Most of us recognise when a client is ‘complex’ and the attendant anxiety this generates but do we have a shared view of what this means? Robin Johnson, a Visiting Fellow at the International Centre for Public Services Management, Business School, in Nottingham UK has addressed this question and suggests that the ‘common thread in definitions of CN was, either explicitly or by implication, a combination of breadth of need (i.e. more than one area of need, with multiple needs interconnected), and depth of need (i.e. profound, severe, serious or intensive needs), plus something in the interlocking nature of these needs that made them

particularly hard to address. He notes that this definition dovetails with research done at

Bristol University ‘which found that any one form of social inclusion is predictive of others: that is, those who suffer exclusion in one aspect of life are significantly more at risk of exclusion in one or many other areas. We can see such social exclusion as both cause and consequence of un-met needs; and the malignant synergies of complexity are a major factor in making needs hard to meet.’

Services are generally arranged around symptom categories, (eg drug and alcohol mis-use or a psychiatric illness) or age with services particularly designated for the elderly or children and adolescence. In complex matters which cut across service categories, a struggle can ensue over which services or service providers should rightly take responsibility for the client and the plethora of issues and symptoms. Very often the struggle becomes one of who won’t be responsible leaving the most disadvantaged and needful client the one who is offered least support. In yet another way those who suffer exclusion in one domain are excluded in terms of service delivery.


Managing complexity needs to take into account this political dimension as perhaps the first and most crucial question in effective service delivery. Once this is resolved, managing the other issues often becomes much simpler.