As their national association celebrates its 50th anniversary, Bernadette Friend examines the changing roles of hospital friends

The league of friends has a rather old-fashioned image. But today's hospital friends are not only about dispensing Lucozade and pleasantries in the hospital shop; that is only part of the story. Some are abseiling down a 160ft chimney tower, befriending lonely patients in a high-security hospital and bringing together families on remote Scottish isles via a video link. The leagues now have 60,000 members who raise£24m a year - more than the income of some trusts - and about 40 per cent work in the community.

The government is keen to increase public involvement in the community through volunteering, and to attract volunteers from a wider range of people. Last month a health service circular urged managers to strengthen the participation of volunteers in the NHS and to ensure that volunteering was integrated into strategic planning.1

Next week the nation's leagues of friends will step into the limelight when their umbrella organisation, the National Association of Hospital and Community Friends, kicks off a year of 50th anniversary celebrations with a party at the House of Lords.

One of the VIP guests will be Diane Norman, who has been a member of the Newbury Hospitals Helpers' League since it was formed in 1948, just ahead of the NHS itself.

She went to a meeting with her dancing teacher to decide the fate of the various organisations that raised money for the local hospitals and, crucially, what would happen to their funds now that a National Health Service was on the horizon.

The league was formed that evening, but as the committee was being elected, one man said: 'It's no good having all of us old people. We need some young members.' Looking round the room, the only young person present was Diane Norman, then 17. She has been a member of the league ever since.

In those days the group met about twice a year and the matrons of the two local hospitals attended with a list of the 'extras' they wanted for their patients and the hospital.

'It was about extra comforts for patients and staff that were not being provided by the NHS,' Ms Norman says. 'We used to have spare slippers for patients and we put in radios throughout the hospital.'

Hospital leagues were very definitely about providing extras. The association has a long list, in alphabetical order, of items provided by leagues in 1950, including 'bed jackets, caps for old men, card tables, cinematograph projectors, confirmation veils, garden hammocks, harmoniums, hens (and upkeep of), punt for use of staff, and wringers'. Today's leagues are still providing comforts for patients, but some provide a lot more besides.

More recent league purchases run to essential items such as a bone densitometer scanner, a monitor for coronary care, defribillators and lasers. What the leagues agree to fund varies from one group to another.

Mike Conway, chief executive of the association, believes the different ways leagues operate reflects the strength and the weakness of the association. 'The strength is that leagues are autonomous, so if they see a need on the ground they go ahead and respond to it the way they want to. There is no diktat from the centre at all. The weakness is that there can be considered to be less of a common bond, in that we are not always singing from the same hymn sheet.'

But Mr Conway says he can live with this, preferring to see the association with strong leagues, rather than the centre ordering its affiliates what to do. Mr Conway, who has been with the association for four years, was previously marketing manager for Nuffield Hospitals, and also has experience of recruiting non-executive directors for trusts.

Leagues have come through a bad patch this decade, trying to stave off competition from national retailers invited into hospitals as part of income generation schemes for the NHS. At the height of the 'hospital trolley wars', one retailer set up a rival service, setting off for the wards 15 minutes earlier than the league's trolley to capture the business.

The competition is still out there. On a visit to a hospital in the north of England, Mr Conway found the new foyer had a John Menzies shop but the two other retail units were shuttered. No one, including the league, was prepared to pay£25,000 per unit a year rent to the contractor.

But the commercial tide may be turning. Business organisations are discovering that setting up in a hospital 'wasn't quite the gravy train they thought it was going to be,' says Mr Conway.

Leagues, too, have fought back and are being promised a hand-up by the government, he says. Of the 42 recommendations in a 1996 NHS Executive report, Making a Difference: volunteering in the NHS, one was to give charities, including the leagues, more of a level playing field when it came to income generation.

Some leagues are highly successful. Two groups raise over£400,000 a year and several generate more than£250,000.

Reflecting on the past 50 years, Mr Conway says: 'From the national association point of view, what it has tried to achieve over that period of time is to turn it from a representative organisation into rather more of a proactive, participative one.'

Among the services the association provides for member leagues are guidance on how to run a successful charity, administering grants and awards, and organising local support networks. It also helps them to cultivate the next generation of volunteers.

Mr Conway's regular sermon to trust managers is that they should cherish their league of friends, or risk losing a prized asset. 'Leagues are tremendous ambassadors for the trust; they straddle that bit between the community and hospital, and the community establishment.'

Managers always claim to value their 'friends', but there are conflicts of interest, particularly over the provision of shop space, he points out.

'On the whole there is a huge amount of goodwill for friends. It is just that the structure of the trust doesn't always allow for friends to gain

co-operation from everybody in it, and that is the difficulty. It is very patchy. Where it is good, it's great and works very well. But there are many others which could perhaps be improved.'

He believes the future will see leagues increasingly working in the community. About 40 per cent of members already do, many more than the estimated 10 per cent who did so 20 years ago.

But while the association is celebrating its half-century, leagues of friends can be traced back much further - over 250 years in fact. According to a history of the leagues, a Bishop Maddox, who founded Worcester Infirmary, is credited with the birth of the movement.

Speaking in 1746, he pronounced: 'Few cures are brought about by drugs alone. Proper food, due regimen, necessary attendance and above all ease and tranquillity of mind have a large share in every recovery.'

The forebears of the leagues have taken many shapes and forms - as linen or comfort guilds, ladies' associations and contributory hospital schemes. They were set up to support the sick in their communities and to raise funds for voluntary hospitals. But as in Newbury, the arrival of the NHS posed leagues with a problem - what would their role be under the new regime?

The answer came from the health minister himself, Aneurin Bevan, who announced that personal and voluntary service in hospitals would always be needed to 'feel where the boot pinches and apply relief'.

It was on 24 March 1949 that representatives from more than 40 leagues met to form the National League of Hospital Friends, later to become the National Association of Leagues of Hospital Friends. Last year, to reflect the expansion of work outside hospitals, the name was changed to its present title, the National Association of Hospital and Community Friends.

Not all leagues are members of the association, but it has 804 affiliated voluntary groups, with volunteers giving 20 million hours of service annually. Leagues operate in different ways, according to local needs.

Callers to the league of friends in Stornoway hear the answering machine message in Gaelic, followed by an English translation. The voice on the tape belongs to Donald Martin, chair of the League of Friends of the Western Isles Hospital, Residential Homes and the Community. The league has 10 projects under way, including a video link between patients in hospital and their relatives on the remote islands, using the hospital's video- conferencing equipment. Volunteers are also trained in hearing-aid maintenance, and hold surgeries for people who cannot easily access the main hospital. Projects in the pipeline include a library service and hospital television.

Mr Martin says: 'We invite the hospitals and homes every year to provide a wish list of items they would like to buy and we vet it.

'Anything we find that is a non-health service essential, and that might benefit patients' or staff welfare, we normally fund.'

Recently, the league was asked for curtains and bedding materials. 'We came to the conclusion that was really a thing that the health board should provide,' said Mr Martin, adding with an unintended pun, '...as part of the fabric of the hospital.'

The tea bar, introduced about five years ago at the Western Isles Hospital, has been a great success, he says. During the week the league provides a late-night slot, from 11pm to 1am, for night staff to have their 'lunch'. But the tea pot runs dry on Sundays.

'The tea bar isn't open because we have Sunday observance here. We don't have any services, and nobody would expect us to provide services on a Sunday.'

With so many other organisations fishing the same pool for volunteers, attracting new members is hard. Enticing young members is even harder, and something the NHS is urged to tackle in the recent circular on volunteering.

The League of Friends of Reading Hospitals has cracked this particular nut, boasting a thriving young league with members ranging in age from 12 to around 25.

'We have had abseils, parachute jumps and bed pushes to make it fun,' says league secretary Carol Arnold. 'That is how we have encouraged the younger element.' One fundraising venture was to scale the inside of a 160ft hospital chimney and abseil down the outside.

'We have had to change our image to prove to people that we are professional, that we are business-like, and we mean business,' says Ms Arnold. The group has set up joint ventures with schools, is involved with the borough council and local businesses and has joined the chamber of commerce. Most of the hospital departments become involved in some way with the league. 'The way to do it is to walk the wards, walk the corridors and make sure that once or twice a week you are seen by most people.'

From their earliest beginnings to the present day, leagues of friends have been many things to many people. For Roy Taberner and Joan Cadman, sharing the rota on the Wigan League of Friends 'helping hand desk' led to a blossoming romance. The couple, who are gently described as 'not in the first flush of youth', will be forming their own league of friends when they get married in April.