In response to the fiscal and political challenges facing society, governments have been prompted to re-evaluate the relationship between citizens and the state and, at least within policy documents, to recognise the contribution that the public can make to health and social care. This chapter examines the current policy context, and traces some of the major policy themes concerning citizen involvement in service delivery. It looks at how the rhetoric of some policies is in sharp contrast not just with other policy pronouncements, but also with the actions taken by government.

The chapter starts by briefly sketching the scale of contribution of current volunteering. In doing this, it notes that volunteer activity is very often happening independent of state activity, although, at the same time, it is true that the scale and coverage of voluntarism can be affected by government policy. There is a discussion on why successive governments have become interested in volunteering and community engagement, with a particular focus on the current Coalition government's Big Society initiative (Cabinet Office, 2010). The most recent Department of Health policy on volunteering (Department of Health, 2011b) and government support for The Marmot Review (2010a) on health inequalities are contrasted with mainstream National Health Service (NHS) policy. While the focus of this chapter is on volunteering, it is important to note that some lay roles are paid, in particular, health trainers, a new public health workforce introduced by the Labour government (see Chapter Three).

The New Economics Foundation (NEF) and National Endowment for Science, Technology and the Arts (NESTA) have put forward new ways of thinking about the state, its relationship with citizens and how health and social care could be provided in a more equitable and empowering way (Ryan-Collins et al, 2007). The chapter concludes that a different model of public health is needed, an argument that is developed further in the conclusion (Chapter Twelve).

Volunteering in England

The contribution of volunteers and members of the public (lay people) to society as a whole is substantial. Over the last 20 years, there has been a growing interest in understanding the scale of volunteering, what motivates people to do it, its benefits and how volunteer activity relates to the roles of the market and the state.