Jan Filochowski: Should hospitals return charitable donations from the Presidents’ Club?

jan_filochowskiPoor old Great Ormond Street Hospital! The hospital, along with several other hospitals and charities, recently found itself prominently highlighted in a rather tawdry debate about the events at the Presidents’ Club where allegations were made of groping and sexual assault at a men-only fundraising gala. And this despite the fact that the event had nothing to do with GOSH or the GOSH charity, no money from it was going to GOSH or its charity, and no one with any connection to GOSH or the charity was there. The connection, such as it was, was that donations had been given in the past.

And yet… the issues at stake affect all charitable giving, and certainly all that is related to hospitals. Should the source of money given or the associations with the giver matter? Yes—what about gifts from repressive foreign governments or companies with dubious employment practices, such as use of child labour abroad? Should the behaviour of the givers matter? Yes—NHS hospitals work for everyone so the funding they receive should be generally acceptable. Could the purpose of a donation alter the answers to the above questions in any way? Well, yes, if the purpose is turned into a condition, such as associating a brand or an individual reputation with the hospital or, worse, seeking some form of favourable treatment for individuals or groups related to the donor.

The media’s reaction shows that the more prominent your organisation is, the more attention you will get, even though in this case there was no GOSH connection with what happened. But if you do get that attention, you must respond, and your stance must be clear and defensible.

Some commentators felt donations should have been kept; others absolutely not. My 20 years as a hospital CEO tell me that you have to take a conservative view in accepting donations. Your reputation is at stake. Money, even a lot of it, will not compensate for damage to that and will ultimately cost you more. The public needs to trust hospitals and find what they do trustworthy. Their values must be rock-solid. This is at the heart of why the NHS is held in such high regard by the UK population. The NHS’s values derive from an unequivocal, altruistic, unlimited commitment to each and every one of us, and not to securing as much money as possible.

GOSH, the hospital, appears to have left comment to the charity, presumably on the grounds that the link was with the charity not the hospital. The GOSH charity made clear that it was unconnected with last week’s fiasco, but nonetheless has immediately returned previous donations to it. Does that mean it feels it made a mistake in accepting previous ones? If so, what was that mistake?

All this suggests it is crucial always to be crystal clear about who decides what matters in seeking and accepting donations and what stance to take on them. The more complex and larger the fundraising, the greater the temptation to pass decisions to professional fundraisers. To the casual observer, the GOSH response seemed to come from the hospital, but on closer inspection most, if not all of it came from the GOSH charity, completely independent, with its own board, and not in any way a public sector organisation. While it is obviously in a symbiotic relationship with the hospital, it is driven by different imperatives. The hospital’s imperatives are about providing good and sufficient care and treatment to everyone regardless, the charity’s imperative is to raise as much money as possible to support the hospital (which, incidentally, the charity is outstandingly good at.) Close, but not the same thing. And because the two bodies have become completely separate (the hospital and charity originally had the same CEO), there is a fundamental ambiguity and tension. How are two such bodies to resolve a disagreement on the acceptability of a donation?

Failsafe governance is surely best provided by a single decision maker, which has to be the body responsible for the hospital—its board. If last week’s episode has shown us anything, it is that responsibility is inescapable. It needs to be clearly and unequivocally owned both for charitable giving—and for the NHS as a whole.

Jan Filochowski‘s final job prior to his retirement at the end of 2013 was as CEO of Great Ormond Street Hospital NHS Trust. He is a visiting professor at Brunel University 2004-16. He has written and lectured about the NHS, and about managing to turn around failing organisations, using the insights in his 2013 book “Too Good To Fail?”. He has chaired several CQC inspections, and advised the Namibian Government on ways of improving management of health services in Namibia.

Competing interests: None further declared.