Charity and the National Health Service in the UK

What is it about?

Before 1948, approximately one-third of the United Kingdom (UK)’s hospital beds were located in voluntary hospitals, many of which continued to benefit from the funds generated by their historic endowments. When the National Health Service (NHS) was created, the vast majority of these hospitals were taken over by the State. This paper examines the neglected question of what happened to these endowments and the role which charity continued to play in the funding of NHS hospitals more generally. It makes an explicit attempt to examine the development of hospital services in each of the UK's constituent nations and shows how the treatment of endowments and the role of charity differed between them. It also highlights the continuing importance of arguments over the ‘boundaries’ between ‘essential’ and ‘non-essential’ forms of health service expenditure, and between the roles of the statutory and voluntary sectors more generally.

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Photo by Nicolas J Leclercq on Unsplash

Photo by Nicolas J Leclercq on Unsplash

Why is it important?

This paper begins by examining the distribution of the endowments held by prewar voluntary hospitals after the NHS was created. This was an important part of the task of reconstructing the ‘legacy’ of voluntarism on the NHS after it came into being. We then look more broadly at the development of attitudes to the role of charity in supporting the health service during the 1950s, 1960s and early-1970s. The paper also highlights a number of other issues, including (1) the robustness of the distinction between ‘essential’ and ‘non-essential’ aspects of health care; (2) the implications of this distinction (and the difficulties associated with it) for the ‘border’ between charity and the state; (3) the use of charitable funding (or funding with charitable origins) to supplement public expenditure in what might be regarded as core areas of statutory responsibility; and (4) the significance of the different territorial contexts.