“Charity’s the cream on the top”: public encounters at the edge of state-provided healthcare

The literature on public encounters with the state starts from the analysis of interactions of service use or claims-making. This paper explores the affective and power dynamics of encounters of a different nature, where publics engage in voluntary or charitable work in support of state institutions. Our focus is how publics encounter organisations in the ‘in between’ realm of NHS charities, a distinctive category of organisations which display hybrid ‘state’ and ‘charitable’ institutional logics (Stewart & Dodworth, 2023). Since the U.K.’s National Health Service (NHS) was established in 1948, charitable and voluntary activity have contributed to the delivery of some healthcare services, 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, both on a macro scale and also within the everyday lives of the people who work within, volunteer for, donate to, or fundraise for, NHS charities. Exploring this question through the lens of affect, particularly Lauren Berlant’s ‘cruel optimism’ (Berlant, 2011), highlights that NHS charities play an important role in sustaining daily practices that help people navigate scarcity in public services. In this context, the notion of the ‘extra’ seems to expand and percolate into the domain of necessities, even when, for many people who are connected to an NHS charity (both in professional and voluntary capacities), the idea of healthcare provision being charitably funded is uncomfortable. Situated in a context where state provision of welfare services is gradually but steadily retracting, NHS charities thus operate within a sphere where cruel optimism manifests, but also within which people enact an everyday pragmatism that fills service gaps and creates safety nets for communities. This paper contributes to debates on the move of public encounters from the realm of service delivery encounters to emotional encounters (explored through the lens of affect), by exploring how micro-level, every-day practices relate to macro-level structural processes. As such, it will add to the growing knowledge base in the field of public encounters, also raising questions about the relationship between citizens and the state within the context of the U.K.’s welfare state.