Article Summary
Drawing on the perspective of Ellie Orton OBE, Chief Executive of NHS Charities Together, this article explores why NHS charities should be involved much earlier in capital planning. It argues that charities provide more than additional funding: they contribute patient and community insight, philanthropic expertise, external relationships and the flexibility to test ideas that can strengthen both the design of healthcare environments and the models of care delivered within them.
The NHS is making capital decisions in one of the most constrained environments it has faced for many years. Across the health service, Trusts are balancing growing demand, ageing facilities and increasing expectations from patients and staff, while making long-term investment decisions amid ongoing resource scarcity.
At the same time, capital projects are becoming increasingly complex. New healthcare facilities are expected not only to deliver clinical functionality, but also to improve patient experience, support workforce wellbeing, support new models of care and respond to the changing needs of local communities. This raises a pressing question: are NHS Trusts making full use of all the strategic partnerships available to them when planning major capital projects?
For Ellie Orton OBE, Chief Executive of NHS Charities Together, one of the most overlooked opportunities lies in involving NHS charities much earlier in the capital planning process. Too often, charities become part of the conversation only once a project has been defined and a funding requirement has emerged. By that stage, many of the fundamental decisions around design, delivery and investment priorities have already been made, and the opportunity for charities to contribute strategically, rather than simply financially, has largely passed.
A changing role for NHS charities
Across the UK, more than 220 NHS charities collectively invest approximately Ā£1.5 million every day in initiatives that improve healthcare. Their contribution spans innovation, new technology and treatments, improvements to care environments and wider support for patients, families and staff. Yet despite the scale and breadth of this backing, the role of NHS charities remains too narrowly defined.
For many years, NHS charities have been viewed primarily as organisations that fund the additions public budgets cannot accommodate. That perception is changing, but it still limits how their role is understood within estate and capital planning.
It is worth being clear, though, that charitable funding should not replace statutory investment, nor should NHS charities be expected to compensate for gaps in core provision. Public funding must continue to sustain the NHS. The purpose of philanthropy is to provide the flexibility to pursue ideas, partnerships and enhancements that can improve the quality, experience or ambition of a project beyond what core capital alone may allow.
This distinction matters. When a charity is invited into a project only after plans are substantially complete, its contribution is largely transactional. It can assess the proposition, consider what may appeal to supporters and begin fundraising, but it cannot shape the assumptions behind the project, bring community insight into the brief or identify opportunities that may have been missed. As Ellie argues,
The question at the beginning should not be, āCan the charity help us pay for this?ā It should be, āWhat could we achieve if we planned this together?
That repositions the charity from a potential funder at the end of the process into a strategic partner at the beginning.
A different perspective on what a capital project should achieve
NHS charities occupy a distinctive position around the health service. They work closely with Trust leaders and clinical teams, while also maintaining direct relationships with patients, families, local communities, businesses, voluntary organisations, researchers, grant makers and philanthropists. Few other partners operate across all those groups.
That breadth gives charities a valuable perspective during the early definition of a capital project. They can bring patient and community insight into discussions about priorities, make connections with external organisations, identify where philanthropic support may have the greatest impact and help leaders understand which aspects of a proposition could inspire wider backing.
They can also ask questions that conventional capital planning may not always foreground. What should the environment feel like for a patient arriving in distress? How might a family use the space during a prolonged admission? What would support staff wellbeing as well as operational efficiency? Which elements could create a more humane, inclusive or restorative experience without compromising clinical performance?
These are not secondary design considerations. The experience of a healthcare environment can influence dignity, anxiety, recovery, staff morale and the way patients and families engage with care. When such questions are raised too late, those same opportunities become more difficult and expensive to recover.
Early charity involvement therefore has the potential to strengthen the definition of value itself. It allows Trusts to consider not only whether a project is technically deliverable, but also whether it can produce the widest possible benefit for the people and communities it is intended to serve.
Creating space for innovation
Capital programmes rightly operate within robust financial, governance and assurance controls. Those safeguards are essential, but they can also make it difficult to test ideas that sit outside established provision or whose value has not yet been fully demonstrated.
Charitable funding can create room for that experimentation. It can enable Trusts to bring in specialist expertise, pilot an approach, support research or invest in an idea before it is ready to become part of mainstream provision.
The Kingās Critical Care Roof Garden at Kingās College Hospital illustrates this potential. Supported by Ā£2 million in donations from Kingās College Hospital Charity alongside Trust funding, the garden allows for some of the hospitalās critically ill patients to receive full life support outdoors, with access to fresh air, natural light and greenery.
What the project offers cannot be reduced to the creation of an attractive external space. It brought clinical care, patient experience and environmental quality together in a way that would have been difficult to achieve through a conventional definition of essential capital alone. The result demonstrates how philanthropic investment can help a Trust pursue an idea that is both clinically credible and more responsive to the human experience of serious illness.
Philanthropy needs time, clarity and credible ambition
There is a practical reason to involve charities earlier: successful philanthropy takes time. Major gifts are built through trust, strong relationships and a clear understanding of the difference a donorās support could make.
People support the NHS for many reasons. A family may want to recognise exceptional care, a local business may want to invest in the health of its community, or a philanthropist may be drawn to innovation and lasting impact. That willingness to give is significant, but it cannot be assumed that goodwill will automatically find the right project at the right moment.
Charities need sufficient time to understand the Trustās future priorities, test the strength of the proposition, identify potential supporters and develop an honest narrative around need, impact and delivery. They also need confidence that the organisation is ready to steward major relationships appropriately and that the project has the leadership commitment required to succeed.
For that reason, the earlier a charity can see the capital pipeline, the better placed it is to advise where philanthropy may be realistic, where expectations need to be managed and where relationships should begin long before a formal campaign is launched.
A strong connection to a projectās ambition, governance and engagement gives philanthropic strategy credibility. Planning under time pressure often strips that credibility away.
Removing the barriers to partnership
Earlier involvement will require changes within Trusts as well as within charities. Charity leaders need access to the strategic conversations in which future estate priorities are discussed. Capital, clinical, finance, communications and charity teams need a shared understanding of the respective roles of public funding and philanthropy. Staff across the organisation should also know how to respond when patients, families or partners express an interest in supporting the Trust.
Alas, larger structural barriers compound the issue. Capital expenditure limits can prevent Trusts from fully capitalising on major philanthropic gifts, even where a donor is ready to support a building or significant development. If the Trust has reached its capital limit for that year, the project may not be able to proceed in the form or timeframe originally intended.
This creates a clear policy tension. The NHS benefits from extraordinary public generosity, yet the mechanisms governing capital can hinder efforts to convert that generosity into timely investment. Greater flexibility, including consideration of how capital limits operate across more than a single financial year, could help Trusts plan more effectively and make better use of significant donations.Ā
National and system leaders should take this as an argument for ensuring the capital framework can distinguish between uncontrolled expenditure and credible, additional investment supported by philanthropy. Where strong governance, clear benefits and sustainable operating arrangements are in place, the system should enable Trusts to respond to generosity rather than inadvertently constrain it.Ā
From late-stage fundraising to strategic partnership
For NHS leaders, the central lesson is straightforward. The value of an NHS charity is greatest when it enters the process before a project has crystallised into drawings, cost plans and a funding gap.
By bringing the charity into early capital conversations, Trusts can draw on a wider range of insight from the outset. It also draws the voice of patients and communities closer to strategic decision-making, creates time to build external support and allows leaders to explore where additional investment could produce meaningful and lasting value.
In an environment where every capital decision must work harder, Trusts cannot afford to overlook partners who understand both the NHS and the communities it serves. NHS charities share the same ambition as Trust leaders: to improve care and create better experiences for patients, families and staff. Their insight should be used when the direction of a project is still open to influence.
For Trust leaders beginning to consider their next capital project, the message is simple: bring the charity into the conversation while there is still an opportunity to shape what the project could become.
