Abstract
Before 1948, hospital healthcare was funded by a mixture of voluntary charitable donations and compulsory local taxation. After 1948, this became compulsory national taxation. Initially the delivery of hospital healthcare differed very little from what had previously been available except that gratitude for charity gradually became replaced by a demand for service. Before 1948, members of hospital management boards were drawn from the local population and included substantial numbers of doctors. Most of these members were unpaid and freely gave their time 1 just as others gave money to support the hospital's functions.
Today those boards have been replaced by highly-paid management executives who decide what is best for the local population without having to abide by the advice of the medical profession or even consult the representatives of the local community. 2 The meaning of charity has become corrupted. Even the General Medical Council masquerades as a registered charity and yet it is funded by compulsory donations from the medical profession. Just as charity has become corrupted so has healthcare management become corrupt. The revelations of the way in which a certain private healthcare provider appears to have charged the NHS in Scotland millions of pounds for services which were not delivered 3 is like a charity giving food aid to an African dictator who then fills the breadbaskets of his own cronies and leaves the general population starving. We would be outraged by the latter but just a little annoyed by the former even though that funding had been raised by public, albeit compulsory, donations.
In the current NHS climate governance has replaced conscience, accountability is just about money management and charity has been thrown out with Nye Bevan and his bathwater. The compassionate disbursement of compulsorily donated charitable funds and charity in its true sense need to be revived.
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