Charities have always played an important role in supporting patients and families. From cancer support and dementia services to psychological support and children’s care, charitable organisations provide invaluable expertise, advice and practical help.

However, a recent BBC investigation raises an important question: is the NHS becoming too reliant on charities to provide services that patients increasingly depend upon?

The BBC reports that the NHS in England spends nearly £2 billion a year purchasing services from the voluntary and not-for-profit sector. Cancer charities alone are estimated to raise more than £1 billion annually. At the same time, some charities say they are effectively subsidising stretched NHS budgets, while concerns have been raised that charitable support may not be distributed equally between different communities.

The changing role of charities in healthcare

The BBC report highlights how important charities have become. I was unaware that the NHS had that level of dependency in respect of some of its obligations.

It highlights a virtual clinic funded entirely by Dementia UK, where specialist nurses support patients and their families. The clinic helps more than 100 patients and family members each week and can assist families dealing with issues ranging from diagnosis to difficulties getting a relative home from hospital.

This kind of support can make an enormous difference to a family navigating an unfamiliar and often confusing healthcare and social care system.

There is nothing inherently wrong with charities working alongside the NHS. Indeed, their specialist knowledge and close relationships with patients can make them particularly well placed to provide advice and support, but the question is where that support ends and responsibility for essential NHS care begins.

The distinction is an important one and whilst charities can enhance healthcare, it seems a dangerous path if it is being used to compensate for gaps in core services.

The relationship between NHS care and social care

The dementia example also illustrates a wider problem. Health and social care do not operate in isolation.

A patient may be medically ready to leave hospital but unable to return home safely because appropriate care, equipment or community support is not yet available. The result can be a patient remaining in an acute hospital bed despite no longer needing hospital treatment.

This is an issue I have previously discussed. Prolonged hospital stays are not simply questions of resources or NHS efficiency. They can also become patient safety issues.

NHS England’s Model Discharge Pathway, published in July 2026, recognises this. It identifies risks associated with staying in hospital longer than clinically necessary, including deconditioning, hospital-acquired infection, delirium and falls. It also recognises the potential for increased dependence on longer term social care. That is why a social care system that works is essential to work alongside the NHS, and Prime Minister, Andy Burnham, has of course announced plans for a National Care Service, given it is intrinsically linked to the NHS.

Could reliance on charities create inequality?

One of the more concerning issues raised by the BBC report is the possibility of geographical inequality.

Critics quoted by the BBC raise concerns that charitable involvement may result in more money reaching wealthier communities.

From a patient-safety perspective, this deserves careful consideration. Access to essential healthcare should not depend on how successfully a local community can fundraise, whether a particular condition attracts significant charitable support, or whether a specialist charity happens to operate in your area. We already know that charities can provide tremendous value. The challenge is ensuring their involvement compliments equitable access to NHS care rather than unintentionally creating further variation and a postcode lottery.

There are moves towards closer collaboration. For example, the government announced Diagnosis Connect in 2025, designed to refer patients diagnosed with certain long term conditions directly to relevant charities and support organisations. Importantly, the government described this support as being intended to compliment rather than replace usual NHS care.

Patient safety issue

As a clinical negligence solicitor, I regularly speak with individuals and families after something has gone wrong with their medical treatment.

A common theme is not necessarily one dramatic clinical error, but a series of smaller failures in communication or coordination: a referral that was not followed up, information that was not passed between services, or a family that simply did not know who was responsible for the next stage of care.

The greater the number of organisations involved in someone's care, the more important clear communication and accountability become.

Practical steps and questions

Patients should not be expected to work out for themselves which organisation is responsible for which part of their care. If a charity becomes involved in your care or a relative's care, there are some practical questions worth asking:

• Ask who remains responsible for the patient's clinical care: Understand which NHS team or clinician remains your main point of contact.
• Clarify the charity's role: Is it providing information and support, or delivering part of the healthcare service?
• Keep records: Make a note of appointments, referrals and the organisations involved, particularly where several services are working together.
• Ask what happens next: If one organisation's involvement ends, establish who takes over and whether a referral has actually been made.
• Speak up when something does not seem right: If you are uncertain who is responsible, ask for clarification rather than assuming information has been passed between organisations.

These are simple measures, but good communication is an important part of safe care.

Ultimately, whatever organisation delivers the service, the patient and their safety must remain at the centre of it.