|
The Government is committed to making public
services available 24 hours a day, seven days a week, where there is a demand. We asked
the People's Panel which out-of-hours services will people want access to; what sort of
business will they use them for; when will they want to be able to make contact; and how.
The results below were published in April 2001.Making It Happen: Public
Services At Your Convenience
This report sets out how the providers of five key public services are making their
services available outside "normal office hours".
Contents
Background
The Modernising
Government White Paper, published in March 1999, included a commitment that public
services would be made available to suit the needs and convenience of the citizen rather
than the service provider. Service providers would actively respond to the needs of their
customers, including being accessible up to 24 hours a day, 7 days a week where there was
a demand.
The problems with the current approach to service delivery, first highlighted by Integrated
Service Teams early in 1999, were taken forward by five Service Action Teams. Four
of the Teams concentrated on the scope for improving services in relation to specific
"life events" (retirement, bereavement, long-term care and changing address) and
the fifth looked at the generic issue of access to public services. The Service Action
Teams' Action Plan,
published on the Internet in July 1999, explained what measures were being developed to
improve the responsiveness of public services generally. It included a target date of the
end of 2001 for the achievement of more convenient service hours by the "top
five" services (those five non-emergency most important to Panel members), and a
commitment to report, by July 2000, progress towards that target.
This report has been compiled by the Modernising Public Services Group in the Cabinet
Office.
Back to top of page 
The top five services
The 4th wave of research
conducted by MORI through the People's Panel identified the five non-emergency services
most important to Panel members (the "top five" services), the times at which
they would want to access those services and the sort of business that they would want to
conduct outside "normal office hours". (These were assumed, for the purposes of
research, to be 9am to 5pm).
The five services for which longer, more convenient service hours were most often
selected by the People's Panel were:
 | non-emergency services in
- NHS hospitals
- GP surgeries
- social services |
| the Passport Agency |
| local authorities (generally). |
Although social services is run by local authorities, and so should be included within
the last of these categories, for the purposes of the People’s Panel research this
service was examined separately.
In the main, Panel members wanted to be able to get information - often basic or
general - about the service. There was, however, a desire to conduct some business - for
example, applying to receive the service, or making enquiries about an existing
application - outside normal hours. (To read more about the findings see the summary of People's
Panel research)
Back to top of page
Progress towards the target
Many service providers already offer, or are trialing, extended service hours. When we
contacted the providers of the top five services we found several examples of measures
introduced to make service more convenient for citizens.
Health services
Looking at the list of the top five services, it is clear that the greatest demand from
the People’s Panel was for health services to be more readily available. There has
been good progress in this sector.
NHS hospitals
Hospitals already offer a round-the-clock service for emergency cases as well as 24
hour care for their patients. Further, a number of services have for some time offered 24
hour access, for example obstetrics and coronary care. Cancer services have also tended to
run in the evening in order to make efficient use of expensive equipment.
But most routine cases are traditionally dealt with during fairly restricted times
during the day - often very inconvenient for patients, especially those in work.
Hospital staff often make appointments well in advance - usually to fit in with the
consultant's timetable rather than the patient's - and these are liable to change at short
notice. And many people will be familiar with the lengthy wait as appointments overrun.
New Appointments System
The approach to making appointments is one of the first problems to be tackled.
Hospitals in over 80 locations, such as St Mary’s Hospital within the Central
Manchester Healthcare Trust , are piloting the National
Booked Admissions Programme, offering firm appointment dates for hospital
treatment. Others are piloting a "partial booking" system which allows patients
to fix a date once they get within 4 weeks of the expected appointment. The pilots, at
some sites, enable patients to make, check or change appointments outside normal office
hours for outpatient consultation or inpatient treatment.
Evening and Saturday morning Outpatients sessions
But an improved appointments system is only part of the story. Some Trusts are now able
to offer evening or Saturday morning outpatient or minor surgery sessions, and they may be
staffed by senior nurses rather than doctors. This helps to improve the speed and
convenience of access to professional health care (and also makes more efficient use of
expensive medical facilities).
Evening Surgical Theatres
Similarly, some Trusts run three surgical theatres sessions a day instead of the usual
two. The evening session can be used for minor procedures for people unable to get to the
hospital during the day - for example, people who work or have caring responsibilities.
Typically, the additional theatre session extends access to support services such as
pharmacy and pathology as well. Extending working hours in this way not only offers a more
convenient service to patients, but also can increase the number of patients seen and thus
help to reduce waiting times.
Case study - Improved hospital appointments systems operating out-of-hours
| Two Trusts, Chesterfield & North Derbyshire
and Basildon & Thurrock have been piloting a new appointment system, which is a
useful step towards direct booking. About 4 weeks before the appointment is due, patients
phone a central call centre to arrange a mutually convenient date and time. The call
centres are open extended hours, including evenings and Saturday mornings, and they have a
24-hour ansaphone. The appointment system is being rolled out to all Trusts this year.More generally, hospitals are being encouraged, through the NHS
National Plan and the National Booked Admissions programme, to look at their systems for
communicating with patients, especially out-of-hours, and to improve these. For example
Trusts are making increasing use of e-mail, and over 50 now have their own websites. |
Back to top of page
GP surgeries
Again, most people know that they can contact a doctor outside surgery hours in an
emergency. But getting an appointment for advice or non-emergency consultation used to be
much more difficult.
That is beginning to change.
About 98% of GPs now offer evening appointments outside normal (9am – 5pm) office
hours at least one night a week, making it easier for people in work to consult them. And
27% of GP practices, serving 38% of patients in England, offer access before 9am (usually
from 8:30am) or after 5pm (usually to 6pm) every weekday. The larger practices tend to
offer the longer hours – those with 8 or more GPs offer on average around nine hours
per week access outside office hours, some two and a half hours per week more than
single-handed practices. Initiatives are planned to provide further improvements in access
to GP surgeries outside normal hours.
Case study - innovative practice in out-of-hours access to GP surgeries
Marple Cottage Surgery is a practice that has
developed a website www.marplecottage.co.uk
which not only provides general information on the practice, but offers patients three
different services:
| It allows patients to ask questions at a time convenient to them. For instance a woman
whose baby developed a rash in the sun was able to ask advice about sun protection without
having to make an appointment and take the baby to the surgery. |
| Patients can book appointments on line, a service which is convenient both from work and
from home outside surgery hours (patients can see on the screen when appointments are
available) |
Patients can request repeat prescriptions on line. |
But the traditional GP is no longer the only source of personal medical advice.
Walk-In Centres
People living or working in city centres and large urban areas in England may be able
to reach one of the new "walk-in centres", open 7am to 10pm on weekdays and 9am
to 10pm at weekends – no appointment necessary.
Walk-in centres offer fast and convenient access to a range of services, treatments and
consultations with experienced NHS nurses. They are being introduced to help anyone whose
modern, busy lifestyle, or particular circumstances and particular needs, make flexible
and accessible services so important. They don’t replace the local GP or hospital
services but complement existing local services. Services available at an NHS walk-in
centre include health advice, treatment for minor injuries and illnesses such as strains
and sprains, coughs, colds and flu-like symptoms, and information on other local services
such as local out-of-hours GPs, dental and pharmacy services.
Case study – flexible access to a range of statutory and voluntary
services on a single site
| North Middlesex NHS Walk-in Centre, at
The North Middlesex Hospital, provides comprehensive nurse-led minor treatment and advice
services for local residents, and the large commuter population that passes the Hospital
every day. The Centre is located alongside the hospital’s new A&E Unit, where
the close links will a seamless service for patients. In addition to information about
local out-of-hours health services, there is signposting, advice and information available
through an in-house Citizen’s Advice Service, which will facilitate links to Social
and Community services. Language and interpretation services will be available for
patients for whom English is not a first language.
The NHS Executive is also working with the Health Authority and Regional Office to
develop plans for a Dental Access Centre, and there are proposed Healthy Living Centres
for Enfield and Haringey which, if successful, will work alongside the Walk-in Centre to
link up a wide range of different statutory and voluntary services and initiatives. |
Thirty six
centres are being piloted this year in key locations such as high streets, and
will be accessible by over 20% of the population. Twenty three such centres are already up
and running. Many are closely linked, and in some cases co-located, with other health and
social care providers such as dental access centres, social services or Citizens Advice
Bureaux.
Telephone Services
Personal advice can also be obtained over the 'phone.
A range of specialist phone
helplines supported by the Department of Health, dealing with AIDS, drinking,
smoking, child protection, drugs etc have been open for several years. The majority of
these are open for extended hours, and half of them – for instance the National AIDS
helpline, the National Drugs helpline and Childline - operate 24 hours a day, 7 days a
week.
A major step forward was the launch, in March 1998, of NHS Direct, the innovative
round-the-clock telephone service [0845 46 47] which provides easy-to-access personal
health advice from a specially-trained nurse, assisted by the latest computerised clinical
decision support systems, at any time of day or night. Now people can obtain advice easily
and quickly at the front-line of health care – the home - a particular benefit to
people caring for young children or elderly or infirm friends and relatives. NHS Direct is
currently accessible by two thirds of the population in England but will be extended to
cover the whole of England by October 2000. It has already taken well over 2 million
calls, been selected by the UK Design Council as a Millennium Product and , in an
independent survey, received an unprecedented public satisfaction rating of 97%.
Online services
A similar round-the-clock service is also available through NHS Direct Online offering
personalised health advice, accredited information on hundreds of conditions and
treatments and even "ask-an-expert" sessions. This website is already receiving
hundreds of thousands of "hits" every week. Soon in addition to the personal
advice offered through NHS Direct Online, information on local health and social services
- contact details, maps, opening hours etc - will be provided online through www.nhs.uk. At present, people wanting online advice
need to use a computer linked to the Internet. However, pilots are about to start which
will make NHS online services available through public kiosks and digital TV.
Back to top of page
Social Services
Social Services is one of many services provided by local authorities, and are subject
to the Best Value regime described in more detail below. Like hospitals, they offer a 24
hour emergency service as well as round the clock care for a range of people, such as
those in residential care or those who need personal help in their homes.
With almost 100,000 full and part-time social workers and care staff, social services
departments are often the first point of contact for those needing help, co-ordinating
work with other agencies to provide integrated care within the community.
Currently, most services are available to the public between 9am and 5pm every week
day, with duty teams providing emergency "out of hours" backup. In addition, a
range of information about social services and service availability is available out of
hours through local authority call centres and websites.
The Social Services Inspectorate Report "Open All Hours" identified variable
practice in terms of access for service users. Work is underway to further investigate
this and to establish what improvement is most needed. Some authorities have already begun
to extend and develop a range of mainstream services out of hours.
Ways are also being explored of linking NHS Direct with social service out of hours
arrangements.
Case Study – Linking NHS Direct and Social Services
| Essex County Council Social Services, as part of their
modernisation programme, have relocated Essex Social Services Direct (a 24 hour customer
advice, information and referral service) and the Essex Social Services Emergency Duty
Service . They are now located alongside NHS Direct and the Essex Ambulance Control Centre
on the Broomfield Hospital site in Chelmsford. The partnership not only enables the
residents of Essex to access appropriate, timely and relevant advice and support when they
need it, without having to make sense of the Health and Social Care systems, but also
provides the opportunity for staff across Health and Social Services to share knowledge
and skills for the benefit of the customer. |
Back to top of page
The Passport Agency
The Passport Agency responded to the delays in 1999 in processing by dramatically
overhauling its approach to service delivery, making full use of the potential of new
technology as well as improving its business processes. The opening of a call centre in
January 2000 has enabled the Agency to provide round the clock information and advice.
Applying made easy
The Agency encourages customers to apply for passports early. One of the easiest ways
is through the 1,500 main Post Offices which, for a small charge, check the application
form for errors before forwarding it to the Agency. Alternatively an application pack can
be ordered by ‘phoning 0901 470 0111.
But other options will shortly become available as a result of new technology.
It may soon be possible to speak to an operator at the Agency’s call centre (0870
521 0410, textphone 0870 240 8090) who will be able to complete the form on the
customer’s behalf. In the longer term, customers will be able to complete an
application online through the Agency’s interactive website www.ukpa.gov.uk with assistance available from
the call centre at the click of a "call back" button. A small pilot is due to
start in the Autumn.
Public counters: faster service by appointment
Some people prefer to conduct their business in person, especially if they need to get
a passport urgently. Nearly 10% of the Agency's customers submit an application in person.
To respond to customer needs, all existing Passport Agency offices provide extended
opening hours, which vary according to locality. Some callers prefer to call by
appointment, to avoid long queues. Appointments for both weekdays and Saturdays can be
made through the call centre.
| Regional centre |
Mondays to Fridays |
Saturdays (by appointment only) |
| Belfast |
08:30 – 18:00 |
09:00 – 15:00 |
| Glasgow |
08:30 – 18:00 |
09:00 – 15:00 |
| Liverpool |
08:30 – 18:00 |
09:00 – 14:00 |
| London |
07:30 – 16:00 (all callers) 16:00 – 17:00 (immediate travel, compelling and compassionate reasons only)
17:00 - 18:00 (to drop off written applications only) |
09:00 – 15:00 |
| Newport |
08:30 – 18:00 |
09:00 – 15:00 |
| Peterborough |
08:30 – 18:00 |
09:00 – 15:00 |
A seventh office, in Durham, will open for business in October.
Round-the-clock telephone service
Many people find it easier and simpler to use the telephone. The Passport Agency's
telephone call centre is open 24 hours a day. Operators aim to respond to calls within 20
seconds. A recorded message answers frequently asked questions and provides day-time
access to an operator for passport applications and more complex enquiries, including
tracking the progress of an existing application. (Very complex enquiries made at night
may be answered by a call back from a Regional Office within four hours of opening for
business the next day).
Passport Agency: Call Centre volumes for July 2000:
| 219,897 calls received, of which |
| 15% were received between 6pm and 9pm. |
| Almost 5% of all calls received at weekends. |
Round the clock information service on-line
More and more people are using the Internet to find out information.
The Passport Agency's new, interactive website www.ukpa.gov.uk provides a round-the-clock source of generic
information. It also offers an e-mail enquiry and complaints facility. The Agency aims to
respond to e-mail enquiries within 4 hours .
Back to top of page
Local Authorities
There are 410 local authorities in England and Wales. The major services provided are:
| education |
| Social Services (see separate entry) |
| planning (for example, for housing, industry, shopping and leisure facilities) |
| libraries (one of the most heavily used services with over 15,000 outlets) |
| waste disposal and collection |
| trading standards (protecting the interests of both the consumer and the business
sector) |
| fire and rescue, and emergency planning for disasters |
| upkeep of roads and highways (over 96% roads in England and Wales, as well as parts of
the motorway and trunk network, are maintained by local authorities) |
| housing (providing around 3.5 million homes) |
| environmental health, including food safety and noise control. |
More work is needed, building on the People’s Panel research, locally and
nationally, to establish which of those services consumers most wish to see available for
extended hours.
Public participation schemes are well established in local government. A DETR survey
in 1998 found that 88% of councils used satisfaction surveys and 92% used complaints and
suggestion schemes. Research through focus groups, citizens panels or citizens juries is
also common.
From October 2000, the community planning process developed by the Department of the
Environment, Transport and the Regions (DETR) and promoted by the Local Government Association will
provide a formal mechanism to ensure that councils and other local public bodies adopt a
common and co-ordinated approach to meeting local needs. About 30% of local councils have
already prepared community strategies.
As a result there are many examples of good service delivery arrangements, including
the provision of services outside "normal office hours", many providing a
"joined up" approach which research tells us customers welcome.
Case studies – Libraries and more
| In 1999, Bristol City Council began to pilot
Sunday afternoon opening of two libraries after managers and unions in libraries consulted
with staff and library users about their preferences. Trafford
Metropolitan Borough Council opens libraries located in leisure centres for 100 hours
a week, including early mornings, late evenings and Sundays. They provide access to the
internet, local and national information networks and links to schools, colleges and
universities.
Warwickshire County Council opens its libraries until 7pm or 8 pm one day a
week. Twenty five (out of 34) open on Saturdays and three main libraries open for four
hours on Sundays. Five mobile libraries cover remote rural areas during day and early
evening. |
A number of Councils operate telephone call centres, which
offer advice on a range of council services.
Case Studies – New technology as an enabler of more accessible services
| Hertfordshire County Council Customer Services
Centre provides telephone access to the council from 8 am to 8 pm weekdays and 9 am to 4
pm on Saturdays. Operators work from a corporate information base which allows 75% of
enquiries to be dealt with on the spot – from enquires about secondary school
admissions to library book renewal. Nottingham City Council operates a 24-hour
emergency call centre available 24 hours a day 365 days a year which can handle any query
about Council services. Five kiosks are located around the city (in a hospital,
supermarket, sports centre and shopping mall), giving touchscreen access to council
website information. There are plans to link the website to the city smartcard. |
"One stop shops", found in many town centres, might also offer several
different services including some (such as legal or social security benefits advice)
provided by other organisations.
Case Study – a "flagship" one-stop shop
| Ashton-under-Lyne Customer Service Centre,
within Tameside Metropolitan Borough Council, was officially opened by Cabinet
Office Minister Ian McCartney on July 24, 2000 - a flagship one-stop shop, with links to
all council departments and other agencies. The first stage in modernising customer
services across the borough, it gives access to people in each of nine town centres. The
project is underpinned by new technology with frontline staff having information at their
fingertips, providing a friendly and efficient service. From Monday to Saturday
customers can access council services in person or by email, get general advice and
personal pensions advice from a member of the Benefits Agency. They can pay their council
tax, rent or parking fines, all in comfortable surroundings. |
A fuller picture of how and where local councils are delivering services over extended
hours should be available in the Autumn when the results of a DETR survey on Promoting the
Work/Life Balance in local authorities become available.
Best Value
In deciding how and when to deliver these services, local authorities must, under the
Best Value regime introduced from April 2000, take into account the views of the local
residents who will use them.
The Best
Value regime is a key driver for continuously improving service delivery at the
local level. Each council is expected to aim at being in the top 25% of councils for each
service provided. Customer-focused services, which includes improved access, are central
to Best Value.
As part of the process, local councils are required to review each of their functions
or services on a five year cycle. To do this they must consult with local taxpayers,
service users, partner organisations and the wider business community as well as the
people and organisations currently delivering the service in question. Annual performance
indicators and standards have been introduced alongside, and three-yearly surveys of
residents will cover their satisfaction with council services and the accessibility of
those services.
The three-yearly customer surveys will look at the percentage of citizens satisfied
with:
| the overall service provided by their authority; |
| the service provided by transport services, environmental services, fire service, local
authority education service, social services, planning services, cultural and recreational
services and housing services; |
| cleanliness standards in their area; |
| recycling facilities, household waste collection and civic amenity sites; |
| local provision of public transport information and local bus services; and |
| the local authorities cultural and recreational activities; |
There are also other surveys of specific groups:
| council tenants; |
| benefits claimants; |
| planning applicants; and |
| library users. |
Case Study– "Best Value" helps to set new standards of service delivery
| The London Borough of Newham
adopted a theme of ’the 24 Hour Council’ within their Best Value Review. Although
one of the country’s most deprived boroughs, Newham is taking the lead in
e-communications with a roll out of six local service centres and a 24 hour call centre,
development of smart cards, online access to services, a data warehouse and electronic
voting for community consultation. Using handsets, the council got instant results from
five hundred local people one Saturday morning on living, working and learning in Newham.
The Newham Language Shop provides 24 hour access to a telephone interpreting service and
can provide for 64 different languages. |
Beacon Councils
The drive to improve services is also a key part of the Beacon
Council scheme, which is now in its second year. One of the beacon themes this
year is Accessible Services. This focuses on the provision of council services at the
places and times that best suit local people . The Local Government Association encourages
councils to apply for Beacon status, and the Improvement
and Development Agency is providing active support by co-ordinating a programme of
roadshows and open days, and by providing a new, web-based source of best practice and
"how to do it" guides.
Case Study – housing maintenance by appointment
| Leicester City Council has introduced a housing "’Till
Eight Maintenance Service" to respond to the needs of its tenants. Under this
service, the normal working hours of 7:30am to 4pm Monday to Friday have been extended to
8pm on Mondays to Thursdays. The service allows for a range of housing maintenance
services – electrical, plumbing and carpentry work – to be carried out by
appointments made to suit tenants’ convenience. York City Council's Repairs
by Appointment service for its housing customers was piloted in 1991 and went Citywide in
1992. Originally, appointments were offered for weekday mornings and afternoons only. In
1997, evening appointments were introduced for minor repairs, in response to customer's
comments on the service. They found it frustrating to have to take time off work for a
simple repair. |
Customers can now have minor repairs done between 5pm and 8pm, Monday to Friday. The
gas maintenance contractor also offers evening and Saturday morning appointments for gas
servicing to suit customers who are at work during the week.
Responding to the challenge of on-line government
Many local authorities are responding to the challenge of online government by using
new technology to provide more citizen focused public services, providing information
through websites, kiosks and call-centres and changing the way services are provided. They
are playing a key role in ensuring that local people can access new technology, so that it
works for the benefit of the whole community.
The Government's Invest to Save
Budget is designed to help develop projects which bring together two or more
public service bodies to deliver services in an innovative and more efficient way. It will
make an important contribution to the delivery of the Prime Minister’s aim of making
all public services available electronically by 2005 and also to delivering round the
clock services.
In Round two, 21 local authorities won funding for projects which were
aimed at developing better access for citizens to local council services through the use
of ICT, including call centres and 'one stop shops'. These projects are being funded from
April 2000.
Amongst the winning projects in round 2 of ISB were:
| Bracknell Forest Borough Council - a single gateway for customer access to out of hours
emergency and non-emergency response in Berkshire. |
| Hampshire County Council - IT to support the development of 24 hour social care
enquiries, information and emergency care response. |
| Kirklees Metropolitan Borough Council - Development of an electronic patient record to
support a 24 hour mental health rapid assessment team. |
| Bedfordshire County Council - developing a single information and services gateway, to
include one-stop shops, call centres, email, public touch screens and digital television. |
| Cheshire County Council - a 24 hour unified public service call and enquiry process to
cover around 25 local authorities and other local services in Cheshire. |
The budget for 2001/02 will concentrate in the main on supporting projects involving
the electronic delivery of services and other projects with a customer focus. Over 200
expressions of interest were received by the closing date.
Case Studies – Towards electronic government
| Knowsley Metropolitan Borough
Council’s Community Information Programme (CIP) has brought state-of-the-art
services, made possible by new technology, into an area of high deprivation. Driven by the
Council’s strategy of social inclusion and economic regeneration, Knowlsey has 1,000
public access PCs at over 160 locations, giving citizens free access to the Internet and a
huge range of community information. Already schools, colleges, libraries, one stop shops,
social services resource centres, business resource centres, sports centres and museums
have access to the CIP. Local people can search for jobs, educational courses and
childcare on line, both in the immediate and surrounding areas. The innovative housing
repairs request page helps the customer to "drill down" to a picture of the
repair site (bathroom, window etc), enabling the problem to be described in detail by a
simple mouse click. The London Borough of Lewisham, which has a record of service
innovation in its use of new technologies (including a public sector one-stop shop, joint
working with the Benefits Agency, and pioneering a video conferencing system) has now
embarked on a strategy for ICT across the borough – for people, businesses and
institutions. The strategy sets the context for the scale and pace of changes required
locally, so that the borough as a whole is connected to the opportunities of the
information age. Elements of the strategy include using ICT to improving education and
skills, enterprise and businesses, supporting voluntary groups and improving the
council’s organisational effectiveness. |
All local councils now have email addresses and an increasing number (currently about
50%) are running their own websites.
Back to top of page
Conclusion
In the twelve months since action plan, the top five services have made good progress
towards delivering more convenient public services at more convenient hours. Many other
public services are also making progress towards modernising their approach to service
delivery, including the provision of "out of hours" services
Later this year we will make public more comprehensive information about the way public
services are improving their accessibility, covering a wider range of services and
including emerging findings from the Department of the Environment, Transport and the
Regions survey of local
councils referred to above.
Back to top of page
Comments and questions
If you have any comments or questions about this report, please contact:
Barbara Rose
3rd Floor, Admiralty Arch
The Mall
London SW1A 2WH
Telephone 020 7276 1723, fax 1731
e-mail bestpractice@cabinet-office.gov.uk |
