Timebanking and the co-production of preventive social care with adults; what can we learn from the challenges of implementing person-to-person timebanks in England?

This paper explores the potential contribution of timebanking, an innovative volunteering scheme, to the co-production of preventive social care with adults in England. Interest in volunteering in social care has increased as one proposed solution to the international crisis of a rising demand for services in juxtaposition with decreased resources. Volunteering has been particularly promoted in preventive services that prevent or delay care needs arising. Despite sustained interest in volunteering and co-production in social care, little is known about how theory translates into practice. Reporting implementation data from a Realistic Evaluation of six case studies in England, this paper explores one volunteering scheme, timebanking. The research explores how timebanks were working, what contribution they can make to adult social care, and whether they are an example of co-production. Data collected included interviews, focus groups or open question responses on surveys from 84 timebank members, and semi-structured interviews with 13 timebank staff. Each timebank was visited at least twice, and all timebank activity was analysed for a period of 12 months. Data were triangulated to improve reliability. The research found that in practice, timebanks were not working as described in theory, there were small numbers of person-to-person exchanges and some timebanks had abandoned this exchange model. Timebanks faced significant implementation challenges including managing risk and safeguarding and the associated bureaucracy, a paternalistic professional culture and the complexity of the timebank mechanism which required adequate resources. Lessons for timebanks are identified, as well as transferable lessons about co-production and volunteering in social care if such schemes are to be successful in the future.     

Public participation and marginalized groups: the community development model

Objectives  To develop ways of reaching house-bound people and enabling them to give their views in planning and monitoring health and social care.
Strategy  HealthLINK – a project based in a community health council – explored ways of involving older house-bound people in the London Borough of Camden, in planning and monitoring health and social care using community development techniques.
Results  HealthLINK set up an infrastructure to enable house-bound people to have access to information and to enable them to give their views. This resulted in access for health and local authorities to the views of house-bound older people and increased the self esteem and quality of life of those who became involved.
Conclusions  Community development approaches that enable an infrastructure to be established may be an effective way of reaching marginalized communities. However, there are tensions in this approach between the different requirements for public involvement of statutory bodies and of users, and between representation of groups and listening to individual voices.     

Social work, general practice and evidence-based policy in the collaborative care of older people: current problems and future possibilities

While collaborative (or joint) working between social services and primary healthcare continues to rise up the policy agenda, current policy is not based on sound evidence of benefit to either patients or the wider community. Both sets of practitioners report benefits for their own work from adopting new arrangements for collaboration. The underlying assumption behind much of this activity is that a greater degree of integration provides benefits to both users and their carers, a perspective that at times obscures the issue of resource availability, especially in the form of practical community services such as district nursing and home help. At the present time there is insufficient evidence to demonstrate that formal arrangements for collaborative working (CW) are better than those forged informally between committed individuals or teams. Furthermore, arrangements for CW have not hitherto been widely evaluated in systematic studies with a comparative design and focus on outcomes for users and carers rather than on processes. In this paper we propose a number of process measures for future evaluation of CW: (1) study populations must be comparable; (2) details of how services are actually delivered must be obtained and colocation should not be assumed to mean collaboration; (3) care packages in areas of comparable resources should be examined; (4) both destinational outcomes and user‐defined evaluations of benefit should be considered; (5) possible disadvantages of integrated care also need to be actively considered; (6) evaluations should include an economic analysis. Those implementing new policies in Primary Care Trusts have, at present, little sound evidence to guide them in their innovative work. However, they should take the opportunity to rigorously test the advantages and disadvantages of collaboration.     

Promoting the Value of Mental Health Nursing: The Contribution of a Consumer Academic

Mental illness is known to occur frequently in the general population and is more common within the general health care system. High-quality health care requires nurses to have the skills, knowledge and attitudes to provide care for people experiencing mental illness or mental distress. Research suggests health professionals, including nurses, tend to share similar negative attitudes to mental illness as the general population, and consequently, mental health nursing is not a popular career path. These two factors signify a need to influence more positive attitudes toward mental illness and mental health nursing among nursing students. A qualitative exploratory research study was undertaken to examine the experiences, opinions and attitudes of an academic and research team to the introduction of a consumer academic within an undergraduate mental health nursing subject. In-depth interviews were conducted with teaching and research team members. The importance of mental health skills emerged as a major theme and included sub-themes: mental health across the health care system; contribution of consumer academic to nursing skills; addressing fear and stigma, and inspiring passion in mental health nursing. Findings suggest academic input from people with lived experience of recovery from mental illness can influence the development of mental health nursing skills and enhance the popularity of mental health nursing as a career.     

Diagnosis of sexually transmitted diseases in Chilean pregnant adolescents

We searched in 100 healthy pregnant women by isolation, the presence of Neisseria gonorrhoeae, Herpes simplex, Mycoplasma hominis, Ureaplasma urealyticum and Chlamydia trachomatis. Blood was also taken for examination of specific antibodies to these microorganisms. We studied only for antibodies titled Cytomegalovirus (CMV), Treponema pallidum and Human Immunodeficiency Virus, and Condyloma acuminatum by cervical cytology. In 85 adolescents we found 5 (6%) patients with C. trachomatis, four of these patients had another microorganism added, one with N. gonorrhoeae, M. hominis and U. Urealyticum, one with U. urealyticum and the last two with M. hominis and U. urealyticum, In relation to Mycoplasmas 69 (81%) out of 85 had Mycoplasmas, 4 (5%) had M. hominis, 46 (54%) U. urealyticum and 19 (22%) patients had both. The seropositivity to CMV was 96.25%. We didn't find any other microorganism. We concluded that the rate of STD in chilean pregnant adolescent women is high, especially with no traditional bacteria.     

Challenging the imperative of health? Smoking and justifications of risk-taking

It has been argued that with the decline in the prevalence of smoking, a number of the remaining smokers have become more resilient to health-promotion efforts. In this article, the justifications of smoking in web discussions are analysed, concentrating on perceptions of risk. While previous research concerning lay knowledge has brought out ambivalent meanings of the concept, smoking as a well-known health risk provides an excellent example for studying counter-reactions to current health discourses. Analysis shows the similarities between justifications of smoking and current health ideologies: argumentation stressed personal responsibility and self-management. However, following rules and health recommendations was juxtaposed with ideals of the autonomous, competent individual. While argumentation reflected the basic principles of the imperative of health, a challenging feature emerged through the accounts that disregarded risk. It is suggested that disregard of risks represents a real challenge for the imperative of health by ignoring the notions of autonomy and competence.