The BBC reports that charities are propping up NHS cancer care for children to the tune of millions of pounds a year. And it quotes experts who are worried by that dependence.

They’re not the only ones to be concerned. The fact that the NHS hoovers up charitable funds has been preoccupying some commentators for decades. But the issue nonetheless gets less coverage than it should.

The basic problem is this. The NHS is allowed to raise money, and spend other charities’ money, on services which are supplementary to basic healthcare needs. So while the NHS cannot accept charitable cash to perform operations or pay for drugs, it can use charity money to pay for extra therapy or some types of specialist nurse.

However, defining what’s ‘basic’ and what’s ‘supplementary’ is almost impossible. As a result, charities can end up providing what looks very much like basic healthcare. This saves the NHS a pile of money, so it doesn’t complain, and it’s in few other people’s interest to make a fuss. After all, care is being provided, so what does it matter who pays?

In reality, a great deal. This is why:

1. Charity cash is inherently unstable. The NHS has its funding guaranteed for years in advance. Charities don't. So if donations to an organization providing healthcare suddenly dried up, patients would suffer.
2. Charity cash isn’t evenly distributed. If you think patients are entitled to the same standard of care across the NHS, you should be concerned by charities’ role. They only operate in some areas.
3. Charity cash could (perhaps) be better spent elsewhere. This is, I admit, controversial. But it’s possible that if charities withdrew from the NHS, then the NHS would plug the gap with public funds. And that would free those millions of pounds of charity cash for less well-funded causes.
4. Charity cash can be misused. This is controversial too, but charities officially affiliated to hospitals are often controlled by the same people who control the hospital itself. To me this screams ‘conflict of interest.’ It’s therefore possible – and I’d go no further than that without evidence – for these charities to be raided to plug funding gaps or cover up for bad management in the hospital.

The relationship between charities and the NHS is incredibly complex. It’s possible - if unlikely - that I, and the other worried commentators, have entirely misunderstood the situation. But, as ever, until the charities do a better job of explaining their work, donors like me will continue to be concerned.
 

 

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