Paper short abstract:

Retrenchment of the welfare state in the UK has coincided with growth in the visibility and role of NHS charities. We trace processes through which NHS charities supplement (or outright replace) established welfare arrangements, through a distinctive everyday pragmatism.

Paper long abstract:

The UK’s welfare state has progressively shrunk in the aftermath of the 2008 financial crisis, and amid ongoing austerity policies since the 2010s. Emblematic of this trend is the National Health Service (NHS), which for years has been considered to be in a state of crisis, but which is, since the COVID-19 pandemic, struggling with growing waiting lists and entrenched industrial disputes.

In this context, there has been a remarkable growth in the visibility and role of NHS charities. These organisations have long existed to supplement state funding of healthcare in the UK (via local fundraising and voluntary activities, such as capital appeals to buy additional equipment, provide non-clinical services, and fund patient and staff wellbeing initiatives), and debate on whether the services they provide are simply ‘add-ons’ or ‘essential’ has become particularly pressing. Based on a focused ethnographic study of an NHS charity in England, this paper examines the emergence of NHS charities as key actors in the UK’s mixed economy of welfare. Exploring this topic through the lens of affect, particularly Berlant’s ‘cruel optimism’ (2011), highlights that NHS charities sustain daily practices that supplement (or outright replace) established welfare arrangements, and create spaces where alternatives, such as ‘fugitive coproduction’ (Stewart 2021), can flourish. The paper thus argues that NHS charities, and those who work and volunteer for them, enact an everyday pragmatism that seeks to address growing gaps in welfare provision, in ways that are very often creative, local, public, and also intimate.