Gemma
22 Aug 2025
The challenge of spending major gifts in hospitals
You might think it’s identifying prospects. Or making the ask. Or getting hospital buy-in.
But in reality, the hardest part of major donor fundraising in an NHS hospital is spending the gift — in a way that’s timely, impactful, and aligned with the donor’s expectations.
Why Spending the Gift Is So Difficult
Once you’ve secured a major gift, the pressure shifts. You’re now responsible for ensuring that:
The hospital spends the funds as promised
The donor sees meaningful impact
The timeline matches the donor’s expectations
The relationship is stewarded professionally
And that’s where things can unravel.
Real Challenges I’ve Faced
Here are just a few examples from experience:
The hospital found capital budget funds and bought the equipment two weeks after the charity completed fundraising for a 7-figure piece of equipment.
A clinician changed their research direction after the gift was made — without informing the charity.
A volunteering pilot funded by a large 5-figure was deprioritised, and no volunteers were recruited.
Procurement ruled out the chosen equipment due to compliance issues.
The department requested add-ons after the fundraising target was met — increasing the goal post-gift.
These situations are common. And they can damage donor trust if not handled carefully.
Your Role: Be the Donor’s Guardian
As a major gifts fundraiser, your job doesn’t end with the ask. You become the guardian of the donor’s intent. That means:
Protecting the gift
Ensuring accountability
Communicating clearly
Navigating hospital systems with diplomacy and persistence
Top Tips to Avoid Major Gift Pitfalls
1. Identify Decision-Makers Early
Before you ask for money, get pre-approval from:
Procurement
Departmental Director
Clinical Engineering
Medical Director (for major projects)
Clinicians often act independently — but spending requires cross-departmental coordination.
2. Educate the Beneficiary Department
Hold a 45-minute session with key staff to explain:
How philanthropy works
Why it matters to patients
Donor motivations
Stewardship expectations
Ask for a commitment of 2–3 hours/month from the department to support fundraising — including donor engagement and impact reporting.
3. Use Gift Agreements
A formal agreement between the charity and the donor:
Prevents misunderstandings
Clarifies spending terms
Shows professionalism
Builds trust
4. Hold a Kick-Off Meeting
Sit down with the lead clinician or academic to:
Share the gift agreement
Explain how funds will be accessed
Outline reporting expectations
Discuss change-of-use protocols
Offer to help with reporting — e.g. gathering stats, writing summaries, or capturing patient stories.
5. Connect Donors with Clinicians
Facilitate a meeting or update between the donor and the clinician. It’s the best way to:
Show impact
Build trust
Encourage future giving
Create accountability
When Things Go Wrong — Be Honest
Sometimes, despite your best efforts, things don’t go to plan. You may need to:
Ask the donor for permission to change the use of their gift
Explain delays
In rare cases, return the donation
These conversations are hard — but they often strengthen the relationship when handled with honesty and care.
Final Thought
Securing a major gift is a huge achievement. But spending it well is where the real work begins. In the NHS, that means navigating complexity, building relationships, and protecting donor trust at every step.
Would you like help designing gift agreements, donor stewardship plans, or internal protocols for managing major gifts? I’d love to support you.