Governance of NHS endowment funds: review report

Foreword

This report shines a light on a particular group of charities in Scotland which deserve to be better known.

Many may be surprised to learn there are sixteen NHS-linked charities in Scotland, holding a combined total of some £301m of charitable assets.^[1] Over many decades, donations have been made by those wanting to thank and support particular aspects of NHS healthcare, be that community nurses, research into new forms of treatment, enhancing gardens for patients and their families to enjoy and many, many other areas. How those charitable funds are looked after, and the selection of decision-makers who oversee how they are used, are therefore questions of some importance, given the sums involved.

The core governance framework for these NHS-linked charities dates from legislation in the 1970s. Times have moved on, and it should come as no surprise that there is a need to consider afresh the nature of the governance arrangements which will place these valuable charities onto a sound footing for the future. Best practice and public expectations have evolved. Events in the last decade in particular have prompted the need to reconsider who should hold the role of trustee of an NHS-linked charity.

When this report was completed in November 2019, it would still be a few months before a seismic public health emergency took hold in Scotland and around the world. This foreword is not the place to reflect on the wide-ranging impacts of COVID-19 on society, the economy and the National Health Service. In a more limited sense, its impact on this report and its themes can be seen in four ways. First, publication of this report was understandably delayed. Second, the pandemic has prompted unprecedented fundraising activity, with NHS Charities Together emerging as a central recipient of donations and onward distributor of grants to NHS-linked charities across the UK.^[2] The comments about fundraising in sections 5.18 to 5.22 of this report reflect a pre-pandemic view of fundraising and therefore understate this aspect. Third, the impacts of COVID-19 and the mental health consequences of the measures to contain its spread will create new/increased demands on NHS-linked charities. Fourth, our recommendation at 2.11 takes on new importance in terms of why continuity of use of the same charity number matters. Such an outcome facilitates how donations, and grants from bodies such as NHS Charities Together, can continue to be received by the NHS-linked charities in Scotland.

Although this report was written in 2019, all its recommendations remain unchanged. If anything, the pandemic has strengthened the need for the recommendations in this report to be implemented, to enhance the flexibility available to NHS-linked charities as they respond to the new and increased health and wellbeing challenges affecting their beneficiaries, namely NHS staff and volunteers, patients and the population of Scotland generally.

In arriving at the recommendations in this report, we have listened to input from many people (acknowledged in Appendix 5) who have generously given their time to share their expertise and experience as a donor, trustee, chair, NHS employee, lawyer, accountant, CEO, academic, civil servant, and the families of patients. The Scottish Charity Regulator, OSCR, has also provided valuable input throughout the process. This blend of insight has shaped what I believe is a balanced and proportionate set of recommendations.

It has been my pleasure to chair this Review and to explore the governance and operation of these valuable charities. They are uniquely placed to play a creative and much-needed role in supporting how we cope with and recover from COVID-19. If the recommendations are implemented as we hope, I look forward to seeing these NHS-linked charities thrive into the future.

Julie Hutchison LLB TEP WS, Chair of the Review of Governance of NHS Endowment Funds

Charities Specialist, abrdn

Visiting Professor in Governance and Innovation, Edinburgh Napier University

September 2021