Attend Academy analysis of Recommendation 12 of the Lampard Review
Published by Debbie Baverstock on Tue, 09/02/2016 - 10:13
Themes and lessons learnt from NHS investigations into matters relating to Jimmy Savile
Independent report for the Secretary of State for Health
February 2015
Authors:
Kate Lampard
Ed Marsden
Recommendation 12
NHS hospital trusts and their associated NHS charities should consider the adequacy of their policies and procedures in relation to the assessment and management of the risks to their brand and reputation, including as a result of their associations with celebrities and major donors, and whether their risk registers adequately reflect such risks.
This document summarises the key aspects of Recommendation 12 of the Lampard Review.
Essentially, there is some confusion around the applicability of this recommendation where this relates to independent volunteering groups, and the analysis below seeks to clarify the picture.
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Attend Analysis:
However, it is clear that the Lampard review is not specifically recommending that NHS hospital trusts develop a ‘Memorandum of Understanding’ with other independent charities and groups supporting the work of the trust.
Attend Conclusions 1. Recommendation 12 of the Lampard Review does not include independent volunteering groups in its remit. 2. It is desirable for NHS hospital trusts and independent hospital groups to develop a ‘Memorandum of Understanding’, including the following areas: - Shared objectives - An agreed process for what services/equipment etc. donated funds can support - An agreed process for communicating how the independent group can enhance their support for the work of the NHS hospital trust.
Attend Recommendations Independent volunteering groups working with NHS hospital trusts should: 1. Welcome the opportunity for dialogue with their NHS Trust that may arise from the Lampard Review. 2. Seek to clarify each parties understanding of how the Lampard Review Recommendations apply to independent volunteering groups supporting NHS hospital trusts. 3. Seek to develop an appropriate ‘Memorandum of Understanding’, which supports the interests of all concerned. ___________________________________________________________________________________________________________________________________________________ |
Recommendation 12
R12 NHS hospital trusts and their associated NHS charities should consider the adequacy of their policies and procedures in relation to the assessment and management of the risks to their brand and reputation, including as a result of their associations with celebrities and major donors, and whether their risk registers adequately reflect such risks.
Background
14.3 Most NHS hospitals have their own associated charities, which hold charitable funds for furthering the aims of the hospital. These are known as NHS charities. NHS charities are bound by and subject to the NHS Act 2006 as well as by charity law.
14.4 Most NHS charities have a corporate trustee governance model under which the property of the charity is held by the NHS hospital itself and the hospital’s board of directors act collectively as trustee for the charitable property given to it. A small number of NHS charities have a body of individual trustees appointed by the Secretary of State for Health to carry out their trustee functions and two hospitals have recently been granted the right by the Secretary of State to establish an independent company limited by guarantee to act as trustee of their associated NHS charities.
14.5 The question of the most appropriate governance structure for NHS charities has recently been the subject of a review by the Department of Health. This review was established in part in response to pressure from some larger NHS charities for a governance model that would give them greater independence from their associated NHS bodies and the Department of Health. As a result of the review the government will now permit all NHS charities to transfer their charitable funds to new, more independent charitable trusts regulated by the Charity Commission under charity law alone. However, NHS bodies will be able to continue to act as corporate trustee of their charitable funds established and regulated under NHS legislation if they wish to do so. The government has repealed the provisions allowing for the appointment of charitable trustees by the Secretary of State for Health and is requiring charities with appointed trustees to choose whether to transfer their funds to a new independent trust or to hold them as an NHS charity with a corporate trustee governance model.
Fundraising by NHS charities
14.6 Our investigations revealed wide variation in the sums generated by hospitals from charitable fundraising. Annual accounts show that nearly half of the £368m raised by the 254 NHS charities in 2012/2013 was raised by and benefited six large high-profile hospital trusts.
14.24 The Stoke Mandeville investigation report shows how Savile’s position in the Stoke Mandeville Hospital Trust gave him the opportunity to interfere in issues ranging from the choice of contractors used to build the NSIC to the type of carpet laid in the centre, sometimes with unhappy consequences. And his control over the significant charitable funds held for the benefit of the hospital allowed him to maintain a presence and influence in that organisation long after he had become unwelcome there. The Stoke Mandeville investigation report says:
“Witnesses told the Investigation that between 1983 and 1990, Savile demonstrated virtually uncontested authority and control at the NSIC…It had been thought that Savile’s intense interest in the NSIC would decrease once the building had been opened; this did not happen. Instead Savile took up residence in his own office suite at the NSIC from where he ‘held court’ and continued to manage the Jimmy Savile Stoke Mandeville Trust Fund…From an early stage Savile was of the view that he ‘owned’ the NSIC and as such had the right to manage its affairs as he saw fit. Savile was able to maintain a tight grip on affairs as the NSIC continued to be dependent upon his Charitable Trust Funds.”
14.25 Besides the governance considerations we discuss above, the best interests of an NHS charity and the fulfilment of its objectives also require a shared understanding between a donor charity and the hospital management about the service needs and priorities of the hospital. As Caroline Lane put it:
“it would be an absolute disaster if we raised millions of pounds for [an] item of equipment and then found that the hospital couldn’t use that item because a proper business case had not been put together that looked at things like ......staffing, training of staff, maintenance, all the extra costs that carry on..”
14.26 We heard of instances of tensions between NHS charities and the hospitals they supported over the way charitable funds were applied. Marion Allford, an experienced professional fundraiser who now acts as a consultant for fundraising projects, suggested that such tensions were quite common. Amanda Witherall, the chief executive of the Association of NHS Charities, pointed out that the fault can lie with either party:
“Unfortunately there are some instances where tension exists between the NHS charity and the parent hospital’s board. Sometimes this is down to poor communications and lack of engagement and either party (or both) can be at fault here. This can result in the hospital board getting frustrated and thinking ‘the charity is just hanging on to the money and not spending it as they should’. Equally the charity often feels the hospital just sees it as a ‘slush fund’ to be used whenever things get a bit tight and don’t fully appreciate the need to plan charitable expenditure properly.”
14.27 The key to minimising the risk of such tensions is continuous engagement between a hospital trust’s managers and its charity trustees to ensure a common understanding of the needs and priorities of the hospital and where the charitable funds can be appropriately applied to best effect to support them. As William Colacicchi, a solicitor and chair of the Association of NHS Charities, put it: “it is about communication” and “encouraging people to the right behaviours”. He also pointed out:
“As charity trustees, you already have a duty to spend your money; as a matter of law you are not allowed just to sit on it, you have to spend it. Generally, you have to spend it within the [the hospital] trust, so you actually have a duty to talk to your [hospital] trust to work out how to spend it effectively. I’m not sure there is additional legislation or rules you can apply which will really enhance that duty, because I think it already exists and it is a question of highlighting rather than expanding it.”
14.28 Marion Allford gave us an example from a London hospital of good practice for ensuring that the hospital and its NHS charity worked together constructively in the interests of patients.
“There were joint steering groups with the chairman and chief exec and medical director and the key trustees coming together at least twice a year. The purpose of these meetings was for the hospital to keep the trustees up to date with the charity’s progress and how charitable funding had been spent, to be informed on the key issues and future plans and to explain where charitable funding would be most beneficial for patients. This allowed trustees to question the hospital representatives on these issues and to discuss with them the options for future charitable projects, before deciding which projects they would select for fundraising or grants. If trustees are kept in tune with the hospital’s vision for the future, the role they can play can be maximised”
14.29 The Stoke Mandeville investigation report shows that tensions arose between Savile and managers at the hospital about the use of charitable funds and that Savile was able to use his control of charitable funds inappropriately to influence the way services were provided. In the light of this we would urge all charities linked to NHS hospitals to consider whether they are structured and at all times operate in such a way as to further their charitable purposes. We also urge NHS hospital trusts and their associated NHS charities to consider how best to engage with each other to ensure a common understanding and respect for each other’s purposes and priorities.
