Hugh Grovesnor, the seventh Duke of Westminster, has donated £12.5 million to a National Health Service charity “to say a huge thank you” to NHS staff. This has been widely (and rightly) greeted with disdain by those on the left, who point to the failure of the Duke to pay inheritance tax on his estimated £10 billion fortune, and the fact that this donation represents a mere 0.1% of his overall wealth. Interestingly, some have also feared that it sets a dangerous precedent in treating the NHS as a charity, rather than as a public service to be provided by government and paid for via taxation (preferably, in future, though a more effective and progressive tax system than we currently have).
I agree with all of this. For me, the UK’s creation of a universal National Health Service - free at the point of use and paid for through taxation - is one of the finest political achievements of the 20th century. It is emphatically not a charity and should not become one. The NHS is about the state fulfilling the human right to health.
An interesting question, though, is how far we are willing to take this argument – and where exactly we see the boundary between heart-warming expressions of solidarity on the one hand, and the start of a dangerous slippery slope on the other.
Arguing that it would be better for the Duke of Westminster to pay an appropriate level of tax rather than make a (proportionally tiny) voluntary donation to the NHS is of course right. The argument is so obvious and compelling that it should scarcely need making (although, sadly, it does need making). But what do we think about the many smaller, well-meaning acts of voluntary support for the NHS that we’re currently seeing around the country?
On the news this morning, I watched Captain Tom Moores complete the 100th lap of his garden. Captain Moores, a 99 year old war veteran who walks with the aid of a walking frame, had aimed to raise £1,000 for NHS charities by completing 100 laps before his 100th birthday. So far, his efforts have attracted over £14 million in public donations.
Elsewhere, craft groups and individuals around the country have turned their hands (and their sewing machines) to making scrubs for NHS staff, while design and technology teachers in many universities and schools – including my university and my daughters’ school – are using 3D printers to manufacture face guards for medics treating coronavirus patients.
It would be churlish in the extreme to condemn such efforts. They are meant entirely as a positive act of support for an over-stretched health service. They are also, I’m sure, doing genuine good in helping to address the continuing shortage of essential PPE.
But do they also raise the danger of a slippery slope towards a ‘charitization’ of a vital public service which is (and ought to be) provided by the state? Where does ‘positive charity’ stop and ‘problematic charity’ begin? Here are four questions that might help us think through this conundrum:
1. What is the need that is being fulfilled here? My suspicion is that there are two separate needs that partly explain the examples above. First, there is a genuine need for essential equipment and supplies that health and care workers do not currently have in sufficient quantity. This is a worrying sign (although it may be partly true, as the government claims, that this relates more to supply chain and logistical difficulties rather than a lack of financial resources). The NHS needs more stuff – and quickly. But the need also seems to be – at least in part – a need of individuals to feel that they are able to make a contribution to their community. This need is, for me, much less of a concern. It is probably a natural, and certainly an entirely laudable, reaction to a crisis. It need not signal any fundamental shift in attitudes about state-provided healthcare. It can be as simple as good people trying their best to do something good. But it leads us to:
2. Is this a temporary emergency measure, or does it risk becoming a more permanent change? To some extent this is a question based on a false premise. The NHS has always been, in small part, supported by charitable donations (here in Sheffield, both the Weston Park Cancer Hospital and the Sheffield Children’s Hospital have major charitable fundraising efforts, with the resources raised used to ‘top up’ NHS support). In addition, a range of services that (in my view) ought to have been funded by the NHS have always in fact been provided through charitable donations: many hospices, for example, run this way. To some extent, then, this Rubicon has already been crossed. Yet it is to be hoped that after the crisis, the dependence of the health system on voluntary donations returns to this lower (pre-crisis) water-mark – and ideally even lower than that. This leads us to:
3. Are these acts of charity exploitable, by whom, and for what purposes? It would be a significant concern if there were attempts to use volunteers as a cover for scaling back state provision (as we have seen with food banks, for example). It seems inevitable that the huge increases in public debt that have resulted from the coronavirus response will lead to attempts by the right to resurrect/continue austerity. And just as David Cameron had his idea of a ‘Big Society’ of voluntary organisations to take on what should have been core functions of the welfare state, future Prime Ministers might be only too happy to exploit the voluntary sector as an opportunity to make spending cuts. After all, if Granny Smith already has the pattern and lots of spare fabric, why should the NHS go back to buying scrubs?
4. Finally, let’s end on a more optimistic note: Might it be that this experience of voluntary action makes people more willing to vote for higher taxes (and better funded services) in future elections? COVID-19 comes on the back of years of underfunding of health services. Could it be a turning point? Let’s hope that it is. But even if the great British public changes its views on the appropriate rate of taxation for a civilised society, I’m pretty sure the Duke of Westminster won’t.