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EVALUATION OF THE CERTIFICATE IN COMMUNITY VOLUNTEERING COURSE

FINAL REPORT

JUNE, 2004

Department of Work and Organisational Psychology Aston Business School Report authors: Aston University Dr. Judy Scully Aston Triangle Dr. Marion Spendlove Birmingham B4 7ET Tel: 0121 359 3611 Fax: 0121 359 2919

Evaluation of the Certificate of Community Volunteering Patient Representation Pilot

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CONTENTS

Page

1. Acknowledgements 3

2. Abbreviations 4

3. Executive Summary and Recommendations 5

4. Aims and Objectives of the Research 12

5. Policy Background 13

6. Review of the Literature 16

7. Research design and methods of data gathering 34

8. Results 38

9. Conclusion 73

10. Areas for further research 78

11. Bibliography 81

12. Appendices

Appendix A: Interview questionnaire for ASDAN trainers 86

Appendix B: Questionnaire for non-attendees 88

Appendix C: Questionnaire for attendees who did not

complete training 90


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1. Acknowledgements

We would like to thank all of the CHC volunteer respondents, who gave their

time so generously.

Our very special thanks and acknowledgement for support go to:

Elizabeth Manero, Chair London Health Link, Regional Association of London CHCs, 164a Holloway Road, London N7 8DD

On behalf of the CHC volunteer respondents, we would also like to

acknowledge Elizabeth Manero. During the course of this research project the

CHC volunteers consistently spoke about Elizabeth with the highest regard,

both of in terms of her leadership skills and personal qualities.

We would also like to thank Delyth Neal and Jenny Singleton from the London

Health Link for their continued support, good humour and hospitality throughout

this research.

Finally we would like to thank the health research team at Aston University for

their sustained collegiality and hard work.

Any errors in this report are the responsibility of the authors


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2. ABBREVIATIONS

ACHCEW Association of Community Health Councils

ASDAN Award Scheme Development and Accreditation Network

CCV Certificate in Community Volunteering

CHC Community Health Council

CPD Continuing Professional Development

CPPIH Commission for Patient and Public Involvement in Health

DfEE Department for Education and Employment

DH Department of Health

ICAS Independent Complaints Advocacy Services

LHL London Health Link

NALS National Adult Learning Survey

NHS National Health Service

NSV National Survey of Volunteering

NVQ National Vocational Qualification

OSC Overview and Scrutiny Committee

PALS Patient Advice and Liaison Services

QCA Qualifications and Curriculum Authority


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3. EXECUTIVE SUMMARY

Faced with the impending abolition of the Community Health Councils (CHCs) London Health Link (LHL) piloted a five-month training course for CHC members designed to promote a range of volunteering skills, as well as specific skills to enhance their effectiveness as patient representatives. A further aim was to reward the CHC volunteers for their commitment and contribution to volunteering. In November 2002 LHL provided 75 places on an accredited volunteer training course, taught by Award Scheme Development and Accreditation Network (ASDAN) trainers CHC volunteers in the London region were invited to participate and 66 volunteers took part in the training. 63 volunteers completed the course and were awarded the certificate. Aston University was commissioned by the Department of Health (DH) to evaluate the pilot training course. The aim was to conduct an independent evaluation of the training course and particularly to evaluate the extent to which it meets the wider goals for the new patient forums. Research design and methods The multi method research design combined qualitative and quantitative

methods, including:

• A stakeholder day

• Six focus groups with 53 volunteers who attended the training course

• Telephone interviews with 13 respondents who had participated in the training course, but could not attend the focus groups

• Telephone interviews with 11 respondents who had attended the focus groups, to further investigate whether they were able to give examples of how and when they had used the training in practice.

• Telephone interviews with Public and Patient Involvement (PPI) leads from Strategic Health Authorities

• Telephone interviews with the ASDAN trainers

• A survey of 463 CHC volunteers who did not participate in the training course.

As required, the evaluation was carried out against the following criteria:

• Relevance to patient representation

• Accessibility

• Cost effectiveness

• Quality


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Evaluation 1. Relevance to patient representation Four outcomes of the training course that have particular relevance for effective patient representation were identified: increased confidence, sharing best practice, organisational skills and time management.

Increased confidence: The most significant finding was that the volunteers reported that their confidence had increased, and that this factor has influenced their effectiveness as patient advocates, particularly when presenting to people in meetings. This finding is particularly important. It validates a key finding in the established literature, which shows that training increases the confidence of volunteers. Moreover the study highlights the outcome of increased confidence on older volunteers and minority ethnic group volunteers. The overwhelming majority concurred that their volunteering skills had improved because of increased confidence. Given that previous research has shown that older people and minority ethnic people are less likely to opt for training compared to the majority younger population (Fitzgerald et al, 2003) this study has demonstrated the benefit of training for these groups. The profile of the volunteers who completed the training is both ethnically diverse and reflects the older population. The average age was 62.25 years, and just over a half of the respondents were women. More than one quarter of the respondents were from minority ethnic groups, a figure which is a representative profile of London. (please see table 1 below)

Time management/organisational skills: The volunteers on the course had learned how to manage their time more effectively. It was felt that time management was an essential skill for patient forum representation. The respondents reported that the course had helped them to prioritise work, and to work more systematically. Also, there is evidence that the volunteers existing knowledge and skills were reinforced and consolidated.

Sharing best practice: There was a strong consensus that the course had given the volunteers the opportunity to network and share best practice. The pooling of shared knowledge was viewed as particularly important for patient representation, as it had created awareness about how other volunteers function. The volunteers had met other people, exchanged ideas, and learned from the experiences of others. This had enabled them to reflect on their own volunteering skills and practice.

2. Accessibility

The training course was intellectually accessible for all the volunteers, who acknowledged the support given to them by the trainers. However, some of the new definitions and acronyms of the NHS did provide some difficulty for the volunteers who suggested a written profile of NHS terminology would be useful for both volunteers and trainers. None of the volunteers reported any difficulty


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in travelling to the venue to attend the training venues. However, there was some difficulty in attending the conference venues at City Hall.

3. Cost effectiveness 63 volunteers completed the training course and were awarded the certificate. The completion rate for the course was very high, at 95.5%. Providing the Commission for Patient and Public Involvement in Health (CPPIH) with the opportunity to use the interim and final report is also deemed as a measure of cost effectiveness. The Greater London Health Authority provided the use of City Hall London for three of the workshops without charge. Also the local CHC offices were available for local workshops free of charge. 4. Quality The majority of the volunteers who took part in the training course reported that it had been of a high quality and that participating in the programme had been a positive, rewarding experience. The quality of the trainers, the conferences and the outside speakers were particularly commended. Table 1 Ethnicity Breakdown of Enrolled CHC members on the CCV Course 47 enrolled members gave information – this equals 71 % of the total

Ethnic Groups Numbers Percentages Ethnic Minority Figures in %

Black African 2 4.25%

Black Caribbean 3 6.38%

Chinese 1 2.1%

Indian 4 8.51%

Pakistani 2 4.25%

White British 30 63.82%

White Irish 1 2.1%

White Other 4 8.51%

12no. = 25.6% 35no.= 74.4%

Total 47

47 of 66 enrolled members

71% ( of total 66 who enrolled )

No info given 9


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Summary of Recommendations 1. Stakeholders The stakeholders felt that it was necessary to widen the volunteer recruitment drive in order to represent the health needs of under-represented groups, particularly ethnic minorities, on the patient forums. They also felt that the training packages should be matched to the needs of primary care trusts, acute hospital trusts, mental health, community trusts and speciality trusts. They suggested that future training courses, designed by either ASDAN or CPPIH, should include:

• Diversity awareness

• External communication skills (e.g. use of audiotapes, building a good relationship with the local media)

• NHS policies and procedures.

• Training in negotiation and assertiveness, listening and presentation skills.

• Training to increase the confidence of the volunteers.

• Team working skills.

• IT Training

• The knowledge and skills to develop a code of conduct to include issues of confidentiality, managing ethical issues, codes of behaviour for meetings.

2. Volunteers who attended the training course The volunteers made the following recommendations:

• Assessment of the different levels of knowledge of the participants prior to the course, so that individual needs are met.

• More written information on the aims and objectives of the course. This would include an introduction package, setting out the aims and objectives of the course, the costs, and the expected outcomes.

• The level of the introduction to volunteering was too basic for all participants because some of the volunteers were already highly skilled in volunteering. The range of volunteering skills needed acknowledging in the introduction.

• The training content could be modularised, and allow volunteers to demonstrate exemption from some modules.

• Constructive feedback on the assignments was necessary, particularly after the first assignment.

• The trainers could be trained in health issues.


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• Information about current health issues could be included in future training.

• NHS terminology could be explained and clarity in explaining tasks for trainees.

• Assignment questions could be designed to give the opportunity for trainees to illustrate their knowledge and experience

• Volunteers start with different levels of IT skills, and would need different levels of training. Exemption is necessary from some modules where trainees can demonstrate a sufficiently high level of skill or knowledge.

• More written information is required on the aims and objectives of the course. This would include an introduction package, setting out the aims and objectives of the course, the costs, and the expected outcomes.

• External events and outside speakers were particularly valuable and that these should remain an integral part of the course.

Volunteer suggestions for changes to course content :

• IT training, particularly in the use of e-mail.

• Training in communication with Social Services.

• Cultural awareness training.

• Health promotion and health inequality.

• Training on new legislation in the NHS.

• Training in youth and mental health issues.

• Placements and mentoring for new volunteers. 3. PPI Leads The PPI leads felt that the training course should include:

• The components, structure and functions of the NHS.

• New legislation and initiatives.

• Raising awareness of confidentiality

• Raising awareness of dealing with sensitive information.

• Skills in sharing information.

• Responsibilities to the public.

• Skills to help volunteers contribute to forums effectively.

• Representing more than one viewpoint.

• Resolving conflict.

• Skills in negotiation, representation and communication.


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Recommendations of ASDAN trainers

• Clear explanation to trainees of the course aims and objectives.

• Adequate access and parking for disabled people at all venues.

• Consider holding all the sessions at places other than the volunteers’ normal workplace.

• Initial assessment of volunteers’ knowledge and skills, possibly through a focused interview and assessed group activity. During these activities, the following could be identified:

- The need for any basic skills training

- The need for any disability support and/or other health issues.

- Level of IT skills

• Joint training, with ASDAN trainers responsible for the CCV, and NHS/CHI representatives to train volunteers on terminology, structures and procedures in the NHS (e.g. health and safety, equal opportunities).

• Increase use of e-mail and IT for coursework and assignments where appropriate.

• More use should be made of conferences for activities and exercises (e.g. workshops).

• Investigate the possibility of running the course over a longer period of time.

• Time to be built into the sessions for feedback to students and “catching up” on work that they have missed.

Results of the questionnaire survey Data from the survey indicated that the age of the volunteers who did not participate in the training course ranged from 34 to 91 years. 41.1% were male and 57.9% were female. 71.1% were white and British. This is consistent with other research, where it has been shown that UK volunteers tend to be white, British and over the age of 50 (Institute for Volunteering Research, 1997). An issue of particular concern is that research in adult education has found that people who are older tend not to participate in learning and training (Beinart & Smith, 1998; Fitzgerald et al, 2003). Notably this finding was not validated in this evaluation, where the average of the volunteers who completed the training was just over 62 years. In this study, the reasons that the volunteers gave for not attending the training course included:

• Not aware that the training was taking place (24.6%).

• Unable to attend the information event that took place prior to the training (32.5%).

• Felt that they had adequate volunteering skills (45.5%).


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• Other commitments had prevented them from attending the training course (62%). 35.4% stated that these were employment-related. 12.1% of the respondents had disability-related needs.

Conclusion The majority of respondents on the training course reported that the training was of a high quality, and it was physically and intellectually accessible for most of them. The completion rate was very high, at 95.5%. Many of the respondents had been volunteers for many years, and were highly experienced. A minority of the respondents reported that the course might be more suitable for new volunteers. The majority of the respondents reported that the training could be modularised to cater for the different levels of volunteering expertise. The report stresses the importance of prior assessment of prospective trainees, to meet their needs, as well as those of the organisation. Despite the volunteers’ comments about the level of the course, there is evidence that their existing knowledge and skills were consolidated and reinforced. Also, their subject knowledge was widened through contact with volunteers in other CHCs. This developed their ability to see other perspectives, an essential skill for advocacy and representation. Through the conferences, the training course gave participants the opportunity to network and share best practice. Respondents reported better organisational skills, improved presentation skills, and higher levels of confidence. In particular higher level of confidence was reported by the large majority of respondents This range of skills are likely to enhance their effectiveness as patient advocates, for example in presentations and meetings. It is clear from the results that people learn from each other, as well as from trainers. When designing future training courses, it might be useful to include seminars and/or semi-structured discussions about what knowledge and skills the volunteers have learned, and to discuss how these might be applied in practice. Concerning the wider goals of the new patient forums, a key finding from this study shows the successful completion rate of training for older people and minority ethnic people, who, according to the establishes literature are generally under-represented in volunteering and in training. It is thus important that voluntary organisations and training courses should strive to be inclusive and widen participation in community life. Areas for further research are identified in the report recommendations.


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4. AIMS AND OBJECTIVES OF THE RESEARCH In November 2002, the Department of Health commissioned Aston University to

evaluate a five-month training course, which was designed to promote a range

of skills for volunteers in the NHS. The study had two broad aims:

• To conduct an independent evaluation of the volunteer training course leading to the Certificate in Community Volunteering (CCV).

• To evaluate the extent to which the course meets the wider goals for the new patient forums.

Evaluation of the training programme was required against four key areas:

• Relevance to patient representation

• Accessibility


• Quality

This report details the research methods, findings and recommendations

developed from this evaluation project.


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5. POLICY BACKGROUND

“The task now is to develop the CHCs into a powerful forum where consumer

views can influence the NHS and where local participation in the running of the

NHS can become a reality”

(Barbara Castle, 1974, Democracy in the NHS cited in ACHCEW, 2002a).

Community Health Councils were established in 1974 and supported by the

Association of Community Health Councils (ACHCEW). ACHCEW was set up

under provisions in the National Health Service (Reorganisation) Act 1977. Out

of 204 CHCs in England and Wales, 198 of them were affiliated to ACHCEW.

Between 1974 and 2003 Community Health Councils (CHC) volunteers in

England and Wales volunteered their services in many types of health care

settings including, hospital trusts, primary care trusts, mental health and

learning disabilities services and care services of children and older people. In

general their role has been to support individual patients and complainants,

monitor local hospital services and provide a patient’s view on service changes,

such as hospital mergers or ward closures.

The NHS plan of July 2000, announced that the CHCs were to be abolished

and replaced with a new system of patient representation. (DH 2000). In the

aftermath of the Bristol Royal Infirmary Inquiry (Kennedy, 2001), legislation was

introduced to establish patient forums for all NHS Hospital Trusts and Primary

Care Trusts in England by 1st December 2003. The government proposed a

package of radical reform, aiming to; “modernise, deepen and broaden the way

that patient views are represented within the NHS.” This reform was designed

to:

“… enhance and encourage the involvement of citizens in redesigning

the health service from the patient’s point of view. As a result community

health councils will be abolished and funding redirected to help the new

Patient Advocate and Liaison Service …”

(DH, 2000:95)

The National Health Service Reform and Health Care Professions Bill

(November 2001) includes provisions for the establishment of Patient Forums,


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and a new national body, The Commission for Patient and Public Involvement

in Health. The role of the new patient forums is to monitor, review, report and

advise on the range of and operation of services provided by that Trust. This

includes services provided under contract with the private/voluntary sector and

through pooled budgets with local authorities. Patient forums will be

accountable to the Commission for Patient and Public Involvement in Health

(CPPIH). The Commission will appoint members, provide staff support,

performance monitor and report to the Secretary of State for Health. Overall

patient and public involvement in the NHS is focused across five new bodies:

Commission for Patient and Public Involvement in Health (CPPIH); Patient

Advice and Liaison Services (PALS); Independent Complaints Advocacy

Services (ICAS), Overview and Scrutiny Committees (OSCs) and patient

forums for all NHS trusts. These bodies will take responsibility to ensure:

“Making progress on promoting volunteering and community

organisations are important aims of Government policy. The health and

social services sectors have a key role in achieving these aims and will

be expected to play a full part”. (DH 2000)

In the light of the new legislation London Health Link (LHL) decided to pilot a

training course that provided a volunteer qualification for their CHC members.

The five-month training course promoted a range of volunteering skills,

designed to enhance the effectiveness of volunteers as patient representatives.

In November 2002, LHL provided 75 places on a volunteer training course,

which was taught by Award Scheme Development and Accreditation Network

(ASDAN) trainers. ASDAN is a national charity offering training and education

in the voluntary sector, and is an approved National Awarding body. The (Level

2) Certificate in Community Volunteering (CCV) has been approved by the

Qualifications and Curriculum Authority (QCA) and its counterparts in Northern

Ireland and Wales for inclusion in the National Qualifications Framework. The

qualification accredits general transferable skills and can be delivered in a wide

variety of settings. The programme for CHC volunteers was partially funded by

London Health and Social Care Directorate, with the core element of the course

funded by the Learning and Skills Council, who also funded the student fees.


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The scheme was initiated to both reward members for their experience and

knowledge by giving them an accredited qualification, and also to pilot a training

scheme for future patient representatives in the new public involvement bodies.

CHC volunteers in the London region were invited to take part, and all 66

volunteers who applied attended the programme, which began in November

2002. Of these, 63 volunteers completed the course and were awarded the

certificate.

.


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6. REVIEW OF THE LITERATURE

The literature begins with a brief overview of the contribution that Community

Health Council volunteers and the Association of Community Health Councils

have made to the body of literature on volunteering. This is followed by the first

main section of the review, which analyses volunteering. The second examines

the literature on training. The discussion identifies why organisations and

trainers need to understand the learner. What sort of people become

volunteers, and what motivates them to give up their time for others then

become important questions. Some relevant studies of adult learning are also

reviewed. The implications for learning and training are included in bold type.

For the purposes of this literature review, volunteering is defined as:

“Any activity which involves spending time, unpaid, doing something

which aims to benefit someone (individuals or groups) other than, or in

addition to, close relatives or to benefit the environment.”

(Davis Smith, 1998)

A distinction should be drawn between formal volunteering, undertaken through

an organisation, and informal volunteering, carried out on a one-to-one basis

(Davis Smith, 1998). This literature review refers to formal volunteering only.

6.1. CHC Volunteers and the Association of Community Health Councils publications In addition to providing training and support for CHC volunteers and other

regulatory services ACHEW produced a number of patient health publications,

some of which involved the work of CHC volunteers. This body of literature

includes: Hungry in Hospital (ACHCEW, 1997a) A study exploring why some

patients do not eat and drink while they are in hospital. The study is based on

the experience of CHC volunteers, and correspondence received from relatives

of patients. CHCs Making a Difference (ACHCEW, 1997b). The report draws on

a survey of CHCs to demonstrate through a range of examples the difference


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they can make to the NHS and its patients. Why are we waiting? Snapshot

surveys of the impact of emergency pressures on patient care (ACHCEW,

2000) Nationwide Casualty Watch 2001 (ACHCEW, 2003). The Nationwide

Casualty Watch survey took place on 26th March 2001. Data was collected on

3,983 patients in 187 Accident & Emergency Departments by 152 CHCs, Local

Health Councils and Health and Social Services Councils. Through these

studies CHC volunteers have contributed to the literature on volunteering.

2. Models of Volunteering

The National Survey of Volunteering (NSV) (Davis Smith, 1998) found that 22

million people in Britain regularly take part in volunteering. Volunteering has

traditionally been seen as a philanthropic activity, whereby the role of the

volunteer is to provide a service for others. Over the past decade, the literature

on volunteering has developed along two paradigms: the economic model and

the leisure model. The leisure model explains volunteering as a leisure activity,

as the activity is carried out in the individual’s free time (Holmes, 2003). The

economic model analyses volunteers as filling the gaps in provision between

the private and public sectors (Gratton et al, 1998), and stresses the volunteer’s

contribution to the economy. It is this model that prevails in central and local

Government reports. The economic model implies that it is justifiable to

measure the work of volunteers and compare it to the economic contribution of

workers in other sectors of the economy. Thus, as Holmes notes (2003), the

economic model considers volunteers as unpaid workers.

In some sectors, for example in the heritage industry, volunteers, unpaid and

unbound by contracts of employment, have traditionally been considered

unreliable and unprofessional (Hooper-Greenhill & Chadwick, 1985).

Volunteers had no induction or training programme, including basic health and

safety training, and no repayment of their out-of-pocket expenses. By contrast,

the increasing influence of “professional volunteer management” treats

volunteers as unpaid staff. Indeed, professional volunteer management seeks

largely to replicate human resource practices with a volunteer workforce


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(Cunningham, 1999). Research examining volunteers’ motives has found that

whilst the professional approach may have advantages for both managers and

volunteers, it may not be appropriate for all volunteers, who may have different

motivations and expectations of volunteering. The characteristics of volunteers,

and their motivations, will now be examined.

6.3. Characteristics of volunteers

As the importance of volunteering has been recognised, studies have attempted

to identify the characteristics of people who become volunteers. There is

relatively little research on volunteers in health care. However, in 1997, the

National Centre for Volunteering was commissioned to carry out a longitudinal

study of NHS trusts to provide a measure of the impact of the volunteering in

the NHS, and to provide baseline information about current levels of

volunteering activity (Davis Smith, 1998). In total, over 36,000 volunteers were

involved in the 257 Trusts that were able to provide information on numbers,

representing an average of 140 volunteers per Trust. This masks a great deal

of variety between Trusts. 33.3% involved between 101 and 250 volunteers,

and 15% in excess of 250, 9% of trusts involved less than 10 volunteers.

The study found that there has been a decline in the average number of

volunteer hours contributed per year, from approx. 30,500 per Trust in 1995/6 to

27,000 in 1997/8, mirroring a decline in the number of volunteers. 25% of

Trusts had both an upper and lower age limit for volunteers. 24% had no age

limits at all. 75% of respondents were female, compared with 82% in the

1995/6 survey. Concerning age, over 60% were 46 or over, with only one in ten

being 35 or under.

The National Survey of Volunteering (NSV) (Davis Smith, 1998), which included

volunteers from many sectors, also found that volunteers tended to be older.

People between 45 and 54 were most likely to volunteer. Women and white


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people were also seen as being over represented, a finding that reflects the

long held stereotype of the typical volunteer.

Research investigating issues in volunteer management found that of the

organisations that admit they do not reflect their local community, the group

most commonly seen as being over represented is retired or older people

(Institute for Volunteering Research, 1998; 2003 a; 2003b). The NSV (Davis

Smith, 1998) found a strong correlation between participation and socio-

economic group. Those from the highest groups were almost twice as likely to

take part in formal voluntary activity as those from the lowest. Those in paid

work were found to be more likely to volunteer than those outside the labour

market. A significant fall was noted among unemployed people (from 50% in

1991 to 38% in 1997) reinforcing the long-held concern that reform of the

benefits system has acted as a deterrent to potential volunteers. In terms of

gender, men and women were equally likely to volunteer (Davis Smith, 1998).

The survey confirmed the finding that volunteering tends to peak in middle age

and tails off after the age of retirement.

A study of more than 400 volunteers in the NSV aged over 50 involved in the

fields of social welfare, education, heritage and environment in the UK found

that 44% of these volunteers were in their 60s (Institute for Volunteering

Research, 1998). There were more women than men in the education, social

welfare and heritage groups, and people from middle class occupational

backgrounds were more likely to volunteer, although, some of the social welfare

groups had been very successful in involving people from more working class

backgrounds. 52% of the sample started to volunteer after they were 50 years

old.

Some participants in Hayden et al’s (1999) study commented that older people

often had the problem of too much time in the day to fill, whereas younger

people had too little time. The time-rich versus time-poor dichotomy between

generations was felt by some participants to be the reason why volunteers

tended to be older in age.


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McCrone et al (1995) found that volunteers in the National Trust for Scotland

tended to be over fifty years of age, retired, middle class, better educated, and

white, although that is not to say that all volunteers fit this stereotype. For

example, Howlett’s (1997) study examined two UK case studies, each involving

volunteers. In one project, the volunteers were unemployed miners, and a

women’s project in London involved Arabic women volunteers.

6.4. Motivations of volunteers

Motivation is most difficult to define, but relates to the reasons that people

behave as they do. Traditionally, volunteering was regarded as a philanthropic

act, whereby the volunteer is motivated by the desire to give something back to

society or the community for the benefit of others, or to work for what they feel

is a “worthwhile cause”. For example, a respondent in Hayden et al’s (1999)

study of older people reported:

“I do voluntary work, always have done, always will do and can’t see any

reason why I shouldn’t show my gratitude to society. That I have been

very lucky and have had a reasonable passage through.”

(cited in Haydn et al, 1999)

Although there is little doubt that altruism may be an important element in the

motivation of many volunteers, over the last ten years, research has shown that

motivations for volunteering are more complex, and that people volunteer for a

range of different reasons. Models of volunteering fall into two broad

categories, both of which can include elements of philanthropy.

(a) The Leisure Model


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“Leisure seeking volunteers” are motivated by the social benefits of volunteering

(for example, meeting other people). In a survey conducted by the National

Trust for England and Wales (1998), volunteers gave the following benefits

derived from their activities:

• I really enjoy it (98%)

• I meet people and make friends through it (85%)

• It gives me a sense of personal achievement (78%)

• It gives me a chance to do things I am good at (74%)

• It broadens my experience of life (73%).

Older respondents in the NSV (Davis Smith 1998) reported that their

motivations for volunteering included connections with either their (or their

friends’ and families’) needs and interests; that someone asked them to help;

that they had time to spare; that they wanted to help others; and that they

wanted to meet people.

Based on a study of visitors at Toledo Art Museum, Hood (1983) devised six

attributes that made up an enjoyable leisure activity, and these may be the

attributes that some volunteers seek in their own leisure experiences, such as

volunteering:

• Challenge of new experiences

• Doing something worthwhile

• Feeling comfortable in one’s surroundings

• Opportunity to learn

• Participating actively

• Social immersion.

As Holmes (2003) notes, these characteristics bear a close resemblance to the

benefits given by respondents to the National Trust survey. Also, volunteers in

Holmes’ (2003) study stated that they meet people, make friends, and that they

gain a personal sense of achievement from their activities. Research on the


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attitudes and aspirations of older people (Hayden et al, 1999) elicited a number

of perceived advantages to volunteering. It enabled people to remain involved

in society after retirement from formal employment. It was considered a means

of engaging the mind, keeping active and staying independent with concomitant

health benefits. There was the opportunity to meet new work colleagues and

make additional friends, thereby sustaining social contacts. It also gave

individuals a greater sense of self worth from the feeling they were doing

something of value to their community.

Hood’s concept of volunteering as a “leisure experience” proposes that key

motivators are ‘doing something worthwhile’, ‘the opportunity to learn’ and

‘social interaction’. Given the correlation with the responses of volunteers in the

above studies, the leisure paradigm offers a compelling model within which to

consider volunteering (Holmes, 2003).

On the other hand, research shows that the motivations of many volunteers do

not fit this model.

(b) The economic model

Findings from the NSV indicate that respondents were less likely to cite free

time as their motivation, and were more likely to stress the learning of new

skills. Young people are apparently less altruistic, with only 10% of 18-24 year

olds citing a need in the community as a factor behind the decision to volunteer,

compared to 26% of respondents overall (Davis Smith, 1998). “Experience-

seeking” volunteers tend to be younger, and may be aspiring professionals,

whose motivation for volunteering may be to gain experience and skills, so that

they can obtain paid work (Holmes, 1999). Their motivation is economic, rather

than leisure-seeking, or philanthropic:

“Experience is high on young people’s wish list for volunteering. They

want relevant and interesting experiences which will stand them in good

stead in their personal and career development. Volunteering needs to


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offer opportunities to learn new skills, to take on challenges, to explore

different careers, and to get work experiences.”

(Institute for Volunteering Research, 1997)

Volunteer Training

Organisations need to understand the motives of volunteers, if they are to

recruit and retain them. Both government and organisations perceive a need

for training in the voluntary sector, and almost half of voluntary organisations

offer their volunteers some form of accreditation or certification for their work or

training accomplished (Davis Smith, 1998).

However, many volunteers are not motivated by the need to obtain

qualifications (Cox, 2002). Findings from the NSV (Davis Smith, 1998) showed

that 95% of volunteers did not believe that any training was necessary for

voluntary work. In Broadbridge and Horne’s (1996) study of volunteers in

charity shops, despite the majority of volunteers having considerable

experience, nearly all of the charity shops in the sample provided volunteer

training. The provision of training related to the three most important tasks

undertaken in the shops: sorting, selling and pricing. The survey found that the

majority of volunteers who had received training were satisfied with it. Although

many charity shop managers believed that their training was sufficient, one third

welcomed additional volunteer training, ranging from refresher courses to

specialised training, and 40% of the volunteers had not received any training at

all. Unemployed people, women looking after the home, and those under the

age of 45 were more likely to have received training than those fitting the typical

volunteer profile, those in paid employment, and men. Students were the least

likely to have received training. The researchers offer no explanation for these

divergent trends. It may be that training is given on the basis of what the

managers perceived to be the need for training, rather than what the volunteers

felt they needed.

“Experience seeking” volunteers are likely to be highly motivated to

participate in a training course, and gain accreditation. However, some


24

volunteers may not be interested in gaining a certificate, but might still

enjoy the opportunity to learn.

There is reason to suspect that the motivation of volunteers is not static.

Researchers have found that motivations and factors influencing involvement

change over time (Bussell and Forbes, 2003, Hibbert et al, 2003). Relatively

vague ideas of the potential benefits of volunteering that motivated initial

involvement were clarified as volunteers participating in a community based

scheme gained experience. There was overt recognition of skill development

and growth in self-esteem and confidence that had been gained during the first

few months of working on the project, and there was anticipation that these

would be enhanced through ongoing involvement.

It is clear from the above that training needs vary depending on the role and

motivations of the volunteer. Training can include an intensive initial course to

develop particular skills and awareness; ongoing courses for updates of skills,

policies and regulations, minimal or no training. It is important that

organisations judge the content and extent of training very carefully, to

serve exactly the volunteer’s and the organisation’s purposes (Gaskin,

2003).

6.5. The characteristics of adult learners

As volunteers tend to be older, it is particularly important to examine the effect

of age on participation in learning, and on learning itself. Concerning the latter,

although the physical capabilities of the adult do decline after a peak in late

adolescence or in early childhood, few of them are very significant in the

process of adult learning (Jarvis, 1995). Those that may affect learning

include loss of hearing and sight and loss of energy, and these

capabilities need to be taken into consideration by trainers. As Jarvis

points out (1995:45), such changes may induce adults to underestimate their

powers to learn, and so reinforce the perception of adults that learning is

something that occurs early in life. In the most recent National Adult Learning


25

Survey (NALS) (Fitzgerald et al, 2003), a quarter of those who did not take part

in learning activities felt that they were too old to learn.

For many adults, attendance on an education or training programme may be

their first experience of formal learning for many years, and they may lack

confidence. Furthermore, prior learning experiences, particularly at school, may

not have been positive. These factors may lead to reluctance on their part to

participate in learning activities, or to a fear of failure. It is well documented that

learners need feedback for effective learning to take place, and this may be

particularly true for older adult learners. The implications for trainers are that

some adults may need more encouragement, reassurance and feedback

than others, particularly during the early stages of a course.

In 1997, the Department for Education and Employment (DfEE) commissioned

the first National Adult Learning Survey (NALS) (Beinart & Smith, 1998), to

explore participation in a wide range of learning experiences. This was a

baseline study, followed by repeat surveys in 2000, 2001 and 2002. It is used

to monitor the effectiveness of adult learning policies, and progress in meeting

the National Learning Target for adult participation, which aims to reduce the

proportion of non-learners from 26% in 1997 to 24% by 2002. Learning

activities were defined as taught learning (if they involved some formal

teaching, including distance learning) or as self-directed learning (if people

taught themselves without receiving any form of tuition).

Numerous studies of adult learning have shown some consistent variations in

participation in learning among different groups (for example, La Valle & Blake,

2002). The latest NALS survey (Fitzgerald et al, 2003) was no exception,

finding that:

• Participation in learning tends to decline as age increases. The highest

learning participation rates (between 80% and 86%) were found among

those aged 20-49, while only 25% of those in the 70+ age group had

undertaken some learning in the previous three years. However, there has


26

been an increase in learning from 67% in 1997 to 74% in the 50-59 age

group.

• Women were less likely than men to report some learning, with the

respective figures being 73% and 79%. The difference is even larger when

looking at vocational learning.

• Disability seems to be associated with lower than average participation. 56%

of people with a work-limiting disability and 71% of respondents with another

type of disability reported some learning.

A strong link was found between adult learning and educational background:

• 55% of those who left continuous full-time education with no qualifications

reported some learning, compared with 94.5% of those who left with a

qualification above NVQ level 3.

• 73% of respondents gained a qualification after completing continuous full-

time education. Those least qualified at the end of their full-time studies

were most likely to have achieved a qualification.

• The highest qualification achieved shows an even stronger link with

involvement in adult learning than that found in relation to qualifications on

leaving compulsory full-time education.

The study found that participation in learning is closely linked to employment

circumstances:

• The highest participation rates were found among respondents in paid work.

89% of full-time employees, 82% of self-employed, and 81% of part-time

employees had done some learning. 68% of unemployed people and just

over half (52%) of those looking after the family reported some learning.

The lowest participation figures were found among those outside the

labour market: that is, retired people (48%), and those unable to work

due to a health problem or disability (42%). Predictably, differences

among these groups were even more marked when looking at

vocational learning. Participation in learning has gone up since 1997


27

among the self employed (from 77% to 82%), respondents looking after a

family (from 47% to 52%) and those who have retired (from 43% to 48%).

There has been a small decline in the proportion of unemployed people who

reported some learning, from 72% to 68%.

For the first time in 2001, data on financial circumstances was collected, to

explore any links with propensity to engage in learning:

• 91% of respondents with a household income of £31,200+ reported some

learning. The equivalent figure for those in the lowest income bracket

(below £10,400) was 53%.

• 56% of people dependent on means tested benefits had done some

learning.

The results on regional differences seem to point to a North-South divide in

terms of participation in learning:

• The highest figures for participation in learning were found in the South East

(84%), Eastern region (81%), South West (79%) and London (76%). The

learning participation rate was between 74% and 76% in the Midlands,

drops to 69-72% in the Northern regions and is lowest in Wales (64%).

• A strong association was also found between learning and local

deprivation. Participation in learning ranges from 85% in the least deprived

areas to 63% in the most deprived ones.

(Fitzgerald et al, 2003)

The literature suggests that adult learners tend to be younger, better educated,

employed, and wealthier than non-participants. They are more likely to live in

the south of the UK, and men are far more likely than women to participate in

vocational training. Those who are retired, and those who are unable to work

due to a health problem or disability are least likely to be adult learners. These

groups may need more active encouragement to participate in the training

course.


28

6.6. Motivations of adult learners

The question remains about the reasons that adults decide to attend

educational institutions and training courses. Research into participation is

among the most established areas of research in adult education (Jarvis,

1995:52). Houle (1979) concluded that participation in any type of educational

activity is usually undertaken for a variety of motives, and that these usually

reinforce each other. He formulated an early and useful typology within which

to classify these motives: goal-orientated learners, activity-orientated learners,

and those whose main orientation is learning for its own sake. Within each of

these classifications, a number of different motives can be specified. For

example, Johnstone and Rivera (1965) classified the motives of their sample as

follows: prepare for a new job; help with the present job; become better

informed; spare-time enjoyment; home-centred tasks; meet new people; escape

from routine; and other reasons.

What is important is that trainers understand the reasons that adults have

chosen to participate in the training course. Also, the aims and objectives

of the course need to be set out clearly, to ensure that these meet the

needs of learners. A learner may be attending a training course for social

reasons (for example, to meet people) and may not be interested in gaining a

certificate. Others may only be interested in gaining accreditation.

It would be unwise to assume that people who do not participate in learning

activities are opposed to learning, or do not wish to attend. McGivney’s (1990)

study isolated five groups who are under represented in adult education:

unskilled/semi skilled manual workers, unemployed people, women with

dependent children, older adults and ethnic minority groups. McGivney also

notes that adults with basic education needs are another category that are

inhibited from participating because of their insecurity, distrust, low aspirations,

limited time, dependence, negative attitudes towards education, and shame at

the low level of their achievement.


29

She records the most frequently mentioned deterrents to participation:

• Lack of time – cited most frequently by unskilled workers and young

mothers.

• Negative effect of school experience – from both the unemployed and the

unskilled.

• Lack of money – cited by unemployed and by women and older people.

• Distance from classes – elderly, women with dependent children and ethnic

minority groups all mentioned this.

• Lack of childcare – mentioned by mothers with dependent children.

• Lack of day-time opportunities – mentioned by women and older adults.

• Unskilled people regard education as less important.

• Lack of transport – cited by mothers with dependent children, older adults

and ethnic minority groups.

• Reluctance to go out at night – mentioned by women and older adults.

These deterrents provide a wide variety of reasons why these groups of adults

did not participate in learning activities.

The NALS survey (Fitzgerald et al, 2002) highlighted similar barriers to learning.

Time constraints (for example, work or family commitments), the cost of

courses, and lack of knowledge about learning opportunities were the difficulties

most commonly mentioned by both learners and non-learners. Predictably, the

latter were more likely to report obstacles to learning, although a substantial

minority also said they preferred to do other things in their spare time (43%),

they were not interested in learning (26%) or did not see the point of education

(11%). While attitudes to learning and perceptions about its relevance might

influence the behaviour or some non-learners, many in this group faced more

practical obstacles, including:

• Lack of time due to work (24%), family (30%), and childcare responsibilities

(19%).


30

• Difficulties in paying for course fees (27%) and fear of losing benefits if they

started a course (9%).

• Lack of knowledge about local learning opportunities (28%) and learning

advice sources (15%).

• Being nervous about going back to the classroom (26%), lack the necessary

qualifications to join a course (24%), concern about not being able to keep

up with the course (21%) and difficulties with reading and writing (11%),

English (7%) and numeracy (6%).

• A quarter of non-learners thought they were too old to learn.

While there is a group of non-learners who do not appear to be interested in or

motivated to learn, there is another large group who would or may have liked to

learn, and are very clear about what would encourage or enable them to do so:

• 44% of non-learners would or may have liked to have done some learning,

with the figure being highest among lone parents (59%).

• The most common subjects they would have liked to have learnt about were

computing (30%), training for professions (20%) or leisure activities (19%).

• The main factors that would facilitate their learning were funding (25%),

advice (19%) and improved job chances (17%).

If the training course is to attract under represented groups, it needs to

address some of the problems and issues identified above.

6.7. The learning experiences of adults

Concerning the adults who have participated in learning, their experiences tend

to be positive. Fitzgerald et al (2003) have explored the problems that people

might have experienced while on a course, the influences on their decision to

undertake taught learning, and what they perceived as the benefits. The

researchers found that:


31

• The majority of taught learners reported no problems with their course. The

most frequently mentioned difficulties were lack of time because of work

(18%) and family responsibilities (10%).

• Common reasons for starting vocational courses included: to develop one’s

career (57%); learn new skills for the current job (54%) and increase job

satisfaction (39%). Many wider motivators were also mentioned by those

doing both vocational and non-vocational courses: skill and knowledge

improvement was reported by 78%, followed by the desire to do something

interesting (39%), curiosity about the subject (27%), the wish to meet new

people (13%) and to have fun (12%).

• The majority of respondents benefited from the course in a variety of ways.

49% of those who had done a vocational course had learnt new job skills.

45% said they were able to do their job better, and 26% got more

satisfaction from their job. Wider benefits included: improved knowledge

(71%), the opportunity to meet new people (33%), and boosted confidence

(31%). People over the age of 70 were particularly likely to report wider

benefits from taught learning. 77% found it interesting, three quarters

enjoyed it, about half gained new skills, 46% met new people and a fifth said

it helped with their disability.

It is important that the level and content of the training course is

sufficiently flexible to allow all the participants to learn new skills and

develop their knowledge. The wider benefits of learning, such as

increased confidence, and the opportunity to meet new people, should

also be considered when evaluating the course.

The CCV has been evaluated by the Volunteer Development Agency in

Northern Ireland (Oakes, 2003). The research included consultation with

volunteers and organisations in six areas across Northern Ireland to investigate

the generic training needs of volunteers. Suitable training courses for

volunteers were investigated, and the CCV was deemed the most appropriate


32

programme. A pilot study was carried out to test the CCV before cascading it

into local areas, but this was somewhat limited by the sample size. Thirteen

volunteers from a range of voluntary organisations took part in the 12-week

course, and nine of these were awarded the certificate. The results showed

that there was a positive response from both the volunteers and their

organisations. Participants on the training course reported:

• Increased self confidence.

• Seeing their role in the “bigger picture” of volunteering.

• Reinforced knowledge around policy and diversity issues.

• Learning from others.

The organisations reported the following benefits:

• More self-confident volunteers.

• Volunteers had a better understanding of policies/codes of practice.

• The CCV programme encouraged organisations to improve volunteer

management practices.

• They also felt that it was good for the image of the organisation to have

volunteers who had gained the CCV.

After the pilot study, the course was condensed into ten weeks and a trainer’s

manual was compiled. Delivery partners were sought throughout Northern

Ireland, and a three-day CCV training for trainers course was arranged. The

CCV is now being delivered to volunteers in eight areas in Northern Ireland.

To summarise, the established literature review has found a tendency for

volunteers to be older, and a tendency for learners to be younger. This paradox

may pose particular problems when trying to attract representative groups of

volunteers to training courses. It is encouraging to find that the reaction of most

adults tends to be very positive.


33


34

7. RESEARCH DESIGN AND METHODS OF DATA GATHERING

Evaluation of training is required against four key areas: relevance to patient

representation, accessibility, cost effectiveness and quality. To unpack

these questions it was necessary to consider:

1. What knowledge and skills did the volunteers gain, that could enable

them to work more effectively as patient representatives? Did they

demonstrate the skills they had learned when working in patient forums?

2. Did the trainees successfully learn new knowledge and skills from each

module?

3. Was participation in the training course a positive experience for the

volunteers?

4. Was the training course physically and intellectually accessible?

5. How cost effective was the training course? How many people

completed the course and how many of them gained accreditation?

6. Was the training course of a high standard? This should include the

venue, the professional standards of the trainers, course content,

presentations, assessment, feedback to learners, external events and

any other activities that were part of the training course.

7. What measures would improve future training courses for volunteers?

To answer these questions, a flexible, multi method research design was used,

to incorporate a range of research methods, both quantitative and qualitative

(see Figure 1). In the first stage of the research, the context was investigated,

and robust measures were developed for the evaluation tool.


35

Figure 1: Research Design

7.1. Stakeholder Consultation Day

A Stakeholder Consultation day was held to elicit the views and opinions of

members with a vested interest in the establishment of patient forums. This

used a whole day focus group method, based on the constituency approach,

and involved representatives from all relevant stakeholder groups. Delegates

from CPPIH were invited to the stakeholder day, however, they were unable to

attend. A copy of the findings from the day was duly sent to them.

6 FOCUS GROUPS

(53 volunteers)

TELEPHONE INTERVIEWS

(11 volunteers)

QUESTIONNAIRE SURVEY

(463 non-participant volunteers)

STAKEHOLDER DAY

Workshops/focus

groups

(30 stakeholders)

TELEPHONE INTERVIEWS

(13 volunteers)

TELEPHONE INTERVIEWS (5 PPI forum

leads) TELEPHONE INTERVIEWS

(4 ASDAN trainers)

QUESTIONNAIRE SURVEY

(3 trainees who withdrew)


36

7.2. Training Session Evaluation

(November 2002-March 2003)

Based on the outputs of the stakeholder consultation, and with reference to the

literature and best practice in training evaluation, a short structured evaluation

questionnaire was designed. A copy was given to each trainee after each

session, giving them the opportunity to feed back their views about how helpful

they found the session and whether they felt that the aims and objectives of the

session had been met.

7.3. Focus groups and interviews

(March-April 2003)

The aim of the focus groups was to gather data about the views of the

volunteers on the effectiveness of the training course, and what they felt the

training programme had achieved. The focus groups provided the volunteers

with the opportunity to voice their assessment of the training, and to highlight

any areas that they felt should be changed or modified. For example, the

volunteers were asked to what extent they felt the training had benefited them

personally and professionally. They were also asked to think of an occasion

when they had used the training in practice as volunteers, and for their

comments about the training course.

The focus groups were arranged at a time when the volunteers had completed

training, giving them sufficient time to apply their training skills in the context of

their work with the NHS.

The volunteers who could not attend the focus groups were contacted by post

to offer them a telephone interview in their own home. Telephone interviews

were also carried out with a further eleven respondents who attended the focus

groups to establish whether they were able to give examples of where they had

been able to put their training into practice.


37

Semi-structured telephone interviews were also carried out with PPI leads to

assess their opinion on volunteer training requirements for patient forums. Data

was also gathered about what training needs the PPI leads felt the patient

representatives would have, and any problems they anticipated with the new

forums. Five PPI leads were contacted in the London area. Four agreed to be

interviewed.

Telephone interviews were carried out with the ASDAN trainers, to investigate

the training programme from their perspective (Appendix A).

7.4. Questionnaire Survey

(April – May 2003)

In order to understand the reasons why some CHC members chose not to

participate in the training, a questionnaire survey was designed (see Appendix

B). This tool was designed with the aim of universal application, and was

informed by the three prior stages. It aimed to ensure that a rigorous

assessment of the four evaluation criteria could be made. A total of 463

questionnaires were sent out to CHC volunteers in the London area. These

were distributed by DH to ensure confidentiality. Given the voluntary nature of

volunteering, and the researchers’ reluctance to exert pressure on the

volunteers, no reminders were sent.

7.5. Participants who did not complete the training

Questionnaires were sent to the three volunteers who did not complete the

training course, to investigate the reason for their withdrawal (Appendix C).


38

8. RESULTS

8.1. Stakeholder Day

The purpose of the stakeholder day was to develop training recommendations

for patient forums and a framework for the evaluation.

The day was well attended by thirty representatives from the voluntary sector

including representatives from the Commission for Racial Equality; the Patient

& Public Involvement DH Department of the NHS, Leadership Centre and other

government agencies.

The day began with a short presentation on the roles and responsibilities of

patient forum volunteers. However, the majority of the stakeholder day was

organised around a morning and afternoon workshop. The participants were

divided into three focus groups for each session. Each group focused on three

questions in the morning session and three questions in the afternoon session.

The groups produced a feed back report on flip chart paper, which was

presented to the whole group for comments. The information from the flip

charts has been analysed to develop training recommendations for the patient

forums. The ideas elicited from the stakeholder day mainly focused on training

policy and practice that would be effective for patient forums.

The training recommendations that are outlined below have been developed

from the themes identified on the stakeholder day.

8.1.1. Recruitment to Training Course

The stakeholders identified access to training for patient forums as an important

issue, identifying it as the key to widening community participation. In

particular, there was a need to widen the volunteer recruitment drive in order to

represent the health needs of all minority ethnic groups on the patient forums.


39

Ideas to encourage a wider community representation included:

• Outreach strategy

Participants suggested that volunteers could liaise with voluntary sector

organisations that represent minority ethnic groups. It was noted that the health

needs of minority ethnic groups have been under represented in the NHS.

• Community Networking

There was strong support for the idea of community networking, such as

making use of local radio stations, where new volunteer recruits could be

informed of the patient forums.

• Recruitment to Training Course

Training to ensure that recruitment was inclusive to all groups within the

community was identified as a priority. This would ensure that all of the health

needs of a diverse community were adequately represented, and recognised as

an important first stage in the development of patient forums. The question of

future availability for training for all patient forum representatives was raised.

No assurance could be offered on the content of training available in the future.

8.1.2. Training in Diversity Awareness

Training in diversity awareness was discussed as an ongoing process that

would consider new legislation, such as amendments to the Race Relations Act

1995, as well as local change. Respondents spoke of the need to monitor

change in their own community, which, for example in one area was

characterised by a profile of more than 25 different languages. Hence the

training component would address how to network and outreach in order to

ensure that all of the community health needs are represented. The task of

outwardly networking with the wider community was spoken about as vitally

important, and one that raised a resource issue.

The issues raised by the stakeholder groups are consistent with the aims of the

CPPIH, who also state the need to “… work with traditionally marginalised


40

groups to ensure that getting involved is as easy as possible” (DOH Press

Release, 3rd January 2003).

These issues compliment the work that is being undertaken with NHS staff on

cultural competencies and the Improving Working Lives standard Positively

Diverse (Positively Diverse, Department of Health, 2001).

8.1.3. Training to improve communication

Introducing mechanisms to improve communication was recognised by the

stakeholders as a resource issue. Good communication was seen to promote a

collective intelligence. One of the participants suggested that communication

training would further an understanding of “… how to proceed with views,

follow them through and turn them into real service improvements.”(

stakeholder participant)

Creative suggestions to improve external communication included: the use of

audio tapes, building a good relationship with the local media, for example

minority ethnic radio stations; developing good relationships within NHS trusts;

up to date information on the policies and procedures of the NHS. One

participant made the point that improved communication with NHS staff would

enable patient forums to support NHS trusts to speak out against ‘bad’ DH

policy. Stakeholders felt that networking across patient forum regions was one

way that families could be involved in service delivery for relatives who do not

live in the same health region.

Group discussions about improving communication in meetings identified

various aspects of communication that would contribute towards a better health

service delivery. These included negotiation and assertiveness, confidence,

listening and presentation skills.


41

8.1.4. Speciality Skills Training

The participants recognised that the wide range of responsibility of the patient

forum remit meant that volunteers would perform different roles and need

different skills to perform these effectively. In addition to induction and general

skills, training volunteers should be allowed to specialise in their strengths in

relation to the needs of the community patient forum they represent. Training

packages would need to reflect the wide range of tasks that is the responsibility

of patient forums. As such training would include a variety of packages, from

which volunteers could select a training module to fit their area of speciality.

Participants recognised the potential for individual training packages to be

matched to primary care trusts, acute hospital trusts, mental health trusts,

ambulance trusts, community trusts and speciality trusts.

8.1.5. Training in Team Working

Training in teamwork was given wide support and viewed as a mechanism to

maximise the effectiveness of the patient forum volunteers. Team training could

indirectly highlight service needs and improve service delivery by enabling the

team to identify problem areas, show possible solutions, be flexible, and

reflexive to look at all aspects of health care. In turn a broader range of

knowledge would be cost effective in the sense of identifying where there may

be waste, such as producing food that might be unsuitable for some community

members.

Research on teamwork has shown that for a team to be effective, the

organisational context should provide teams with clear objectives and feedback

on performance in relation to these objectives, appropriate and relevant

rewards, training for teamwork, and technical and practical assistance to

support the team in its work. It is therefore important to include training in team

work to contribute to the effectiveness of patient forums.


42

8.1.6. IT Training

The discussion on IT training showed it was viewed as an essential skill but one

that required a learning process that might deter the recruitment of volunteers.

On the one hand, the benefit of IT training was recognised, for example to

improve communication, gather and distribute information, produce reports,

network across and within communities and being cost effective in the long run.

On the other hand the point was made that IT training should not take

precedence over other training needs, and if it was made compulsory, may

deter the recruitment of volunteers from socially excluded groups.

8.1.7. Evaluation Training

The task of monitoring how effective the patient forums were was linked to

evaluation training. The group talked of the need for a feedback loop both from

the community and within the NHS. There was strong agreement that if patient

forums monitor NHS performance outcomes they will also be able to identify

patient forum effectiveness.

8.1.8. Partnership Training for NHS Staff

Training for NHS staff was seen as necessary in order to involve staff and

encourage feedback, which will ultimately close the feedback loop.

Stakeholders added that developing working relationships based on a mutual

trust would enable Trusts to carry out statutory patient involvement. Sharing

best practice and developing good partnership working with the patient forums

would also feature as part of this training process, and contribute to an

understanding of how to publicise best practice. It was acknowledged that

together, the Trusts and the patient forums had a vested interest in educating,


43

involving and informing the public on health issues, and this was talked about

as a shared task. The discussion on partnership working with the Trusts also

raised the point of inter team training

8.1.9. Developing a code of conduct

There was some discussion concerning the need for a code of conduct for

members of patient forums. A code of conduct would cover specific tasks and

sensitive areas, such as coping with confidentiality, managing ethical issues,

agreed behaviour in meetings, coping with authority and agreed procedures to

influence the CPPI.

8.1.10. Summary of stakeholder recommendations

• Widen the volunteer recruitment drive in order to represent the health

needs of all marginalized groups on the patient forums

• Training in diversity awareness

• Creative suggestions to improve external communication included the

use of audiotapes, and building a good relationship with the local media,

for example minority ethnic radio stations.

• Ongoing training on NHS policies and procedures.

• Negotiation and assertiveness training, confidence training, training to

listen, and presentation training.

• Training packages to be matched to primary care trusts, acute hospital

trusts, mental health, community trusts, ambulance trusts and speciality

trusts.

• Training in teamwork.

• IT training

• Develop a code of conduct to include issues of confidentiality, managing

ethical issues, codes of behaviour for meetings.


44

8.2. Focus groups

53 volunteers who had taken part in the training course participated in the six

focus group discussions.

The data from the focus groups is presented against the four evaluation criteria

that were identified for the programme:

• Relevance to Patient Representation

• Accessibility


• Quality

8.2.1. Relevance to Patient Representation

Four positive outcomes of the training course were identified:

• Confidence Building

• Sharing Best Practice

• Organisational skills in meetings

• Managing time

Confidence Building

Respondents were asked to what extent the training had benefited them

personally and to what extent it had benefited them professionally. They were

also asked to think of an occasion when they had used the training in practice,

and for any comment they would like to make on the training.

Most of the respondents found the course personally rewarding, and were

pleased that they had undertaken the course. There was consensus amongst


45

most of the respondents that their confidence had grown as a result of the

training. Different volunteers in the focus groups made the following comments:

‘The programme helped build my confidence, due to the knowledge gained

and the linkages I can make …’

‘I feel I can now deal with different situations.’

‘The programme helped to build my confidence. I look at things more

systematically, clarify things and learnt how to approach things in a more

constructive manner.’

Some respondents commented that this skill would be particularly useful and

relevant in their work at patient forum meetings, as they felt that presenting

evidence to a range of people from different backgrounds required a high level

of confidence.

For one respondent, gaining skills on the course had not only increased her

confidence, but she felt a sense of achievement through gaining the certificate:

“I mean, I was left to bring up three sons in 1961, three little boys who

are now men, and one of them is fifty three. But I mean, I couldn’t get

any qualifications, I had to run after money to keep my kids. And, I

mean, I’ve got no qualifications at all. Nothing. Nothing on paper except

two or three things where I’ve gone for a day’s course somewhere or

other. The thing is that what it meant to me was, once I’d been pushed

into doing it … that it was a qualification for me. It was self satisfaction

that I knew what I was talking about, and that I could put it in writing what

I was talking about. That I could tell somebody else, and if I get a

certificate, or whatever it is that I do get, it makes it worth it. So it gives

me some sort of satisfaction.”


46

Sharing Best Practice

Some of the trainees reported that the programme had provided the opportunity

to learn from other CHC members. They discussed how the course created

awareness among members of how other CHCs function and offered the

opportunity to share best practice.

In one focus group one respondent pointed out:

“… one thing that we can learn from each other is where it’s best

practice. And in the north east, we could learn where somebody had

done something in a particular way, which would seem to be useful for

the City of London, for example. That was useful, that comparative

element.”

One respondent appreciated “… the chance to do more networking, beneficial

to all”. This pooling of shared knowledge was viewed as particularly important

for patient representation, and enabled the respondents to reflect on their own

volunteering skills and practice.

Organisational Skills in Meetings

One of the trainees reported that this particular aspect of the course was:

“good, informative and easy to follow”. The participants were able to practice

their organisational skills during their seminar work, as the “… seminars were

very good, and you could share experiences and views”. Others mentioned the

value of both acquiring new skills for preparing material and presenting in

meetings, as well as reaffirming that the skills they had acquired previously

were appropriate in patient forums. One respondent said how the training


47

course “… helped integrate the different groups”. In general there was strong

agreement that this aspect of the course “… could be more use in the future”

and that this part of the programme was integral to the success of patient

forums.

Managing Time

It was felt that time management was an essential skill for patient forum

representation. Respondents felt that through attending the course, they had

learned how to manage their time more effectively. For example:

“… (the) workload of the course made me prioritise”.

“… (the training) enhanced my management and time management skills.”

It is noteworthy that many of the survey respondents who were unable to

participate in the training course gave lack of time as a reason for not attending.

They had other commitments, and were concerned that the training course

would take up too much of their time.

8.2.2. Accessibility

Some respondents reported difficulties travelling to the location of the main

events. However, the events were also acknowledged to be the most

interesting aspects of the course, and also where they gained most knowledge

of the best practice of other CHC’s. Attending their local CHC for the training

course was not identified as a problem by any of the volunteers.


48

8.2.3. Cost Effectiveness

The cost effectiveness of the training course will be evaluated against two

external criteria.

1. The London CPPI have agreed to inform the evaluation team of the

numbers of CHC volunteers who have undertaken the training and have

been accepted on the patient forums.

2. The CPPI is committed to providing training for the volunteers, and will

be given the opportunity to utilise the interim and final report.

8.2.4. Quality

The following issues were identified from the data.

Positive comments

(a) The trainers

The respondents reported that the trainers had provided high quality training

and had offered them support throughout the course as well as sensitively

identifying their learning needs. All the focus groups acknowledged that the

majority of trainers were extremely helpful and they always received individual

attention if required. Another praised the trainers for their ability to “…bring so

many people together and get them to work together without distractions”.

Another respondent added: “I couldn’t turn up at the meeting, and the tutor

came to me … and they bent over backwards, really.”

It is interesting to note that one focus group reported that the trainer had

changed their title from trainer to facilitator as the course progressed.


49

(b) The conference events

Many of the respondents felt that the high point of the training had been the

quality of the main conference events. They discussed the knowledge that they

had gained from other CHC volunteers with regard to best practice, and how

the conferences had given them the opportunity to network and share good

practice with other volunteers.

Many respondents also mentioned the high quality of the external speakers.

Comments to Support Recommendations

(a) Level of the course

There was agreement that volunteers have reached different levels of skill in

their volunteering role and that the training should be modularised to reflect this.

For example, one respondent stated:

“I believe the difficulty is the level of the people who are coming, what

level are they coming at, what level are you going to address? You’ve

got a mixed layer of people ...”

The respondents felt that the training content should be modularised, and that

volunteers should be able to demonstrate that they were exempt from some

modules. A volunteer in one focus group said:

“Well, we were going to get a certificate to actually say that we had

undergone a course, that would be useful to continue as volunteers, but

as I say, there wasn’t any element in that, I don’t think, of grading us ...

some of the people on the course had only just started at CHC. Some of

them had done ten years or more. Some much more.”


50

It was felt in one of the focus groups that: “It certainly would make a good

foundation course” and “… it would be good for people who had just become

members.” The respondents in this group suggested that: “… an evaluation, a

sort of basic evaluation, of the people who decide to go on the course would be

useful.” Others felt that the programme for volunteers should be in several

parts, with a grading for each part until volunteers had completed the whole

programme. One volunteer suggested:

“If you do that, it would be nice to do something at the end, which doesn’t

have to be long, but can involve a little bit of research. I really do mean

from your own experience.”

(b) IT Skills

The opportunity to learn IT skills was a key factor in the recommendations for

training for patient forums. Particular emphasis was placed upon the

importance of learning how to e-mail in order to improve communication. The

ability to produce well-presented documents was viewed as an essential skill for

patient representation. A number of respondents stressed that it was

necessary to recognise that respondents were starting with different levels of IT

skills, and that this variation in skills needed to be taken into account on future

training courses.

(c) Assessment

It was suggested that the group assignments could be more focussed. It was

felt that the questions could be more specific, to enable the trainees to illustrate

their knowledge and experience. For example:

“ The questions, for example, on race: How would you deal with racism?

Which is an open-ended area, you just spell out everything you know,

every cliché you know. You didn’t have to give a concrete example. Some

of those (questions) were too general.”


51

Another added:

“All I would say is ‘illustrate’ at the beginning (of the question) … What

brought it alive was when a question was asked that was good, use an

illustration to show how marginalized and so on, then I used the example

of how women were marginalized in maternity services.”

(d) “Health Trainers”

The respondents were keen to include ongoing health issues in future training

courses, and recognised the need for this to be regularly updated. They

discussed how the trainers themselves had learnt about the patient service role

that the volunteers provided for the NHS. The issue of training the trainer in

health issues was discussed in several of the focus groups:

“ Whilst recognising it as a pilot, nonetheless, many, many people who

attended felt that they were training the trainers…”

(e) Terminology

The rapid change in the NHS, which is accompanied by new terminology and

acronyms was also seen as a problem that would impact on both volunteers

and trainers alike. Some participants commented that the terminology needed

explanation, for example PCT (Primary Care Trust) and suggested that a

glossary of terms in use in the NHS should be provided. This would be useful

for trainers, as well as new volunteers.

(f) Objectives of the course

Several respondents felt that if patient representation was the focus of their

work, it should be the focus of the training course.


52

(g) Feedback to the learners

All of the respondents would have welcomed more constructive feedback during

the course, particularly after the first assignment, as this was seen as essential

to monitor the quality of their own progress. As many participants had not been

on a formal training course for a long time if ever, feedback would have given

them reassurance and guidance.

(h) Training days

One volunteer in the focus groups raised the possibility of introducing training

days. She felt that, bearing in mind the rapid changes in the NHS: ” … it would

be quite good to have a training day once or twice a year, to update your skills.”

(i) Recruitment issues

The issue of recruitment was raised during the focus groups. One respondent

explained that:

“It is difficult to get younger people to come along, ethnic (minority)

people to come along. It is very, very difficult to get people in their

twenties to come along and show interest. It is almost impossible.”

Another added:

“Of all the London boroughs, we have the youngest working population,

between 25 and 45, and to try and get them to come along and show any

interest is very, very hard.”

8.3. Volunteers who did not complete the training course

The three volunteers who did not gain accreditation were sent a questionnaire,

to establish the reason or reasons for their withdrawal. Three questionnaires

were returned. All three of these volunteers were in paid employment. One


53

respondent stated that the course would not add to his/her volunteering skills,

and the timing was unsuitable. Another felt that the training was not useful or

appropriate and would not equip him/her for effective representation. The other

volunteer left because he/she was paired with someone with whom he/she

could not work.

8.4. Telephone Interviews

Taped telephone interviews were carried out with 13 respondents who

participated in the training but who did not attend the focus groups. The data

provides internal validation of the key findings from the focus groups.

8.4.1. Interviews

The trainees interviewed by telephone had been unable to attend the focus

groups for various reasons, such as family responsibilities and time constraints.

The questions asked by the researchers mirrored those asked during the focus

groups. However, none of the respondents mentioned IT skills, although these

had been discussed during the focus groups.

Positive comments

Confidence

Similar to the focus groups, the large majority of the respondents

discussed how the training had improved their confidence. In particular

they felt that they now had more confidence in meetings.


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Quality of the training:

The following comments were extracted from the interview data:

“All the trainers were very friendly, helpful, focused and interested. They

were also interested in acquiring knowledge from us as well, and I

enjoyed it.”

“They (the trainers) were very obliging, very helpful. For those sessions

that were missed on the workshop, through commitments with meetings,

chairing meetings, all that sort of thing, you can’t put those things aside,

yes, they were very obliging. They filled in the gaps that we missed …”

“All the trainers and the administrators were all very charming and very

helpful.”

“I only made a couple of the workshops. So I had a very nice young man

come home and he sort of guided me through what I had to do. I found

that very good.”

“I thought it was very interesting, and I thought it was well structured …

very well organised and structured.”

“It was good. Professional. Good presentation, which you would expect

of trainers.”

“It was very good. I think overall it was quite informed, quite an

interesting course to follow, and I enjoyed it … gaining a certificate was

quite a good idea, and you have got some sort of document to say that

yes, you have done the course.”

The above respondent felt that as a result of the course, he now worked better

as a volunteer. He added:


55

“Sometimes you don’t think what you are doing, but when you are doing

that sort of course and you have to put these things into words, and

practice, then you learn also, and you gain some more.”

Level of the training course

Concerning the level of the course, one respondent, who had been a CHC

volunteer for six years, and had worked as a volunteer in the community for a

total of 15 years, had not found the course particularly easy. However, this

respondent added:

“I was lucky enough, you know, I had good trainers, to give me the help

and guidance.”

A respondent who had been involved in volunteering for 30 years said that he

found the training course “a challenge, but one that I was able to cope with.”

The other participants who were interviewed reported that they did not find the

course too difficult. As in the focus groups, many of the respondents suggested

that the course would be particularly suitable for younger volunteers:

“The one that we had, it was a pilot. I think we took part in that more

because it was a pilot scheme. I think that I wouldn’t have found it

particularly relevant … to take it.”

Networking and sharing best practice

The trainees acknowledged that the programme had provided a good

opportunity to share knowledge and experiences. The opportunity to meet and

learn from other CHC members was viewed as helpful in their role as

volunteers. For example, a respondent with ten years experience as a

volunteer stated:


56

“I think what came up for me in the training was fellow participants and

learning from them about their experiences and what they have been

doing, which is different or better than us. That was great, that was the

best part, I think.”

Another respondent, who had been involved in voluntary work for 20 years, also

reported that the opportunity to network had been particularly valuable:

“It brought together CFCs as a whole, gives them the chance to do more

networking than we would normally do, because we work together in

groups, you see. So there was a benefit there. I could see amongst my

own colleagues there was development there, and that was an

encouragement in itself.”

This respondent had found the seminars particularly useful:

“I think the actual seminars, where we all got together, that was very

interesting. We were doing work, and bringing work in, and sharing that

work with colleagues. I thought that was very good, I have to say,

because we were seeing a different perspective from our colleagues

from neighbouring CFCs. So that was interesting, I liked that.”

Another participant said that the most interesting part of the course had been:

“… meeting other people, exchanging ideas and viewpoints, learning

from others’ experience. It was quite beneficial.”

A respondent who had been a volunteer for 30 years, found the visiting

speakers on the conference to be the most interesting part of the training

course.


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Consolidation of prior learning

Respondents commented that the course had enhanced both the volunteers’

management and time management skills.

“I think it made one look more systematically at what one was drifting

along in, in a way. It made one actually codify the things one was

supposed to know, and how one should approach things.”

A volunteer with 8 years experience made the point:

“What I did like about it, it made you think about what you had done, and

to sort of put your thoughts about what you were doing in order.”

Evidence showed that the training course reinforced and consolidated the

volunteers’ existing knowledge and skills. One respondent commented:

“I think what it did, it very much confirmed to me the things that I was

familiar with, and that was definitely of value to me … It pulled a lot of

loose strings together. Things like equal opportunities, more recent

legislation that I wasn’t aware of.”

Accessibility

None of the respondents had experienced difficulty in travelling to the venue to

attend the training course. One respondent, who said he had difficulty walking,

reported that he had finally taken up the offer of assistance:

“I regret, really, because I have something called a disability, but if I am

ever asked if I have a disability, I never say yes, and claim special

arrangements. But I have difficulty walking a lot, you know. And I never

took up what was on offer there, except the very last gathering, the last


58

seminar. And I found that it was so arranged, it was so obliging, that with

hindsight I thought, well why didn’t I take advantage of this before? You

know, provision of parking up at the City Hall, and all that. I think it was

very well organised.”

Using the training in practice

A volunteer, who had worked for the CHC for 4 years, reported that:

“When I have visited, and carried out visits, it has been extremely useful.

It has enabled me to be more structured in assessing departments and

asking relevant questions … I felt more confident.”

This volunteer felt that she worked more effectively as a result of the course.

8.4.2. Interviews with the focus group participants

To elicit further examples of where the training had enhanced the volunteers’

practice, a further 11 telephone interviews were conducted with those who had

attended the focus groups. Questions were asked to establish whether the

volunteers could give any examples of skills they had learned from the training

that they had been able to use in practice as volunteers. The respondents

talked implicitly about how the training had benefited their practice,

particularly how their confidence had increased, but were unable to cite

explicit examples.

Summary of the recommendations of the volunteers who attended the

training course

• Exemption from some modules where trainees can demonstrate a

sufficiently high level of skill or knowledge .

• Introduction package, to include the aims and objectives of the course,

and the outcomes.


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• Constructive feedback to trainees, particularly after the first assignment

• Clear, focused assignment questions that provide the opportunity for

trainees to illustrate their knowledge and experience.

• Clarity in explaining tasks for trainees.

• Terminology should be explained.

Future programmes should include:

• More IT training, particularly e-mail training.

• Cultural awareness training.

• Health promotion and health inequality training.

• Training on new legislation, for example the merging of health and social

services.

• Training in youth and mental health issues.

• Placements and mentoring for new volunteers.

8.4.3. Interviews with the PPI Leads

Telephone interviews were carried out with four PPI leads in the London area.

They were asked what training for volunteers they thought would be necessary

in the future, for their comments about PPI forums, and any problems they

anticipated. The respondents felt there was a need to provide volunteers with

continuous training and development, and that it was necessary to start looking

at competencies and skills. Issues they identified include:

• There was a need for a good knowledge base about the NHS and the

people who work in it: the components, structure and functions of the NHS.

• It would also be necessary for volunteers to have up to date knowledge of

new legislation and initiatives.

• An understanding of confidentiality and anonymity was seen as essential,

as some information may be sensitive.


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• Skills in sharing information would also be required, for example raising

and discussing local issues for those people the volunteers represent.

• The volunteers would need clarity about their responsibility to the public.

• Skills were required to resolve conflict and move toward solution focused

approach.

• Other skill training included: negotiation skills, representation skills,

personal skills, communication skills and presentation skills.

Recruitment to Patient Forums

Generally the PPI leads did not consider that there would be any problems with

recruitment. However, concern was expressed about:

• Attracting volunteers of the right calibre, who are representative of the

whole community.

• The ways that volunteers will be recruited. Notably CPPI has started a

recruitment drive and advertising campaign.

It was agreed that better use could be made of the voluntary sector to attract

volunteers.

PPI forum needs:

• There was a need to have high quality administrative support in place for

meetings to run efficiently and productively.

• Forums need to be given time, support and resources.

• It is essential that all members have role clarity and shared aims.

• The commission needs to communicate more with all those who are

involved.

• Representatives from different groups of the community that are hard to

engage should be encouraged to join and/or to contribute.


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• It is necessary to understand the needs, roles and functions of the different

people and services within an organisation.

• A diverse population must be adequately represented

The telephone interviews with the PPI leads in the Strategic Health Authorities

identified “… a feeling of fear that patient forums would create CHC's in a new

form”. Respondents also stressed the need ”… to overcome challenges without

replicating CHCs”.

Summary of recommendations of PPI leads

• Training in confidentiality issues.

• Training in sharing information.

• Training and development about responsibility to the public.

• Training to contribute to forums effectively.

• Training to engage with NHS and its staff.

• Training to resolve conflict

• Solution-focused approaches

• Negotiation, representation, communication and presentation skills.

8.4.4. Interviews with the ASDAN trainers

Taped telephone interviews were carried out with four of the ASDAN trainers,

using a semi-structured interview questionnaire. The interviews lasted between

half an hour and one hour. Three of the respondents were female, one was

male. One of the trainers was registered disabled.

The respondents said that in all, eight staff had been involved in training on the

course, including two trainers who came specifically for conferences. The four

trainers who were interviewed were responsible for the administration and the


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main body of the training. The programme comprised of a series of

conferences. Trainers then assigned the volunteers to smaller groups and

workshops, with two trainers to each group. The groups varied in size, with

between four and ten people in each group. In addition there were follow up

telephone calls and one-to-one sessions for some individuals as the need

arose.

The trainers said that the attitude of the trainees to the course had generally

been positive. However, regular attendance had been a problem for some of

the volunteers. This was often due to time constraints:

“A thing we found about the voluntary people in the CHCs is that they

were, for want of a better word, almost professional volunteers, that it

wasn’t the only voluntary organisation they were involved in. They were

sometimes involved in as many as five, six seven different voluntary

(associations) and very actively involved in them. They are stretching

their time to the maximum. I think one person had something like 220

meetings in the course of the previous calendar year, which is a

phenomenal amount of time to be giving up, considering it involves

voluntary work.’

It was noticed by the trainers that attendance was very high at the conferences.

Trainer support and feedback to students

The trainers provided a high level of individual support for the trainees. For

example:

“One of the ladies had fallen and broken her hip, so there were house

visits to make … There was a lot of one-to-one work going on”


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“We spent a lot of time on the phone, possibly, if there was the

opportunity, a small chat afterwards, and occasionally we organised

smaller group get-togethers in which we would see people.”

The trainers were asked whether they gave feedback to the students about their

work, and to give examples of how this was done:

“A couple of times it was directly, there and then. Another time they had

to find out about their community. So they came back and told us all

about their community, and that was done at the conference’

Feedback was also given to the volunteers during the workshops. This was

done as a group, although one-to-one feedback was offered. When asked

whether this was adequate, one of the trainers replied:

“We sat down and we had lots of meetings about it, and really, if we think

about it, we should have maybe gone a little bit more into detail with the

individuals.”

Knowledge and skills gained by the trainees

The trainers spoke of how the respondents had gained new knowledge and

skills during the course. The following comments were made:

“I think they got to know an awful lot more about the NHS. They got to

learn from other CHC departments how they do things. I think it built up

a lot of their confidence, through talking in groups with people they’d

never met before. Communication, learning how to speak out, because

a lot of them were very quietly spoken. And the communication skills

improved from the start of the course. At the end, you could actually

notice it yourself … The biggest one, I think was the networking, and

getting to know what was available to them.”

“I think they gained a lot of knowledge of how other areas worked.”


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One trainer felt that the trainees had gained the ability to transfer knowledge

from one area to another:

“They had a big basket of knowledge. Almost like the networking of your

own knowledge that is not just specific to this one topic. The fact that I

get involved in diabetes, say, their needs and issues are no different to

the people who are in outpatients, or in heart treatment, or whatever.

They had all this knowledge.”

Concerning IT skills, one trainer said:

“We spoke to them about IT. London Health Link themselves were going

to sort out a course for them. So it’s going to be separately done.“

Other suggestions

A useful suggestion from the ASDAN trainers was that in future they would like

to offer training for the CCV in conjunction with either someone from the CHC or

the NHS, or the voluntary organisation that the volunteers would work with.

ASDAN would be responsible for training for the CCV, and the other person

would be there to debrief, pick up and correct anything that needed amendment

in the area of health care. It was also felt that the course would benefit from

more flexibility:

“A lot of them (the volunteers) have meetings they have to attend, they

just have a diary full of meeting … I would recommend (the course)

being over a year … I think you would get a lot more quality out of it.”

The trainers all felt that more conferences would be beneficial. The attendance

level on these had been very high, and it was felt that there was a good choice

of outside speakers. The conferences offered the trainees the opportunity to

“…mingle with other CHC members, and realise the way that others worked.”


65

The trainers felt that the location for the conferences had been good, and had

helped the students to develop a positive working attitude.

Recommendations of ASDAN trainers.

• Adequate access and parking for disabled people must be available at all

venues.

• Consider holding all the sessions at places other than the volunteers’

normal workplace.

• Initial assessment of volunteers’ knowledge and skills, possibly through a

focused interview and assessed group activity.

• Joint training, with ASDAN trainers responsible for the CCV, and

NHS/CHI representatives to train volunteers on terminology, structures

and procedures in the NHS (e.g. health and safety, equal opportunities).

• Increase use of e-mail and IT for coursework and assignments where

appropriate.

• More use should be made of conferences for activities and exercises

(e.g. workshops).

• Consider the possibility of running the course over a longer period of

time.

The ASDAN trainers have now adapted the training to include a basic skills

package, and a group activity has been designed to assess prospective

trainees. Also more IT has been introduced into the training package. This

module has been evaluated as successful.

8.5. Questionnaire survey

As part of this evaluation, all CHC members who did not participate in the

training programme were given` the opportunity to take part in a questionnaire

survey (See Appendix B). This was designed to investigate why some CHC

members chose not to participate in the training programme.


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A total of 463 questionnaires were sent out, and 114 were returned, giving a

response rate of 24.6%. This is an acceptable response rate for a

questionnaire survey of this nature. An analysis was carried out on these

questionnaires, and the results are outlined below.

8.5.1. Social profile of respondents

114 questionnaires were returned and analysed. Their age ranged from 34

years to 91 years. The average age was 62.25 years, and just over a half of

the respondents were women. Slightly over a third of the respondents were in

paid employment.

A total of 110 participants responded to the questions on disability and ethnicity.

Approximately one quarter of the respondents stated that they had a disability.

Table 1 shows that approximately three quarters of the respondents were

White-British.


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Table 1: Ethnicity of respondents who did not attend the training

programme

Ethnic Origin Number of respondents

Bangladeshi 2

White-British 81

Black African 2

Asian Other 1

White-Irish 5

Black Caribbean 4

Mixed-White & Asian 1

White – Other 5

Black UK 1

Mixed White & Black African 1

Mixed Other 1

Indian 6

8.5.2. Reasons for not participating in the training programme:

Of the 114 respondents, just under a quarter were not aware that the training

was taking place, while just under a third could not attend the information event

that took place prior to the training.

The respondents were asked about their reasons for not participating in the

training programme. They were also asked to rate the extent to which they

agreed with a list of statements on a five-point scale, ranging from ‘strongly

agree’ to ‘strongly disagree’.

Table 2 shows the number of people that rated their agreement for each item.

Mean scores were also calculated for each item. (Note: the higher the mean

score, the lower the agreement with the statement.)

It is clear from Table 2 that some of the statements show less varied responses

than others, suggesting that the majority of participants tended to either ‘agree’

or ‘disagree’ to a greater extent with these statements.


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Table 2: Reasons for not participating in the training programme

Statement

Strongly Agree

Agree Neither Agree nor Disagree

Disagree Strongly Disagree

Mean Score

1. I believe I have adequate volunteering skills

17 23 24 7 5 2.47

2. I believe I do not need any extra training

10 9 26 22 8 3.12

3. I felt it was of no value to me

15 17 19 21 6 2.82

4. I felt that being offered extra training was insulting

5 8 30 19 13 3.36

5. I feel that the travelling expenses should be paid in advance

6 9 16 18 24 3.61

6. I had other commitments

31 19 14 11 6 2.28

7. The course was too long

6 9 41 13 5 3.02

8. The course would take up too much of my time

13 15 25 15 6 2.81

9. I disagree with the changes occurring with patient representation

30 22 14 8 3 2.11

10. I felt the training may be too difficult

2 2 25 20 25 3.86

11. I felt the training may be too easy

4 8 28 23 9 3.34

12. I would find it difficult to reach the training destinations

10 13 33 13 7 2.92

13. I feel uncertain about the changes happening with CHCs

17 29 15 10 8 2.53

14. I feel that the information about the changes from CHCs to patient forums is unclear

33 23 8 6 5 2.02

15. My CHC had filled all the places

3 2 24 22 14 3.64

16. My CHC was unable to fund me

2 1 23 23 17 3.78


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45.5% of respondents believed that they had adequate volunteering skills

compared to 18.2% who ‘disagreed’ or ‘strongly disagreed’ with this statement.

(See Figure 2).

Figure 2: Perceived adequacy of volunteering skills

0

5

10

15

20

25

30

35

40

45

50

Strongly agree/agree Neither agree nor

disagree

Strongly

disagree/disagree

'I believe I have adequate volunteering skills'

%age of people

The mean score for item (6) 2.28 suggests that the majority of participants had

other commitments that prevented them from attending the training programme.

62% of participants cited other commitments as their reason for non-

attendance, compared to 21% who disagreed with this statement (see Figure

3).


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Figure 3: Other commitments

0

5

10

15

20

25

30

35

40

45

50

Strongly agree/agree Neither agree nor disagree Strongly disagree/disagree

'I had other commitments'

%age of people

Respondents were asked to comment on whether they did not attend the

training because of any of the following reasons:

- disability related needs

- language needs

- employment commitments

- caring needs

Table 3 shows that many respondents did not attend the training programme

because of employment commitments:

Table 3: Disability, language, employment and caring needs of

respondents Disability

related needs Language

needs Employment commitments

Caring needs

% age of participants

12.1 0 35.4 15.8

Of the 110 volunteers in the survey who responded to the question, 12.1% did

not attend the course because of disability needs.


71

8.5.3. The difficulty of the training programme

The mean scores for items (10) and (11) are 3.86 and 3.34 respectively,

indicating that their decisions about not attending the programme were unlikely

to be influenced by the level of difficulty of the training.

8.5.4. Changes in patient representation

The mean score for item (9) is 2.11, indicating that the respondents tended to

disagree with the changes occurring with patient representation. 67.6 % of

participants agreed with the statement: “I disagree with the changes occurring

with patient representation”, compared to 14.3% who did not (see Figure 4).

Figure 4: Changes in patient representation

0

10

20

30

40

50

60

70

Strongly agree/agree Neither agree nor disagree Strongly disagree/disagree

'I disagree with the changes occurring with patient representation'

%age of people

Figure 5 shows that the majority of participants (51.7%) felt uncertain about the

changes happening with CHCs. 19% neither agreed nor disagreed with the

statement on the questionnaire, while 22.3% disagreed.


72

Figure 5: Changes happening with CHCs

0

10

20

30

40

50

60


disagree

Strongly

disagree/disagree

'I feel uncertain about changes happening with CHCs'

%age of people

Similarly, the majority of participants (74.7%) also felt that information about the

changes from CHCs to patient forums was unclear. In comparison, only 14.6%

of participants disagreed with this statement.

Figure 5: Information about changes in CHCs

0

10

20

30

40

50

60

70

80


disagree

Strongly

disagree/disagree'I feel that information about the changes from CHCs to patient forums is

unclear'

%age of people


73

9. CONCLUSION

Many of the CHC volunteers who participated in the training course were highly

experienced in volunteering, and almost half of respondents in the survey of

volunteers who did not take part in the training course felt that they had

adequate volunteering skills. Only two respondents who attended the course

felt that they had not derived any benefit. Only a tiny minority reported that they

had found the training course a challenge.

There is evidence that the existing knowledge and skill of the volunteers was

consolidated and reinforced. Their subject knowledge was widened through

contact with volunteers in other CHCs. This developed their ability to see other

perspectives, an essential skill for advocacy and representation.

Both the volunteers who took part in the course and the ASDAN trainers felt

strongly that the knowledge, skills and abilities of volunteers should be

assessed before training begins. The volunteers, who had taken part in the

course, suggested that the training programme should be graded, in a similar

way to National Vocational Qualifications (NVQs), allowing trainees to progress

from elementary to advanced level.

In line with these recommendations, ASDAN now offer the CCV training course

at two levels. The QCA in England (and its equivalents in Northern Ireland and

Wales) approved the new qualification for volunteers, the ASDAN Level 1

Certificate in Community Volunteering, in 2003 for inclusion in the National

Qualifications Framework. For some volunteers, this Level 1 qualification will

provide a stepping-stone to the Level 2 ASDAN qualification or to vocationally

specific training and employment. For others, the certificate will be a sufficient

reward for their voluntary work.

Both Level 1 and Level 2 of the CCV are now widely available. Of the 3,000

ASDAN centres, 113 are currently registered to deliver the CCV. ASDAN

provide a high level of support for those who deliver the course, including:


74

• Workshops for trainers.

• Detailed written guidance on delivery and assessment of the course.

• Distance learning materials.

• A CDROM containing all the materials published by ASDAN to support and

deliver the qualification.

• Additional IT modules

Progression from elementary to more advanced levels of accreditation provides

volunteers with a framework for professional development training that can be

undertaken over a period of years. It is essential that the needs of volunteers,

as well as the organisation, are met, and that training courses offer an

achievable challenge for participants.

9.1.2. Communication and generic skills

It is clear from the results of the focus groups and interviews that people can

learn through sharing knowledge and experiences with each other, as well as

learning from their trainers. Other outcomes can be identified from the data as

a result of the training course, and these are particularly relevant for patient

representation.

The respondents in the focus groups reported higher levels of confidence

as a result of the training course, and spoke particularly of how that their

presentation skills had improved. Many respondents reported that they

had improved their organisational skills, such as time management and

prioritising their work. These skills are likely to enhance their

effectiveness as patient advocates, for example in presentations and

meetings. Respondents who could not attend the focus groups and took

part in telephone interviews also validated the finding that the knowledge

and skills they had gained during the course could be of more use in the

future. Furthermore, they all spoke of an increased level of confidence


75

that enabled them to conduct meetings effectively and demonstrate their

knowledge in different situations.

The respondents found the external events particularly valuable, as these

offered them the opportunity to network, to compare their work with that of other

CHC representatives and groups, and to share experiences and best practice.

The majority stated that this had been one of the most valuable aspects of the

training programme. Confidence, time management, networking and sharing

best practice are useful skills for volunteers to develop, bearing in mind the

wider remit of the new patient forums.

Applying theory to practice is a high-level skill, and the links between theory and

practice are sometimes obscure. It may be beneficial to include time on future

training programmes to discuss how the knowledge and skills gained during the

course could be used in their work as volunteers, for example, through

discussing relevant case studies, and drawing on the volunteers’ experience.

9.2. Accessibility

The respondents said that they all found the course intellectually accessible,

and most acknowledged the support they had received from the trainers to

complete the assignments. A key suggestion to assist clarity for both

volunteers and trainers concerned the request for a definition of NHS terms and

acronyms.

Concerning the physical accessibility of the training course, some volunteers

experienced difficulties in travelling to the conference events. During the

interviews with the volunteers, a female respondent mentioned that she was

unwilling to travel across London at night. A quarter of the volunteers who did

not participate in the training course were disabled, and almost half of these felt

that their disability was a barrier to participation in the training course.


76

Cost effectiveness

The completion rate for the training programme was very high at 95.5%, which

demonstrates the cost effectiveness of the course. Of the 66 volunteers who

began the course, 63 volunteers successfully completed and were awarded the

certificate. To further ensure the cost effectiveness the CPPI will be given the

opportunity to use the interim and final reports. In addition the GLa provided

City Hall for the conference venues and award ceremony free of charge. Also

local CHCs provided offices for local workshops without charge.

9.4. Quality

The majority of trainees who took part in the research reported that the training

had been of a high quality, and that participating in the course had been a

positive, rewarding experience. The quality of the conferences and the outside

speakers were particularly commended. All the respondents made positive

comments about the trainers, and said that they were friendly and helpful.

Respondents reported that some of the terminology on the course needed

explaining. During the course, the trainers built a glossary of terms and

abbreviations, so that everyone understood these. Trainers should consider

incorporating this practice into future training programmes.

It is well documented that learning needs feedback in order to be effective.

Some of the respondents recommended earlier feedback from the trainers,

particularly after the first assignment. As many of the volunteers had not taken

part in formal training since leaving compulsory education, and others had not

attended a formal training course for a long time, constructive feedback

throughout the course would have provided them with reassurance and

guidance. One trainer suggested that future courses should incorporate

“feedback time” and time for students to “catch up” on any work that they had

missed, and this should be considered.


77

Concerning the wider goals of the new patient forums, it is important that not

only volunteering, but also training courses, should be inclusive and widen

participation in community life, volunteering and learning. However this study

does not support the existing literature on volunteers and on adult education

and training, that certain social groups are under-represented in these activities.

Rather in this study older volunteers and ethnic minority group volunteers were

adequately represented on the training course. The findings suggest that more

attention needs to be paid to enabling disabled people to training venues and

recruiting young people to volunteering. However, this may not be the case in

other geographical areas and the respondents were keen to stress the need for

community inclusiveness in volunteering recruitment. Such measures will help

to provide the new patient forums with representative volunteers, who have the

knowledge and skills to enable them to operate effectively as patient

representatives.

To conclude, the stakeholders, the participants on the course, PPI leads and

ASDAN trainers have put forward useful, practical recommendations on how to

improve the training course. These can be used to shape future training

programmes so the needs of the volunteers, as well as the new patient forums,

are met.


78

10. AREAS FOR FURTHER RESEARCH

Continuing Professional Development (CPD) for volunteers

It is important to develop measures to support the continuing professional

development (CPD) of volunteers in the NHS, and develop structured career

pathways. This can aid the process of recruitment, training and retaining

volunteers. Further research could involve developing and testing a tool to

monitor career development pathways for volunteers, measure the support

mechanisms provided, and the extent to which the volunteer is acknowledged

and feels valued.

This study provides valuable baseline data for the first stage of such a project.

The essentially practical nature of action research makes this method

particularly suitable. Action research has been described by Cohen & Mannion

(1994) as: “… essentially an on-the-spot procedure designed to deal with a

concrete problem located in an immediate situation.” Ideally, the step-by-step

process is constantly monitored over time and by a variety of mechanisms

(questionnaires, diaries, interviews and case studies, for example), so that the

ensuing data may be translated into modifications, adjustments, directional

changes, and redefinitions, as necessary, so as to bring about lasting benefit to

the ongoing process itself.

Using an action research design, the results of the present study could be

implemented into practice, and then further research would be undertaken to

evaluate the effectiveness of the changes made. Based on the findings, the

training course for volunteers could be refined over a period of years. An action

research design would allow any background factors that might exert an

influence on the success of the training courses, for example changes in the

way the training course is funded, to be taken into consideration.


79

11.2. Social inclusion

It is particularly important to ensure that training and volunteering are inclusive

activities. Longitudinal research is needed to monitor and evaluate any

differences in the social profiles of the participants and non-participants of both

the new patient forums, and associated training courses. This would establish

whether people who, according to the established literature, are currently

under-represented in volunteering and in training, for example disabled groups,

ethnic minority groups, young adults, and older people, are adequately

represented in al range of different geographical areas.

Finally, it is a notable fact that the volunteers in this study, who, as a group of

predominantly older volunteers, including 25% minority ethnic volunteers, were

acutely aware of the pressing need to ensure that the health of the nation is

represented by volunteers drawn from a cross section of all communities.


80

12. BIBLIOGRAPHY

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ACHCEW website, accessed on 14.1.04

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emergency pressures on patient care, February 2000, Royal College of

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14.1.04

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accessed on 14.1.04

Beinart, S. and Smith P. (1998) National Adult Learning Survey 1997, Research

Report 49, DfEE, London

Broadbridge, A. and Horne, S. (1999) Volunteers in Charity Retailing:

Recruitment and Training, Non-profit Management and Leadership, Vol. 6 No.3,

Spring 1996

Burke, A. (2000) Health Matters, December 2000 accessed ib 14,1,03 at

http://www.healthmatters.org.uk. See also Burke, A. (2000) The NHS Plan:


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Stifling the patients’ voice? British Journal of Community Nursing, November

2000

Bussell, H. and Forbes, D. (2003) The volunteer life cycle: a marketing model

for volunteering, Voluntary Action, Vol. 5, No. 3, 2003

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London, Routledge

Cox (2002) Rewarding volunteers: a study of participant responses to the

assessment and accreditation of volunteer learning, Studies in the Education of

Adults, 1st October 2002, Vol. 34, No. 2, pp. 156-170

Cunningham, I. (1999) Human resource management in the voluntary sector:

challenges and opportunities, Public Money and Management, April-June 1999,

pp. 19-25

Davis Smith, J. (1998) Volunteering in the NHS – a report of a survey, National

Centre for Volunteering

Department of Health (1996) Making a difference: strengthening volunteering in

the NHS. Department of Health, NHS Executive: London

Department of Health (1998) In the public interest: developing a strategy for

public participation in the NHS. Department of Health, Institute of Health

Services Management and NHS Confederation: London

Department of Health (1999) Promoting Volunteering and Relations with the

Voluntary Sector in The NHS and Social care, Health Service Circular HSC

1999/023: LAC 99(6) 5th February 1999, Department of Health: London


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Department of Health (2000) The NHS Plan: A plan for investment, a plan for

reform, No. Cm4818-1, July 2000, HMSO, London.

Department of Health (2001) Working Lives: programmes for change –

Positively Diverse, HMSO, London.

Fitzgerald, R., Taylor, R. and LaValle, I. (2003) National Adult Learning Survey

(NALS) 2002, Department for Education and Skills.

Gaskin, K. (2003) A choice blend – What volunteers want from organisation and

Management, Institute for Volunteering Research

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volunteers in sports clubs, Managing Leisure, Vol. 3, No. 3, 1998, pp. 119-127

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School, University of Warwick

Hibbert, S., Piacentini, M. and Al Dajani, H. (2003) Understanding volunteer

motivation for participation in a community-based food co-operative,

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Hooper-Greenhill, E. and Chadwick, A. (1985) Volunteers in museums and

galleries: a discussion of some of the issues, Museums Journal, Vol. 84, No. 4,

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report of a survey, London, Institute of Volunteering Research

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want from organisation and management, Institute for Volunteering Research

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a report of a survey, Institute of Volunteering Research

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La Valle, I. & Blake, M. (2002) National Adult Learning Survey 2001,

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of Scottish Heritage, Edinburgh University Press, Edinburgh

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85

Appendix A

TELEPHONE INTERVIEW WITH ASDAN TRAINERS

DATE OF INTERVIEW: NAME OF TRAINER:

1. How were the sessions organised?

2. How many trainees were in each session/group? 3. What was the general attitude of the volunteers to the course?

…………………………………………………………………………..

4. Do you think you were adequately prepared to undertake the training?

Yes No

5. At the start of the course, do you feel you had adequate knowledge of the NHS?

Yes No

6. At the start of the course, do you feel you had adequate knowledge of current issues in healthcare?

Yes No

7. Do you feel that there was any confusion about the terminology and abbreviations that you or the students used?

Yes No

8. Do you think you had enough information about the people who

would be undertaking the training course?

Yes No 9. Before the course began, were you informed about their:

Yes No

- Age? - Any disabilities they had?

- Their ethnicity?

- Prior qualifications?

- Level of knowledge and experience?


86

- 2 -

10. How did you give feedback to the students?

………………………………………………………………………………

11. What skills did you feel the students gained during the course?

……………………………………………………………………………. 12. How do you think future training courses could be improved?

Age: Gender M F How long have you been involved in training?


87

Appendix B CHC VOLUNTEER TRAINING – NON ATTENDEES

Section 1 I did not participate in the ASDAN training because:

I knew nothing about the training Yes □ No □

I could not attend the information event Yes □ No □

I did not participate in the ASDAN training

because:

Strongly

agree

Agree Neither

agree nor

disagree

Disagree Strongly

Disagree

I believe I have adequate volunteering skills

I believe I do not need any extra training

I felt it was of no value to me

I felt that being offered extra training

was insulting

I feel that the travelling expenses should

be paid in advance

I had other commitments

The course was too long

The course would take up too much

of my time

I disagree with the changes

occurring with patient representation

I felt the training may be too difficult

I felt the training may be too easy

I would find it difficult to reach

the training destinations

I feel uncertain about the changes

happening with CHCs

I feel that the information about the

changes from CHCs to patient forums is unclear

My CHC had filled all the places

My CHC was unable to fund me


88

I did not attend the training because of: (you may tick more than one box)

a) disability related needs Yes □ No □

b) language needs Yes □ No □

c) employment commitments Yes □ No □

d) caring needs Yes □ No □

Any further comments:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________

Section 2

We are interested to see if we are reaching all members of the community. The

following questions therefore ask for some background information.

1. Are you

a. Male

b. Female

2. Do you have a disability?

a. Yes

b. No

3. How would you describe your ethnic origin?

Bangladeshi Pakistani White – British

Black African Asian – Other White – Irish

Black Caribbean Mixed – White & Asian

White – Other

Black UK Mixed – White & Black African

Not Known

Black – other Mixed – White & Black Caribbean

Chinese Mixed – Other

Indian

4. Are you currently in paid employment? ....................

5. What is your age in years? ........................

Thank you for your co-operation.


89

Appendix C

CHC VOLUNTEER TRAINING – ATTENDEES WHO DID NOT COMPLETE

THE TRAINING

Section 1

I decided to leave the training because: Strongly

agree

Agre

e

Neither

agree

nor

disagre

e

Disagre

e

Strongl

y

Disagre

e

The training did not meet my personal needs

I felt the training was too difficult

I felt the training was too easy

I believe the training did not add

to my existing volunteering skills

I did not think the training was going to

equip me for effective patient representation

I found it difficult to reach the

training destinations

The training was taking up to much

of my time

I felt the timing of the course did not

suit my personal arrangements

I did not choose to leave the training course

but extenuating circumstances forced me to

I did not complete the training because of: (you may tick more than one box)

a) disability related needs Yes □ No □

b) language needs Yes □ No □

c) employment commitments Yes □ No □

d) caring needs Yes □ No □

Any Further Comments:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

_________________________________________________________________


90

Section 2

We are interested to see if we are reaching all members of the community. The

following questions therefore ask for some background information.

1. Are you

Male □

Female □

2. Do you have a disability?

Yes □

No □

3. How would you describe your ethnic origin?

Bangladeshi Pakistani White – British

Black African Asian – Other White – Irish

Black Caribbean Mixed – White & Asian White – Other

Black UK Mixed – White & Black African Not Known

Black – other Mixed – White & Black Caribbean

Chinese Mixed - Other

Indian

4. Are you currently in paid employment? ....................

5. What is your age in years? ........................

Thank you for your co-operation.

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