Hundreds of thousands of citizens have volunteered to help the NHS during the pandemic, but it has been difficult to mobilise them effectively. To be ready next time, we need a National Health Reserve of volunteers; trained, vetted and ready at short notice to take on roles which would free up NHS staff for “frontline” duties.
PROTECT THE NHS More than any other single factor, the UK government’s response to the pandemic has been driven by the need to stop the NHS being overwhelmed. Out of a total of about 125,000 NHS acute and general overnight beds, first wave Covid occupancy peaked at over 21,000 and second wave at nearly 40,000. Even the creation of 10,000 Nightingale beds did not fulfil its promise because of the lack of health professionals to staff them. So, where does this leave us if or when there is a next time?
NHS bed and staff numbers are below average in international comparisons and there may be good arguments for spending more to increase capacity, but this would mainly address the NHS’s regular day-to-day needs, not an exceptional event like Covid-19. Mothballing Nightingale-style beds might be possible and relatively affordable, but keeping medical professionals on standby to staff them would be another matter. For example, an additional 10% of hospital staff (around an extra 90,000 support staff, nurses and doctors) would cost at least £2bn a year. In a few years’ time, wouldn’t it simply be too tempting for a government to trim this? Instead we need something which could rapidly increase emergency NHS capacity but cheap enough to survive austerity cuts: I’ve called it the National Health Reserve (NHR).
Volunteering is popular. Before the pandemic there were already some 100,000 regular volunteers in NHS hospitals. When Covid hit, in just three days, 750,000 people expressed interest in becoming NHS Volunteer Responders. The British Red Cross has 80,000 Community Service Volunteers. The goodwill is there, but mobilisation of such large numbers from scratch has been challenging and in many cases inconsistent, haphazardly coordinated and often weighed down by red tape. We now need to draw on this experience and create a permanent, fully-vetted volunteer force trained in a wide range of ancillary medical skills, who could be quickly mobilised in an NHS emergency. This would be modelled on other volunteer networks such as Army Reserve, St John Ambulance, British Red Cross, Community First Responders, special constables and Royal Voluntary Service.
ROLE OF THE NHR
The NHR’s role when mobilised would be to enable NHS professionals to concentrate on the most demanding jobs, while the NHR takes on the less skilled tasks. These could cover many of the sorts of services provided by healthcare assistants in the NHS, test and trace, and administering a vaccine, etc.
WHO WOULD JOIN?
Some NHR volunteers might be former health professionals, but the majority would be people without previous formal medical experience who would need to be trained in a range of medical skills. Volunteers could include 16-18 year olds (NHR cadets) and there could be other specific schemes for students and apprentices.
This would take place at local centres based in hospitals. Volunteers would need to be offered a flexible training menu, including hands-on skills, classroom teaching and online modules, which would need to reflect how much time the volunteer could commit and any prior relevant training they had completed. Formal accreditation would be given as different skills are acquired.
This would also have to be flexible, but a minimum might be six hours a month during non-deployment/training periods, though much higher during actual emergencies. Employers would be required to allow NHR volunteers time off work for emergency duties – on the lines of jury service – but during other times volunteering would usually take place in the volunteer’s own time, although employers would be encouraged to facilitate days or weeks away from work for specific training.
Apart from reimbursement of reasonable expenses, volunteers would not normally be paid for providing their services, but where volunteers had specific and valuable skills, retainer fees may need to be considered, as would compensation for the self-employed for time away from work.
COST AND SIZE
St John’s Ambulance has over 15,000 volunteers and an operating cost in a normal year of about £100m. Their pilot project (jointly with the NHS) aimed at creating 10,000 NHS Cadets has a budget of £6m. This gives a range of average costs per volunteer from £600 to over £6,500. I do not have the information or specialist knowledge to provide more accurate costings, but would suggest that an annual average cost of £2,500 to train and support each NHR volunteer would be a reasonable starting point. I suggest an initial target size of 100,000, at an annual cost of £250m.
NOT REINVENTING THE WHEEL
It is essential that existing health sector volunteer organisations are partners in the establishment, training and deployment of the NHR. As well as British Red Cross, St John Ambulance and RVS, there are many other national and local health volunteering organisations, including Helpforce, which “partners with health and care organisations to increase volunteering opportunities and accelerate their impact” and the Voluntary and Community Sector Emergencies Partnership – “Bringing together local and national organisations, to deliver a more coordinated response to emergencies”. They have all made a vital contribution during Covid, but their work tends to be either supporting the NHS on a continuing day-to-day basis, or is more broadly focused than supporting the NHS alone. In contrast, the NHR’s aim would be specifically to support the NHS during a “disaster”. Other than as part of their training, volunteers would not be expected to support NHS staff except during emergencies, nor would they be expected to play a role in non-NHS activities.