Fundraising for the NHS: Policy and Practice in Scotland by Dr Ellen Stewart (University of Strathclyde) and Dr Kathy Dodworth (University of Edinburgh)

Public fundraising for the NHS – via official ‘NHS Charities’ – grew exponentially during the covid-19 pandemic. NHS Charities Together’s Urgent Covid-19 Appeal raised around £150 million. However the precise goals of the fundraising were not always clear. This relates to very patchy visibility of NHS Charities across the UK: one NHS charity staffer we interviewed described their organisation as ‘the biggest charity you’ve never heard of’. In a recent article in the Journal of Social Policy, we report a pre-pandemic study of the Scottish NHS charities, then in the midst of a formal governance review following some controversial spending decisions.  We explore their peculiar role within Scotland’s tax-funded NHS, arguing that wealth disparities between different charities risk exacerbating inequalities in provision

The history of these organisations is significant in understanding their current peculiarities. NHS Charities began as endowments: large financial balances held by voluntary hospitals before the NHS and retained to supplement NHS services. While a source of controversy since the system’s creation, in the 1980s the Conservative government liberalised the rules on active fundraising. There followed the significant and rapid growth of a handful of the richest endowments, especially in large London hospitals, into some of the most recognisable charity brands in the UK. In 2020, there are more than 250 NHS Charities across the UK, which supplement statutory healthcare provision, often funding “add-ons” to patient care (such as arts in health), staff development and medical equipment for which there would be no business case by a needs-based definition of the local population.   

Scotland’s 14 endowment funds are wealthy organizations in charitable terms. In 2019, Edinburgh and Lothian’s Health Foundation’s income of £15.5 million in 2018 or Greater Glasgow’s endowment income of £12 million placed these charities within the top 1% of charities in Scotland in those years (OSCR, 2020). However the mean income for the 11 mainland Scottish endowments in 2018 was only £3.4 million. Distribution thus varies significantly, with 76% of the total endowment income in 2018 concentrated within the three “wealthiest” (in absolute terms) and/or populous Boards with historic teaching hospitals: Lothian (including Edinburgh); Greater Glasgow and Clyde; and Grampian (including Aberdeen). While the endowments reflect patterns of population, they also reflect concentrations of wealth. Lanarkshire, for example, is the third most populous Board, but its very small endowment represents less than £7 per capita of the population, compared to Lothian’s £85 (see figure 1). Some Boards with significant poverty among their populations, such as Lanarkshire and Ayrshire, are among the smaller endowments.  We argue that these Boards, demonstrating high need and small charitable funds, ‘lose out’ due to the uneven spread of endowments across the country .

Beyond inequalities in wealth, our qualitative interviews pointed to significant differences in endowment operation across the country. We see these as shaped by the more abstract charitable and state logics identified by Breeze & Mohan. A charitable logic manifested in excitement about mobilising public affection for the NHS into financial support to enhance services, while a state logic entailed squeamishness regarding active fundraising, minimal investment in endowment staffing and a reactive ‘bank and thank’ model for unsolicited donations. We identify these two ideal types as competing logics that had shaped the very different belief systems, processes and definition of success described to us within this small, and legally identical, population of study. Endowments shifted over time, as staff and trustees changed, as well as in response to political and regulatory interventions. Nevertheless, differences remained stark. 

Many of Scotland’s NHS Charities spent decades existing mostly on balance sheets: budget lines whose trustees had not actively sought the role, operating with a minimal dedicated staff to maintain them. We report a change in activities across a handful of the charities, reflecting more substantive differences in the underlying practices, definitions of success, and values through which endowment staff explained and justified their work. We identify examples of wealthy Endowments which consolidate their wealth by investing in fundraising expertise and activities (Lothian), and poorer Endowments which do not fundraise, staying small (Lanarkshire). However, we also found outliers such as Greater Glasgow & Clyde, which has a large and historically wealthy endowment but limited public profile and fundraising. Our research suggests organisational choices were not dictated by prior endowment wealth but by an entrepreneurial staff member or trustee who advocated for investment in endowment staffing. Once in place, there was a degree of path dependency as a charitable logic was ‘added in’ to the endowment. Endowments that invested in staff with professional fundraising skills (hired to “pay their own way” in increased revenue) were reshaped by those staff bringing in not just skills and experience, but contrasting institutional logics. 

Since publication, and following an independent review, the Scottish Government has announced its intention to formally separate the governance of these charities from the NHS organisations they support, with Health Secretary Humza Yousaf acknowledging: “the current situation puts health boards in a difficult position and open to criticism when making spending decisions on behalf of NHS charities”. Proposed changes will see Health Board trustees precluded from also acting as endowment trustees, severing the formal links between the two organisations. We expect this to entail the final victory of entrepreneurial charitable over state logics in Scotland’s NHS Charity landscape, and a general expansion of fundraising for the NHS in Scotland. While policy debates have focused on legal questions of charity governance, NHS Charities also have more far-reaching risks and possibilities for how the ‘publicness’ of healthcare is enacted in the NHS.

Getting back to the Archives by Gareth Millward

staffordshire record office

As the country begins to open up, so are the nation’s archives. While not every library, county records office, museum or any other form of heritage centre is fully accessible yet, many have been running controlled opening hours for months. I decided to take advantage.

I joined the Border Crossings project in May, working on a project which relies heavily on archival research. My first task has been to investigate Leagues of Hospital Friends. These are charities attached to hospitals which provide money and volunteering services to patients and staff. Many were formed in the earliest years of the NHS, drawing from the voluntary networks that surrounded the pre-1948 hospital system.

A few of these groups have deposited their correspondence, minutes and accounts in county records offices. So, being based in Birmingham I thought: why don’t I take a look at Midlands archives and see what I can find?

Arranging trips has not been impossible, but it has not been as convenient as it was with my last research project (where my archival research conveniently drew to a close in late 2019). My previous work has been heavily based on The National Archives, so having to take small bites out of several local repositories was a new experience for me. Trying to learn how to do so at the (hopefully) tail end of a global pandemic was, in hindsight, sub-optimal. However, I still managed to get a lot of useful material.

Most archives have been running appointment systems, with limited slots across the week and restrictions on how many people can be in the reading room at any one time. Choosing to research the Midlands allowed me some flexibility – even the furthest archives are only about an hour from Birmingham New Street – but it did require a higher level of co-ordination than normal.

Thankfully, most collections have become more tolerant of allowing photography over recent years. This meant I could use my shorter appointments to furiously click away and get copies of all the material I needed. I could then read it all in detail when I got back home.

So, what did I find? Of course, looking for records of voluntary organisations is always tricky. It is impossible to predict which groups will create usable documents, retain them and then deposit them somewhere publicly accessible. (Yes, they are more likely to be bigger organisations with officers drawn from the professional classes in areas with more wealth, but that’s a “risk factor” – there are plenty of small grassroots organisations in county records offices too! Just check the catalogues.)

Archive box from Warwickshire County Records Office.

That said, I found groups representing a range of hospitals from village ‘mental institutions’, through market town general hospitals, to a large specialist children’s hospital. The material showed the commonalities – almost every group had a fete or fair of some kind – and the differences in how Friends raised money, spent their surpluses and volunteered their time for the benefit of patients and staff.Archive box from Warwickshire County Records Office.It was also fascinating to see the celebrities who were involved. For example, records show Warwick’s League of Friends was delighted when it was asked to organise a fete in 1964 so that the crew of ATV’s Emergency Ward 10 could record footage of a typical hospital scene. The excitement shown by the committee showed how popular the show was in the 1960s – but perhaps just as importantly, it showed that Leagues were such a fixture in British hospital life that ATV were compelled to include it in their programme.

I became even more engrossed in the papers of the Friends of Weston Hospital – an institution for people with learning disabilities in a village outside Kenilworth. It shut in the mid-1990s, but the Friends archives offer remarkable insights into how a voluntary organisation of this type wound down when the target of their philanthropic endeavours closed.

In any case, despite their relatively small membership, they too liked a good celeb. Norman Painting – Phil Archer to those who tuned in every week to The Archers – opened the 1978 Christmas Fair. But sadly, despite their best efforts they were not able to secure the services of the PG Tips chimpanzees in 1975. The handler at Twycross Zoo said they had grown too big.

That is, the chimps were now too large to perform – not that they had gone Hollywood and refused to do appearances they thought were beneath them.

The research is ongoing. I still have to visit a few more records offices before my collection of West Midlands archives’ photograph passes is complete. However, it is heartening to know that archival research is again possible – and what we can find is just as interesting now as it has ever been.

Crowdfunding healthcare in Shetland: maakin the NHS

The shoreline on Shetland

Author

Ellen Stewart, University of Edinburgh.

The tiny, twin prop plane landed at Sumburgh Airport in Shetland and we boarded the bus into town. It felt like an odd quasi-homecoming; the familiar made ineffably strange. Shetland is an archipelago of islands sitting in the middle of the North Sea. My Mum is a Shetlander and my extended family are still there; I’ve visited since childhood. Author Mallachy Tallack writes that the islands’ location at sixty degrees north — famously closer to Oslo than London — “is a story that we tell, both to ourselves and others. It is a story about where – and also perhaps who – we are” (Tallack, 2015, p. 3). While geographically isolated, Shetland is in the middle of a renaissance, not least thanks to the popular BBC drama series Shetland. I had landed in the middle of ‘Wool Week’ 2019: a major international event attracting passionate knitters to learn, admire and spend money on Shetland’s famous wool and traditional knitting (maakin, in the local dialect). It is big business for these far-flung and sparsely populated islands. The hotels were nearly full, and cafes, pubs and streets were busy with groups of enthusiastic North American visitors.

Johnson (2018) observes that Shetland has long been “a particular favourite” of social scientist visitors, too. Erving Goffman’s PhD thesis was based on covert fieldwork in Shetland’s most Northerly island, Unst, and the islands have continued to fascinate researchers. Social structures are distinctive in these close-knit, geographically remote communities, with a population of 23,000 people spread across 16 inhabited islands, including both locals (defined across generations, not just years) and abootcomers (everyone else). Having grown up ‘sooth’ (in mainland Scotland), my visits over the years have always contained the ambivalence of not-quite-outsider-ness. I’m a ‘soothmoother’ (not speaking Shetland dialect) but can understand well enough to get by. As an auntie once explained me to a shopkeeper: ‘no need for knappin (speaking English words) for her’. There has been significant inward migration to the islands in the last decades, but Shetland retains a truly exceptional degree of what we’d now recognise as social infrastructure (Kelsey & Kenny, 2021). There remains an extensive range of community events in local halls all over the islands. These dances, teas, quizzes and celebrations are organised, catered and run by local people, and often raise money for Shetland causes.

My own visit was fieldwork around a series of fundraising events being put on by a local maakin group, with all proceeds going to NHS Shetland’s campaign to buy an MRI scanner for the islands. One of the fundraisers had joined the campaign having experienced the “long, gruelling” journey to Aberdeen for scans every 3 months for several years. Shetland’s population doesn’t justify an MRI scanner based on NHS Scotland calculations, and so patients are transported either by airplane or on the overnight 12.5 hour ferry crossing to the hospital in Aberdeen. Their travel costs are reimbursed, but everyone I spoke to described the disruption to family life and work, and also the discomfort of these journeys. That evening, I sat in the corner of a hall with knitters, while we all drank tea, and ate soup and filled bannocks. I have neither inherited nor cultivated my maternal relatives’ formidable knitting skills, and, taking pity on me, one woman put me on pom pom making-duty with a small plastic gadget and strict instructions.

The MRI Maakers fundraising evening had many of the familiar tropes of Shetland community events, some of which Goffman observed 70 years ago. Fold-up tables and chairs were organised around the edge of the room. A cooperative squad of organisers filled huge metal teapots, sliced bannocks and served out salty reestit mutton soup, then cleared it all away and washed up in the kitchen. It was never clear to me that anyone was in charge, although everyone seemed to know who to ask if they had questions. A raffle was held, in which a huge number of donated items were announced in no particular order and interminably slowly. I have proud memories of winning a small electric toaster when I was 8, at just such a raffle. There was a familiar background buzz of companionable gossip, and many, many women knitting as they chatted. This crowd was  different, however: at least half of the attendees in the packed hall were visitors who (like me) had bought tickets that would help fund the MRI scanner. Lerwick’s Jarl Squad (from the Viking-inspired Up Helly Aa Festival held each January) turned up in full regalia for photo opportunities with excited tourists.

This busy public event was at a remove from how the MRI Maakers started out, in the basement canteen of the local hospital. One fundraiser explained how the MRI Maakers occurred to her:

“When I was growing up, if you needed anything extra, then you just got out your knitting. And you knitted, to get extra money… And like, when I was growing up, probably the main things was knitting, fishing, or crofting. And my mum, sometimes literally, needed to knit to put food on the table. So it just was natural for me to think, well why does everybody not just get out their knitting and try and raise extra money that way?”

She had started attending local craft fairs and events to sell pieces of knitting, then someone from the NHS MRI campaign suggested she design a Fair Isle knitting pattern and sell it for the campaign. One family member created a PDF pattern for her design (even though “Shetlanders never usually work with a pattern”) and a website to sell both patterns and donated finished knitwear. Then, as the pattern became more popular than expected, another family member who worked in the Lerwick hospital suggested a regular knitting group. 

“maybe we’ll start a maakers group, that might be an idea, right enough. So we started the maakin group in May. The Wool Brokers and Jamieson of Shetland donated wool, so we don’t have to buy any wool, it doesn’t cost us a penny. We had our maakin group, we meet every second Thursday, in the canteen of the hospital, from six o’clock ‘till late, at night.”

The pattern has been downloaded (with 100% of the fee to the MRI Scanner appeal) all over the world, reflecting the ongoing global appetite for Shetland knitting (Carden, 2019). The fundraiser I attended was a special ticketed event hosted by the MRI Maakers group for Wool Week, as an alternative to their usual canteen meeting.

Knitting followed me around in my visit to the islands. In Shetland, knitting is a pervasive activity, and a significant marker of cultural identity (Carden, 2019). The morning after the fundraiser, I visited the hospital where the maakin group met. I was there to visit another of my Aunties, then nearing the end of her life following several years living with cancer. She lay supine in the bed to avoid the pain of sitting up, a barely touched hospital meal pushed to one side, declaring herself “bored shitless and wanting home”. I sat by her bed and we talked about family, and then she told me dirty jokes that made me laugh inappropriately loudly for a ward environment. Throughout, apparently effortlessly, she knitted. The quiet click of the needles low down on her stomach was a background hum to our conversation, and she never needed to hold up the needles to check a stitch. Those jokes and the background of her perfect, constant knitting are my last memories of spending time with her.

I was, after all, in Shetland to work. The MRI Maakers are mobilising knitting as a central “identity vector” of Shetlandness (Carden, 2019) for their cause. Through their pattern and knitwear sales, they have contributed large sums to the Scanner Appeal directly, as well as generating global publicity for the cause. At the time of writing, the MRI appeal as a whole had raised 85% of the £1,650,000 needed for the scanner. Existing academic analyses of crowdfunding for healthcare focus on individuals trying to raise money for novel or unaffordable treatments, and often emphasise the risk to health inequalities when care entitlements depend on popular perceptions of deservingness. While surely there is some ambivalence across the community, those I spoke to were unconcerned by the need to fundraise for what is elsewhere a tax-funded service. Shetlanders are accustomed to their remoteness from services that are proximous for other populations, and fundraising seems hardwired into these close communities. When I asked an NHS manager how the appeal had started she explained:

“[A colleague] asked, can’t you do something for a scanner, we are so desperate for one, and it was mentioned. And the next thing – it was so quickly grabbed that it kind of almost just spontaneously grew into a bigger thing.  It was never really properly thoroughly discussed, it just grew.”

There was, of course, a bureaucratic business case and a plan for how NHS Shetland could meet the ongoing running costs of the scanner, based partly on cost savings from patient travel to Aberdeen. But fundraisers I spoke to had relatively little interest in these practical aspects of the campaign. Their descriptions of process emphasised the events not as a material means to an end, but as great fun. The maakin knitted community and connection, as well as hats. The maakin group, and their offshoots in care homes and on other islands, sounds like something dreamed up by a public health project looking to combat isolation. The anomalous creation of a formal pattern engaged knitters untrained in the Shetland approach (generally handed down through oral tradition) and in so doing brought money and more attention to the islands.

These connections surely contain many continued exclusions, as mobilisations of community always do. In their study of patients crowdfunding for their own access to experimental cancer drugs, Kerr et al (2021, p. 189) describe the fundraising as “practices of private patienthood… creating and breaking down solidarities in novel and important ways”. These solidarities are even more complex when the collective effort of fundraising is directed towards a collective goal, to improve, and not to circumvent, ‘standard’ NHS care. Charitable money has a long, complicated history in UK healthcare, which has been greatly magnified in the last year (Harris & Mohan, 2021; Stewart & Dodworth, 2020). But in our rush to assess its consequences for the collectivisation or privatisation of healthcare, it seems important to pause and note the processes along the way.    

For now, I can theorise community action but I still can’t knit. The morning of my return journey from Shetland, I got a message from the ferry operator to say the boat was leaving two hours early to avoid a coming storm. On the way to the ferry terminal, I bought my very own pom pom gadget, and my Mum found a mixed bag of ends of wool in a charity shop. We boarded the ferry, I fed my kids some seasickness pills and hunkered down in our cabin to make pom poms while the boat rolled onwards past the headland.

Acknowledgements: Fieldwork was funded by the Carnegie Trust for the Universities of Scotland. The MRI Maakers website is raising funds for NHS Shetland’s MRI Scanner Appeal.

References

Carden, S. (2019). The Place of Shetland Knitting. TEXTILE, 17(4), 357–367. https://doi.org/10.1080/14759756.2019.1639416

This blog was first published on The Polyphony website under a  CC BY 4.0 license

After the death of Captain Sir Tom Moore, what role should charity play in funding the NHS?

Captain Tom

Authors

John MohanUniversity of Birmingham and Bernard HarrisUniversity of Strathclyde.

After the recent death of Captain Sir Tom Moore, outpourings of appreciation for his commitment to raising funds for the NHS during the pandemic have come from every corner of the UK.

Moore inspired people of all ages and from all backgrounds to give to charity. However, the scale of the funds raised – around £150 million – has also prompted questions about the role of charitable funding for the NHS.

Moore was one of a diminishing number of people with direct experience of the pre-NHS healthcare system. As a second world war veteran, he understood the risks and sacrifices ordinary people made at that time. These sacrifices directly influenced post-war promises to build a new and better Britain, including providing people with the security of a comprehensive health service.

Funding in the early days of the NHS

Before the NHS came into being, health services depended on what Aneurin Bevan (the first post-war minister of health) described as the “caprice of private charity”, where people’s chances of being treated by a voluntary (charitable) hospital varied fivefold between local authorities.

The NHS’s efforts to reduce unequal access in the post-war period were financed through taxes, national insurance and fees for some services. Charity played a largely marginal role.

Donations to NHS institutions were never formally banned. However, from the birth of the NHS until 1980, health authorities weren’t allowed to raise funds because it could lead to unbalanced service provision if some regions were able to raise more funds than others. The guidance suggested that gifts of money and equipment could be accepted, but charity shouldn’t be used to pay for items related to direct patient care, which was the government’s responsibility.

From 1980, restrictions on fundraising by health authorities were relaxed as part of initiatives by the Thatcher government to promote greater community support for public services. Since then, the NHS has seen more fundraising, but the outpouring of support since 2020 is unprecedented. Moore’s efforts encouraged fundraising across all ages, from 98-year-olds to young children.

Donations: a blessing or a curse?

Fundraising has divided opinion among a number of camps. One widely held view is that using charity for resources and staff and patient comfort is acceptable, which is broadly the NHS’s official position. However, some argue that supporting staff wellbeing is a public responsibility, which should include providing decent wages and working conditions without any need for charity. Others in favour of raising charitable funds to support healthcare service provision would remove restrictions on the use of donations altogether.

To put the issue in context, it’s worth summarising how much money is raised for the NHS through charities directly associated with individual NHS Trusts (the principal providers of healthcare).

When Moore launched his appeal, he stipulated that donations should go to an umbrella organisation called NHS Charities Together. The organisation is responsible for coordinating most of the funds generated by charity for the NHS and has over 200 member organisations.

Before the pandemic, these organisations were spending close to £500 million a year on NHS support. Even so, these sums don’t even add up to 1% of total public expenditure on healthcare in the UK. At best, this funding serves as “added extras” to the existing tax-funded system.

However, while many NHS charities are small in financial terms, that’s not the case for all of them. As Ellen Stewart, social studies of health and medicine researcher at the University of Edinburgh, has pointed out, they should not be dismissed as being marginally significant.

NHS charitable funds are spread very unevenly among communities and sectors of the NHS. Some major London teaching hospitals have received some of the largest donations of any British charity, and a number of NHS charities spend over £10 million a year.

There are also differences in the fundraising potential of different sectors of care. Charities associated with mental health or community health services generally receive far less fundraising income, which has led researchers to question how well charitable fundraising is aligned with health priorities. Despite substantial contributions to specific NHS institutions, less fortunate organisations or communities can be left out.

It’s possible that any increase in charitable giving may concentrate resources on parts of the NHS that are already well resourced. This isn’t a new issue. In 1848, political philosopher John Stuart Mill stated that “charity always does too much or too little. It lavishes its bounty in one place, and leaves people to starve in another.” The challenge for the NHS is balancing aspirations for providing equal access to care with the inequalities that arise as a result of voluntary fundraising.

There’s also the vexed issue about whether NHS fundraising is paying for services and facilities that should be the responsibility of the state. For many years, commentators have questioned the potential blurring of the line between supporting amenities and welfare on one hand and paying for core services on the other.

NHS staff receive public support because they’re working against the most dangerous threat to the nation since the second world war. But the public’s commitment to fundraising shouldn’t be seen as approval for transferring responsibility from the taxpayer to charity. If anything, recent events have reinforced public support for the NHS remaining a state-funded service for the entire population. The government should be very wary of assuming that support for appeals like Moore’s indicates otherwise.

John Mohan, Director, Third Sector Research Centre, University of Birmingham and Bernard Harris, Professor of Social Work and Social Policy, University of Strathclyde

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Public fundraising for the NHS, and its discomforts

Text which says Covid 19

Authors

Ellen Stewart and Kathy Dodworth.

The fundraising of Captain Tom Moore and many others during the coronavirus outbreak has propelled charitable giving to the NHS into the public eye. At the time of writing, NHS Charities Together had raised over £100 million for its emergency Covid-19 appeal “that acknowledges and supports NHS staff and volunteers caring for COVID-19 patients”, with over £32 million of this raised by Captain Moore’s sponsored walk alone. However, this feat has also prompted a backlash in some quarters, including concerns that donations are masking underlying long-term underfunding of the NHS, and that philanthropic giving more generally has deleterious democratic consequences. Both the unprecedented scale of this fundraising, and the pressing question of how the money will be spent, need to be understood in their historical context, and within wider debates on the ‘mixed economy of welfare’ and the role philanthropy can and should play in meeting public needs.

A first point is simply to contextualise the fundraising within total NHS budgets. Comparative figures with other countries vary depending on how much social care and long-term care is included, but the UK spends about an average amount of its GDP on health compared to other European health systems. Nonetheless, the figures can be startling in black and white: in 2017 the UK as a whole spent £197 billion on healthcare. That makes £100 million look less like a threat to the taxation-based funding of the NHS and more plausible, as NHS Charities Together argue, as an embellishment of ‘added extras’ to the existing tax-funded system.

Second, NHS charities are far from new, and certainly not a vehicle created by the current Westminster Government to advance the creeping privatisation of the NHS. Many have existed since the creation of the NHS, and often grew out of charitable funds that predated it. In one speech Bevan declared that the fledgling NHS needed “all the voluntary help we can get”. In practice, charity was strictly limited (in another speech he declared it “repugnant to a civilised community for hospitals to have to rely upon private charity”) but the charitable endowments remained in existence and some grew. That is not to say that they have not changed over time. NHS fundraising has always been a fairly vexed policy issue and governmental enthusiasm for the NHS charities has waxed and waned along with concerns about the governance of the charities. More generally, the NHS has rarely been a monolithically tax-funded healthcare system. The briefest glance at the financial position of hospice care in the UK, for example, puts paid to the idea that as a country we are outraged by vital services relying on charitable pounds.

Third, some of the debate about NHS charities has become embroiled in wider debates about ‘big philanthropy’, with key advocates of organisations like the Gates Foundation defending their role, while others critique their unaccountable power in the world as a threat to health governance worldwide. Far from being excessively influential, NHS charities, with the exception of a handful of the major teaching hospitals, are tiny, local charities. ‘NHS Charities Together’ operates as an umbrella organisation with a small staff. That doesn’t mean we shouldn’t question the governance of these significantly increased funds, but that we should distinguish the right questions to ask.

There are valid critiques of the role of charities within the NHS. The funds are spread very unevenly across the country in geographical terms. The big London teaching hospitals function with large historical endowments and few others outside the capital can compete with their brand awareness. There are also differences in the fundraising potential of different sectors of care, such as mental health trusts or addiction services. This is especially problematic when we consider the potential of charitable donations in England’s fragmented NHS, as compared to the Welsh, Scottish and Northern Irish territorial boards. This inequality also exists, of course, beyond the narrow parameters of what has conventionally been seen as ‘the NHS’. We should ask why social care services (almost all run by the private sector) and indeed, preventative public health measures tackling the wider social determinants of health, languish without nearly enough funding from any source. In the last few weeks we’ve seen repeated calls to enlarge our ‘clap for the NHS’ towards a more expansive ‘clap for carers’. However the financial corollary of this doesn’t exist for social care. NHS Charities Together, who launched their first ever nation-wide fundraising campaign in 2018, has been perfectly placed to capitalise on current public outpourings of gratitude for ‘the NHS’.

‘The NHS’ stands in, as it always does, as placeholder for a myriad of public hopes, fears and thanks in our current crisis. Reflecting on #clapforcarers last week, Gary Younge eloquently centers the role of Black and Minority Ethnics immigrants in sustaining and dying working in the NHS; “clearly, we’re not all clapping for the same thing”. A recent paper by Des Fitzgerald and colleagues explores the role of the mythologised NHS in the 2016 Brexit campaign. In order to understand the meaning and consequences of current exceptional patterns of public donation to the NHS, we will need to explore the work of NHS charities in practice, and how members of the public understand the cause to which they are donating. A new Wellcome Trust Collaborative Award, granted before the covid crisis but now more pressing than ever, seeks to do just that. Starting this autumn, we will take a wide historical lens and draw on insights from a range of disciplines across the social sciences and humanities to rethink the past, present and indeed future of charitable giving in the NHS.

This blog was first published on the Cost of Living website