Financial capability: are we focusing on the wrong sort of behaviour change?

Screen Shot 2018-10-29 at 16.23.07 copyIdeas to Impact working in partnership with Vista, CALS and the WEA undertook an evaluation of workshops for older people funded through the Money Advice Service What Works? programme.  The full report is downloadable on the Vista Leading the Agenda webpage or the Money Advice Service Evidence Hub.

The research originally intended to answer the question:

Is support around money management more effective when delivered within the wider context of older people’s lives than solely focusing on money knowledge and skills? 

We ran into some methodological and practical issues in relation to recruitment of participants, and despite reaching some of the most socially and economically excluded people in the country, in particular older Asian women living in the most deprived wards in Leicester, MAS asked us to stop the project before we had completed the evaluation, although we did have 163 survey responses and had run two focus groups from which the results below come.  The issues and implications around the practicalities of running evaluations in the VCS will be covered in a blog post to follow shortly.  In the meantime this post focuses on one of the key issues to emerge from the project.

Does financial capability training and support lead to financial behaviour change?

A report commissioned by MAS, Financial capability and wellbeing[1] states, “behavioural economists report that most individuals do not behave rationally and predictably, when it comes to spending money. Even though an individual may be financially literate, this same individual may behave in an irrational financial manner”.  The paper Financial Literacy, Financial Education and Downstream Financial Behaviors[2] describes a meta-analysis of financial capability interventions and concluded, “Our meta-analysis revealed that financial education interventions studied explained only about 0.1% of the variance in the financial behaviours studied, with even weaker average effects of interventions directed at low-income rather than general population samples”.

Much of the existing literature around financial effectiveness and behaviour change talks as if it were a given that people’s financial goals are paramount in their decision making, as opposed to people deciding not to act in their financial best interests because something else is more important to them. Behaviour change techniques such as goal setting, regulation, social pressure, and rewards are suggested, but no number of techniques focused around financial capability are going to be effective if it’s focusing on the wrong behaviour.

Some of the reasons that people in our project gave for less than logical financial behaviour included:

“My health is bad, if I don’t spend money on myself now my life is not worth living.”

“I don’t want to cause difficulties in the family by asking my husband about money.”

“If I save for the future I won’t have much money now, and I still can’t save enough to make a difference in the future anyway, so I might as well enjoy it now instead of being poor now and poor in the future.”

“I find keeping track of money stressful and I don’t want to do something that causes me stress.”

“I do not use savings accounts because they are not Islamic.”

“I know direct debits are cheaper but putting money into a meter I know what I’m spending.”

“I stay with British Gas because I know they’re a good company.”

What does this mean for practice?

The statements above are all logical decisions in some way, it’s difficult to fault any of them, and yet we may still believe that there is a need to change financial behaviour.  This means and there is a need to look broader than financial capability knowledge and skills to change them, for example:

  • Running whole-family workshops, or workshops around financial capability that were targeted at how to talk to family about money perhaps depending on how good people’s relationships with their families are?
  • For the woman who was worried about cultural traditions and upsetting her husband, support needs to be focused around how she addresses this first.
  • For the man who feels he has to spend money or his life is not worth living, behaviour change could address how he could feel as though he could make his life worth living through activities that are low or no cost, or how improving his mental and emotional health might be key to reducing spending.

Of course, this will be no surprise to the agencies who are at the sharp end of supporting people day in and day out.  After all, money advice did used to be called debt counselling, and advice agencies supported people across a wider range of issues than “just” advice.  To some degree the change towards a more focused financial capability intervention and away from the broader issues was caused by a positive effort to stop advice being given by people who were well meaning but legally-challenged, for example with the development of the Community Legal Service Quality Mark, which I was involved in developing on behalf of the advice sector with the now defunct Legal Services Commission (the Quality Mark is now the Advice Quality Standard).  On the other hand, commissioning of advice services has become more restrictive and it is often difficult to find grant funding for advice, so it has also divorced many advice services from being able to take a more holistic approach.

Call to action

What can be done?  None of this is rocket science, many organisations are already doing this, but there may be opportunities for further partnerships:

  • For advice agencies getting out into the community to deliver advice in conjunction with other organisations.  This will also help with the need that many participants expressed to have support on an ongoing basis rather than as a short term intervention.
  • For community organisations inviting advice services into your organisations and looking at joint funding bids.
  • For funders and commissioners – recognise the important role that advice plays in communities, but also that this will be a revolving door or have reduced impact without addressing the broader issues that people face.
  • For all, consider how your practice captures the range of factors that people might use when financial decision making and equip your staff with the knowledge and skills for effective behaviour change.

[1] Money Advice Service (2015) Financial Literacy, Financial Education and Downstream Financial Behaviors, available from https://mascdn.azureedge.net/cms/financial-capability-and-wellbeing.pdf

[2] Fernandes et al (2013) Financial Literacy, Financial Education and Downstream Financial Behaviors, available from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2333898

How can volunteering improve health outcomes?

I was lucky yesterday have an opportunity to discuss volunteering in healthcare settings, primarily hospitals, with NCVO, NHS England, NHS Trusts, a Healthwatch and Investing in Volunteers assessors. In the NHS’s Five Year Forward View, increasing community engagement including through volunteering is one the aims (see chapter 2).  The purpose of the meeting was to look at how working towards and gaining Investing in Volunteers could help with this.

Organisations that have achieved the Investing in Volunteers quality award identify that it has had a positive impact on their volunteering programmes (see the Investing in Volunteers Impact Assessment downloadable from WCVA), but I wondered what the bigger picture was in terms of evidence about how volunteering helped to improve patients’ health outcomes.

So here are some of my thoughts after a quick review of the literature on the way home.  I look at:

  1. The type of support the volunteers provide
  2. How these help healthcare services to achieve their outcomes
  3. How Investing in Volunteers can help with this process.

It’s not intended to be exhaustive, it’s a fairly short train journey back to Market Harborough, but I think provides a case:

  1. For the value that volunteers bring to patient satisfaction and health outcomes; and,
  2. That properly resourcing and managing the volunteer management programme makes a difference to these outcomes.

What sort of support do volunteers provide?

Faulkner and Davies (2004) break down volunteering support into four categories – the interpretations and comments are mine:

  • Appraisal support that helps someone to think through the situation they are in, the impact on them, and how they might be able to deal with something, this could be counselling, but could be key worker / support worker roles.
  • Informational support is, as it says, providing information to someone and can also include referral.  This might include advice services in GP surgeries or social prescribing.
  • Instrumental support is practical help, this could include support to help people to leave hospital and return home, such as safety checks, getting food in, settling someone back at home, or may involve providing goods, services or financial help.
  • Emotional support that helps a person feel cared for, listened to, understood, this is typically provided by volunteers on wards, outpatients departments, clinics etc.

It is the power of volunteers to provide emotional support and why this is so important that I will focus on.  The impact of social isolation on health is well documented.  Hilary Cottam in a paper or excellent and thought provoking TED Talk  discusses how public services have become a series of transactions, but what is really transformation is the relationship between people – for example we know that the strength of the relationship between a therapist and a client is more important than the specific approach they take (De Haan, 2008).

Neuroscience helps with explanation: our brains are not optimally configured but have adapted over time and the different parts are not always working in harmony with each other.  The best model that we have is that of the triune or three part brain, a reptilian part that deals with instinctive behaviour, the mammalian brain that developed to care for our young that processes emotions, and the prefrontal cortex, the rational thought bit that we prize in the west.  Because of this Lewis et al point out, much of people’s brains are not “amenable to the pressure of argument and…much of one’s brain does not take orders” (2001: 33), instead identifying that changing how someone feels is a matter of tuning in to them at an emotional level, which has the ability to stablise and change their emotional state.  It is this that clinical staff often don’t have time for, but volunteers do.  Handy and Srinivasan (2004) highlight the important role of volunteers in reducing patients’ anxiety, which they identify is important in quality of care.  In addition, Hotchkiss et al cite research in America that “volunteers are more agreeable and extroverted than paid employees who performed the same jobs. This allows what otherwise might be an impersonal environment to become more personal and enhances patient satisfaction” which they theorise gives the organisation a “competitive advantage,” a notion that might be a bit strange (at least at the moment) to our NHS (2014: 1112).

In what ways can volunteers help healthcare services?

Hotchkiss et al (2014) identify a number of ways that volunteers can help hospitals or other services:

  • Improving health outcomes through the activities above – researchers identify that more work needs to be done directly to link volunteering to health outcomes (e.g. Naylor et al in a Kings Fund report state, “There is a striking lack of information about the scale or impact of volunteering in health and social care. Addressing this should be a priority.”(2013, viii)).  However, a picture is starting to emerge through some of the research cited in this article, and other initiatives such as social prescribing that are being developed (although these are not new, Faulkner (2004) evaluated a social prescribing type service in South Yorkshire in 2001-2).
  • Increasing capacity and helping out staff Both Jones (2004) and Handy and Srinivasan (2004) surveyed staff in hospitals and found that they rated volunteers’ support highly in helping with their workloads.  The latter found that providing personal care, providing support to patients and families in waiting rooms, clinics, support groups, and providing companionship and friendly visiting were most important for staff.
  • Delivering early intervention and prevention activities either in the hospital or in the community, including peer support provided by volunteers who have had similar experiences.
  • Providing positive messages about the health service to communities Jones (2004) identified that this can help to combat poor media coverage or poor general impressions, also suggesting that volunteers from diverse communities can help to increase social inclusion and community cohesion.
  • Reducing people’s stay in hospital through hospital to home schemes, providing support for people to leave hospital who are currently there because of the need for social care / support rather than for medical reasons.
  • Increasing donations to the hospital Handy and Srinivasan (2004) found that volunteers highly likely to donate to hospitals in fundraising campaigns as well as to be ambassadors into the general community.

Can Investing in Volunteers help to improve health outcomes?

Hopefully the case for involving volunteers in healthcare has been demonstrated, but what might the role of Investing in Volunteers be in improving both effectiveness and efficiency for hospitals?  Rogers et al (2016) investigated whether hospitals taking a cost-driven approach to volunteers (minimising costs) or a quality maximising approach (putting investment into volunteers) had any effect on patient satisfaction.  Their findings were that there was a positive relationship between good volunteer management and patient satisfaction.  Interestingly this related to volunteers opportunity and ability to perform, but had no impact on their motivation.  We know that Investing in Volunteers has been demonstrated through the impact assessment to improve volunteer management, so we could infer from this that Investing in Volunteers can help to get the best out of your volunteers, which will ultimately improve the outcomes identified above.

Other resources and developments

The Institute for Volunteering Research along with NAVSM has published Health check A practical guide to assessing the impact of volunteering in the NHS this discusses their work in a number of NHS Trusts across the country.

The Institute for Volunteering Research is also working with researchers in Canada to investigate the role of volunteering in helping people coming back home from hospital.

Bibliography

De Haan, E. (2008) Relational coaching. Chichester: John Wiley.

Faulkner, M., & Davies, S. (2005). “Social support in the healthcare setting: The role of volunteers” Health and Social Care in the Community, 13.

Handy, F., & Srinivasan, N. (2004) “Valuing volunteers: An economic evaluation of the net benefits of hospital volunteers” Nonprofit and Voluntary Sector Quarterly, 33

Hotchkiss, R., Unruh, L., and Fottler, M. (2014) “The Role, Measurement, and Impact of Volunteerism in Hospitals” in Nonprofit and Voluntary Sector Quarterly, 43(6)

Jones, H. (2004). Volunteering for health. Wales Council for Voluntary Action, Welsh Assembly Government. Available at www.wales.nhs.uk/documents/volunteering-for-health-report-e.pdf

Lewis, T., Amini, F. and Lannon, R (2001). A general theory of love. New York: Vintage Books.

Naylor, C., Mundle, C., Weaks, L., Buck, D. (2013) Volunteering in health and care Securing a sustainable future, The Kings Fund, available from http://www.kingsfund.org.uk/publications/volunteering-health-and-care

Rogers, S., Jiang, K., Rogers, R. and Intindola, M. (2016) “Strategic Human Resource Management of Volunteers and the Link to Hospital Patient Satisfaction” in Nonprofit and Voluntary Sector Quarterly 45(2)