The Welfare State We're In, The website of the book by James Bartholomew
September 26, 2008
The Archbishop criticises capitalism

It is a shame and shameful that the Church of England has deviated so far from what it could and should be about. First it should be about the religion itself – about leading a Christian life, behaving well, helping others, obeying the ten commandments, praising God and so on. Second it should be about putting Christian charity into action.
Most people don’t know what a hugely important force for good the Church of England used to be. All the leading teaching hospitals in London were originally charitable hospitals. They were created by wealthy people encouraged by the church.

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July 13, 2007
Mapp and Lucia had a local hospital

After writing The Welfare State We're In, I now notice instances of welfare provision as they appear in novels which previously I would have missed. Recently I listened again to an audio-book of Mapp and Lucia, the comic novel by E.F.Benson. For the first time, I noticed that the focus of the early rivalry between the two women was the competition between their two charitable events for the benefit of the local hospital.

Lucia won this battle hands-down. Everyone went to her fete. No one went to Mapp's event. But underneath the comedy lies the way in which it was simply normal for people of their class to put on events to raise money for local hospitals.

These hospitals might be charitable or run by the local authority. In either case, the people of the town or locality felt that they were connected to it. They, personally, might need it one day. They had a stake. They could also gain status by helping it financially and probably in other ways, too.

The town in which Mapp and Lucia is set is called Tilling. But I think I am right in saying it is based on the very pretty Sussex coastal town of Rye.

I wonder how hospital provision in Rye has changed since Mapp and Lucia was written (circa 1930?)? Did it have a hospital then? Does it have a hospital now?

Whatever may be the case, it is certainly true that hundreds of local hospitals have been closed down since the NHS was created. There are some good reasons for this and some bad. It is noticeable that the Labour Party, when it promoted the idea of the NHS in 1942 argued that local provision of hospitals was important. After the NHS was created, both parties were persuaded that big hospitals offered economies of scale and could develop the capacity to deal with all eventualities. They could also develop particular strengths. But since then, the political parties have re-discovered the idea that local healthcare has it merits in maxi-GP practices or mini-hospitals.

Of course local hospitals have their merits. That is why pre-NHS healthcare created them. In some ways the value of them has actually increased. If there is an emergency in one part of London and a patient needs to be rushed to hospital, it now takes longer to get there because of the density of traffic. The same applies all around the country. I presume that, in some cases, patients lives can be at risk because of the distance between an emergency patient and a hospital.

A local hospital can promote loyalty and commitment on the part of both staff and patients. Patients in hospital are also easier to visit if they are local and this, in turn, means they are more likely to be visited and, I believe, those who are visited are more likely to get well soon.

The closure of quite so many local hospitals has surely been one of the range of bad effects of the creation of the NHS.

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March 21, 2007
Debate: Does public spending gives us enough bang for our buck?

In the wake of the budget, I will be taking part in a lunchtime debate tomorrow (Thursday) on the subject: "Does public spending gives us enough bang for our buck?". It will come no surprise to those who have read 'The Welfare State We're In' that I will argue that public spending tends to be extremely wasteful.

The debate will take take place at the Royal Society for the Encouragement of the Arts. (I am sorry to be disrespectful to the hosts of this debate, but I notice that the RSA appears to be another ancient charity whose original purpose is no longer respected. I rather doubt that the 18th century creators of the society would have subscribed to its current commitment towards creating a 'zero-waste society'. It is quite a modern racket, this taking over old charities and using the money to get an income and promote one's views.)

For a variety of entries on 'waste in public services', try this category in the list in the left-hand column.

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February 08, 2007
For more about charity...

The reference to The Welfare State We're In in the Wall Street Journal Econoblog yesterday related to the parts of my book concerning charity.

Those who are interested to pursue the subject further could look at the references to the remarkable history of charity in the book itself. They could also click onto the category 'charity' in the column on the left or, rather better, use the search facility further down the left-hand column and search for 'charity'.

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December 22, 2006
David Cameron in favour of charity and quoting Hayek, too!

Below is a section from a David Cameron speech this month. It is clear that he intends to support charity as a part of his approach to welfare. I am a sceptic about Cameron but this, as far as it goes, is a plus.

There are some 700,000 non-statutory, non-profit organisations in the UK. They include everything from a handful of neighbours getting together to organise a play group, to the great national charities like the NSPCC or the National Trust. They include social enterprises, clubs, religious bodies, trade unions, pressure groups, friendly societies, care homes, and many more. The map of social action in Britain is a vibrant kaleidoscope of institutions and organisations, competing and combining, developing effective local responses to local needs.

Gordon Brown once described charity as "the sad and seedy competition for public pity." I think that attitude is patronising, damaging and profoundly misguided. The voluntary sector should be neither poor relation nor a cut-price alternative to government. lt is absolutely central to the life of the nation, but with a character and contribution all of its own.

This reflects a profound philosophical difference between the parties. Where Labour think that an individual's identity consists in being recognised, registered and assisted by the state, Conservatives think that identity is derived through membership in society. Labour think that social justice principally means equality, achieved and guaranteed by government. We think it means community, built and maintained by people themselves.

To me those 700,000 organisations prove that there is such a thing as society. It's just not the same thing as the state. The term "the third sector" was first coined by the liberal economist Friedrich von Hayek, the intellectual guru of Thatcherism. In Law, Legislation and Liberty Hayek wrote that "it is most important for a healthy society that we preserve between the commercial and the governmental sector a third, independent sector."

I mention this not because I want to claim the sector for the Conservative political tradition. That would be quite wrong. But because I want to show that the principles of the free market are not incompatible with the principles of voluntarism and social action which we associate with the third sector.

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July 06, 2006
A revival of charity should be welcomed with enthusiasm

(Unedited version of article which appeared in the Daily Express last week.)

Just when you think that the world is getting into a worse and worse state, something happens to revive your faith. Yesterday it was revealed that a 'hedge fund' - an exclusive kind of investment fund - might be the biggest charitable donor in Britain. Last year it gave £50 million to a foundation which helps impoverished and orphaned children in Africa and another £33 million to a charity based in America.

These were not one-off donations either. The Children's Investment Fund donates half a per cent of its assets to charity every year and another half per cent if it does particularly well. It was set up by Chris Hohn, 39, a graduate of Southampton University, and has become one of the most successful hedge funds in Europe.

These gifts - from the heart of high-finance - come on top of the news earlier this week that Warren Buffett, the second richest man in the world, is giving US$37 billion to a charitable foundation. It happens to be one set up by the richest man of all, Bill Gates.

Suddenly there seems to be a deluge of charitable giving by the super-rich. It is wonderful and encouraging. But the most significant thing about it is that it is also realistic.

There has been a growing realisation - both here and in America - that governments are not going to put right all the wrongs in our own countries, let alone all the problems of the world. We need to take action ourselves - either by creating charities of our own or by funding those people willing to do the work.

We have seen how a significant minority of government schools have become academies of crime. We have seen, only this week, how one NHS hospital is in such a bad way that the dead have been left in wards overnight. Yesterday also brought news of a giant £215 million stock of unused mobile homes ordered by the US government for distribution to the victims of Hurrican Katrina. They were never put into place.

There is a growing understanding that government-controlled operations have a tendency to develop top-heavy bureaucracies, to waste money and cause downright undesirable outcomes. Charities, it must be admitted, are not perfect either. But they have their advantages. They tend to be quicker to react. They are often operated by highly-motivated, philanthropic individuals who work for less than they could get in commerce - or government.

Some people may think that a revival of charities is a throwback to the days of Charles Dickens. They are right. But that is no cause for shame. On the contrary, it should be a source of confidence in the potential power of charity.

Where did all the great teaching hospitals of London like St Bart's and St Mary's come from?

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June 28, 2006
David Beckham's little recognised charitable work

If you Google 'David Beckham charity' you discover that his involvement in charities is much larger than most people realise.

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'This letter is granted to the applicant in being poor. Its acceptance therefore by anyone not really poor constitutes an abuse of charity.'

I was fascinated today to come across a sidelight on the psychology of welfare before the welfare state.

I was doing a check on the history of Moorfields, the eye hospital. The hospital's own website reveals how it was set up explicitly for the poor. It also shows how it was consider utterly wrong for those who could afford to pay for medical care to take advantage of its free services:

The London Dispensary for curing diseases of the Eye and Ear was opened in 1805 by John Cunningham Saunders (1773-1810). The impetus for the formation of the world's first specialist eye hospital seems to have been an epidemic of trachoma. This is a form of potentially blinding tropical conjunctivitis which was brought back to England by British troops returning from the Napoleonic wars in Egypt. However, the number of patients seeking treatment steadily increased, forcing a move to a larger site in 1822 and finally to its present main site on City Road, central London, in 1899. At this time, the first specialist departments were set up (X ray and Ultra Violet treatment rooms). The hospital was still operating as a charity and each patient received an admission card that read:

'This letter is granted to the applicant in being poor. Its acceptance therefore by anyone not really poor constitutes an abuse of charity.'


I notice that the Moorfields website includes guidance on waiting times. They are pretty daunting if you add, as it seems you should, the waiting time for the first appointment to the waiting time for sugery. For glaucoma, for instance, the total waiting time is over six months.

I wonder what the waiting times were like before the NHS took over the management of the hospital? I wonder what the waiting times are like now in other comparable countries in Europe and in America and Japan?

Posted by James Bartholomew • Indexed in Charity • NHS

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January 18, 2006
On the Today programme this morning

I provided a soundbite for the Today programme on BBC Radio 4 this morning. I was the last of several people to be interviewed by Polly Billington on the subject of 'social enterprise'. To listen, click here and go to the 8.10am segment of the programme. This link should work today but I am not sure about thereafter.

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January 16, 2006
It looks like a good charity

I am always on the look-out for charities worth supporting. This one, featured in the Daily Telegraph today, looks, on the face of it, as if it is one.

They turn despair into hope. They take people who are homeless, people struggling with drug and alcohol addiction, people on whom life has seldom smiled, and provide them with a home and a job - and, just as importantly, a sense of self-worth. They are also in the conversion business in another sense: they make the projects pay for themselves by taking in unwanted household goods, restoring and sorting them, and selling them at a decent profit. The bits and pieces, like the people themselves, are restored to a proper and valued place in life.

I have a feeling, though I could be wrong, that this charity does not receive government funding. Given that government funding tends to lead to the government telling charities how to operate and superimposing costs and waste, this would good.

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December 21, 2005
How best to give to charity?

The most fashionable Christmas present this year is a goat. Not for oneself, of course, but for some poor family in Africa or India. The giving of a goat is advertised everywhere. As an alternative, one is encouraged to give a toilet. The true sound of Christmas is no longer a tinkling sleigh bell but a distant bleating or a resounding flush.

We hear a lot about charitable giving at Christmas and it is tempting to think we are generous people, forever digging into our pockets to help those less fortunate. Viewers of Strictly Come Dancing have had the satisfaction when voting for Darren Gough, Zoe Ball or Colin Jackson of knowing that some of the inflated cost of the phone call is going to Children In Need. The BBC annually tells us how generous and wonderful we are for supporting its favoured charity.

The truth is that we give a fraction of what the Victorians donated. According to a survey in 1895, middle-class people gave 10 per cent of their income to charity. And what do we give? Last year it was £8.2bn - well under one per cent of our income.

(The above is an excerpt from an article I wrote for The First Post website. The full article is here. The article concludes with the following:)

We are right to be careful about charitable giving. The Victorians were very thoughtful about it. We should be both more generous and more selective. There is little point helping an NHS hospital to buy a new operating theatre if it is going to stand idle for long periods of time because the hospital trust is in deficit and has to save money.

One key to good giving these days, is to choose those charities which have as little as possible to do with government. My own personal dream is to be involved in creating a new charitable clinic or hospital wholly outside governmental control. In the meantime, charities must learn to be careful what they do with my money, or the goat will get it this Christmas.

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