Volunteering in health and social care is a big deal. A 2013 King’s Fund report estimated that about three million people volunteer in health and social care across England.   

The volunteering landscape is complex. Volunteering is organised by NHS organisations, large charities like the British Red Cross and Royal Voluntary Service, and small community groups. It encompasses a large array of roles such as first responders, befrienders, interpreters, independent living supporters and health champions. It ranges from high level governance to front line activities like meeting and greeting hospital visitors. We are all familiar with volunteers in hospitals. But the focus can also be on reducing social isolation in the community. Or it might be about supporting service change and improvement, such as the work of the patient leaders highlighted in David Gilbert’s new book The Patient Revolution or the collaborative practice model developed by Altogether Better. Volunteering can be a set of stand-alone activities, or part of a broader initiative to improve public health like Healthier Fleetwood.  

The King’s Fund research suggested that volunteers play an important role in improving people’s experience of care, building stronger relationships between services and communities, supporting integrated care, improving public health, and reducing health inequalities. The support that volunteers provide can be of particular value to those who rely most heavily on services, such as people with multiple long term conditions or mental health problems. And there are also benefits for staff and for the volunteers themselves.

In a health and care system that is under huge funding, workforce, and demand pressures, it is no surprise that volunteering has risen up the agenda. The NHS Long Term Plan commits the NHS to doubling the number of volunteers over three years and confirms more than £2 million to boost the Helpforce volunteering programme. 

These are worthy intentions, but translating them into good outcomes is not straightforward. How best to do it? The latest initiative from NHS England and NHS Improvement illustrates some of the paradoxes of national efforts to promote good local things. It is a three year programme, available to all the STP/ICS areas in England. It requires applicants to “identify and develop an appropriate volunteering approach that can be integrated into your system transformation plans towards your priorities and outcomes.” Successful areas will receive £35,000 in the first year. A small subset of promising areas will receive more funding in years 2 and 3, amounting to some £150,000 each. And an infrastructure of shared learning and support is offered in addition to the funding. Applicants had 8 days, from the publication of the scheme documents, to lodge an expression of interest.

At best this scheme might accelerate the development of volunteering activities that work and add value.  But there are pitfalls. Volunteering is not a simple mechanism that can be “rolled out”. It is a rich ecosystem of activities. The challenge is not only about establishing what works (and the evidence base is patchy).  The kind of volunteering we choose to favour also reflects our values and priorities. And there is a danger of unintended consequences, for example, that new initiatives displace or undermine existing efforts or create perverse incentives and behaviours.  

In all its variety volunteering is at heart a grassroots thing. It’s about people helping other people, or people coming together in a common purpose. The good things that arise from these efforts are often messy, unplanned, and unforeseen. Offers to support and grow them will probably work best when they are locally owned, go with the grain of existing activities, and are kept free of excessive bureaucracy.    

It is by no means clear that there is such a thing as “an appropriate volunteering approach that can be integrated into system transformation plans.” It is a very managerial notion. “Come up with a plan that dovetails with your other plans”. STP areas cover populations of a million people or more and are probably at the wrong scale when it comes to volunteering. £35,000 is a drop in the ocean; much of it will be swallowed up in the red tape of contract management. More (uncosted) NHS time will have been spent by staff scurrying round to draft an expression of interest within the madcap deadline. 

“Integrated volunteering approaches” is a nice idea but illustrates some of the dangers of NHS top down initiatives. Much volunteering is supported by small, hard pressed and under resourced local community groups. Why not give the money to them instead?

Jeremy Taylor is an independent consultant and former CEO of National Voices. He is a member of the BMJ patient panel.  

Competing interests: None declared