As a new report shows that London's NHS now gets almost a tenth of its funding from charity, Roger Dobson looks at how the charitable sector is still propping up the health service
Aneurin Bevan, the founder of the NHS, said in his book In Place of Fear: “It is repugnant to a civilised community for hospitals to have to rely upon charity. I have always felt a shudder of repulsion when I have seen nurses and sisters who ought to be at their work . . . going about the streets collecting money for the hospitals.”
Now, more than 50 years later, some doctors and charity workers are complaining that the health service is still too reliant on voluntary contributions. Charity funding, once the icing on the cake for the NHS, is increasingly providing the filling as well. A new report, Philanthropic Funds in London's Healthcare, estimates that charitable funding accounts for almost 10% of NHS spending in the capital. Charities contribute about £500m ($700m) a year to health care in London, compared with about £5bn that comes from the NHS. London's hospitals alone are now estimated to be getting more than £200m a year from charitable funds. Apart from the huge funds that London hospitals attract, health research across the country owes an increasing debt to charity, rather than the NHS. Of £180m spent a year on cancer research, only £20m comes from the governmentthe rest coming from charities. Charity funding is being used not only for research but for refurbishment and expansion of hospital buildings, for clinical equipment, and for salaries of researchers. The Arthritis Research Campaign, typical of many of the leading national charities, makes award for research fellowships and clinical fellowships, as well as travel bursaries, project grants, clinical arthritis centres, and innovation grants. Hospitals have always benefited from charitable funding, but in recent years the amount of such funding has been growing. The National Audit Office showed in its report last June that over 500 trustee bodies are now administering charitable funds associated with the NHS, which together hold net assets amounting to some £1.8bn, compared with £1.5bn in March 1997. In 1998-9, these bodies spent £322m in support of the NHS. And according to the charity Bliss, which provides neonatal intensive care equipment for hospitals, 80% of orders for equipment dealt with by manufacturers of neonatal incubators and ventilators now come from charities rather from than the NHS. Bliss said that it had been approached by University College Hospital London to supply 10 incubators: “[This hospital] is universally regarded as a centre for excellence in neonatology. But in sharp contrast, all its incubators are obsolete.” Bliss, which currently has requests for help that would cost £7m, said that the NHS is taking advantage of the ability of charities associated with babies to raise money: “[The NHS] allows too much to rest on the charities' shoulders,” it said. Trevor Guppy, chairman of Diabetes UK's voluntary groups committee, said that, although in theory the NHS should provide everything that is needed, reality is very different: “This is the real world. With so many demands on the public purse we have to accept, however reluctantly, that voluntary organisations will need to help out.” He added a note of caution, however, for fundraisers: “It is not our policy to take over the responsibilities of the NHS. Never forget you are spending other people's money, and give it away with great consideration. Contribute only when local pressure has failed. Always check that the equipment will be fully used, refuse requests for salaries and running costs, and ensure you don't become a soft touch for the NHS.” Just how much money goes into health and research nationally is not clear. Contributions from the Wellcome Trust, Britain's biggest charitable provider, now exceed £400m a year. In the last year for which accounts are available, 1999, the grants it awarded totalled £402m. The Cancer Research Campaign puts more than £60m into cancer research, three times as much as the government. “In the United kingdom, research funding on cancer research is about £180m and the government puts in about £20m; the rest comes from the charities. Tony Blair has said that the government would now match the charity spend in cancer research. We are trying to get to the bottom of what that will mean. If they were to put in another £160m that would be fantastic, but we wait and see,” said James Davidson, director of finance at the Cancer Research Campaign. Research carried out into charitable funding of health care in London by the Charities Aid Foundation for the King's Fund and Guy's and St Thomas's Charitable Foundation, whose early results were published on Monday, has provided real insight into the scale of the contribution. Of the £500m spent by charities on health care in the capital, it found that more than £214m came from four main sources: hospital trusts, big grant givers such as Wellcome, Leagues of Friends, and the National Lottery Charities Board. Fund raising charities, non-profit hospitals, and hospices spent a further £138m. How was that money from these four sources spent? The study found that medical research was the single largest beneficiary, spending about 48% of the total. Just over 8% (about £18m) was spent on the refurbishment and expansion of hospital buildings and inpatient facilities. A further 6.2% (£13.4m) was spent on clinical equipment. Ian Mocroft, one of the authors of the report, said, “What we found was that charitable funding for health care provision in London is equal to 10% of NHS expenditure£500m on top of the NHS's £5bn.” With such large amounts of money involved and no end in sight to the increasing demand for charity funding, there have been calls for a review of the role of charities. As Bliss's chief executive, Suzanne Dobson, said, “We cannot keep pace with the need, and we are not alone. The situation is simply unsustainable. Because there is no reversal in sight we have had to raise the debate and call for a revolutionary but pragmatic reappraisal of the role of charities within the funding of the NHS.”
Philanthropic Funds in London's Health Care will be available in December from Charities Aid Foundation, Kings Hill, West Malling, Kent ME19 4TA (tel 01732 520 125) and on the foundation's website (www.cafonline.org).
Figure.
“I have always felt a shudder of repulsion when I have seen nurses… going about the streets collecting money” (Aneurin Bevan)