The UK's National Health Service (NHS) is increasingly leaning on charities to deliver services, a trend that critics argue is blurring the lines between charitable support and essential public healthcare, potentially creating problems for patients.
Charitable involvement in healthcare in the UK is not new. Before the NHS was established in 1948, healthcare was a mix of voluntary organizations, local authorities, and private arrangements, with many hospitals relying on donations. The creation of the NHS aimed to shift healthcare funding to taxation, with founder Aneurin Bevan believing it should not depend on charity. Initially, NHS hospital charities faced restrictions on active fundraising, though they could still receive gifts.
A significant change occurred with the Health Services Act of 1980, which fostered a more active fundraising culture. This led to a substantial expansion of NHS charities, which by the 1990s were raising considerable sums for equipment, buildings, and research. Today, over 220 NHS charities attached to hospitals or community services collectively raise approximately £620 million annually. This sum, however, represents only about 0.3% of the total health budget.
While many charities focus on supplementary services like CPR training or community defibrillator placement, others are funding what some consider core NHS functions. For instance, charities have funded expensive equipment such as scanners, blood transfusion apparatus, and emergency department coordinators. Ellie Orton, chief executive of NHS Charities Together, defends this practice, stating that the goal is to provide services beyond what the NHS can afford with its finite budget. She suggested that if charitable funding allows a parent to stay near their ill child in a hospital room, it is a positive outcome.
The 1980s legislation and subsequent market reforms in the 1990s also opened doors for disease-specific charities like Macmillan, Marie Curie, and Dementia UK to become involved in service delivery. Dementia UK, for example, has developed a network of Admiral Nurses, specialist dementia nurses who work in both hospital and community settings. The model typically involves the charity co-funding posts for up to two years, with the expectation that the NHS will assume full funding afterward.
However, charities are reporting increased pressure. "We are being asked to fund them for longer or find more than half the cost," said one representative, indicating that services are being cut back. The charity WellChild, which supports specialist nurses for very sick children, noted that for the first time, a funded nurse post was not continued by the NHS. WellChild nurses are now dealing with caseloads significantly larger than their intended limits, with concerns that "services are being dismantled - and our nurses are propping things up."
Similar challenges are faced by other voluntary sector organizations. Rethink Mental Illness reported that charities are increasingly expected to absorb shortfalls to keep essential services operational. Parkinson's UK stated that its funding covers about 70% of specialist nurses in their field. The charity's chief executive argues this is unfair, effectively imposing an additional "tax" on individuals affected by Parkinson's, who are often the main donors, to fund essential nursing care that should be a core NHS offering.