Reviewing previous reforms to public services for socially excluded groups, this report makes the case for a locally-led and coordinated programme to support people with multiple and complex needs. First it looks at what lessons can be learned from the successes and failures of previous attempts to reform public services for disadvantaged individuals. The report discusses national programmes, such as the Rough Sleepers Unit and Troubled Families programme; early intervention; outsourcing public services; social investment and social investment bonds, and decentralisation. It finds that previous reforms have failed to give local areas the powers and responsibility for improving the lives of the most excluded. These reforms have also failed to give greater choice and control for service users, with disadvantaged groups experiencing greater conditionality and compliance. The final part of the report argues for a new locally led, nationally driven approach to tackling exclusion. The report cites the Troubled Families programme as an example of successful integrated support which also produced savings by reducing the demand for crisis-led services. It recommends that a new 'Troubled Lives' programme, based on the Troubled Families model of centrally driven but locally led reform for vulnerable groups, should be established, focussed on supporting people who experience two or more of the following problems: homelessness, substance misuse and offending. The report also proposes six specific reforms for the next government spending review.