Take the NHS for example. The political narrative is always about the dearth of resources available – and of course this is bound to be a problem.
But it is odd, nonetheless, given that so much of what needs doing requires no obvious training – visiting, companionship, friendship mutual support – when there is such a vast wasted resource that is so rarely tapped by NHS managers.
That is becoming a familiar idea and the NHS is embracing the co-production agenda, even if they don’t yet very fully understand what it means. But the practical application of the idea is to set up time banks in hospitals and health centres, and I was involved in launching the UK’s first – at the Rushey Green Group Practice in Catford in 1999.
Now there time banks pushing the boundaries of health in many places. Ashworth Time Bank is one of the most successful and active time banks in the UK, with over 400 members, operating in 14 villages in Cheshire.
Its members have made a huge success of linking time banking with healthcare, including providing people with therapists who can give them time. “I say that being a time bank is like having an insurance policy,” says Susan Ross-Turner, the time banks co-ordinator, “And you never know when you’re going to need it,”
Ashworth is now turning over about 200 ‘exchanges’ a month. They have a holistic therapy group covering four villages and involving 30 complementary therapists, some of them giving time every week in return for training to upgrade their skills which the time bank organises.
They have a link up with homeless people and people on the substance abuse programme run by Turning Point in nearby Northwich, providing acupuncture three times a week. They have a prostate cancer group meeting three times a week, plus pilates classes and tai chi classes. They have an aquafit class, two ‘keeping history alive’ discussion groups and a textiles group for sewing.
This is all run by a time bank that stays largely led by voluntary effort. It is a huge amount of health promotion activity and it is mutual.
Their Parent and Carer Support (PACS) scheme gives help and support for carers, especially of people who are terminally ill. They work alongside local Macmillan Nurses which had seen that there needed to be some kind of referral service for people who needed very informal support.
Sarah Bird and I have written a new book, just published, which sets out some of the lessons of time banking and health – but the key seems to me the unanswered question of how to organise it at scale.
What we need is some thought about how to provide this preventive infrastructure at local level. I suggest that every public sector provider or contractor should be asked the following questions:
- How do you plan to help rebuild social networks?
- How do you plan to encourage mutual support among users?
- How do you plan to reduce the level of need for your service year by year?
This is important for other reasons too, because – as things stand – the most powerful inducements on contractors are to increase the level of need, not reduce it.
Often what the contractors will do to answer the questions is to link up with and fund a time bank, or similar local project, to help plug their service into a network of mutual support. That is the main way by which this supportive infrastructure is going to be funded – by contractors who need to explain to commissioners how they will fulfil their obligations to encourage mutual support.