What happens at an organisation's front line can affect the entire way people perceive it. The problems are multiplied when a range of agencies are required to present a 'joined-up' face to consumers.
Growing support for 'one-stop shops' is one response - but what can we really expect?
Most limited evidence on their operation comes from local government, and much of it from Scandinavia. Recent initiatives involving the NHS suggest onestop shops are seen as a generic public-sector panacea for addressing fragmentation and complexity in service delivery.
These initiatives include:
Healthy living centres: while the government is said to be keen to see a range of models, the bestknown examples tend to have an integrated approach, with a multiplicity of activities in one location. The West End Resource Centre in Newcastle houses a GP practice, physiotherapy, chiropody, speech therapy, health promotion, an integrated elderly care team, a rights project, a drug and alcohol support group, community room, creche, gym and family and complementary therapists.
NHS Direct and Care Direct: these are more concerned with a one-stop approach to information provision. Care Direct, to be piloted later this year, raises the opportunity to work jointly with NHS Direct. Some local authorities already have such links - Essex social services department has linked up with NHS Direct to provide a one-stop call centre for local health and social care around the clock.
Private finance initiative: although normally viewed as an NHS concern, PFI is spreading across organisational boundaries.
Last year, a link between Dudley council and Dudley Priority Health trust used PFI to build a one-stop shop providing a range of social and health services.
Long-term care charters: the second round, later this year, aims to link NHS, social care and housing agencies in a more co-ordinated, accessible way. It is likely to improve information provision via a one-stop approach.
A recent evaluation of the one-stop shop model in Swedish local government raises important issues for the UK.
One-stop shops may serve several purposes, not all mutually compatible. The main aim may be to reduce the cost of services by avoiding duplication of effort;
restructuring and possible job losses will be a feature of this approach.Where the aim is to improve service quality, this could be through providing better information in a more accessible location, or encouraging staff to represent the public in dealings with other agencies.
The Swedish approach involves establishing a new location with a new image based on the principle of accessibility. Staff have been recruited who are willing and able to develop generic skills to address the most common problems. The evaluation found staff highly motivated. Many had come from routine and narrow jobs, and no-one interviewed wished to return to these posts.
There are two basic location choices: within local shopping/ housing areas or next to the main offices of participating agencies.
Each has advantages and disadvantages, with the former leading to a closer link with the public and the latter retaining more influence with the mainstream agencies.
Also important is the extent to which the one-stop shop should be confined to 'routine' cases, and where the cut-off point to more complex cases is to be determined.
In principle there is no reason why the approach should not be deployed for specialist services or groups of services in a locality. It may be more appropriate to think of 'first-stop' and 'second-stop' shops.
Perhaps the most important - yet unsurprising - finding of the Swedish evaluation is evidence of resistance from mainstream organisations to 'encroachment'.
Staff expressed frustration at being unable to meet citizens' needs because of the poor relationship between the various agencies, and overall one-stop shops seem to have been 'add-ons' to existing structures, rather than the realignment of public services originally envisaged. It is a familiar tale in the history of partnership working in the UK.
If the emerging enthusiasm for one-stop shops over here is to avoid Sweden's 'add-on' fate, it should address underlying issues of partnership working. These include: investing in information technology to provide an integrated service; appropriately recruited and trained staff; cross-professional training of all staff; formal monitoring and review; and a willingness by mainstream organisations to concede power to one-stop shop staff. Anything less will result in it being judged little more than a third-way gimmick.
1 Gaster L, Rutqvist H. Changing The 'Front-Line' to Meet Citizen Needs. Local Government Studies 2000; 26: (2): 53-70.