NHS knitted sign

The Government has called for a ‘volunteer army’ amid the Covid-19 outbreak. Here we take a brief look at a long history of community involvement in healthcare. In a large sector, this article focuses on the NHS hospital environment in England.

Priories, private donors, and pickled eggs

Before there was a national health service, some healthcare functions were historically provided by religious or local institutions on a voluntary or charitable basis. In The NHS at 70: A Living History, (2018) Ellen Welch cites the example of monastic almshouses in the sixteenth century providing care and lodging for the poor and unwell. These were disbanded following the dissolution of the monasteries, but the citizens of London petitioned the King, and a few facilities were able to remain open as hospitals, including St Bart’s and St Thomas’. Some local councils and committees took on their local institutions around the UK.

In the eighteenth and nineteenth centuries, donations of money from philanthropists helped to kickstart the large voluntary hospital movement, with new hospitals built and healthcare provided more widely. This era saw the establishment of the first specialist hospitals such as the Great Ormond Street Children’s Hospital in London. Founded by Dr Charles West, it had several well-known supporters including Queen Victoria, Charles Dickens, and later J M Barrie, who famously donated the rights to Peter Pan. In some establishments the less wealthy were treated for free and others paid a small stipend. Voluntary hospitals constituted part of a disparate health sector and universal provision was still a way off.

Professors Hayes and Doyle argue that in the early twentieth century, voluntary hospitals were a focal point for civic pride and engagement. In addition to substantial contributions from individuals, community activities helped to fund hospitals, including fancy dress parades, local fetes, and whist drives. Linen guilds supplied clothing and bedding. Individuals and companies also gave free labour, equipment, and provisions to local hospitals. For example, in Nottingham in the 1930s, over 150,000 eggs and the brine to pickle them in were donated by the public each year.

The Wars

In the World Wars, it was all hands on deck to provide the healthcare needed by war casualties and people injured in bombings. In the interwar period, the British Red Cross and the Order of St John Voluntary Aid Detachments continued the work they had undertaken in WW1 to provide voluntary first aid and ambulance services for local communities. Both are still significant in the health volunteering sector today.

There was also significant hospital expansion in the interwar years. By the Second World War, the voluntary sector and local authorities had developed “a formidable array of services, at least nominally covering the basic medical needs of all sections of the population” according to Charles Webster in his 2002 work The National Health Service: A Political History. However, these services varied and overlapped, and accessing them was far from simple. The inadequacies of an unevenly distributed, decentralised system came to the fore as demand had increased rapidly in wartime. Calls for a national health service grew, culminating in the creation of the NHS. The role of the voluntary sector changed, but remained key to healthcare provision.

After the founding of the NHS, The Royal Voluntary Service (RVS) and Leagues of Friends made up a large part of hospital volunteering. The RVS (founded by Stella Isaacs, later Baroness Swanborough, in 1938 as the WRS—the Women’s Voluntary Services), recruited women to help evacuate children and aid civilians in air raids. By the start of the war, a recruitment drive had inspired over 300,000 women to join up. Within two years the number had risen to 2 million. They soon expanded their role to assisting in hospitals “with preparations for war, where volunteers would be needed to fill staff shortages in non-medical jobs, help with emergencies and recruit people to fulfil specific jobs such as ward maids or ambulance drivers”. They also formed the Volunteer Car Pool (VCP) to deliver “anyone and anything to anywhere”.

Anything from the trolley?

Post-war, RVS volunteers continued to support the NHS by running shops, canteens, and trolley services in hospitals. Twice weekly, volunteers visited the patients selling biscuits, sweets, fruit, and cigarettes. They have also worked on immunisation clinics and blood donations. The RVS currently has around 20,000 volunteers running shops and providing ward support, community transport, and helping older people on their return home from hospital.

Leagues of Friends also continued to support the NHS, and by the late 1970s there were reported to be around 1,300 leagues. When voluntary hospitals were taken on by the new NHS, the British Hospital Association recommended the setting up of Leagues of Friends as they recognised the ongoing contribution which could be made by community groups. The National Association of Leagues of Hospital Friends was formed. In May 1949 Captain J W Price proposed a core objective: “To mobilise, encourage, foster and maintain, the human love of the people of this country, in the giving service to supplement the healing work of the staff and the state, and always ensure a humanising supplement to the work of the hospitals”.

The Community Hospitals Association lists some of the leagues’ ongoing roles, including patient transport, fundraising, and running hospital shops. Leagues are associated with specific hospitals, though many choose to be members of Attend, which “supports and expands the roles volunteers play in creating healthy communities”.

Big Society and beyond

2010’s Coalition Government advocated ‘Big Society’: “We want to give citizens, communities and local government the power and information they need to come together, solve the problems they face and build the Britain they want”. The plan encouraged volunteering, set up the National Citizen Service, and gave charities and social enterprises more opportunity to have “much greater involvement in the running of public services”. In 2011, the white paper Liberating the NHS said “We believe that the NHS is an integral part of a Big Society”, and proposed changes to structures and policy, encouraging involvement from outside the public sector.

Civil Exchange’s Final Big Society Audit noted “signs that the NHS is seeking to engage with the ‘renewable energy’ of civil society, not just to deliver better services but also to deliver better health”. But cautioned that funds and reform were needed. It also drew attention to ‘informal volunteering’: people helping non-relatives without reward, for example babysitting, pet care, or transportation. Data on levels of formal and informal volunteering across all sectors is available in the Cabinet Office’s Community Life Survey.

Geoff Mulgan of The Young Foundation, is reported to have said that the NHS already reflected the ideals of the Big Society. As it “has always been made up of thousands of small businesses, like GP practices and pharmacists, and it has always depended on the work of hundreds of thousands of volunteers, not to mention six or seven million carers”.

One example of a community interest company involved in NHS volunteering is Helpforce, which is working with NHS England with the aim of doubling the number of volunteers in the NHS by 2021. Volunteers are used to ease “pinch points” in the patient’s progress, cutting time in reception queues, providing transport, or making trips to the hospital pharmacy.

Before the latest volunteering push, NHS England estimated the number of its volunteers at 3 million. In its Five Year Forward View, published in 2014, NHS England list a range of roles carried out by the voluntary sector, including advice, advocacy and care and support at home. It also points to community first responders who provide swift medical attention in emergencies, particularly in rural communities where ambulances may take longer to attend.

The GoodSAM app technology, which is used to alert community first responders, is now being mobilised, in partnership with the NHS and RVS, to organise NHS Volunteer Responders to support the NHS and the care sector during the Covid-19 outbreak. At time of writing over 700,000 people had registered to help; the most recent event in an established history of volunteering.

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Image by Tugce Gungormezler from Unsplash.