To pay or not to pay? Options for supporting citizen engagement in public health programmes

1. To pay or not to pay? Options for supporting citizen engagement in public health programmes Jane South, Leeds Metropolitan University Mark Gamsu, Department of Health Judy White, Leeds Metropolitan University Peter Branney, Leeds Metropolitan University UKPHA, 24th-25th March 2010

2. Acknowledgements • This independent study was funded through the National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO) Programme. • The views expressed in this presentation are those of the research team and not necessarily those of the NHS, the NIHR or the Department of Health. • The study was delivered by a partnership between: • Centre for Health Promotion Research, Leeds Met • Policy Research Institute, Leeds Met • NHS Bradford & Airedale • Public health group, Government Office Yorkshire & Humber • The research team would like to thank the research team, advisory and steering group and all the people contributed to this study sharing advice and experience; helping with the public involvement events; and providing research and library support.

3. Study Aims • To improve understanding of valid approaches to identifying, developing and supporting lay people who take on public health roles in community public health activities. • To undertake research on public perspectives regarding the acceptability and value of lay people in public health roles • To aid public health commissioning and planning by identifying elements of good practice and how these might be applied to different contexts.

4. Walking for health (local scheme) Breastfeeding peer support Neighbourhood health project Sexual health outreach Community Health Educators Interviews with 90 participants: Public health workforce Lay people in public health roles Other partners Interviews and focus groups with 46 service users in 3 of the case studies: Walking for Health (20) Breastfeeding peer support (11) Neighbourhood health project (15) Case studies

5. Scoping study – incentives & rewards • Use of payment & volunteer schemes in practice • Payment was not a distinguishing characteristic of models • Options included: • Sessional payment • Regular payment (employment?) • Expenses • Incentives (gym membership) • No pay (volunteers) • Economic benefits but not cost free • Issue of benefits system raised in expert hearings

6. Case studies – payment? • Sexual health outreach • Volunteer only • Walking for health (local scheme) • Volunteer only BUT previous sessional payment to cover expenses • Breastfeeding peer support • Paid peer support workers • Volunteer scheme in addition • Community Health Educators • Sessional payment • Neighbourhood health project • Volunteer only

7. Altruism Career pathway The time is right Health and social benefits Previous experience as a service user “I absolutely love it. And because it’s helped me so much and I feel that if it’s helped me as much as it has, I’d like to pass that on to somebody else. And the only way you can do that is to get involved in a big way...” Case studiesMotivations

8. Lack of pay not an issue but some discrepancy between responsibilities & rewards Social rewards Small financial rewards would show appreciation Different expectations for volunteers “Everyone is really, really nice and I have met some down the pub and things like that and if they do things they invite volunteers along and it’s a really great thing to be involved in”. “They produce a timetable, keep their website up to date, make sure they’re insured, make sure they’re recce-ing the route, they make sure they’re trained, they're taking all their health questionnaires, and keeping it all locked away. To say ‘Oh, we're not going to pay you but you have to do this as well’.” Volunteer service models

9. Advantages Helps with employability Supports people on low incomes Helps with retention Indicates value Disadvantages Potential to undermine volunteer ethos Hierarchy between volunteers and paid workers Payment models

10. Community Health Educators on payment • “It’s like being valued, being given that little bit of money is just like being valued”. “… really I don't want to see it as a wage, I don't want to see it as doing so many sessions a week so that I get paid so much money. So I'm not looking at it as a sort of a paid job it's just something extra to do besides the voluntary work”. • “The money was really good, because I was self-employed at the time … I wasn’t on benefit, so it was a good income … (but) … if you’re on benefits, then you’ve got to watch what you can earn and what you can’t earn”.

11. “I’d bought juice and biscuits when we ran out and I replaced them and then I had a £10 receipt and I had to actually ask … who I would give that to because I had no idea. As it happens I’ve lost the receipts, so I’m not going to claim it anyway…I’m not actually bothered about £10 quid…” “…and we kind of sat there one day and just thought well I’ve given up work, this is actually costing us a quite significant amount of money for him to come home from work ... and miss an afternoon’s work”. Expenses

12. Reliability “Volunteers are more likely to turn around at short notice and say they can’t make it because I have got a dentist appointment or whatever.” Retention “… volunteers need to feel supported, because it’s a volunteer network it’s easy to fall apart, within a paid network, it works a lot stronger, because there’s a structure.” Passion “there are all kinds of other issues with volunteers, like them keeping their own identity and doing what they want and the PCT recognising that they need to all be standardised well for everyone’s safety really…” . The challenges of independence

13. Conclusions – To pay or not to pay? • There are various options around payment and rewards • Common sense protocols for expenses and small rewards (in kind?) are needed • Choices about a ‘volunteer workforce’ highlight the tension between professional control and community empowerment.

14. The big questions • Are we trying to develop a community workforce or support community activists? Are the two aims compatible? • Does the current public health skills and career framework fit with these volunteer roles? Does the competency route fit with grassroots action? • What are advantages of providing pay and possibly stable employment? What is fair in the context of an economic recession? • What should we be concerned with when setting up these type of programmes? What should we leave safely alone (the limits of professional interference)?

15. Find out more • The report from the study is due to be published through the NETSCC • Summary planning guidance is being produced • Visit the PIPH website and Register your interest in the study http://www.leedsmet.ac.uk/piph