Abstract
AbstractThe boundaries between state and charitable activities within the NHS are set out in regulations but are also enacted, blurred, and contested through local practices. This article reports research on NHS Charities– charitable funds set up within NHS organizations to enhance statutory provision – in Scotland. We analysed financial accounts and conducted qualitative interviews with staff in 12 of the 14 NHS Charities in Scotland, where they are generally known as endowments. Our findings suggest that Scotland’s endowments are relatively wealthy in charitable terms, but that this wealth is unevenly distributed when population size and socio-economic deprivation are considered. We also identify two diverging organisational approaches to decisions, including those about appropriate and inappropriate fundraising. We argue that these approaches cohere with contrasting ‘state’ and ‘charitable’ institutional logics, which in turn imply different attitudes to potential inequalities, and to relationships with local publics.
Highlights
Scotland’s NHS appears an archetypal example of a state institution
This study demonstrates a change in activities across some of the Scottish NHS Charities, along with continued ambivalence about this shift within more traditionally-run endowments
What might a charitable institutional logic mean for NHS organizations seeking to mitigate the impacts of austerity?
Summary
Scotland’s NHS appears an archetypal example of a state institution. It remains overwhelmingly financed through general taxation, subject to central planning and governed through appointed regional Boards which act as both purchaser and provider of services, closely-controlled by central government (Greer et al, ). In this context, local practices that test the boundaries of this apparent monolith can illuminate ways that state practices are formed, become dominant, and change. Healthcare fundraising and philanthropy is commonplace, and often researched to assess and improve fundraising “performance” (Erwin et al, ; Haderlein, ).
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