Feature

Time to give a little

The NHS can’t build healthy communities – but it could stimulate mutual caring and giving through timebanks. Paul Hodgkin explains

For years the NHS has tried to involve and empower patients — and for years it has failed. This is not because people are uninterested in health. Far from it: health-related websites are among the most popular on the internet, health-related magazines have been the fastest growing sector of the UK market for the past 10 years, and people feel passionately about the health service. Clearly we need a new approach to patient involvement.

The need to involve people in health services is becoming a demographic essential. If in the past decade the NHS has come to understand that health services are immeasurably improved by the patient’s voice, in the next 20 it will come to realise that they can only be delivered with the citizen’s hand. For the NHS faces a real demographic dilemma: there are not enough young people to fill all the available jobs, let alone to care for ageing parents.

In the absence of large-scale immigration, there are only two groups society can call on to fill this gap:

• Older people in good health – the group aged 60 to 75 who are time-rich, experienced and intensely interested in the quality of health and social care;
• People with disabilities – currently more than three million people receive incapacity benefit, and many of these have useful knowledge of the NHS and would like to return to some form of work or volunteering.

The NHS has typically thought of such people as part of the problem rather than part of the solution. In fact they are essential to delivering (as opposed to receiving) effective healthcare in the 21st century – and time banks may be the key to unlocking their potential contribution.

Time banks start from the assumption that everyone’s time is of equal worth – an hour of your time, my time, someone with learning difficulties time, Bill Gates’ time, we are all equal in a time bank. And this equality leads to another time bank fundamental – since everyone’s time is worth the same, everyone has something to give.

As they work alongside time bankers, professionals slowly find that all the people who previously only presented as problems – indeed who could often only grab the attention of professionals because of the number or severity of their problems – are in fact part of the solution.

At some abstract level people working in the health service have always known that everyone has something to give, but a time bank offers a way of turning this theoretical knowledge into effective social capital. Patients, people who are housebound, people with learning difficulties and those with chronic mental health problems not only all have something to give but, through the exchange, both they and the recipients gain confidence and new sources of social support. And since time credits are exempt from benefit calculation, they are an ideal way to compensate people on benefit or who are retired.

What can time banks offer primary care?

At a practical level, time banks enable a range of tasks to be performed that would not otherwise be done. To date this has included picking up prescriptions, shopping, gardening or doing DIY for older people, and going on day trips.

But there is clearly the potential to extend this model to primary care. For example:

• Time banks could be used to support self care: with suitable help from a primary care trust, time banks could draw together groups of people with a particular condition and then build up a network of lay experts who could develop ‘cascade’ groups, run internet discussion groups focused on the local area and so on;
• Time banks build and strengthen communities: these groups are then ready-made for involvement in planning and developing services;
• Time banks tackle social exclusion by providing a means of exchange that can draw in members of the community who are isolated or excluded; in Chicago, inner city teenagers have swapped time bank credits earned through community service for refurbished computers.

It has been demonstrated that providing practical ways in which people can be involved in mutual giving is highly valued by participants, professional organisations and service providers. Studies in the US have shown that participants in time banks have better mental health, are less socially isolated and use fewer health services.

What have time banks achieved for health?

Currently there are about 50 time banks in the UK. Most operate on a small scale, focusing on a particular institution or particular services, including several run by mental health trusts. Perhaps the best evaluated health-related time bank is one based at Rushey Green general practice in south London. The evaluation, by Gill Seyfang of East Anglia University (see www.timebanks.co.uk for details), showed that over a two year period around 3,000 hours of service were traded between members with a wide variety of tasks being shared. Members were more diverse than typical volunteer populations, and more than two-thirds traded time at least once a week.

The most difficult task for many time banks is not finding people who want to give their services but identifying those who are happy to receive them. Just like health professionals, people often prefer ‘giving’ than receiving services. In fact one of the strengths of time banks is that they move people away from a volunteer mentality (with its undertone of superiority) towards the recognition that we all have needs with which others can help us.

When people start using a time bank they often worry about getting into ‘debt’. In fact time banks do not operate any kind of a strict balance sheet; most time bankers only ever reclaim 50 to 60 per cent of their time credits. Instead time banks seem to be a way of publicly recognising and legitimising the giving and receiving of services.

The mere fact that I am able to log up the time I have spent collecting my elderly neighbour’s prescription and that someone else, in the form of the time broker, is there to make the introduction and legitimate the meeting, helps create new social links and exchanges. In our fragmented neighbourhoods, where much social contact carries feelings of anxiety for both sides, time banking offers an acceptable bridging mechanism that is safe enough to allay fear and reciprocal enough to avoid the insidious doubts that one is being used.

Time credits are a type of currency for social capital but, unlike money, are not based on scarcity. And because we all have the same amount of time each day, time credits are commensurate with the intimate economy of friends, neighbours and family in a way that money can never be. Attempts to pay housewives an economic wage fail not just because of the cost but because, at root, the idea of monetary reward within the intimate economy of home seems to damage our core sense of family and domesticity.

Time is, in principle, equally available to us all and so time credits seem to work. Just as with any other currency, the result is to increase the number and speed of exchanges within this intimate economy.

This is not to say that some of us don’t run ourselves ragged through frantic over-work; ‘time poor’ people are unlikely to be among the first to join a time bank. But then, they are usually able to access the commodified world of anonymous markets easily in any case.