There is an increasing interest in the role that the voluntary sector, and in particular volunteers, can play in supporting delivering better health and care services – something recognised in the Five Year Forward View. We have just published an analysis of one such scheme run by the British Red Cross, which has a significant role played by volunteers.
The work of volunteers has been part of the fabric of health services for a long time, often operating as part of a complex network of care providers with strong links in the local community. Such services can offer benefits to formal health and care services as well as to individual users of the service. It’s important that we assess the benefits that such schemes can bring.
The British Red Cross ‘Support at Home’ scheme
We were funded by the British Red Cross to look at their ‘Support at Home’ programme, which provides practical and emotional support to older people to help maintain their independence. The scheme uses volunteers as well as British Red Cross paid staff to help individuals with daily tasks of living.
One part of this programme supports people who are being discharged back to their homes after a stay in hospital, and one of the objectives is to help prevent potentially unnecessary readmissions in the weeks following the stay. Such readmissions are often distressing for the person involved and are also costly for the health service.
Regular readers of our evaluations will know that we specialise in a certain form of brutalist summative assessment – like moths to a flame we are drawn back to hard-nosed questions like: does it reduce emergency admission and if so, does it look likely to save money? We know there’s more to life than reducing emergency admissions – but somebody’s got to do it.
In this study, we compared a cohort of people from seven different sites who received support through this programme to a retrospectively selected group of controls who were discharged from the same hospitals. We wanted to see if the programme reduced hospital readmissions.
In terms of our headline findings about reducing longer-term readmissions, we were disappointed to find the scheme did not appear to be having the desired effect. The ‘Support at Home’ patients did not have lower readmission or hospital costs in the six months after discharge. As we have noted before, reducing emergency admission is not easy.
There were some positives, though. Elective admission in the Red Cross patients seemed to be lower. There were differences between the sites too, but the numbers of cases were too small in any one site to see statistically significant effect. There were also some signs that there may have been some very short term impacts – readmission after one month were slightly lower in the Red Cross patients.
Does this mean that volunteer services don’t work? No. There is more to these schemes than short-term reductions emergency admissions (we only looked up to six months) and there are host of other possible impacts we did not look at, such as pressure on primary care or benefits for users and carers.
We have to be realistic about what we think this type of scheme can achieve, how those benefits are seen, and over what timescales.
The diversity of schemes based on volunteers is an indication of the fact that there is a need for additional types of support – especially where people are frail and vulnerable. Moreover there will be differences in the ways these schemes operate – and we suspect some approaches will be more successful than others. There were certainly differences between the sites in the study we looked at.
It’s important to evaluate the impacts of these sorts of volunteer-based projects. Indeed, we are currently undertaking another study looking at seven different projects that use volunteers funded by the Cabinet Office. This study has a slightly broader remit to look at the process of setting up and implementing these volunteer schemes (including a focus on the realities of recruiting and training volunteers, variations in the skills and availability of people coming forward to volunteer and the challenges of collaborating with with statutory health and social care professionals) – as well as a fuller exploration of the impacts that they may have on the wellbeing of older people. We plan to report in the summer of 2015.
Whether it’s a result of the current coalition policy on the ‘social action‘, or something else about the state of care services, there is currently a renewed interest in the range of schemes that use the power of volunteers to offer help when people need it. With statutory health and social care providers facing constraints on their funding, the role of voluntary sector organisations is set to become ever more important in enhancing the quality of care for individuals.
Bardsley M (2014) 'An army of the willing?' Nuffield Trust comment, 15 December 2014. https://www.nuffieldtrust.org.uk/news-item/an-army-of-the-willing