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Volunteering and health

:
evidence of impact and
implications for policy and
practice

A literature review
Institute for Volunteering Research
Jonathan Paylor
October 2011

Regent’s Wharf
8 All Saints Street
London N1 9RL
Tel: +44 (0) 845 305 6979
Fax: +44 (0) 20 7520 8910
E-mail: info@ivr.org.uk
www.ivr.org.uk
Volunteering England is a registered charity No. 1102770
The Institute for Volunteering Research is an initiative of Volunteering Registered as a company limited by guarantee
England in research partnership with Birkbeck, University of London in England and Wales No. 1275922
The Institute for Volunteering
Research
The Institute for Volunteering Research (IVR) is a specialist research and
consultancy agency focusing on volunteering. It was set up in 1997 in
response to the increased demand for research on volunteering. Since then
IVR has carried out a wide variety of research, consultancy and evaluation
projects on many different aspects of volunteering, including four national
surveys of volunteering.

IVR aims to:

 Carry out and commission research on different aspects of volunteering
at a variety of levels
 Disseminate findings so as to maximise the policy and practice impact
 Act as a focal point for research on volunteering
 Develop links with bodies involved in volunteering research in England,
the UK and other countries, with a view to sharing knowledge and
exchanging ideas
 Stimulate and contribute to education and training on volunteering.

For more information, visit: www.ivr.org.uk

IVR is an initiative of Volunteering England in research partnership with
Birkbeck, University of London.

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Contents
Executive summary 3

1. Introduction 5

2. Method 6

3. Health 7

3.1 Impact 7
3.2 Implications 9

4. Public health 11

4.1 Impact 11
4.2 Implications 11

5. Social care 14

5.1 Impact 14
5.2 Implications 16

6. Individual and community well-being 20

6.1 Impact 20
6.2 Implications 23

7. Characteristics of volunteers 27

8. Conclusions 28

Bibliography 30

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Executive summary
This literature review has been conducted to inform the Department of
Health’s strategic vision for volunteering in health and care. The review
explores literature in four key areas: health; public health; social care; and the
broader health and well-being impacts of volunteering. The review examines
the evidence around the impact of volunteering and draws out the implications
for policy and practice.

The literature reveals how volunteers are involved in a wide range of settings
across health, public health and social care, and are integral to the functioning
and maintenance of the services provided. Research demonstrates that the
value of volunteers not only lies in increasing the capacity of the workforce,
but also in the ‘special qualities’ they bring, which complements the work of
paid staff and provides a more satisfying experience for service users.

Furthermore, studies highlight that the involvement of volunteers helps to
create a service that is more responsive to local community needs. Whilst
limited, studies also show a substantial financial return for investing in
volunteers.

The benefits of volunteering are not restricted to the service user,
organisations and staff. Research demonstrates that volunteering can have a
positive impact on the well-being of volunteers, providing them with increased
feelings of self esteem, a sense of belonging and a network of support which
they can draw on in times of need.

The benefits of volunteering also spill over into the wider community.
Research shows that public participation in shaping and delivering services
increases community resilience, as people become more active in their
communities and provide mutual support for each other.

The multiple impacts of volunteering revealed through the literature provide a
compelling argument for embracing and investing in volunteering. There are a
number of key issues to emerge from the literature that provide direction on
how best to push forward this agenda and cultivate the benefits of
volunteering:

 Commissioning should be based on strategic investment in
infrastructure, not just piecemeal initiatives
 Organisations should look towards new and innovative models of
volunteering and adopt an approach that is tailored to the local context
as well as the specific aims of the organisation
 Organisations should ensure that all staff value the contribution of
volunteers
 Organisations should utilise different recruitment techniques and
strategies to make volunteering more accessible to a range of people,
particularly ‘hard to reach’ groups

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 Volunteers should be offered multiple, flexible opportunities which feed
into their individual needs and wishes and, moreover, be provided with
an adequate level of training and support.

Whilst extremely useful in taking our understanding forward, the literature
does not provide a complete picture. To support and help direct the move to
involve volunteers in health, public health and social care, there will be a need
to further develop the evidence base around the value of volunteer
involvement.

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1. Introduction
This literature review has been conducted to inform the Department of
Health’s strategic vision for volunteering in health and care. The aim of the
review is to provide a background to volunteering in health, public health and
social care. The review will also signpost leaders and practitioners within local
authorities, NHS Trusts and other organisations to research that will help
inform their own local decision-making around volunteering initiatives.

The review was primarily designed to explore literature in four key areas:
health, public health, social care and the broader health and well-being
impacts of volunteering. The focus was to examine the evidence around the
impact of volunteering and to draw out the implications for policy and practice.

The section on health presents literature on the role of volunteers in different
parts of the NHS (primary care trusts, mental health trusts and acute
hospitals) and hospices. Literature which focused on public participation in
decision-making processes within the NHS is also discussed.

The section on public health examines the involvement of volunteers in
delivering public health programmes. Although only a small amount of
literature is outlined, the studies presented cover a number of different
volunteering roles and initiatives, such as healthy eating educators and
exercise class leaders.

Reflecting the diversity of the social care sector, the section on social care
focuses on the involvement of volunteers in a number of different supporting
and caring roles and social care interventions. These include befriending
schemes, peer-support, respite care and short-term breaks. In addition to this,
studies which have examined community-based and co-production models
(an approach in which service users become active participants in developing
services) are also discussed.

The section on individual and community well-being examines the impact of
volunteering on the psychosocial well-being and mental health of the
volunteer and the related wider community benefits. Here, the literature is not
restricted to volunteering within the health or social care sector but focuses on
volunteering more generally. The section pays closer attention to co-
production models of delivering services, and in particular, time banking.

A brief examination of the type of people who volunteered and participated in
the initiatives discussed across the literature is also provided.

Finally, the review summarises the themes emerging from the literature and
draws out the key issues that organisations need to consider when setting up
and implementing a volunteering initiative.

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2. Method
The first stage of the review consisted of comprehensive key word searches in
Google scholar for the years 2008-2010 around ‘volunteering’ and
‘participation’ in the four key areas. This was followed by more detailed
searches of relevant journals, organisations, research groups and individuals.
The searches produced a range of results, from which 27 relevant texts were
obtained. These included literature reviews, research reports / summaries,
academic papers and consultancy reports. The focus was on England, but
some relevant UK wide and international studies have also been included.

A further search was carried out in the Institute for Volunteering Research’s
(IVR) Evidence Bank1 to identify IVR’s previous research around volunteering
in the health and social care fields. Thirteen relevant studies dating back to
2000 were obtained.

Relevant references and citations in the literature were also followed up and,
in response to emergent themes, a number of additional key word searches
were conducted around ‘time banking’, ‘co-production’, ‘respite care’ and
‘short breaks’. These produced a range of results, from which a further
number of relevant texts were obtained and reviewed. In total, 64 texts
informed the final literature review.

1
www.ivr.org.uk/evidence-bank

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3. Health
3.1. Impact

NHS service delivery
There are only a small number of studies that discuss volunteering directly in
relation to the NHS. Notable pieces of work include IVR’s series of service
evaluations which assessed the impact of volunteering at six NHS trusts
(Teasdale, 2008; Teasdale, 2007a; Teasdale, 2007b; Teasdale, 2007c;
Teasdale, 2007d; Teasdale, 2007e; Gerry, 2007). The trusts involved in the
project included acute hospitals, mental health trusts and a primary care trust.
The tasks and roles carried out by volunteers were multiple and diverse, but
predominantly focused on delivering a service. The evaluations were primarily
based on surveys with the volunteers, staff and patients, and in some cases
these were supplemented with in-depth interviews, focus groups and analysis
of the economic value.

The findings varied across the trusts and each evaluation should be treated as
an individual case study. However, a number of underlying and key benefits of
volunteering that emerged from the overall project can be identified:

 Volunteers developed their skills and gained a sense of purpose, which
in turn, appeared to have a positive impact on their sense of self
esteem. Significantly, physical and mental health benefits were most
apparent among volunteers who were current or former patients
(Teasdale, 2007c)

 Local communities benefited from the use of volunteers. For example,
in a mental health trust (Teasdale, 2007c), volunteering was a means
of increasing the community’s understanding of mental health issues,
while at an acute hospital (Teasdale, 2007a), the local community
benefited indirectly through an increase in trust and social networks
within the hospital

 Patients benefited from receiving vital support and having a more
comfortable and enjoyable experience. For example, in one study
(Teasdale, 2008), elderly disabled people expressed that they could
not continue to live independently in their own homes without the
support of volunteers. In another study (Teasdale, 2007e), cancer
patients expressed that the special qualities that volunteers brought
made them feel cared for and reassured, especially when going
through traumatic experiences

 Staff benefited from gaining additional support and increasing their
capacity. In one study, for example, the support volunteers provided
freed up time for staff to concentrate on more clinical tasks (Teasdale,
2007d)

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 The economic value of volunteering averaged around £700,000 per
annum in acute hospital trusts, £500,000 per annum in mental health
trusts and £250,000 per annum for the primary care trust (Teasdale,
2008). A further analysis showed that a nominal £1 investment in a
volunteering programme yielded an average return of between £3.38
and £10.46.

Participation
In the studies above, the volunteers who participated were, in the main,
involved in delivering a service. Other studies have paid closer attention to
volunteering opportunities that go beyond service delivery and move towards
participation in planning, consultation and research within health care services
(Gay, 2005;2006; Howe, et al 2009; Macdonald, 2009).

A notable piece of work is Gay’s research into participation in the NHS (2005;
2006). Based on interviews with senior managers from a primary care trust,
an acute trust and social care services, Gay explores the impact of the
government’s drive to increase public and patient participation. In doing so,
she identifies a range of opportunities, such as being a member of an advisory
group, that have enabled the public and patients to air their views, help
develop services, monitor their provision and actively shape the organisation.
Gay concludes that, if properly conducted, such participation can lead to a
loosening of the bureaucratic grip, resulting in policies that empower local
people and allow them to take part in decision-making processes.

Hospices
Echoing IVR’s analysis of volunteering within the NHS, there are a number of
studies which highlight the vital role that volunteers play in supporting
hospices. Davis Smith (2004), for instance, demonstrates that volunteers are
involved in all aspects of hospice life, in a wide variety of roles. Without this
input, he concludes that hospices would not be able to operate; at least, not
on the scale that they currently do.

The valuable input of volunteers is also demonstrated in Gaskin’s (2003)
economic analysis. Gaskin’s study revealed that the volunteer 'outputs' (value
of volunteer time measured in financial terms) give a high return on the 'inputs'
(money used to support the volunteers). On average, each volunteer
contributes £1,500 worth of work each year, supported by less than £200
worth of hospice management.

The impact of volunteering in hospices is further explored in Scott’s (2006)
study of volunteering at a children’s hospice. In addition to enhancing the
capacity of the workforce, Scott shows how volunteers further developed and
complimented the work of paid staff. Staff at the hospice stated that
volunteers brought flexibility and fresh ideas, while families of patients
expressed that volunteers offered a more personal service and helped them to
develop new friendships and contacts and increase their trust in others.

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3.2. Implications

Volunteer management
In the main, across IVR’s series of NHS evaluations and studies that examine
the involvement of volunteers in hospices, it is reported that the management
of the volunteers reflected good practice and the volunteers were generally
positive about their support and management.

Common features of programme and management success include
volunteers:

 Knowing what was expected of them
 Feeling that they could get support whenever they needed it
 Receiving sufficient information and relevant training which was of
good quality and prepared them for their roles
 Obtaining expenses
 Feeling that staff valued the contribution that volunteers made.

These factors were seen as central to keeping volunteers satisfied and
motivated to perform their task effectively, and ultimately point to the
importance of investing in volunteer management.

In recognising the need for continually investing in volunteer management and
tightening up practice, Davis Smith (2004) warns against the dangers of
becoming over-formalised. He suggests that organisations should only
introduce systems and procedures deemed necessary for the effective
management of volunteers and should attempt at all times to try to retain
some of the informality and flexibility which is central to the relationship
between an organisation and a volunteer.

Managing participation
A significant issue raised in Gay’s (2005; 2006) research is that the success of
participation is largely dependent on senior managers overcoming their
reluctance to embrace lay participation. Within the trusts she researched,
participation initiatives were initially stifled due to senior staff feeling that their
authority was challenged and that participants had little understanding of the
health service. She notes, however, that as a result of the introduction of new
policies and strategies, there has been a shift in attitudes and understanding.
Consequently, participation initiatives have moved forward and proven to be
more successful.

Another key theme to emerge from Gay’s work revolves around the model of
management most appropriate for public participation. Within the trusts she
studied, standard volunteer management techniques were, in the main,
applied to manage the participants. Although Gay shows these provided a
valuable framework and were in some respects vital to the success of the
programme, she highlights the differences between participation and
traditional service delivery volunteering.

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This ultimately raises questions regarding the extent to which traditional
management principles should guide the management of participation.

In not providing a conclusive answer and noting that there is little research on
participation within the NHS and knowledge of best practice, Gay puts forward
a number of points to consider:

 Does a distinct management model for participation need to be
created?
 Should there be a designated manager for participation?
 Do people involved in the management of participation need to receive
training to meet the specific needs of participants?

In addition to these questions, Gay proposes a more general and overarching
question in relation to increased public and patient involvement in health and
social care services: To what extent are the volunteers who sit on the various
panels that deliver the views of users really able to change things?

In other words, by establishing a programme of public participation and
involvement, are volunteers being co-opted to defend the status quo, or are
they given a voice that is representative of users? Within the context of recent
attempts to increase public participation and empower communities, this is a
compelling and pertinent question that calls for further research.

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4. Public health
4.1 Impact

There are only a few articles which discuss volunteering directly in reference
to public health. A significant study is South et al's (2010) People in Public
Health. Through carrying out a literature review and a number of case studies,
along with obtaining expert hearings, they provide a detailed account of public
involvement in delivering public health programmes. In doing so, they identify
a range of roles, such as community health educators and health advocates,
which lay people, often on a voluntary basis, take on.

In addition to increasing workforce capacity, South et al argue that such
positions are valuable, as lay people are more likely to be trusted and
accepted in communities and thus can deliver health messages and offer
support to people whom professionals cannot often reach. This bridge
between services and communities which lay volunteers provide not only
improves community access to health resources and activities, but also opens
up a channel so that community knowledge can be fed back to inform
strategic planning and service delivery.

Another study that focuses on the involvement of volunteers in delivering
public health programmes is Gay’s (2005) Volunteering for Participation in
Health. Based on research carried out in Suffolk, England, Gay identifies a
great variety of innovative public health initiatives delivered by volunteers,
including exercise classes and advice and information services. Her research
highlights the potential for voluntary organisations to play a leading role in
promoting and providing health-related activities and pushing forward the
government’s public health agenda. However, for this potential to be realised,
Gay shows that there are number of challenges to overcome.

4.2. Implications
A key theme to emerge from Gay’s (2005) study was that, while there were
many innovative public health initiatives delivered by the voluntary sector, the
work was patchy, hampered by a lack of funding from the statutory sector and
lacking strategic direction.

To address these issues, Gay suggests that the County Council needs to
establish a policy with regards to voluntary organisations and health
promotion, and in doing so, look into developing avenues of funding. This
proposal, along with the study’s findings, must be understood in relation to the
specific context of the research. The study, however, raises important issues
which need to be considered in the development of partnerships between
voluntary organisations and local government.

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In light of their findings, South et al (2010) suggest that lay workers and
volunteers can make a valuable contribution to the delivery of public health
programmes and argue that such approaches need to be considered as a way
of addressing persistent health inequalities. They put forward a number of
recommendations to inform and develop future policy and practice. These
include:

Policy issues
 There needs to be greater recognition of the contribution of active
citizens to public health across all the different levels of engagement,
from helping out through to community leadership
 There is scope for developing a framework that adequately reflects the
social skills, knowledge and qualities that lay workers bring to their
roles
 Simple protocols are needed that provide guidance on how
volunteering, sessional payment and welfare benefits fit together.

Adopting a strategic approach
 Commissioning should be focused on investing in a wider
infrastructure, rather than being limited to funding a discrete
intervention
 Commissioning, target setting and evaluation should be informed by a
broad understanding of the wider health and social benefits of involving
members of the public
 There needs to be an appropriate balance between professional
support and community control as relationships between communities
and services have to be built on mutual respect and trust.

Enabling people to contribute to public health
 Barriers to recruitment need to be minimised, particularly when working
with socially excluded groups
 Services should recognise and enhance the skills and inherent qualities
that people bring
 Services should foster the altruism and commitment of people,
ensuring that they can benefit from involvement.

Support systems for delivery
 Training and development opportunities should be offered to manage
risks and develop skills
 Payment and expenses need active management in programmes
 Organisations should develop adequate support systems as access to
‘light touch’ support helps people to feel valued and any issues can be
managed effectively.

Some of these recommendations, particularly around the recruitment and
management of volunteers, are echoed in Howlett and Lukka’s (2000)
evaluation of the Walking for Health programme – a public health initiative
which aimed to get people to volunteer and lead walks.

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Although the evaluation’s findings and the proposals must be interpreted in
relation to the specific research context, they do have wider relevance and
point to issues that other public health volunteer programmes may also face.

Most significantly, in recruiting and retaining volunteers, the study highlights
the importance of:

 Utilising different recruitment techniques and strategies to make
volunteering more accessible to a range of people, particularly ‘harder
to reach’ groups
 Providing the volunteer with detailed information, prior to their
involvement, allowing them to make an informed decision if they want
to volunteer
 Providing volunteers with the opportunity to feed into the design of the
programme
 Making opportunities more flexible, meeting the needs of the individual
 Striking the right balance between more informal and formal
approaches to management.

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5. Social care
5.1. Impact

Respite care and short breaks
An area of social care in which volunteers have played a role is respite care or
short breaks for carers and people with a disability and mental health issues,
particularly children and older people (Lewin et al 2009; Bamford et al 2009;
Littlechild, 2009; Arksey et al, 2007; Mason et al, 2007; Jeon et al, 2005).
However, there is limited research specifically focusing on the role and value
of volunteers, with much of the literature discussing respite care and short
breaks in general and making no distinction between paid staff and
volunteers. The impacts presented below must therefore be interpreted in
relation to respite care and short breaks in general, rather than volunteering.

Across the literature, a number of different models of respite services are
discussed across a range of settings; for example, day care, in-home respite,
host family respite, institutional/overnight respite. Despite these differences,
respite care and short break initiatives are seen to have a number of key and
underlying aims: firstly, relieving carers of any responsibility and thereby
alleviating the stress of caring, enabling them to continue to efficiently support
the person; secondly, offering a positive and enriching experience for the care
recipient and providing them with a break from their routine; and thirdly,
delaying entry into residential care and saving costs.

Significantly, previous literature reviews have highlighted that there is a lack of
evidence to verify that respite care and short break initiatives meet these
aims. For example, Arksey et al (2004) found limited evidence of the
effectiveness and cost-effectiveness of respite care and short breaks for
people with dementia. Mason et al (2007) identified some evidence that
respite for carers of frail elderly people may have a small positive effect (such
as reducing burden), but found no reliable evidence to confirm that respite
delays entry to residential care or favourably affects frail older people. In
relation to mental health, Jeon et al (2005) revealed that there are
contradictory outcomes of respite services for care-givers of people with
severe mental illness and a lack of controlled empirical studies and evaluative
research on effectiveness.

This lack of evidence of effectiveness, however, does not mean that services
are ineffective. As Arksey et al (2007) point out, undertaking studies of respite
services is particularly complex, with a number of significant conceptual and
methodological challenges. Furthermore, they note that there is a
considerable amount of qualitative evidence from carers – and some from
care recipients – of the perceived benefits of respite services.

Such benefits are illustrated in a recent study which evaluated a range of
respite care and short break services for children and young people with
disabilities in Luton (Littlechild, 2009).

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The report concludes that such initiatives provided parents with the
opportunity to recharge their batteries, have some ‘normality’ and give more
attention to siblings. At the same time, these services provided the children
with the opportunity to engage in activities they wouldn’t necessarily be able to
do at home, to interact with other children and to gain some independence.

Befriending
A social care intervention that volunteers have also been central to is
befriending (Mead et al, 2010; Bradshaw and Haddock, 1998; Harris et al,
1999; McGowan and Jowett, 2003; Mentoring and Befriending Foundation,
2010). The literature explores a range of different befriending models, each
providing a particular function in particular settings. There are, however, some
central characteristics to the befriending role.

Essentially, befrienders, often on a voluntary basis, provide social support to
vulnerable individuals, particularly elderly people and people with mental
health problems, through the development of an emotion-focused relationship
over time. Although in varying degrees, the literature demonstrates that
interventions have the effect of alleviating social isolation, as well as
preventing or reducing loneliness and depression. Knapp et al (2009) suggest
that these benefits can have the advantage of reducing the need for health
and social care and therefore costs for the NHS and local government.

Peer support and personal experience volunteers
Research has shown how befriending initiatives among ‘peers’ can have a
significant impact. For instance, in a project which facilitated peer support
between mental health service users, the support that people offered and
received proved to be the main contributor to the psychological well-being of
the participants (Malpas and Weekes, 2001). Well-being was fostered by
forming friendships which extended beyond the drop-in, reducing the
participant’s isolation and increasing their confidence and self esteem.

The value and impact of peer support in a different social care setting is
highlighted in Goddard’s (2005) study at a large cancer charity into ‘personal
experience volunteers’ (volunteers who have personal experience, past or
present, of the problem or issue that they hope to address or prevent through
their volunteering). The study shows that the volunteers had a significant
impact on the organisation and the recipients they supported through
contributing experiences, skills and knowledge based on their own experience
of cancer.

Furthermore, Goddard demonstrates how the volunteers also benefited from
obtaining up-to-date information and understanding about cancer, developing
mutual support and shared friendship between fellow volunteers, developing a
positive perspective about their own experience and reflecting on the ongoing
role of cancer in their lives.

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Participatory approaches to shaping and delivering social care
There are number of studies which have reviewed participatory and co-
production approaches to shaping and delivering social care services.

A recent study is Fenner and Martin’s (2010) review of user-driven social
enterprises in relation to disability. For Fenner and Martin, the value of user-
driven social enterprises lies in their ability to facilitate co-production: an
approach in which people who use services become active participants in
developing their services, rather than passive recipients. In other words, the
service becomes user-driven. Fenner and Martin suggest that such an
approach benefits disabled people, as they can develop services that suit
them and, more broadly, become more active and equal citizens in society.

A model of delivering social care, albeit in a different context, which is also
seen to facilitate co-production and empower communities to play a greater
role in shaping and delivering services, is the navigator model (Hudson, 2010;
Anderson and Larke, 2009; Stalker et al, 2008; Appleton et al, 2010;Turning
Point, 2010). Although the model has been applied in a range of contexts,
with differing objectives and intervention designs, there are some central
tenets to the navigator role.

Fundamentally, navigators are individuals, often volunteers from the
community, who help people navigate their way around health and social
systems. This involves facilitating connections between individuals, agencies
and the community, and thus directing people to services they need. In
holding this position, navigators are seen to provide a more effective approach
to service provision, as they help to create a service which is more responsive
to local community needs, help people access the appropriate services to
meet their needs and create a more connected and integrated health and
social care system. This in turn can improve efficiency, the service user
experience, and in some cases can produce savings.

5.2. Implications

Managing personal experience volunteers
In IVR’s series of NHS evaluations and studies which examine the
involvement of volunteers in hospices (outlined in section three), the volunteer
management practices analysed largely reflect standard volunteer
management models. Goddard’s (2005) research highlights that such
practices and procedures might not be readily applicable to the management
of personal experience volunteers, as their lived experience and shared sense
of belonging with other volunteers and the patients shapes their motivation to
volunteer, the benefits they receive, their commitment to the organisation and,
consequently, their management needs.

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In light of her findings, Goddard suggests that practitioners involving personal
experience volunteers should:

 Understand how the lived experience shapes their volunteering and
how this changes overtime
 Consider the vulnerability of volunteers, as they might be revisiting
negative experiences
 Facilitate support between fellow volunteers, enabling them to build
interpersonal relationships
 Provide training and information in relation to the cause of the
organisation
 Provide a mixture of formal and informal management approaches,
depending on the context.

Managing and developing respite care and short breaks
Across the literature which discusses respite care and short breaks, there are
a number of implications for policy and practice. These, however, must be
viewed in relation to short breaks and respite care in general, rather than
volunteering specifically. Nevertheless, they do raise a number of important
issues which may be considered when developing and managing respite care
and short break volunteering programmes.

A common theme underpinning much of the literature is that, to be effective,
organisations need to provide a range of flexible opportunities which are
tailored to the expressed needs and wishes of the user and their carer. In
relation to respite services for carers for people with dementia, Arksey et al
(2007) propose that such a person centred approach should involve
recognising the care recipient’s specific situation and background, particularly,
young people with dementia and people from ethnic minority groups.
Likewise, Littlechild et al (2009) suggest that when developing respite care
and short breaks for disabled people, it is important to recognise the different
types of ‘disability’ and to differentiate to meet the specific needs of
individuals.

A significant theme also to emerge from Littlechild et al’s (2007) study is the
issue of accessibility. Here, they demonstrate the need for organisations to be
responsive and to put in place effective information systems that keep carers
informed of the services on offer, particularly for disengaged groups, such as
ethnic minorities.

The studies all stressed that the quality of provision provided by staff or
volunteers is central to the effectiveness of the service. Lewin et al (2009), for
example, in their analysis of respite carers working with older people,
demonstrate that carers need to be sensitive and respectful, acknowledging
the individuality of the recipient. Moreover, they argue that carers need to be
able to form good trusting relationships with the recipient as well as the
informal carers such as husbands, wives, adults or children.

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Investing in befriending
A significant theme across the literature on befriending is the potential of such
initiatives to provide a cost effective way of delivering social care. Drawing on
research which shows that befriending schemes can prevent depression,
Knapp and Perkins (2010) argue that investing in such schemes at the local
level may delay the need for more costly health and social care service
provision.

Echoing Knapp, Mead et al (2010) suggest that befriending could offer a
preventive strategy for individuals at risk of developing mental health
problems; a strategy which they argue is in line with the UK policy focus on
health prevention throughout the NHS.

Developing and maintaining participatory approaches to shaping and
delivering social care
A dominant theme to emerge from the literature on user driven organisations
is the importance of the lived experience. For instance, Fenner and Martin
(2010) suggest that through the lived experience of disability, disabled people
have the knowledge and understanding of what is best for them. Furthermore,
the lived experience that disabled people share provides a collective identity
and solidarity which is needed to clarify the purpose of the organisation.

With this in mind, Fenner and Martin argue that when developing a user
driven organisation, groups need to engage in dialogue and find ways of
sharing knowledge, ensuring that the aim or purpose reflects the shared
experience of those involved and where they want to go together.

Across the literature on navigator type roles, there are a range of models,
each possessing their own design and objectives. Without wanting to flatten
these distinctions, from reviewing their implementation, a few of key factors
were shown to be central to the effectiveness and development of such
approaches:

 Navigators having first hand knowledge of the local community as well
as up-to date knowledge of local health and social care services
 Local communities being involved in designing and developing the
initiative
 Navigators providing a service which is responsive to local needs
 Navigators being clear about their role.

In light of evidence showing that navigator type approaches provide an
effective way of delivering social care, others have sought to examine the
value of such approaches. For instance, Appleton et al (2010) examine a
Local Area Co-ordination (LAC) in Darlington – a navigator type role for
supporting people with disabilities that has proven to be cost effective in
Australia (Bartnik and Psail-Savona, 2003 cited in Turning Point, 2010, p. 17).

18
Although their findings show that the approach has positive outcomes for
disabled people, Appleton et al argue that there is little evidence that it is cost
effective. Subsequently, they suggest that, in the context of Darlington, rather
than investing in LAC, the local council should improve and invest in existing
services provided by the voluntary sector and incorporate some of LAC
principles.

Their research highlights the importance of recognising the specific context
and not assuming that models proven to be effective in one place will be the
most effective in another.

19
6. Individual and community
well-being
6.1. Impact

In the previous sections, the impact of volunteering on the health of the
individual volunteer is briefly touched on. This section discusses this theme in
more detail and examines the related wider community benefits.

Whilst it is important to recognise how volunteering can improve the physical
health of the volunteer (Reynolds, 2000), this review focuses on the impact
that volunteering has the psychosocial well-being – such as happiness, life
satisfaction and self esteem – of an individual. Across the literature, a number
of factors are revealed which can help explain this relationship. These can be
grouped under two categories: ’perceptions of self’ and ‘social integration’.

Perceptions of self
‘Perceptions of self’ refers to how volunteering can shape the way that people
think about themselves. This is illustrated in a recent study which explored
environmental volunteering (Obrien et al, 2008). Here, volunteers expressed
that through contributing to a ‘good cause’, they gained a sense of satisfaction
and felt good about themselves. Furthermore, they saw their participation as a
constructive way to spend their time, providing them with a sense of purpose
and increased feelings of self esteem and self confidence.

With such potential therapeutic benefits, it is no surprise therefore to find a
number of studies which have explored the benefits of volunteering for older
people (Age Concern, 2010; Warburton, 2006; Lee and Brudney, 2008;
Volunteer Development Agency, 2009), and people who experience mental
health problems (IVR, 2003; CSV, 2008). For example, in a qualitative study
into volunteering in later life, Warburton (2006) found that volunteering gives
older people a sense of fulfilling a productive role with ageing and
subsequently increasing their self esteem and self-efficacy. Likewise, in a
survey of people who experience mental health illness, results suggested that
volunteering improves people’s mental health by giving direction and meaning
to their lives (IVR, 2003).

Social integration
‘Social integration’ refers to how volunteering connects people with other
people and provides the building blocks of social capital. There are a number
of studies which point to the health benefits of this. Konwerski and Nashman
(2008), for instance, show that through meeting new people and reaffirming
established social contacts, volunteers gain a sense of belonging and feel
connected to the wider society. This in turn is seen to combat depression
associated with loneliness.

20
Significantly, in light of concerns regarding social isolation amongst elderly
people, studies highlight how social integration and gaining a sense of
belonging is a chief benefit of volunteering for older people (Age Concern,
2010; Warburton, 2006; Lee and Brudney, 2008; Volunteer Development
Agency, 2009). Such benefits have also proved to have been valuable to the
recovery of people who have experienced mental health problems (CSV,
2008).

An additional benefit of social integration, bound up with feelings of belonging,
is the readily available resources people can draw on in times of need.
Studies (Hill and Westrip, 2010; Sixsmith and Boneham, 2003) have shown
how through building networks, bonds, trust and common values with other
people, and thereby by developing ‘social capital’, volunteering increases
people’s access to help and support from other people. This, therefore, can
contribute to the well-being of an individual, as they have a network of support
which they can draw on to help them cope with difficult, stressful and
potentially harmful situations.

Interestingly, in Sixsmith and Bonham’s (2003) study into volunteering in a
deprived area in North England, informal volunteering, such as looking after a
friend’s child, was central to the creation and maintenance of social capital.
This activity was based on mutuality and sharing, rather than the traditional
notions of altruism associated with formal volunteering. What Sixsmith and
Boneham’s study also points to is how the development of social capital not
only benefits the individual through increased coping resources, but also how
this feeds into the wider community. More specifically, the study highlights the
potential of volunteering to increase community capacity and resilience as
people work together, help each other and draw from resources within the
local community.

Co-production
The notion of social capital and ideas surrounding community capacity and
resilience have informed much of the literature which focuses on lay
participation and ‘co-production’ models of delivering public services. In a
recent report, Boyle et al (2010) argue that the involvement of the public and
local people in shaping and delivering public services not only creates a
person-centred service which is more responsive to the needs of local people,
but also fosters a sense of responsibility and community activism where
people take control of their own lives and local services, create and develop
social networks and galvanise resources from the local community. For Boyle
et al this, in turn, strengthens community resilience, promotes well-being and
undermines the culture of dependency on statutory services.

These arguments are supported by a number of studies discussed in the
previous sections which have reviewed and evaluated co-production models.
For example, South et al (2010) demonstrate how lay and public participation
in public health roles can improve the well-being and resilience of
communities through strengthening community networks and improving
access to resources and information, especially for disengaged groups.

21
Likewise, community navigator type roles, such as the Local Area Co-
ordinator (Hudson, 2010; Stalker et al, 2008) play a valuable role in building
bridges between families and individuals and guiding people to utilise the
informal networks of support within their community, thereby reducing
dependency on statutory services.

Time banking
Time banking is an initiative championed for being a practical tool that
stimulates co-production. First conceived by the North American Edgar Cahn,
time banks have been used in the UK since 1998 in a range of settings and
across different public services (Seyfang, 2002; Boyle, 2003; Ryan Collins et
al, 2008). There are a range of models (person-to-person, person-to-agency,
agency-to-agency), but all are based on the fundamental premise that people
offer their time and skills to others in exchange for time bank credits (one hour
equals one time credit). People can use their earned credits to ‘buy’ time from
others; this can be in areas in which people feel they lack skills or do not enjoy
pursuing.

Unlike traditional concepts of volunteering, time banking is designed to create
‘give’ and ‘take’ relationships among those who contribute the time and skills.
This reciprocal relationship is seen to empower the recipient as a contributor
and foster equity and trust between people, thereby providing the building
blocks for strong local networks of support and healthy communities.
Significantly, evidence also shows how time banking is successful in engaging
‘hard to reach’ groups – such as the deprived, disabled, elderly or young,
single parents, those suffering from learning difficulties or mental health
histories and ethnic minorities – who generally do not get involved in
traditional volunteer programmes (Seyfang, 2002).

There are a number of case studies that illuminate the value and impact of
time banks (Warden, 2009; Warne and Lawrence, 2009: Gould, 2006; Seeley
and Bond, 2005; Seyfang, 2004). One time bank that has received a great
deal of attention is the Rushey Green Time Bank (RGTB) (Ryan Collins et al,
2008; NEF, 2001; NEF, 2002).

Founded in 1999 by the Rushey Green General Practice, based in Lewisham,
South East London, RGTB enables participants to give and receive a wide
range of neighbourly support – from lifts to accompanying people to shops;
from companionship to checking up on people after hospital discharge.

Through such mechanisms of mutual support, RGTB has proved to be
successful in a number of related areas:

 Getting so called disengaged groups active and engaged in their local
community
 Building people’s confidence and self esteem by shifting the emphasis
from where they are challenged or failing, to areas where they can help
others by sharing a skill or a talent

22
 Increasing an individual’s contact with other people and thus tackling
symptoms of isolation and depression
 Widening and strengthening support networks and fostering community
based self-help
 Reducing the burden on the GP and the other traditional carers from
social services.

6.2. Implications

Recognising complexity
While there is a large amount of evidence which shows that volunteering has
a positive impact on the health of individuals and communities, there are a
number of dynamics which complicate this relationship. For instance, in an
evidence review, Kroll (2010) identified research which revealed that mothers,
as a societal subgroup, actually do not benefit from voluntary activity in terms
of increased life satisfaction. She points to another study carried out which
might help explain this phenomenon which she calls the ‘motherhood penalty’.
According to the study, mothers frequently reported having a guilty
conscience when volunteering because they felt that they were neglecting
their family responsibilities.

The importance of gender, albeit in a different set of circumstances and
outcomes, is also highlighted in Sixsmith and Boneham's (2003) study. One of
the key findings to emerge was that settings such as community centres play
a key role in facilitating volunteering and subsequently the creation and
development of social capital. However, Sixsmith and Boneham show that
their appeal is limited to female activities and thus exclude men. The research
highlights that although social capital can give individuals valuable access to
resources and promote their well-being, this might possibly be built on the
exclusion of others.

The work of Kroll (2010) and Sixsmith and Boneham (2003) points to the need
for a more nuanced approach to understanding the benefits associated with
volunteering, recognising how they vary between different groups and are
shaped by the specific context.

Investing in volunteering
Within the context of an ageing population, and fears about increasing
depression and growing health inequalities, some argue that the government,
voluntary and community sectors, public and private organisations must
prioritise volunteering and see its value in promoting and maintaining good
health, particularly among older people and mental health patients (CSV,
2008; Lee and Brudney, 2008; Age Concern, 2010). In considering this
overarching argument, there are a number of implications and issues in
relation to policy and practice which also need to be recognised and engaged
with.

23
Hill and Westrip (2010) argue that while investment is welcome in activities
such as volunteering, it is important to be aware of the dangers of more formal
state funding, as this can lead organisations to become over formalised,
bureaucratic and subsequently, lose their effectiveness in providing the kind of
informal activity which has an impact on an individual’s well-being. They
therefore tentatively suggest that the way forward is a mode of state funding
which will allow organisations full autonomy.

Warburton (2006) also warns of the dangers of coercing people into
volunteering. In arguing that the choice and agency of the volunteer is central
to the cultivation of feelings of purpose and self esteem, rather than forcing
people, Warburton suggests that volunteering should be encouraged through
designing programmes that attract volunteers and feed into their motivations.

Reconceptualising volunteering
In recognising that volunteers receive important well-being benefits when they
contribute to the welfare of others, Aked (2011) suggests that policy makers
should embed the ideas of reciprocal exchange into an understanding of
volunteerism. For Aked, this requires the creation of opportunities based on
alternative models such as co-production and a shift from seeing volunteering
solely in terms of charitable giving, to acknowledging the mutual exchange
that exists between people and organisations.

In relation to practice, Konwerski and Nashman (2008) also suggest that ideas
of reciprocal exchange should inform and direct the management of
volunteers. Significantly, to maximise the sense of well-being that volunteers
gain through volunteering, Konwerski and Nashman stress that managers
need to make sure that volunteers feel they are part of a mission driven
organisation and have a stake in reaching its goals; moreover, the goals of the
organisations should feed into the volunteers’ needs, interests and aims.

Managing elderly volunteers and people who experience mental health
illness
In relation to volunteering amongst older people, studies have highlighted the
need to break down barriers to make volunteering more accessible. The
Volunteer Development Agency (2009), for example, suggests that there
should be a wider range of opportunities which meet different people’s
interests, abilities and needs and a focus on providing adequate transport and
meeting expenses.

In terms of management, Lee and Brudney (2008) suggest that there needs to
be adequate training and support provided by a manager who possesses
special knowledge and understanding of the older generation.

Some of these implications are echoed in the studies which focus on
volunteering amongst people who experience mental health problems.

24
Significantly, CSV (2008) proposes that opportunities, projects and support
should be developed around individuals’ and communities’ needs and
interests and that there should be a focus on building reciprocal relationships
between the volunteer and the organisation. In relation to support and
management, IVR (2003) further highlights the importance of reimbursing
expenses and providing regular support and supervision by people with good
interpersonal skills and knowledge of the implications of mental ill health.
Their study reveals that the awareness of mental illness amongst all staff in
organisations is also central to the engagement and retention of volunteers.

Investing in co-production
In their recent report, Boyle et al (2010) argue that co-production provides a
powerful alternative to the conventional model of public service delivery, which
in their view has a tendency to disempower people who are supposed to
benefit from services, to create waste by failing to recognise service users
own strengths and assets and to engender a culture of dependency that
stimulates demand. For them, co-production has the potential to transform this
model and be better positioned to meet the current challenges facing society,
including public spending cuts, an ageing population and increasing numbers
of those with long term health conditions. Moreover, they see the co-
production model as a way to realise the government’s vision of a Big Society.

In making such claims, Boyle et al propose that the core values and features
of co-production – recognising people as assets, building on peoples’ existing
capabilities, promoting mutuality and reciprocity, building social networks,
breaking down barriers between professionals recipients, and facilitating
rather than delivering – should become part of mainstream planning across
public services. This would involve:

 Changing the way services are managed and delivered, through
building the key features of co-production into existing services, along
with transforming the underlying systems and structures that underpin
public services
 Changing the way services are commissioned, giving priority to
prevention, encouraging flexibility and collaborative working
 Opening up new opportunities for co-production through developing co-
production models across a range of fields and sectors.

Developing and managing time banks
Significantly, Boyle et al (2010) see time banks as a vital tool to facilitating co-
production and are central to their policy recommendations. This is in line with
an earlier report published by the New Economics Foundation (Ryan-Collins
et al, 2008) which proposed that public service leaders and commissioners
should embed time banks within public service institutions, including doctors’
surgeries, hospitals, schools and housing estates. Here, they demonstrate
that there are different ways of using the time banking tool and suggest that
agencies need to adopt models that best suit their needs.

25
It is important to keep in mind that the time banking model is flexible and that
there is no one correct model. Nevertheless, the reviews and evaluations of
time banks often identify the common and key characteristics of programme
success, which can help inform future practice. Significantly, in their
evaluation of UK time banks, Seyfang and Smith (Seyfang, 2002) determined
that time banks were more likely to succeed if they: adapted to their local
situations; created a strong local presence; secured adequate funding; were
based in a local organisation; offered incentives to participants; and
developed the social side of the project.

In a more recent review aiming to capture the best practice implications of a
series of time banks, Warne and Lawrence (2009) found that time banks are
most effective in engaging socially excluded groups, when it is used in the
context of a community-building, self help setting, and where equal reciprocity
is fostered. Furthermore, they argue that success is largely dependent on
effective community leadership, and suggest efforts should be made to
recognise and invest in the critical role of the Time Broker in managing the
scheme, maintaining a database of participants, and recruiting people and
organisations. Finally, they stress the importance of creating links and joint
working arrangements with local public services and community
organisations, and focusing on and evaluating the sustainability of time banks.

26
7. Characteristics of
volunteers
In the main, the people who volunteered and participated in the initiatives
discussed in the literature come from a rather narrow stratum of society.
Concerns about the diversity of volunteering are raised by Davis Smith (2004),
who found that volunteers within the hospice movement tended to be female,
white and over 55 years of age. Davis Smith (2004) does not conclusively
explain why this is so, but tentatively suggests that this type of volunteering is
more attractive to this group of people, as older people are more likely to
come into contact with hospices through the care they provide for family and
friends. Moreover, he also points to the possibility of a ‘cloning effect’ going
on, where the heavy reliance on word of mouth as a recruitment mechanism
leads to volunteers recruiting other volunteers in their own image. In light of
these findings, he proposes that hospices should explore new avenues and
adapt their practices and procedures to engage the interest of men, young
people, and people from black and minority ethnic communities.

The lack of diversity is not just restricted to hospices, but is also evident in
volunteering across the NHS (Teasdale, 2008; Teasdale, 2007a; Teasdale,
2007b; Teasdale, 2007c; Teasdale, 2007d; Teasdale, 2007e; Gerry, 2007).
For instance, although there were variations across the case studies, on the
whole, the volunteers who participated in IVR’s series of evaluations were
generally, elderly, white and female – a finding repeated in Howlett and
Lukka’s (2000) evaluation of the public health programme, Walking for Health.

Interestingly, in comparison to traditional volunteering programmes, time
banks have proven to be successful in attracting individuals who are:
deprived, elderly, young, single parents, disabled, suffering from learning
difficulties or mental health histories and people from ethnic minority groups
(Seyfang, 2002).

27
8. Conclusion
This literature review has revealed how volunteering is embedded in a range
of settings across the NHS, public health programmes and the social care
sector, and that the volunteer roles and tasks are diverse and multiple,
ranging from supporting and caring roles, advisory roles, to participation in
decision-making processes. Significantly, a number of studies have also
highlighted that current or previous patients and service users are holding
such positions.

The impact of volunteers cannot be underestimated. This review has
demonstrated that the vast number of volunteers helping to deliver health and
social care services is integral to their functioning and maintenance.
Significantly, studies have highlighted that the value of volunteers not only lies
in increasing the capacity of the workforce, but also in the ‘special qualities’
they bring, which complements the work of paid staff and provides a more
comforting and enjoyable experience for patients or service users. Literature
has also shown that the involvement of volunteers in social care interventions,
such as befriending, can act as a preventive strategy and delay the need for
more costly service provision.

The benefits of volunteering are not restricted to the patient, organisations and
staff. A dominant theme across the literature is that volunteering has a
positive impact on the volunteer. Volunteering is seen to provide volunteers
with a sense of satisfaction and self esteem and an increased stock of social
capital. In relation to social capital, studies have pointed to how the benefits of
volunteering spill over into the wider community. More specifically, research
has shown how volunteering can increase community capacity and resilience,
as people help each other out and draw on resources from within their local
community.

Ideas surrounding social capital and community resilience informed a number
of recent studies which focused on participatory and co-production models of
delivering services, such as time banking and community navigators. Here,
research demonstrated that public involvement in shaping and delivering
services not only created services which met the individual and local
community needs, but also increased community resilience as people became
more active in their communities, took control of their lives and services and
became less dependent on statutory services.

It must be recognised that the literature does not provide a complete picture
and that there is a need to further develop the evidence base around the
value of volunteer involvement. Nevertheless, the multiple impacts of
volunteering revealed through the literature do provide a compelling argument
for embracing and investing in volunteering. How best can organisations take
on this agenda and cultivate the benefits of volunteering?

28
What is apparent from the literature is that there are a wide range of
volunteering roles set within a variety of contexts, each with differing
objectives, impacts and management needs. It would therefore be wrong to
suggest that there is a single, correct approach and volunteering model to
follow. Rather, what the literature points to is the need to adopt an approach
and model which is tailored to the local and organisational context.

In this sense, organisations need to:

 Be clear about their intended aims of involving volunteers
 Choose the ‘right’ volunteering model to fit their aims and objectives
and the specific context in which it is being implemented
 Put in place the appropriate procedures and support measures to
effectively organise and manage the programme.

Although there are differences between the multiple volunteering roles and
initiatives discussed in this review, a number of underlying and key points
emerge from the literature to consider when setting up and implementing a
volunteer programme:

 Commissioning should be based on strategic investment in
infrastructure, not just piecemeal initiatives
 Organisations should ensure that all staff value the contribution of
volunteers
 Organisations should utilise different recruitment techniques and
strategies to make volunteering more accessible to a range of people,
particularly ‘hard to reach’ groups
 Volunteers should be offered multiple, flexible opportunities which feed
into their individual needs and wishes and, moreover, be provided with
an adequate level of training and support.

29
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36
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