The biggest challenge for a major gifts programme in an NHS hospital is…spending major gifts!

‍You’ve convinced your Trustees to invest in a major gifts programme. You’ve built robust foundations for your major gifts programme. You’ve done your prospect research and due diligence, identified your major donor prospects and you’ve identified ways to connect with them. You’ve identified a project in the hospital and have written a compelling case for support. You might have hosted cultivation events or invited prospects to bespoke tours designed around their interests. Finally after all of this work, you’ve made the ask and you’ve secured a major gift! It’s the best feeling in the world to make your ask and secure your first major gift. Surely you’ve done all of the hard work by this point and it’s all straight forward from here?

Not quite.

From this moment on, it’s a heavy responsibility to make sure that your hospital spends that major gift in the way you’ve committed to the donor. Often, spending the major gift well is one of your hardest challenges as a major gifts fundraiser in an NHS charity. Here are some of the challenges I’ve faced once I’ve secured major gifts:

1. The hospital found money in a capital budget which they had to spend by year-end so they bought the ultrasound machine a donor had pledged to buy. Two weeks before the gift came in.
2. The doctor who was leading on a research project funded by a donor decided to take his hypothesis in a different direction after the gift was made - after all, the money is in “his” bank account so he could change his mind, right?
3. A volunteering pilot for young people fell down the Volunteering Team’s list of priorities so they didn’t recruit any new volunteers.
4. After the gift was secured, we started the procurement process for equipment for the Breast Unit. However the Clinical Engineering team ruled out the chosen equipment as it didn’t adhere to their (absolutely necessary!) standards.
5. The Surgery team decided they wanted to buy add-ons for the kit funded by the major donor, asking us to increase our fundraising target, days after hitting target.

All of these challenges are commonplace. In an NHS environment, the charity needs to work really carefully with the hospital to ensure that gifts are spent in line with donors’ wishes. But how do you avoid a situation where clinicians change their mind, or don’t spend donations in the way the donor intended, or within a responsible timeframe? Your most important responsibility as a fundraiser is to act as your donor’s guardian.

‍Here are my top tips for avoiding the pitfalls I’ve experienced!

1. Identify the key decision-makers in your hospital when it comes to signing off expenditure and seek pre-agreement from them before you ask donors for money. E.g. involve Procurement, the Departmental Director, the Medical Director (for a major project) and Clinical Engineering. Clinicians do like to act independently but this can mean it is even harder to ensure funds are spent in a timely fashion.
2. Educate the beneficiary department about fundraising. Talk to them about philanthropy; how it works, why it’s important for patients’ wellbeing, why it’s great for their team, donors’ motivations for giving, our responsibilities to donors etc. Often I do a 45 minute meeting with key department members to talk to them about fundraising. I will often say to clinicians that I won’t fundraise for their project unless they commit 2-3 hours a month to work alongside the charity team - speaking to donors, identifying prospects, working on impact reports. The more involved they are, the easier it usually is to spend major gifts. I will also attend a team meeting monthly to update them on fundraising.
3. Introduce a gift agreement between the charity and the donor. Gift agreements prevent misunderstandings and are a wonderful way to show your donor how important they are to your charity, and that you are a professional organisation.
4. Sit down with the lead clinician or academic for a kick-off meeting. Share the donor’s gift agreement and explain a) how they will access the funds b) what the funds can and can’t be spent on c) should they need to request a change in use of the funds that you will need to seek the donor’s permission d) explain when reporting is due and what your expectations are about reporting. E.g. Do you need statistics, patient case studies, graphs, narrative? Can you sit down with them to capture the results to save them writing a long report themselves?
5. Introduce the clinician to the donor to update them on the impact of their gift. This is the best way of stewarding the donor towards the next gift and puts the clinician on the hook for accountability!

There have been times when I’ve had to talk to a donor and tell them we haven’t been able to spend their donation, or I’ve had to ask their permission for a change of purpose for their gift. The worst case scenario is to return a donation because this would leave the donor feeling unappreciated. By having honest conversations with donors, often this increases their trust of the charity - even if it’s uncomfortable for you as a fundraiser to be so honest - often these situations just deepen the strength of your relationship.