Over the past few months, Changing Futures Bristol has worked with partners across the BNSSG Integrated Care System to analyse the BNSSG ICB System-Wide Dataset. This linked dataset brings together information from health, mental health, substance use, and adult social care services, offering a unique opportunity to understand the health needs of people experiencing multiple disadvantage (MD), and how people with MD interact with health services across primary care and secondary care.

What was the aim?

The analysis aimed to pull together a health-focused perspective on multiple disadvantage - those at high risk of poor health outcomes and frequent use of crisis services. 

What is the dataset?

The BNSSG System-Wide Dataset is a linked dataset covering around 77% of the local population. It includes data from primary care, mental health services, substance use treatment, and adult social care. However, it does not currently include data from criminal justice or domestic abuse services, meaning the analysis provides a partial view, mostly from the health and care system. 

The cohort analysed was defined as individuals meeting three out of four criteria:

• Homelessness*, asylum seeker or refugee status

• Substance or alcohol dependency

• Mental health diagnosis

• Support from adult social care

What does this tell us?

• Adjusted estimates suggest around 2,100 people across BNSSG meet the MD definition, with approximately 1,360 people in Bristol. This figure accounts for gaps in data coverage and under-recording in primary care.

• Nearly all individuals in the MD cohort had mental health needs (99%), and a large majority had substance misuse issues (95%). Over 70% were supported by social care, and 40% were either homeless or seeking asylum.

• The cohort showed significantly higher use of acute health services compared to the general population. This includes non-elective hospital admissions and emergency care, with associated costs highlighted in the analysis. 

Why does It matter?
This work helps build a clearer picture of the scale and complexity of MD in our area. It will support commissioners with more informed decision-making, better service design, and earlier intervention. It also strengthens the case for trauma-informed, person-centred approaches by showing where needs are concentrated and how services can respond. A second phase of analysis is planned to explore how MD presents in adult social care, including service access, demographics, and comorbidities. This will help inform future commissioning and support planning.

*Homelessness is generally not well coded and difficult to track in primary care, work is ongoing within the ICB to improve this.