The NHS is finding itself turning to charitable organisations to supplement services that the health service can no longer fully provide on its own. From virtual dementia clinics funded entirely by a charity to specialist nurses in oncology and children’s wards, the voluntary sector is becoming a more permanent fixture in the delivery of frontline care. This shift reflects both the expanding demand for health support and the financial constraints faced by the public system, but it also raises questions about equity, sustainability and the long‑term role of philanthropy in a tax‑based health service.
Charity Partnerships Fill Gaps in NHS Care
A recent virtual clinic run by Dementia UK illustrates the new reality. Nurse Louise Burns, who helps more than 100 patients and relatives each week, says: “No matter what stage they are at, we try to help.” The service, set up during the pandemic and kept running because of strong demand, is funded solely by the charity. It assists families like the man whose mother struggled to be discharged from hospital, guiding them through the process and connecting them with community support.
The charity’s chief nursing officer, Paul Edwards, describes the mission as “trying to fill the gaps” within stretched NHS services. He notes that rising dementia cases, coupled with pressure on both the NHS and social care, mean “it’s not always easy to get the support you need.” Similar arrangements exist across the health spectrum. Cancer charities raise more than £1 billion annually, while the NHS in England spends nearly £2 billion a year purchasing services from not‑for‑profit and voluntary organisations.
Growing Reliance and Funding Landscape
The trend did not emerge overnight. Before the NHS was founded in 1948, healthcare in Britain was delivered through a patchwork of local charities, voluntary groups and private arrangements. Hospitals relied on donations, subscriptions and fundraising events to survive. The post‑war system aimed to move away from charity, but the Health Services Act of 1980 encouraged a more active fundraising culture. Since then, NHS‑affiliated charities have become increasingly professionalised, raising £620 million a year today.
NHS Charities Together, which represents over 220 hospital‑based charities, argues that this sum represents only about 0.3 % of the total health budget. Its chief executive, Ellie Orton, says the purpose is to provide “support, equipment and services that are additional to what the NHS provides.” Recent examples include CPR training for the public, community defibrillators and green spaces within hospitals.
Recent years have seen large one‑off donations that have amplified the sector’s impact. A £10 million gift from the trading firm XTX Markets went to the NHS Charities Together Covid appeal, while the Rausing family contributed £5 million. Sir Kevin Sinfield’s campaign for motor neurone disease raised £6.8 million for a specialist centre at Leeds Teaching Hospitals.
Orton points out that the government is showing growing interest in what charities and larger philanthropic donations can achieve. “We are not talking about returning to a pre‑1948 situation, but there is real interest in what such philanthropy can do,” she says.
Challenges and Inequalities in Service Delivery
Despite the goodwill, the expanding role of charities is not without tension. Many voluntary organisations report that they are being asked to subsidise squeezed NHS budgets. Dementia UK’s network of Admiral Nurses, for instance, is co‑funded by the NHS for up to two years, with the expectation that the health service will eventually take over. Edwards says the reality is “a struggle” to secure the necessary funding, noting that “we are being asked to fund them for longer or find more than half the cost.”
The squeeze is not limited to dementia care. WellChild, which established a network of 54 specialist nurses for seriously ill children, funds these posts for the first three years before the NHS is expected to assume responsibility. This year, for the first time, a nurse post was not retained, says Amy Mitchell, the charity’s director of programmes. Moreover, while the intended caseload is 15, the average is now 40. “Services are being dismantled – and our nurses are propping things up,” she observes.
Rethink Mental Illness’s chief operating officer, Mark Yates, warns that “there is too often an expectation that we will absorb shortfalls ourselves to keep essential services running.” Parkinson’s UK reports that its funding now covers roughly 70 % of specialist nurse posts in the field. CEO Caroline Rassel argues that this amounts to an “additional ‘tax’ on people with Parkinson’s as they are our main donors,” and stresses that “nursing care should be the cornerstone of what the NHS offers.”
A 2023 poll by the National Council for Voluntary Organisations (NCVO) found that 71 % of health charities believe the value of their contracts does not meet the demand for services, forcing many to use their own donations to keep programmes alive. NCVO chief influencing officer Leigh Brimicombe says charities are clearly “subsidising” public services and calls for contracts that “cover the full cost of delivery.”
The situation also creates inequalities. Some disease areas, such as cancer, have a well‑established charitable sector that can attract substantial funding. Others, like sickle‑cell disease, have a smaller charitable presence and less financial backing. Hospice UK’s chief executive, Toby Porter, notes that “some communities will be able to give more than others, leading to inequalities in hospice provision.”
Sarah Scobie of the Nuffield Trust adds that “more people from deprived areas die in the place where most people say they don’t want to die – in hospital.” She attributes part of this disparity to health literacy and the uneven distribution of charitable resources.
Why it Matters
The growing involvement of charities in frontline NHS care reflects both the ingenuity of the voluntary sector and the pressures on a publicly funded health service. While philanthropic support can bring vital services, equipment and community connections, the reliance on donations risks entrenching health inequalities, shifting the burden onto patients and their families, and blurring the line between what should be a universal right and a charitable privilege. As the NHS continues to grapple with rising demand and limited resources, policymakers must decide whether to formalise these partnerships, ensure equitable funding across disease areas, or reaffirm the principle that core health services should be delivered through taxation rather than generosity. The stakes are high for patients whose care increasingly depends on the generosity of their community rather than the guarantees of the state.
