Leading by example

Volunteers are often regarded as benevolent helpers on the fringes
of health and social care when the truth is many public services
would not be able to function well without them.

By providing a range of social, emotional and practical support,
including advocacy, transport schemes, home help and respite care,
volunteer-run initiatives offer more than an occasional helping
hand to support mainstream services. When added together they make
a substantial contribution to the public sector. An estimated
170,000 volunteers are active in the NHS and more than 100,000 work
with voluntary organisations in social care.

Given the increasing demand on services, volunteers are likely to
play an even bigger role in the future. Some regard this as an
unwelcome trend, simply a reflection of our unwillingness to invest
enough resources in health and social care.

But there are benefits to involving more volunteers in the running
of public services. Volunteer schemes provide opportunities for
citizens to play a more active role in their local community and to
gain greater insight into the workings of the public sector. What’s
more, voluntary initiatives also have the potential to contribute
towards shaping the development of mainstream services.

More than just filling gaps in provision, some volunteer-run
schemes have pioneered approaches to service delivery and have
challenged thinking about the demarcation of professional
roles.

Some of the best practice in rehabilitation and intermediate care
services has come from volunteer initiatives. And voluntary schemes
have played an important role in shaping thinking about how support
for parents and children in the early years can be refocused.
Initiatives such as Home Start have shown that home visiting by lay
people can have a positive impact on parental well-being and child
development. Such approaches are now being mirrored in mainstream
services such as Sure Start.

The success of such home-visiting schemes has exposed the problems
that can sometimes arise in the professional-client relationship.
Parents often welcome peer-to-peer support because they feel the
help provided by health and social care professionals after the
birth of their child fails to meet their needs. Professional
intervention can be perceived to be intrusive and judgemental. So
in providing “non-professional” support, volunteer-run initiatives
have been able to help parents that mainstream services may
otherwise have failed to reach.

Some services delivered by volunteers have drawn attention to the
difficulties that arise because of boundaries between professional
groups. The rigidity of roles within the health and social care
workforce is a key factor preventing needs being met. Public
services are more prone to fail when they are designed around the
needs of professionals rather than those who use them. Free from
the constraints of the usual professional boundaries, volunteer-run
schemes can be more flexible in combining elements of support and
draw attention to needs in health and social care.

Some of the emerging ideas about new kinds of professionals have
their genesis in innovative cross-sector schemes involving
volunteers. Take rehabilitation services. The fact that almost one
third of people occupying acute hospital beds have needs that are
not commensurate with the level of care they receive has prompted
calls for new professionals specialising in rehabilitation. These
professionals would combine the skills spread across nursing,
social work and home care – responsibilities already familiar to
those volunteers who provide home support to older people.

A major realignment of professional boundaries is likely to take
place in the health and social care sector in the coming years. New
configurations are needed because society has changed and some
services are now unable to match users’ needs. But momentum has
also been created by staff shortages. High levels of social work
vacancies have led to questions about the future shape of the
profession. On the basis of current trends we are likely to face a
25,000 shortfall in the number of doctors in 20 years. Alongside
workforce planning and recruitment drives, changes to the
professional skills mix will be needed if we wish to retain current
levels of public service provision.

Much attention is already being paid to the relationship between
health and social care. But developing services that integrate and
build on the learning from volunteer-run schemes will also be
essential. Far from simply adding fringe benefits to the public
sector, volunteers could be part of shaping its future. CC

Lisa Harker is chairperson of Daycare Trust

l See feature page 30