What is the role of NHS charities in Wales?
NHS charities have existed since the inception of the NHS. They play a vital role in enhancing national healthcare by providing extra support to the NHS, including raising funds, improving workforce wellbeing, transforming patient experiences and outcomes and championing the health and wellbeing benefits of arts and green spaces in the community.
This explainer provides an overview of NHS charities in Wales, defining their purpose, structure and impact within the Welsh health system.
What are NHS charities?
NHS charities are charities, registered with the Charity Commission, that are linked to a respective NHS body. Unlike core NHS services funded by the public purse, they exist to provide additional public benefit that goes above and beyond the statutory provision of their local health board or trust.
To read more about how the NHS in Wales is funded, see our explainer: How is the NHS in Wales funded?
There are over 220 local and specialist NHS charities across the UK. Their role is to:
- accept charitable donations from the public and from grant-making bodies
- develop fundraising campaigns to solicit further charitable donations
- ensure funds are held separately to public funding, and to ensure good charity governance
- ensure funds are spent appropriately for charitable public benefit
- demonstrate the impact of donations and charitable expenditure.
What are the NHS charities in Wales?
There are nine NHS charities operating in Wales, collectively supporting the services provided by NHS Wales. They are:
- Awyr Las (serving Betsi Cadwaladr University Health Board)
Whilst remaining separate charities, all nine charities work closely with each other to share knowledge and expertise, as well as to coordinate fundraising messaging on some campaigns. Collectively, they raised an additional £25 million in 2023-2024 to support NHS Wales services, significantly contributing towards the NHS Wales financial position.
How are they operated and governed?
Each of the NHS charities in Wales operate under a “Corporate Trustee” model. This means that the respective local health board (LHB) or trust is legally responsible for the charity. When the trust Board or LHB Board meets to discuss charity matters, they are meeting as the Corporate Trustee, even though the board membership may be identical to the trust Board or LHB Board.
Unlike in many other charity governance models, it is the corporate entity, rather than individual trustees, that have the legal responsibility for the charity’s governance. In Wales, all Corporate Trustees delegate some of their responsibilities to a Charitable Funds Committee, which makes decisions on the charity’s financial plans and governance.
Why do NHS charities exist?
It has long been recognised that some patients will wish to give a donation, as a way of thanking the staff and volunteers involved in their care.
The Healthcare Financial Management Association (HFMA) sets out the legislative context:
“NHS bodies are empowered by their incorporating Statutory Instruments to receive, hold and apply new funds on trust. It is these funds and the property held on trust for exclusively charitable purposes that constitute one of more charities…As well as being governed by their statutory duties under NHS Acts, NHS trustees must comply with the relevant Charities Act guidance.”
Therefore, NHS bodies are able to receive donations from patients and from others, which are then held in trust to be spent on charitable purposes. Charity law puts a legal duty on these charitable funds to be registered with the Charity Commission, to be kept separate from exchequer funds, and for these funds to be used for the public benefit. NHS charities are subject to the same charity law and fundraising regulations as any other charity.
Although there can be confusion between the role of the public sector and the role of NHS charities, there is widespread public support for the work of NHS charities. According to a survey commissioned by NHS Charities Together, 63% of UK adults now agree that giving to an NHS charity is important to help the NHS achieve more.
What do NHS charities spend their money on?
Ultimately, all charities must be for the public benefit – in the case of NHS charities, this is interpreted as ensuring that all expenditure ultimately has benefit to the patient. The Corporate Trustee of each charity is responsible for ensuring that there are strong decision-making processes in place. These processes must ensure that expenditure is legally charitable, is additional to statutory spending, and is for public benefit.
All NHS charities will have guidance in place to ensure that expenditure, particularly on staff wellbeing project, ultimately provides patient benefit. For example, when a project is designed to support staff wellbeing and welfare, there should be a link to improved patient outcomes, such as through reduced staff sickness rates or lower staff attrition.
How do they raise money?
Where a donation is eligible for Gift Aid, NHS charities are entitled to claim Gift Aid (25% of the value of an eligible donation) as any other charity. This can be an important source of income for many NHS charities. Generally, because of the corporate structure of NHS charities, it is not always possible for charities to fundraise through things such as trading subsidiaries or charity shops.
Who manages NHS charities in Wales on a day-to-day basis?
Historically, the governance of these charities was managed within existing staff capacity (generally within finance and corporate governance directorates). Donations were accepted only when they were offered by patients, and an internal process then determined how funds should be spent.
In recent years, however, largely thanks to investments during the Covid pandemic, all charities have been able to invest in staffing in order to increase donations, to manage the governance more effectively, and to ensure funds are spent in a strategic way that aligns with the NHS trust or LHBs ambitions.
In all cases in Wales, the trust or LHB (rather than the charities themselves) are the legal employers of staff, and the staff are employed on NHS terms and conditions. The charity is recharged for some or all the direct salary costs, as well as general overheads.
What is ‘NHS Charities Together’?
NHS Charities Together (or “NHSCT”) is the working name for the Associations of NHS Charities. It’s a membership organisation for NHS charities that offers grant funding, as well as training and support for its members. Currently, all nine NHS Wales charities are also members of NHS Charities Together and have benefitted from grant funding.
It was the investment from NHS Charities Together during the Covid pandemic that has enabled many of the NHS charities in Wales to grow. NHS Charities Together raised £162 million from its Covid-19 Urgent Appeal, the majority of which has been distributed directly to NHS charities across the UK through grant funding. This has included specific grants to support charity infrastructure, which in turn has allowed charities to increase their public fundraising.
How could NHS charities transform NHS Wales services in the future?
As NHS charities are not designed to replace statutory funding, there are opportunities for NHS charities to contribute towards pilot projects, testing new models of delivering care, service transformation and preventative healthcare. This could be in the form of providing funding for pilot projects, which could then be evaluated and adopted as business as usual.
Increasingly, NHS bodies are acknowledging that by investing relatively modest sums within their charity infrastructure, they can multiply that investment into further charitable funds that help them achieve their objectives. Although there will be separate planning processes, NHS charities are often involved in strategic planning conversations within their LHB)/Trust, so that the priorities of LHB/Trust and the charity align for mutual benefit.
Summary
To conclude, the nine NHS charities in Wales are legally registered entities operating under the Corporate Trustee model, which places the governance responsibility directly on the respective Local Health Boards and Trusts. Their existence is justified by legislation that empowers NHS bodies to hold funds on trust, satisfying the public desire to donate and ensuring these gifts are used for charitable public benefit.
By focusing expenditure on areas like patient comfort, medical innovation and staff welfare, the charities actively enhance rather than replace statutory services. The investment in their infrastructure, supported by NHS Charities Together membership and strategic collaboration, position NHS charities in Wales as a powerful source of funding for future pilot projects, service and staff wellbeing improvements across NHS Wales.
