The Big Society and the NHS

Volunteer holding the hand of a hospital patient

In the news this week…

The Daily Mail launches its campaign to create an army of NHS volunteers with the aim of freeing up more time for frontline staff to focus on patients’ clinical needs. Big celebrity names have stepped up to support the Mail’s campaign which has been backed by the Care Quality Commission and the Royal College of Nursing.  

Since its inception in 1948 volunteers have played a valued support role in the NHS. Today around 78,000 already carry out a range of duties from running cafes and shops and visiting patients to providing library services and staffing hospital radio; that should be celebrated.  However, we should be cautious about welcoming this proposed extension to volunteering and serious questions need to be asked.

The Big Society idea, as conceived by David Cameron who suggested in 2010 that it was a mechanism for ‘empowering communities,’ has proved to be less about transformation through fostering community spirit and reinvigorating civil society and more about government delivering its neoliberal agenda. Indeed, Ed Miliband who was Labour leader at the time suggested that it was a ‘cloak for the small state’.

Over the last eight years through its cuts to public spending the government has shifted its responsibility downwards to local government and communities whilst, at the same time, depriving them of sufficient funds to deliver services and forcing them to make draconian cuts. Local charities which depended on funding have found themselves struggling to continue their work and individuals have been encouraged to fill the gaps by giving their time for free to staff libraries for example – either that or face the closure of these services.

Now, in this cash strapped environment, the Big Society is being called upon to deliver the government’s ideologically driven agenda for the NHS. This is framed in NHS England’s Five Year Forward Plan where volunteering and social action will become key to service delivery. Replacing services, rather than simply providing support.  

Over the last eight years the NHS has been one of the major victims of cuts to public spending with catastrophic consequences for services, patients and staff. Staffing levels are at an all-time low and the pressures to deliver a quality service have never been greater.  Figures from June show that the health service has 107,743 unfilled posts which was up from 98,475 total just three months before. The NHS was also short of 41,722 nurses, the highest number yet, and similarly there were 11,576 vacancies for doctors. As a result of the withdrawal of nursing bursaries there are fewer students applying to study and, due to the government’s pay cap and more stressful working conditions, many have chosen to leave the profession. The situation has been worsened by the decision of many health professionals from Europe to leave as a result of growing intolerance and being made to feel not welcome despite being the linchpins of the NHS and without whom things can only get worse.  Experts have warned that understaffing is so serious that it threatens patient safety and is a national emergency.

And so, conveniently, in step the volunteers with the help of the Daily Mail who is working with the charity Helpforce. This is aCommunity Interest Company, which stands to benefit from £2.3m in funding from NHS England to develop a range of volunteer services. It has suggested for example that with the right training volunteers could work with heart-surgery patients in the gym, take notes during consultations, book people into outpatient clinics and offer support and comfort to bereaved families. As an aside, these sound very much like regular jobs not volunteer ones!  

It is risible when top advisers like Richard Murray fromthe King’s Fund think tank or Sir Robert Francis, head of Healthwatch applaud the role of volunteers and in the same breath stress that they must not be expected to make up for short-staffing or do the work of paid employees. In the current funding environment that is exactly what is being suggested in a language narrative that draws attention away from the consequences of austerity and cuts to NHS spending. And yet, as a Registered Nurse commented:

 “Letting untrained members of the public provide direct clinical care to patients puts them at risk. This list not only undermines the nursing profession but also fails to acknowledge the hard work and dedication of other allied healthcare professionals.” Adding; “Those who offer their time are amazing but it’s important we use their time and skills appropriately.”

A good government dedicated to ensuring the health of the nation instead of the interests of global health corporations would have used its currency issuing powers to train homegrown health professionals to fill the growing gaps in staffing levels. It would have invested for the long-term in a strategy to provide a top-quality publicly funded and provided health service. Instead, it has chosen to cut funding to the NHS causing hospital closures, rationing or closure of clinical services and poach staff from countries with few resources which are already struggling to provide a decent health service for their own citizens.

Serving an ideological agenda, the government and its institutional and ‘charitable’ lackeys have shamelessly exploited the goodwill of citizens expecting them to do work which could provide a paying job to someone. This is not to decry the valuable work that volunteers do, but it ignores a fundamental economic truth that spending equals income to someone, and depriving people of a paying job is detrimental to the economic health of the nation and its citizens. Let’s not forget that government spending on wages and salaries of NHS workers is spent back into the economy and in themselves generate economic activity – the Fiscal Multiplier.

Furthermore, it is unclear where this army to fill the gaps for free are to come from.  Are they to be older people? They are facing retiring later, on meagre state pensions, whilst also providing child care for their own financially overstretched children, who are also struggling to get by. Expecting them to volunteer is as ludicrous as expecting those in the middle of the generational divide, working and caring for both elderly parents and children, to offer their services for free whilst finding the time to juggle their own responsibilities.

Volunteering is all part of the Tory plan being played out under NHS England’s Five YearForward Plan.  But goodwill will not be enough to keep the NHS functioning any more than our public services or the wider economy. People deserve better. Instead of the government relying on volunteers wouldn’t it be better to ensure that workers have a right to a job that pays a living wage? Wouldn’t it be better to re-embrace a full-employment policy by introducing a Job Guarantee programme at a fair wage for those that find themselves without work? Wouldn’t it be better to ensure that those who can’t work receive sufficient benefits to allow them to live with dignity, instead of in living in a state of permanent anxiety? The advantage of such an approach is not just economic.  A society free from the fear of falling into penury creates healthier and happier people and communities, which benefits everyone.   

Sir Robert Francis, head of Healthwatch, suggested in October that hospital patients, once fit, could give back to the NHS by volunteering. He claimed that the NHS ‘would work so much better’ if everyone did their bit. Let’s of course celebrate the work dedicated volunteers do to create a more compassionate society, but let’s not confuse that with a reference to wartime spirit to get us through when the situation has been created through a deliberate, politically motivated choice.

Change will not come from the top. It can only be driven via grass roots action. It starts by challenging politicians who describe the money system as if it were like our own household budgets when that narrative is false and bears no relationship to monetary reality.  We need politicians that serve us by putting public and social purpose at the heart of government policy making for the best interests of the nation.    

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