VOLUNTEERING in hospitals has a long history in this country, going back to the First World War at least. But its contribution has often been undervalued and overlooked, the health think tank the King's Fund says. 

Recently, however, that has begun to change. In 2011, the Department of Health (DH) declared: "Our vision is of a society in which social action and reciprocity are the norm, and where volunteering is encour­aged, promoted, and supported wherever it has the power to en­­hance quality, reduce inequality, or improve outcomes in health, public health, and social care."

Two years later, in March 2013, the King's Fund published a report commissioned by the DH, Volun­teering in Health and Care: Securing a sustainable future. This was followed, eight months later, by a second report, specifically on volunteering in acute hospitals in England.

"We were surprised, frankly, at just how diverse volunteering already was, and at where hospital managers were planning to take it," one of the report's co-authors, David Buck, says. "Almost everyone said they wanted to work more with volunteers in the future rather than fewer.

"Forward-thinking hospitals recognise that they need to be more connected to their local commu­nities, to help people to stay healthy outsidetheir walls; and [that] bring­ing in volunteers from those com­munities is part of that connection." 

THE King's Fund estimated that there were more than 78,000 volun­teers in acute trusts across England. That figure does not include the con­tribution of volunteers in mental-health trusts, general prac­tice, and other settings, or those who give their time in a governance capacity in acute trusts.

In 2008, Volunteering England estimated that volunteers in acute hospitals produced an average "return" of £7 to £10 for every £1 invested. But after the 70,000 Games Makers at the 2012 London Olympics demonstrated how much value volunteers can add, King's Fund researchers recalculated the value of volunteers in the health- and social-care sector, in 2013, to be worth £11 for every £1 invested.

None the less, the report authors also sounded a pessimistic note: what would be the impact on volunteering, they asked, if the private sector was to play a much bigger part in the NHS? What would the effect of cost-cutting be on volunteering if money ran out? Was there a threat, real or perceived, that volunteers could take away people's jobs? "We will do huge damage if we start using volunteers to save money," one health professional was quoted as saying.

In looking at the importance of volunteers' helping the future sustainability of the NHS, the March report stated: "It is doubtful whether the system could continue to operate without them." It acknow­ledged, however, that, while volunte­ers do not undertake profes­sional roles, their support adds much to enhance the patient experience - through their involvement in Feeding Buddy schemes (providing extra support to assist patients with eating and drinking while in hospital), infor­mation points, chaplaincy services, and more.  

MORE than two years have gone by since Volunteering in Health and Care, and, Mr Buck says, "many of the pointers are quite positive." The visibility of volunte­ering in hospitals has improved greatly, he says, and it is being seen not as something marginal but mainstream. Policy-makers at the DH and NHS England, as well as hospital manage­ments, are paying it increasing attention, and more examples of good practice are emerging.

"Trust boards are starting to re­­alise that it's worth thinking stra­tegically, and investing in recruiting, training, managing, and supporting volunteers" rather than "finding them something to do when they come through the door", Mr Buck says. What's more, the Government has ploughed £600,000 into "Help­ing in Hospitals" - an initiative from the social-innovation charity Nesta. In a scheme launched last summer, it is assisting six pioneering hospital trusts to expand their existing volunteer schemes.

Some hospitals have embraced the potential value volunteers can offer to patients. King's College Hospital, in London, has had a big push on volunteers since 2010, and in five years has increased its roster from 150 to more than 1400. One hospital mentioned in the acute-trusts report had a staff of 2000 and 1200 volunteers.

When the Pennine Acute Hospitals NHS Trust appointed its first volunteer co-ordinator in 2008, volunteering "took off", Mary Sunderland, who took up the post, says. "We've got volunteers on reception, in many of the wards, in the pharmacy, in theatres, in outpatient clinics, being cancer buddies, driving minibuses, doing patient-experience surveys. We've got 56 volunteers in the chaplaincy. But we still have more people wanting to volunteer than we can accommodate.

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"Anybody can volunteer as long they've got the right attitude, and I enjoy creating opportunities for everyone. Ultimately, it's all about the small things that make a big difference - things that the nursing and clinical staff can't do because they're so busy."

FEARS of "job substitution" do not seem to have been realised. "I hope we have helped to allay them by establishing clear boundaries between what a professional can do safely, and what a volunteer is able to contribute," the associate director of patient affairs at the National Association of Volunteer Services Managers, Carol Rawlings, says.

"As long as it's done correctly, there is no risk that volunteering will put people out of work," Miss Sunderland insists. "We make sure that each role we create for a volunteer is not like that of a paid member of staff, and we emphasise that at no point will a volunteer ever be counted in the staff numbers."

The head of health at Unison (which represents 460,000 NHS workers), Christina McAnea, says: "We're not against having volunteers in hospitals; indeed, some of our members volunteer themselves, being publicly minded."

The issue, she says, is whether the task is an essential service, and the test is: "What happens if the volunteer who is doing it doesn't turn up one day? Does the hospital have to send someone else in to do it? In that case, it is probably a job they need to train and pay someone to do."

Historically, the majority of volunteers were white, female, and middle-aged or older. In some hospitals, however, this profile is changing. The University College Hospital Macmillan Cancer Centre, in London, receives so many applications that it has to shortlist them. A volunteer co-ordinator, Zainab Oladokun-Olawale, says: "We get a wide range of people: a lot of students from the university across the road, people who are out of work, people who are working who just want something extra to do, people who are retired who want to do something useful with their time.

"Some come because they just love to help. They want to work with people, or give back to the community. We get people who have relatives who have had cancer, and they want to show their appreciation. Other people want to put something on their CV that shows that they have other interests."

In addition, anyone who wants to go into medicine or nursing or midwifery now has to do some voluntary work in a hospital.

NOT every hospital has been successful in attracting volunteers. Of course, not all have tried. While some NHS trusts recruit volunteers and manage them, others (often for historical reasons) work in partnership with organisations such as the Royal Voluntary Service, and their own Friends group, which recruits and manages its own volunteers.

Some trusts have been reluctant to fund the costs associated with volunteering, such as paying for the necessary checks, the induction and training, and the uniforms. And smaller hospitals outside big cities can struggle to find volunteers.

Anna Ellis, the voluntary services co-ordinator at Addenbrooke's Hospital, which is one of Nesta's six pioneers, says: "I don't think there will ever be a single pattern for everyone. But we can share information, and pool our knowledge, and establish best practice."

Addenbrooke's Hospital, in Cambridge, works hard not to waste the experience of its volunteer workforce: 

ADDENBROOKE'S HOSPITAL has 725 volunteers on its books, although not all are currently volunteering. It adds 30 to 40 new people to its volunteer base every month.

The hospital's voluntary services co-ordinator, Anna Ellis, says that there are many more women than men, and 60-70 per cent are under the age of 24, "because we're a well-known teaching hospital in a university town," she says. But the hospital would like to attract larger numbers of older people who are available during the daytime.

Volunteers come in once a week, and are asked to make a minimum commitment of 30 hours over 15 weeks. "Some hospitals say that volunteers have to do a year, but we find it's better to have a more realistic target, and take it from there. When people pick up their 30-hour certificate, they can consider whether they want to carry on.

"Once people get going, they can volunteer for a very long time. We have an awards lunch every year, and this year 33 volunteers are going to get a long-service award. Last year, someone got an award for 50 years.

"We screen applications to make sure people are volunteering for the right reasons, and then we go through a structured telephone interview. We do all the checks required by law, and we also require two references. Provided you bring the right ID, the vetting can be completed within 30 days."

Obviously, hospitals are not asking people to volunteer for their own good, but volunteers do gain from the experience, Ms Ellis says. "If you're volunteering even for 15 weeks, you will change and develop: it is a big personal learning curve, whoever you are. We offer training and support to make the experience better. None the less, the focus is always firmly on the patients. Volunteering isn't work experience, and it isn't playing games."

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Normally, staff are very welcoming to volunteers, she says. "But, sometimes, when a nurse is eight hours into her fourth long day in a row, and here comes a volunteer, all full of enthusiasm to do two hours, it can be a challenge. We have to make sure that volunteers are well trained enough not to be a burden to the staff on the wards.

"Having said that, when I was a nurse myself, the presence of a volunteer made me feel more valued, if anything, because here was someone who was prepared to give their time to support the work I was doing, and sometimes to ask me: 'Are you OK?' when things were really busy."

Linda Wright, who is 58, is a carer for her husband, but still makes time to volunteer at the Queen Elizabeth Hospital, Birmingham:

"EVERY Friday, I spend two- to two-and-a-half hours on the surgical assessment ward. I get there at 12, and help to serve lunch to the patients, and then I clear up. I'll fetch someone a magazine, or make them and their visitors a drink.

"The other week, an older lady was really upset because her family hadn't been to see her; so I sat with her, and held her hand, and she showed me some photos. I'm good at listening, and the staff haven't got time to do that.

"I used to be in the catering business, but I had to retire early to care for my husband, who has heart trouble. When I do my voluntary work, one of his family comes and sits with him.

"I'd love to be trained up to do more. The QE is one of the biggest hospitals in the country - and one of the finest, I would say. I can't praise it enough. The staff work so hard. I see how tired they get, but nothing's too much trouble for them. I do all the patient feedback for the ward, and 99 per cent of patients have such a good opinion of it.

"Last year [we] won the award for the best ward in the hospital, and the Sister bought everybody cakes. I said to her, "Congratulations," and she said: "Linda, you're a big part of this as well." I get hugs from the nurses; and even the two cleaners, who I've become very good friends with, tell me my help is appreciated.

"I'm not trying to be a do-gooder, but I feel like I've done a lot of good. I've got so much out of the NHS - if it wasn't for them, my husband wouldn't be alive today - and I want to put something back in for free."