A study of rural service standards

Transcription

FA I R AC C E S S T O R U R A L S E R V I C E S I N T H E N O R T H W E S T
A study
of rural service
standards
JUNE 2006
Rural Innovation
The Rengeneration Business
Rural Innovation
The Rengeneration Business
communityfutures
Table of contents
S E C T I O N O N E : I N T R O D U C T I O N A N D OV E R V I E W
S C H E D U L E O F TA B L E S
1.1 Introduction
Table One – Range of Rural Services
1.2 Definition of ‘Service Standards and Benchmarks’
1.3 Structure of Report
Table Two – Van & Car Ownership
SECTION TWO: RURAL SERVICE NEEDS
Table Three – How are Services Accessible
2.1 Demographic Context
2.2 Community Testing
Table Four – How Do You Access Rural Services
2.3 Expectation and Aspirations for Accessibility
Table Five – Customer Hierarchy of Local Service Accessibility
SECTION THREE: POTENTIAL OF DEFRA SERVICE
S TA NDA R D S T O D E L I V E R S E R V I C E E Q U I T Y
Table Six – Proximity v Quality
IN THE NORTH WEST
3.1 National Service Standards
APPENDICES
3.2 The Regional Dimension
Regional Definition, Standards and Challenge Tools
3.3 Local Measures, Performance Indicators and Targets
3.4 Appropriateness of Local Standards to Improve Fair Access &
MAPS
Address Social Exclusion
Social Exclusion in Rural Lancashire
3.5 Conclusions on Standards
Service Point Mapping:
Burscough
S E C T I O N F O U R : H O W FA I R I S AC C E S S T O S E R V I C E S
Garstang
IN THE NORTH WEST?
Hornby
4.1 Formal Performance Assessment
Kelbrook
4.2 Is Access to Services in Rural Lancashire Fair?
4.3 Community Views
S E C T I O N F I V E : D E F I N I N G FA I R AC C E S S T O R U R A L
SERVICES IN THE NORTH WEST – THE POTENTIAL
F O R S E R V I C E S TAN DARD S
5.1 Benchmarks of Fair Access to Services in the North West
5.2 Core Conclusion and Recommendations
5.3 Potential Service Standards
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Section One:
Introduction and Overview
1.1
Introduction
The Government’s Rural Strategy (June 2004) set out a new direction for rural delivery based upon simplifying the customer experience
through greater devolution of decision-making to local level (regions and sub-regions). This intent has been followed through by the
development of the Regional Rural Delivery Framework, supported by the ‘action research’ activity of the local Rural Delivery Pathfinders.
Within the North West, both the Regional Rural Delivery Framework and the Rural Delivery Pathfinder have highlighted the need to
promote ‘fair access to services’ as a priority. The evidence base for the region developed as part of the Regional Rural Delivery Framework
(RRDF) found that within rural areas, there are marked differences in accessibility, with ease of access decreasing as sparsity increases.
For example:
• Less than 10% of rural town households are more than 4km from benchmark services, with sparse rural towns having lower
accessibility than less sparse towns.
• Over 50% of sparse households have limited access to banking and ATM services, with significant reliance on Post Office provision.
• Post Office accessibility decreases with sparsity, 17% of households in sparse dispersed areas have limited access.
• Although proportion of school age children is not significantly lower, children in sparse rural areas have to travel further to primary,
and particularly, secondary school.
• Access to a doctor is again limited, with 22% to 56% of rural households experiencing accessibility issues.
• Job centre provision is universally poor across all rural areas, even for the towns, with 65% to 90% living further than 4km away
from any sort of provision.
• Some 30% of less sparse households live more than 4km from a library, rising to 60% in sparse areas.
• Petrol stations are less accessible in sparse dispersed areas (40% live more than 4km distance).
• Only 8% of town households are more than 4km distant from a supermarket, this rises to 63% in sparse dispersed areas.
The RRDF Steering Group concluded that the cumulative effect of the above is one of comparative disadvantage in terms of accessing services.
This is particularly so for the 30% of rural households in the sparse areas that do not have access to a car or van in order for them to travel
independently to the point of service availability. Given these imbalances, more could, and arguably needs to be done to provide accessible
public services (including multi-service outlets) and to meet the needs of those with limited mobility (e.g. young and old) and/or income
(employed/unemployed) etc.
Consequently, the RRDF set as one of the regions six rural priorities:
Priority Four: Ensuring fair access to services for rural communities – this will include:
• providing accessible and quality public services that meet the needs of rural residents;
• better targeting to meet the needs of those with limited access/mobility and income, particularly the young and elderly
• striking a fair balance between taking the service to the community and the community to the service
The evidence gathering and consultation carried out as part of the development of the Regional Rural Delivery Framework and Rural Delivery
Pathfinder highlighted the lack of clarity, amongst service deliverers, performance plans and consumers, around what ‘fair access’ means.
For many, especially those with higher incomes and access to a car, the inconveniences of having to travel to access the services they need
are more than outweighed by the attractions of living in a beautiful area, with low levels of crime and a strong community spirit. For those
on low incomes however, and especially those without access to private transport, the inaccessibility of services has a serious detrimental
effect on their quality of life.
3
‘Fair access to services’ is therefore an important issue of social justice, but it is also an issue of sustainability. The disparity of the impact
of lack of ‘fair access’ on different groups has implications for the individuals affected but also has implications for the future sustainability of
rural communities. Besides the environmental costs of increased car use, declining rural services will make it more difficult for those
on low incomes, and especially young people to live in rural areas and so exacerbate the current trend towards rural communities becoming
enclaves of the older and more affluent sectors of society.
Rural people and rural communities should expect a ‘fair’ level of service from public agencies and not be ‘unduly’ disadvantaged because they
live at a distance from towns or cities. The problem of course is that there is no consensus about what ‘fair access’ means, nor often,
about how to achieve it.
The purpose of this study is to improve the understanding of just what constitutes ‘fair access’ to services in the region, to work towards the
development of a set of benchmarks (for the most appropriate services) that define ‘fair access’, to put in place both a definition and series of
challenges to drive improvements in access to services in rural communities in the North West. It is envisaged that this work may help inform
national thinking on the delivery of public services in rural areas and the future sustainability of rural communities.
It is anticipated that such benchmarks, or Service Standards, and the methodology for applying them at regional and local level, will improve
the ability of rural service providers (and policy makers), to minimise social exclusion by improving the accessibility of services, and introducing the
concept of ‘fairness’ into performance planning and measurement.
The Rural Innovation & Community Futures project team has brought together community development professionals, local service deliverers,
policy makers and senior rural analysts with direct experience of the creation and management of Local Strategic Partnerships, preparation and
implementation of Local Area Agreements, evidence based targeting and the current rural development policy context. Community engagement was
carried out by Community Futures (the local Rural Community Council), leveraging existing relationships with communities and building on current
activity. This partnership approach has allowed the views and expertise of a wide range of stakeholders (from community, private, public
and the ‘third sector’) with diverse points of view, to be considered, and taken into account. As such the outcomes and conclusions have been
collectively developed, tested with communities, and subjected to Peer Review. In particular, the project team has worked closely with the Access
to Services Thematic Group of the Rural Delivery Pathfinder.
This report represents the final output of the study, it has been put together following completion of an iterative methodology designed to address
the key tasks as set out in the original brief, this has comprised:
Analysis to identify the key rural service needs in the NorthWest; this has been based upon a review of the main influencing documents and
existing research on service needs, accessibility, delivery and quality.
An assessment (working with local service providers, policy makers and service consumers) of whether the current national service standards
are appropriate for the identified regional service needs in addressing social exclusion and promoting sustainable rural communities.
A review of performance at sub-regional level against the existing national standards based upon a review of Lancashire County Council’s Best
Value Performance Indicators, investigations with service providers, and consultation by the Rural Community Council with customers/consumers
of services across a range of sample communities
Consideration and recommendations around the development of; a definition of ‘Fair Access’, a set of ‘challenges’ to improve accessibility,
the use of ‘standards’ or ‘service level indicators’ together with thoughts as to how these ‘standards’ can be applied (against RRDF outcomes)
and monitored through Local Area Agreements
4
1.2
Definition of ‘Service Standards or Benchmarks’
It became clear early in the project that the language used around ‘standards’, ‘outcomes’, ‘indicators’, ‘targets’ and ‘performance measures’
was potentially confusing. It is therefore important to define what is meant by the phrase ‘Service Standard’, and thereafter use it consistent
in that context.
For the purposes of this study (and related discussions), a Service Standard is taken as being something that defines a ‘minimum service level’
that can be expected by the consumer, and therefore must be guaranteed by the deliverer. For example, a service standard related to a flu jab
might be that ‘all eligible patients will be provided with a flu jab by no later than 30th September in each year and without having to travel for
more than 20 minutes to access the inoculation’. This ‘standard’ puts the onus of addressing barriers to access for this type of ‘quality of life’
critical service on the service deliverer and not the service consumer. A Service Standard is universally applied to its target group, and should
define the minimum level of service that is acceptable; therefore if one eligible patient cannot access a jab on these terms, the standard has not
been met.
A target or outcome is a tool for improving service delivery, and sets a level that it expects the service deliverer, aided by the policy maker and
funder, to meet. For example, a target or outcome related to improving the health of the population, especially those at risk (and so suffering from
social exclusion) might be that ‘preventative inoculations should be made available to 90% of residents in Lancashire who are eligible to receive
them, within 3 weeks of release’.
An indicator or performance measure used to assess whether this outcome had been achieved might be ‘the number or percentage
of people eligible to receive the flu jab that had received it within three weeks of its release’.
So, when the commentary in this report refers to Service Standards, it should be read as meaning a minimum service level, agreed between
deliver and consumer, and applicable universally across the target group or area. If any individual does not experience the minimum service level,
then the standard has not been met.
1.3
Structure of the Report
Section Two of the report considers the key North West rural service needs, based a review of evidence, existing research and feedback from
service providers, policy makers and consumers of services.
Section Three reviews the existing National Service Standards, and assesses whether they are appropriate for application at regional and local level,
and if they can be effectively used to address rural social exclusion and so promote sustainable rural communities.
Section Four reviews the ‘fairness of access’ available at sub-regional level when assessed against the national standards; this review considers both
‘formal’ assessment based around best value indicators and reported performance, and also the qualitative experience and views of residents and
interest groups within four sample communities. It seeks to draw conclusions on the level of ‘fairness’ currently experienced in Lancashire,
understand and highlight variances in experience based on services, type of settlement or the characteristics of the consumer, and assess likely
impact of the national standards in improving and delivering ‘fair access’.
Section Five builds on the analysis and conclusions of the remainder of the report, and goes on to consider how ‘fair access’ might be defined,
the potential for rural service standards in the North West, at what level service standards are appropriate, and how they might be incorporated
at regional and local level.
The report concludes with recommendations to implement its conclusions, and sets out a number of ‘challenges’ that can be used to improve
service accessibility. Readers interested in the main outcomes, headline definition and indicators can turn directly to Section Five. In addition
a briefing note (Regional Definition, Standards and Challenge Tools) has been prepared, setting out the headline definition of ‘Fair Access’, together
with advice and commentary on the use of Indicators, Targets and Challenge Tools. A copy of this briefing note has been included within the
Appendices; a separate version designed for ease of use is as a separate pdf document.
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The Rural Innovation & Community Futures project team would like to thank all those who supported the project, especially the communities of
Kelbrook, Hornby, Garstang and Burscough; our colleagues in Community Futures, the Government Office Client Group, the Access to Services
Group of the Lancashire Rural Delivery Pathfinder, and those professionals that participated in the peer review process.
Section Two:
Rural service needs
In order to develop recommendations around ‘rural service standards’, it is necessary to first define those public services most relevant to the
rural communities of the North West. The section below seeks to accomplish this definition, based upon existing influencing document
or authorities and engagement with four sample communities, those considered include:
• Rural Strategy 2004 (Defra)
• State of the Countryside 2005 (Commission for Rural Communities)
• Defra’s Rural Service Standards
• Future of Rural Services 2015 - University of Gloucester for Defra
• Regional Rural Delivery Framework
• West Midlands Rural Services Scoping Study
• Lancashire County Council Accessibility Strategy
• Shropshire County Council Accessibility Strategy
The range of services put forward within the Rural Strategy 2004, and identified by the West Midlands Rural Services Scoping Study appears
to cover the core areas that residents look to the state to provide in return for taxation, and includes most of the services that can directly
impact on the quality of life of ‘consumers’, so addressing social exclusion and improving the sustainability of rural communities. In particular,
it includes those services which are considered to be of particular importance to disadvantaged groups living in rural areas; public transport,
primary and secondary health care, food retailing, obtaining cash, training and further education, and information provision.
Defra Rural Strategy 2004 -
WM Rural Services Scoping Study
State of the Countryside 2005 Lancashire County Council
services basket
Long list of services
Indicator service points
Accessibility Strategy Core service points
Affordable housing
Shop
Banks & Building Societies
Hospitals
Local transport/Accessibility
Post Office
Cash points
Leisure facilities
Posy 16 education & training
Public transport (bus/train)
GP surgeries
Public toilets
Children’s services
Pub
Job centres
Dentists
Mental health services
Restaurant/café
Libraries
Industrial estates
Services for older people
Pre school care
Petrol stations
Pharmacies
Drug treatment & rehabilitation Primary school
Post offices
Doctors surgeries
Business support services
Secondary school
Primary schools
Community halls
Uptake of sport and recreation
GP surgery/health centre
Secondary schools
Post offices
6
Defra Rural Strategy 2004 -
WM Rural Services Scoping Study
State of the Countryside 2005 Lancashire County Council
services basket
Long list of services
Indicator service points
Accessibility Strategy Core service points
Productivity of the
Pharmacy
Supermarkets
Schools
tourism industry
Dentist
Food Shops
Hospital
Link & Cash Machines
Employment rates of
Community Hall
Public Houses
disadvantaged groups
Day Centres
Banks & building Societies
Post 16 Education/Training
Libraries & Information Services
Informal outdoor recreation
Employment & Benefit Agencies
Sports and Leisure facilities
Business Locations
Bank & Building Society
Bus stops
Road traffic accidents
Community engagement
Cash Point/ATM
Petrol Station
Workspace
Affordable housing
Public toilets
Job Centres
Benefits Office/Agency
Business Support Facilities
The larger ‘basket of services’ that can be made up from ‘washing’ together the Rural Strategy list with the West Midlands list appears to include
those ‘service points’ chosen by a range of organisations to measure ‘accessibility’. The Commission for Rural Communities (formerly the Countryside
Agency) has been measuring the proximity of a range of service points to households in its ‘Access to Services’ data series within the State of
the Countryside Report for the last five or six years. Lancashire County Council has developed a similar approach, and has mapped each ‘service
point’ across the county. It then uses an analysis of travelling time (using Accession software) to assess the ‘accessibility’ of these services to
households in the county; this is consistent with national targets for ‘accessibility’ set by the Department of Transport. This approach underlines
one of the key challenges to achieving ‘service equity’; it immediately begins to assume that accessibility is a function of moving people to a fixed
service point, rather than defining a way for the consumer to ‘meet’ the service in the most effective manner. Nevertheless, in this instance
the choice of a range of ‘service points’ for use in service planning matches the services within the Rural Strategy 2004 & West Midlands work as
those which residents will seek to consume.
2.1 Demographic Context
Demographics and social conditions are a key influence on the way in which rural residents demand, consume and access services. The work
by Gloucester University on the Future of Rural Services cites demography and prosperity as key drivers for change in the way that services are
demanded; it highlights increasing levels of disposal income for rural households and a shift towards an older population profile as critical elements.
In considering which rural services are important to communities in the North West, it is necessary to consider the overall demographic context.
Extensive work has been carried out to build the evidence base for the rural North West; the key document to which we refer is the State
of the Rural North West Report prepared by PION Economics in the summer of 2005. We have also referred to more recent work undertaken
using the Public Benefit Recording System to develop a targeting framework for the Regional Rural Delivery Framework (RRDF) priorities,
and work in progress by Land Use Consultants into the functionality of Key Service Centres. The work to develop a targeting framework for
RRDF Priority 4 (Access to Services) is of particular interest as it introduces a visual and spatial element to the data.
7
Population and Age Profile
At the time of the 2001 Census, the population of the region was placed as some 6.7m persons. The Defra urban/rural definition suggests that
88% of these people live in urban areas and 804,000 (12%) in rural areas; 703,500 of these live in the less sparse area of the region, and 100,500
(1.5%) in the sparse areas.
Rural areas share the overall age profile of the region, with a dip in the 16-25 year old range and a spike in the 45-60 age range. There is only
a small difference in the distribution of the age profile across sparse and less sparse areas; there is a very slightly lower proportion of the primary
working-age cohort (20-64 years) in sparse areas. Likewise, there is a marginally smaller proportion of the under 20’s, whilst the reverse is true
in the 60-75 years band. The proportion of population within the 60 - 75 age group increases directly with sparsity, with close to 10% of the sparse
area population belonging to this age group. The 75+ band is generally more balanced with broad comparability across all areas.
So to put it simply; there are slightly fewer young people in rural areas (although not materially so), and slightly more ‘older’ people. There are
more ‘older’ people in sparse than less sparse rural areas. What might this mean in terms of demand for services?
• Services for children and young people are just as important in rural as urban areas
• The large group of 45-60 year olds are likely to become higher demanders (and perhaps more discerning – see Future of Service
in Rural England) during the next several years as they age
• Whilst there is an overall consistency between the age profiles of sparse and less sparse areas, there is a significant, and growing constituency
of elderly consumers likely to be high demanders of health care and ‘community’ services in sparse areas.
The emerging work on Key Service Centres for the North West Regional Assembly offers some interesting insights into the relative distribution
of population around the 143 ‘Key Service Centres’ settlements identified in the emerging Regional Spatial Strategy.
‘According to the 2001 Census, the average percentage within the 174 KSCs of people below the age of 29 is around 36.6% while on average
22.2% are over 60. In general, the settlements contain a fairly normal distribution of ages; however a small number of outliers showing significantly
high proportions of people over 60 or under 29 have been identified. The KSCs of the Lake District National Park and to a lesser extent Lancaster
district (the Sparse areas of the region) contain a proportionately larger group of pensioner households as well as people over the age of 60,
and below 29 than any other area. Of the 20 KSCs with lowest proportion of its residents below the age of 29, only Heswall, and Formby,
in Merseyside, and Uppermill, in the north of Greater Manchester are located outside these two areas. Grange-over- Sands has by far the highest
proportion, almost 45% of its population, in the over 60 age bracket.’
Clearly service planners need to understand where such ‘outliers’ exist, and make the necessary adjustments to provision and style of delivery
if people are not going to miss out.
Mobility
The manner in which people access services, and to a material extent the way in which they demand and prioritise services is hugely influenced
by their ability to move around; defined as their mobility. Realistically for most residents of rural areas (other than those living centrally within well
serviced market towns), mobility is delivered through access to a private vehicle. The graph below (taken from the PION State of the Rural North
West report) shows the profile of mobility across the different types of rural areas. It is interesting to note that multiple car ownership tends to
increase with sparsity, but that nowhere does access to at least one car (per household) exceed 50%, meaning that 1 in 2 households across the
entire rural area of the region are not likely to have access to a private vehicle during the working week. It is also important to note the relatively
high proportion of households (c. 27%) in sparse dispersed areas that do not have access to a private vehicle at all; it must be highly likely that
these households include elderly, those on lower incomes and ‘high demand characteristic’ service consumers.
Rural KSCs in Cumbria and parts of Lancashire contain a significant proportion of households without access to a car. This is particularly so in
Keswick where such households represent 28.5% of the total, but also relates to settlements such as Aspatria (25.8%), Barnoldswick (25.8%),
Wigton (25.2%), Ambleside (24.8%), Silloth (24%), Ulverston (23.8%) and Kendal (23%). This demonstrates the degree to which such
households are dependant upon local services and facilities within these relatively isolated rural centres.
1Future
of Services in Rural England – A Scenario for 2015 June 2005
8
Table Two: Car / Van Ownership
Source: PION State of the Rural North West
Health
Analysis of various health data sets within the State of the Rural North West report demonstrates that the rural population the North West has
better life expectancy than its urban counterpart, lower Standard Mortality Rates and overall better health status as measured by Birth Pattern
data. It also shows how rural residents are more likely to self-certify as being in good health than urban residents, with those living in sparse
dispersed areas (furthest away from the GP!) most likely to self certify as being in good health.
It is interesting to note however that despite the apparent better health status of rural residents, nearly 1in 3 rural households in the region claim
to be providing some form of unpaid social care (Census 2001).
The apparently better health status of rural communities demonstrated by the headline statistics is likely to have an impact when Strategic Health
Authorities and Primary Care Trusts are planning their service delivery.
Housing
State of the Rural North West found that there is a fundamental difference in the accommodation structure of the two areas with much greater
reliance on detached accommodation in rural areas – the proportion of detached properties in rural areas is more than double that in rural areas.
Conversely, urban areas have more of all other types of accommodation with the greatest difference between the two in terms of terraced
properties. It also found differences in terms of tenure pattern and household composition; owning property is more common in rural areas and
a significantly higher proportion of rural residents own their residences outright. Ownership through a mortgage/loan is also more prevalent
in rural areas but only marginally so while renting is far more common in urban areas – particularly with regard to social rented and local authority
housing where stock reduces quickly with rurality.
Household composition is also different in nature between rural and urban areas. Rural areas tend to have higher concentrations of single pensioner
and married couples (with and without dependent children). Cohabiting couples are broadly similar while lone parents with dependent children
are more prevalent in urban areas, although they are apparent in all type of rural areas.
What implications might these characteristics have in terms of service planning? Perhaps very little; unless ‘accessibility’ support is introduced that
directly targets the individual and incorporates some form of ‘means testing’. In such circumstances, an elderly, vulnerable but home owning
resident of a sparse dispersed area might be substantially more disadvantage in terms of accessibility than their counterpart in an urban, or even
market town, context.
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Implications of Demographics to Service Planning and Securing Service Equity
So what might this mean in the context of understanding which services are likely to be important to rural communities in the North West, and
in terms of implications for delivery? In general terms, there is little here to indicate that demand for services is likely to be any different in rural
than urban, sparse or less sparse areas. Clearly there are some issues of detail, such as the age profile in sparse areas, linked to relatively high
incidence of single car ownership.
There are however some headline statistics that might allow service providers to determine that the need for certain types of service will be
lower in rural areas, and that the ability of people to access it, based on their wealth and mobility, may be greater. It seems apparent however,
these headline trends mask a very complex position at local level, and it will be important for service providers, and those trying to influence
them, to ensure that they have the necessary understanding and evidence to inform local decisions and priorities.
2.2
Community Testing
These assumptions, and their relevance to residents of different types of rural communities have been tested locally as part of this study; a range
of different interest groups have been interviewed in four sample settlements; one key service centre and one much smaller village representing
‘sparse’ and ‘less sparse’ conditions. The four settlements were chosen with reference to the incidence of social exclusion (based on a ‘rural on
rural’ analysis of the relevant domains of the 2004 Index of Multiple Deprivation , issues such as mobility and age profile, current service provision,
and the local experience of the Client Peer Review group) . This process aligns strongly with the PBRS approach, and a clear ‘fit’ was found when
assessing these settlements against the targeting work developed for RRDF Priority Four.
Burscough is the smaller of the two ‘service centre’ settlements in the district of West Lancashire; it has a relatively disadvantaged socio-economic
profile, with pockets of social exclusion as acute as any across Lancashire situated close to areas of high household income and house prices.
The town has a limited economic and retail ‘service centre’ function, yet is will equipped with service points and outlets.
Kelbrook is a small village, located on the eastern edge of the region, in close proximity to the towns of Nelson & Colne and the East Lancashire
urban area of Burnley. Situated on the border of Lancashire and West Yorkshire, it looks ‘both ways’ for service centres, with many residents
engaging with Skipton as often as Nelson or Colne. The village and its surrounding area consistently registered in the 15% most deprived output
areas for income, employment and skills.
Hornby is a small and relatively isolated settlement in North Lancashire; it is situated within Lancaster district in a dispersed rural area. The
nearest ‘Service Centre’ is at least 15 miles distant. The socio-demographic profile of the village aligns to the ‘older affluent’ characteristic,
yet there are real issues of housing affordability and mobility.
Garstang is an increasingly ‘affluent’ settlement situated between Preston and Lancaster on the main arterial north/south route (non motorway).
The town acts as a local retail and service centre to an extensive rural hinterland, and in recent years has attracted increasing levels of ‘retirees’
and families attracted by the quality of place and school offer.
Community Futures engaged with a range of groups in each community, selected in order to provide a wide perspective that included the young
and old, those using childcare, health and social services, those within and without access to private transport etc. These sample groups were
asked which of basket of services (defined) from Table One above, should be available to them at home, within their community, via a local town
(Service Centre within 30 minutes travel) or further away.
2 Health,
3A
Income, Employment, Education & Skills
copy of the map developed to support this targeting is included in the Technical Appendices
10
The response of the communities should be considered against the ‘service points’ available to them in each settlement. The Lancashire County
Council Intelligence Management Team has kindly reproduced maps from the LCC Accessibility Strategy that show the services ‘available’ within
each settlement. These demonstrate how the two larger towns contain many, but in both cases not all, of the core service points set out above,
whilst the two small settlements contain a very limited range of service points .
The table below sets out the responses around how services were accessible:
Table Three: How are Services Accessible?
Service Type/
Point
% Walking
% By Usable
Only
Distance
Public Transport
by car %
Service Type/
Point
(10 mins)
Nursery/Childcare
72
% Walking
% By Usable
Only
Distance
Public Transport
by car %
(10 mins)
15
12
Secondary education
47
39
11
Primary Education
78
6
13
Further education
7
54
29
GP Surgery
37
31
27
Training
3
46
35
Pharmacy
39
35
23
Hospital
3
43
50
District Nurse
31
35
27
Dentist
26
32
35
Health Visitor
35
33
28
LIbrary
42
32
25
Specialist Health
16
42
37
Advice Services
13
37
35
Post Office
67
12
19
Employment Services
5
50
38
Bank/Building
33
36
29
Sports/Leisure
34
39
27
Higher Education
52
35
Care
Society
Cash
55
21
22
Food Shop
63
15
20
Community Hall
68
13
17
Pub
74
11
14
4Copies
of the maps are included in the Technical Appendices
It is interesting to note:
• Whilst public transport is considered to be a viable means of access for health care, education and advice services, it is not an effective
means of accessing ‘community services’ for those beyond a 10 minute walk from the service point
• The proportion of respondents within 10 minutes walk of ‘community’ type services peaks at 78% (primary education), and is below
70% for Post Offices, Community Halls and Food Shops
• Around 30-45% of respondents consider public transport to be available as a means of accessing health care, education and advice services;
this level tends to exceed those that feel these services are only available via the car
• The proportion of respondents who felt that services were only available by car averaged between 205 – 30% for healthcare, education and
some community services, and between 30 – 40% for advice services
The communities were also asked how they accessed the services in terms of movement. From these results (Table X) it is clear that use of public
transport is very limited as a means to accessing ‘community services’, but that it is used between 20% - 30% of the time to travel to and within
‘service centres’ in order access education, advice and leisure services.
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Table Four: How do you Access these Services?
Service Type/
Point
% Walking
% By Usable
Only
Distance
Public Transport
by car %
Service Type/
Point
(10 mins)
% Walking
% By Usable
Only
Distance
Public Transport
by car %
(10 mins)
Nursery/Childcare
57
2
41
Secondary education
40
28
32
Primary Education
64
4
32
Further education
14
28
63
GP Surgery
29
17
44
Training
12
23
59
Pharmacy
29
14
48
Hospital
2
23
64
District Nurse
23
13
42
Dentist
19
16
57
Health Visitor
33
13
42
LIbrary
37
15
62
Specialist Health
12
16
57
Advice Services
10
22
62
Care
Post Office
63
5
30
Employment Services
7
26
62
Bank/Building
30
14
53
Sports/Leisure
26
21
51
Cash
42
12
43
Higher Education
6
26
62
Society
Food Shop
46
9
42
Community Hall
54
9
35
Pub
62
5
31
Reliance on the private car as a means of access is significant; it never drops below 30%, and exceeds 40% for almost every service bar primary
and secondary education and the post office. It should be remembered however that two of the communities engaged (Garstang and Burscough)
are service centres. The results would have been different if they took in a wider rural area, when we can expect to see reliance on the car
increase substantially.
2.3
Expectations and Aspirations for Accessibility
The findings from the field study in terms of where rural people believe that services should be available can be usefully divided into three
categories – ‘Local - on demand’ (at home or within 10 minutes walking distance , ‘Service Centre’ (within 30 minutes travel), and ‘Distant’ (within
60 minutes travel).
12
Table Five: Customer Hierarchy of Local Service Accessibility?
‘Local - On Demand’
‘Service Centre’
‘Distant’
Home/Within 10 minutes Walk
Within 30 minutes Travel
Primary School (81%)
Further Education (72%)
Higher Education (45%)
Nursery/Childcare (81%)
Hospital (71%)
Post Office (76%)
Employment Services (71%)
GP/Health Centre (74%)
Advice Services (64%)
Food Shop (74%)
Training (60%)
Cash (71%)
Secondary School (60%)
Community Hall (67%)
Library (53%)
Pub (65%)
Dentist (51%)
District Nurse (62%)
Specialist Health Care (43%)
Ante Natal/Health Visitor (61%)
Sports & Leisure
Pharmacy (60%)
Bank/Building Society (60%)
5 Remembering
that this means different things to different people
% figures show percentage of respondents that placed the service in this category
The significant features of these findings are:
• There was strong consistency of response from those in towns and villages, and across the different age/mobility profiles of the respondents
• It is was clearly considered to be important that primary schools are available locally (within 10 minutes walk); whilst there appears to be an
acceptance that other education facilities (secondary and tertiary) will require up to 30 minutes travel
• There was a relatively high demand expressed for access to healthcare services (GP, District Nurse, Specialist and Ante Natal/Health Visitors)
at home – particularly from the elderly and those lacking mobility
• Health services that people expect to be able to access ‘locally on demand’ (at home or within 10 minutes) appear to be GP’s, Pharmacy,
District Nurse, Ante Natal / Health Visitors – and also interestingly ‘specialist’ health services. The respondents seem to expect to travel for
access hospitals and dentists
• Whilst there a relatively high level of demand for ‘community services’ (i.e. post offices, local shops, cash, food shops, community halls,
pub) to be available within a 10 minutes walk (65%); just over 1 in 4 respondents were content to travel for between 10 and 30 minutes
to access these sorts of facilities
• There is a higher demand expressed for Libraries and Sports / Leisure facilities to be available locally than for advice and employment services
• There are very low levels of preparedness to use ‘remote’ access (bar higher education and training)
• Acceptance that any service should be more than 30 minutes travelling time was very limited; except for Higher Education
13
Even more revealing, perhaps are the findings in relation to the ‘trade-off’ that people are prepared to make between proximity and quality.
The services where there is a high consensus that quality should not be compromised for proximity are focussed around education and childcare,
health care, training and to a slightly lesser degree advice services. Services where a significant number of people (40% or more) are willing to
sacrifice quality for proximity are centred around those in the ‘Community’ services block – Cash, Post Office, Bank / Building Society, Community
Hall, Library, Food Shop, Pub.
It is also interesting to note that those for whom proximity was important and especially those willing to sacrifice quality for proximity, were more
likely to be the elderly or those with limited mobility (access to private car).
Table Six: What is More Important; Quality or Proximity?
‘Local - On Demand’
Q
P
Home/Within 10 minutes
‘Service Centre’
Q
P
walk
Primary School (86%)
95
5
Further Education (72%)
95
5
Nursery/Childcare (81%)
92
8
Hospital (71%)
80
20
Post Office (76%)
41
59
Employment Services (71%)
69
31
GP/Health Centre (74%)
72
28
Advice Services (64%)
67
33
Food Shop (74%)
58
42
Training (60%)
94
6
Cash (71%)
30
70
Secondary School (60%)
98
2
Community Hall (67%)
51
49
Library (53%)
49
51
Pub (65%)
59
41
Dentist (51%)
76
24
District Nurse (62%)
78
22
80
20
Ante Natal/Health Visitor (61%)
80
20
Sports & Leisure
62
38
Pharmacy (60%)
67
33
Bank/Building Society (60%)
50
50
80
20
‘Distant’
Q
P
95
5
Within 60 minutes travel
Higher Education
Further analysis of the findings from the field research around ‘fairness’ and the implications of these findings can be found in Section 4.2
2.3 Conclusions around Key Rural Services
It seems clear from the combination of desk research, demographic analysis and community engagement that the services considered of importance
to rural people in the North West accord with those identified in the Rural Strategy 2004 and the West Midlands study, and can be reasonably
characterised as Childcare, Healthcare, Education, Community and Advice services. The further insight given to this work from engagement with
the four communities is the relative importance of these services in terms of ‘locality’ and ‘quality’. When considering implications for Service
Standards, this ‘Customer Hierarchy of Local Accessibility’ and views on quality v proximity will be taken into account.
14
Section Three:
Potential of DEFRA service standards to deliver service equity
for the North West
3.1
National Service Standards
The project brief seeks confirmation as to whether the national (Defra) Rural Service Standards are appropriate for the identified regional needs in
addressing rural social exclusion and in promoting sustainable rural communities. These national ‘service standards’ were first published as a response
to the Government Rural White Paper ‘Our Countryside: the future’ (December 2000); these were reviewed in 2004 to incorporate the principles
of national standards being taken forward by the individual or community.
Defra’s 2004 National Service Standards are as follows:
• By 2006, all rural LEAs to have at least one full-service-type Extended School offering a core of services, including health and social care,
childcare, study support, parenting support, adult education and family learning, ICT access and arts and sports facilities.
• By March 2006, Sure Start children’s centres will be established in the 20% most disadvantaged areas, providing good quality childcare with
early education, family and health services and training employment advice, and offering services to at least 650,000 local children and their families.
• Presumption against closure of rural schools: published guidance requires that the need to preserve access to a local school for rural communities
is taken into account in considering closure proposals.
• Improve the quality of life and independence of vulnerable older people by supporting them to live in their own homes, where possible, by:
o increasing the proportion of older people being supported to live in their own homes by 1% annually in 2007 and 2008; and
o increasing by 2008 the proportion of those supported intensively to live at home to 34% of those being supported at home or in residential care.
• All schools will have broadband connectivity by 2006. By the end of March 2004, the proportion stood at 60%.
• Formal requirement on the Post Office to maintain the rural network of post offices and to prevent any avoidable closures of rural post offices
until 2006.
• By December 2005, all hospital appointments will be booked for the convenience of the patient, making it easier for patients and their GPs
to choose the hospital and consultant that best meets their needs. By December 2005, patients will be able to choose from at least four to five
different healthcare providers for planned hospital care, paid for by the NHS.
22
• All patients, including those living in rural areas, can expect to be offered an appointment to see a primary care professional within 24 hours
or a GP within 48 hours.
• To ensure that everyone who wants it has access to the internet by 2005.
• The NHS ambulance service is required to respond to immediately life-threatening calls (Category A) within eight minutes in 75% of cases,
irrespective of location. Other emergency calls that are not immediately life-threatening (Category B/C) should be responded to 95% of the time
within 14 minutes in urban areas and 19 minutes in rural areas.
• The proportion of the rural population living within about 10 minutes’ walk of an hourly or better bus service to increase from 37% to 50% by
2010, with an intermediate milestone of 42% by 2004.
15
In addition to the set of national Service Standards, Defra has adopted a set of Accessibility Indicators with which to measure progress against its
Public Service Agreement target of ‘improving the accessibility of public services in rural areas’. The performance measure being that the overall
% improvement in these indicators should not be any worse in rural areas than in urban areas (as defined the by Government’s rural/urban definition).
These ‘indicators’ are as follows:
1. Mental health. Access to (i) crisis services and (ii) child and adolescent mental health services
2. Drug rehabilitation and treatment. (i) Participation of problem drug users in drug treatment programmes. (ii) Proportion of users successfully
sustaining or completing treatment programmes.
3. Children’s services. Increase in the stock of Ofsted recognised childcare places.
4. NEETs. Proportion of young people not in education, employment or training.
5. Employment rates of disadvantaged groups.
Combined employment rate of (i) lone parents, (ii) minority ethnic groups, (iii) people aged between 50 and state retirement age, (iv) least
qualified members of the working age population and (v) those living in the wards with the poorest initial labour market position.
6. Pensions. Number of (i) pensioner households being paid Pension Credit and (ii) disadvantaged pensioner households in receipt of the
Guarantee Credit.
7. Accessibility.
• % of a) pupils of compulsory school age ; b) pupils of compulsory school age in receipt of free school meals within 15 and 30 minutes of
a primary school and 20 and 40 minutes of a secondary school by public transport
• % of 16-19 year olds within 30 and 60 minutes of a further education establishment by public transport
• % of a) people of working age; b) people in receipt of Jobseekers' allowance within 20 and 40 minutes of work by public transport
• % of a) households b) households without access to a car within 30 and 60 minutes of a hospital with an outpatients' facility by public transport
• % of a) households b) households without access to a car within 15 and 30 minutes of a GP by public transport
• % of a) households; b) households without access to a car within 15 and 30 minutes of a major center by public transport
8. Road traffic accidents.
(i) Number of people killed or seriously injured in road accidents. (ii) Number of children killed or seriously injured in road accidents.
9. Affordable housing; ratio of lower quartile house prices to lower quartile earnings.
These ‘Service Standards’ and ‘Accessibility Indicators’ do not extend across the full ‘basket of services’ as defined in Section Two; rather they
appear to record performance targets from a range of Government departments, and so measure national progress / delivery against them; they
include few standards which are not already the responsibility of government departments and reflected in their plans, strategies or PSA’s. When
local service providers in Lancashire considered this list of ‘National Standards’, the overwhelming conclusion was that whilst any standards that
highlight ‘rural service equity’ with national policy makers are to be welcomed, these specific standards are not particularly comprehensive, nor
do they set out and offer any definition of ‘accountability’ between service consumer and provider. As importantly perhaps, they do not make any
distinction between different types of rural areas, and so will mask the realities of service accessibility in the most remote parts of the Country,
including many communities in the North West.
They provide a thematic, and hopefully interesting measuring tool at high level for policy makers centrally, but are at best a fairly blunt stick when
applied locally. This view is typified by comment in the Lancashire County Local Transport Plan; it sets out the Department’s of Transport national
‘accessibility’ standards in terms of travelling time from a range of service points (as included in the PSA4 Accessibility Indicators below) and
commits to monitoring them, but states that it will seek more appropriate local indicators in order to measure its actual performance.
16
In addition, the PSA4 indicators appear to omit most of the services expressed as being important to quality of life such as:
o Shops and ‘service’ outlets (i.e. banks, dry cleaners etc)
o Pubs, cafes and restaurants
o Access to cash (via Post Office, ATM or via ‘cashback’)
o IT connectivity
o Community Buildings
o Sports and recreation
A number of organisations, stakeholders and commentators have put forward the view that the value of these measures in terms of improving
service equity from the perception of the customer is extremely limited. For example, if performance is low in rural areas – e.g. participation of
problem drug users in drug treatment programmes, they are not measuring whether it ever actually catches up with urban provision – only the
relative rate of improvement.
SPARSE, the membership group of 57 Local Authorities with sparse rural areas states in its development document for the Rural Services
Partnership that ‘national standards perpetuate ‘episode and reference costs’ which when used as national norms / benchmark embed
rural disadvantage’.
The review of the Rural Service Standard carried out in 2003 by the University of Gloucester found that the RSS did not address the reality that
many ‘service standards’ were set at local level; the need to ‘address the local dimension’ was reported to be the single most common comment
during consultation.
3.2
The Regional Dimension
So if the use of National Standards has been found not to provide for Fair Access to Services for rural communities, is it possible to define and
apply individual Standards at a regional level that might work? The conclusion from this research and related analysis is that this is unlikely to
be the best way forward. Standards are best set by the department or body that has the direct ‘tasking or funding’ relationship with the service
deliverer; in public service terms, this means Central Government; without such a direct requirement standards will not be universal and are
unlikely to be implemented by local service providers unless agreed locally against shared outcomes. There is no real means of doing this at regional
level without substantial co-ordination, as none of the services identified above are delivered by regional bodies, and to do so now would mean
replicating the Local Area Agreement process which clearly would not be acceptable.
7
West Midlands Rural Services Scoping Study (October 2005); Scottish Executive xxx
8
An Independent Evaluation of the Rural Services Standard, June 2003, University of Gloucester
It may be possible for partners at regional level to agree ‘standards’ that define shared outcomes and indicators around improving service equity,
perhaps by pro-active targeting against agreed thematic and spatial parameters of dis-advantaged groups, but it is not considered realistic that
standards for individual services could be set, and accountability secured, at regional level. As identified within the 2003 RSS review, (written
before the arrival of Local Area Agreements), this needs to be addressed (somehow) at local level.
17
3.3
Local Measures, Performance Indicators and Targets
The project team has reviewed a range of ‘measures’ and ‘performance targets’ that have been defined at local level (that which fits the ‘service
constituency’), in order to assess whether these might be appropriate for use and development as ‘service standards’. Sources used have included
Accessibility Strategies, Best Value Performance Plans and emerging Local Area Agreements. Analysis of these documents shows how efforts to
improve and measure the standard of access to services often focus on ‘physical accessibility’ – the proximity of people to a fixed service point,
or the ability of people to move towards the service. For example, set out below are Shropshire County Council’s Accessibility Indicators taken
from the Local Transport Plan 2006 - 2011:
• % of all the public satisfied with local bus services
• % of rural households, or rural households without a car, able to access a town centre by public transport ( or demand responsive transport)
available two days per week
• % of a) people of working age, b) people in receipt of job seekers allowance able to access a key employment destination within 45 minutes by
a public transport service which operates at least hourly (7.30 – 18.00) on 6 days per week
• % if people able to access a broad place or customer first point within 20 minutes by foot or public transport
• % of households without access to a car who can access a further education establishments within a) daytime b) evening for households
• % of pupils entitled to free education transport using services
• % of people that reside within 20 minute travel time (urban areas by foot, rural areas by car) of a range of 3 different sports facility types of
which one has achieved a quality assured standard
Within the Shropshire Local Area Agreement, these indicators have been applied against accessibility (transport) outcomes. Rather than rely upon
a proximity indicator for broad places however, the LAA instead seeks to target the number of residents that use the broad places to access services
– so focusing on the user, rather that the service point.
The major source of new thinking on locally developed targets and indicators can be found within the emerging ‘set’ of Local Area Agreements.
Local Area Agreements were introduced by the then ODPM in 2004 as a way of improving the effectiveness and efficiency in the way government
works with local authorities and other delivery partners to improve public services. They were introduced as a pilot, and gradually rolled out
more widely; Lancashire is in the second tranche of ‘pilot’ areas, its LAA has been implemented in April 2006.
9
Para 8.1.3
The Lancashire Local Area Agreement contains a wide range of outcomes and targets (x in all); many of these relate to services assessed as being
important in rural areas, and those included in Defra’s Rural Service Standards and PSA4 Accessibility Indicators. A selection of these is included below:
• Number of people in structured drug treatment (S10)
• % of people retained in structured drug treatment over 12 weeks (S11 baseline 57%, target 64%)
• % of residents who said they were either very satisfied or fairly satisfied with their local area as a place to live (S20 baseline ‘very’ 29% target 32%)
• The number of drivers and passengers of powered two-wheel vehicles killed, seriously injured or slightly injured on the roads in Lancashire as
measured by STATS 19 accident database (S25)
• % residents who strongly agree or tend to agree that they can influence decisions affecting their local area (S26 baseline 32% target 35%)
• Proportion of key public services delivered by the VCFS (S29)
• % residents surveyed who are satisfied with the delivery of local services (S30 target 9 ex 13 services show an increase in satisfaction)
• Number of young people aged 13-19 who undergo personal and social development which results in an accredited outcome (C5)
• Number of young people accessing sexual health services based in Lancashire (C9)
• % of Lancashire’s 16-18 year old young people not in education, employment or training (C15)
• The number of adults participating in at least 30 minutes of moderate intensity sport and physical activity on 3 or more days each week on
average over a year (H2)
• % of vulnerable households in the private sector that are in a decent condition (H15)
• Affordable decent housing brought on stream (H20)
• Benefit take up by older people aged 65 and over (Number of new awards) (H26)
• Number of emergency admissions to hospital of people 65 and over (and under 65) suffering from long term health conditions (diabetes,
chronic heart disease, respiratory disease and acute psychosis) per 1,000 population (H30 & H31)
18
• Number of Lancashire people moving into sustainable employment and ceasing to claim an incapacity benefit or lone parent benefit (E8)
• Number of Lancashire businesses assisted to improve their competitiveness as measured by GVA (E9)
• % people surveyed who believe that access to employment by public transport has improved (E11)
It is clear from even a cursory analysis of these outcomes/targets that none have been defined specifically to address ‘rural services’, but that all
are equally applicable to a rural as an urban context. It is interesting to note that outcomes relating to services have begun to focus on the individual,
and their experience of accessibility. There are no references to geographical proximity of ‘service points’, nor to travelling times. Instead, the
outcomes are aimed at the proportion of residents engaging, or ‘satisfaction’ ratings, and even (S29) the type of service provider. These outcomes
therefore seem to be about ‘counting’ the use of services, or the scale of different types of service use (i.e. the number of young people accessing
sexual health services). They do not, at least in their ‘raw’ form, offer any intent to target identified vulnerable or disenfranchised groups (i.e.
residents of sparse dispersed rural communities or those without access to a car), or in any real sense seek to set standards governing access to,
or the quality of experience of consuming services applicable to, and available to all within a target group. As such, none of them can be considered
to be ‘Service Standards’ as they do not offer any minimum level of service to an individual; indeed, they are more likely to ensure that the level
of service experienced varies across the county depending on the location, and ability of the consumer to access services.
This is clearly demonstrated by LCC key performance indicator on the accessibility of library services; the national standard is that a minimum of
85% of the population has access to a fixed library service point within 2km of their home. In Lancashire overall, LCC library services report that
94% of households are within 2 miles of a fixed library. If however, the population is split into urban and rural areas of the county, only 57% of
rural households are within 2km of a fixed library point, and a further 28% within 4km making 85% of rural households within 4km (i.e. further
than 2 miles) of a fixed library point. Effectively therefore whilst the county performs well above the national minimum standard when measured
against the national standard in overall terms, it falls some way under actually delivering against that standard to a specific element of its constituency
when data is dis-aggregated to allow for urban / rural analysis.
3.4
Appropriateness of these ‘Local Standards’ to Improve Fair Access and Address Social Exclusion
Considering the various sets of standards and indicators above it becomes clear that none of these represent a ‘service standard’ i.e. an agreement
on a minimum service level, when considered from the viewpoint of a consumer/service demander. The fact that 95% of all households without
access to a car can get to a GP surgery within 30 minutes by public transport may mean that the measure addressed by the indicator is met, but
does not necessarily mean that a member of a household in either the 95% or 5% can access the ‘flu jab’ at a time relevant to them, and before
they fall ill. Indeed, there seems to be plenty of room for confusion and overlap between what might constitute a ‘service standard’, and the much
wider range of performance indicators, targets and measures included for example in Local Area Agreements.
A ‘service standard’ should imply that the service (at the standard set) will be delivered to 100% of the population described, for example – 100%
of schools will have broadband connections; all patients will be able to secure a GP appointment within 48 hrs, all children in families on low
incomes will be eligible for free school meals. The point about these standards is that they apply to 100% of the target population, regardless of
geographic location. It is possible of course to set standards that are differentiated for urban and rural areas (as the target ambulance response
times are). Here the level of service would be set differently for urban and rural areas, but nonetheless a specific standard set for each.
Existing ‘standards’ usually only describe one aspect of the service (for example the time or distance to access the service) but not others
(the speed of the broadband connection and its availability to pupils, the quality of the school meal etc.). This of course applies to urban as well as
rural areas.
The application of a ‘standard’ across its targeted geography is important however, as we have seen from the Lancashire Library Service example,
if the ‘standard’ is not dis-aggregated for urban and rural areas, the failure to meet the general standard in rural areas can be masked by the overall
distribution of population. Equally, a spatial classification made for specific purposes can have a material impact; Lancashire Ambulance Service is
designated by the Department of Health as being a ‘Rural’ Service; at least in so far as its performance is measured by the standard relating to rural
rather than urban areas. This classification has been applied at sub-regional level, and so makes no distinction whatever between service levels
achieved in the middle of Preston and the north eastern periphery of the Forest of Bowland.
10
Defra Evidence Base for Lancashire Rural Delivery Pathfinder
19
Another difficulty faced in rural areas is that if the service standard does not specifically address all elements of accessibility (e.g. you may be able
to make an appointment with a GP, but how do you get there (and back home) to use it when there is no bus and you don’t have access to a car?)
then whilst the Standard may be entirely valid as a performance driver for the service provider, as far as the individual is concerned the standard
is useless.
Many outcomes, performance indicators and targets defined locally are set at below 100%; often because they are seeking to measure improvement
by an increase in use or satisfaction. In reality, these measures cannot equate to a ‘service standard’ since they do not describe the level of service
that is available to all regardless of geography (or any other constraining factor) and therefore cannot be guaranteed to any individual consumer.
The language in common use becomes tricky. Performance indicators and targets are useful in driving up ‘standards’ (improving range and quality
of services), but do not describe ‘a service standard’, i.e. a particular (minimum) level of service that can be expected in every case.
Specific performance indicators and targets defined and applied locally, can be used to redress the balance between variable levels of access to
services experienced between different localities, or populations, particularly where these describe services specifically targeted at rural communities.
For example, the Shropshire Local Area Agreement includes an outcome seeking to measure the number of customers accessing a range of service
electronically delivered through Community ‘Broad Places’ in rural settlements.
However, most of the indicators in the LAA documents examined describe a performance indicator (often set a target below 100%) to be measured
across the entire service area. There is a real danger that these will actually have an unintended but detrimental affect on the provision of services
in rural areas, by creating a perverse incentive to concentrate effort in larger centres of population in order to meet the new (stretched) target.
To take one example from the Lancashire LAA; those responsible for delivering against the targets in relation to young people (the number of 13-19
year olds undergoing personal and social development, or accessing sexual health services), will obviously find it far easier to make rapid improvements
in the % of young people accessing these services by focussing on where most of them live – in the towns and larger settlements.
Improvements in area wide performance indicators can mask and blur significant differences in the service delivery levels between urban and rural
areas. More importantly, when resources are short, performance indicators that seek to drive up the % of a population benefiting from a service
will almost inevitably mitigate against improvements in rural service delivery and even drive down levels of service in the most remote areas,
unless specific steps are taken to disaggregate service delivery data to smaller geographic levels.
The ‘Flu jab’ case study.
Considering a simple service, such as a flu jab, allows us to un-pick some of the complexities around setting and maintaining service standards.
It also of course raises some interesting questions still to be addressed.
Objective: to receive my flu jab before I get at risk of illness
The current national service standards/performance indicators relating to this service are:
• % of a) households b) households without access to a car within 15 and 30 minutes of a GP by public transport (Accessibility Indicator, PSA4)
• All patients, including those living in rural areas, can expect to be offered an appointment to see a primary care professional within 24 hours or
a GP within 48 hours. (Defra Service Standards)
Unless the first performance indicator is set to apply to 100% of the target group (those eligible to receive a flu jab) the likelihood of this level
of service being available will diminish relative to the remoteness of the rural area, the sparsity of the population and level of public transport provision.
So if I live in a very rural area I am unlikely to be able to access the service in the time specified, particularly if I have no access to a car.
What are the alternates, and what impact might fitting in with them have on my quality of life? What impact might failing to access the flu jab,
or having a long wait; have on my quality of life?
• If I am disabled and in a wheelchair, even if there is public transport available, I am unlikely to be able to use it unless it has been specifically
designed to carry wheelchair users and the bus driver is trained to load them.
20
• If I am old and infirm and the ‘public transport’ is a ten-minute walk away and it is freezing, I may not be prepared to risk a fall on the ice to get
the bus.
• I can get an appointment with my GP for the next day (Tuesday), but I can’t have the flu jab then because the nurse, who only works Mondays,
Wednesdays and Fridays, is responsible for administering them. The bus runs through the village on Tuesday, Thursday and Saturday.
• My daughter is coming over on Wednesday and is willing to take me to the doctors, but she works and can only get here by 5.30 pm – the last
appointment in the surgery is at 5.45 and we live a 30 minute drive away.
• The GP surgery has arranged to deliver the flu jab in the local Church Hall on the second Tuesday in the month. I live 15 minutes walk from the
Church Hall and will need to organise a lift; I can plan for that and get help to get there – if I know about it far enough in advance.
For many eligible consumers, these issues will be immaterial of course; ‘both my partner and I have access to a car and are willing to drive to the
nearest surgery. The surgery is able to give us a choice of appointment times and these fit in well with our regular visit to the local town for shopping.’
The ability of a single standard to deliver a fair level of access to services is directly linked to the capacity, and willingness of policy makers, funders and
service deliverers to apply it to 100% of their target group. If this is to be done, some difficult decisions may need to be made around that target group.
If it is drawn to be completely inclusive, and takes no account of specific circumstance, the cost incurred by the deliverer is likely to be that much greater.
3.5
Conclusions on Standards
1. The combination of Defra’s national set of Service Standards and Accessibility Indicators offer very limited help locally in defining and delivering ‘fair
access’ to each and every service consumer.
2. Local performance indicators, and targets set against these, may be useful in driving up standards generally, but cannot be described as ‘a service
standard’, unless the target is set at 100% of the consumer group. Would the GP surgery have made arrangements to use the village hall, and made
sure that all its patients eligible for the flu jab knew about the plan far enough in advance if they were not obligated (or motivated) by a standard
that required them to deliver the flu jab, rather than available, to 100% of their patients?
3. Some current National Service Standards describe a guaranteed level of service for all (100% of the target population). These will ‘nail down’ some
aspects of a service, but do not consider all aspects of service quality or accessibility, nor necessarily the barriers experienced by a range of individuals
in accessing the service.
For rural areas and communities to derive equal benefit (to urban areas) from service standards, measures of relative accessibility need to be included.
4. Performance indicators that have targets set at below 100% may have an unintended detrimental effect on rural service delivery unless specific steps
are taken to disaggregate the data and performance assessment on service delivery between urban and rural areas, and between different types of rural
areas (i.e. sparse & less sparse, towns and dispersed villages and hamlets).
5. Where targets and standards are applied across an entire ‘service area’ regardless of spatial characteristics (rural/urban, sparse/less sparse, town/village),
it may be necessary to pro-actively target activity in different parts of the area, and imperative to ‘dis-aggregate’ the performance management data
in order to ensure that the service has been ‘equitably’ delivered across the entire area, and not focused on ‘honey pots’ where delivery is easy with
consequent disenfranchisement of elements of the ‘customer’ base.
6. Local ‘Rural Service Standards’ can perhaps be effectively introduced within the region by robust targeting of interventions and actions implemented
to achieve existing and refreshed LAA outcomes within a rural area. This approach is being piloted within the Lancashire LAA by a process of ‘mapping’
rural social exclusion, disadvantage and opportunity (based on ‘rural on rural’ analysis of IMD domains) against individual outcomes, and ‘tagging’ Super
Output Areas & ward within the PERFORM monitoring and performance management system. In order to be fully effective in setting a ‘service standard’
however, this targeting requires comparable levels of delivery and experience of accessibility to all within a target group or area.
21
7. In order for a ‘service standard’ to be useful, and validly address social exclusion, it must meet the following requirements:
• It must apply to 100% of its target group or area
• It must allow for ‘smart’ measurement across the entire target area, ie measurement which acknowledges and caters for different elements of the
whole (i.e. sparse and less sparse, those with and without access to a car etc)
• It must be sufficiently comprehensive as to address all elements of accessibility; the ability to engage with the service provider, and (where the service
requires physical contact) the ability for the service provider and customer to be in the same place at the same time.
Section Four:
How fair is access to services in the North West?
The brief seeks information about the performance within the region against the national Service Standards. In order to assess this, the project team has
reviewed performance assessments formally carried out, such as County Council Annual Performance Reports, and Annual Monitoring Reports. These
findings have been supplemented by consultation with service providers, performance analysts, and customers. The customer consultation has been
carried out by the local Rural Community Council, working with representative groups and individuals in the four sample communities; further details
on the community consultation are provided overleaf.
4.1
Formal Performance Assessment
A review of formal assessments and annual monitoring reports demonstrates that there is very limited connection between Defra’s National Service
Standards, and performance indicators used to review mainstream service providers. The Lancashire County Council Performance Report for 2004
includes over 200 Key Performance Indicators relating to Best Value, PSA targets and local indicators. Service areas include education, transport,
environmental and social services; areas directly relevant to six of the eleven service standards. Analysis of the compendium of performance indicators
shows that there are only three or four indicators that can be directly related to the Service Standards – interestingly three of the four related to
improving the quality of life and independence of vulnerable older people by supporting them to live in their own homes. Despite Education being one
of the service areas covered, no mention is made of standards relating to extended schools, maintenance of rural schools, access to broadband connectivity.
Indicators related to public transport are included, but none relate to the specific standard around the proportion of rural population’s access to bus services.
The same limited connection is apparent in the Local Public Service Agreement monitoring report, and in two district council annual monitoring reports.
In order to test whether this dis-connection is particular to Lancashire, the project team also reviewed the Annual Performance Plan for Cumbria
County Council (2005). This included some indicators that directly contributed towards Rural Strategy 2004:
• The number of rural jobs created and safeguarded
• % of residents satisfied with services provided by the council
• % of Cumbrian’s with access to broadband
There was little evidence however that any regard had been given to Defra’s Rural Service Standards when selecting Key Performance Indicators for
Council Performance.
Having failed to find reference to Defra’s Rural Service Standards (or the individual elements of them) in these reporting processes, the study team
made direct enquiries of Service Providers in an attempt to determine whether they were recording their performance against the RSS. In reality many
are, as has been identified earlier, RSS collates a number of standards set by individual government departments within their tasking/PSA frameworks.
11
Planning and Compulsory Purchase Act 2004
22
Lancashire Ambulance Trust reported success in exceeding both national performance targets; attending within eight minutes to 75% of life threatening
cases, and within 19 minutes to 95% of cases that are not immediately life-threatening. In each case, the targets were exceeded by relatively small
margins; 76.7% for life threatening cases, and 95.3% for non-life threatening cases. The service is designated as ‘rural’ in its entirety, and therefore no
indication is provided by the Trust’s reporting mechanisms as to how their performance breaks down across rural and urban areas within the county.
Lancashire County Council Education Services Department has provided information about the level of broadband connectivity to schools, and
‘Extended School’ provision.
• As at May 2006 94% of schools in Lancashire have broadband connectivity; the few remaining ISDN schools will have broadband available by early
Autumn term. This will mean that despite the rural nature of areas of both Lancashire and Cumbria we will have provided broadband to all schools
ahead of the DfES target for the end of 2006.
• Lancashire has four Full Service Extended Schools; St John's RC Primary in Skelmersdale, Marsden Primary in Nelson, Moor Nook Primary in Preston
and Central Lancaster High. There will be no further Full Service schools, since they were a pilot funded by the DfES. All schools have to provide access
to a range of extended services by 2010
Analysis within the Provisional Lancashire Local Transport Plan (2006/07 – 2010/11) clearly shows that the virtually the entire rural area does not meet
the Department for Transport travel time indicators adopted within Defra’s Accessibility Indicators. The analysis of the percentage of the population
living within 1km of the five basic services within Lancashire revealed that 69.31% of Lancashire’s population did meet that target in 2005, but this figure
has fallen by 1.59% since 2004. The five Districts that exceeded the 73% target were Blackburn with Darwen, Blackpool, Burnley, Hyndburn and
Preston, while Blackpool’s performance was higher at 94.07%. The rural nature of the Ribble Valley explains the poorest performance against the target
with only 43.61% of the population being able to access the five basic services within 1 km.
The impacts of changes within health service provision particularly the move to concentrate services within central health centres is seen to have
had the greatest impact on accessibility, and has led to the deletion of doctor’s surgeries across Lancashire with accessibility declining in Rossendale
(-32.4%), Lancaster (-10.93%) and Fylde (-7.18%).
At the time of writing, it has proven impossible to secure performance information from Primary Care Trusts for both East and West Lancashire.
Enquiries are ongoing.
4.2
Is Access to Services in Rural Lancashire Fair? Community Views and Responses
The work undertaken with people in the four sample settlements sought to test the perceptions of service consumers around whether the level of
accessibility currently experienced can be considered ‘fair’. The concept of fair is of course entirely subjective, each response will be based upon the
individual’s personal experiences, characteristics and state of mind. It must therefore be understood that in asking questions around fairness, the project
was simply trying to get some sort of feedback in terms of perceptions around service equity and accessibility.
In all, 136 people were consulted from the four settlements; there was a good spread of representation from those over 25 years old including luncheon
clubs for senior citizens and mothers and toddlers groups. There was a very limited representation from ‘hard to reach’ group 16-24 year olds, so overall
satisfaction with access to services cannot be ‘assumed from this group’.
The mobility of the consultation sample was relatively representative of rural Lancashire (47% of households have access to one or no car, whilst 20%
do not have access to a car at all). The constituency without access to a car at all must be a key consideration for service planners.
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Differences between ‘Sparse’ and Less Sparse
The community engagement was carried out exclusively in Lancashire in order to meet project logistical and budgetary constraints, and also to provide
for follow up ‘testing’ of outreach service delivery supported by the ‘Pathfinder In Practice’ funding Programme. This meant that it was not possible
to engage with a truly sparse settlement (in accordance with the rural / urban definition); in an attempt to build in as many sparse characteristics as possible,
two of the sample settlements were chosen on the basis of low population density and relative lack of mobility (Hornby and Burscough).
The findings from the Community Engagement where mainly consistent from the ‘proxy’ sparse and less sparse settlements, although it is possible to
define some interesting differences in certain areas:
• The proxy Sparse communities demonstrated greater levels of access to a car all the time, whilst the Less Sparse respondents were less likely to have
access to a car
• The proxy Sparse communities articulated a general acceptance of the need to travel further to access education and advice services (except
libraries), but were more concerned about health, cash and community services being available locally.
• Access to advice services, particularly libraries, was materially poorer in the Sparse Communities
• There was little variance between Sparse and Less Sparse when considering the relative merits of quality and proximity of services, although it is
possible to discern a greater interest in the proximity of outreach health services in the proxy Sparse respondents
• When expressing views on the ‘fairness’ of existing access, the picture is mixed. There appears to be little difference between satisfaction levels for
Education and Community Services; Sparse respondents were happier with their access to Health Services than Less Sparse, but unhappier about their
access to advice services, especially libraries, than their Less Sparse counterparts.
In this instance, both villages chosen are fairly well provided for in terms of service points (see maps in the Technical Appendices), and the Sparsity of
the two proxy Sparse settlements was limited, compared to areas of North East and West Cumbria. It is therefore possible that greater differences
between Sparse and Less Sparse would have been found if a greater range of settlements had been included in the community engagement piece.
Is the access to services that you experience ‘fair?’
In line with many other surveys that measure satisfaction, the field research revealed that, in general, most people who live in rural areas do not expect
greater access to services than they already receive. High percentages of respondents expressed the view that access to particular services is ‘fair’.
For some services however, particularly hospitals, training, advice and employment services, there are in the region of (and over) a quarter of people
saying that the access is ‘unfair’.
What level of dis-satisfaction is acceptable however, in a County where the Council’s strap-line is “A county where everyone matters” and which
embraces the national slogan of “Every child matters”? From the point of view of the taxpayer, it would not seem unreasonable that providers of key
public services should be required to achieve very high customer satisfaction ratings, yet the evidence from the field study shows only 9 out of the list
of 23 services (and only the childcare service block) scoring within the top percentile.
Perhaps more significantly, those respondents without access to a car and in the older age ranges (post 65) are more likely to consider that access to
services is unfair than the remainder of the sample.
24
Education
% Yes
% No
Health Care
% Yes
% No
Childcare
% Yes
% No
Primary School
96
4
Hospital
Secondary School
97
3
GP
76
24
Nursery/Children
91
9
85
15
Ante Natal
Further Education
81
19
Dentist
Higher Education
80
20
Pharmacy
76
24
& Health Visitors
90
10
93
7
Training
74
25
District Nurse
90
10
Specialist
82
18
86
14
84
16
90.5
9.5
% Yes
%No
% Yes
%No
% Yes
%No
Community
% Yes
% No
Quality of life/
advice
% Yes
% No
Post Office
90
10
Library
86
14
Bank/Building Soc
77
23
Advice Services
73
27
Cash
83
17
Emp Services
72
28
Food Shop
88
12
Sports & Leisure
88
12
80
20
Community Hall
94
6
Pub
96
4
88
12
% Yes
%No
% Yes
%No
Access to services in rural areas depends on mobility but more journeys are not always the answer.
A significant number of respondents need to travel to access the services they need and in many cases people can only access services by car. Reliance
on being able to travel increases as the service becomes more specialist – rising to 87% for Higher Education and 93% for hospital services. However,
even for the ‘Community’ service block nearly 40% have to travel by public transport or car to access these services. If access to services is to be
improved, then mobility must be a key targeting consideration.
Difficulties with mobility need to be addressed by those planning the delivery of services and those without access to a car or useable public transport
(the disabled for example) should be a key target group for public service providers. However, with 40% of people having to travel to access even basic
community level services and 70% to access services in the ‘quality of life’ block, improving the ability of people to travel to the service is only the part
of the answer. None of the services in these blocks could be described as ‘specialist’ services and new ways of bringing the service to the customer,
rather than relying on increasing the number of journeys must be a key to improving access to these more ‘basic’ level services. Even some specialist
services, especially those that rely on specialist knowledge, rather than specialist equipment, can be delivered more locally by greater use of multi- purpose
buildings and/or linking customer to service through the use of ICT.
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Monitoring of service delivery should therefore be extended to include questions around mobility and the information collected used to inform service
planning, including alternatives to moving the customer to a fixed point, which requires the customer to travel by car or on public transport.
People are willing to travel for some things – but only so far.
One of the most interesting findings of the community engagement is that in general rural people accept that they have to travel to access the services
they need (and presumably they are willing to trade this inconvenience for the benefits of living in a rural areas), but they also have very clear ideas
about the cut off point at which travelling for services becomes unacceptable. Very few people thought it was acceptable that any service should be
more than 30 minutes travel time away (except for Higher Education).
Defra’s Accessibility Indicators measure the % of households that have to travel (over a given time limit) to reach a service; as has already been noted,
the rural area of Lancashire does not fall within the DfT thresholds. A more detailed analysis by service providers would reveal geographical ‘hot spots’
in terms of unacceptable travel times – that is to say services over 30 minutes travel time away. This approach is similar to the accessibility work that
Lancashire County Council has been undertaking recently.
The Customer ‘Hierarchy’ of Local Accessibility of Services (Local-on demand, Service Centre, Distant - see Section 2) provides a good framework for
deciding which services rural people feel should be provided locally and which they are willing to travel to access. More detailed local research
(through Parish Plans for example) might provide variations on this list, which could be used to target particular services for increased local delivery.
Often, some local service is better than no service at all – for other services quality is what matters most.
As well as investigating where people felt that services should be located, the field study also asked people to indicate for which services they were
willing to trade quality for proximity. The findings provide a very clear picture of the balance that needs to be struck in most cases. What is most
significant however, is that for many of the services in the ‘Community’ block people clearly feel that some service (even if at a lower quality) is better
than having to travel. It is apparent from the dis-aggregated field survey data that the elderly and those with limited personal mobility were most likely
to focus on proximity before quality.
These findings support the argument that there are some ‘essential’ services that need to be provided locally, even if not at the same level as in other,
more populous areas. So, for example, it is much better to have a post office open mornings only (and not providing more specialist services) than
no post office at all. When figures for the value that people place on quality for particular services with the % that require local access are combined
graphically, a very clear picture emerges of where particular services ‘lie’ in relation to each other.
Services for the under 10s and non hospital-based health services score highly in both ‘quality’ and ‘local access’. People are not willing to sacrifice
quality in these services but expect to see them delivered locally, putting these services top of the list of priorities for these rural communities.
Other services, such as Food Shops and Post Offices people expect to access locally, but are willing to accept a lower quality in order to do so.
For some services, such as further and higher education, quality is seen as important and people accept that as these services cannot be provided
in every community or service centre, they are willing to travel.
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Section Five:
Defining fair access to rural services in the North West the potential for rural service standards
5.1 Benchmarks of Fair Access to Services in the North West
One of the initial intentions of the project was to improve understanding of what ‘fair access to services’ means within the region and to suggest a set
of measures/ benchmarks (for appropriate services) that define fair access and against which the performance of the region could be measured.
The RRDF (Priority 4) specifies the outcomes that the region is trying to achieve in general terms and includes an objective that “Public service
providers meet agreed standards on accessibility and quality”. In addition Priority 5 of the RRDF includes an outcome in relation to rural equity in
terms of service delivery arrangements, which is also relevant to this project.
The central point of the project is to find ways for service deliverers, including local communities and the VCS, to increase equity in the delivery of
services in rural areas, with a particular focus on those most disadvantaged. There is a presumption in the framing of the brief that the identification
of a regional set of benchmarks/performance indicators will be the most effective mechanisms for driving the improvement of accessibility to services
in rural areas. Firstly however, it is necessary to determine just what the purpose of a Service Standard might be, whether the creation of a ‘Standard’
can address that purpose, and if so, how that might be achieved.
In order to do so, it is vital to clarify the definitions of ‘standards’, performance indicators, targets and outcomes
Equity of service delivery is compromised by the confusion around the way people define and apply ‘standards’, ‘performance indicators’, ‘targets’ and
‘outcomes’. Definitions (suggested in Section 1) of these will help move towards a more transparent analysis of actual service delivery across both rural
and urban areas. In particular a standard should apply to 100% of a target population or group (i.e. those without L2 qualification and access to a car),
even where the standard is set at different levels for different populations (or geographic areas). Service Standards (when set at 100%) that allow for
measurement between different geographic areas (particularly if mapped against super output areas) will highlight deficiencies in service delivery and
can be used in the drive for service equity.
The use of the national Rural Service Standard
The national Rural Services Standard was designed to work from a customer point of view – that is to say it was meant to articulate ‘what rural residents
can reasonably expect’. The reality has been that the RSS has operated as a mixture of information to customers, statements of government policy,
standards (both discretionary and mandatory), performance targets, exhortation to providers, a monitoring tool and dissemination of good practice
(Moseley et al 2003). Our conclusion from this study is that the RSS may be useful as a national framework to focus attention on rural service delivery
issues, and that monitoring these standards at a regional level will provide a regional benchmark for comparison with other regions and with England
as a whole. The RSS alone however, will have limited impact in driving an improvement in service accessibility within the region.
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What do rural communities think is ‘fair’?
The research undertaken with the four communities as part of this project provides some very useful information on the perceptions of residents about
which services they access and how, and what they consider is ‘fair’. Other national studies have grappled with this question. The new Rural Services
Partnership define ‘fair’ as ‘broadly commensurate’ in terms of cost (to the consumer), range and quality to their less rural counterparts. The community
research for this project did provide some information that could support the development of a definition of ‘fair access’ for the North West:
1. All services except those related to higher education (and presumably other specialist training courses) should be accessible within a 30 minute journey.
2. An individual’s definition of ‘fair access’ will vary with locality and depending on the mobility and age of individual residents – pointing to the need for
local engagement at a service specific level to truly define ‘fair access’.
3. A ‘hierarchy of services’ can be used to define which services people expect to access locally (within 10 minutes) and for which they are prepared to travel.
Validity of Regional Service Standards or Benchmarks
The project has given rise to a number of issues that suggest the need for a reshaping of the original intention of the brief to arrive at a set of regional
level ‘standards’ or benchmarks.
• If the RRDF is to make a difference then the focus must be on finding mechanisms that will increase the equity of access to services on the ground.
The jury is out about how far the National RSS performs this role (although it is probably fair to say that it has not yet reached its potential in this
respect – see Moseley et al 2003). A new regional set of standards focused on informing rural communities ‘what to expect’ is therefore unlikely to add
value to the national set.
• A comprehensive set of regional standards/performance indicators related to the list of services identified in the project report could provide an
overview of aspirations for the region (see examples in Section 5.3 of the report). However, as there is no line of accountability between the RRDF,
service providers and funders, the impact of such a set of standards on improving service accessibility is likely to be limited, as delivery organisations
struggle to meet the targets set by their funding departments or other (intermediary) funding bodies.
• The picture is further complicated by the fact that local and individual definitions of what is ‘fair’, as well as priorities for improving access to services,
will vary substantively across the different rural areas in the region.
National Standards:
The region could use the National RSS to benchmark performance in the North West against that achieved in other regions and nationally. The region
could also feed back to the Defra Rural Services team suggestions for adjustments and improvements to the National RSS to better reflect the aspirations
of rural communities and to address inconsistencies.
Defining Fair Access to Rural Services at Regional Level
The findings of the Study offer a potential definition of what constitutes ‘fair access to rural services in the North West’ that could be used as a litmus
test for regional and local partners when considering service accessibility in rural areas:
Access to a service can be said to be ‘fair’ when
a) it is broadly commensurate in terms of cost (to the consumer) quality and range to that available to residents of other (less rural) areas
b) it is provided either within 10 minutes walking distance (for those services agreed with the community that should be available locally – see
hierarchy of locality) or within 30 minutes journey time by useable public transport (for those services agreed with the community should be
available in larger service centres)
c) it is accessible to the same degree by those who are more disadvantaged (by age, mobility, disability, language etc)”
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Changes in the ‘fairness’ of access could be measured by assessing changes in:
• provision and proximity of services by community, using existing Service Point mapping, Accession Software and the Accessibility mapping process
• increased satisfaction or reduced dissatisfaction rating within communities
• an improved response to questions of ‘fairness’ from the most disadvantaged; perhaps by using Local Authority Citizen’s Panels cut by mobility and
age, or RCC’s as a means of aggregating community views
• provision of out-reach amongst targeted services
• inclusion of specific outcomes, targets and measures designed to improve service equity with Local Area Agreements
Regional Accessibility Targets & Indicators:
It would be possible to arrive at a set of ‘accessibility targets’ for the region that would define the aspirations of partners and stakeholders against the
RRDF Priority 4. This set of targets could then be used alongside the spatial targeting framework developed using PBRS to measure progress towards
regional ‘accessibility’ aspirations and highlight either services or geographic areas that were meeting or moving toward the aspirational accessibility
level (subject of course to the rigor with which relevant data was collected, collated and analysed).
Local Area Agreement level standards
It would be far more effective (in terms of improving service equity to rural communities in the North West) to seek to influence the shape of Local
Area Agreements in order to include measures of access to services in rural areas in the way described (paragraph 5.2) overleaf. If the RRDF (via the
Rural Board and Practitioner Group) could influence the effective inclusion of specific ural ‘service standards’ within LAA Outcome Frameworks,
and particularly the way that data on service delivery is collected and analysed, this would exert direct pressure on service providers (public, private
sub-contractors and the voluntary sector) to consider issues of rural equity. This mechanism would deliver the Priority 4 objective of ‘public service
providers to meet agreed standards on accessibility and quality’ – i.e. agreed at LAA level.
Additional recommendation in relation to LAAs
Since disadvantage is so scattered across and within rural communities, in order to effectively capture the experiences of the most disadvantaged,
satisfaction surveys should not only take a rural/urban cut (using new definitions) but also be designed to examine satisfaction rates among particular
groups. In a rural context these should be particularly those without access to a car, older people and younger people.
Involvement of local communities
The only sure way of responding appropriately to the diverse needs of rural areas is to involve local people in identifying service access priorities, and
the solutions to service delivery (e.g. multi-purpose outlets, services located in shops and pubs etc.). Parish Councils (Parish Plans) and locally based
Voluntary and Community based workers have key roles to play here. However, individual residents also need clear information about service availability
and standards to expect as well as routes for registering when the service falls short of these standards. This can only be delivered at a sub-regional
or more local level.
Dis-aggregating data
A key message of the project reports is that if data is not dis-aggregated to reveal differences in service accessibility between different areas then there
is little point having the standard, whether it is national, regional or county level.
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5.2
Core Conclusion and Recommendations
Our core conclusion is that real ‘Service Standards’ can be used to drive service equity for rural communities. However, if such standards are to provide
an effective guarantee of a ‘minimum service level’, both national and regional ‘standards’ can only provide a framework for the process of agreeing and
delivering against service standards at the appropriate local level.
If Service Standards are to be introduced in addition to the targets, milestones and indicators that exist, then it should be within the Local Area
Agreement that this is done. Any such Service Standards should align with the Priorities, Outcomes and Actions of the Regional Rural Delivery
Framework, but should relate to locally specific services, target groups and geography.
The region has a role in ensuring that these agreements are both responsive to local need and reflect government priorities; in particular Government
Offices of the Regions have been charged with taking the lead in embedding rural proofing at the regional level. The Regional Rural Board and
Practitioners Group, working through GONW is therefore in an excellent position to influence the shape and detail of LAAs in the region, and so improve
their ability to address rural accessibility issues.
We recommend that Local Area Agreements should be benchmarked to see whether they include:
• Responses to specific rural priorities (RRDF) (e.g. affordable rural housing, community access points etc) and specific mechanisms to address rural
service needs (e.g. multi-agency delivery).
• Commitments to universal service standards (regardless of geography) over and above national standards (e.g. in Herefordshire – 100% of primary
school children must have the opportunity to play an instrument).
• Any targets or indicators that could have a perverse incentive to deliver a greater proportion of services in larger centres of population and any
mitigating measures.
• Specific arrangements for collecting data that accounts for different spatial areas (i.e. urban and rural) and which can identify different levels in service
delivery and take up (e.g. Lancashire rural ‘tagging’ pilot).
• Whether any account has been taken, or allowance made of the impact of sparsity on the cost of meeting access standards when allocating funds
from national or regional to local level. Performance measurement structures could collect evidence on the increased cost of meeting specified
standards in rural areas (for the ambulance service for example) and so make the argument for a ‘rural or sparsity’ premium.
Defining Fair Access
For this ‘challenge’ or review process to be effective, it will be necessary to be able to articulate a common sense of what ‘fair access’ actually means
in the rural North West, and in due course to be able to measure change. The study team has therefore developed a high level definition, supported
by recommendations on the use of indicators and ‘accessibility targets’.
These are designed to be simplistic and consistent; it is understood that such definition and standards are generic, and unlikely to be achievable for all
communities and all services across the region. The intention is that they can be used as a benchmark, as a common expression of what ‘fair’ means
for rural communities. They can be applied by practitioners, politicians, communities and the VCS, by anyone with an interest in improving fairness
of access to ‘measure’ existing access, test and challenge proposals within local delivery plans and Local Area Agreements, and in debate with service providers.
30
a) it is broadly commensurate in terms of cost (to the consumer) quality and range to that available to residents of other (less rural or less sparse)
areas
b) it is provided either within 10 minutes walking distance (for those services agreed with the community that should be available locally – see below)
or within 30 minutes journey time by useable public transport (for those services agreed with the community should be available in larger service
centres)
d) it is accessible to the same degree by those who are more disadvantaged (by age, mobility, language, disability etc)”
Over-Arching Regional / Sub-Regional Indicator
The objective, in order to secure service equity for rural communities, is to close the gap between accessibility to services for residents between urban
and rural, sparse and less sparse areas. In order to identify and measure change, it will be necessary to monitor accessibility against an indicator, starting
with a common baseline.
It has been determined that the most effective way of understanding and monitoring the gap in accessibility is to use ‘accessibility indicators’ as is
becoming increasingly common in sub-regional Accessibility Strategies; % of households with X minutes travelling time to a service point.
In order to get a comprehensive picture, it will be necessary to be able to map all service points, i.e. not just fixed service points, but those used for
delivery of outreach services, such as a regular GP consultation in a village hall. It is vital however that the service points are classified as either;
permanent (open five days a week), part-time (open between 1 & 3 days per week), occasional (available less than 2 days per fortnight).
The data should be built up at Output Area level, but aggregated to show the gap between urban and rural households at regional and sub-regional
level. If it is built in this way, it could also be further analysed by Sparse and Less Sparse areas of the region.
Challenge Tools
In addition to an arms length review of Local Area Agreement, the Study Team recommends that the Rural Board and Practitioner Group seek to
engage with Local Strategic Partnerships, as the primary partnership for service delivery at sub-regional level via Local Area Agreements, (perhaps via
the sub-regional rural partnerships) and work with them to improve equity in access to services for rural communities. The ‘challenges’ set out
below should help to lead and guide the debate.
1. Dis-aggregate data
Improvements in local (service area) performance indicators can mask and blur significant differences in service delivery levels between urban and rural
areas. More importantly, when service delivery resources are static, performance indicators that seek to drive up the % of a population benefiting from
a service will almost inevitably mitigate against improvements in rural service delivery and even drive down levels of service in the most remote areas,
unless specific steps are taken to dis-aggregate service delivery data to smaller geographic levels. Dis-aggregation of data to super output area (wherever
possible) is a first step in identifying inequity of delivery to rural areas.
Organisational corporate, operational and delivery plans will need to be ‘rural-proofed’ as well as the LAA delivery plan to un-pick what really makes
a difference at a local level. It may be necessary for example to include specific questions about rural accessibility disadvantage in Corporate Impact
Assessments such as that used by the County Council.
31
2. Target the most disadvantaged
Since access to many services does depend on travelling to the nearest town, people without access to a car, particularly those of them that find it
difficult to use public transport and those on low incomes are the most disadvantaged. The decline in local services and the difficulties that this group
find in accessing services at a distance have a seriously detrimental affect on their quality of lives. Those without access to a car are targeted in the
national (Defra) Accessibility Indicators.
In designing the delivery of a service which improves service equity, the burden of ensuring that the service meets the customer (whichever travels
where) should fall to the service provider where the individual has difficulty in travelling. In many cases, increasing delivery at a local level for this group
(through the use of local service points, home visits or use of ICT) will be preferable (for the individual, for the environment and for the sustainability
of local communities) to an increase in the trend towards concentration of services and increased journeys for rural customers.
3. Those disadvantaged by a combination of mobility, geography and service planning are a valid ‘minority’
All public service providers will have a diversity and equalities policy and many will be using Equality Impact Assessments to judge how their policies and
service planning will impact on particular (disadvantaged) groups. It would clearly be possible (and there are some examples of this across the country)
to include those disadvantaged by mobility and geographic location as one of the named disadvantaged groups in the policy. In this way the impact of
service delivery plans on the most disadvantaged in rural communities could be considered at an early stage.
Interestingly the Audit Commission’s CPA guidance to local authorities – in the CPA ‘Key Lines of Enquiry” asks: “Does the Council seek to ensure
equal access to services among all groups and areas ”, whilst the Protocol (December 2005) for the Lancashire Local Agreement states that it will
ensure that information and services are accessible to everyone who needs them as a key plank of achieving social inclusion.
4. Use the ‘Hierarchy of Service Accessibility’ to define what is ‘fair’ in the delivery of rural services - Focus on delivering services where
people want them.
Our field study has found that people generally agree about what services they expect to be delivered locally and what they are prepared to travel to
access. Many ‘Community’ services still require a journey in a car or by public transport to access, as well as, perhaps more obviously, specialist services.
Information from Parish Plans and Community Strategy consultations could be used to build up a picture of which services it is important to deliver
locally to where people live.
5. Apply the 30 minute travel rule.
The field study also revealed a high level of consensus that travelling for more than 30 minutes to access services (except higher education) was unacceptable.
Accessibility planning is already being undertaken by County Councils. It would be relatively easy to track which communities were having to travel
more that 30 minutes for which services and use this information, alongside commitments to use Community Resource Centres in future service delivery
planning. The work that is on-going to develop a Targeting Framework for the Regional Rural Delivery Framework will provide a regional picture of
relative accessibility. It should then be possible to identify service deficiencies and geographic ‘hot spots’ by adding Accessibility Modelling at local level
to take account of ‘travelling time.
6. Be prepared to offer a lower level of service in rural areas rather than no service at all (for some services)
There are some services where people are willing to sacrifice quality in order to secure proximity of a service. This is particularly true of services that
are traditionally seen as ‘community’ services and services which people without access to a car need regularly – cash, post office or food shop.
7. Gather evidence of local delivery barriers, including resources
It is important to capture the commitment of public service delivery organisations to improving equity for rural communities. Mechanisms which
impose another ‘layer’ of performance indicators or increased bureaucracy when there is little chance of gaining the necessary resources to do anything
about it are disheartening and frustrating for all concerned. However, the dis-aggregation of service delivery data, information on the costs of delivering
to rural communities, information on the numbers of people unable to access their services for lack of a car, is all valuable evidence that can be used
to influence national government and other public service bodies to improve the accessibility of services in rural areas.
32
5.3
Potential Local Service Standards
The matrix below sets out a potential approach to applying and monitoring Rural Service Standards within the framework of a Local Area Agreement.
It is based upon the key services identified by field study as ‘Local – On Demand’ and is referenced to the Regional Rural Delivery Framework and
Lancashire Local Area Agreement. It is stressed that the Standards put forward are not necessarily recommended for implementation; rather they are
offered as examples.
Service Area
Service Standard
RRDF Action
Lancashire
Monitoring Tool
LAA Outcome
Primary Schools
All primary school pupils will have individual access to
Broadband by 2010
4.3.3
C4
LEA Annual Report/
LAA Annual Monitoring Rpt
All pupils in Year 6 will have remote access to a School
Computer (IT) network by 2010
4.3.3
C4
LEA Annual Report/
LAA Annual Monitoring Rpt
Nursery/Childcare
All residents of Lancashire will have access to a free
4.2.,
S30
childcare place for under 4’s within 30 minutes travelling
4.3.1
S29
time from home
4.3.2
S28, S27
Accessibility Planning /
LEA Annual Monitoring Rpt
Post Office
All residents of Lancashire to have access to services
4.1.2
S20
equivalent to those available a sub-post office within 30
4.2.1,4.3.1
S26
minutes travelling time from home
4.3.2, 4.3.3
S29, S30, H26
Accessibility Planning /
Local Transport Plan
Annual Monitoring report
GP/ Health Centre
All GP practices will offer a minimum of X outreach sessions
(at which GP, Nurse and Health Visitor will be available) each
month at identified Community Halls or;
All registered patients without access to a private car will be
enabled to access their health centre with 30 minutes travelling
time in order to attend appointments
Food Shop
4.2.1, 4.3.2
H30, H31
PCT Annual Reports
S20, S30
Accessibility Planning/
All residents of Lancashire to have access to a retail outlet
offering basic food stuffs within 30 minutes travelling time
4.2.1
from home
4.3.1, 4.1.2
Annual Monitoring report,
VIRSA
Cash
All residents of Lancashire to have access to a facility to access
4.2.1
cash within 30 minutes travelling time from home
4.3.1, 4.3.2
S20, S30
Accessibility Planning/
Annual Monitoring report,
CF Annual Report
Community Hall
All community halls to be DDA compliant by 2008
4.2.1, 4.3.2
Trading Standards Annual
Report, Community
Futures Annual Report
Access to Service
All residents of Lancashire without access to a car during the
Centre for Limited
working week to be enabled to travel to and from a Service
Mobility Residents
Centre containing a Health Centre, Post Office, Church,
Accessibility Planning,
Food Shop and Pub within 30 minutes travelling time from
4.1.2
home on a weekly basis during business hours
4.2.1, 4.3.1
33
S30, S29
Annual Rpt
5The ‘sample’ set of Service Standards set out above demonstrates only too clearly the potential implications of setting Service Standards, and the need
to ensure agreement and commitment between policy makers, funders and service delivers in order for any such standards to be achieved. In order
to develop a consistent approach to Service Standards within Local Area Agreements, and to move this process on within the region, we suggest that
it will be necessary to consider some key questions that the work has raised with Local Strategic Partnerships and LAA groups, in addition to the
recommendations set out in paragraph 5.1 above:
Q: What does ‘service equity’ really mean in the relevant rural area? Are the subject rural areas generally disadvantaged in terms of accessibility,
or does this disadvantage lie in specific places with specific groups?
Q: Should service standards be universally applied across the whole rural constituency? Or rather, should (some or all) standards only be applied for the
benefit of the most vulnerable and disadvantaged, i.e. those without personal mobility?
Q: What is needed to ensure that performance indicators and targets within both the LAA and individual Service Provider’s organisation are properly
‘rural proofed’ – to ensure that the data does not mask low levels of (or gaps in) service delivery in rural areas? LAA performance indicators and targets
can be mapped geographically, but operational and delivery plans of individual organisations will also need to be ‘rural proofed’, and some form of
accountability agreed.
Q: Are specific Service Standards the right answer? Might a robust ‘Corporate or Service Planning Impact Assessment’ adopted by each service provider
that included effective challenges around the effect that the proposal would have on improving service equity for target groups in rural areas be more
effective?
Q: Given the current direction of Public Service Reform; the enabling of the individual by personal (and so means tested) intervention, might the
temptation may be to focus on Standards which enable dis-advantaged individuals (i.e. by allowing them to ‘buy’ mobility) whilst permitting the increasing
centralisation of service delivery into the urban areas? As can be seen from the field study work, that approach is unlikely to address the demand, and
expectation amongst rural communities in the North West for the existence of a core set of services at very local (within 10 minute walk) level within
their settlements.
If fairness of access to services is to be improved, then all parties; service providers, service users, policy makers, funders and facilitators (i.e. the
Voluntary and Community Sector) will have to work together. It must be remembered that in reality, service providers are not accountable to these
partners, but ultimately to the community via their sponsoring government department. It may therefore be necessary to secure support from these
sponsoring departments for this type of ‘Standard’ led approach, and then to agree specific standards locally (ideally within the Local Area Agreement).
Government Office will have a key role to play here.
Rural Innovation & Community Futures
June 2006
34
Appendices
REGIONAL DEFINTION, STANDARDS AND CHALLENGE TOOLS
HOW FAIR IS ACCESS TO SERVICES FOR RURAL COMMUNITIES IN THE NORTH WEST?
Rural people and rural communities should expect a ‘fair’ level of service from public agencies and not be ‘unduly’ disadvantaged because they live at
a distance from towns or cities. Currently, the level of accessibility to services varies substantively across the North West, but in one element there
is consistency, the residents of much of the rural area of the North West experience a lower level of accessibility than their urban counterparts.
For example, analysis of accessibility within the Provisional Lancashire Local Transport Plan (2006/07-2010/11) clearly shows that the virtually the entire
rural area of the sub-region does not meet the Department for Transport travel time indicators adopted within Defra’s Accessibility Indicators. The
analysis of the percentage of the population living within 1km of the five basic services within Lancashire revealed that 69.31% of Lancashire’s population
did meet that target in 2005, and that this figure had fallen by 1.59% since 2004. The five Districts that exceeded the 73% target were Blackburn with
Darwen, Blackpool, Burnley, Hyndburn and Preston; Blackpool’s performance was highest at 94.07%. The ‘rural’ districts all failed to reach 73%;
the lowest figure is in the Ribble Valley where only 43.61% of the population is able to access the five basic services within 1 km.
D E F I N I N G FA I R AC C E S S T O R U R A L S E R V I C E S I N T H E N O R T H W E S T
The definition, accessibility standards and indicators set out below are designed to promote ‘service equity’ and improve the ‘fairness’ of access
to services in the rural North West. They are designed to be simplistic and consistent; it is understood that such definition and standards are generic,
and unlikely to be achievable for all communities and all services across the region. The intention is that they can be used as a benchmark, as a common
expression of what ‘fair’ means for rural communities. They can be applied by practitioners, politicians, communities and the VCS, by anyone with an
interest in improving fairness of access to ‘measure’ existing access, test and challenge proposals within local delivery plans and Local Area Agreements,
and in debate with service providers.
a) it is broadly commensurate in terms of cost (to the consumer) quality and range to that available to residents of other (less rural or less sparse) areas
b) it is provided either within 10 minutes walking distance (for those services agreed with the community that should be available locally – see below)
or within 30 minutes journey time by useable public transport (for those services agreed with the community should be available in larger service centres)
c) it is accessible to the same degree by those who are more disadvantaged (by age, mobility, language, disability etc)”
35
IMPROVING FAIR ACCESS TO RURAL SERVICES
Use the following challenges to ‘test’ whether service delivery is likely to improve accessibility for rural communities when engaging with service
deliverers and policy makers:
1. Show us that you can and will dis-aggregate data against rural / urban, sparse / less sparse or by target customer groups (i.e. those over 65,
families with children under 5, households without access to a private car during the working week).
2. Show us how you will target the most disadvantaged service consumers in order to deliver service equity; have you considered information
within your Accessibility Strategy and Local Travel Plan? What use have you made of Parish Plans and other local area plans such as Market Town
Initiative plans etc?
3. Those disadvantaged by a combination of mobility, geography and service planning are a valid ‘minority’. Show us that you have considered
location, sparsity, peripherality and the mobility of service users as part of your equalities policy and practice.
4. Use the ‘Hierarchy of Locality’ to refine the definition of ‘fair access to services’ locally – show us how you have focussed on delivering services
where people want them.
5. Show us how you have considered the travel time ‘cut offs’ to ensure that services are available where people want them; show us how you will
move services to people and used innovative methods to reduce reliance on services users travelling to a fixed service point.
6. Be prepared to offer a lower level of service in rural areas rather than no service at all (for services such as cash and ‘post office counter’, food shops
and if absolutely necessary visiting healthcare professionals)
7. Tell us about evidence of barriers to meeting these standards
In designing delivery to improve service equity and address rural disadvantage, the burden of ensuring that the service meets the customer (whichever
travels where) should fall to the service provider where the individual has difficulty in travelling. In many cases, increasing delivery at a local level for
this group (through the use of local service points, home visits or use of ICT) will be preferable (for the individual, for the environment and for the
sustainability of local communities) to an increase in the trend towards concentration of services and increased journeys for rural customers.
USE OF STANDARDS AND INDICATORS
Over-Arching Regional / Sub-Regional Indicator
The objective, in order to secure service equity for rural communities, is to close the gap between accessibility to services for residents between urban
and rural, sparse and less sparse areas. In order to identify and measure change, it will be necessary to monitor accessibility against an indicator, starting
with a common baseline.
It has been determined that the most effective way of understanding and monitoring the gap in accessibility is to use ‘accessibility indicators’ as
is becoming increasingly common in sub-regional Accessibility Strategies; % of households with X minutes travelling time to a service point.
In order to get a comprehensive picture, it will be necessary to be able to map all service points, i.e. not just fixed service points, but those used for
delivery of outreach services, such as a regular GP consultation in a village hall. It is vital however that the service points are classified as either;
permanent (open five days a week), part-time (open between 1 & 3 days per week), occasional (available less than 2 days per fortnight).
The data should be built up at Output Area level, but aggregated to show the gap between urban and rural households at regional and sub-regional
level. If it is built in this way, it could also be further analysed by Sparse and Less Sparse areas of the region.
36
Use of Standards and Indicators
In order for a ‘service standard’ to effectively address social exclusion, it must meet the following requirements:
• It must apply to 100% of its target group or area
• It must allow for ‘smart’ measurement across the entire target area, ie measurement which acknowledges and caters for different elements of the
whole (i.e. sparse and less sparse, those with and without access to a car etc)
• It must be sufficiently comprehensive as to address all elements of accessibility; the ability to engage with the service provider, and (where the
service requires physical contact) the ability for the service provider and customer to be in the same place at the same time
Standards and Performance indicators that have targets set at below 100% may have an unintended detrimental effect on rural service delivery
unless specific steps are taken to disaggregate the data and performance assessment on service delivery between urban and rural areas, and
between different types of rural areas (i.e. sparse & less sparse, towns and dispersed villages and hamlets).
Where targets and standards are applied, they should take account both spatial characteristics (rural/urban, sparse/less sparse, town/village), and the
characteristics of different customer groups (age, mobility, poverty etc). It may be necessary to pro-actively target activity in different locations
and at different customer groups parts; in any event it will be imperative to ‘dis-aggregate’ the performance management data in order to ensure
that the service has been ‘equitably’ delivered across the entire area, and not focused on ‘honey pots’ where delivery is easy with consequent
disenfranchisement of elements of the ‘customer’ base.
North West Service Theme
One or two Examples of indicator per Theme
Childcare
% of households without access to a car and with under 5’s within 2km of nursery/childcare
Healthcare
% of households without access to a car within 10 minutes journey time of a GP surgery;
% of households without access to a car within 30 minutes journey time of a GP surgery
Education
% of households without access to a car and with under 12’s within 10 minutes journey time of a primary school
% of households with under 16’s within 30 minutes journey time of a secondary school
Community
% of households with over 65’s within 10 minutes journey time of a Post Office
% of households claiming benefits within 10 minutes journey time of a Post Office and a Food Shop
% of households within 10 minutes journey time of a Community Hall
14
Journey time by useable public transport (including walking and cycling) i.e. available daily between 9am and 5pm
37
Advice
% of households with over 65’s within 10 minutes journey time of a Post Office
% of households claiming benefits within 10 minutes journey time of a Post Office and a Food Shop
% of households within 10 minutes journey time of a Community Hall
% of households without access to a car within 30 minutes journey time of a library
% of households with occupants claiming Job Seekers Allowance or Incapacity Benefit within 30 minutes journey time of Employment Advice
North West Regional Service Standards - Hierarchy of Locality
North West Service Themes
Core Rural Services
10 minutes
Childcare
Nursery/Childcare
Nursery/Childcare
Ante Natal
Ante Natal
& Health Visitors
& Health Visitors
Hospital
GP
Dentist
GP
District Nurse
Hospital
District Nurse
Pharmacy
Pharmacy
Specialist
Healthcare
30 minutes
60 minutes
Dentist
Specialist
Education
Primary School
Primary School
Secondary School
Secondary School
Further Education
Further Education
Training
Higher Education
Community
Advice
Training
Secondary School
Post Office
Post Office
Bank/Building Soc
Bank/Building Soc
Cash
Cash
Community Hall
Community Hall
Food Shop
Food Shop
Pub
Pub
Library
Library
Advice Services
Advice Services
Employment Services
Employment Services
Sports & Leisure
Sports & Leisure
Community Futures & Rural Innovation
June 2006
38
Higher Education
MAPPING
Social Exclusion in Rural Lancashire – Target Map
39
S e r v i c e Po i n t M a p p i n g
40
41
42
This research was funded on behalf of the Government Office for the North West as part of Defra’s Voluntary
and Community Sector Infrastructure Programme
43

A study of rural service standards

Transcription

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