by Helen Abnett, James Bowles and John Mohan
Our recent research, published in Policy & Politics, shows that in the English and Welsh National Health Services (NHS), support from NHS-linked charities funds a wide range of goods and services. This includes substantial spending on amenities intended to make hospital visits more comfortable for patients and staff. Charities pay for newspapers, toiletry packs, toys for play areas, cushions and books. Charity support also funds education and wellbeing activity and medical research.
We also find that support from charities funds basic hospital equipment and furniture, such as vital signs monitors, bladder scanners, pulse oximeters, mattresses, and chairs, as well as some larger pieces of medical equipment (x-ray machines and ultrasounds).
Given these findings, the research draws attention to the lack of policy guidance determining what government should, and charity can, provide within the NHS.
In recent commentary on charity in the NHS, such as this BMJ article, there seems to exist a perception that charitable funds in the NHS should not be used to support ‘core’ elements of health service provision. However, this is not true. There is no legislative or policy guidance that determines what should be provided by government and what can be provided by charity within the NHS. Our research shows that charities are providing goods and equipment that are essential to the provision of basic health services.
This raises important questions. We know that charity has lots to offer, particularly in enabling support for diverse communities. However, charitable funding is also beset by well-documented challenges of insufficiency and the unequal distribution of resources. We argue that charitable funding of basic hospital goods has the potential to contribute to growing inequalities in the provision of NHS services.
Our findings also have broader policy implications. Many charities worldwide are involved in funding, supporting, or providing services that might otherwise be seen as the responsibility of government. Similar types of questions to those posed here have been raised in consideration of parent-teacher associations (PTAs) by Ali Body and Eddy Hogg (2017; 2021), while the implications of philanthropic giving in the public school system in the US have been explored by Rob Reich from a number of perspectives (including this 2012 piece). A very recent paper by Cadence Willse (2023) also considers how charitable support maps on to – and increases – existing inequality in access to parks and other natural resources in the US.
With the current inflationary ‘cost of living’ challenges in the UK, and its government seemingly keen to reduce their spending on welfare services, we hope this research stimulates further interest and debate on the appropriate roles of charity and government in the provision of public services in the UK. We further hope this research inspires comparative analyses in other countries.
You can read the original research in Policy & Politics:
Abnett, H., Bowles, J., & Mohan, J. (2023). The role of charitable funding in the provision of public services: the case of the English and Welsh National Health Service, Policy & Politics, 51(2), 362-384 from https://doi.org/10.1332/030557321X16764537061954
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