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

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.