The place of charity in a public health service

Inequality and persistence in charitable support for NHS trusts in england

Bibliographic Data

ID4591994
AuthorsJames Bowles (0000-0003-1473-6329, University of Birmingham), David Clifford (0000-0002-5347-0706, University of Southampton), John Mohan (0000-0002-6063-3454, University of Birmingham, corresponding author)
Year2023
Volume322
Pages115805
Publication date2023-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2023.115805
PMID36889220
OpenAlexW4322011983
LanguageEN
Citations received7
References cited19

The British National Health Service (NHS) relies for the great bulk of its funding on direct taxation, but the contribution of charitable sources of income to the NHS is not well-understood. The few studies of charitable giving to the NHS to date have concentrated on aggregate levels of income and expenditure. However, to date there has been limited collective understanding about the extent to which different kinds of NHS Trusts benefit from charitable funding and about the persistence of inequalities between trusts in their access to these resources. This paper presents novel analyses of the distribution of NHS Trusts in terms of the proportion of their income that comes from charitable sources. We build a unique linked longitudinal dataset which follows through time the population of NHS Trusts, and the population of associated NHS charities, in England since 2000. The analysis illustrates intermediate levels of charitable support for acute hospital trusts compared with the much lower levels of charitable support for ambulance, community and mental health Trusts and, conversely, much higher levels of charitable support for Trusts providing specialist care. These results represent rare quantitative evidence relevant to theoretical discussions about the uneven nature of the voluntary sector's response to healthcare need. They provide important evidence for a key feature (and arguably weakness) of voluntary initiative, namely philanthropic particularism - the tendency for charitable support to focus on a restricted range of causes. We also show that this 'philanthropic particularism' - reflected in the very sizeable differences in charitable income between different sectors of NHS trusts - is becoming more marked over time, while spatial disparities, notably between elite institutions in London and other locations, are also substantial. The paper reflects on the implications of these inequalities for policy and planning within a public health care system

Business · Demographic economics · Economic growth · Economics · Health care · Inequality · Political science · Population · Public relations · Service (business · Sociology · Voluntary sector · Healthcare Policy and Management · Nonprofit Sector and Volunteering · Social Policy and Reform Studies