At the in-house laundry at Tickhill Road Hospital, staff are washing more than patient gowns and bed sheets.
Since last March, the hospital has been running a free service for people in Doncaster who lack access to washing facilities and are preparing for job interviews.
For those who do not have suitable clothes, the South Yorkshire hospital has also created a “community wardrobe”, enabling local residents to borrow suits to help them present themselves more professionally.
“Some people might say this is ludicrous, that the NHS is subsidising interviews,” said Steve Forsyth, Tickhill Road Hospital’s chief nursing officer who helped create the initiatives. “But we have a responsibility to the community. This is preventive work, as employment links to physical and mental health.”
The work of Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) is one example of the growing role of the NHS. No longer expected to simply treat illness, it is becoming an institution trying to bridge the gap left by the deterioration of other public services.
Across England, NHS trusts are paying to deep clean the homes of patients, covering the cost of bus fares and helping them with their finances.
Some hospitals, including in London and Cambridgeshire, are employing housing officers to organise urgent cleaning and repairs for patients. They also co-ordinate with local councils to source short-term housing for patients clinically fit for discharge but with nowhere suitable to go.
In other A&E departments, such as Colchester Hospital, patients are offered the opportunity to be put in touch with advisers offering support on issues including benefits and loneliness.
The precise extent of these services across the country is unknown.
But Rory Deighton of the NHS Confederation, which represents health managers, said post-2010 austerity measures and current limits on public finances were “leaving other sectors, including local government and notably social care, hollowed out”.
“NHS organisations are often stepping in to fill gaps in services elsewhere,” he added.
The NHS now costs the state about £560mn a day to run in England, up from £395mn a day in 2011 after adjusting for inflation — the government spends more on the day-to-day running of the NHS in one month than it does on local government services in a year.
By the end of the decade, the Department of Health and Social Care will account for almost half of the government’s day-to-day departmental spending, according to the Resolution Foundation think-tank.
While the vast majority of NHS spending goes to traditional healthcare, the health service is picking up extra responsibilities as voluntary sector and local authority budgets are squeezed — contributing to claims that Britain is turning into a “National Health State”.
“Paying for people’s laundry and cleaning seems a perverse use of NHS resources when millions are languishing on waiting lists,” said former Conservative health secretary Jeremy Hunt. “Surely a better use of resources would be to help people get back to work so they can stand on their own two feet.”
Dr David Gannon, deputy chief medical officer at Colchester, concedes his role has slowly changed over time. “There is a bit of mission creep,” he said, but he believes it is logical to seek to help address the root causes of patients’ ill health: “It’s more about can we do something extra to benefit the patient . . . a lot of it is just sensible lifestyle advice.”
Speaking to the FT last year, Amanda Pritchard, the former head of NHS England, raised the question of what “the core business” of the health service should be as other parts of the state are cut back.
Referring to a mental health service that she was told employs a housing team, she said: “You wouldn’t say the core business of the health service is as a housing provider, but that’s where we’ve ended up.”
In September 2024, health secretary Wes Streeting warned: “Rather than a country with an NHS, we’re going to have an NHS with a country attached to it if we’re not careful.”
Reforming the way the NHS works has been a central part of Prime Minister Sir Keir Starmer’s promise to voters since entering Downing Street. Last summer ministers published a long-awaited 10-year plan for the taxpayer-funded service.
As part of the 168-page blueprint for change, it opened the door to recording “social risk factors” in patient records — the parts of their life that do not seem medical at first glance but may in fact impinge on their health.
“In the long term, this saves public money,” said Toby Lewis, chief executive of RDaSH, speaking of his own trust’s initiatives. From April 2026, almost every service his trust offers will have a maximum waiting time of four weeks — among the shortest in the NHS.
“At a very practical level, it makes sense for us to be interested in things some people say are ‘not our job’,” he said. “We see this work as core business. We’ll invest in the voluntary sector and local services where that makes sense, and we’ll talk openly about it.”
One of the trust’s programmes involves purchasing bus tickets for people who cannot afford to travel to appointments.
A number of NHS schemes reimbursed patients for the cost of travelling to their appointment, but they assumed people had the £3 to part with in the first instance, noted Lewis. For someone on a very tight budget, a £3 bus fare could mean missing a meal, he said.
“We’re not making a political point or taking over local government,” Lewis said. “We’re giving staff the tools to address the root causes of health problems, which are often poverty related.”
Sally Jameson, the Labour MP for Doncaster Central, said that while the services RDaSH provided were “above and beyond what people would ordinarily think a health trust should do”, it was reflective of a decade of public spending cuts which meant there “isn’t as much in the public purse to spend on schemes to help people battle societal barriers”.
James Smith, research director of the Resolution Foundation, noted that while the UK spent an “awful lot” on healthcare, this was far from unique in a country that was getting older and richer over time.
But he added that as a society, “we need to have a public discussion about how future increases are funded, or else the NHS risks crowding out funding for other key public services, like those delivered by local government”.
The Department of Health and Social Care said: “Our NHS plays a crucial role in keeping our nation healthy. We’re working across government to tackle the root causes of ill health, while ensuring every pound of NHS funding delivers the best possible outcomes for patients and taxpayers.”
