Imagine stopping a harassed member of staff in a busy A&E department and asking them what words pop into their heads when they think about the role of volunteers in their working lives. Tea and cakes? Helpful at signposting? Nice to have?
Or ‘invaluable’? ‘Part of the team’? ‘Vital in effectively reducing unnecessary admissions’?
The latter suggestions might seem unlikely, but they were the reflections of NHS staff on the impact of a project led by Age UK in Leeds, which used volunteers as part of a service to avoid admissions and reduce pressure in an A&E department. The interviews formed part of our evaluation of seven ‘social action’ projects, funded by the Cabinet Office, NHS England, Monitor, NHS Trust Development Authority and the Association of Directors of Adult Social Services.
The aim of the ‘Reducing Winter Pressures Fund’ was to scale up and test projects that used volunteers to support older people (to manage health conditions or recover after illness) and thereby reduce pressure on hospitals. Projects delivered a wide range of services. These included direct support, including befriending, help with shopping, help with getting to appointments or filling in forms to access benefit payments. Projects also helped connect people with a wide range of other services in their local areas, with the aim of reducing isolation and improving people’s confidence to be independent at home. Our evaluation was designed to add to the evidence base about what value these sorts of projects could bring to a stretched NHS.
The basic case for using volunteers is persuasive: a three-million-strong source of support, twice as large as the NHS workforce. The projects generated a great deal of learning about how voluntary sector organisations can gear up to connect trained volunteers with some of the most pressurised parts of the system. The service in Leeds based in an A&E department had to work hard to overcome staff scepticism and organisational challenges: ‘Don’t be defeated and chase and chase and chase again to break down the barriers’ was the top piece of advice from their project manager to other voluntary and community sector providers looking to do the same thing. ‘Prove yourselves indispensable – it’s all about relationships’.
Westbank, a local charity near Exeter, also reflected on the challenge of building relationships – in their case with staff on wards in their local trust: ‘start with one ward and build it up from there’. Establishing strong relationships resulted in a much more complete understanding of patients’ needs, which could then be used to deploy volunteers effectively, even in small tasks like moving furniture in someone’s home to make way for a hospital bed. ‘By delivering a quality service that met the needs of both patients and staff, word of our service spread throughout the rest of the hospital’, added Westbank.
In addition to the A&E-based model, and the hospital discharge schemes (run by five of the projects), the other type of service in our evaluation was the community-based model (run by four of the projects, including Age UK South Lakeland, which won an award for their Compass tool for identifying people at risk). These projects also had to build relationships with both NHS and social care bodies in their areas, to raise awareness of their services in order to get referrals. This was also a time-consuming task, as Age UK Oxfordshire found, but their persistence paid off: ‘The service is like a right arm to me, and is as vital as occupational therapists or physios to the health and wellbeing of my patients’ reported an NHS professional working alongside one of Age UK team members.
The task facing all of these projects was complex: being able to target services at the right people at the right time and matching the skills and availability of volunteers of different age groups to the needs of older people. As a result, the intensity and duration of support given to more than 7,000 older people between October 2014 and July 2015 varied considerably, and evolved as projects learned on the job.
This is important context for the results of the quantitative element of evaluation, which did not find reductions in hospital use among those referred when compared to a closely matched sample of people from the rest of England. Using volunteers to support older people did not appear to be a magic bullet to reduce pressure on hospitals, but the services were of value to older people and NHS staff. Then again, magic bullets to reduce emergency admissions – regardless of who delivers them – have proved to be stubbornly elusive in the NHS.
This raises a dilemma from a commissioning perspective: should scarce public resources be used to fund projects such as these? One of the biggest frustrations we heard from the voluntary sector staff we interviewed was the short-term funding offered to these kinds of projects, which were expected to show results within short time frames, even though they were working with older people who had very complex problems. Projects of this kind often end or change because funding runs out. And yet one of the most striking findings from our evaluation was the value placed on the reliability of the projects by NHS staff, who reported that it saved them time, as well as benefiting patients. That seems a pretty strong case for value.