Health

Charities Step In to Fill NHS Gaps, Raising Concerns About Funding and Inequality

By Nick Triggle

A dementia specialist nurse, Louise Burns, explained how a virtual clinic run entirely by the charity Dementia UK helped a man secure a safe discharge for his mother. The clinic, which supports more than 100 patients and families each week, was set up during the Covid pandemic and continues because of strong demand. Burns said the NHS and social care are under huge pressure and dementia cases are rising, making it difficult to obtain the necessary support.

Dementia UK’s chief nursing officer, Paul Edwards, said the charity is “trying to fill the gaps” within stretched NHS services. The charity’s model involves co‑funding specialist dementia nurse posts with the NHS for up to two years, after which the NHS is expected to take over. Edwards warned that demand is increasing and that the charity is struggling to secure the funding needed from the NHS or from donations.

Charities are increasingly involved in health care across the UK, from children’s care to mental health and cancer services. Some have formal NHS contracts, while others work side‑by‑side with the health service. The government’s long‑standing desire to create a market of providers—NHS, private and voluntary sector—has made the charity sector a significant part of health care. Cancer charities alone raise more than £1 billion a year, and the NHS in England spends nearly £2 billion a year buying services from the not‑for‑profit and voluntary sector.

However, the scale of charity involvement has raised concerns. Service providers report that they are subsidising squeezed NHS budgets, and critics argue that charitable work with the NHS can lead to more money ending up in wealthier communities. Defenders say that additional funding should be welcomed.

Historically, before the NHS was created in 1948, healthcare was delivered through a patchwork of local charities, voluntary organisations, local authorities and private arrangements. The Health Services Act 1980 encouraged a more active fundraising culture, and by the 1990s NHS charities were raising substantial sums for equipment, buildings and research. Today, more than 220 NHS charities attached to hospitals or community services raise £620 million a year, about 0.3 % of the health budget.

The charity sector is dominated by a few large organisations. For example, the Royal Marsden and Great Ormond Street charities together account for nearly a sixth of the investment made by NHS charities. This concentration raises concerns about a level playing field.

Charities such as WellChild and Rethink Mental Illness report that they are being asked to do more with less. WellChild’s specialist nurses, who are funded for the first three years before the NHS takes over, are now carrying an average caseload of 40 instead of the intended 15. Parkinson’s UK says its funding has helped the NHS pay for about 70 % of specialist nurses in the field, but the charity’s chief executive, Caroline Rassell, argues that this effectively acts as an additional tax on people with Parkinson’s.

A 2023 survey by the National Council for Voluntary Organisations found that 71 % of health charities believe the value of their contracts is insufficient to meet demand, with many relying on their own donations to keep services running. The survey’s chief influencing officer, Leigh Brimicombe, said charities are subsidising the NHS and that the government needs to offer contracts that cover the full cost of delivery.

NHS England acknowledges that while the proportion of the budget spent on the voluntary sector has fallen, the cash value has risen. The current 10‑year plan aims to build on the potential of these partnerships and give the sector a stronger voice in health and care.

Experts note that the relationship between the NHS and charities can create inequalities. Cancer charities, for example, attract large amounts of funding and can develop specialist services, whereas charities for conditions such as Parkinson’s, dementia or sickle cell disease invest their own funds but may still fall short of needs. Inequalities also exist within sectors; for instance, hospices may receive more support in wealthier communities.

Health literacy and the ability to navigate services also affect access to support, potentially widening disparities. While the UK is not returning to a pre‑NHS era of charitable dependence, charities are no longer operating on the margins of the system, and their growing role raises questions about sustainability, equity and the future of health care delivery.