In Part 4 of the Hospital Charity takeover, Agnes Arnold-Forster traces the history of Great Ormond Street Hospital’s fundraising campaigns and the Royal Family’s involvement in them.
The Royals only rarely use the NHS, but the NHS uses the Royals.
When the architects of the NHS were drawing up their plans, they faced a problem. What should they do with hospitals’ vast charitable endowments? Should they allow individual institutions to keep their cash, pool the money regionally or even nationally, and should they let hospitals continue to actively fundraise? This was supposed to be a state-funded system, with funds more or less equally distributed across the country – the vast wealth of some institutions posed a challenge. So, they came up with a solution. Individual hospitals in England were allowed to keep their cash, but weren’t allowed to fundraise. And, they were restricted in what they could spend their existing money on. They could spend it on added extras – staff Christmas holidays, ward window boxes, and research – but they could not spend it on things like patient care, essential running costs for, or staff salaries. Those would be state funded.
In the 1980s, though, things changed. In October 1979, the Department of Health and Social Services sent hospitals and health authorities a memorandum on fundraising by NHS staff. It stated that Ministers were reviewing the general policy, and while they indicated further changes were also being considered, they had already instituted a key reform: “there is no longer any objection to the participation of NHS staff in voluntary fund-raising activities.”[i]
This was great news for some hospitals, which were struggling to update their buildings and facilities, and were in desperate need of more money. One such hospital was Great Ormond Street Children’s Hospital in London. Over the course of its NHS history, it had been able to make some extra cash via the royalties it earned from the sale of the children’s book Peter Pan, which the author, JM Barrie, had bequeathed to the institution in the 1930s.
In February 1980, GOSH’s Treasurer wrote to the Department of Health and Social Security to request an update on potential changes to the legislation. “Further to our conversation of yesterday,” he wrote, “I should be grateful for your further advice as to whether the Board will be able to seek funds from non-exchequer sources.” He justified his request by explaining GOSH’s financial situation, “the Hospital Group is facing a desperate financial crisis and has been forced to close two twenty bed wards.”[ii]
GOSH was in luck, and later that year, the government liberalised hospital fundraising policy, transforming the way NHS institutions raised money for things like big capital projects. No longer reliant solely on the public purse, they could get creative. GOSH wasted no time, employing a professional fundraiser, Marion Allford, who was tasked with raising £30 million to address the “extreme lack of space” in the crowded central London site. “Clearly”, she wrote in 1987, “a hospital which has evolved over more than 100 years had not always had the opportunity of constructing new buildings where necessary.”[iii] In 1986, the Secretary of State had approved this rebuilding plan, and agreed that the DHSS would contribute £20 million, leaving the hospital to raise the rest.
Marion had ten months before the appeal would go public, during which she planned to make “personal approaches to individuals, companies and trusts” in an attempt to secure large donations from people flattered to have been identified as particularly benevolent. The second phase would open “with as much publicity as we can obtain” which required, in Marion’s opinion, the support of the Royal Family.[iv]
Initially, they planned to just approach Diana, Princess of Wales, but decided that because a children’s hospital ought to be the concern of parents, rather than just mothers, they should attempt to bring Charles on board too. The GOSH archive is fully of letters back and forth between Marion and the royal staff – persuasive, flattering letters that attempted to make clear the hospital’s dire straits.
During the first phase, the Prince and Princess of Wales secretly (so as not to blow the appeal’s cover) visited the hospital to assess the situation and meet the fundraising team. About a month later, they agreed to host a “small reception” at Kensington Palace for “major donors to the Redevelopment Appeal”. Towards the end of 1987, the hospital launched the appeal under a new name. The Wishing Well Appeal was the “largest single project appeal that has ever been mounted” and was remarkably creative in its approach, setting the standard for hospital fundraising for the rest of the century and beyond. The largest single donation they received was £3 million from Gary Weston, chairman of Associated British Foods, and the Variety Club of Great Britain pledged to raise the same sum.
The Midland Bank donated £1/2 million, enabling GOSH to run a major advertising campaign, and multiple magazines and newspapers offered the hospital free advertising space. This actually caused some trouble, when GOSH ended up promoting its campaign on billboards opposite other children’s hospitals across the country, who were understandably peeved by the sudden flow of cash from their local communities to this relatively well resourced central London institution.[v]
The Prince and Princess of Wales were key to the public face of the campaign. Both were the appeal’s patrons, and publicity materials made much of the fact that Charles had gone to GOSH to have his appendix removed as a child. The couple were regular visitors to the hospital, ensuring that their meet and greets with sick kids and their parents were captured in photographs and on television broadcasts. On the 3rd December 1987, Diana distributed Christmas presents to the children on the wards. The couple’s relationship with GOSH and its fundraising continued into the 1990s, and even after they separated in 1992, they still made regular individual visits.
GOSH was the first NHS hospital to run a campaign of this scale. Since the 1980s, they have continued to set the standard, and charitable donations have funded a growing proportion of NHS services and capital projects. The British public has a remarkable emotional investment in their health service, and GOSH was smart to bring together two much-loved national institutions in their efforts to raise cash.
But as I’ve written elsewhere, charity in the context of the NHS “isn’t without its flaws, both ideologically and practically”. As the discontent of other regional children’s hospitals suggests, it is difficult to distribute donations evenly and fairly across the country, and the very rich institutions, like GOSH, tend to be in major urban centres. GOSH, as a hospital that cares for blameless babies, also has an easier time raising money than institutions catering for adult and supposedly less deserving patients and communities. Indeed, the royals’ involvement in such campaigns reflects their fundamentally inequitable nature. Effective, maybe; generous, of course. But not, perhaps, particularly fair.
About the author
Agnes Arnold-Forster is a writer and historian of healthcare. She is Chancellor’s Fellow at the University of Edinburgh. She tweets from @agnesjuliet.
References
Arnold-Forster, Agnes. 2022. “Charitable Health Service”, LRB Blog. February 22. https://www.lrb.co.uk/blog/2022/february/charitable-health-service
[i] GOS/15/444 Board Funds General, Endowment Funds, 1977-84
[ii] GOS/15/444 Board Funds General, Endowment Funds, 1977-84
[iii] GOS/6/2/6 Visit of TRH The Price and Princess of Wales
[iv] GOS/6/2/6 Visit of TRH The Price and Princess of Wales
[v] GOS/6/7/29