Volunteers have worked in the NHS since its inception, but their massive input has only recently been recognised. Three years ago the NHS Executive published a report entitled S trengthening Volunteering in the NHS, aimed at improving and supporting voluntary services across the country.
1Though commissioned by the previous Conservative government, its principal recommendations have been adopted by the present government.
Figures published by the National Centre for Volunteering, and supported by the NHS Executive, show that in the NHS alone, 36,000 volunteers contribute nearly 20 million hours a year - averaging 27,000 hours per trust.
2 Last year, at Salisbury Health Care, a combined acute and community trust, 427 volunteers - individuals as well as members of some 30 voluntary organisations - gave over 1,400 hours of their free time each week.
3 (These gross figures are based on the simple calculation of multiplying the number of volunteers by their average hours per week. ) As management costs are excluded from this figure, it largely tends to reinforce the notion that voluntary work is free work.
Against this background, the trust's voluntary services department carried out a survey in March and April 1999 to place a value on the contribution provided by the trust's volunteers. The evaluation used a system known as volunteer investment and valuation audit - or VIVA. Formulated and developed by Katherine Gaskin and Barbara Dobson in their paper The Economic Equation of Volunteering for the centre for research in social policy at Loughborough University, the VIVA method endeavours to quantify the costs to organisations of involving volunteers.
Volunteers have long been regarded as a free option, with few, if any, accompanying costs. But volunteering is far from being a cost-free enterprise, as recruiting, placing, supporting and training volunteers all require careful consideration which, in turn, requires considerable input of time and money.
By adapting the VIVA method of collecting volunteer costings and calculating the value of volunteer activity, divided by the volunteer management and running costs, it was possible to arrive at a calculation of the cost of investment against return.
Volunteers were fully informed about the survey. It was also agreed that the study be restricted to voluntary placements at Salisbury District Hospital. The time period chosen was from Monday 8 March to Sunday 4 April 1999.
Describing their own work Fifteen volunteers were selected from the 165 individually registered volunteers placed in the 26 departments and wards of Salisbury District Hospital, and each was asked to complete a diary covering the four-week period.
Volunteers were requested to describe, in their own words, their activities during each period or session.
The volunteers were asked to include details of duty times, plus costs and expenses incurred.
Each volunteer was asked how best they would describe their voluntary work.
Each volunteer was asked to complete a questionnaire detailing their age, experience, training and qualifications.
Assessing and assigning a value The volunteers' input was then assessed by:
Job titles: derived from the volunteers' own description of duties in their diaries and validated by the department or ward manager and the voluntary services manager.
Component parts: derived from the activities recorded in the diaries.
Volunteers' diary entries were evaluated by comparison with the task descriptions held by the voluntary services department for those activities.
An NHS grading or scale was assigned to each volunteer's input. In validating the volunteer's work the department managers were asked what grade or scale they would consider appropriate if they were advertising for staff to do the work the volunteers were doing. This scale was then applied to all volunteers in the trust carrying out that activity.
The work was then costed at local trust pay rates.
The volunteers were graded on one of three scales. Volunteers from the Community Service Scheme, all aged 16 to 18, were placed on scale A (nursing auxiliary), under 18. Many of these young people apply for paid holiday work at this level.
Adult ward volunteers were placed on scale B, over 18, to reflect their experience and the maturity required in this role.
In and out of the wards Volunteers working in wards where their training was peculiar to their task - for example, palliative or hospice care - were positioned in the healthcare support workers category.
Two other areas of voluntary work by individual registered helpers were identified. One was helping in reception areas, such as outpatient clinics, or carrying out minor clerical roles, who were graded on the administrative scales. But in certain locations, such as stoma or breast care, the healthcare support worker grade reflected their work more accurately.
The volunteers graded on the medical technical officer scale were more difficult to categorise as their ranking needed to reflect their special skills or more intensive training.
The remaining area of voluntary assistance comes from members of voluntary organisations and groups (see box). It was decided to grade all of them on the national minimum wage.
It should be stressed that the grades assigned to the various groups were not intended to reflect any ranking order of an individual or group's efforts.
It was important to include management costs, such as employer's national insurance and pension costs. Despite tight controls on telephone calls and other costs, it was nearly impossible to separate the voluntary services department's utility or maintenance expenditure. After soliciting the views of various managers in the field, it was agreed to group these costs and include them under a heading of non-staff costs.
By extrapolating the amount of time given by the volunteers each week - 682 hours - it can be seen that our volunteers gave 35,464 hours of their free time last year. This compares well with the NHS national average Even if the national minimum wage of£3.60 an hour were used to calculate the value of all this work - rather than allocating NHS-style gradings to different volunteer placements - the total would come to£127,670.40 for the year ending 31 March 1999.
Adopting the VIVA method of cost benefit analysis produced a ratio of 1:5.5 - in other words, for every£1 invested by the trust in the volunteers, there was a return of£5.57.
Finally, it needs to be remembered that while Salisbury District Hospital is the largest single location for volunteers giving help in the trust, it covers less than half of all our volunteers.
There is still a great deal of work to do in auditing the value of volunteers' work, but this research shows they give excellent value to the NHS.
An audit of volunteers' work at a district general hospital showed its value to be more than£127,000.
For every£1 the trust invested in volunteers there was a return of£5.57.
The research showed that volunteers gave 35,464 hours of their free time to the hospital last year. The national average is 27,000 hours per trust.
1 Strengthening Volunteers. NHS Executive, 1996.
2 Volunteers Change Lives. N H S Executive survey, 1998.
3 Annual Report. Salisbury Health Care trust, 1998-99.
4 Gaskin K, Dobson B. The Economic Equation of Volunteering. Centre for research in social policy. Loughborough University, 1996.