Part of my role as a non-executive director of a London hospital was sitting on its charity committee. What never ceased to amaze me was the generosity of those who had recovered from a serious illness.  If someone recovered from a stroke, the stroke unit would get a nice donation.  If a child had been treated the grateful parents gave money to the children’s unit, with the result that many hospitals end up with dozens of different charity pots all ring-fenced for a particular speciality.

The same desire to give money has been reflected in the huge effort to fundraise for the NHS in the past three months. Celebrities have been running auctions to buy PPE, £32 million was raised by Tom Moore, and there have been sponsored walks and dressing up in abundance. These all seem like feel-good stories but, however churlish it sounds, my experience suggests those donations are unlikely to be spent wisely or well.

The first problem is that the NHS already has a lot of money. Government spending on the NHS is currently £140 billion a year, an additional £6 billion has been allocated from the Covid fund and £13.4 billion of debt has been written off. Whatever problems it has encountered during the pandemic, lack of funds is not one of them. The shortage of PPE was never about hospitals not having the money to buy it but about production, supply, and distribution – activities which the NHS just isn’t very good at.

The next problem facing those trying to dispense charitable funds is that while the sums raised are large, they are still not enough to buy anything big. Groundbreaking medical equipment is expensive, usually costing millions of pounds. Most charity committees find that what tends to happen is that an activist doctor in a particular speciality spots the availability of money and puts in a bid for funds for their pet project. Sometimes it will be a worthy investment, sometimes less so, but the committee will be so pleased to get a credible bid with a medical outcome they will just nod it through without any real due diligence.

Then there will be applications for funds for nice things for the staff. Obviously, given their heroic status these days, there will be some who think this is only right. But it is an open question just how many of those donating money to the NHS really want their money to go on a nurses’ jolly to the bowling alley or a pampering day. Will they really be happy to discover that their fundraising efforts have gone on buying a few comfortable chairs for the staff room or putting up a picture or two?

The NHS Charities Together organisation, which has received most of the recent donations, says that it supports 230 charities in individual hospitals. Its own overheads are low but the profusion of organisations it supports means it is not an efficient system of dispensing money. They too struggle to provide examples of how their largesse makes a medical difference. The highlights of their spending  (listed on their website) include “brightening wards and waiting areas with colourful and engaging art,” and a weight loss programme for nurses in Nottingham, worthy perhaps but not the life-changing activity the donors might have anticipated.

Good people will no doubt do their best to spend the millions given to NHS charities well, but spending money is difficult, spending a lot of money is harder still and the hard truth is that good intentions do not always lead to good outcomes.

The philosopher William MacAskill in his book “Doing Good Better” highlighted the need to focus on effective altruism, the need to make sure our charitable giving really makes a difference. He outlines how many of the accepted forms of charitable giving such as to disaster relief appeals or established charities are not very effective in terms of the outcomes they achieve. If the main motivation of people giving money in the pandemic was to save lives they should give money to poorer countries struggling to tackle coronavirus, rather than the NHS.

Giving money to a state run organisation like the NHS means there is a high risk that your money will not be spent effectively. Yet there are hundreds of charities suffering in this pandemic, donations to cancer charities are down 87% and mental health charities by 85%. A contribution to them is much more likely to save or improve lives than a drop in the ocean of the NHS’ multi-billion pound budget.