This paper examines a key aspect of the relationship between charity and the establishment of the United Kingdom’s National Health Service(s) in 1948: the distribution of endowment income and the future of charitable fundraising for public health care.
Prior to 1948, the UK possessed a patchwork of different types of hospital: ...
(Show more)This paper examines a key aspect of the relationship between charity and the establishment of the United Kingdom’s National Health Service(s) in 1948: the distribution of endowment income and the future of charitable fundraising for public health care.
Prior to 1948, the UK possessed a patchwork of different types of hospital: unreformed Poor Law hospitals, municipal hospitals (including not only former Poor Law but also specialist institutions for the treatment of infectious diseases and other conditions), and voluntary hospitals. However, this patchwork came under increasing pressure during the 1930s and early-1940s, culminating in the passage of the three National Health Service Acts, dealing separately with the three jurisdictions of England and Wales, Scotland and Northern Ireland, between 1946 and 1948.One of the most important issues confronting reformers was the status and financing of the voluntary hospitals. The majority of these institutions had been established over the course of the eighteenth and nineteenth centuries as charitable institutions and they continued to derive significant proportions of their income from endowments and other charitable sources. However, when the Minister of Health for England and Wales, Aneurin Bevan, introduced the first of the National Health Service Bills in 1946, he described the hospitals’ continued reliance on charitable funding as ‘repugnant to a civilised community’ (House of Commons Debates, 30/4/1946).
The establishment of the NHS(s) therefore had two major implications for the role of charity within the health care system. In the first place, it raised fundamental questions about the status of the charitable funds which many hospitals had already amassed. Second, if it was also accepted that charity should not have a significant role to play in the provision of core health services, what role should it play? What role did the Government foresee for ‘voluntarism’ within the health service(s) once the new arrangements came into force?
This paper will endeavour to answer these questions by looking at the history of voluntarism before the NHS Acts came into operation and then examining the ways in which the three Acts addressed the problem of hospital endowments. The final part of the paper will look at the role of charity more broadly. It has often been assumed that, after 1948, the role of charity was quite tightly circumscribed but to what extent was that really the case, and what can an examination of the role of charity tell us about the prioritisation of different types of health care in the UK during the postwar era?
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