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CHAPTER FIVE: ACCESS & QUALITY: GROUP FINDINGS
DEFINITIONS OF ACCESS AND QUALITY
5.1 As part of the group process, participants were asked to define access and quality. With regards to some service priorities, for example road maintenance, participants struggled to split the definition of access and quality. However, on the whole, with most service priorities participants were comfortable with the distinction between access and quality, and a range of definitions of each were identified. Definitions did, however, tend to relate to particular services or types of service and are not all applicable to all services.
Access
5.2 Access was variously defined as:
Travel Time
5.3 The length of time taken to access services.
Physical access
5.4 Ramps empowering access to buildings.
Opening hours
5.5 Longer than they were currently getting in relation to banks (currently 2 hrs for some) and A&E services (closing at 6.30pm).
Service being brought into the region
5.6 Mobile services such as libraries, cinemas, shops, health officials (Locum GP, district nurse, chiropodist, physiotherapist, community support workers, trainers for carers, youth leaders, elderly leisure workers).
Level of personal contact
5.7 A range of different issues with respect to personal contact were given to define access. These included having calls answered by telephone staff within an acceptable time, having someone available to talk to about a specific issue and not being presented with a call centre with interactive voice response rather than a call operator. Having a representative from the company or organisation visit to assess an issue and listen was also thought to be important.
Response time
5.8 Speed of call answering, of responding to requests and complaints, speed in acknowledging that there is a problem and repairing/consulting/apologising and so on.
Regularity/frequency of service provision
5.9 Rather than one-off visits, many asked for more frequently supplied services e.g. recycling collection, refuse collection, mobile cinema, mobile shops, mobile bank, mobile dentist, public transport (buses, trains and ferries).
Service integration & reliability/capacity
5.10 This mainly focused on public transport and in particular integration of different services, e.g. the last train not leaving until the ferry has docked. Also more reliability with ferries ensuring school children can get home (more capacity to accommodate the local residents as well as tourists).
Quality
5.11 Quality was variously defined as:
Acceptable range of service
5.12 This included shops having greater ranges of goods, a fuller range of health services being available more locally, public transport (range of types and times) and range of leisure activities.
Features of the service product
5.13 Many felt that although they did receive a service it was limited e.g. recycling centres which were unable to offer recycling for glass, plastics, fridges etc, post offices unable to offer the full range of services and health centres only able to offer the basic GP service.
Cost
5.14 Many felt that they were penalised cost-wise for living in remote areas so requested cheaper fuel, cheaper fresh produce and goods, subsidised Sky TV subscriptions, cheaper septic tank emptying etc.
Staff
5.15 Quality of staff was defined as politeness, flexibility and willingness to help. Many felt staff did not listen to them to ( e.g. communications or utilities suppliers, local councils etc).
Time allocated to service users
5.16 Access was often available yet quality was poor in that the time allocated to patients was too short. This was specifically so for health services such as GP. However overall, many thought quality of health services excellent in this respect.
Services tailored to community
5.17 This was defined as appropriateness to the community e.g. many islands felt that there was little strategic planning for their community in terms of transport links, affordable housing, health services, education, adult education and leisure and pest control.
Cleanliness of premises
5.18 This was considered a key quality standard although no service priorities were highlighted which required improving cleanliness in this study. The only issue was where recycling banks over-flowed causing unsightly mess and hygiene issues.
Access
5.19 Access was sometimes indistinguishable from quality and in this respect, a quality service is one that exists, is available or is accessible.
Access & quality improvements required
5.20 These are summarised for each service area as follows:
INNOVATIVE OR ALTERNATIVE DELIVERY SOLUTIONS FOR IMPROVED ACCESS
5.21 Perhaps reflecting the fact that many of the participants' service priority improvements were quite 'basic' e.g. increased frequency of refuse collection, there was little discussion on innovative delivery solutions. This was also seen as the case for services that had been recently withdrawn. Many felt that as access has previously been successful for some services (specifically health services), then the service could be re-instated successfully again.
5.22 For services which would be new to residents, such as recycling, few felt that access would be a challenge and in many cases were able to state exactly what services they needed and why.
5.23 There were some suggestions for co-location of services as a successful solution to service provision and improved access, as many residents had very positive experiences of co-location. Co-location as an access solution is discussed below.
5.24 Having said that, there were some ideas for innovative service delivery. Some examples of innovation to improve access to services, which residents would like introduced were:
- greater incentives for local farmers to supply locals with food
- scooter hire for teenagers
- incentives for healthcare workers to take up posts in remote areas
- after school childcare provided at schools
- more funding for visiting arts events and services - puppet theatre, football coach in summer holidays etc
- evening classes through video conferencing
- adult evening classes run at schools
5.25 Many participants also benefited from delivery solutions, which were undoubtedly valued. Those mentioned as popular and successful were:
- mobile cinema,
- mobile bank,
- mobile shops,
- food train,
- Tesco delivery van
- mobile dentist
- mobile fishmonger
- mobile library
- internet access at community centre
- medical caravan (including blood donations)
CO-LOCATION AS AN ACCESS SOLUTION
5.26 Many respondents spontaneously mentioned co-location as an access solution to many services. Some services have been successfully co-locating for many years and in the very remote regions co-location was often considered by the group participants to be the only viable option. Existing examples include the One Stop Service Points in Highland, the Multi-Use Centre in Dalmellington, East Ayrshire and the New Young Person's Drop In in Maybole, East Ayrshire (see chapter 3 paragraph 3.20).
5.27 For those who have experience of co-location the village or community hall seemed the obvious location, as many believed that the service needs to be "delivered to the village rather than the individual having to go to a specific new building". In terms of banking this would mean a temporary bank set up in the village hall rather than expecting the bank to build a specific building which they would then share with other services. However, some individuals disagreed and believed that any strategy to co-locate more services could justify a new building such as a new health centre.
5.28 For those communities who felt that they had adequate services, co-location meant greater centralisation. They instantly feared that they would lose their current provision and service would be downscaled if co-location were to be introduced. In this respect, they felt that co-location of a service were only appropriate if it meant that otherwise the service would be under threat.
5.29 Some services were thought by the group participants to be inappropriate to co-locate:
- health services offered in public houses (elderly patients might be offended and privacy would be in jeopardy).
- well-person clinics in GP surgery (some respondents felt that often patients wanted a second opinion or some consultation without involving the GP).
- benefits office and job centre
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