Health officials are drawing up plans to draft in thousands of extra volunteers to help the NHS cope with ambulance delays and hospital pressures this winter, according to a leaked document that lays bare the scale of the crisis in Britain’s healthcare system. NHS performance is “highly likely to deteriorate further” under increased winter demand and industrial action, reveals the Department of Health and Social Care (DHSC) briefing seen by the Observer. It also warns of a potential rise in hospital admissions because of the cold weather and soaring cost of living. “If some people, especially the elderly, respond to higher fuel prices by turning heating down or off, this may drive an increase in admissions for heart attacks, strokes and respiratory diseases,” the document says. The 31-page briefing has been leaked as the NHS faces some of the biggest strikes in its history and record waiting lists. More than 7.2 million people in England are waiting for routine treatment, the highest number since records began. Last month, 37,837 patients waited more than 12 hours to be admitted to hospital after the decision was made to admit them – up 255% on 2021, and 3,303% higher than in November 2019. Among measures being considered by ministers to “build resilience” in the NHS is expanding the drive to recruit volunteers, to bolster ambulance crews and provide support in hospitals and the community. In August, the NHS started a £30m four-year contract with St John Ambulance to provide “surge capacity” to 10 ambulance trusts and act as an official auxiliary service for England. Under the arrangement – the first of its kind – the charity is providing a minimum of 5,000 hours’ support a month via crews with the capacity to respond to the most urgent, life-threatening 999 calls. The leaked government document says the plans to boost the volunteer workforce will “build on the approach recently agreed with St John Ambulance”. It adds: “We will build on the volunteers who are already supporting the NHS and extend this further within local communities.” Thousands of volunteers were recruited during the pandemic to help deliver the vaccination programme, and volunteers already provide support behind the scenes in other parts of the NHS. However, the document sets out plans for a concerted effort to expand and extend their role at a time when core services are struggling to find staff and are under increased strain. Roles played by volunteers in the NHS range from delivering medicines and driving ambulances to preparing beds for newly admitted patients and “general ward housekeeping”. One ad, posted by an NHS trust in northern England, states it is seeking “urgent and emergency care volunteers” as well as people to volunteer on its 33-bed ward for cardiology patients and older people. There, tasks for volunteers include “ensuring patients stay hydrated, ensuring hygiene needs are met … and basic clerical duties including answering the phone”, it says. Miriam Deakin, director of policy at NHS Providers, which represents acute, ambulance and other NHS trusts, said that while volunteers have “always played a key part in the NHS” beyond core services, there is “simply no substitute for a properly staffed workforce”. “There are a staggering 133,000 vacancies across the NHS right now. This needs to be addressed urgently by the government in the form of a fully funded, long-term workforce plan,” she said. Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: “What we need is a skilled and trained workforce to try to deal with the problems we’ve got at the moment. It’s not just boots on the ground – it’s also about the capability and training of staff.“There is an unfolding crisis in emergency care caused by a massive supply and demand mismatch. There is too much work for our hospitals and our ambulance services, and the consequence of this is manifesting in long queues of ambulances outside emergency departments, but it is a mark of whole system stress. Hospitals are absolutely full at the moment.” Details of the plan to expand the volunteer workforce are set out in internal winter preparedness documents drawn up by civil servants for ministers in October. The briefing paints a bleak picture of the challenges the NHS faces and its ability to cope, stating that waiting times for elective care and urgent and emergency care are already “well beyond standard” and winter 2022-23 will “highly likely see performance deteriorate further”. The document also states that “external threats and challenges could impact on health/life” of the population, “as well as adding additional pressure to the running of the health and social care system”. The key threats are “industrial action, social care provider failure, energy disruption, extreme weather incidents and civil unrest”, it says. A rise in other health issues linked to cold homes is also a concern, with data cited in the briefing suggesting that mortality rate rises 2.8% for every degree drop in temperature for those in the coldest 10% of homes. The health impact will probably be compounded by a drop in people spending money on medicines and nutritious food, and a rise in mental health issues linked to debt, it adds. NHS England said it could not yet share further details about its plans to expand volunteering but that it was “exploring options”. It has begun discussions with the 42 integrated care systems in England to create volunteer roles that will be “designed and mobilised to meet local priorities”.The webpage for the NHS Volunteer Responders scheme, which launched in April 2020 in response to the Covid pandemic, says the volunteering programme is now being redeveloped “for the longer term” and will be “reshaped to help the NHS support people’s needs, locally and nationally”. More volunteers will be recruited and “additional roles” created, it says. Separately, NHS England has published advice for trusts on how to manage pressure on services during the winter, which includes instructing them to consider commissioning voluntary organisations to help respond to 999 calls for “level two” falls. These include cases where patients have a small wound or pain, and further clinical assessment is needed, but the injuries are not life threatening. NHS guidance from 2017 says volunteers are not a replacement for paid staff and play a different role. They do not have contracts and the duties they perform are instead based on “mutually agreed expectations”. Wes Streeting, Labour’s the shadow health secretary, said ramping up reliance on volunteers was “not a long term solution”. “The NHS clearly needs all hands on deck this winter because of the Conservatives’ failure to train enough staff over the past 12 years,” he said. The DHSC said: “We are hugely grateful to the selfless individuals who volunteer with the NHS, but we know the NHS needs further support. This is why we have prioritised health and social care in the autumn statement with up to £14.1bn over the next two years, and announced a new elective recovery taskforce to further bust the backlogs caused by the pandemic.”