well for most people often don’t work well for the 15% of people who are most in need of effective support.

The most visible evidence of this is those most in need struggling to engage with mainstream services, or engaging only at the point of crisis.

For example, many of DCM’s clients need help from MSD to get income support, to get on the housing register and move into more stable accommodation. But doing this is very difficult.

On the left hand side below, you can see a summary DCM sketched out to us of the challenges their clients face getting help through the mainstream system.

On the right hand side, you can see how they’ve partnered with MSD to bring the services onsite at the community hub, delivered in a tailored way for their clients.

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Step one: get to the service

Mainstream

• Need a phone to call MSD

• Wait 30-80 minutes to speak to someone

• Book and wait for an appointment ~currently a 1 month wait time to register for a new benefit

• Need transport to the appointment

• Services on site

• Walk-in appointments

• Hub walking distance in the city centre

Tailored

• Services on site

• Walk-in appointments

• Hub walking distance in the city centre

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Step two: enter the environment

Mainstream

• Security guards at the door

• Glass windows and crowded rooms

• Different and unknown staff

• No time to build trust before engaging

Tailored

• Friendly, personal service that is highly skilled

• Culturally led

• Warm environment

• Consistent staff

• Peer support workers with lived experience

• Opportunities for social connection and kai

• Unlimited time to build trust before engaging

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Step three: engage with the service:

Mainstream

• Staff have very limited time to help

• Requirement to follow standardized processes

• Staff not trained to support with people in distress with complex needs, may be trespassed from agency

Tailored

• Staff have more time to help

• Flexibility to do what works and provide individualized support, such as sorting IDs to be able to access services and calling people to unblock processes

• Staff specialize in supporting people in distress with complex needs

• Continuity of support, you can come back later if needed

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The bottom line of the Mason Curve:

‍Designing social services for the ‘’average user’’ is unlikely to help the 15% of New Zealanders in most need to achieve their aspirations. We need to understand our biggest customers, and adapt services to meet their complex and unique circumstances.

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INSIGHTS

For the policymakers:

A common concern of policymakers is that if you fund on the basis of outcomes, providers might ”cherry pick’’ the people that are easiest to support.

A good way to counteract this is to:

1. Understand the shape of need, identify who the target customer for funding is and where they sit on the curve of support needs.
2. Identify providers who can build relationships of trust and adapt their services to effectively meet the needs of those specific people.
3. Expect that different service provision models, with different investment profiles, will be needed for different parts of the curve.

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For the analysts:

Averages can be very misleading. Customer segmentation is an essential analytical tool for understanding long term social return on investment in services. This segmentation is important not just up front when deciding where to focus investment, but even more so after services have been invested in: frontline operational data from providers is essential to determine who the investment is actually reaching, and whether access barriers are being overcome.

Some useful public data tools to get started with that are mentioned in this article are the MSD Older People’s Data Explorer and the Ohi Data Navigator.

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For the frontline workers:

It can be helpful to think about where on the curve of complexity, or what mix of complexity levels, your organisation is best placed to support. Segmenting based on complexity within your population can help answer questions like:

• How long might we need to work with this family to empower them to engage with support?

• What’s the level of investment we should expect to make to help shift the trajectory of this person’s life?

• Do we have the right mix of direct services and partnerships to meet the needs of the different people we serve.