www.vds.org.uk

Volunteering and older people’s care in Tayside

March 2013 www.vds.org.uk

Contents

1. Introduction ...... 02 1.1 VEnable context...... 02 1.2 Influencing policy and practice...... 03 1.3 VEnable methodology...... 06

2. VEnable findings - volunteers in hospitals...... 08 2.1 Mapping volunteering support in hospitals...... 08 2.2 Matching needs and volunteer opportunities in hospitals ...... 09

3. VEnable findings – community settings...... 12 3.1 GP Surgeries ...... 12 3.2 Care homes and sheltered housing...... 14 3.3 Home and Wider Community...... 15 3.4 Matching needs and volunteer opportunities – community settings...... 17 3.5 VEnable findings - mapping summary...... 20 3.6 Volunteering motivations and experience ...... 22

4. Findings - key challenges and barriers ...... 25 4.1 Strategic challenges – connecting volunteers to health and social care needs...... 25 4.2 Challenges – heath and social care staff and their engagement with volunteers ...... 27 4.3 Challenges – finding, matching and placing volunteers with older people ...... 29

5. Conclusions and recommendations...... 33 5.1 Findings: availability of support and creating more volunteering opportunities...... 33 5.2 Questions for consideration...... 35 5.3 Recommendations ...... 36

01 The objectives and intended outcomes of Stage 2 are 1. Introduction listed below:

This report highlights the findings from the VEnable pilot led by Volunteer Development Scotland (VDS) Objectives with support from the Scottish Government Health To demonstrate ways in which volunteering Directorates, and in partnership with NHS Tayside. can impact on older people’s health and Work was undertaken from November 2011 support services (including older people who throughout 2012. volunteer and those receiving support through volunteering). 1.1 VEnable context To identify where volunteering interventions could support (alongside other services) older The ambitious and experimental VEnable pilot came people to stay in their homes longer /remain about in response to the issues relating to volunteering independent/contribute to community. and health which were identified through the Identify potential interventions that would delivery of the Refreshed Strategy for Volunteering enable opportunities related to volunteering in in NHSScotland (launched in 2008) as well as the health to be more integrated. growing challenges associated with Scotland’s ageing population. The first stage of VEnable was a desk based review of current literature and good practice Intended outcomes with respect to the relationship between volunteers, Increased ability for NHS Tayside to make older people and health and care outcomes. This was informed decisions relating to the development completed in November 2011 and is available on the of volunteering within older people’s care Volunteer Development Scotland website. services. The second stage of VEnable utilised primary research Better understanding of how volunteering in order to investigate the potential of volunteering to can contribute to health outcomes and wider enhance health and care service outcomes of health policy/strategy. older people. Increased understanding of how volunteering can contribute to service outcomes relating to older people. Increased demonstration of how health services can engage and respond in an integrated way to volunteers contribution.

02 As a point of reference the following definitions which time and energy in providing information, advice and were outlined in the Refreshed Strategy for Volunteering support to the VEnable project team. This included a in NHSScotland: dedicated Reference Group which has provided clarity, specialist support and has provided help in connecting “[A volunteer is a] person who gives freely and willingly the project team to relevant information and people. of their time to help improve the health and wellbeing of patients, users (and their families and carers) of the VEnable was intended to support the celebrated work NHS in Scotland.” For the purposes of the Venable which has taken-place within and as a result of the project this definition is extended to include those Refreshed Strategy for Volunteering in NHS Tayside as volunteers providing support to older people in the well as the positive approach already adopted through community; for example, the Investing in Volunteers award process. By older people, we mean those aged 65 and above. It is worth noting however that VEnable did not aim to audit nor complete a directory of all volunteering The knowledge gained from Stage 1 of VEnable was activity in relation to older people and care in NHS used to develop the methods and the approach which Tayside. Rather, the intent was to provide a snapshot underpinned Stage 2 in particular, it was felt that in of these activities as well as to capture the perceptions order to better understand the relationship between and experiences of key stakeholders. As such we are volunteering and health and care services for older aware that statistics and some information relating to people, it was important to focus on one geographical the mapping of volunteer support which we report area in Scotland. Consequently, the Scottish below may have changed since the project team were Government and VDS approached NHS Tayside as in the field. We hope that the project findings will a partner. We are immensely grateful to everyone’s provide new evidence which can be taken into account when planning and delivering health and social care services for older people in Tayside.

1.2 Influencing policy and practice

On a national level, VEnable will contribute to, and aims to influence, the approach taken by policy makers as well as those working directly to support the challenges faced by our ageing population. The key policy issues relating to the care of older people and to volunteering are outlined below.

For the first time ever, there are more people aged over 65 in Scotland than there are people aged under 16. This tipping of the age balance is socially significant and presents challenges to public policy and the allocation of health and social care resources. Over the past decade the Scottish Government has dedicated

03 a great deal of work to anticipating the needs of the growing number of older people. It is clear that a high priority is being given to addressing the implications of a demographic shift which will increase demand on public services, on financial support with reduced resources, on our communities, and on those of us willing and able to offer help and support through volunteering.

The reshaping care for older people Programme for Change strategy document states that it is also important to note that older people themselves can have a critical role to play in keeping other older people out of the formal care system and living Potentially, independently at home. The document highlights that volunteering older people provide far more care than they receive. has a major and For instance, it is estimated that over 3,000 people significant role to over the age of 65 receive more than 20 hours of paid play in reshaping care care per week while over 40,000 people over the for older people. There is age of 65 provide more than 20 hours unpaid care per an assumption on the part of week. The issues highlighted by practitioners and policy policy makers that communities will makers in the document include: easily respond to the shift in demand for volunteers major financial pressure of ageing population as older (i.e. community activists, local leaders, local charities, people ‘consume’ more health; trusts and groups) to support the new approaches to public service reform; for example in community asset demand for unscheduled care; transfer, increased demand for people to support care balance between acute and community sector of the elderly (preventative measures) and for people provision; to participate more in supporting physical activities. These policy areas are all based on assumptions that delayed discharge; people in Scotland are willing, motivated and able to partake in this policy shift. comparative costs of acute and community based care; Yet in the past 25 years however, there has been the need for a sustainable model of care; little increase in participation in volunteering, as measured by the Scottish Household Survey. Over the assumption that any new approach must include the past quarter century, consistently around 30% of a model which emphasises partnerships/joint the Scottish population has reported participating in working and especially co-production; ‘formal’ volunteering. This refers to all those who a concerted shift from spend on unscheduled care to preventative treatment/anticipatory care.

04 provide their energy and time towards the NHS, other Yet encouragingly, people’s motivation to offer help, public services and in formally constituted charities and time and commitment seems not to have altered. The groups. Most (80%) of the people who do volunteer latest Scottish Household Survey findings confirmed formally in Scotland do so through charities and groups that people most commonly engage with volunteering (SHS 2012). For the assumption that more people in by being asked by someone they trust such as a family Scotland will engage with volunteering to hold true, member or friend. Technology is however becoming a there may need therefore to be a different response new point of access with around 20% of people saying to engagement of volunteers. It is also likely that the that they would use the internet to access volunteer relationship between public bodies and individual opportunities (VDS 2012 Scottish Charities Survey). volunteers will have to change. Furthermore, volunteering continues to be an important component of health and social care Most recent surveys of the public have indicated that services. There are good examples of this in the NHS there are people who are willing to volunteer but who Scottish Ambulance service and in charities such as don’t know how to access opportunities, who have Chest, Heart and Stroke Scotland (CHAS), Women’s not been asked to do so, or who experience barriers Royal Voluntary Service (WRVS), befriending groups, in accessing volunteering opportunities. Equally people where 1000s of volunteers contribute their time also say that a lack of consistently available free time towards health and care. In total, it has been estimated and changes in their lifestyle can impact on their that the financial value of older people’s volunteering ability to volunteer (SHS 2012, TNS 2011). These in the UK reaches some £10 billion, with older factors need to be taken into account by policymakers people spending an average of over 100 hours a year in devising strategies which assume the willing ‘informally’ volunteering (i.e. not through formally involvement of people in public service provision and constituted organisations) and more than 55 hours in reform. Volunteer programmes were designed around formal volunteering roles (WRVS, 2011). 25 years ago for a different world, there is also some evidence that volunteers from the ground up are asking There is also a growing body of literature which for a different approach to volunteer management. highlights that volunteering has important emotional and health benefits for older people and the wider VDS recognises the shifts in, for example: community. Evidence suggests volunteering encourages family dynamics which influence volunteering; independence, resilience, provides a valued role and combats social isolation. The experience and skills of increased isolation – more individualism and less older people have also been recognised as a valuable community; resource for businesses and for voluntary sector demands for flexibility in volunteering; and civic organizations (Government Office for Science, 2008). technology – increase of social networking;

professionalism in volunteer management – increase in multi-skills development.

05 The findings from VEnable summarised below present In agreement with the Reference Group, the VEnable opportunities to develop complementary approaches project team collected data about volunteering which consider how professionals in health and care activities in two key environments: in hospitals in services and in volunteer development along with Tayside, and out in the broader community. For the service users, community, and individual’s voluntary purposes of this study, ‘community’ settings included: effort can be better aligned in response to health and GP surgeries, community care (care-homes and social care challenges. In this respect, the findings sheltered housing units), third sector organisations will also contribute to the development of varied and local authorities as well as individual volunteers’ approaches which come under the umbrella of ‘co- support provided to older people in his or her production’, which is increasingly being applied to home. Pictures depicting various settings within the new types of public service delivery in Scotland, community and acute settings were used to stimulate including new approaches to care. Co-production responses from participants at events. Some examples refers to the active contribution of the people who of these are outlined below. use services, as well as – or instead of – those who have traditionally provided them. It therefore contrasts Figure 1: Community settings with approaches that treat people as passive recipients of services designed and delivered by someone else. Co-production emphasises that the people who use services have assets and by becoming equal partners in all aspects of service design and delivery can strengthen and improve those services. These assets are not usually financial, but rather are the skills, expertise and mutual support that service users can contribute to transport effective public services. It is fair to say that volunteers, whatever their age, fit this mould well both as active participants and as willing contributors to communities but also as users of health and care services. care home

1.3 VEnable methodology

In order to attain the objectives outlined above, Stage 2 utilised a mixed methods approach which included: home

one to one interviews with key stakeholders (policymakers and practitioners); group interactive sessions (with volunteers and key stakeholders); GP formal surveys (of GP surgeries, of care homes and sheltered housing units, and of third sector organisations); secondary analysis of existing reports and documents.

06 Figure 2: Interactive events As part of the original methodology the VEnable team planned to capture the perspectives of a small number of older patients through 1:1 interviews. This element of the pilot was not progressed as there were challenges in accessing patients to participate. The view from an older person’s/patient’s perspective will undoubtedly add considerable value to the findings in this report and should still be considered in any future developments. We should also note however that the project team did interview older people as stakeholders rather than patients/service users and their views are taken into account in the report.

What follows is structured into four substantive sections. The first reports on the availability of volunteer support for older people in hospital settings as well as the activities where new volunteer opportunities could be created. The second section reviews the extent and range of volunteer support in non-hospital settings (home, GP surgeries, care homes and sheltered housing units, and that provided by third sector organisations out in the broader community) as The stakeholders and participants who offered their well as the un- or partially met needs of older people experience, perceptions and skill to the VEnable where opportunities for new volunteer activities could research included: be created. The third section discusses the challenges and barriers which stakeholders identified as being health and social care professionals (staff) in NHS problematic in accessing currently available volunteer Tayside and in other settings including voluntary support or in creating new opportunities. This leads organisations, onto the conclusion in which VDS summarises the local government, community groups; key findings and poses a series of questions which volunteers; are intended to help NHS Tayside consider how the staff/managers leading in specialist areas such as findings are taken forward within the health dementia, older people’s services, befriending board area. groups; staff from third sector organisations; volunteers.

07 2. VEnable findings - volunteers in hospitals

The following section maps the relationship between it is reasonable to assume that volunteers are making volunteers and their involvement in hospital settings a significant contribution to the in-patient experience in supporting older people. This is followed with in hospitals in Tayside. Figure 2 outlines the diversity reflections on health and care gaps or needs identified of roles and activities conducted by the 921 NHS by VEnable contributors where more volunteer volunteers. opportunities could be created. According to the NHS database the most numerous 2.1 Mapping volunteering support roles are drivers, hospitality/trolley service volunteers, in hospitals befrienders/ward visitors, fundraisers, flower arrangers, and welcome/meeter greeters in that order. One The mapping of volunteering in hospitals revealed that volunteer told the project team that the role could volunteers play a substantial role in supporting older simply be one of sitting with patients: in-patients. The majority of these volunteers are co- ordinated through the NHS which, at the time of the “I am a patient person, I just hold their mapping had 921 volunteers registered. In addition, hand as they don’t speak, I will sit there” the WRVS and the League of Friends also co-ordinate (Event participant, Ninewells event, May 2012)1 volunteers in Tayside hospitals. Given that older people constitute up to three quarters of hospital inpatients

Figure 2: NHS volunteers’ activities and roles

Volunteer Roles

Drivers Fundraiser Renal buddies Hospitality/trolley service Flower arrangers Complementary therapists Befrienders, Ward Visitors DJ on hospital radio Chaplaincy volunteers Welcome, Meeter Greeters Admin, reception Art therapists Day care support Library assistant Music, dance therapists Hairdresser Gardening assistant Occupational therapists Health promotion Counsellors

1 All quotes provided by participants in this report have had their role generalised for confidentiality purposes.

08 WRVS volunteers provide shop and cafe services, 2.2 Matching needs and volunteer ward trolley services, and welcome desk services. The opportunities in hospitals League of Friends volunteers organise an additional range of activities such as fundraising, gardening, Despite the obviously significant contributions that flower arranging and transport. In addition to in-patient volunteers make to the support and care of older volunteer support the NHS co-ordinates approximately people as outlined above, VEnable contributors 100 volunteer drivers who are based within community identified four key areas of unmet needs where there hospitals in Tayside. The drivers transport older people are opportunities for increasing the support from who need assistance in getting to and from hospitals. volunteers. Half of the drivers are based in Angus, the remainder support outpatients travelling to and from the Murray a) Addressing inconsistency – directly managed Royal Hospital, Crieff and Royal Liff Hospitals. Those ‘NHS volunteers’ contributors at events who were aware of volunteers The first and most obvious gap is a lack of consistency on hospital wards were extremely positive about the in the directly managed volunteer support across difference they made to patients and staff. Angus, Perth & Kinross and Dundee. Almost two “Excellent volunteer support in Perth thirds of NHS Tayside’s 381 hospital volunteers (NB Royal Infirmary to support dementia the remainder of NHS volunteers are mainly deployed patient engagement” in hospices) are located within the city of Dundee: in Ninewells hospital, Roxburghe House and the (Event participant, Perth, May 2012) Macmillan Day Care Unit. In contrast, within Perth “Volunteers have been brilliant” and Kinross there are two hospitals that currently have no NHS directly managed volunteers – Aberfeldy (Event participant, Perth, May 2012) Community Hospital and St Margaret’s Hospital in Auchterarder. Similarly in Angus, two hospitals Stakeholders also recognised there was a ‘huge role’ (Ashludie and Irvine Memorial Hospital) have no active for volunteers on hospital wards. NHS Volunteers although it should be noted that the Ashludie Hospital is closing down. To illustrate this inconsistency, Table 1 shows the number of NHS volunteers who are deployed within each individual acute, community hospital or hospices.

09 *Table 1: Number of NHS volunteers by hospital and hospice settings

Perth & Kinross Dundee Angus

Location No. Location No. Location No.

Aberfeldy Community 0 Kingscross Hospital 11 Arbroath Infirmary 11 Hospital Blairgowrie Community 42 Ninewells Hospital 116 Ashludie Hospital 0 Hospital Crieff Community 3 Royal Dundee Liff Hospital 4 Brechin Infirmary 5 Hospital

Perth Royal Infirmary 20 Royal Victoria Hospital 55 Irvine Memorial Hospital 0

Pitlochry Community 8 Roxburghe House 126 Little Cairnie Hospital 5 Hospital

Murray Royal Hospital 14 Montrose Royal Infirmary 8

St Margarets Hospital, 0 Strathcathro Hospital 13 Auchterarder Cornhill MacMillan 115 Whitehills HCCC 31 Centre Strathmore Hospice, 61 Lippen Care

MacMillan Day Hospital 53

*Figures sourced from NHS Tayside volunteer database in April 2012.

This may be in some cases related to the size of the within the Medicine for the Elderly wards of Ninewells hospitals but is still significant in terms of inconsistency hospital in Dundee whereas, in contrast, Kingscross in where patients access volunteer support. These Hospital currently has no ward visitors or befrienders. roles are relevant to all patients and are not specific to VEnable contributors identified the critical importance older people although it can be assumed that hospital of company, someone for older in-patients to talk volunteers will provide support and activities to a high to and enjoy activities. This was raised as especially percentage of older recipients. important for older people without friends or family. The quotes below from participants at mapping events b) Specialist needs - volunteer ward visitors and illustrate where some of the identified needs: befriending “I feel wards could benefit from more The second gap identified was in the deployment of volunteers to do activities, such as volunteer ward visitors and befrienders or generally knitting, reading and chatting about the more access to volunteers. NHS Tayside’s 93 volunteer newspaper” ward visitors/befrienders are currently concentrated (Event participant, Pitlochry May 2012)

10 “Service users with dementia can have Key policy aims of NHS Tayside are to reduce delayed difficulty moving from one ward to discharge from hospital as well as to more actively another, more co-ordination of this plan for discharge. In addition evidence suggests that would assist with smoother transfers” early support on discharge for older people reduces (Event participant, Arbroath, June 2012) the demand for future hospital services or readmission rates. It was highlighted that older people who didn’t In addition to the companionship offered by ward have adequate support at home could result in delayed visitors, VEnable contributors also referred to how discharge. volunteers could carry out practical ward-based tasks for patients, such as filling jugs of water, serving teas, The VEnable project identified only one volunteer helping to feed patients and encouraging patients service which supports older people on their discharge carry out everyday activities whilst in hospital, such as from hospital - the WRVS Home from Hospital Service washing their hair and getting dressed. in Perth and Kinross. Older people who are referred Some also referenced the need for support in looking to this project receive 6 weeks of volunteer support to after pets when older people were in hospital. help him or her settle back into their home. Volunteers assist with prescription collection, shopping as well as helping people attend their medical follow up c) Direct opportunities to support older peoples’ appointments transporting people to appointments. travel needs

VEnable contributors reported that there was a Several other specific unmet needs were identified in greater need for volunteers to support older people relation to the discharge of older people from hospital attending or travelling to acute settings as outpatients. which could be matched to the creation of new This included volunteer drivers who could assist older volunteer opportunities. These included: people in getting to outpatient clinic appointments as well as to accompany him or her for the duration of the specific follow-up of older patients after discharge, appointment. While there were some volunteer driver by telephone or a ‘good neighbour’ approach schemes identified which were referred to above, in order to monitor progress; there were no volunteer drivers at the two acute a contact point/person for the discharged person if hospitals: Ninewells and the Royal Infirmary. This quote he or she needs assistance or advice; was typical: general help with practical tasks such as shopping, “We need volunteers to ‘chum’ people to dog walking and assistance collecting prescriptions. their appointments, wait with them and then take them home.” To summarise, the VEnable mapping research (Event participant, Arbroath, June 2012) identified substantial opportunities for the creation of volunteer opportunities in hospitals. The following d) Discharge from hospital section reviews VEnable’s findings in relation to volunteer support in other types of care settings in the A particularly important unmet need was for volunteers community. to assist older people being discharged from hospital.

11 3. VEnable findings – community settings

Community and primary care settings are of critical 3.1 GP Surgeries importance in reaching older people who may otherwise be isolated from support. The VEnable Gaining involvement from GP surgeries was viewed project set out to map how, where and in what ways by many VEnable participants as critical to enabling older people are supported/engaged with volunteers or greater volunteer support reaching those older people volunteering outside hospitals. In order to try to reach who needed it most. Participants also highlighted this ambitious aim, the research team spoke to a range more generally that the evidence of the impact of health and social care stakeholders across Tayside at of volunteering for older people needed better the mapping events and through one to one structured recognition as this activity was leading to better health interviews. In particular the team sought the views and outcomes. GP surgeries are considered as one of the experiences about the engagement of GP surgeries central points within the community setting for older and care homes and sheltered housing units with people as they are more likely to use this service. volunteering support. The research team also spoke to and surveyed third sector organisations which involve The timing of referrals of older people to volunteer volunteers in their work with older people. support was consistently raised by all interviewees and event participants as an issue. Many considered The timing of referrals of older people to volunteer that older people access support too late and that support was consistently raised by all interviewees there is a major role for volunteers in preventative and event participants as an issue. Many considered and anticipatory, low level, support for older people. that older people access support too late and that In short, early intervention was identified as a primary there is a major role for volunteers in preventative and contribution which volunteers can make (if motivated, anticipatory, low level, support for older people. In willing and interested) to older people which may short, early intervention was identified as a primary contribute to reduced admissions and re-admissions to contribution which volunteers can make (if motivated, acute care. Equally older people as active volunteers willing and interested) to older people which may often provide this early intervention themselves and contribute to reduced admissions and re-admissions to volunteering can result in less isolation, more activity acute care. Equally older people as active volunteers and better health outcomes. often provide this early intervention themselves and volunteering can result in less isolation, more activity The survey of GP surgeries in NHS Tayside indicated and better health outcomes. However, other factors that a quarter has volunteers providing support to which may prevent early access to support include older people direct from the surgery premises. These older people’s lack of trust or unwillingness to ask for surgeries were spread relatively equally between help as highlighted later in the report. Angus, Dundee and Perth & Kinross. Table 2 outlines the types of activities carried out by volunteers based This section reports the findings in relation to mapping within surgeries. The provision of health information what support is already being accessed as well as was the most popular type of volunteer activity the opportunities where particular gaps or needs followed by support groups. have been identified by the participants or through information provided to the project team.

12 Table 2: Number of GP practices in Tayside with volunteer support

Type of volunteer activity Angus Dundee Perth & Kinross Total

Health information/signposting 4 1 2 7

Transport 0 0 1 1

Counselling/listening 0 1 2 3

Support groups 3 1 2 6

Other (exercise group for CV disease) 1 0 0 1

Total 8 3 7 18

*NB 40 out of 68 surgeries responded. Surgeries were asked in the survey to tick all activities that applied. Column and row totals do not therefore add up to the number of respondents.

In addition to those reported a stakeholder also reported referring patients onto volunteer support. A highlighted the provision of volunteer transport from an further 14 practices report referring onto other support Angus based GP which indicates there is likely to be but are unsure if it is provided by volunteers. Only three more support than that reported through the survey. practices reported that they don’t refer onto volunteer support. Surgeries were also asked whether they commonly Table 3 (below) outlines the findings. referred or signposted older patients to volunteer support (i.e. that they could access from other organisations). Overall half (50%) of the practices

Table 3: Referrals and signposting by GP practices to volunteer support

Refer or signpost to volunteer support Angus Dundee Perth & Kinross Total

Yes 5 10 6 21

No 1 2 0 3

Refer/signpost to support but do not know if a 3 4 7 14 volunteer is involved

*NB 40 out of 68 surgeries responded. Surgeries were asked in the survey to tick all activities that applied. Column and row totals do not therefore add up to the number of respondents.

13 The Angus Volunteer Centre Single Point of Contact were identified. Figure 2 sets these out. It is of note (SPOC), established in 2012 was referred to by several that volunteer provision in older people’s residential stakeholders as a potential model of good practice in care formed part of the Change Fund proposals within relation to co-ordinating volunteer support from GP Angus and Dundee. This includes volunteers providing practices. The SPOC provides GP surgeries and other a ‘walking leaflets’ pilot service in Mayfield sheltered health and social care services with a named contact housing. Dundee CHP is also working in partnership who can be contacted for advice and signposting to with the Dundee City Council, the Care Commission volunteer support or volunteer opportunities. This and care home providers in Dundee to improve project has made particular efforts to engage GP standards in care homes. surgeries. In Angus there have been discussions with residents Although just under half of the GP respondents (45%) of a sheltered housing complex to identify their assets reported that they didn’t signpost older patients onto and skills that could potentially be offered to younger volunteering opportunities a total of 16 practices (38%) people in the community. This would help to bridge the confirmed that they do which indicates some are seeing intergenerational gap and younger people could offer the value of volunteering for older people. skills to sheltered housing residents in a reciprocal way.2

3.2 Care homes and sheltered In Dundee, Bield Housing Association has received housing funding to set up a community cafe for people with dementia in association with Alzheimer Scotland, and The project also surveyed over 100 care homes Caledonia Housing Association received funding for and 150 sheltered housing units in Tayside; this was a volunteer co-ordinator to develop volunteer-led less successful as only 11 responses were received, activities for older people. suggesting that these settings are not especially engaged with volunteering. Nevertheless, of those that did respond, a diverse range of volunteer activities

Figure 2: Range of volunteer activity within care homes and sheltered housing units

Volunteer Roles Visiting /befriending Pet therapy Hospitality Seated exercise Facilitating social events (i.e. bingo, quizzes) Music performance Arts and craft sessions Hairdressing Transport Garden maintenance Reminiscence based activities Book delivery/reading Library services Massage Information provision

2 (Information from Change Fund Sub Group Performance and Service Improvement Workstream Update Summary).

14 3.3 Home and Wider Community opportunity, usually weekly, for older people to congregate and to enjoy a meal together. Volunteers Volunteers play a crucial role in the social, emotional host the lunch clubs as well as sometimes provide the and practical support of older people in his or her transport to and from the venues. VEnable identified a home as well as in broader community settings such as total of 28 lunch clubs: 9 clubs in Angus, 4 in Dundee day care centres, lunch and social clubs, libraries and a City, and 15 in Perth & Kinross. Seven of the 15 clubs variety of environments. In these settings, a substantial in Perth & Kinross were organised by the Healthy amount of volunteering support occurs through third Communities Collaborative. In a variation on the lunch sector organisations. club, Contact the Elderly, which operates in Perth, Dundee, Forfar, Brechin and Montrose, supports VEnable reviewed the types of help which volunteers volunteers in the organising of high teas for give to older people. Broadly there were four types older people. of volunteer support identified: support aimed at overcoming the social isolation of older people, support in keeping older people fit and healthy, Social clubs, in addition to the lunch clubs, provide transportation and specialised services which provide specific opportunities for older people to meet, play volunteer support for older people with dementia. games, enjoy other forms of entertainment, and in Each is described briefly below before turning to the some cases exercise classes. Twenty four volunteer- unmet needs of older people where new opportunities led social groups were identified in Tayside. These could be created for volunteers were organised by a range of providers including Age Concern, WRVS, and Perth & Kinross Healthy Communities Collaborative. A total of 17 day care a) Overcoming social isolation: befriending centres in Tayside which offer a range of activities schemes, lunch and other social clubs for older people were also identified. These centres Volunteers offer support to older people in the form are run by charities as well as statutory providers. of befriending, through hosting lunch and social clubs However, as these quotes illustrate, this is not always and through providing support at day care centres. the best approach for older people: Volunteer befrienders commit regular time to visit people either in their own homes or to accompany “move away from traditional service them to social events and functions in the community. models like day care and encourage At the time the research was conducted, VEnable development and identified five befriending services across Tayside, use of local community support” with one in Perth & Kinross, two in Angus, and “we need more non-bingo activities and two in Dundee City. Providers included Monifieth more non denominational activities” Befriending Scheme, ‘4 Ever ‘Freends’ Older Adults (Event participant, Dundee, May 2012) Project, St. John’s Boomerang Project, and the WRVS Good Neighbour Scheme. In addition, Angus Council The need for a higher level of personalised support was supports approximately 70 volunteer befrienders. recurrent theme both in relation to having consistent support from the ‘same face’ but also ‘support to Volunteers also provide support for older people engage in personalised activities that are important to in lunch and social clubs. Lunch clubs provide an the individual’.

15 Although beyond the scope of this project, many shopping and spend time with clients. churches/faith groups within Tayside also host lunch The research also identified a large number of exercise clubs as well as other forms of activities and social clubs activities and groups taking place throughout Tayside. for older people. In addition, some activities such as Exercise classes are organised by social clubs, and are learning about computers and drama activities are also either led or supported by volunteers, with Perth & provided by groups such as Angus Gold (Angus Council Kinross Healthy Community Collaborative referred Department of Education). to frequently. In addition, walking groups led by volunteers were mentioned with some frequency. b) Practical support and keeping fit and healthy Walking groups such as Steps Tay Health, Stride for Volunteers in Tayside offer support to older people Life, and Alyth Walking Group are not necessarily through a multitude of types of practical support such targeted specifically at older people, but nevertheless as food shopping. For the elderly housebound, receiving involve a significant number of older people. These practical support can be of great assistance in helping to types of groups help to overcome social isolation as maintain independence and to continue to eat healthily. well as helping to keep older people healthy. Providers of this type of support included the WRVS Shop Drop Service and the Dundee Food Train which Chair-based exercise was identified by many VEnable were viewed very positively by stakeholders. The Food contributors as a specific activity which is supported Train is a model that has been developed in other local or led by volunteers. This exercise, much as the authority areas and started in Dundee in 2012 and name suggests, allows person to remain seated while currently engages around 50 volunteers who deliver exercising, and is therefore mostly aimed at older or frail people. Volunteers help with the activities, as well as with preparing equipment, ‘buddying’, transport and providing refreshments. Three providers of this type of volunteer-involving activity were identified in Angus, including Angus Gold, Angus Cardiac Group and Angus Council.

Other forms of exercise-based activities which involve volunteer support were also identified, including bowling, tai chi, dancing, which are all promoted for instance by Dundee Celebrate Age Network (CAN) and are provided at venues such as community centres and libraries.

c) Support for people with dementia

The provision of services and support for people with dementia, both in hospitals and in the community has been identified as a key national and local priority

16 within health and social care planning. VEnable set out interviewees to be available in Angus are those engaged to explore the extent of specialist volunteer support by Angus Council, and can only be accessed by means offered for people with dementia-related problems. of a referral from a case worker/social worker.

Alzheimers Scotland is the main provider of volunteer The Perth and Kinross Community Transport Group support for older people and families who live with is an umbrella organisation that works to support and alzheimers. In addition, Perth & Kinross Council promote voluntary transport. They report numbers provides volunteer support through the Strathmore of over 650 volunteers providing transport in Perth Day Opportunities Service and the North West Older and Kinross. A similar model is being developed in Peoples’ Community Mental Health Team (CMHT). Dundee (Dundee Community Transport) through Contributors from the latter services reported the Change Fund. This model was viewed positively that volunteers support older people with arts and by stakeholders although it is important to note that crafts activities, carer support, counselling, exercise feedback suggests that there is still significant work to and transport. In addition, WRVS reported that it is be done in improving access to existing services. developing specialist training for its volunteers in Perth & Kinross; while the Blairgowrie Community Hospital has developed a specialist volunteer befriending team 3.4 Matching needs and volunteer for older people with dementia-related illnesses. opportunities – community settings d) Transportation and volunteer drivers Taking into account the findings above, there were Transport is a vital component in the packages of four main areas identified where new volunteer support which older people require in order to opportunities could be created to respond to needs: remain in the community. The issue of transport volunteer drivers, support to overcome social isolation, was consistently referenced. ‘Transport’ referred to personal support and practical support. Each is the support which volunteer drivers can offer older described in turn below. people in order to reach medical appointments, as much as driving older people to simply get ‘out and a) Opportunities for more volunteer drivers about’ or to social functions. In addition to the NHS volunteer driver schemes referred to above, within In part this related to the inconsistency of pre-existing Perth & Kinross VEnable identified 13 different support. For example we identified a lower number voluntary transport providers out in the broader of volunteer drivers within Dundee and Angus in community. These schemes are based within Pitlochry comparison to Perth & Kinross, which was relatively Hospital, Perth Royal Infirmary, Kinross, Comrie and well-served. Although this may be reflective of the rural Aberfeldy. Providers included the WRVS, British Red geography of Perth and Kinross and a greater need Cross, Samaritans, and Pitlochry Senior Citizen Good for transport provision stakeholders still highlighted Neighbour Association. Within Dundee, volunteer a need for more accessible community transport in drivers are provided by the British Red Cross, Dundee all areas. Therefore there is potential to create more Community Transport, funded by the Change Fund opportunities for volunteers who are interested and Dundee City Council. In contrast, according to in volunteer driving across Tayside, particularly in interviewees, the only volunteer drivers reported by Dundee and Angus. It is fair to say that there is also

17 opportunity to consider how the provision of volunteer reported unmet needs of older people was simply drivers can be better networked geographically by the having someone to talk to and companionship. As one various providers. In addition to these potential new contributor told us: opportunities VEnable identified that there was a need for more support specifically in the following areas: “Older people are falling through the net and feeling isolated in their home. to offer help with out of hours transport; We need more time – just 5 minutes for to help in offering transport to visit relatives/spouses a cup of tea – to be listened to by those in hospital; caring for them.” (Participant, Blairgowrie VEnable event June 2012) help with transport to appointments (i.e. GP, optician, outpatients); Helping older people to feel less lonely was not help with transport to social activities; only seen as a valuable impact in itself; being less help with transport to shopping. lonely is thought to contribute to the avoidance of healthcare crises and ultimately to keep people out of hospital. In response, contributors felt that As one participant reported: volunteers could offer more social visits to older people in the community, including checks on “Transport is one of the biggest issues wellbeing, companionship and conversation. Overall affecting older people in accessing contributors recognised the value of an ongoing activities and social events.” volunteer befriending support to encourage people Participant, Royal Victoria, Dundee VEnable event to stay independent, motivated and to take part in June 2012) activities and community life. The importance of these types of volunteer support can be seen by Gaps in support were reported to be compounded by these quotes: a lack of information about the availability of volunteer drivers reaching older people as well as the particular “A major gap in services for old people problems faced by older people in rural areas. are ones that would address loneliness Consideration of networking providers and volunteers and isolation; [this could be] a simple or improved communications may therefore be niche for volunteering.” worth noting. (Third Sector Manager, June 2012) b) Opportunities to help with addressing social isolation of older people “[We need] more support in / out of the Although VEnable clearly identified volunteer support home, to support individuals to remain for older people aimed at overcoming social isolation, motivated and encouraged to maintain contributors felt that there could be a lot more done to their independence.” address this need. The loneliness of older people was a (Participant, Arbroath VEnable Event, June 2012) recurring theme in conversations with health and social professionals, with third sector organisations and with volunteers themselves. One of the most commonly

18 Volunteer befriending was said to be especially valuable were predominately raised in relation to how this can for those living alone, recently bereaved and where impact on mobility and potentially contribute to falls. family support was unavailable. Accordingly, this type Suggested tasks associated with dental care included of volunteer support was also reported by contributors assistance with keeping dentures clean and checks on to be of value for the carers - and spouses - of older fitting in order to ensure older people were not just and frail people. The need for consistency in volunteer comfortable but also able to eat properly. Support in support was raised time and again, particularly for these areas could provide important preventative care. old people where having to meet new volunteers on As one contributor reflected: a regular basis could be confusing. In all, the range of types of support which volunteers could offer was “As people are living longer, we need highlighted by this quote: to be proactive in identifying health risks. For example untrimmed nails can “From my experience when I play lead to pain, mobility problems and an music for older people I invariably hear increased risk of falls. Many older people comments such as, ‘Oh I wish we could struggle to care for their feet as they have more of this’ and ‘this brightened can’t reach them. Podiatry services do my day’, or ‘what a difference hearing not provide personal nail foot care, i.e. music makes” what the person would normally do (Volunteer, Pitlochry VEnable Event, June 2012) for themselves. This has the potential for development opportunities for care home staff and volunteers.” c) Opportunities to support the personal care of older people (Participant Arbroath VEnable Event June 2012)

Key areas of need identified by VEnable contributers in d) Opportunities where volunteers could assistance relation to personal care are listed below: with practical tasks

Foot care (chiropody, podiatry); Although the mapping identified a number of care and repair services available for older people, none of these Dental care; involved volunteers. Practical support in the home was Hairdressing; highlighted frequently as an unmet need. Contributors Eye care. identified that there were significant gaps in everyday practical assistance that could support older people In particular, foot care (including nail-cutting) was raised remain independent in their homes. The types of tasks as an unmet need. Issues around foot care and nail care

19 mentioned by contributors where volunteers could between volunteer motivations, different volunteer help included: involving organisations activities, the needs of older people and the needs of the NHS as a key service Gardening provider. Shopping (food and clothes) A critical part of the project was to identify the Minor household chores different settings around which volunteer support Minor repairs is co-ordinated and accordingly to identify where Paperwork and form filling/administration more is needed or could be offered. Older people Dog walking/pet sitting in hospital wards currently receive some volunteer support, provided by NHS direct volunteers, albeit this Accompanying to health and social care appointments support significantly varies in each of the hospitals and there are some notable gaps. There is a patchwork 3.5 VEnable findings - mapping of volunteer support for older people out in the summary community and a number of unmet needs identified by the VEnable project where significantly more volunteer To summarise, volunteers offer an enormous range opportunities could be created. Table 4 summarises of different types of support for older people who the findings from the surveys, VEnable events and access health and social care services in NHS Tayside interviews. The table shows the similarities in the areas area. Support ranges from in-patient care, including reported to be ones in which volunteers could offer ward visiting and befriending, help with practical more support to older people. It seems significant that tasks, support with personal care, and assistance with befriending, volunteer driving and personal care are transportation. Undoubtedly, volunteers are a crucial highlighted across most settings. part of the health and social care package of support for older people and as demonstrated above there is an array of new opportunities which could be created where older people will benefit both as recipients of care and as volunteers.

What seems significant however, from the VEnable findings, is that any offer of care and help by volunteers and the matching of this offer to needs of older people seem more by chance rather than part of an integrated universal strategy – across the region as a whole. For example older people have different types of volunteering support and opportunity provision depending on where they live or where they access care. There seems a rather random connectivity

20 Table 4: Matching needs and creating more volunteer opportunities

Acute settings Care homes and Home and Wider GP Surgeries (hospitals) sheltered housing Community Ward visitors and Befrienders and buddies Befrienders befrienders

Volunteer drivers Volunteer drivers Volunteer drivers Volunteer drivers

Accompanying to Accompanying to Accompanying to outpatient appointments appointments appointments Activities associated with discharge from hospital Personal care Personal care (hairdressing, (hairdressing, foot care, foot care, dental care, dental care, eye care) eye care)

Social Activities Social Activities

Exercise and keeping Exercise and keeping active active Practical tasks (gardening, Practical tasks shopping, household (gardening, shopping, chores, minor repairs, housework, finances and paperwork, dog walking form filling) and pet sitting)

Information/Advice (particularly signposting Information/Advice Information/Advice to volunteering opportunities/support)

Support for carers

21 A final key point to mention in relation to activities, or “My mother was looked after brilliantly areas where volunteer opportunities could be created, and I wanted to do something to pay was that interviewees consistently also referred to back for this care” the need for this support to be personalised. In other words, rather than slotting older people into ‘off-the- Volunteers in health and social care spoke to the V shelf’ volunteer support, it was important to decide in Enable team about why they kept volunteering and partnership with the individual what type of support he what they got out of it. In addition to relating personal or she required and design packages of support with experiences of receiving support and wanting to that in mind. return support they talked of the mutual benefits of volunteering – for them and for the older people they “[Older people] need support to support and provide activities to. engage in personalised activities that are important to the individual “You learn a lot from the people you rather than group settings” support; it is not just one way” (Participant, Pitlochry VEnable Event, June 2012) “Through volunteering I have become aware of my own abilities” 3.6 Volunteering motivations and experience The majority of volunteers described how much they enjoyed volunteering in health and social care From V Enable interviews with 32 volunteers it is clear environment and the ways in which it benefits them that the act of volunteering contributes greatly to the through a sense of constructive purpose. volunteer in a number of ways. The V Enable findings are supported by other work in this area. Volunteers “It fills the day, and it keeps you active” were asked specifically about their experiences of providing volunteer health and social care support “Getting good work experience” and and activities to older people. For many, volunteering through volunteering “now on the road in this environment with older people in particular is to part time employment after years of about giving something back. A significant number of disability” volunteers reported that they had been motivated to volunteer by a desire to give back to health and social “You get your self-esteem back, care services after they themselves or a family member especially if you have had to stop had been a recipient support: working”

“My friends daughter died and I wanted Meeting people and making new friends was also to give something back” mentioned by many volunteers as a benefit to them of volunteering. NHS Tayside Volunteer Evaluation “I became involved after suffering years (December 2011) also found that meeting people was with depression, I wanted to try and be the thing most volunteers enjoyed about their role. of help to others”

22 There were mixed views expressed on the place All volunteers were asked about the challenges they of accreditation and recognition for volunteers in faced as a volunteer within a health and social care health and social care. A number spoke of not being environment. In the main, these related to their own interested in certificates for example as they “just confidence as volunteers and their engagement with want to help out”. For others however, volunteering older people. in health and social care setting had been a deliberate decision related, in part, to a desire to be employed Confidence to volunteer in a medical or social care in this area in the future. For them formal training and environment is an issue for a number of volunteers. accreditation was important. One explained “when your retire you have no confidence. I was stressed out at the thought of volunteering, but I got “I would like to have official recognition of to know people and socially I have really benefited” and the work I have done while volunteering another that “actually taking the first step to volunteer, to to help towards future employment” do something new. It was frightening”.

“I would like more formal certificates for A small number of volunteers talked about the what I do – instead of asking ward nurse challenge of engaging with older people who were for a reference” confused or had memory problems. One volunteer driver explained “with one lady with dementia conversation can be difficult. At her husband’s suggestion I put on Radio 4. You learn as you go along”. A further challenge relates to the remit of volunteers. Some spoke of the challenge of “standing back and not getting involved” and a desire to contribute more than their role allowed. Some volunteers raised issues around gaps in support for some volunteers working with older people particularly relating to emotional and social needs. Whilst volunteering in the community one volunteer shared their experience of feeling under pressure to undertake more activities and responsibility:

“Because you volunteer you get asked to do a lot more but I also have my own family and other commitments”

23 Volunteers also highlighted challenges in finding the motivations for volunteering and nearly all volunteers right volunteers to help older people. Some volunteers V Enable spoke with felt they were making a significant felt that the opportunity to allow them to provide difference to the health and social care of the older more help for older people was significant. Within an people they engaged with. However, there are acute setting some volunteers identified that there was clearly some challenges for consideration around the a need to ensure more staff understood volunteering engagement of volunteers and matching to motivations roles and the contribution they could make. and suitability, the provision of support for volunteers and ensuring there is greater understanding of the “You have to match what older people contribution volunteers make. There is also a need want with what the volunteers are to improve communication around how volunteering capable of providing” support can be accessed.

Some volunteers felt that they could be regarded negatively by others and felt at times their views were not being taken on board as they were ‘only a volunteer’. There were also some examples of volunteers not having a good experience of recruitment where they had not received timely responses after expressing interest in volunteering.

The experience of volunteering in a health or social care environment is clearly a rewarding one for those involved. For many it is driven by a desire to ‘give something back’ to the NHS or social care providers. Feeling useful and having a purpose are also

24 4. Findings - key challenges and barriers

The sections above reported the availability of 4.1 Strategic challenges – connecting volunteer support for older people in NHS Tayside volunteers to health and social and where the possibilities were for creating more care needs volunteer opportunities. The research team also asked stakeholders and volunteers to reflect on the challenges The VEnable mapping revealed an excitingly diverse and barriers to accessing volunteer support or to patchwork of volunteering activity and volunteers creating more volunteer opportunities. throughout Tayside. The patchwork also however indicated the scale of the challenge of attempting to The research found that while the nurses, doctors and connect volunteering practice in a universal way - to healthcare assistants who work with older people in respond to the needs within health and social care for hospitals and hospices were relatively well-served in older people in the region. Integrating volunteering terms of being able to access and engage with almost may refer both to how services involve volunteers as 1000 NHS direct volunteers (albeit somewhat limited well as to how services access external (third sector) in terms of roles and distribution) , those health and volunteer involving organisations. social care staff in other settings (e.g. social services, GPs and staff in GPs surgeries, staff in care homes and VEnable participants were asked to reflect on how sheltered housing units) reported finding it substantially well integrated and connected they felt volunteering more difficult knowing when or how to put older was within health and social care practice and policy people in contact with volunteers. Some reported to in their respective areas, as well as the perceived the research team that, quite simply, they did not feel challenges. Views were varied as to what extent that it was their job. integration or connectivity had been achieved in and across each of the three local authority areas within This section reports the research findings on the Tayside. In some settings volunteering was more perceived challenges expressed by health and social integrated than in others but there was an overall care staff, volunteer-coordinators and managers and consensus among stakeholders that there is significant by volunteers themselves. For the purposes of this room for improvement. NHS Tayside has a long summary report, the key challenges and barriers valuable tradition of volunteerism with the Refreshed to accessing volunteer support have been grouped Strategy on Volunteering (the preparation of which was into three sections: strategic challenges to including supported by VDS) published in 2008 and updated in volunteering in the planning and design of services for December 2011. In 2010, a Non-Executive Director older people; day to day challenges faced by health told VDS that volunteering was “integrated in service and social care staff in accessing volunteer support for because we recognise the value of volunteers helping their patients; and the challenges of finding and placing us to deliver better quality service to our patients; volunteers with older people requiring support. Each is volunteers are not an aside, volunteers are very elaborated on below. much who we are” (Investing in Volunteers Assessment 2010).

25 Nevertheless, some VEnable participants reflected The key challenges to strategy identified by participants that below the most senior levels, there was less included: evidence of integration or connectivity. At council level, integration and connectivity of the approach to ‘High level’ policies, including volunteering, are not volunteering within the planning and delivery of health always embedded throughout services at all levels, and social care services was more mixed, with some from senior managers down to frontline staff; having volunteering policies and co-ordinators, others ‘Organisational silos’ and a lack of clear information not. The following quote illustrates the importance of a channels can make it difficult to share information strategic approach toward volunteer engagement. and plan cohesively;

“We need to look at volunteer A substantial amount of volunteering (including development in a really wide context. informal) takes place in the community and at grass This includes public health agenda, roots level which is challenging to integrate. inclusion, equality. And not just narrowly as a way of increasing numbers of There is inadequate and inconsistent available volunteers.” structural support in the form of volunteer co-ordinators, or staff with responsibility for (Third Sector Manager, June 2012) volunteering who have the capacity to ensure that volunteering is integrated into planning and delivery Approaches taken in Angus towards more integration of health and social care services were viewed positively although there was also recognition that ‘it can always be improved’. In other A final point raised by NHS interviewees identified areas, stakeholders highlighted challenges in having a that there were also concerns about paid roles clear strategic direction as illustrated in the being a substitute for volunteers. In other words quotes below: that the NHS was intending to deploy volunteers in order to substitute paid jobs with voluntary “There is not a clear strategic direction for ones. This suggests the need for a clear – and well- volunteering except that we are all signed communicated – demarcation of roles between up to it. It is linked into other strategies, volunteers and NHS staff. It is recognised however like Older People’s commissioning, but that progress has been made in this area and its about how it supports strategies rather attitudes and perceptions have improved than an end in itself.” Strategic challenges were not the only ones identified “The use of volunteer services doesn’t by the VEnable project. The following section filter from top to bottom (of the discusses the challenges faced by health and social organisation) which means there is a lack care professionals in their day-to-day lives in terms of of knowledge of what volunteers can engaging with volunteers. provide.”

26 4.2 Challenges – heath and social have about volunteering was sometimes out of date – care staff and their engagement or at least they had no way of knowing whether it was with volunteers current or not. This made it difficult to know which group to refer to and sometimes led to a reliance on The research team asked interviewees about how one or more groups as this quote illustrated: and when they referred or signposted older people to volunteer support, as well as any difficulties faced by “There are so many groups. Staff who can them in so doing. In order to ensure that the research refer cannot keep up to date. Also they included the other perspective, these questions were tend to get fixated on one group and refer also asked to third sector organisations which involve everybody to that one place.” volunteers. The research team’s survey of third sector (Third Sector Manager, May 2012) organisations that match volunteers with older people’s needs, found that overwhelmingly, older people A volunteer interviewed was also sympathetic approached these non NHS organisations themselves to this point: in order to be matched with a volunteer or a friend or family member contacted the organisation on the older “There seems to be a lot of different person’s behalf. That said, third sector organisations also voices shouting about similar things. How acknowledged that around half of the older people that would you differentiate between what got in touch with them had been referred by either GPs they do?” or social workers. Few reported older people being (Chair based exercise volunteer, Angus, June 2012) referred by care home or sheltered housing. On the other hand information overload was also raised Findings from the stakeholder interviews and mapping as an issue, and most emphatically by GPs in interviews events highlighted three potential reasons for why and through the survey of GP surgeries. Volunteering health and social care staff may find engaging with support just being one item which GPs receive volunteering support challenging. information about on a daily basis. This quote by a GP was typical: a) Lack of Information or Information Over-Load

Overwhelmingly, health and social care staff and “GP surgeries are inundated with letters, premises (GP surgeries, care homes and sheltered flyers and posters, many of which the housing unit) reported that information – and GPs never see as [they] too much to predominantly a lack of information – about the deal with. [The relevance] is not seen availability of volunteer support and about how by GPs/ practice managers in their to access it was an issue for them. For instance, role. Sometimes leaflets are put in the respondents to our survey of care homes and sheltered volunteer-ran help desk and occasionally housing facilities reported a lack of information about posters put in waiting areas if relevant, driving insurance, where the desire was to engage more i.e. around medical conditions such as volunteer drivers, and that this was problematic. cancer.” (Practice Manager, May 2012) However, rather than receiving too little information, some health and social care staff reported receiving too much untargeted information about volunteering. Interviewees reported that the information they did

27 As well as targeted information about the availability of c) ‘On-the-job’ support for health and social care volunteering support, GP respondents identified that staff and volunteers they would like a greater sense of the evidence-base The third challenge reported by health and social care for the contribution of volunteers to health outcomes. staff and by volunteers was the restricted time that In other words, GPs were not all convinced about the is available for the recruitment, training and ongoing utility of volunteering support for older people. GPs of volunteers engaged in supporting older people. said at the very least, information about volunteering Volunteers who attended the mapping events told the which was ‘written in GP language’ could be provided. research team that sometimes nurses and healthcare Consequently, GPs reported that they were not sure assistants do not have sufficient time to train or to whether making ‘referrals’ to volunteer support was support them. This, they felt, then impacted on their even within their role as medical doctors. One GP ability to know where they could best help on the reported that his doctor-patient relationship requires a wards. For instance, training was said to be needed careful negotiation of the power-balance between the in how to recognise changes in a patient which may two parties, and that making suggestions about what need another intervention by a nurse or doctor. In such older people do in their personal life would be outside circumstances, volunteers reported that they found it the scope of their role as doctors. difficult to approach busy nursing staff to ask for help. The following quote was typical: VEnable contributors also reported that from the other perspective, there are a number of challenges for third “It can be difficult for a volunteer to walk sector organisations in finding who the right contact into a health environment; staff are busy, person to whom information should be sent within they (volunteers can be shy and staff don’t each health and social care setting is at any one time. have time to guide/ support them.” A particular issue for these groups was reported to (Participant, Venable Arbroath event, June 2012) be the turnover of staff within health and social care settings which meant that time had to be continually Volunteers also identified the need for support in invested in refreshing routes of engagement. relation to the particular challenges of supporting older people. One volunteer put this down to the needs b) Protocols and processes of older people in terms of his or her higher levels of Health and social care staff working with older people dependency and vulnerability: also reported needing to feel confident that volunteers receive appropriate support and guidance on an on- “Some think it is just visiting an older lady going basis. This point was also related to the need but it can be emotionally draining.” for staff to have confidence that volunteers had a clear (Volunteer, Venable Arbroath event, June 2012) understanding and respect for patient confidentiality. Interviewees spoke about the need for clear protocols to be in place as well as training and support for volunteers in relation to patient confidentiality.

28 The need for ongoing support and training of a) The practicalities of finding volunteers volunteers working with older people was recognised Finding enough people to match to volunteering by health and social care staff who were interviewed by opportunities with older people reputedly seemed the research team. One commented that: less popular than volunteering with young people or children. Some volunteer roles were reported to be “There is a tier of support for volunteers less popular than others. Participants commented that is missing; day to day emotional and on the difficulty in engaging volunteers to help social support for them.” older people in continuing care compared to the (Event participant Arbroath, June 2012) numbers willing to support older people in hospices and other palliative care settings. In particular, third The key challenges are summarised in Figure 3 below. sector organisations reported difficulties in finding experienced and skilled volunteers to support older 4.3 Challenges – finding, matching people with high or complex levels of need, such as and placing volunteers with mental health problems, dementia and other types of communication challenges. Third sector organisations older people and volunteers felt that this may result from a lack of This section discusses some of the challenges in finding, awareness on the part of would-be volunteers about matching and placing volunteers which were reported the diverse range of volunteering opportunities as well by interviewees, participants at the VEnable events and as the mechanics of the routes in which people could by survey respondents. get involved in supporting older people. For instance, one contributor told the project team that:

Figure 3: Understanding the challenges to health and social care professionals

Information and communication Protocols and processes Time and resources

Time needed to read information Need for information about Processes for vetting of volunteers and understand the usefulness availability of volunteers support. working with older people. of volunteering.

Need for information about how Time needed to recruit, support Protocols for confidentiality. to access volunteers. and train volunteers.

Need for targeted and Clear demarcation of roles Ongoing funding to support the coordinated information about between paid staff and volunteers. involvement of volunteers. volunteering - avoiding confusion.

Need for education / communication about evidence- base on volunteering.

29 “Once a person decides they would like This quote was typical: to volunteer, [it is] difficult to find out what opportunities are out there.” “[There is a] huge commitment to maintain/increase the volunteer base (Volunteer, Dundee, June 2012) which I think, is common with other organisations we do not have enough In Tayside, individuals can become involved in voluntary time or funding for this.” activity through local volunteer centres, local NHS (NHS stakeholder, May 2012) voluntary service managers and individual voluntary organisations; the routes into volunteering and the Another commented that: mechanisms for becoming engaged are diverse and wide ranging. VEnable contributors suggested that “Volunteer Centres need to take the the diversity of these routes may themselves lead to time to find out the potential skills confusion among would-be volunteers about how to of volunteers and then find them an get involved. opportunity. They are too ready just to match people to what opportunities they Third sector organisations reported that finding have already.” sufficient people with enough regular routine time (Third Sector Manager, May 2012) to volunteer was also a challenge. This also was highlighted in relation to the issue of limited time by Another stakeholder commented that the reason this was volunteers and the timing of volunteer support. an issue was because volunteering in health and social care has traditionally been top-down and been treated as b) Matching volunteers aspirations with unmet ‘a service and not a volunteer development opportunity’. need for support To underline the importance of understanding the VEnable contributors reported recognising the volunteer motivations, he continued that: motivations and aspirations of the public to volunteer is vital, as well as the needs of the older person in “We get requests for volunteers to come receipt of volunteer support. Interviewees reported and sit with someone in their house that older people’s needs are often managed by health/ every Saturday night and I say to them care organisations and often these organisations do not why would they want to do that?” consider or understand the full needs of the volunteer: (Third Sector Manager, May 2012) for example lack of time, their interest or out of pocket expenses being recognised or being flexible around roles. VEnable contributors also though referred to the sometimes unrealistic expectations of older people and Others told the research team that the relationship carers as to what volunteer support was on offer. An matching process between older person and volunteer example was given where an older person expected could sometimes be challenging. Engagement and support such as cleaning, shopping and tasks around matching of volunteers and those in receipt of the house to be provided by a volunteer befriender. support requires time and the capacity to coordinate One contributor told the project that some older relationships, train and support volunteers. people and volunteers may experience personality

30 clashes. On the other hand, major factors to take into The PVG check was said by interviewees to be consideration in increasing the matching of volunteers especially off-putting. Discussions about vetting with older people was the sometimes reluctance of and other types of disclosure checks took place those most in need to put themselves forward for within wider debates about the over-formalisation volunteer support. This was also said by participants of volunteering. Although this type of ‘red tape’ to arise out of an unwillingness to ask for what can be was largely viewed as off-putting for people getting seen as charity particularly when there is a strong sense involved, many others also raised issues of security of independence. where older people have fear of crime which can prevent them from going out, having a fear of strangers Challenges were raised again in relation to the and trusting people in their home. boundaries between older people and volunteers Another particular challenge was the place of where it can be difficult to maintain the ‘formality’ of accreditation and training for volunteers in health and volunteering role and the older person could become social care. Views of volunteers who participated in too reliant on the volunteer. Volunteers also reported the VEnable events were mixed. While some reported that maintaining a distance could also be challenging. only wanting ‘to help out’ and consequently to not get “It is sometimes difficult if you know the involved in for example accreditation schemes; others patient and you have to stand back and had deliberately sought out volunteering opportunities not get involved.” in order to embark on a career in health and social care. For the latter group accreditation was decidedly more important. This demonstrates that individual Others reported that vetting and Protecting Vulnerable volunteers have different motivations for volunteering Groups (PVG) check processes were a particular and that these should be taken-into account when challenge. There was the reported perception that matching volunteer needs to those of older people. while for some health and social care professionals (notably GPs) vetting was an important part of the To summarise, overall, there were three groups of process for other organisations and for volunteers, challenges to creating more opportunities for volunteer vetting was time-consuming. As one interviewee support: to health and social care strategy and planning reflected: of services, to health and social care professionals “The paperwork volunteers have to who engage with older people in community and fill out is horrendous and it can take acute settings, and to finding, placing and matching four weeks to sort out. It needs to be volunteers. Table 5 summaries the three types of streamlined.” challenges. (Participant, Perth Venable event June 2012)

31 Table 5: Challenges to increasing and enabling volunteer support for older people

Strategic: planning and design Day to day engagement of health Finding, placing and matching and social care professionals with volunteers – relationship volunteer support (accessing) management Having adequate information to Lack of awareness of professionals about Volunteer involving organisational capacity understand where volunteering what is on offer. for practicalities of finding, processing and support could help older people. supporting volunteers

Having adequate structural support Lack of certainty as to whether volunteer Ability to take into account the aspirations, in place to coordinate the delivery of engagement is part of their role. motivations of volunteers alongside those of volunteering strategy. older people.

Addressing difficulties in embedding Targeted, clear and up to date relevant Keeping information up to date to send to/ high level policies on integrating information. share with health and social care professionals. volunteering right down to frontline staff.

Having organisational silos which make Lack of evidence-base about usefulness of Locating the right contact person within each information-sharing difficult. volunteers support to health outcomes. health and social care service/setting.

Coordinating or connecting Information-overload and lack of time to Capacity to reach out to older people to or understanding more about sort through. encourage ‘self-referrals’ to volunteering volunteering which takes place out in support. the community.

Lack of willingness of older people to be “Red-tape” – being able to work within the put in touch with volunteer support (fear of constraints of the PVG scheme. strangers, asking for charity).

Lack of adequate protocols governing Understanding the appropriateness of when patient confidentiality. volunteers can add value.

Lack of reassurance about ongoing support/ Understanding volunteers needs management of volunteers. e.g. time, flexibility.

Clear demarcation of roles between volunteers and paid staff.

Time and resource to support volunteers where paid staff work alongside volunteers.

32 5. Conclusions and recommendations

5.1 Findings: availability of support a substantial foundation for building on new ways to and creating more volunteering increase the ability for NHS Tayside to make informed opportunities decisions relating to the development of volunteering within older people’s health and care service (a This summary of the VEnable pilot project will VEnable project outcome). undoubtedly have raised many interesting questions as well as sparked ideas for opportunities where the act Overall the project does seem to have full-filled its of giving one’s time, help and support by volunteers can remit regards objectives and outcomes and in particular meet the needs of older people’s health and social care. has raised the question on how better integration or perhaps more ideally networking , coordination and The following section reflects on some of these communication can take place when addressing the opportunities. Not unsurprisingly the mapping challenges which are highlighted by policy makers and exercises and the feedback from the participants in the practitioners. Nevertheless the mapping of available project have illustrated the wealth of what is already volunteer support has also demonstrated that there happening across the NHS Tayside region and this are enormous new opportunities, where if motivated, should be celebrated. These everyday support systems, volunteers can contribute significantly towards older services and paid professional and voluntary effort are peoples health and care outcomes.

33 In summary the findings highlighted:

There is a complex patch-work of activity across the region as a whole. When addressing how volunteer interventions or health and care interventions can better co-produce to benefit older peoples’ health outcomes and this should be recognised.

There are multiple interventions supporting older people’s health and care which take account of both formal and informal volunteering.

There are significant needs in both acute and community settings for older people that volunteers could potentially meet with the right support and roles.

Most of the needs identified are similar in all settings and these are already being partly met through various Volunteer Involving Organisations.

There are some real examples of good practice where volunteers support older people and there are models of this support in both acute and community settings. There are significant challenges identified, including: - Older people’s perceptions and fears; - Lack of information / information overload /information sharing; - Lack of time and resources to support volunteering; - Attitudes and knowledge around volunteering; - Confidentiality of patients/service users; - Co-ordination, support and training of those who support volunteers; - Matching volunteer aspirations to older people’s needs; - Engaging with and vetting volunteers.

34 5.2 Questions for Consideration

The following questions were addressed, which supported the challenges outlined in section 4.3:

Given current policy and practice how might co-production aspirations be tackled in accounting for the VEnable findings?

Given the complex patch-work of volunteer support which is evident from the findings – how might a universal (less by chance) approach be taken to connecting volunteer’s motivations to health and care needs for older people and vice-versa?

How might current strategy within NHS Tayside be modified to improve the understanding and implementation of this locally so that the gaps identified in the finding can be addressed?

How might strategy better connect across local authority areas - addressing the gaps identified in the findings e.g. the findings highlighted very particular geographical variances?

Can the re-prioritisation of strategy respond to the obvious need for particular volunteer opportunities to support: transportation, befriending and social needs of older people?

Given the many unmet needs of older people - how might NHS Tayside recognise the changing motivations of the public to volunteer where time and changing lifestyles affect people motivations, and word of mouth is the most successful way to engage people to volunteer?

What are the priorities for supporting health and social care professionals in enhancing their understanding of how volunteers play a part in health and social care for older people? e.g. improving information to GPs, nurses etc?

How can volunteer opportunities be created which respond to people’s desire for informality but in turn adequately respond to the need for support for older people?

Can technology play a role in helping new volunteer opportunity creation, connectivity and sustainability? For example in the areas of volunteer transportation.

35 5.3 Recommendations

Strategic Strategic

NHS Tayside should review its approaches to co-production given the evidence presented by the VEnable project as this may affect allocation of resources, decision making, planning and importantly the effectiveness of the region’s volunteer strategy.

Consideration should be given to how volunteering support can be better integrated into NHS Tayside and local planning systems (e.g. Community Planning Partnerships, Local Government partnerships) at an earlier stage, for older people, in both acute and community settings.

Recognise the positive outcomes from the Change Fund by local third sector interfaces (including development of models to better co-ordinate transport provision, link workers, time-banking and shared recruitment of volunteers). But equally improvements could be made on how these developments are shared within local authority areas and across the health board area. e.g. - Consideration should be given as to how effective models will be sustained beyond the funding period.

Recognise the potential untapped resource of older people as volunteers in providing care, support and information is considerable. There is evidence of where this is working effectively through models such as the Health Communities Collaborative and significant potential to develop this wider. - It is recommended that more could be done to target older people as potential volunteers for example at retirement age to undertake valuable roles in the community providing peer support and health promotion activities.

36 Take into account participants views on unmet need or gaps in health and care provision which can be appropriately matched to potential opportunity for a volunteer. - Improve awareness of volunteer’s efforts in health outcomes rather than viewing their services as a “commodity”. In this respect viewing volunteers as co-producers of health outcomes.

Understand and act to reduce the challenges and barriers identified by participants in this pilot project (in all settings) and in particular: - tackle the perceived disconnect between high level strategy (planning and subsequent actions) and how this is translated locally; - the day-to-day work of professions and their perceived over-load of information about volunteering or the lack of information about appropriate volunteer engagement; - the third sector organisations challenge in resourcing, finding, understanding and matching volunteers to the vast needs of older people’s health and care.

CommunicationCommunication

Consider models where communication is working more effectively on how older people can access volunteering support and opportunities and how this could be replicated/expanded across Tayside (i.e. hospital link workers, single point of contact).

Improve effective communication and understanding of volunteering support which is available in both acute and community settings and how these can be more joined up. e.g. - Consideration should be given for how a more effective forum could be developed to share learning, resources and information between acute and community settings.

Address the provision of information to older people, carers and families on the available volunteering support and opportunities.

Consider how volunteer transportation in particular might be co-ordinated or networked to respond to the needs of older people.

37 CommunityCommunity – - GP GP

It is recommended to fully consider the potential role that GP’s play in signposting older people to volunteering support and opportunities needs to be considered and clarified (currently this is considered a key point of contact for many older people in the community and therefore a valuable opportunity to promote services/support available for older people).

Improve the information provision to GP’s on volunteering support and opportunities – including for example: - better planned, co-ordinated evidence of the impact to mental and physical health where possible; - better management of communication to GPs – avoiding information overload which seems to be the case currently.

Utilise the excellent current examples of volunteer support provided from within general practices across Tayside but recognise that this is happening in a relatively fragmented way with little wider sharing or understanding of the impact. - Attempt to reduce the current fragmentation in the community and improve the wider understanding of the impact of volunteering - learning about the opportunities, benefits and operational aspects of volunteer support from within surgeries should be shared across practices.

Consider having a ‘volunteering champion’ (i.e. an existing volunteer) that could provide a link between the primary care team and local Third Sector Interfaces to help ensure timely and appropriate information on volunteering support and opportunities.

Build on the positive work ongoing within GP surgeries but to consider what ideally GP surgeries need to better sign-post older people to volunteer opportunities and vice versa for older people to benefit from volunteer support.

More fully consider the role of GP surgeries (and GPs) in the community as a whole in tackling the policy challenges of our older population – particular as they have demonstrated a significant motivation in sign- posting older-people to volunteer.

38 ResourcesResources and and good Good practice Practice

Share widely the examples of good practice in Tayside where volunteers are already supporting the needs of older people including how these have been developed, supported and potentially expanded.

Increase and broaden the role volunteers could play in early intervention and to evidence the impact – particularly based on the emerging examples of where volunteers are providing support for older people with dementia.

Consider supporting and prioritising those organisations that are engaging volunteers extremely effectively to support older peoples needs (i.e. ‘4-Ever-Freends’ befriending project).

It is recommended that continued provision of adequate resources for volunteers support is addressed - in particular to: - improve access and information on volunteering support and opportunities. - improve information and support needs to organisations and staff on developing appropriate, motivating and accessible volunteering opportunities to ensure effective matching and relationships. - improve the creation of more volunteering roles to meet the needs identified through the VEnable project, e.g. expansion of Volunteer Involving Organisations that are currently providing these services and also the resources required to support them.

Recognise the specific needs within hospitals directly, and in particular the needs for new volunteer opportunities in the area of: befriending and volunteer drivers.

Recognise particular areas of need such as those when older patients are discharged from hospital, or when seeking transport back and forth from hospital or to look after pets and how these can be developed into new volunteer opportunities.

Consider how to make it easier for older people and their friends and family to connect to volunteer opportunities and volunteer support and the benefits of current practice such as the Angus Single Point of Contact scheme.

39