The place of charity in a public health service: inequality and persistence in charitable support for NHS Trusts in England
The place of charity in a public health service: inequality and persistence in charitable support for NHS Trusts in England
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.
Charitable endowments, Charitable fundraising, Inverse care law, NHS Trusts, National health service, Spatial inequality
Bowles, James
1c1bbaab-954e-43c3-999f-0b428c005ed0
Clifford, David
9686f96b-3d0c-48d2-a694-00c87b536fde
Mohan, John
30a03189-46ba-4ebf-895d-00fd1138325a
April 2023
Bowles, James
1c1bbaab-954e-43c3-999f-0b428c005ed0
Clifford, David
9686f96b-3d0c-48d2-a694-00c87b536fde
Mohan, John
30a03189-46ba-4ebf-895d-00fd1138325a
Bowles, James, Clifford, David and Mohan, John
(2023)
The place of charity in a public health service: inequality and persistence in charitable support for NHS Trusts in England.
Social Science & Medicine, 322, [115805].
(doi:10.1016/j.socscimed.2023.115805).
Abstract
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.
Text
SSM_D22-03484_revDec22_clean
- Accepted Manuscript
Text
1-s2.0-S0277953623001624-main
- Version of Record
More information
Accepted/In Press date: 21 February 2023
Published date: April 2023
Additional Information:
Funding Information:
Funding from the Wellcome Trust, for a Collaborative Award on the topic of “Border crossings: charity and voluntarism in Britain's mixed economy of health care since 1948” (ref: 219901/D/19/Z), is gratefully acknowledged.
Funding Information:
Funding from the Wellcome Trust, for a Collaborative Award on the topic of “Border crossings: charity and voluntarism in Britain's mixed economy of health care since 1948” (ref: 219901/D/19/Z), is gratefully acknowledged. We would also like to acknowledge the helpful comments and suggestions made by investigators and researchers associated with that award and audiences at recent conferences of the Social Policy Association, the International Society for Third Sector Research, and the Association for Research on Nonprofit Organisations and Voluntary Action.
Publisher Copyright:
© 2023
Keywords:
Charitable endowments, Charitable fundraising, Inverse care law, NHS Trusts, National health service, Spatial inequality
Identifiers
Local EPrints ID: 476150
URI: http://eprints.soton.ac.uk/id/eprint/476150
ISSN: 0277-9536
PURE UUID: 62f45c2e-e5c9-4663-a546-f7acb2205573
Catalogue record
Date deposited: 12 Apr 2023 16:55
Last modified: 17 Mar 2024 03:06
Export record
Altmetrics
Contributors
Author:
James Bowles
Author:
John Mohan
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
