Here we summarise the findings from the “managing demand” element of the pilot phase of the “Developing Access to Advice” project. Many advice agencies report that they are overwhelmed by the demand for advice and that this often leads to long waiting times, delays in clients receiving advice and increased pressure on reception and advice staff. We realise that capacity to meet demand depends largely upon resources and funding, but we think that many agencies may benefit from a review of the ways in which they assess clients’ enquiries, allocate work among advisers and manage referrals to other suppliers.
Before designing the specification for the pilot phase, we conducted a survey among advice agencies across the various advice networks. We asked those who responded to describe how their clients currently gain access to advice services; how they assessed the advice needs of their client group; what referral arrangements existed locally and how effective these were; what changes they would like to make in order better to manage demand for their services.[1] The following is a summary of the factors identified by the survey respondents as contributing to the difficulty of managing demand for advice.
External factors
Funders and commissioners of advice services generally set conditions prescribing to a greater or lesser extent the way in which the advice service is delivered and its achievements measured. Funding is usually offered on a contractual basis and the terms will require compliance with some or all of the following:
Demand from clients
Demand for advice is generally high, especially in welfare benefits, debt, housing and employment. In recent years, it has been fuelled by the recession and by failures and inefficiencies in public administration, particularly within the welfare benefits and tax credits systems. For some advice services this has resulted in unmanageable levels of demand, leading to dissatisfaction and complaints from clients and excessive pressures on staff, restricting time available for necessary activities such as research, preparation and case recording.
Internal factors
The survey indicated that many advice agencies consider that they lack the resources and mechanisms to manage the demand for their services. Many reported that they had insufficient staff and funding; that they lacked access to effective and affordable training for advice and reception staff; that there was often internal resistance to implementing changes which seemed necessary in order to meet contract requirements and to manage demand.
The advice agencies which participated in this aspect of the pilot wished to improve access to their services by reviewing the methods they use to assess clients’ queries and to manage the flow of work within the organization, improving efficiency by, for example, creating a balance between client-facing and “back office” functions. The work carried out in the pilot phase focused mainly on finding ways to meet the challenges arising from demand from clients and from problems internal to the organisation. The scope and duration of the pilot exercise did not allow us to address the external problems, but policy work has been undertaken by all the advice networks to influence the funding and commissioning of advice services and the measures which funders use to assess their value.
All pilot agencies completed an initial self-audit, to describe current procedures and identify changes the agency wished to make in respect of:
All advice agencies which chose to participate in the “managing demand” pilot were also required to take part in the “improving reception” pilot – on the basis that the way in which the agency first assesses a request for advice is crucial to its effectiveness in managing demand and addressing the client’s advice needs.
[2] We found that the following principles formed a useful point of reference for an advice agency wishing to manage demand for its service while at the same time keeping the client’s interests and needs paramount:
Within the Citizens’ Advice Network, a standard system of triage (“Gateway”) has been implemented. Within the not-for-profit advice sector generally, most advice agencies adopt either a triage-type interview, conducted by someone other than an adviser, or the initial diagnostic interview, conducted by a legal adviser. The function of triage is to ascertain the area of law in which the enquiry falls; details of the client’s circumstances; any urgent matters such as impending hearing dates – and then to arrange the necessary level of service (an advice appointment, referral, information or self-help materials).
The function of diagnosis is to make an assessment of the legal issues involved; to provide some initial advice on options and merits; to allocate work within the organisation (or to refer) in accordance with the type and complexity of the enquiry. Triage and diagnosis are distinct functions achieving different ends and requiring distinct skills and specific training. The initial interview, whether triage or diagnosis, should also identify any support needs the client has in order to benefit from the advice service: e.g. interpreting, access needs related to physical or mental health problems and whether then a home visit or an interview at another venue would be more appropriate than at the agency’s office.
The agency is a multi-disciplinary centre located within an inner London borough. It provides a range of services for local residents including a medical practice and education and training facilities. It delivers an advice and casework service in welfare benefits, debt and housing, and some initial advice on employment and consumer matters.
Aim of Pilot Exercise: “to manage demand more effectively by introducing an initial diagnostic service for callers seeking advice”.
Pilot Activities
Changes Effected
The agency is a legal practice in the not-for-profit sector, located within an inner London borough. It has contracts with the Legal Services Commission (LSC) and several other funders and delivers a specialist-level advice, casework and representation service in 6 areas of social welfare law.
Aim: “to enhance access for clients and to enable the Advice Centre to meet its targets for New Matters Starts for the LSC contract and demonstrate the value of its work to other funders.”
Pilot Activities
The ideal service for the advice client is that s/he receives full and complete advice at the first visit to the advice agency, and that any necessary action to resolve the problem is taken as soon as possible after the first contact. However, the level of demand for advice services may render this an unachievable ideal and present advice services with the dilemma of providing such a service only for those few clients fortunate enough to be at the front of the queue, regardless of the urgency of their advice needs or their ability to take action for themselves.
The advice agencies in the pilot programme wished to provide the best possible service for as many clients as possible and to ensure that access to advice was not determined solely by the random nature of [3] first come first served” access systems. They wanted to find better ways of utilizing the resources of the advice service, and specifically the skills and knowledge of their staff, to implement the principles described above.
In the examples given, the advice agencies were able to make changes which enabled them to manage demand better and to improve access for their clients within the limits imposed by their existing resources of staff and funding. In the next section, we describe the strategies which the pilot agencies adopted in order to achieve this aim. However, for any advice service, there will be a limit on the numbers of people to whom they can offer advice (and casework, as appropriate), while maintaining necessary standards of quality and allowing adequate time for follow-up work and “back office” activities.
A challenge which some of the participants faced was managing change within the advice service: one agency encountered resistance from advisers when they proposed changes to the ways in which clients’ queries were initially assessed. We discussed ways in which the proposed change could be managed within an organization – for example through discussions at staff meetings or with the key personnel affected; by introducing the change in phases or through an initial pilot exercise; by providing training and mentoring support to staff required to implement new procedures or to undertake new tasks.
Our work with the pilot agencies enabled us to conclude that the following principles form a useful guide for an advice service wishing to improve its clients’ experiences of accessing advice and to manage demand for its services:
1. Assess And Utilise Your Assets
Most not-for-profit organisations deliver their advice services using paid staff and volunteers who will between them bring a range of knowledge, skills and expertise to the organization. An internal audit of an organisation’s “assets”- i.e. the skills, knowledge, expertise, availability of paid and volunteer staff – advisers, administrators, receptionists – will help inform a system of allocating work according to each person’s competence and ability.
For example, it is generally more efficient for an experienced adviser to undertake the initial diagnostic interview with the client and to assess the action needed than for this to be done by a trainee or inexperienced adviser. Similarly, it may not be a good use of an experienced adviser’s time to complete a routine welfare benefits application form.
[4]Following the diagnostic interview, work on the enquiry or case can then be allocated to the most appropriate person, minimizing the time needed to supervise less experienced staff and the number of times a client needs to be interviewed. Where a triage system is in operation (e.g. where the organiztion is open to callers outside the advertised advice times), the aim of this should be simply to assess the type and urgency of the enquiry and to gather any information from the client which will expedite the advice process.
| TASK | ALLOCATED TO | SUPERVISED BY |
|---|---|---|
| Meeting and greeting clients | Receptionist | (Office) Manager |
| Maintaining information resources | Receptionist/information worker | (Office) Manager |
| Triage | Triage or “Gateway” staff | (Office) Manager |
| Diagnostic interview with client | Experienced adviser | Advice Supervisor |
| Non-complex enquiries and cases | Trainee or less experienced adviser | Advice Supervisor |
| Help with form-filling and administrative matters | Trainee or less experienced adviser | Advice Supervisor/caseworker |
| Complex cases | Experienced adviser | Advice Supervisor |
| Litigation and representation at court or tribunals | Experienced Adviser | Advice Supervisor |
Volunteers are often an essential component of an advice service’s assets – but they should not be regarded as a less costly alternative to employing paid staff. New or inexperienced volunteers or those who are able to offer only a few hours per week may best be deployed and trained for specific tasks such as completing certain welfare benefits application forms, under the supervision of an adviser, rather than being responsible for the conduct of cases. It may be advantageous for the advice agency to prepare role descriptions and person specifications for prospective volunteers as this clarifies what tasks can be delegated to them and how their role complements that of paid staff.
2. Be clear about what you do (and don’t do)
Some advice agencies, especially those which provide a range of services for a designated client group, will aim to provide advice on any matter and at all levels and may be reluctant to refer clients to other advice services. Often clients will also expect that the advice service they approach will be able to assist on any legal matter. For example, in the case of the n-f-p legal practice in the pilot exercise, local residents expected to able to obtain advice on the entire range of legal matters, not just social welfare law.
Advice services which claim to meet all their clients’ advice needs are in danger of exceeding their competence and hence giving wrong or incomplete advice (which could lead to a negligence claim). Trying to deal with every issue a client presents can tie up advisers’ time which might be better spent dealing with the types of query on which they are able to offer competent advice and assistance.
[5]A clear statement (to clients, funders, other local providers and staff) of what the agency does and does not do can help the advice service manage the demand for its services and identify situations when clients must be [6] referred to other advice services. If there is no local referral network, the advice service can still maintain information about other advice local and national providers including the criteria for using the service (e.g. legal aid eligibility). The list should be updated at least quarterly.
One pilot agency decided to keep a [7]record (a tally chart maintained at reception) of the number and type of requests for advice they received. Monitoring of this kind can provide useful evidence of local need as well as indicating gaps in supply, and can be presented in support of local advice plans and funding bids.
3. Train And Support Staff To Fulfill Their Role
Training formed a significant part of the support for the pilot agencies. We found that the reception service is often undervalued and that in some cases, receptionists received little training or support; were not always aware of what services the advice agency offered; were expected to act as the “public face” of the advice service but had little opportunity to influence the way in which access was managed.
[8]Training courses were delivered to reception staff and volunteers covering reception skills, triage, assessing eligibility for legal aid, recognizing discrimination enquiries. We found that it was essential that staff managing the first contact with clients had a comprehensive knowledge of what the advice service did (the areas of law, level of work undertaken); information and self-help resources available; what other local advice services existed and how they could be contacted.
The advice service (case study one above) wishing to implement a diagnostic interview system found that advisers welcomed this change when they realized that the clear delineation between time spent with clients and time for follow-up work and case recording enabled them to plan and manage their time more effectively and reduced the pressures they had experienced when the access system had been more haphazard.
Depending on the type and range of work the advice service undertakes, it may be beneficial to calculate the appropriate allocation of each adviser’s time between client-facing and “back-office” functions. This calculation helps the agency decide how much time can be allocated to client interviews, drop-ins, telephone advice etc. and hence to estimate its total capacity in respect of numbers of enquiries and cases. For example, an adviser undertaking casework and representation might be expected to spend 2.5 to 3 days per week in client interviews and the remaining time on research, preparation, follow-up work and case recording. The proportion of time spent with clients may be greater if the advice service provides “one off” advice only rather than a casework service.
When making changes to methods of access or allocation of work, it is important to engage staff in the process – through meetings, away days, group and individual discussions. Agree to experiment and then review and consult if there is strong resistance to a given change.
The learning from the pilots may help other advice agencies to manage the demand for their services and to maximize their capacity, but where demand exceeds supply, advice services will need to make the case for additional funding. If they are able to persuade funders that they are operating efficiently and in the best interests of their clients, this may support their case.
