King's College London

Full study title: 'How can we better demonstrate the impact of CFR volunteers on the ambulance service, and what policy recommendations can we make based on this analysis?'

Background

The health system is working to recover from the impact of the COVID-19 pandemic and keep up with demand for healthcare. Its workforce and services remain under pressure and both health and care sectors continue to benefit from the generous support of volunteers and voluntary sector organisations. It is estimated that there are approximately 50,000 volunteers in NHS trusts, (over 170 different volunteer roles) and these people play an important part supporting the public and easing pressures on the NHS.

The NHS Long Term Plan, The People Plan, and The NHS Long Term Workforce Plan all make commitments to make the best of NHS volunteer input and in developing the 10 year health plan there is an opportunity to explore how groups beyond the formal workforce can support transformation in the NHS. In 2023 the government responded to the Health and Social Care Committeeinquiry on workforce Recruitment, Retention, and Training; it committed to “maximis[ing] the use of volunteers where they can be most effective” and recommendations in the NHS Volunteering Taskforce Report committed to improve the experience of people who volunteer in the NHS.

However, it is a complicated volunteering landscape in the NHS. Volunteers are recruited from a mixture of places including direct NHS trust recruitment and local or national Voluntary, Community and Social Enterprises (VCSE) and others come from supporting roles that straddle both health, care, and social support. There are also national schemes such as the Volunteer Responders programme. In addition, there are many different types of information recorded about volunteer activity. Some NHS services gather highly developed and detailed information but others have little, beyond a basic volunteer headcount and activities.

There are many pockets of good practice across the system in relation to how the NHS benefits from volunteer input. For example, the ambulance service has a highly developed and long-standing Community First Responder (CFR) programme. However, it is difficult for policymakers to plan for future volunteering involvement because of a lack of evidence, particularly with regards to the impact of volunteer inclusion.

Policymakers aim to increase the number of volunteers to help support patients, the existing workforce and service providers in a safe way, more quickly. There is a pressing need to generate evidence so that policymakers can efficiently focus on future volunteer input and how the NHS can best support volunteers in the system. This will be especially important in considering how volunteering can support the 10 year health plan and delivering the government’s health mission.

Aims

We aim to investigate the impact of Community First Responders as a positive, long established example of volunteers supporting the ambulance service. Through doing so we will contribute to the evidence for supporting and developing volunteering to help patients and services more broadly across the NHS.

Our primary research question is:

How can we better demonstrate the impact of CFR volunteers on the ambulance service, and what policy recommendations can we make based on this analysis?

Secondary research questions:

What can we learn from the Community First Responders to support other volunteer roles more widely? In particular:

• How can local operational managers improve the deployment of volunteers?
• How do staff understand the support they receive from volunteers (including the effect on their workload and morale)?
• How do patients understand the support they receive from volunteers?
• How are volunteers influencing services (i.e. ambulance waiting times and non-attendance/transportation times?)
• What opportunities are there to further develop this volunteer role?

Method

We will combine qualitative and quantitative methods to learn more about the effectiveness and wider value of the Community First Responder (CFR) role. We will ask CFRs for their views, as well as other NHS staff (both managerial and non-managerial) and NHS patients who may interact with them.

Our study will look to build upon the work of the National Ambulance Volunteering Dashboard by helping the Ambulance Trusts involved to identify and standardise the information they hold about CFRs. At the moment different trusts measure different elements of their CFR programmes making it difficult to combine, compare and analyse information across England. In addition, NHS now requires mandatory quarterly reporting from trusts on their volunteering activity, and some trusts are struggling to do this.

We will work with 5 of the 10 English NHS Ambulance Trusts. We will develop clear guidance about how they collect their CFR data and look to develop standards and identify gaps in their information. We will look at how this ties-in to existing mandatory data collection on volunteer activity generally and the work completed for the Dashboard to try and rationalise data collection and minimise burden.

We will look at data from NHS trusts on (1) the total number of CFRs; (2) their demographic characteristics (age, gender, ethnicity etc); (3) CFR activity and impact to see how this can be improved to help inform us about the impact of CFRs. We will look at and compare information linked to Ambulance Quality Indicators to enable comparisons with existing data and (4) incident level data including location, time, category, and CFR attendance which may provide insight into health inequalities and the communities served by these CFRs.

We will select 2 from the 5 participating ambulance trusts to hold semi-structured interviews (approximately 15 interviews per site) with CFRs, NHS staff, managers and patients and some analysis of documents. These two sites will be carefully selected to reflect different types of challenges faced by Ambulance Trusts (for example urban versus rural, and younger versus older and other patient characteristics, as well as different CFR profiles).

Timetable

October 2024 - June 2025

Funding

NIHR Policy Research Programme NIHR206121(08)

Policy Relevance and Dissemination

Helping policymakers to understand more about volunteer impact on patients and staff will enable them to make more effective volunteering policy decisions and implement measures to improve volunteering in health and care. This understanding can help plan for and refine volunteer roles to deliver the greatest benefit to patients and the workforce, improving value for money of volunteering policy. We will produce a slide deck summary and a full report of findings which will be shared with the Department of Health and Social Care (DHSC) prior to publication and discussion with policy colleagues. Once the report is agreed we will send a copy of the summary and its recommendations to all participants and publish the full report online on the Unit’s website and the IFS website. We will also share the findings with ambulance trusts to support the development of their volunteer schemes and prepare further outputs for different stakeholder groups. We will present findings at academic conferences and publish at least one article in a peer reviewed journal.