In the recent busy build up to Christmas, I’d had a particularly task-filled day, and at 6pm took a few minutes to rest and catch up on social media stuff. The first message I opened was a request to help move some furniture and household items from a friend’s mother’s flat, to a homeless chap who was just moving into accommodation. It took approximately 2.5 seconds to dawn on me, that logically now was the best time. I was grumpy for those 2.5 seconds and spent the next half a minute coaching myself to dissipate this grumpiness(!)

So, after some disassembling, driving, lugging and reassembling, I was confronted with the impact of these tasks, when the chap looked around his place and exclaimed “Now this doesn’t feel like accommodation, it feels like home!”

I spend the rest of the evening resolving to never allow the feeling of grumpiness to enter me again, and continue my quest to search for my elusive altruistic self!

This personal experience reminded me of discussions in the volunteering community a few years back, where the notion that volunteering stems from altruistic motives, came under attack from prominent practitioners and writers in the sector.

Back in 2005, in the publication The 21^st Century Volunteer, Elisha Evans and Joe Saxton, 2005 highlighted a number of interviewees were keen to point out “a worrying swing towards catering for the harder motivations and associated incentives for volunteering”. Rob Jackson (then with Volunteering England) suggested these motivations have always been there, and that it is simply becoming more acceptable for the 21^st Century Volunteer to express them, stating “Egoism is gaining equal weight to altruism but, as with anything new, the former is getting a higher profile because it is being expressed more than before. This will balance out in time.”

Well, that was over 20 years ago, so has enough time passed since, to balance this out??

The writers concluded that the volunteering sector needs to harness ‘selfish altruism’, explaining that “by tuning into volunteers’ changing desires and expectations; appreciating the many benefits of volunteering (soft, hard and altruistic)…volunteer managers can begin to develop the volunteering product in a way that does it, and the organisation’s cause, justice.”

In 2008, the Chairman of the Association of Volunteer Managers, John Ramsey, stated that he was “not a believer in the existence of altruistic volunteering, of giving with no regards for yourself.” His view was that “the volunteering relationship is not a one-way altruistic pathway, but a two-way reciprocal relationship” (AVM 2008). A similar theme echoed by Dr Peter Ngatia who argues that “volunteerism built on altruism… remains episodic, short-lived and hence not sustainable” (The Guardian 2010).

Meeting the needs of the ‘selfish volunteer’ became more prevalent in articles and discussions. For example, in 2013, NFPResearch conducted the roundtable discussion, ‘Should we be doing more to support the selfish volunteer?’

These discussions tended to result in folks wrestling with the question “Should we incentivise volunteering?” famously debated by Rob Jackson and Susan Ellis back in 2014 (each taking a side, to help with the discussion).

More recently, many writers have recognised this ‘selfish altruism’ paradox.

In 2023, Karen Knight makes the case for selfish volunteers and concluded “So, let’s embrace our selfish volunteers; they can be a powerful force for good!”.

Paul Hefron, in 2024 concludes that “by understanding and accepting the multifaceted motivations behind volunteerism, we can foster a more robust, realistic, and ultimately more effective approach to encouraging altruistic behaviour”

It got me thinking that we might be missing the point in asking the question “Should we incentivise volunteering?”, so I thought I’d explore this again, using the AI resources now available to us, because I’m finding that using AI appears to be largely about working out what is the right question to ask.

Here are the responses to some initial questions:

_____________________________________________________________________________

The “altruism is dead” argument misunderstands what altruism actually is.

Altruism isn’t Martyrdom, self-erasure or purity of motive.

Altruism is choosing to benefit others, even when you didn’t have to, even when you could have chosen yourself instead.

By that definition, volunteering is full of altruism.

Volunteering is a cultural counterweight to transactional society.

We live in a world where everything is monetised, measured, and optimised. Volunteering is one of the last spaces where people act outside market logic.

Even if motives are mixed, the existence of volunteering proves altruism isn’t dead. If altruism were dead, volunteering wouldn’t exist at all.

Volunteering doesn’t require perfect people — it creates better people.

It’s not a museum of altruism. It’s a workshop for it.

_____________________________________________________________________________

This changes the question we need to ask. Something like: “How might we develop our volunteering programmes and volunteer management processes in a way that better celebrates altruism?”

Btw, if you fancy a thought-provoking activity, pop that question into your favourite AI engine, and drill down on some of the things that interest you.

A timeline of volunteering in health

For decades, the health care sector has wrestled with the relationship it has with its volunteers.

The first half of the 20^th century…

Merritt (2020), provides a helpful summary, explaining that volunteers used to run the show. For example, in the First World War, hospitals were staffed by voluntary nurses, who willingly gave their time to care for wounded patients. Red Cross volunteers also provided ambulances, transporting the sick and wounded to hospital, and loaned out medical equipment to the injured.

After the Second World War, the creation of the NHS and its early years…

Volunteers continued their roles, with over 1300 Hospital Leagues of Friends and the Women’ Royal Voluntary Service (now RVS) running a host of services to support patient care. However, now that a paid model was being embedded in the NHS, hospitals decided to recruit their own volunteers, from a desire to manage their contribution and activities with a little more control from the centre. The first paid hospital volunteer manager was recruited in 1963 at Fulbourne Hospital in Cambridgeshire.

The development of NHS Trusts…

The engagement the volunteering community has with its local hospital has never really stood still, or been fully understood. For example, the concept of the local hospital has largely been overshadowed by the establishment of larger NHS Trusts. Longstanding independent groups have sometimes discovered their hospital they have lovingly supported over the years, is about to disappear. Or that they are requested to donate the funds they have raised to a much wider geography of hospital locations.

Recent developments…

More recently, many NHS Trusts have been seeking to create a Memorandum of Understanding with independent volunteering groups, in order to manage and control risks associated with volunteering and fundraising. This has in part been driven by the creation of NHS Charities, that are keen to ensure all volunteering and fundraising activities are managed effectively.

It’s as if there are two distinct types of volunteers supporting the NHS. One that values its independence, and wants to contribute in the way it wants to contribute, and another that prefers control, and ensuring volunteers deliver roles deemed important by the NHS Trust, and in ways that are underpinned by robust management practices.

These types of volunteering are recognised as ‘thick’ and ‘thin’ volunteering. No one better than the other, and with the potential to complement each other (O’Toole and Grey, 2015). NHS Trusts that ‘get’ the relationships with their independent volunteering groups right, will be practically celebrating the first line of the NHS Constitution: “The NHS belongs to the people”.

Over the last few years, the team at Attend have been supporting some hospital Friends Groups regain their footing once the pandemic restrictions were eased, has provided the opportunity for useful insights into what can help make volunteering work in hospital settings.

There’s been some really good examples of NHS Volunteer Services Managers working in partnership with their local Friends Group, to not only get things back up and running, but to also create new initiatives to help the community maintain their support for their hospital, which was so evident during Covid.

How have they done this? It appears there’s been some inspired application of management and leadership in practice. Check these terms below, to get a sense of their differences and overlap…

Management is often described as: The process of planning, organising, leading, and controlling resources—whether human, financial, or material (Oxbridge Editing, 2024). A significant point to make here is that management involved an element of leadership.

Leadership can be described as: The social process that enables individuals to achieve collective results together (Centre for Creative Leadership, 2025).

So how have these paid NHS Volunteer Services Managers been able to support the development of such a positive environment?

• By managing the volunteering programme to optimise the contribution that (Trust-managed) volunteers can make to the ‘areas’ they are allocated to.
• By creating an environment where each ‘area’ can create a climate where volunteers feel connected to each other and committed to the cause.
• By developing a relationship of trust and high engagement with independent volunteering groups, and the wider community.

So is this management or leadership?

Let’s check with what others’ say about whether volunteers should be led or managed:

Volunteer Ireland: “The person called upon to guide volunteers cannot swap management acumen for leadership skill or vice versa”

Tobi Johnson (drawing from Kouzes and Posner, 1987) explains the importance of “modelling the way”, “inspire a shared vision” and “encourage the heart”.

The Association of Volunteer Management refers to the term “Volunteer Management Professionals” and Rob Jackson Consulting refers to the term “Volunteer Engagement Professionals”.

And, significantly, the acronym NAVSM means the National Association of Voluntary Services Managers.

So, on a day-to-day basis, an NHS Volunteer Services Manager’s role is mostly management; but underpinned by insightful leadership.

To create a sense of connection and commitment for NHS-managed volunteers, a climate of great local leadership is needed in all the areas where volunteers are placed. The role of the NHS Volunteer Service Manager is to ensure local managers are excited about the contributions volunteers can make, and equipped with the resources to create a welcoming environment.

To create sense of trust and engagement with local independent volunteering groups, the role of the NHS Volunteer Service Manager is to do anything that enables these groups to achieve collective results together. Quite often, this is not about leading people, but rather creating an environment where leadership can thrive.

In both situations, the key attributes are the ability to manage diverse relationships, and a knowledge and understanding of the processes available that can facilitate this.

In summary:

• Volunteering in hospital settings has changed and will continue to change.
• Leadership is about inspiring people through change
• Volunteering needs to be managed
• Volunteers can be led by people that volunteers recognise as being committed to the cause.

To lead or to manage?

The concept of ‘managerial leadership’ has something to offer here.

M.S. Rao (2017) highlights managerial leaders must be flexible, humble and down-to-earth.

The Indeed Editorial team (2025) explains that managerial leaders need to lead consistently by example, communication clearly, encourage team spirit and transformation, celebrate hard earned achievements and admit/learn from mistakes.

These qualities and behaviours could form the blueprint for a modern-day NHS voluntary services manager.

Ever since the NHS was formed, the League of Friends has been a practical demonstration of Aneurin Bevan’s proclaimed mission for volunteers “Watch to see where the shoe pinches first … and if the nation cannot do it, there your voluntary services will be required”.

For over three-quarters of a century, Hospital Friends Groups have faithfully stepped up to this challenge, without seeking recognition or praise, just with a desire to support the lives of patients and former patients of their local hospitals.

Here’s a wonderful story telling what these committed folks continue to do. It’s about the transformation of an open space, into a tranquil wellbeing path. The path is accessible for anyone who uses a wheelchair, crutches or a walking frame, and provides an area of relaxation and reflection for staff, patients and their loved ones.

It was an inspired idea of one of the hospital’s Therapy Associate Practitioners, and funded by NHS Charities together. As you read the article there is a nod to the support from the hospital’s League of Friends – but their role was key to developing the idea into a fundable project with the Hospital Charity, and then making the funding application to NHS Charities Together. Quietly, behind the scenes, demonstrating the support of the local community to secure the resources to bringing this idea to an inspirational reality.

I haven’t asked for permission to shine the light on the role of the Friends, as the answer might be “no”! But someone needs to flag up that these Friends Groups are living examples of  the central principle that “The NHS Belongs to the People”.