The role of charitable funding in the provision of public services: the case of the English and Welsh National Health Service

Abstract

The role of charity in the provision of public services is of substantial academic and practitioner interest, and charitable initiative within the English and Welsh National Health Service (NHS) has recently received considerable attention. This study provides rich insights into the role that NHS-linked charities present themselves as playing within the NHS. The dataset analysed is a novel construction of 3,250 detailed expenditure lines from 676 sets of charity accounts. Qualitative content analysis of itemised descriptions of expenditure allows us to explore how these charities portray their activities. We distinguish between expenditures that can be framed as supplementary to government funding (such as amenities and comforts) and items that suggest charitable effort is substituting for government support (such as funding for clinical equipment). We also consider the claims being made through these representations, and suggest that the distinctiveness of the charity and NHS spheres are currently under question. We argue that, through their representational practices, charities are both shaping and blurring the expected roles of government and charity. Acceptance of the benefits that charitable initiative does provide, in terms of innovation, pluralism and participation, must be tempered with the realisation that charitable funds are playing a role in service provision that is not guided by clear policy, and that this has the potential to widen existing inequalities within a key public service.

Charity and Abuse: Fundraising and Symbolic Power in the Case of Jimmy Savile

“…But he was acting as the popular vanguard for Thatcher’s economic policy, encouraging personal responsibility, and the building of the public good through acts of charity and private finance rather than state investment (see Mohan, 2014). The rebuilding of Stoke Mandeville through private money and donations was to be “a pioneering example of the type of ‘partnership’ between government and the public that the prime minister was keen to promote” (Davies, 2014, p. 356), with Savile maintaining that it was not the duty of the government to find the money, referencing the history of private and voluntary hospitals in the United Kingdom pre-1948 (for more on the balance between public and charity funding of the NHS, see Abnett et al, 2023, and Bowles et al, 2023). His secretary Janet Cope saw Stoke Mandeville and other large public institutions (like the Leeds General Infirmary and Broadmoor) as the big beasts that Savile wanted his name attached to, where the limelight and good publicity was ensured, leading the way to a knighthood.…”

Strategic distinctiveness: awakening the ‘sleeping giants’ of England and Wales’s NHS charities

“…This study draws on qualitative interviews with senior staff and trustees of NHS Charities Together (NHSCT hereafter), the national network of over 230 NHS charities funding a wide range of patient and staff well-being services, as well supporting research, and the upgrading and provision of buildings and equipment (Abnett et al, 2023). NHS charities are those charities that are linked to a particular NHS body or Trust.…”

“…Such a link is often, although not always, obvious in the charity name (for example the Hillingdon Hospitals Charity); is explicit in the organisation's governing document; and in many cases is enacted through the NHS body acting as the corporate trustee 1 for that charity, although some NHS Charities also have a set of individuals as Trustees. All NHS charities raise funds from the public, private, and philanthropic sectors, and then provide funding (either directly or as grants) to their NHS body, or occasionally the wider NHS or health sector (Abnett et al, 2023).…”

“…While charitable action has always been a feature of the NHS (Mohan and Gorsky, 2001;Gorsky and Sheard, 2006;Stewart and Dodworth, 2021;Bowles et al, 2023;Abnett et al, 2023), the organisations now known as NHS charities were largely only formally established and regulated as charities from the 1990s, subsequent to regulatory changes put in place by the Charities Acts 1992/1993. As detailed below, between the 1990s and the passage of the NHS (Charitable Trusts etc) Act of 2016, these NHS charities were subject to a unique -or distinct -dual regulatory model.…”

All the trimmings: patient and staff wellbeing should not be left to charitable funding

“…Decades later, boozy staff parties won’t be charitably or NHS funded. But charitable funding still pays for many things that are deemed to be non-essential for NHS staff and patients,6 including celebrations of a broader range of religious holidays 7. Since the height of the covid-19 pandemic, staff wellbeing initiatives—counselling, helplines, and “wellbeing zones” in hospitals for breaks—have been a particular focus of NHS charity spending.…”