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Short abstract:

This paper presents novel findings on public participation in the UK's healthcare system, looking at the work of NHS charities (a distinctive category of organisations which display hybrid ‘state’ and ‘charitable’ institutional logics) and those who support them by fundraising and volunteering.

Long abstract:

Literature on public participation in health systems has always foregrounded formal mechanisms designed by authorities to elicit and channel public voice, neglecting ‘quieter’, and also potentially more subversive, modes of participation (Stewart 2016). This paper investigates how publics act in the ‘in between’ realm of NHS charities, a distinctive category of organisations which display hybrid ‘state’ and ‘charitable’ institutional logics (Stewart & Dodworth, 2023). Charitable and voluntary activity has always taken place within the NHS, and there is a widespread understanding that NHS charities provide the ‘add-ons’ or ‘extras’ that cannot be funded through government spending. In practice there exists a significant realm of discretion, and a blurry boundary between healthcare ‘extras’ and necessities. There is almost no scholarship on how members of the public understand their own roles in this hybrid realm of healthcare between community action and the state.

Exploring this question through the lens of affect, particularly Lauren Berlant’s ‘cruel optimism’ (Berlant, 2011), highlights that NHS charities sustain daily practices that help people navigate a diminished healthcare system, and to contest scarcity through avenues not offered by ‘traditional’ policy processes. In a context where state provision of welfare services is gradually but steadily retracting, NHS fundraisers enact an everyday pragmatism that fills service gaps and creates safety nets for communities. This paper provides novel findings on a previously unscrutinised field of public participation, exploring how micro-level, every-day practices of fundraising and volunteering relate to macro-level structural processes within the context of the U.K.’s welfare state.