Charity and the NHS

Charity and the NHS

What we did

Our research involved both qualitative and quantitative historical and social science research.

The NHS is the classic tax-funded healthcare system. But charitable activities have remained an important part of healthcare in the UK.

What did we find out?

Charities have made significant contributions to the NHS.

The impact of NHS charities is not just about money.

Charitable contributions fund a wide range of healthcare needs:

Health policy has neglected the role of charity within the NHS.

Inequalities can be unintentionally exacerbated by charitable activities.

What next?

Exacerbate inequalities between NHS organisations

Offer communities more of a say in local services

Understanding the role of charity in the NHS over the decades can inform better discussions about its future. Decision-makers should understand these roles and recognise that charity might:

Charitable funding in the NHS has evolved over time:

Combat some of the causes of ill-health

Improve patient experience

NHS early years (1948-1979)

Before the NHS (pre-1948)

Funded by

Let’s start better conversations about charity in the NHS.

The recent NHS (2019-2023)

The expansion of fundraising (1980-2018)

To find out more visit bit.ly/Border-Crossings or email Professor Ellen Stewart at Ellen.Stewart@Glasgow.ac.uk

The expansion of active fundraising (1980-2018)

The amount and scale of fundraising campaigns in the NHS increased greatly following the Health Services Act (1980). The Act permitted NHS bodies to engage in fundraising. Major appeals like the Great Ormond Street Hosptial Wishing Well Appeal followed. Some charities hired professional fundraisers.

Health policy has neglected the role of charity within the NHS.

• Charitable activity in the NHS has been shaped by – but has also shaped – policy and practice.
• It is often argued that charitable money should pay only for ‘extras’ beyond standard NHS provision, but that distinction has never been clearly written in Government policy.
• And what is a necessity or an extra anyway? Views vary between organisations, and over time.
• Examples of things considered as charitable extras over the last 75 years include comfortable chairs for the hospital bedside, major building projects, and medical equipment like scanners.

Before the NHS (pre-1948)

Before the NHS, many UK hospitals relied upon charity and voluntary subscription schemes. Funding was variable across different hospitals. Nye Bevan described this as “the caprice of charity”. The NHS was intended to provide more stable funding.

Inequalities can be unintentionally exacerbated by charitable activities.

• In England, specialist and acute NHS Trusts receive a much greater proportion of their income from charitable funds than other Trusts (e.g. community, ambulance or mental health Trusts).
• Trusts in deprived communities receive a lower proportion of income from charitable sources.
• Not all NHS-supporting charities actively fundraise. Over time, this increases disparities between large, well-resourced charities, and smaller, minimally staffed ones.

Mohan, J & Clifford, D. (Feb 2024) 'Spatial inequalities in charitable fundraising and income generation for NHS acute trusts in England'

The recent NHS (2019-2023)

Since 2018, the NHS birthday (5th July) has been associated with national NHS fundraising campaigns. This accelerated during the Urgent COVID-19 Appeal, which raised over £150 million. New modes of digital fundraising now supplement traditional fundraising approaches.

Our multidisciplinary research included:

• Archival research across the UK.
• Oral history interviews with former Ministers.
• Assembling and analysing new datasets of NHS and charity finances.
• A witness seminar on hospital fundraising from 1980 to present day.
• Qualitative case studies of contemporary NHS charities and appeals.

Our research on charity and the NHS since 1948 is a large collaborative programme that ran from 2020-2025. The research was led by Professors John Mohan (University of Birmingham), Martin Gorsky (London School of Hygiene & Tropical Medicine), Bernard Harris (University of Strathclyde) and Ellen Stewart (University of Glasgow). The research programme was generously funded by the Wellcome Trust (219901/Z/19/Z). With valued contributions from Drs Helen Abnett, Puren Aktas-Vincent, Agnes Arnold-Forster, Hannah Blythe, David Bomark, James Bowles, David Clifford, Rosemary Cresswell, Steph Haydon, Michael Lambert, Diarmuid McDonnell, Gareth Millward, Chris Möller, Samantha Shave and Francesca Vaghi.

The impact of NHS charities is not just about financial contributions.

• As well as gifting money many people volunteer to support local NHS services.
• Charitable capital appeals (e.g. for equipment, buildings or projects) also promote community engagement with local services.
• People who choose to support NHS charities often acknowledge that charitable funding is needed due to a lack of statutory funding. Fundraisers and volunteers emphasise that they simply want to help local services.

Charities have made significant contributions to the NHS.

• Healthcare costs rise rapidly, and NHS funding has rarely kept pace.
• In this context, NHS charities have innovated and experimented with both fundraising and spending.
• Larger charities have pushed the boundaries of charitable innovation furthest, including paying for buildings and major equipment purchases.
• Charitable fundraising in the NHS doesn’t simply raise money. It generates and signals public support and priorities.

NHS early years (1948-1979)

Core hospital costs were now centrally funded. Hospitals were allowed to keep and spend some of their pre-NHS charitable funds. Some scope remained to accept spontaneous donations, and charitable fundraising was permitted through local independent charities such as Leagues of Friends.