Large Grant - Project, Post, Equipment or Capital

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Use this form if you are applying for a Grant from a designated fund for a project, post or equipment of £5,000 or above.

We recommend applicants read the entire form and prepare sections in advance. Before confirming your submission, please save a copy of your application by selecting the Print option and choosing to save a copy as a PDF. The form includes the following:

Proposed use of funds: King's College Hospital Charity (KCHC) seek applications for projects, King’s College Hospital NHS Foundation Trust (the ‘Trust’) or KCL specialist post(s) or equipment, including Medical and IT equipment/software over and above what the NHS can provide.

Content of application – additionality: Please note the Charity will not pay for any project, equipment or staff undertaking work which is considered to be the core normal function of the NHS.

Authorisation: Applications must be supported and authorised by the Fund Advisor and the associated General Manager (projects and equipment) or Clinical Director, Head of Nursing, General Manager prior to submission.

FT approval: Approval from the Trust will be expected as a condition of the grant prior to disbursement

Additional approvals: All projects and equipment requests should seek approvals from relevant departments e.g., Estates to ensure adherence to the FT’s procedures and/or to ensure compatibility with existing equipment, on-going maintenance, and adherence to the Trusts standards of care. Please speak to your service manager (otherwise General Manager) about getting consent and approval.

Grading and salaries should have the approval of the relevant HR department.

Supporting documents and clarification: Supporting documentation, such as existing project plans and business cases are welcome and can be uploaded, where advised, in support of your application. The Charity may come back to you to ask for more clarification on information.

Process for Charity approval: Grants above £50k require Charity board approval and will be considered at quarterly board meetings after review at our Finance, Audit and Investment Committee. For the Charity to evaluate the proposal and circulate recommendations ahead of these meetings, we may ask for more information and seek the opinions of senior Trust stakeholders. Grants below £50k may be considered outside board meetings or approved by Director of Grants & Insight or Charity CEO.

External funding: where the Charity is seeking external funding for this project, post or equipment application we will follow an assessment and approval process that meets funder requirements and will discuss this with you case-by-case.

Submission: All questions with a red Asterix * are mandatory. You will be asked to review your application prior to submission.

Help and Support: Please contact grants@supportkings.org.uk with any questions.

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Applicant Details

Title

First Name

Surname

Job Title

Department, Ward or Area

Care Group

KCH Site where you are primarily based

Please provide the name of the site you are applying from

Organisation

Please provide the name of the organisation you are applying from

Work Phone

Work Email

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Do you have a co-applicant(s)?

Co-applicant(s)

Co-applicant Title

Co-applicant First Name

Co-applicant Surname

Co-applicant Job Title

Co-applicant Department, Ward or Area

Co-applicant Care Group

Co-applicant KCH Site primarily based

Please provide the name of the site

Co-applicant organisation

Please provide the name of the organisation

Co-applicant Work Phone

Co-applicant Work Email

Page 4

Grant Details

Type of Grant

Designated Fund Name (if known)

Designated Fund Number (if known)

Grant Title

Please provide a description of your project, post appointment or equipment purchase
What are you aiming to achieve with this grant?
For projects, what is your project delivering and what are the components of the project?
For the appointment of a specialist post, what will the post holder be doing, when and how?
For equipment purchases, what equipment are you ordering and what will it be used for? What is the reasoning behind the purchase? How will the equipment be procured and installed in the Trust and who will manage this?

Please enter the duration of your project in months

Page 5

Post Appointment Only

Title of Post Holder (if known)

First Name of Post Holder (if known)

Surname of Post Holder (if known)

Job Title and Band of Post

Email of Post Holder (if known)

Name of Line Manager for the Post

Employing Department

Employing Organisation

Please provide the name of the organisation the post holder will be employed with

Number of FTE

Length of Contract

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Equipment Only

Will any training be required for utilising and maintaining the equipment? How many people will be trained? Is ongoing support available? Is this cost included in the purchase price?

Are there any installation costs? If so, will these be covered as part of the service contract with your supplier, or will a third party be hired to install the equipment? Alternatively will the Trust or your department cover the cost?

Is there a warranty on the equipment? If so, when does the warranty end and what does it cover? If the equipment needs repair, who will be responsible for the costs?

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Plan of Action

What are the key milestones/timescales?
For projects, please tell us your overall project plans and detail the plans for the different components.
For posts, please include a timetable of recruitment and appointment.
For equipment, please include a plan for procurement.
For capital projects, please include a project plan and timetable, including any planning requirements.
For all situations identify any stakeholders or individuals who are key to implementation of the plan.
Please attach a business case and/or other documentation in support of your answer.

Upload Documentation

Page 8

Justification

Please outline the objectives for this grant.
What need is being addressed?
What result are you seeking?
How will you deliver this result?
Please detail the activities you will be undertaking to deliver the results you are seeking.

How will the grant make a difference to patients, families, staff or service users of King's?
What are the expected improvements in the outcomes or experiences for those directly involved?
If the results be translated into improved efficiency, time saved, or costs reduced, please tell us how.

How many patients, families, staff or service users might benefit from this project each year?
Please provide a figure for each group who might benefit.

What longer-term impact will this grant have on patients, families, staff or service users in your ward, department or speciality? Please describe any wider potential impact on other wards, departments or specialities and what you will do to secure these wider benefits, e.g. sharing lessons learned. Will the impact be felt further afield than just King's? If so how?

Please explain how this meets the Charity's grant expenditure principles that an item should be over and above what is required for an NHS service

How will you ensure the project, post or equipment is sustainable beyond the period covered by this grant?
Consider future funding needs for revenue and any other items required to deliver the outcomes and ensure the benefits are maintained for the longer term, e.g. ongoing maintenance costs, securing Trust funding for further work. Tell us how this project may be sustainable in ways other than funding, eg embedding better practice.

Please give the names and roles of any other participants involved in developing and delivering your grant, including any supporting departments.

How will you monitor progress on the plan of action and ensure that the project delivers on its objectives? How will you measure whether the targeted improvements and wider impact have been achieved after the project? How will you learn and share lessons?

Who will be responsible for providing the Charity with updates on progress and reporting on the outcomes and impact of your project?

Is a business and/or investment case required for this project?
If the case has been approved, please attach here.

Upload Documentation

Will your project require Trust approval from the Estates, MEMs, KfM, IT or other teams at the FT?
Please speak to your Service Manager (otherwise General Manager) about procurement and getting consent and approval.

Which Trust departments have you approached to enquire about any necessary costs or approvals? What Trust approvals are required? Where are you in the process?

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Guidelines for Completion:
1. The budgeted expenditure should be specific to the project for which you are applying for funding.
2. All activities described in the application form must be fully costed for the period of the project.
3. Salary costs must be specific to the project and should not include the costs of permanent staff
4. Salary costs must include all on-costs eg NI and pension
5. All non-salary costs should include VAT
6. Where the project involves costs incurred by other departments eg Works, the costs must be based on an estimate provided by that department and that estimate submitted with this template

Budget

Expenditure Type

Expenditure Description

Supplier Name (if applicable)

Quantity

Item Amount

Total Per Claim

Total Quantity

Total Amount

Page 10

Are you the Fund Advisor for the Designated Fund you are applying to?

Applicant Declaration

I confirm that the expenditure detailed on this form conforms to the Charity’s expenditure principles, is for the purpose detailed in this application and is consistent with the purpose for which the fund was set up.
I have ensured compliance with KCH procurement procedures in terms of procurement waivers and/or obtaining competitive quotes, where applicable.
I have obtained all the required FT approvals and confirm that no other sources of funds are available to fund this expenditure.
I have attached the necessary documentary evidence e.g. approvals, quotations, invoices

I confirm the above statement

I have read and understood the Charity’s Data Privacy Statement regarding use of the above personal data and confirm I agree to this use of personal data.

I confirm the above statement

Date

Page 11

If this application is coming out of a designated fund, we require all applications to be supported by the fund advisor. The list of fund advisors can be found here. Please ensure you speak to the fund advisor to get support for your application prior to submission. The person named below will be emailed a copy of this form and asked to confirm their authorisation for it through an online process. Please ensure you provide accurate details and you may like to inform them about this process as the Charity will not be able to process your application without these authorisations.

Fund Advisor Approval

Fund Advisor Name

Email Work

I confim the above statement

I have read and understood the Charity’s Data Privacy Statement regarding use of the above personal data and confirm I agree to this use of personal data.

I confirm the above statement

Date

Approval Status

Page 12

We require all applications to be supported by the relevant management approvals. The person named below will be emailed a copy of this form and asked to confirm their authorisation for it through an online process. Please ensure you provide accurate details and you may like to inform them about this process as the Charity will not be able to process your application without these authorisations.

Trust Approval

Title Clinical Director, Head of Nursing, General Manager or equivalent Senior Trust Staff Member

First Name Clinical Director, Head of Nursing, General Manager or equivalent Senior Trust Staff Member

Surname Clinical Director, Head of Nursing, General Manager or equivalent Senior Trust Staff Member

Job Title Clinical Director, Head of Nursing, General Manager or equivalent Senior Trust Staff Member

Email Work

IMPORTANT: In the next screen you will be able to save a PDF copy of your application by clicking Print this page and from the Destination drop down select Save as PDF.

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