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Volunteers at work

Faced with an enormous backlog of patients waiting for treatment, and unprecedented levels of vacancies, the NHS is planning to recruit a volunteer army. But what is the likelihood of appeals for volunteers succeeding, and what impact might they have?

Let’s start with a thought experiment. Could volunteers substitute for paid professional staff even in a quantitative sense? It’s estimated that there are 133 000 vacancies in the NHS, but most will be for specialist roles in which replacement by volunteers would not be feasible; and even if it was, it could breach long-standing guidelines in the NHS which guard against substitution of paid staff by unpaid volunteers.

But even if volunteers could cover 10% (13,000) of the roles for which there are vacancies, the NHS would require an additional 200 000 people, based on what we know about the weekly commitments of the most committed group of volunteers - averaging around 2.5 hours per week. 

Many people simply don’t have the resources or time to volunteer. The UK labour market is characterised by growing levels of precarity, which is unhelpful if you want people to have the time and space to make regular commitments to their communities.

Professor John Mohan - Director of the Third Sector Research Centre, University of Birmingham

Surveys estimate that some 17% of people carried out ‘formal volunteering’ – through a setting such as a group, club or organisation - at least once a month. That’s around 9.2 million people; recruiting 200,000 more equates to a 2% increase in volunteering, which would constitute a startling reversal of a recent decline. The numbers of people volunteering on at least a weekly basis – which would be needed to sustain a 24-hour public service - is likely to be much smaller still; perhaps fewer than 10% of adults engaging in the sort of weekly commitment the NHS would need.

Would people respond on this scale?

Many people simply don’t have the resources or time to volunteer. The UK labour market is characterised by growing levels of precarity, which is unhelpful if you want people to have the time and space to make regular commitments to their communities. A long-established body of social science established the connections between “orderly careers” and social participation of all kinds. Recent British studies of recessionary periods clearly show the adverse impact of economic dislocation on involvement; experiences of labour market precarity have scarring effects on participation that are evident decades later. However urgent the underfunding of the NHS, launching an appeal for volunteers in the middle of a cost-of-living crisis is not great timing.

Potential volunteers aren’t necessarily to be found where their support is needed most – the largest contributions to voluntary efforts come from a relatively small “civic core” – a prosperous, middle-aged, well-educated subset of the population. Many reside in the most prosperous parts of the country. Geographical variations in volunteering are not, as implied in some commentary, a matter of community-level deficiencies in the propensity to engage in pro-social behaviour; they are strongly related to the resources available to different communities and their residents. Thus, the NHS would also face the challenge of ensuring that volunteers are available where pressures on the service are greatest.

Much will also depend on the nature of the appeal. A key influence on volunteering is whether people are asked to engage; crafting a convincing message is crucial. Studies of attitudes to volunteering show that the public are sceptical about appeals to close gaps in underfunded public services. This was found to be the case in the mid-1990s, and when we repeated questions from a study in 2012. The latter study revealed profound scepticism and cynicism, including from committed volunteers, about David Cameron’s ‘Big Society’ ideas; many wanted nothing to do with stepping up to the plate to compensate for austerity. With well-established evidence documenting how limited the growth in NHS spending has been in the past decade, expect a sceptical reaction.

What about the Covid NHS volunteers?

It's true, of course, that an appeal for NHS volunteers in the early stages of Covid – 19 provoked a substantial response, with an estimated 750,000 people putting their name forward. There was also substantial involvement in fundraising; very large numbers of people engaged in voluntary acts of an informal nature, supporting vulnerable residents in their communities; and many people also supported NHS workers directly in several ways. These efforts were collectively directed at supporting individuals – people who were perceived as vulnerable, either because they were shielding from the pandemic, or because they were directly exposed to it, such as the NHS workforce. This is quite different from an appeal to compensate for underfunding and staff shortages. Even so, the wave of goodwill appears to have subsided: survey evidence suggests that despite the optimism expressed in 2020 about building on the momentum from this outpouring of support, the increase in volunteering was short-lived.

One issue that policymakers can focus on is how to communicate the need for and the distinctive contributions of volunteers to the NHS. Given trends in volunteering, there are likely to be challenges recruiting volunteers anyway, so alienating potential recruits is potentially harmful. There also needs to be a recognition that volunteering is not a ‘free good’ for the NHS or an untapped resource that can be drawn on unproblematically. Instead, it cannot be taken for granted, but requires investment in the infrastructure to mobilise and maintain it, as well as close partnership working with NHS organisations.

The NHS was founded in 1948, a year which also saw the appearance of Lord William Beveridge’s major volume on Voluntary Action, following on from his influential reports laying foundations for the post-war welfare state. His 1948 report suggested that the welfare state could play a significant role in meeting the ‘material needs of individuals’, which would provide foundations for them to give back to their communities. That’s a lesson that governments could also learn today.