By Salma El-Sakka
The NHS is increasingly relying on charities to deliver frontline health services, a trend that experts warn may be creating problems for patients and widening inequalities across the UK.
Charities filling gaps in stretched services
Dementia specialist nurse Louise Burns runs virtual clinics supporting more than 100 patients and families each week, a service entirely funded by the charity Dementia UK. Its chief nursing officer, Paul Edwards, says the charity is "trying to fill the gaps" within stretched NHS services as dementia cases rise. Similar charity-led initiatives operate across children's care, mental health, and cancer services, some with formal NHS contracts and others working alongside the health service.
Growth of charity involvement in health
Charities have long played a role in UK healthcare, but their involvement expanded after the Health Services Act 1980 encouraged fundraising. Today, more than 220 NHS charities attached to hospitals raise £620 million annually, while cancer charities alone raise over £1 billion. NHS Charities Together chief executive Ellie Orton says this represents only 0.3% of the health budget and funds extras like CPR training, defibrillators, and family accommodation. However, charities also fund scanners, blood transfusion equipment, and emergency department coordinators – items some argue should be core NHS responsibilities.
Concerns over subsidising NHS budgets
Charities report growing pressure to subsidise squeezed NHS budgets. WellChild, which funds specialist nurses for seriously ill children, saw a nurse post not renewed for the first time this year, and its nurses carry average caseloads of 40 against a target of 15. Rethink Mental Illness says charities are expected to absorb shortfalls to keep services running. Parkinson's UK funds around 70% of specialist nurses in its field, which its chief executive Caroline Rassell calls an effective additional "tax" on people with the disease.
Inequalities in charitable funding
The charity sector is dominated by large London hospitals and specialist centres, with the Royal Marsden and Great Ormond Street charities accounting for nearly a sixth of NHS charity investment. Hospice UK chief executive Toby Porter notes that communities with greater fundraising capacity secure better provision, leading to more people from deprived areas dying in hospitals against their wishes. Health literacy differences also affect access to support, widening inequalities further.
NHS and government response
NHS England maintains that charities remain valuable partners and says its 10-year plan aims to build on the "potential" of these partnerships. The government has shown increasing interest in philanthropic donations, with recent large gifts including £10 million from XTX Markets and £6.8 million raised by rugby league legend Sir Kevin Sinfield for a motor neurone disease centre. However, the National Council for Voluntary Organisations warns that without contracts covering full delivery costs, services risk reduction or closure when communities need them most.
