Large Grant Application: Requests over £5,000

Please do not submit requests for Staff Training & Development on this form, as they will not be accepted.

There is a separate Application Form for Staff Training and Development

The Application can be downloaded at the bottom of the Charity's intranet page: http://nuhnet/nottingham_hospitals_charity/Pages/default.aspx or by emailing charitygrants@nuh.nhs.uk

Charitable funds can transform your ward or service and fund research to help you deliver extraordinary health care.

The money often comes from grateful patients and their families who have made donations or left legacies, or because you, the staff, have been actively involved in fundraising.

We have a responsibility to ensure that money from donations is spent wisely and that its impact is maximised. This form helps us to understand how you would do that.

Please note: The Charity must ensure that charitable donations are only used to fund enhancements, which are considered ‘above and beyond’ what the NHS should provide. Funding cannot be used to replace statutory funding, bridge NHS shortfalls, or to replace like-for-like broken or damaged NHS equipment. Applications made in response to infection control or health and safety issues will not be considered as charitable.

Spending on NHS staff

Spending charitable funds on staff, equipment to be used by staff and staff events, will only meet the public benefit test if the staff benefit translates demonstrably to the relief of sickness of NHS patients.

In deciding how to spend funds available for staff we will consider:

• to what extent the intended charitable outcome from any grant funding can be measured and demonstrated AND

• how effective (in terms of value for money) the funding will be in delivering the ultimate outcome AND

• how strong (or tenuous) the connection may be between the funding and the charitable outcome intended.

Please note: The Following Items will not be funded by the Charity unless exclusively

for use in wider charity funded initiatives.

Badges: including personalised badges and “Hello my name is….” Badges
Lanyards
Pens and Stationery including Tote Bags
Personalised items e.g. mugs
Trophies, Vouchers or 'Gifts' for individuals/staff

We will review the application for funding in terms of patient benefit and assess it against other options and priorities for funding. This includes considering whether the type of purchase and level of expenditure are appropriate.

Applicant Details

Title

First Name

Last Name

Job Title

Ward or Department

Which Division will this Grant come under?

Email

Telephone

Co Applicant Details

Title

First Name

Last Name

Job Title

Ward or Department

Division

Email

Telephone

Fund Details: Please tell us which fund you are requesting funding from?

Fund Name

Please complete this section if you know the fund you are applying to. If this is unknown please leave this section blank.

Research Funding: Requests for research funding must relate directly to the research specialty associated with the Research Fund you are applying to. We would advise that you speak to the Fund Advisor in the first instance before submitting this application

Research Projects Please complete proposed start date for research projects

Staffing costs For projects requesting funding for staff which are following on from previous funding, please include the first day after the previous funding will have completed

For all other applications the start date to be on confirmation of approval

Please note: We do not accept retrospective claims for funding

Drop down calendar

Is this a Shared Governance project?

Please tell us which Shared Governance Council this relates to.

Please select the primary beneficiary of your project

Please tell us how your application links to the NUH inclusion agenda. (if this is not applicable, please just enter not applicable)

Details about your grant request

Please take time to consider your answers and provide all the information requested.

Project Title (Maximum of 20 words)

To help us identify the correct fund, please tell us the name of the ward or service or department the funding is to be used for. Please include the FULL name and type of ward service; avoiding acronyms

Please do not use this section to tell us what you would like us to fund.

Please provide a summary of the project, including what you would like us to fund

and what you hope to achieve with the funding (the aim) this should include any background to the request for context.

Requests for Staffing costs should outline details about the posts in relation to the funding being requested.

Please include information on whether you have received funding for the same request in the past and when that was.

Research projects should include the background to the research being proposed and should clearly outline the clinical relevance of the application in ‘layman’s terms’ so that a person not familiar with the research can understand it.

Please describe how patients will benefit from this funding.

If there is no direct benefit (e.g. the benefit is initially for staff) please include the initial staff benefit as well as the eventual benefit this will have for patients.
Research projects should include what the eventual benefit to patients will be; along with a timescale of when those benefits can expect to be achieved

The role of the Charity is to consider funding requests that are 'above and beyond' what is normally provided by the NHS. This includes what a basic service would need to provide for patients accessing that service or what should be provided for staff by the NUH Trust.

Please tell us how this request is ‘above and beyond' by explaining how this is an enhancement to the service you already provided

Research projects: Please include information about any other funding the project has received, from where and what that funding covers

How will you measure the impact of the Grant to determine if the project has been successful? Please put N/A for one-off purchases.

For New Services: Please provide details of the Key Performance Indicators (KPIs) you will use to measure success.

Please include details on how you will share the outcomes of the project.

Research Projects: Please provide details of the objectives/performance measures for the project against which success will be measured. Please tell us whether you intend to have the results peer reviewed and by whom.

How will the benefits of the project be sustained beyond the life of the funding being requested? And/or how will any on-going costs be funded once the grant has completed and the funding ends?

Research projects should include what the eventual benefit to patients will be; along with a timescale of when those benefits can expect to be achieved

Please Note: the Charity is unable to fund ongoing revenue costs; ongoing costs for maintenance support, upgrades, service contracts, licensing or consumables.

Ownership of any equipment funded by a Grant from Nottingham Hospitals Charity will be transferred to Nottingham University Hospitals Trust who will be expected to fund any ongoing operating costs

Have you discussed this application with other members of staff? If yes, please tell us who and their job title.

If appropriate, have you discussed this with patients? Do you have any comments you can share?

If you are requesting funding for this project from a particular donation, please give details of the donation and any requests issued by the Donor

You can also use this section to include any other information that you would like to include in support of your application

Research Projects: Please tell us if this project has any is involvement from either NUH R&I or the National Institute for Health Research (NIHR)

Details of Funding Being Requested

Please do not leave this section blank. We are unable to process applications without the funding information recorded in the expenditure details. If you need advice on completing this section, please email charitygrants@nuh.nhs.uk

If you need to remove VAT please contact charitygrants@nuh.nhs.uk with the details

Please Note: the Charity is unable to fund ongoing revenue costs; ongoing costs for maintenance support, upgrades, service contracts, licensing or stand alone requests for consumables that do not form part of a wider project aslo being funded by Nottingham Hospitals Charity.

Ownership of any equipment funded by a Grant from Nottingham Hospitals Charity will be transferred to Nottingham University Hospitals Trust who will be expected to fund any ongoing operating costs

Please note: The Following Items will not be funded by the Charity unless exclusively

for use in wider charity funded initiatives.

Badges: including personalised badges and “Hello my name is….” Badges
Lanyards
Pens and Stationery including Tote Bags
Personalised items e.g. mugs
Trophies, Vouchers or 'Gifts' for individuals/staff

*For multiple similar Items of the same general type: You can group similar items under their main description e.g. Craft Items, Furniture etc and then upload a more detailed list as an attachment below

1st Year and one-off payment (£) (excl. VAT)	2nd Year (£) (excl. VAT)	Total VAT (£) (Added Automatically)
£	£	£
£	£	£
£	£	£
£	£	£
£	£	£

Total Expenditure Including VAT (Auto Populated from lines above)

£

Do you want to upload a detailed breakdown of items from above? Research Projects: Should provide a costing template detailing the expenditure and for applications that include staffing costs, a Gantt Chart of the proposed project activity.

YesNo

Please upload here

Please upload QUOTES on the next page.

Expenditure Details for Staff Salaries

Salary costs must include on-costs (employer's pension and NI) and should be checked with NUH Trust or University finance departments.

Salary 1st Year	Salary 2nd Year	Total £
£	£	£
£	£	£
£	£	£

Proposed Staff Salary Total

£

Total Amount Requested

Total Amount requested from NUH Charity

£

Please take note of the following before completing this section.

1. Purchasing items including equipment (medical & no-medical) and furniture

Please be aware that the Trust procures from commercial businesses only. If you have not done so already, please contact Procurement
procurementbuyingteam@nuh.nhs.uk so they can provide you with a supplier quote before you send the application. Please remember there may also be a carriage charge for delivery.

All Electrical items, furniture and any items that will be in contact with patients will require a quote.

For Medical Equipment you must get procurement advice, so they can check if the item is on the NUH Supply Chain.

2. Infrastructure projects: refurbishments and minor building works including fixture & fittings

For minor building works including fixture & fittings Please contact the Minor New Works (MNW) service. MNW@nuh.nhs.uk who will be able to provide you with a quote.

MNW will also be able to advise on any additional costs your grant may involve and provide a MNW quote. For example, works that may involve small installations of fixed equipment and minor building works including the relocation or reconfiguration of existing items and equipment.

Typical Examples of Minor New Works:
S
Supply and fixing of picture fames
Painting and redecoration works
Floor laying – vinyl and carpet
Installation of minor electrical installations – additional power sockets and lighting
Small plumbing installations
Shelving
Complete minor refurbishment of small wards areas.
Digital television signal provision

Unfortunately, the MNW Team cannot action the new network ports element of this MNW and a new ICT job needs raising directly with the ICT Team digitalservicescontractormanagement@nuh.nhs.uk

Please bear in mind that for any space that you are changing the use of, including Garden improvements, you will need to complete a space management form. You should also send this to the Charity

Large Scale Refurbishments should be discussed with your Divisional Leadership Team in the first Instance. The NUH process for Capital Projects requests should be followed.

Please be aware: Due to the requirement to provide a 50% deposit, the Charity is no longer approving grants for projects using Grosvenor Interiors.

Please contact MNW@nuh.nhs.uk for wall glamour/mural quotes and procurementbuyingteam@nuh.nhs.uk for furniture quotes
Minor New Works for non-NUH owned estate
Please be aware that in some areas of the Trust where we occupy space as a tenant (for example the Treatment Centre, University embedded, CDC, NHS Property Services spaces), we are unable to progress with minor new works without gaining approval from the service provider or landlord. In these cases, the NUH Estates Team will advise accordingly when they receive your request.

3. Purchasing IT equipment and new IT services

Please check with your ICT Business Development Manager to ensure that your IT requirements are costed accurately and the items being requested are both fully compatible with Trust systems and also IT supported ICTASR@nuh.nhs.uk

If the grant is for either a new service or a change to an existing service, they can also advise if they require you to submit an Additional Service Request (ASR).

PLEASE NOTE: Responsibility for providing quotes sits with the grant applicant. The Charity is unable to do this on your behalf.

Failure to provide the required information will result in your Grant being delayed or your application being withdrawn

If you have contacted Procurement /Estates/ICT and have an email saying a quote is not required, we may contact you to request a copy of the email.

For Medical Equipment, Electrical Items, Furniture etc. Do you have a quote for the items being requested?

Please attach your quote or a copy of the email from Procurement

For building works, refurbishments and changes to fixtures and fittings:

Do you have a quote for the work being requested?

Please attach your MNW order or email from Estates with the Quote

For new IT Equipment and new IT Systems including Additional Service Requests (ASR)

Do you have a quote from ICT Services for the equipment or service being requested?

Please attach your IT Quote or email from ITC

NUHC – Terms and Conditions of Charitable Grants

1. Grants are awarded at the level indicated in the offer letter.

2. Grants are awarded towards the project set out in the application form, at the costs confirmed, and it is the responsibility of the grantee to ensure that it is spent solely on these purposes. No further funds will be provided to complete the Project in the event of any short-fall. Unused funds may not be used for any other purpose than set out in the application. It is assumed that this is understood by applicants upon acceptance of the offer.

3. Grants must be accessed within six months of the offer letter. If a grant has not been accessed within six months, the Trustees reserve the right to withdraw their original commitment to support. The applicant would need to provide a report, detailing the reasons for delays, any changes to delivery timescales and a request to renew the commitment for a further period, if applicable. Periodic progress reports may be requested by the Charity, failure to comply may lead to withdrawal of funds.

4. Grants may be allocated wholly or in part towards total salary costs; funded staff are employees of the organisation to which the grant is made. The grant approval will only cover the post holder’s basic salary and national insurance. Pension payments will be considered as applied for. Any other staff-related costs, including sick leave or sick leave cover, maternity pay or redundancy payments must be borne by the employing organisation. Any changes to salary arrangements must be notified to the Charity as soon as known. i.e post-holder on long-term sickness/maternity leave).

5. The responsibility for ongoing costs associated with equipment after a grant has ended lies with the organisation to which the grant was made. Any equipment funded by a grant from NHC will be owned and operated by the recipient organisation and will be maintained and operated at its own expense.

6. In all cases where a grant has been agreed, NHC will require a report from the lead contact on completion of the grant and, if appropriate, annually thereafter. Failure to provide comprehensive feedback for the project, when requested and in a timely manner could jeopardise future grant applications and/or final payment for this project. The pro-forma will be emailed to the lead contact at the relevant time – any changes in lead contact must be notified to NUHC immediately. It is the responsibility of the lead contact to provide the name and details of the new contact.

7. It is the responsibility of the grantee to ensure that a) the Charity is recognised for its funding contribution to the project and b) the grantee will take advantage of opportunities to promote this. The Fundraising Department of NHC or the Trust’s Communications Department may contact you to discuss the Charity’s support in order to further promote the Charity to encourage further donations and fundraising. This will be in the form of a plaque, marketing materials and/or within publications or posters arising from the grant. Where the Charity funds a staff post, our Charity Logo should be embossed on to their uniform. NB: Large capital projects will be required to display a Charity banner for the duration of the project.

8. NHC reserves the right to terminate a grant award at any time. Written notification will be given and costs incurred up to the termination date will be reimbursed.

9. NHC reserves the right to make changes to terms and conditions: written notice and a full explanation will be given.

Applicant’s Declaration. By submitting this application I confirm that:

I have read and accept the NUH Charity terms and conditions of grant listed above.

I will not claim for any items that are not set out in the application form and understand it is my responsibility to discuss any changes to the grant awarded with the Charity in advance.

I acknowledge that if my application is successful, there is a requirement to ensure that the Charity’s support is recognised in all internal and external publicity.

Keeping in touch

As a successful applicant to Nottingham Hospitals Charity's grant programme, we would like to stay in touch with you, to provide updates and information on our fundraising events and latest news. You can change your mind and unsubscribe at any time.

Please select below if you would like Nottingham Hospitals Charity's grant programme to email me updates,fundraising events information and latest news

I have read the Nottingham Hospitals Charity privacy statement available here and I agree to these terms and conditions.

What happens after you submit your application?

*We recommend you discuss your application with a Fund Advisor and Divisional Leadership Team before submitting the form*

Step 1: The Charity will check that your application meets our charitable criteria. If a grant is not eligible the Charity will contact you at this stage.

Step 2: All eligible applications will be sent to a Fund Advisor signatory on the appropriate fund.

Step 3: If the Fund Advisor confirms their approval, the application will then be sent to the Divisional Leadership Team for confirmation that they support the application that you are making.

Please be aware: Grant Applications of more than £100,000 will also require the approval of one Executive Director of the NUH Trust.

Step 4: Applications over £15,000 will require final approval from our Charity Trustees.

Step 5: The Charity will inform you of the outcome of your grant application; including how to claim your grant.

The time the review process takes, will be dependent on all fund signatories within NUH processing your application and the final approval of the Charity’s Trustees.

In ALL cases, confirmation of grant approval shall be in the form of an email from Nottingham Hospitals Charity to the email address entered on the application form.

N.B. The Charity will not accept responsibility for any commitment made in anticipation of an application being submitted, which does not receive approval. No retrospective claims will be accepted

Please keep a copy of this application for your records. You can print this off after you have reviewed it and before confirming.