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”.

In celebration of International Volunteer Day, I’ve been sitting underneath an apple tree hoping for an unexpected moment of inspiration. It arrived courtesy of a groundbreaking new study from the Chartered Management Institute (CMI) in partnership with YouGov.

Finally, we have a way of improving volunteer retention for your volunteering programmes. Keep your volunteers away from 82% of your managers!

The report reveals that 82% of managers who enter management positions have not had any proper management and leadership training – they are ‘accidental managers’.

…and this lack of training reduces productivity, increases staff turnover, and makes staff feel less valued, disengaged and unappreciated.

One of the central findings is that these untrained managers are promoted into management positions simply because they are popular, good at their job, or happen to be available to take charge.

This landmark study has revealed for the first time the scale of damage being caused to the UK economy by the lack of training within Britain’s managerial ranks. The results suggest that only 18% of managers have a deep positive impact on employees, including on their motivation, satisfaction, and retention.

So, what has this got to do with volunteer management?

It’s widely accepted that most people who manage volunteers are ‘accidental volunteer managers’, with little training tailored to managing volunteers. Many have experienced volunteers being thrust on them at times of organisational change, or that their first experience of managing volunteers was a by-product of a personal promotion opportunity.

What then is the damage caused by untrained ‘accidental volunteer managers’ to the UK volunteering economy? Organisations perceived as unwelcoming by volunteers, ‘stressy’ volunteering placements, difficulty in keeping good volunteers, disillusioned management teams, damage to the organisation’s reputation in the wider community, and ultimately delivering an impoverished service for beneficiaries.

So what should we do?

In response to the research, Ann Francke OBE, the CEO of the CMI, said “By investing in management, the UK has the opportunity to set a positive trajectory that can deliver a growing economy, invigorated public services and a healthy, inclusive society driven by good management and leadership.”

Applied to volunteer management?  Invest in training tailored to ‘accidental volunteer managers’ to create a healthy, inclusive society.

If the lessons of this study are applied to volunteer management, those who have received formal training are substantially more likely to feel confident in their volunteer managerial abilities, being significantly more likely to trust their team, feeling comfortable leading change initiatives, and feeling comfortable addressing issues that need addressing.

So where can we get this tailored training for ‘accidental volunteer managers’? At this point I was considering a shameless plug of Attend’s ‘Managing Volunteers for Line Managers’ courses, but that would be too crass for a blog inspired by Isaac Newton!

Following on from the previous post’s criticism of NHS England and the DHSC’s approach to researching volunteering in the NHS, this piece seeks to find a way forward. A way that embraces the best of organisational cultures and promotes working relationships. A way that generates light rather than heat.

This proposal is based on a number of premises:

• Everyone is working hard and committed to providing the best service possible for their beneficiaries. NHS staff & volunteers, voluntary sector staff & volunteers and policy makers alike.
• All public sector and voluntary sector organisations want to have positive relationships with each other.
• The greatest value is gained by exploring and celebrating what is working well, rather than what is not.

So, what to investigate? Where is the pinch point, where the secrets of what is working well can be discovered?

The answer might be found back in 1948, where the then Minister of Health, Aneurin Bevan said to those who had volunteered to support health care before the NHS was formed: “Watch to see where the shoe pinches first … and if the nation cannot do it, there your voluntary services will be required”

This would suggest achieving best value for this research, would be to look at where the shoe pinches: the point where public sector and voluntary sector services touch each other.

…but no-one who is working hard to support the NHS wants to have an intrusive investigation, with the associated negative connotations of accountability associated with it. So maybe the research piece needs to give everyone a break, and help to support what they do want.

They would love to have:

• A celebration of what they are currently doing well in working in partnership.
• Lots of ideas and tips from similar organisations to improve things.

For example, one outcome would be case studies of great partnership working, ones that the organisations involved can be proud of, and others can be inspired by…. creating an organic evolution of partnership working, that aligns with the principle of ‘spontaneous order’, which is so fundamental to the voluntary sector.

A research methodology that would help to achieve this is ‘Appreciative Inquiry’ that poses a central question ‘When have things gone really well what can we learn and apply from those moments of success?’.

NHS staff & volunteers, voluntary sector staff & volunteers and policy makers – who wouldn’t want this?

The links between primary and secondary care and the Voluntary Sector are key here, and this is where the Voluntary, Community and Social Enterprise (VCSE) Health and Wellbeing Alliance offers some potential. However, if you look at the partners, the voluntary sector organisations that are linked to hospitals are largely missing. Once this is resolved this piece of research offers significant value to so many.