090709--R0701093145

HAMPSHIRE COUNTY COUNCIL

Report


Committee:			Culture, Communities and Rural Affairs Select Committee
Date of meeting:			9 July 2009
Report Title:			Hard to Reach Review Final Report
Report From:			Hard to Reach Review Panel
Contact name:		Martin Combs
Tel:	01962 847479			Email:	Martin.combs@hants.gov.uk

1. Purpose of Report

1.1. To undertake a review in order to provide greater clarity around Hard to Reach which is of concern to Hampshire County Council and its partner service providers.

1.2. To make recommendations to the Cabinet of the County Council and/or its partnership umbrella organisation in support of all Hampshire residents, including the `hard to reach', being able and enabled to learn about all services available to them at point of need, and to access them.

2. Contextual Information

2.1. The issue was identified by the Executive Member Policy and Resources as being of importance to the County Council

2.2. The Committee is asked to endorse the attached report, including the recommendations which are reproduced below for your attention. It is expected that the report will go to Cabinet.

3. The Committee is requested to endorse the following recommendations:

3.1. Recommendation 1

That the following recommendations are used to inform work in the County Council on developing policy, strategy and practice in service development, and particularly around `transforming customer services'

3.2. Recommendation 2

That Hampshire County Council as a lead provider organisation, explores with partners the feasibility of developing a (possibly virtual) provider community co-ordination function with a view to mapping contact/relationships between individuals and provider silos. To manage the ground between silos and customers, more information about relationship patterns seems essential.

3.3. Recommendation 3

That new initiatives such as the `trigger tool' and OPAL for older people are strongly supported and monitored, and if successful, are then extended to other individuals or groups to explore the scope for using natural networks (links with customers) to increase awareness of other service offers, and further develop successful models of partnership working around agreed purposes.

3.4. Recommendation 4

That Hampshire County Council and partners promote themselves as a `listening partnership' including a pledge to provide access to an `independent services advisor' if requested, to discuss all viable options with them (Perhaps as part of community development, led by CVSs and the Citizens Advice Bureaux )

3.5. Recommendation 5

That providers review and test their literature, documents and forms, with prospective customers/clients/individuals and other key stakeholders to simplify and present content in ways that engage those who will be required to negotiate them, to understand the offer made to them, or to apply for help. Consideration will also need to be given to non-written information, and communication with non-literate individuals and non-English speakers.

3.6. Recommendation 6

That staff, particularly in trusted services such as Libraries, primary care or the Fire and Rescue service, be trained to engage with customers/clients or signpost other provider services (including multiple signposting) as neutral brokers in appropriate circumstances. Opportunities to ask people questions about perceived barriers or reluctance to access services should also be explored and recorded for system learning.

3.7. Recommendation 7

That partnership initiatives be focused, where possible, around common, specific goals and objectives, drawing on examples of good practice, such as the older people's `trigger tool' and the OPAL work which can substantially improve individuals' wellbeing.

3.8. Recommendation 8

That consideration be given to establishing a Hampshire-wide intelligence unit, funded by major statutory organisations (possibly through the consolidation of existing expertise in departments and organisations as a virtual resource) to be made available to the whole partner provider community to support management of the territory between silos and residents, as well as access to services by all Hampshire people, including the hard to reach.

3.9. Recommendation 9

That front line staff are made fully aware of protocols that allow them to share, often limited, information about customers/clients.

4. Conclusions

4.1. The Review Panel believes it has fulfilled its remit by shedding additional light on issues of relevance and importance to the County and partners in the Provider Community

4.2. The Panel also believes it has contributed significantly to this area of concern by suggesting a working definition of `hard to reach' such that positive ways forward can be identified and measured.

4.3. The Panel was also pleased to identify a number of initiatives within the County that demonstrate the County Council's and partners' commitment to addressing some key concerns.


Section 100 D - Local Government Act 1972 - background documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report. (NB: the list excludes published works and any documents which disclose exempt or confidential information as defined in the Act.)

Document	Location
None

IMPACT ASSESSMENTS:

5. Equalities Impact Assessment:

5.1.

6. Impact on Crime and Disorder:

6.1.

7. Climate Change:

7.1. How does what is being proposed impact on our carbon footprint / energy consumption?

a) How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?

Culture and Communities Select Committee

Hard to Reach Review Panel

Final Report

Forward by Cllr Keith Chapman

Chairman, Hard to Reach Review Panel

When the Culture and Communities Select Committee, of which I am Chairman, was asked to undertake a review of Hard to Reach in Hampshire. Initially we were uncertain as to what scope existed to contribute to what was already known, given the considerable work that had previously been undertaken to research facts about minority groups in the County. We wondered what value we could add.

The breakthrough occurred when we began to explore this significant issue from a different, complementary perspective to that normally taken by Equality and Diversity where concerns tend to focus on the ethnicity, sexual orientation, disability and other features of people themselves. Instead the Panel chose to look at the issue from the perspective of service providers and how it is that people become hard to reach, or conversely, find difficulty in reaching the services they need! We consequently, developed a working definition for `hard to reach' which was shared with many key stakeholders, including witnesses who provided invaluable comments, and insights into this challenging area.

I am most grateful for the time and enthusiasm of members of the Review Panel and for their searching questions and perceptions that ensured best use was made of the evidence we received. I would also like to thank all those who have helped us to understand better the issues and challenges that face us in Hampshire concerning hard to reach people.

1. Introduction

Hard to Reach People was identified as a potential scrutiny review topic as part of the 2008-9 work programme for the Culture and Communities Select Committee. Subsequently the Executive Member Policy and Resources also indicated that it would be helpful to undertake a review in order to provide greater clarity around this issue which is of concern to Hampshire County Council and its partner service providers.

2. Timeliness and relevance

· Relevant to LAA priorities and targets

· Relevant to Audit Commission assessment

· Relevant to the Corporate Improvement Plan

· Relevant to those who might benefit from, but are not accessing services provided by Hampshire County Council or other service providers.

· Relevant to many government policy and guidance documents around the empowerment of citizens/electorate - strong direction of travel

· Potential to gain greater understanding of the nature and extent of the challenges of managing and minimising the gap between `hard to reach' people and service provider organisations.

3. Conduct of the Review

· Preliminary research was undertaken to understand pertinent issues and work undertaken to obtain background information about minority groups in Hampshire and rurality characteristics.

· A Briefing paper was produced, shared, and commented on by various stakeholders (Appendix One)

· Draft terms of reference for consideration was produced for consideration by the Committee (Appendix Two)

· A paper was provided that summarised possible links between recent Hampshire County Council policy and strategy documents and the Briefing paper (Appendix Three)

· Review Panel meetings were arranged to take evidence from witnesses:

o 15 December 2008 (Agenda: Appendix Four, Notes: Appendix Five)

o 29 January 2009 (Agenda: Appendix Six, Notes: Appendix Seven)

o 10 February 2009 (Agenda: Appendix Eight, Notes: Appendix Nine)

· 1^st Draft Report was produced 8 April 2009

4. Scope of the Review

To keep a higher level county-wide focus with a view to understanding what the issues are for the County (and its partners) in ensuring that `hard to reach' residents in Hampshire know about, and are able to access services provided by Hampshire County Council, its partner service providers and by community based initiatives.

5. Anticipated Outcomes of the Review

Recommendations to the County Council and/or its partnership umbrella organisation in support of all Hampshire residents, including the `hard to reach', being able and enabled to learn about all services available to them at point of need, and to access them.

6. Indicative Key Stakeholders

It is anticipated that the report will be of interest to:

· Hampshire County Council

· Hampshire Fire and Rescue, Hampshire Constabulary

· District and borough councils

· Community and voluntary action organisations

· Citizens' Advice Bureaux

· Residents of Hampshire

7. Review Panel Members

Cllr Keith Chapman (Chairman)

Cllr Anne Edwards

Cllr Roger Kimber

Cllr Roger Price

8. Review Panel Findings

8.1 Key concepts taken from the Panel's original Briefing Paper

8.1.1 Early in the Panel's review of Hard to Reach, the members developed a Briefing paper in which were set out some key concepts that influenced the direction taken by Members and many witnesses and stakeholders who contributed to the review.

Definition for `hard to reach'

8.1.2 Perhaps the single most influential idea was the proposal of a new working definition for `hard to reach'. Members proposed that,

"...The term `hard to reach' needs clarification. It is suggested here that it should mean more than just a local authority communicating information about its services to local people, but rather it should include the extent to which local people engage with the local authority through the use of services provided. `Hard to reach' should have something to do with meeting the real needs of individuals and communities regardless of whether residents can be classified on the basis of age, ethnicity, disability or sexual orientation. If the classification, and many people could be classified in more than one way, implies need that can reasonably be addressed by service provider agencies, then classification may be helpful, but `minority' classifications may obscure the real differences in need experienced within the group.

In theory, every household in Hampshire is reached by the County Council's Hampshire Now publication, but reaching households with a magazine does not necessarily mean that the people of Hampshire have been reached in the sense implied by `hard to reach' if the expression includes a sense of `lack of connection' between an authority and its constituents. Neither is it particularly helpful to apply the term to the many `minority groups' or other classifications of people, as if to say that all members of such groups do not know of, or do not use services available to them.

It is proposed that people defined as `hard to reach' for the purposes of this review might include those who:

a. are unaware of services provided by HCC or its partners, or

b. are unable to take advantage of services provided by HCC or its partners, or

c. are reluctant to take advantage of services provided by HCC or its partners..."

This definition was considered to be directly relevant to the wellbeing of the people of Hampshire in relation to their use, or potential use, of services delivered by the `provider community', and therefore to enhancing their quality of place.

Rurality

8.1.3 The Briefing paper identified two contexts in which known issues exist for residents with respect to access to services, those were `rural areas' and the mainly urban, areas of deprivation. The paper commented,

"...Geography plays a significant part in how well people are likely to be served by HCC and other service providers. The major distinction appears to be between rural and urban areas where the challenges differ considerably.

Rural areas

Rural areas are, almost by definition, characterised by small numbers or clusters of households distributed across otherwise relatively sparsely populated areas. The Socio-Economic Profile draws attention to some of the key characteristics that can contribute to some people in rural communities being `hard to reach', not just by the County Council but by any providers of services in those areas.

The people who are unable to take advantage of services may be unable to do so because:

· The services are not provided at all in the locality

· The services are not accessible by public transport

· The services are provided, but infrequently, or not to the same level as those provided in most urban areas

Limitations to service delivery in rural areas are normally due to affordability. The Secta: partners for change report, `Review of Evidence on Additional Costs of Delivering Services to Rural Communities' (2004) concludes that there are "...three potential reasons why the cost of delivering services per capita of needs-weighted population may vary between urban and rural areas...", namely:

· Mileage costs

· Time-related costs, and

· Economies of scale tend to be lower

Reducing the additional mileage and time-related costs, and improving the economies of scale do, and will require innovative thinking, exploiting opportunities for creative and efficient partnership working, such as reducing the number of separate visits to service users from partner organisations or even individual services within single organisations. The Rural Delivery Task Group Report - Supporting Hampshire's Rural Communities, 2008, contemplates possible responses such as developing service centres and local hubs which may help reduce the degree of isolation from services for some rural residents.

The Briefing went on to note that, "...The general perception of rural Hampshire is that of prosperity..." and it goes on to say that in general it may be true. However the Commission for Rural Communities (The housing and support needs of older people in rural areas, Commission for Rural Communities, 2004) identified that ... "Many older homeowners are asset rich but income poor". Such households can blend into the affluent landscape which may effectively mask their real needs. Further information/research is required to identify who the hidden `hard to reach' people are in rural communities, and where they are."

8.1.4 This report contains the Review panel's suggestions about possible ways forward, and includes examples of initiatives already in place, or being considered to address such rural issues.

Urban areas of deprivation

8.1.5 Deprivation exists in rural areas too, but because of greater numbers, the issues for residents and service providers are more concentrated in urban communities. The Briefing included typical reasons for people in deprived areas (rural or urban) not accessing services, for example:

· "The service sought may not be available when needed

· The resident may be housebound, have a disability, or have caring responsibilities that prevent access to a service

· The resident may not be entitled to a service, or the resident may think he/she is not entitled to it

· The resident may have religious, cultural and/or language related reasons for not accessing services, or being able to access information, advice or services.

· The resident may feel pressured by his/her community or significant others not to access the service"

8.1.6 Evidence provided to Members confirmed the above general observations, but they heard examples, in addition, of what might be called issues of `reputation' where residents are not convinced that authorities have their `best interests at heart'.

The Individual's or service user's perspective

8.1.7 The Briefing took the view that, "By taking the perspective of a single local authority or agency to providing residents with information, it is possible that the perspectives of residents are forgotten. Residents may not know what layer, agency of government, or voluntary organisation provides specific local services. It would seem better for information about services to contain clear contact details for all county, district, parish or independently provided services, and probably all locally provided central government services too. In the spirit of partnership it should also be possible to add NHS and all third sector service providers in order to complete the range of resources available to the people who might need them. People should not have to understand the complex web of service provision and who provides what, in order to access relevant sources of help when they need it."

8.1.8 The significance of the `individual' as opposed to groups, became more evident to the Panel in assessing evidence as the review progressed, particularly as it become clearer that the working definition of `hard to reach' better accommodated that perspective.

Wellbeing

8.1.9 The Briefing suggests that the term `wellbeing' has scope to capture people's values; things they consider to be important in measuring their quality of life, but that these may be different for service providing organisations, compared to those who might use them, "...However this Briefing suggests that they are hard to reach only if they do not know of services available to them, or they do not access services which would contribute to their wellbeing. Wellbeing is an important issue since `maximising wellbeing' is one of the County's corporate priorities, but there is a question as to whether a local understanding of `wellbeing' necessarily matches with that assumed by others who are not part of that community. `Wellbeing' may need a local definition negotiated between communities and agencies providing services or resources to help."

8.1.10 It is conceivable that agreed wellbeing goals might progress through a ladder-like series of aspirations over time.

8.1.11 The Briefing assumed progress towards addressing inequalities experienced by individuals would have to move forward within a partnership context, partly because individuals' needs are often complex, and people tend to look for solutions rather than single provider silos to meet those needs. But Members were also convinced that scope must exist for the many service providers to work more effectively and efficiently together. This report thus takes some initial steps forward, building on the ideas contained in the original Briefing paper and will make recommendations.

8.2 The Briefing as background to review panel sessions

8.2.1 Members found the review panel sessions very helpful in drawing attention to issues considered relevant by witnesses to `hard to reach'. Witnesses identified issues that contributed to people being:

a. Unaware of services

b. Unable to access services, or

c. Reluctant to access services

8.2.2 Most, although not all, witnesses accepted this working definition of `hard to reach' adopted by the Panel; the definition centres on the experience of the individual in terms of accessing services. In that sense, it takes a bottom up view, and therefore complements most `equality and diversity' work which tends to be top down, typically considering groups of people who share a disability, ethnic origin or other characteristics.

8.2.3 The Briefing document which set out the definition and initial thinking about `hard to reach' provided a framework for discussion with Panel Members and witnesses, but did not constrain or limit any observations made. Councillors were encouraged also, to learn of initiatives and innovative thinking relevant to this issue.

8.3 Top challenges

8.3.1 The following reflect comments and concerns that were expressed by witnesses either as part of their presentations or during discussion with Members. The issues identified by the Review Panel as of most concern to witnesses overall are:


Silos	Working within one's own department or professional context with little or no knowledge of what other departments, organisations, or services are providing or could be providing for individuals or local communities
Duplication	Where customers/individuals may receive multiple visits/services from providers in an uncoordinated way, resulting in inefficient use of time and resources
Reputation	Where customers associate provider organisations with lack of trust, the suspicion that they will have more to lose than gain by accessing them, or with bureaucratic walls that prevent access to meaningful help
Partnership	Where `partnership' is seen as an abstract term that means different things to different people, and could mean investment of time and resources for uncertain return
Each of these issues is explored in more detail below:

Silos

8.3.2 Witnesses frequently commented on the problems created by silo working and how it contributes to the problem of being `hard to reach'. The evidence suggested that many individuals who could be considered `hard to reach' according to the definition, may well already access some services. However, because of the strong tendency of providers to work in departmental or professional silos, people could still be considered hard to reach because they are unknown to, and are unaware of, other services that could be relevant to their life circumstances or a life event.

8.3.3 One of the apparent causes of information silos is the concern about `data protection'. It was pointed out by legal counsel that data protection should be balanced by undertaking `privacy impact assessments' for which there is a `toolkit'. Providing for `information gateways', or data sharing is the response to protecting data - this needs to be anticipated and planned for in conjunction with safeguarding personal information. If permission is granted, the purpose of sharing is legitimate, and personal data exposure is limited, appropriate protocols can usually be developed.

8.3.4 However, when even basic information about the contact that exists between a service and a customer/client/patient is trapped within a silo; it is as if that person is invisible to other service silos, and therefore can be considered `hard to reach'.

8.3.5 The Panel concluded that scope ought to exist to take more advantage of contact that already exists between service silos and customers to gain a better understanding of the current needs of customers and to extend a range of offers to them.

8.3.6 An assumption made here is that individual customers may have need for a range of services, that a customer's life circumstances will change over time, and that they will sometimes experience `life events'. It is incumbent upon providers to use knowledge about customers from existing contact, as well as socio-demographic intelligence, to reach customers/individuals in a variety of appropriate ways and contexts - thus establishing more effective communication through relationships that are already in place.

Duplication

8.3.7 The Panel concluded that because of silo working, significant risk of inefficient use of resources exists. Duplication and overlap of functions such as intelligence gathering and market research can occur; multiple visits to customers' homes or rural areas happen without opportunity to optimise use of resources because one silo does not know what another is doing, and it is often no-one's responsibility to co-ordinate on behalf of the wider Provider Community (PC). Because of the range of provider organisations, the number of provider silos and the complexity and effort required to work across boundaries, this relatively unmanaged ground between customers and the PC not only implies higher than necessary costs, but also exacerbates `hard to reach' situations.

Reputation

8.3.8 Evidence indicated that for a significant number of `hard to reach' individuals, there is a reluctance to engage with, or accept help and support from the either the County Council or other `official' bodies. A number of reasons were either provided or implied, such as:

· Language, and the control of language of officialdom can be intimidating, for example, forms controlling access to services can be confusing, complex, or requiring highly detailed responses

· Attitudes of `authorities' can be perceived as unhelpful and defensive

· Paternalistic attitudes, such that people who don't seem to understand customers or their issues, prescribe unworkable solutions for individuals or local communities

· Perceived reluctance on the part of authorities to engage with, or really listen to local people

· Organisations can be very large and complex - difficult to penetrate and get answers from

8.3.9 Two witnesses commented that employees of one authority frequently pretended to work for other organisations with more acceptable reputations locally. There appears to be a need to improve the level of trust between authorities and customers of their services.

8.3.10 Another aspect of reputation or trust that is well documented, is that vulnerable people, particularly the elderly, are concerned that if they seek help, then they have more to lose than they will gain. For instance, the fear of means testing can cause some pensioners to be reluctant to seek help when they really need it, particularly when they have worked hard to acquire modest independence through their working lifetime. Another example cited, is that of elderly drivers who may avoid seeking medical advice if they think there is a risk that they might lose their licence. This is a particularly sensitive issue for rural residents who depend upon their own transport.

Partnership

8.3.11 Partnership was widely considered by witnesses and the Panel to be part of the solution in tackling `hard to reach' challenges, but witnesses also had concerns. Reasons for these included:

· Partnership can mean different things to different partners

· Historical baggage and legacy attitudes can get in the way of successful partnership planning and delivery

· There is variable evidence of commitment to genuine partnership working

· Management of expectations within a complex picture of disparate organisations working within the same geographical area, each with different agendas, remits, assessment regimes, funding and budgets

· Numerous organisational, departmental and professional boundaries to be negotiated

· Provider agencies do not always understand the true potential, limitations of, or constraints on their partners, and are consequently reluctant to take the risk of depending upon others for their delivery

8.3.12 Despite the significant challenges, there was a strong sense that it will only be possible to ensure that most individuals will know where to turn (for information, help and guidance, will not face un-necessary barriers to services, or be afraid or put off accessing them) if providers work intelligently together to deliver high quality services at lowest cost, or a comprehensive offer set, to all individuals in Hampshire.

8.4 Initiatives identified by witnesses and written evidence

8.4.1 The findings of the Panel, and direction of travel suggested by the initiatives identified below, appear to be strongly consistent. Most of the work mentioned here is very recent, but indicates a strong commitment to supporting customers/individuals in Hampshire, and confirms the Panel's evaluations expressed in the `top challenges'. The initiatives below are those of which the Panel has been made aware, others may well be the subject of planning or implementation.

Project/Pilot/Initiative

Partners

Status

Trigger Tool

"November 2008 saw the official launch of the Older People's Well-Being Trigger Tool... The Trigger Tool provides a list of quick and useful contacts for staff and volunteers who visit older people in their homes. It encourages organisations to think about an older person's needs, and shows them how to signpost people to other organisations." (Messenger, issue 107, January 2009)

A very powerful example of best practice, designed to remove silo barriers with respect to minimising the risk of older people being `hard to reach'

http://www3.hants.gov.uk/

communications/mediacentre/

mediareleases.htm?newsid=280093

· Hampshire County Council: Chief Executive's Dept - Wellbeing Team

· Trading Standards

· Hampshire County Council: Adult Services

· Police

· Hampshire Fire and Rescue Service

· Pensions Service

· Carers Together

· Older People's Area Link project (OPAL)

· Hampshire Primary Care Trust

Piloted, and being rolled out across the county - supported by training for staff and volunteers

Yet to be fully evaluated.

Project/Pilot/Initiative

Partners

Status

Older People's Area Link (OPAL) project

An excellent example of best practice. Aims to identify older people who have been cut off and isolated from their communities, and uses teams of volunteers to re-engage them. This directly addresses `hard to reach'

· Hampshire County Council: Chief Executive's Dept - Older People's Wellbeing Team

· Hampshire County Council: Adult Services - Community Innovations Team

· Age Concern Hampshire

· Hampshire Voluntary Care Group Advisory Service

Has been rolled out across the county and should be in operation in all areas (by March 2009)

Note: still to be fully evaluated

Community Innovation Teams

An Adult Services initiative to provide support, advice and guidance to older people

Assist with linking into appropriate health and community services

Specialist advice and support

The service is aimed at promoting the wellbeing of older people who are at risk of losing their independence, but who currently do not meet the criteria for Adult Services. This is an excellent example of best practice, which again directly addresses `hard to reach'.

Key professionals include: social workers, occupational therapists, community nurses.

· Hampshire County Council: Adult Services Community Innovations Team

· Hampshire County Council: Older People's Wellbeing Team

· Hampshire PCT

· District Councils

· Voluntary Sector

Initially introduced to six locations, incl: Totton, Eastleigh, Petersfield, Basingstoke, Havant

Project/Pilot/Initiative

Partners

Status

Falls Prevention and Physical Activity project

Aimed at older people to help maintain healthy independence. Helps reduce risk of possibly being put in a situation of being `hard to reach'.

· Hampshire County Council: Adult Services

· Hampshire County Council: Chief Executive's Dept - Older People's Wellbeing Team

· Hampshire PCT

· District Councils

· 3^rd Sector organisations

To be initiated April, 2009

Implementation of Personalisation, particularly the `universal offer' element

"Personalisation means starting with the individual as a person with strengths and preferences...reinforces the idea that the individual is best placed to know what they need...everyone needs universal access to information and advice..."

A central government initiative, and informed by Hampshire's Personalisation Commission findings. Has the potential to address many of the issues raised in this review on `hard to reach' - at least in part. A very powerful initiative.

For the Hampshire Commission recommendations see, http://www3.hants.gov.uk/getting-personal-summary.pdf

Hampshire County Council: Adult Services working with a range of statutory and 3^rd Sector partners.

A recently introduced initiative in early stages of development and implementation.

Project/Pilot/Initiative

Partners

Status

Children's Services/Adult Services protocol

Important contribution to help identify and communicate information about children who may become default carers for adults/(other children?) across social services, thus avoiding important information being trapped in silos.

· Hampshire County Council: Children's Services

· Hampshire County Council: Adult Services

Not at implementation stage yet.

Basingstoke: Personalisation / Self Directed Support

Hampshire CC take on the Government's agenda to reform adult social care. Puts the individual / client at the centre and aims to empower vulnerable people to influence and choose elements of their care. The `Universal Offer' aims to provide "A `universal' offer of help with information and advice regardless of where people live, how much money they have and whether they are assessed as being eligible for social care" to make sure that clients know where to turn. By giving clients more control over their own quality / experience of life, this initiative also has some power to improve clients' perceptions of the County and therefore remove some of the reluctance to access services. However, the Hampshire County Council recommendations to raise the level of disregard would have an even more positive impact on Hampshire's reputation.

· Hampshire County Council: Adult Services

· Individual clients

· Carers

· Hampshire PCT ?

Basingstoke pilot completed together with a review of it. Service users found the experience "positive, enabling and highly beneficial" LB presentation

Project/Pilot/Initiative

Partners

Status

Havant: Park Community School - an agent of change, organic contagion of a respect culture, passengers to drivers.

The Park Community School achievement is a unique, but potentially repeatable example of how the `respect' of a strong and innovative Head for his students, was a value caught by them, and subsequently by their parents and families. This experiment profoundly changed the views of people in the community of themselves and others. The head's belief in the students developed into tangible achievement, belief in themselves, and belief in the community that they could succeed. This in turn changed the balance of power between the people and authorities, making it easier for the people to engage with services.

· Hampshire County Council: Children's Services - Education

· Park Community School

Amazing tangible improvement - 8% achieved 5 A* to C GCSE grades 10 years ago - now 85% achieve that. School has achieved the best `value added' score in the country! More than that, the school has become a catalyst for positive change in the community.

Project/Pilot/Initiative

Partners

Status

Hantsdirect - Hampshire County Council initiative to simplify access to information and advice about Hampshire County Council services

Launched in 2007, the contact centre provides telephone access. Over time, the centre has developed to provide general and particular information and advice to include:

· Libraries

· Rights of way

· Recycling, waste and planning

· Roads and transport

· Adult Services

· Children' Services

· Registration of births, deaths and marriages

Different County Council departments

Scope limited to the County Council.

Visibility, testing, monitoring, customer satisfaction?

Hampshire Now - Older People's edition

A once-yearly edition of Hampshire Now. This version for older residents provides a variety of articles, signposts people to services and contains a lot of well targeted and interesting material. The edition directly addresses the `hard to reach' concern with making people aware of services available to them.

Hampshire County Council publication, provides information on, and signposts, relevant services provided by the County Council and partners.

· Hampshire County Council: Older People's Wellbeing Team

· Hampshire County Council: Corporate Communications

Given the success of this edition, agreement has been reached to trial two per year.

Project/Pilot/Initiative

Partners

Status

Collaborative working between Adult Services and Recreation and Heritage

Adult Services commissions the Recreation and Heritage Department to provide a range of invaluable arts performance, music and sports input to the County's residential and nursing homes. The contribution of such joint working between departments greatly enhances the wellbeing of residents of these homes. This work directly contributes to the `hard to reach' concern about silo working by ensuring elderly residents can access the rich variety of services provided by R&H in addition to having their health and social care needs met - thus improving their experience of well-being

· Hampshire County Council: Adult Services

· Hampshire County Council: Recreation and Heritage (Arts, Music, Sports and Libraries)

The Recreation and Heritage Country Parks have a programme to improve access for older people and those with reduced mobility.

8.5 The way forward

8.5.1 Witnesses and Members were keen to identify opportunities and existing good practice that address these issues and that therefore have potential to improve the experience of individuals who could be identified as hard to reach. The foregoing demonstrates that the `top challenges' recognised by the panel, share common ground with the initiatives referred to above. In each case the initiatives directly address one or more of the top challenges.

8.5.2 Two significant contexts were highlighted in the Briefing paper where access to services is an issue in Hampshire. The first was where rural areas pose logistical problems for service providers because of time, distance and transport. Identifying individuals `hidden' in these areas, is a challenge. The second context related to pockets of multiple deprivation where individuals may be hard to reach, or conversely, where individuals find providers hard to reach. The Panel believes that the following specific ideas that suggest ways forward, could equally apply in either context:


Eyes and ears	Where, as a result of special training and provision of routes to escalate information, an employee in one department or service may observe there is scope for other services to provide additional or needed support to a customer/individual
Partnership	Where it is recognised that a collaborating partnership of services can provide greater benefit to a customer/individual than any one, or limited group of services can alone, *and where the scope of partnership is limited to a specific locality, specific goal, or is otherwise bounded by a context in which there is shared commitment and objectives*
Protocols	Developed specifically to formally facilitate cross boundary/silo working through agreed procedures and sharing of necessary information about customers/individuals with their consent
Life events	Where, for example, illness or the death of a loved one suddenly causes a customer/individual to face new and often stressful circumstances; each life event implying the potential need for a *set* *of supporting services, information and advice* and of which the person has little or no previous knowledge
Each of these ideas is explored more fully below:

Eyes and ears

8.5.3 The Review Panel became aware that many people may be `hard to reach' with respect to some services, whilst at the same time they may be in contact with others. Such situations suggested it might be possible to maximise the use of these existing contacts to reach individuals with information, or listen to any concerns they might have. If, as the Citizens Advice Bureaux suggested that it is often `life events' or changes in life experience that prompt individuals to seek help, or require additional support, any existing face-to-face contact with known, trusted services has the potential to act as a channel of communication to help vulnerable individuals to know where to turn.

8.5.4 The "trigger tool" (cited above in examples of good practice) adopted in support of older people's well-being has the specific remit to act as `eyes and ears', allowing trained representatives (note that training is provided to all relevant statutory or voluntary representatives as required) from a specific range of partner organisations, to signpost people to other partners if it seems appropriate when they visit people's homes. Sharing of information between partners relies on permission being given by the older person concerned.

Partnership

8.5.5 Collaborative partnership, particularly between departments and service silos has the potential to:

· Remove/overcome boundaries between silos

· Release trapped information that contributes to individuals being hard to reach - or being invisible to services

· Make more effective and efficient use of resources

· Support innovation and creative solutions, including to improve the experience of those defined as `hard to reach'

· To improve the reputation and trust relationship between individuals and institutions by capitalising on existing positive contact, thus helping reduce reluctance to access other services

8.5.6 As previously noted, there are a number of concerns about partnership that should be addressed, however evidence was provided of pilots in some areas of the county of goal-driven partnership working. In addition the Panel was told of increasing and very effective collaboration between County Council departments - typically around specific projects. The journey towards full partnership working in the county would appear to be based, at least in part, on `natural' complementary initiatives where the scope for silos to add value without adding significant overall costs can be demonstrated. They may have to be justified more on `end game' savings, than immediate financial benefits.

Protocols

8.5.7 Evidence was presented of the development of protocols as one key element in overcoming problems where silo working plays a role in exacerbating `hard to reach' through trapping of information that could be essential for other services. Protocols need to release the flow of critical information, but at the same time safeguard the unwarranted spread of personal data beyond into silos for which it is unnecessary and inappropriate.

8.5.8 Some services have the potential to be `eyes and ears' for others, but for this to happen, individuals must agree to it, protocols need to be in place, and the support of appropriate training must be provided. It may also help in some circumstances to arrange mutual work shadowing to better understand how this might work.

Life events

8.5.9 One witness drew attention to the importance of `life events' as a critical reason for individual seeking help and advice. Life events, or changing life circumstances may prompt some to seek help, but it also implies that others who experience the same things, and who may need similar help, can be reluctant to seek it because of perceived or real dis-incentives.

8.5.10The witness commented that service providers should attempt to identify the reasons for people seeking information or advice, and recognise that different types of life events imply particular sets of information, advice or support that the individual may need. Service offers can therefore be tuned in such cases around particular life events or experiences. This approach could overcome the risk of someone being `hard to reach' with respect to them being unaware of the full range of service provision relevant to their experience.

8.5.11 It should be noted that Panel is grateful to all of the witnesses who represented a wide range of service providers and agencies for their evidence on which both the `top challenges' and ideas for the `way forward' have been based.

8.6 Managing the ground between the Provider Community Silos and individual Customers/Clients

8.6.1 The `top challenges' identified by the Review Panel from evidence, depicts a situation in which there are potentially hundreds of available services available from the provider community, which includes all services provided by Hampshire County Council and its partner agencies, to approximately one and a quarter million Hampshire residents. It is probably rare that residents receive or avail themselves of no services. The Review Panel saw silo working as a situation that contributes to people being hard to reach, or, conversely making it difficult for people to reach services that they need. The diagram below attempts to represent this situation, and suggests that the gap between providers and individual people needs to be bridged by three elements to improve situation.

The Silos

8.6.1 The diagram above captures some characteristics of the hard to reach experience and issues that arose during Review Panel meetings. The top of the diagram depicts the provider community consisting of a range of types of service provider organisations. The larger ones, in particular, can be responsible for many services, typically provided through departmental and professional silos. In some contexts a degree of coordinated management of resources exists.

Individual Customers/Clients/Patients

8.6.2 The bottom of the diagram attempts to show individual people who will each typically use a selection of the available services. The suggestion is that most individuals, even those considered `hard to reach' are either reaching or being reached by some `silos', however these people may not be aware of others, or may be unable, or reluctant to access them. The fact that an individual may be `reached' by, or `reaching' one silo, does not mean that they are not hard to reach in respect of others, but it does reveal something about the `system'.

The Ground in Between

8.6.3 The diagram puts three necessary (probably virtual) functions in the middle ground, between silos and individuals:

· Information about services/silos must be made available to those who want it (when they need it, where they need it, and in a way that is acceptable to them),

· Effective signposting needs to be provided to more specialised advice which recognises that when advice is sought about some life events, advice about a set of services may be required, and

· A function is required to understand (map) which people use which service silos, and how it might be possible to use existing relationships to reach people who might otherwise experience the negative impacts of silo working.

8.6.4 The proposition here is that it may be possible to record the patterns of relationships between individuals and services received such that more effective use might be made of existing, naturally links. By using communication links between individuals and trusted services, such as, libraries, GP surgeries and the Fire and Rescue service, service offers for other services might be extended to residents. Gaining an understanding of mapping patterns should contribute to more efficient use of resources, and how to plan for how more vulnerable individuals might be reached, and where training of staff could be focussed.

8.6.5 Panel members recognised that information and advice services already exist, for example, Hantsdirect provides information and advice to telephone callers about County Council services. The service provides simpler (a one stop shop) access to information, replacing some 200 numbers used by people to reach different parts of the council, by one general number and four others, each for areas of the council that tend to receive many calls. The Hantsdirect webpages comment that it can be "confusing and difficult" for callers to know which of 200 numbers might be the best one to provide the information or advice being sought.

8.6.6 Hantsdirect complements existing provision of `face to face' contact centres. These could be expanded to include opportunities for providing face to face contact in `natural' drop in venues, such as libraries. However, for many individuals they may still not know which organisations or departments provide what services.

9. Conclusions

Reflections on the hard to reach Briefing paper

9.1 The Briefing paper that set, but did not limit, the context for consideration and review of `hard to reach' suggested a working definition for the term based around a key function of local authorities and other government bodies, ie. their remit to provide services. The definition read that `hard to reach':

"might include those who:

a. are unaware of services provided by Hampshire County Council or its partners, or

b. are unable to take advantage of services provided by Hampshire County Council or its partners, or

c. are reluctant to take advantage of services provided by Hampshire County Council or its partners."

9.2 The Panel wanted to take the perspective of the ordinary person, who conceivably would not necessarily know what organisation provided which services, and therefore considered that `hard to reach' was a relevant issue for all services, whether provided by the statutory or 3rd Sector.

9.3 Reaction by witnesses to the working definition was largely positive, with many considering it helpful. A minority, however appeared to feel uncomfortable with the change in orientation to the question implied by the review. Some thought that perhaps the term `yet to reach' might be preferable to `hard to reach', but the definition remained valid for either preference.

9.4 The Briefing paper also drew attention to the particular challenges posed by rurality for identifying `hidden' individuals who may not know of services that could improve their life experience, or who find it difficult to access services. The Panel considers that the `top challenges' elicited from witnesses, as well as suggestions for the way forward, are as valid for rural areas as for urban, including areas of multiple deprivation.

9.5 The Briefing also suggested that "`wellbeing' may need a local definition negotiated between communities and those with the resources to help." As it has become clearer through evidence given, that the `individual', rather than groups should be at the heart of services, including removing barriers to their access, it is critically important to recognise the individual's perspective and experience of service provision. The negotiation of a person's wellbeing should be with that individual. This view would appear to be consistent with the principles behind `personalisation'.

Reflections on evidence provided by witnesses

9.6 Evidence included concerns about perceived causes or factors that contribute to `hard to reach' situations. However the Panel also heard examples of initiatives that address hard to reach concerns, and identified considerations for the way forward.

9.7 Top concerns include the pervasive problem of silo working (and thinking) that results in information being trapped inside silo boundaries and gross inefficiencies, which can give rise to duplication. The `hard to reach' problem is exacerbated since even when an individual already receives or uses some service silos, others may be hidden to them, just as the individual is hidden to the other services.

9.8 Reputation was also identified as a real issue, not just for the County Council, but for other organisations where customers/clients believe they may have more to lose by accessing services than they have to gain, particularly if in order to access the service, they have to be means tested.

9.9 Another key concern that stood out was the variety of expectations, understanding, and levels of commitment around partnership amongst different partner organisations. Different organisational agendas, structures, management, funding and performance regimes, resulting in an absence of common understanding was seen to inhibit progress with partnership initiatives, which in turn could undermine partnership approaches to tackling `hard to reach' problems

9.10 Reflections on the way forward, tended to be predicated on the perceived problems. If silo working results in sometimes causing or making the `hard to reach' problem worse, then the establishment of protocols to allow information to move safely across silo boundaries is a partial antidote. Examples of good practice and the development of protocols to overcome the worse effects of silos were welcomed by the Panel. It was also noted that collaboration between partners has seen success where the focus is on a clear, well defined common/agreed goal. This seems to be a good way forward.

9.11 Another approach considered by the Panel, was to suggest that if many individuals could be `hard to reach' with respect to some service silos, whilst they may be accessing others, then consideration should be given to how existing contact could be more effectively used to extend service offers - by staff being trained to become `eyes and ears'.

9.12 Members saw the importance and potential of partnership working to taking forward work on overcoming `hard to reach' problems, and were pleased that evidence suggests initiatives with specific, focused and agreed goals, have prospects for success.

9.13 The Panel understood that `life events' could often prompt individuals to seek help, and that recognising the reason for seeking information or advice can imply how organisations should respond. Changing life circumstances may require multiple signposting to those services relevant to people experiencing specific life events.

9.14 Members acknowledge that there are no simple answers, nor single, simple recipes that will fully address `hard to reach' problems. However, by orientating the issue of `hard to reach' around access to services, and by putting the individual or customer at the centre, the Panel found strong resonances with the Personalisation agenda, and the work being developed around customer insight, the Panel believes that through these, real opportunity exists to significantly improve customer experience, including those considered hard to reach.

9.15 It was also clear to Members that a range of initiatives and innovation in partnership and Hampshire County Council contexts are actively addressing problems that contribute to people being hard to reach. For example, the `trigger tool' now being introduced county wide aims to, and does, improve the wellbeing of older people, dissolving silo boundaries between relevant silos. Also Park Community School has become a powerful catalyst in enhancing the reputation of the Authority in the area. From these instances of success, others must spring. The Review Panel hopes the greater understanding generated through this review, will provide constructive support to a growing customer ethos in the County Council and across the provider community, and a consequent reduction in `hard to reach' experience.

10. Recommendations

10.1 The Review Panel makes the following recommendations in the full knowledge that the views they have come to are those of elected representatives of Hampshire residents of a publicly accountable organisation - but that as County Councillors they also represent just one, albeit a major, provider of services. The Panel sought to better understand issues around `hard to reach' and to gain insight into how the broken relationship between provider services and individuals, implied by `hard to reach' can be bridged or repaired. The following recommendations represent the intention of the Panel to positively contribute to a greater understanding of the issues, and to suggest how and where beneficial work might be undertaken.

10.2 The Panel is clear that Hampshire County Council is just one of many key players in this context. No single organisation can, from the customer's perspective, possibly supply all the answers and informed people may need to help them access services. The recommendations should be taken as being addressed to the wider community of providers, and therefore of relevance to all.

10.3 This report has highlighted a number of challenges and examples of good practice relating to hard to reach. Hampshire County Council has given priority to this area of work and the Panel hopes that the following recommendations will be supported by the Cabinet and contribute to addressing the problem of `hard to reach' for people living in Hampshire:

Recommendation 1

Recommendation 2

Recommendation 3

Recommendation 4

Recommendation 5

Recommendation 6

Recommendation 7

Recommendation 8

Recommendation 9

That front line staff are made fully aware of protocols that allow them to share, often limited, information about customers/clients.