‘The Biggest Charity You've Never Heard of': Institutional Logics of Charity and the State in Public Fundraising in Scotland's NHS

The 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.

Doing 'our bit': Solidarity, inequality, and COVID-19 crowdfunding for the UK National Health Service.

The expanding phenomenon of crowdfunding for healthcare creates novel potential roles for members of the public as fundraisers and donors of particular forms of provision. While sometimes interpreted as an empowering phenomenon (Gonzales et al., 2018), or a potentially useful communication of unmet needs (Saleh et al., 2021), scholars have predominantly been critical of the way in which crowdfunding for healthcare normalises unmet needs and exacerbates entrenched inequalities (Berliner and Kenworthy, 2017; Igra et al., 2021; Paulus and Roberts, 2018). We report a thematic analysis of the text of 945 fundraising appeals created on JustGiving and GoFundMe in the first months of the COVID-19 pandemic, where the recipient was NHS Charities Together's dramatically successful COVID-19 Urgent Appeal. Unlike in existing accounts of individual healthcare crowdfunding, we identify the relative absence of both coherent problem definition and of a fundable solution within the pages. Instead, appeals are dominated by themes of solidarity and duty during the UK's 'hard' lockdown of 2020. A national appeal reduces the risks of crowdfunding exacerbating existing health inequalities, but we argue that two kinds of non-financial consequences of collective crowdfunding require further exploration. Specifically, we need to better understand how expanded practices of fundraising co-exist with commitment to dutiful, means-based funding of healthcare via taxation. We must also attend to how celebration of the NHS as a national achievement, might squeeze spaces for critique and challenge. Analyses of crowdfunding need to explore both financial and non-financial aspects of practices within different health system and historical contexts.

Segmenting communities as public health strategy: a view from the social sciences and humanities.

On the 5th of May 2020, a group of modellers, epidemiologists and biomedical scientists from the University of Edinburgh proposed a "segmenting and shielding" approach to easing the lockdown in the UK over the coming months. Their proposal, which has been submitted to the government and since been discussed in the media, offers what appears to be a pragmatic solution out of the current lockdown. The approach identifies segments of the population as at-risk groups and outlines ways in which these remain shielded, while 'healthy' segments would be allowed to return to some kind of normality, gradually, over several weeks. This proposal highlights how narrowly conceived scientific responses may result in unintended consequences and repeat harmful public health practices. As an interdisciplinary group of researchers from the humanities and social sciences at the University of Edinburgh, we respond to this proposal and highlight how ethics, history, medical sociology and anthropology - as well as disability studies and decolonial approaches - offer critical engagement with such responses, and call for more creative and inclusive responses to public health crises.

Credibility Contests: Media Debates on Do-It-Yourself Coronavirus Responses and the Role of Citizens in Health Crises.

During the early months of the COVID-19 pandemic in Europe and North America, news outlets ran a series of stories reporting on "do-it-yourself" (DIY) coronavirus responses that were created and implemented by citizens. This news discourse exemplifies and can illuminate wider shifts in the roles of citizens in science, as individuals outside professional science institutions are becoming more actively involved in scientific knowledge production than before, while the epistemic authority of professional "expert" scientists has been increasingly contested. This paper focuses on DIY citizenship, taking news discourses on citizens' DIY coronavirus responses as a lens to explore wider questions around the changing ways in which the roles of different public health actors are delineated and represented under conditions of significant social and epistemic uncertainty. We aim to shed new light on the nature of-and the role of the news media in mediating-the credibility contests and boundary work that is currently at play around DIY citizenship. We do so by focusing on four discourses: polarized discourses around DIY face masks and hand sanitisers; delineation of credible from incredible interventions and actors around DIY coronavirus treatments and tests; delineation of professional science from "fringe" citizen science; and discourses declaring that "we're all in this together." We conclude that making sense of these discourses requires a thorough appreciation of the context in which they emerged. Our analysis reveals how emancipatory accounts of DIY citizenship can mask structural inequalities underlying who can and is expected to "do-it-themselves," and how.