The Untapped Potential of NHS Philanthropy
If the first question is how NHS philanthropy is performing, the second, more interesting question is performing compared to what.
Here's one way to answer it. Take two NHS trusts, similar size, similar patient mix, both part of the Shelford Group of large teaching hospitals. One raises around £30 for every patient who comes through its doors, through its hospital charity. The other raises around £4. Same type of hospital. Same scale. Roughly an eightfold difference in what's being raised from, in effect, the same opportunity.
What £30 looks like, and what £4 looks like
This isn't a one-off. Across the Shelford acute trusts, income per patient ranges from around £4.42 at the lower end to £38.74 at the higher end, a spread of eight to nine times within a single peer group of comparably sized teaching hospitals. Addenbrooke's, Oxford and Newcastle all raise more than £30 per patient. Manchester and Sheffield sit closer to £4 to £5.
None of that difference comes from the hospitals themselves. Patient numbers, case mix, the basic shape of the opportunity, all of that is broadly comparable across this group. What differs is what's been built around the hospital: whether there's a structured way for grateful patients to find the charity, whether clinicians feel able to mention it, whether there's a stewardship process that turns a first gift into a lasting relationship. That's the central argument of this whole series. The gap isn't structural. It's a gap in what's been built, and what's been built can be built elsewhere too.
The gap, in pounds
Scale that gap up and it gets interesting fast. NHS charities last measured raised around £387 million a year in donations and legacies across the sector. Based on the legacy pipeline already moving through the system, even a conservative 0.5% conversion rate points to something in the region of £264 million. Add cash giving from grateful patients and families at a 5% giving rate, roughly another £30 million a year, and you're looking at a combined opportunity of around £189 million beyond what's currently being raised.
That's not a forecast, and it's not asking anyone to find new donors who don't exist. It's the same patients, the same families, the same gratitude that's already there. The £189 million is the difference between what that gratitude currently produces and what it could produce if every trust had what Addenbrooke's, Oxford and Newcastle have built.
Not just a UK story
None of this is unique to the UK. Look at the United States, where hospital philanthropy operates as standard infrastructure rather than as something a handful of pioneering charities have built for themselves. Even using figures from the mid-2010s, now a decade old, hospitals and health systems across the US and Canada were raising close to $10 billion a year through dedicated philanthropic foundations. That's not because Americans are more generous: donation rates per capita in the UK are broadly comparable. It's because almost every significant hospital in the US has had a professional fundraising foundation built into its operating model for decades, and the NHS, with a small number of exceptions, mostly the specialist children's and cancer hospitals, doesn't.
There's an efficiency case here too, and it should matter to anyone holding a trust's budget. The Association for Healthcare Philanthropy estimates it costs around 31 cents to raise a dollar through a dedicated hospital foundation in the US. Moody's has estimated it costs hospitals roughly 97 cents to generate the equivalent through core clinical and operational activity. The ratio holds even if the currency doesn't translate directly: professionalised philanthropy is roughly three times more cost effective than other routes to the same money. Every pound raised through a well run grateful patient programme is a pound that didn't need new beds, new staff or new contracts to generate.
The donor pipeline that already exists
Every trust treats thousands of patients a year who have a story worth telling. The cancer patient whose treatment worked. The parent whose child came home from a children's ward. The family who watched a relative recover from something that, ten years ago, might not have been survivable. Every one of those people is a potential donor, not because they're wealthy, but because they're grateful, and gratitude looking for an outlet is one of the most powerful, least cynical drivers of giving that exists.
The data backs this up directly. Grateful gifts, gifts made by patients and families with a direct personal connection to the care they've received, run at somewhere between ten and fifteen times the value of gifts to other charities. And the NHS already measures the sentiment that sits behind that: nationally, around 90% of patients say they'd recommend their NHS care to friends and family through the Friends and Family Test. With around 600 million patient interactions across the NHS every year, even a small fraction of that goodwill, channelled through a structure that makes it easy to act on, is the donor pipeline most charities spend years trying to build from scratch.
Most of those patients never find out their hospital has a charity. Most clinicians have never been told it's acceptable, let alone encouraged, to mention it. That's not a donor problem. It's an infrastructure problem, and infrastructure problems are solvable.
The public is already willing
It's worth remembering that the constraint here isn't public generosity. UK charities collectively received around £32 billion in donations and legacies in the most recent reporting year, out of total sector income of roughly £102 billion, itself up around 6% on the year before (Charity Commission, 2025). And when it comes to the NHS specifically, the public's appetite is moving in the right direction: 68% of people now say giving to an NHS charity is an important way to help the NHS do more, up from 63% in 2024 and 53% in 2023. Over half say they're more likely to buy a product if some of the profit goes to NHS charities.
The British public gives, generously and increasingly, and they're increasingly comfortable with the idea that some of that giving should go to the NHS. The question for individual trusts isn't whether that generosity exists. It's whether they've built a way to be part of where it goes.
Potential beyond the balance sheet
The case for growing NHS philanthropy is sometimes framed purely in financial terms, and the financial case alone is strong. But the potential here isn't only about money. Grateful patient programmes consistently surface the kind of positive feedback that gets lost in a system designed to focus on what goes wrong. At a time when NHS staff morale is under sustained pressure, giving staff a structured, low-effort way to hear "you changed my life" from the people they've cared for isn't a nice-to-have alongside the fundraising case. It's part of it.
What this looks like in practice
I've seen this gap close, more than once, including in my own work. At Addenbrooke's, the grateful patient programme I built grew the charity's donations and legacies from around £2 million to £11.6 million. Same hospital, same patients, same starting point as every trust currently sitting at the lower end of that Shelford range. What changed wasn't the opportunity. It was the infrastructure built around it.
I've also led two capital campaigns from essentially zero prospects: a Children's Hospital appeal that raised £32 million, and a Cancer Hospital appeal that raised £8 million. Neither trust had some untapped reservoir of wealthy donors waiting to be discovered. What both had, once we built it, was a structured way for grateful patients and families to find the charity, a clinician community that felt comfortable acknowledging it, and a stewardship process that turned first gifts into lasting relationships.
If that's achievable starting from zero, in individual trusts, the question worth asking at sector level is what it would take for the £30-per-patient end of that Shelford range to be the norm, not the exception.
What's actually missing
None of the building blocks here are exotic. They're the same ingredients I've used in every successful programme I've built or supported: clinician engagement, a clear and ethical referral pathway, and stewardship that respects the relationship between patient and hospital. What's missing isn't a new idea. It's the conditions that would let more trusts build it, faster, without each one having to work it out from scratch.
That's where national-level action comes in, and it's the subject of the final piece in this series.