Need versus effectiveness

By Iona Joy 24 August 2011

Usually I urge people to donate based on effectiveness. But not today. Today I want people to donate based on need—if it’s a hospice.

Paul Ramsbottom at Wolfson Foundation, a funder of hospices, recently told me he was alarmed by the finances of some of the far flung hospices in deprived areas. The published audited accounts are lagging reality somewhat—but as a funder Paul is party to budgets and business plans, and his warning light is on. Feeling the pinch on community fundraising and poor legacy performance, some hospice’s deficits are increasing, with management contemplating the unpleasant option of reduced services. Which is bad news if you or a loved one are dying somewhere poor or remote.

The local nature of hospice fundraising is often a factor in this conundrum. Hospices based in nice middle class areas generally have less difficulty fundraising. Sure, even these may be feeling slightly worse off at the moment, but compared to hospices in poorer areas they are in clover. We noticed this eight years ago—indeed my first piece of charity analysis—when examining the hospice inHartlepool. Its catchment area includes some of the worst off wards in theUK (so its constituents were sicker), it had no leafy suburbs and no decent-sized corporate to provide regular sponsorship. We compared it to Trinity Hospice in Clapham (also serving Kensington and Chelsea). On a different planet, Trinity’s access to resources was not only reflected in the cost base but also the services and facilities.Hartlepool deserved much credit for doing its level best on very limited resources. Trinity meanwhile was Rolls-Royce with every sort of therapy and attention to ease people’s spiritual, physical and psychological pain.

Some hospices are better run than others, so I’ve generally told potential donors to head for St Christopher’s in Sydenham, a major pioneer of good practice led by the awesome Dame Barbara Monroe. But Dame Barbara’s influence won’t be felt in, say, Cornwall, if vital services are cut. So for equity’s sake, right now I’d say find a really hard up hospice in a hard up area. Not every hospice has the human and financial resources of St Christopher’s. Most are just trying their best to meet pressing local needs. And if you are a major donor, and worried about whether your chosen hard up hospice is as effective as it might be, then you can think about how best to support your hospice to help it to become more so. Does it need help recruiting trustees? Does it need investment in its local shop chain to help generate future income? Does it need guaranteed income for a few years so it can commit to an essential post?

We’ve been working with Help the Hospices looking at hospice service data collection, and starting to plot a future where service provision can be mapped against social need. One day, I hope, a donor could click on a map and see the areas needing more investment.

In the meantime, we can help to locate hospices for you. Or take a look at the map here  and then look up a nearby hospice in Help the Hospice’s directory.