2024-03-31-accounts

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Report and Financial Statements Year ended 31 March 2024

Company No. 2904446

Registered Charity No. 1035089

Contents
	Page
About Keech Hospice Care	2 to 3
Trustees, officers and professional advisors	4 to 5
Annual Report of the Trustees	6 to 33
Directors’ Report	6
Objectives and activities	6
Public benefit	8
Structure, governance and management	8
Trustees	10
Responsibilities of the trustees	10
Going concern	11
Auditors	12
Strategic Report	13 to 32
Vision, mission, values and philosophy of care	13
Achievements and performance	14
Financial review	24
Risk management	26
Principal risks and uncertainties	26
Future activities	28
Independent Auditors’ Report	33 to 36
Consolidated Statement of Financial Activities	37
Consolidated and Charity Balance Sheets	38
Consolidated Statement of Cash Flows	39
Notes to the Financial Statements	40 to 61

“Making the difference when it matters the most.” Liz Searle , Chief Executive Officer

About Keech Hospice Care

Keech Hospice Care is the adult hospice for Bedfordshire, and the children’s hospice for Bedfordshire, Hertfordshire and Milton Keynes.

As a charity, we provide free specialist care for adults and children with life-limiting and complex terminal conditions as well as vital support for their family and friends. We are one of a small number of hospice charities in the UK which supports and cares for both adults and children.

Since the hospice first opened in 1991, initially providing support for adult patients and their families and later expanding to include support for child patients and their families, we have supported thousands of patients with life-limiting or terminal illness. There are no second chances to get it right so, at Keech Hospice Care, we make sure we do everything we can.

Patients and their families are given the support and care they need from the day they are diagnosed and, when the time does come, we support them to achieve a peaceful death. Our care is not just provided at the hospice itself but in hospitals, schools, care homes or family homes – wherever support is needed the most.

What is more, our care does not stop at death. As leaders in our field, our excellent standard of care extends to support a patient’s family, partners, friends, neighbours and colleagues for as long as they need us afterwards, when we offer emotional, spiritual and practical support. For these families, when it seems as though nothing will be the same again, Keech Hospice Care is there to help.

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Trustees, officers and professional advisors

Served in the year and up to 25 September 2024

Trustees

Simon Ogden (Chair) Patricia Norman (Vice Chair) Peter Cannon Miriam Heyes Jeffrey Lustig Michael McMahon Judith Greevy (appointed on 4 October 2023) Debra Smith (appointed on 4 October 2023) Iain Malcolm (Treasurer) (appointed on 17 November 2023) Clive Medlam (Chair) (resigned on 4 October 2023) Karen Proctor (Vice Chair) (resigned on 4 October 2023) Frank Dalton (Treasurer) (resigned on 17 November 2023) Chandra Shekar (resigned on 21 July 2023)

Audit and Risk Committee

Geoff Lambert (Chair and Independent Member) Judith Greevy Debra Smith Iain Malcolm Jeffrey Lustig Pam Garraway (Independent Member)

Trading companies

Pasque Charity (Trading) Limited Geoff Lambert (Chair) Keech Hospice Care (Trading) Limited Geoff Lambert (Chair)

Geoff Lambert (Chair)

Senior Leadership Team

Executive directors

Chief Executive Deputy Chief Executive & Clinical Director Executive Director of Finance and Corporate Services Executive Director of Engagement, Innovation and Digital

Liz Searle Elaine Tolliday Rob Davies Andrea Daniels

Associate Directors Associate Director of Supporter Engagement Nikki Samsa Associate Director of Commercial & Trading Angela Burgess Associate Director of Patient Services – Children Sonya O’Leary Associate Director of Patient Services – Adults Juliette Benson Associate Director of People Matt Ambler Associate Director Integrated Governance & Improvement Paula Welsh Associate Director Patient Services (Supportive Care & Social Work) Clare Burden

The directors are not directors within the meaning of the Companies Act.

Registered Office

Great Bramingham Lane Streatley Luton LU3 3NT

Auditor

Haysmacintyre LLP 10 Queen Street Place London EC4R 1AG

Bankers

NatWest Bank plc 31 George Street Market Hill Luton Bedfordshire LU1 2YN

Investment Managers

Cazenove Capital 1 London Wall Place London EC2Y 5AU

Solicitors

Pictons LLP Studio K/2 274 Witan Gate West Witan Studios Milton Keynes Buckinghamshire MK9 1EJ

Pinney Talfourd LLP 78 Ongar Rd Brentwood CM15 9BB

SA Law Gladstone Place 36-38 Upper Marlborough Road St Albans Hertfordshire AL1 3UU Veale Wasborough Vizards LLP Narrow Quay House Narrow Quay Bristol BS1 4QA

Annual Report of the trustees

The trustees present their report and the audited financial statements for the year ended 31 March 2024. The financial statements comply with current statutory requirements, the Memorandum and Articles of Association and the Statement of Recommended Practice – Accounting and Reporting by Charities: SORP applicable to charities preparing their accounts in accordance with FRS102 (second edition 2019).

Directors’ Report

The trustees present their report for the year ended 31 March 2024, which should be read in conjunction with the Strategic Report.

Objectives and activities

Objectives

The charity’s principal objective is to provide palliative, supportive and end-of-life care, and to support those with specific needs, within Bedfordshire for adults and their families and within Bedfordshire, Hertfordshire and Milton Keynes for children and their families.

The founders used a Trust Deed, settled on 3 June 1987, to set up the charity as the Luton and South Bedfordshire Hospice. The trustees changed the charity’s name to Pasque Charity in June 2002 and then to Keech Hospice Care on 23 September 2009. The Memorandum and Articles of Association, as amended in 2003 and 2010, state the objects of the charity are to promote the relief of sickness in such ways as the charity shall from time to time think fit and in particular:

By establishing, maintaining and conducting hospices, day centres, residential homes and home/community support services in the counties of Bedfordshire, Hertfordshire and Buckinghamshire (including Milton Keynes) and elsewhere as required for the reception and care of people who are suffering from cancer or any chronic or terminal illness or from any disability or disease whether attributable to old age or otherwise or from any other physical infirmity, disability or disease and by providing medical or other treatment and attention for such persons in their own home;
By conducting or promoting or encouraging research into the care and treatment of persons suffering from any such illness, disability or infirmity as aforesaid and particularly into the care and treatment of persons suffering from cancer or terminal illness and to disseminate the results to the public;
By promoting or encouraging or assisting in the teaching or training of doctors, nurses, physiotherapists and other persons engaged in any branch of medicine, surgery, nursing or allied services;
By providing or assisting or encouraging the provision of spiritual help and guidance for any persons resident (either as patients or otherwise) or working in any such hospices, day centres or homes;
By establishing and conducting clinics, out-patient departments, surgeries, dispensaries and convalescent homes;
By providing or arranging such medical or other attention as the charity may think fit for patients in any such hospice, day centre, home, clinic or out-patient department as aforesaid or for patients in their own homes; and

By providing such medical supplies, equipment and apparatus, drugs, amenities, comforts and other things conducive to the material or spiritual welfare of any persons resident in or attending any such hospice, day centre, home, clinic or outpatient department or any persons being treated or attended in their own homes as the charity may think fit.

Principal activities

The charity fulfils its purpose through its principal activity of providing adult and children’s palliative and supportive care as follows:

Adult in-patient palliative medical and nursing care for residents of Luton and south Bedfordshire in an eight-bed unit;
Adult out-patient palliative and supportive care for residents of Bedfordshire in the Luton site Wellbeing Centre and dedicated facilities in Bedford;
Support for adults in Luton within the last two years of life through the My Care Coordination Team, providing a 24-hour advice and support line for patients, families, carers and professionals; co-ordinating support from other care professionals and agencies and providing personal care, practical help and emotional support to both patients and families in their own homes;
Children’s in-patient and palliative and supportive day care for residents of Hertfordshire, Bedfordshire and Milton Keynes (or from any other area if the family wishes to use the children's service) in a five-bed unit and day care facility;
Children’s day support for residents of Hertfordshire, Bedfordshire and Milton Keynes; and
Support for children through the community nursing team which provides palliative care in the home, school, hospital and other community settings for residents of Hertfordshire, Bedfordshire and Milton Keynes.

We are the only children’s hospice commissioned by the Integrated Care Board in Hertfordshire and Bedfordshire.

Supportive care signifies services provided by social workers, therapists (talking, occupational, physiotherapy, spiritual, music, art and complementary) and bereavement care workers. This ensures the charity’s care takes a holistic approach that not only considers the patient’s condition, life and circumstances, but also supports and cares for the patient’s family and other significant people in their life. The charity provides its services free to patients, carers and families to ensure accessibility. Last year we launched our Compassionate Communities programme, aiming to improve conversations on death and dying and grief in our community.

The management and administration team provides the necessary governance, oversight and operational management as well as finance, human resources (HR), administrative support and communications and marketing. The housekeeping team and catering, maintenance and IT services provide essential support services for the principal activities.

The fundraising and retail teams - and, of course, the incredibly generous members of the public, corporations and trusts - generate the vital income needed by the charity to supplement the lower level of statutory funding (from the NHS, local authorities and the Department of Health). However, 2023/24 was again a challenging year, significantly affected by the recovery from the pandemic with reduced support for fundraising activity. However, whilst fundraising has been challenging, our retail operation has seen a strong and encouraging bounce back. We have still received wonderful support from our community but inevitably we were unable to generate the same levels of income across many of our usual income streams.

This past year we have seen a significant rise in our costs. Like many, energy and wage increases led this pressure. We continue to work closely with our commissioners to ensure they understand the significant rise in costs against a very small increase in their funding.

Public benefit

The trustees have considered the purpose, aims and objectives of the charity and its current and planned activities, against the Charity Commission’s general guidance on public benefit. The trustees are satisfied the charity’s purpose, aims, objectives and activities are fully consistent with charitable purposes as defined in the Charities Act 2011, including the advancement of health or the saving of lives and the relief of those in need, by reason of youth, age, ill health, disability, financial hardship or other disadvantages.

The charity produces quarterly corporate and performance dashboards and a quarterly quality report, reviewed by the senior leadership team and trustees, which provides a detailed focus on effectiveness, particularly on the number of patients using each service, patient demographics, incidents, complaints, patient experience surveys, results of internal audits, palliative outcome scores and a substantial number of other measures.

We regularly assess the performance and impact of the Charity and a quarterly quality report focusing on effectiveness, efficiency, patient numbers, incidents, complaints, user experience alongside various other measures is produced and reviewed by senior management and the Trustees.

Structure, governance and management

The consolidated financial statements that follow later in this report comprise the Consolidated Statement of Financial Activities, the Consolidated and Charity Balance Sheets, and the Consolidated Statement of Cash Flows and related notes, which include the results of the related company - Pasque Charity (Trading) Limited and the wholly owned trading subsidiary of Keech Hospice Care, Keech Hospice Care (Trading) Limited. The objective of these companies (Pasque Charity (Trading) Ltd is now effectively dormant) is for making best use of and maximising the returns from the resources of the charity.

Day-to-day management

The trustees delegate day-to-day management responsibility to the chief executive, who in turn delegates some leadership functions to the senior leadership team (SLT). The Schedule of Delegation is set out in the Governance Manual.

The Audit and Risk Committee, comprising trustees and two independent members (one of whom is the Chair), monitors all risks faced by the charity and meets every two to three months. It has a direct reporting line into the trustee board meetings and forms an important role in the overall assurance framework.

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Investment policy and objectives

The main purpose of the charity is to provide hospice care and, because of the uncertainty of fundraising income streams, it is necessary to ensure that funds are always readily available for use to ensure that levels of care are not adversely affected in the event of any short-term income reduction.

However, the trustees recognise that the Charity does hold reserves in line with its reserves policy target and has set aside funds for certain designated purposes. It is therefore important to ensure that the charity’s funds are utilised to achieve the best return, within an acceptable level of risk, to generate income to mitigate the effects of rising inflation. Cazenove Capital have been appointed as our investment advisors and that provides the opportunity to seek higher investment returns. As at the 1 June 2023, we had fully invested £5m and at the year end our total investment portfolio was valued at £5,362,000.

The Charity has adopted an ethical investment policy to ensure that its investments do not conflict with its aims. The Charity is also committed to being an environmentally sustainable organisation and understanding the impact of our investments on people and our planet was an important factor in selecting our investment strategy. The image below is taken from the annual report for the year ended 31 December 2023 for the investment fund we have chosen and gives an overview of the sustainability performance of the fund.

Trustees

In accordance with s418 of the Companies Act 2006, as the charity’s directors, the trustees certify that:

so far as they are aware, there is no relevant audit information of which the charitable company’s auditors are unaware; and
as the directors of the charity, they have taken all the steps that they ought to have taken in order to make themselves aware of any relevant audit information and to establish that the charity’s auditors are aware of that information.

This confirmation is given and should be interpreted in accordance with s418 of the Companies Act 2006.

There is no specified number of trustees but our aim is to maintain a diverse range of skills and experience to provide the broadest possible level of support to the chief executive and senior leadership team. When vacancies arise or are anticipated, we consider the skills mix and diversity of the continuing trustees and determine the person specifications to be sought in trustee recruitment. A skills audit has been completed and this feeds into an open, competitive recruitment process. At the time of writing this report, the Board of Trustees is seeking to further enhance the Board with more clinical experience.

Every trustee must sign a Trustee Commitment and Disclosure Form to act as a trustee of the charity before he or she is eligible to become a trustee, and again annually. On appointment or election as a trustee, a trustee becomes a member of Keech Hospice Care. Trustees hold membership of Keech Hospice Care only during their trusteeship and retirement, resignation or removal as a trustee is deemed to end their membership of the charity.

It is the charity’s policy and practice to provide trustees with appropriate training to undertake their role and to ensure that new trustees receive appropriate induction to the charity and to the role of a charity trustee and company director. In particular, new trustees attend a corporate induction day and we are looking at a potential scheme to provide them with a mentor trustee who would give them specific support over the first 12 months of their trusteeship. Trustees are also required to complete ongoing mandatory training and we also provide additional training, with topics in 2023/24 including Measuring Success and KPIs and Patient Safety Incident Response Framework.

Trustees are elected for a three-year term and it is intended that they should ordinarily serve for up to two three-year terms, with the possibility of further yearly terms, approved annually.

Responsibilities of the trustees

The trustees (who are also directors of Keech Hospice Care for the purposes of company law) are responsible for preparing the Trustees’ Report, including the Strategic Report, and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).

Company law requires the trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charitable company and the group and of the incoming resources and application of resources, including the income and expenditure, of the charitable company and group for that period. In preparing these financial statements, the trustees are required to:

select suitable accounting policies and then apply them consistently;
observe the methods and principles in the Charities SORP;
make judgements and estimates that are reasonable and prudent;

state whether applicable UK Accounting Standards have been followed, subject to any material departures disclosed and explained in the financial statements; and
prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charitable company will continue in operation.

The trustees are responsible for keeping adequate accounting records that disclose with reasonable accuracy at any time the financial position of the charitable company and enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charitable company and the group and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

The trustees are responsible for the maintenance and integrity of the corporate and financial information included on the charitable company's website. Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.

Going concern

The financial year 2023/24 has seen high rates of inflation which has affected the charity’s cost base, particularly wage and energy costs. High inflation, together with rising interest rates is also impacting our staff, volunteers, supporters and beneficiaries with increasing cost of living pressures. significant cost increases driving by high rates of inflation and cost of living pressures driving up salaries.

We have also completed the merger with North Bedfordshire Hospice Care Ltd (trading as Bedford Daycare Hospice). Whilst there were costs associated with the merger transaction and integration into Keech Hospice Care the assets transferred have strengthened the financial sustainability of the charity.

We continue to closely monitor the financial position of the charity with detailed cash-flow and out-turn projections forming an important part of our financial governance.

We have also continued to receive fantastic support from our local community, trusts and supporters. Legacy income in 2023/24 was just over £1.1m and whilst we are continuing to invest in legacy awareness, the quantum and timing of such bequests is still unpredictable, and we may see legacy income reduce to lower levels in future years.

We are obviously delighted to receive such generous gifts in wills, and it has given the charity additional financial resilience and sustainability and provided us with an opportunity to invest in the charity, develop income streams and develop news services. We know the demand for our services will only increase and it is our commitment to do our utmost to meet this need, develop our services and reach all parts of our community.

In addition to annual budgeting and monitoring, a rolling three-year financial forward plan is maintained and reviewed annually by the trustees to provide further assurance that the charity will continue as a going concern. Furthermore, the culture of the organisation is such that the trustees have confidence that, if any budgetary problem were to arise, it would be flagged up promptly so that measures to address it could be identified and evaluated swiftly. A monthly financial dashboard is circulated to Trustees detailing reserves, cash-flow, outturn, income and expenditure which provides up-to-date information on the financial status of the organisation and a series of contingency plans are also regularly reviewed and updated should significant savings be required at short notice.

There are no material uncertainties regarding the charity’s ability to continue in operation. The trustees have reviewed financial forecasts and are confident that the charity will continue as a going concern for the foreseeable future. The trustees also recognise that an adequate level of reserves supports and maintains the charity as a going concern by allowing the chief executive and senior leadership team a period to implement change or contingency plans to address any budgetary problems.

Auditors

Haysmacintyre LLP was appointed as the charitable company’s auditor during the year and has expressed its willingness to continue as auditors for the next financial year.

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Strategic Report

The trustees present their strategic report for the year ended 31 March 2024, which should be read in conjunction with the Directors’ Report, which contains further strategic information.

The charity’s vision, mission, values and philosophy of care

The trustees, staff and volunteers of the charity conducted a strategic review during 2022. The review included revisiting and reaffirming the charity’s vision, mission, values and philosophy of care. In 2022/23 the charity rewrote its strategy “Palliative Care in a post pandemic world”.

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Vision

Making the difference when it matters the most.

Mission

To lead the way in providing excellent care, supporting children and adults with life-limiting conditions and those affected by death and dying, helping them to live well and make every day count.

Values

Our values have remained unchanged and are central to all we do.

Philosophy of care

Keech Hospice Care’s philosophy of care is that of enablement; accepting without judgement the patient, carer and family’s circumstances and nurturing them at appropriate stages in the patient’s journey. The staff place high importance on close and effective liaison with others and welcome partnership working.

Strategic ambitions

As a result of the development of the new strategy the following ambition statements described what will be different as a result of delivering this strategy.

A sustainable building and processes fit for the future
A more equal and inclusive organisation
A Teaching Hospice and Centre of Excellence
Digital and innovation first
New and improved income streams
New and effective internal and external partnerships

Achievements and performance

We would like to start by thanking all our staff and volunteers for their outstanding work throughout the year. It has been a year to be very proud of.

We completed and submitted our Quality Account which outlines our achievements for last - year and our quality ambitions for the year ahead www.keech.org.uk/wp content/uploads/2024/07/Quality-Account-2023-24.pdf

The quality of our services is very important to us, and we know you want to be assured of our attention to the quality of our delivery and our efforts to continuously improve wherever we can.

In the last year we’ve seen improvements and traction against our new strategy across all areas of the organisation. This can particularly be seen in the areas of Digital Development and Sustainability.

We’re extremely proud of all our recent feedback, once again we achieved an ‘Outstanding Organisation to Work For’ in the Best Companies List 2024, as voted by our staff. We were also delighted and humbled by the positive feedback that we received from patients and their families across all our services, with 100% of friends and family extremely likely to recommend our care.

We were inspected by the Care Quality Commission, and were rated Good overall and Outstanding for Responsiveness

June 2023 saw the merger of Bedford Daycare Hospice into Keech Hospice Care. The bringing together of these two historic and much-loved charities will ensure that services provided by Bedford Daycare Hospice, for the people of Bedford and surrounding villages, are preserved and indeed grow. The clinical strategy is well underway and a promising increase in referrals confirms the ambition.

Our challenges for the year ahead, like other healthcare providers, is the recruitment of nurses. A full cross organisational steering group is in place including Trustees to ensure that we leave no stone unturned in our wish to maintain full staffing levels.

We work closely with our system partners, and we are delighted to have an Macmillan Transformation Lead in place to review and improve Palliative and End of Life Care priorities.

Funding also remains a challenge, with NHS funding not keeping pace with cost increases and in some cases reduced, and voluntary income also remaining challenging in these difficult economic times, the pressure remains to be effective and efficient with our resources.

We look forward to the year ahead delivering our services to our whole community.

The charity remains committed to working collaboratively with its partners in providing palliative, supportive and end-of-life care for adults and children. This ensures the charity’s services complement and improve other provision, and allows an integrated response to the opportunities and challenges presented by the government’s national Strategy for End of Life and Palliative Care as well as its more recent conversations on palliative care. We also work closely with, and align ourselves to, the national charities Hospice UK and Together for Short Lives.

The NHS architecture significantly changed again. We continue to make great inroads to working in this new structure with extensive representation at many of the meetings. We will work hard on continuing this collaboration.

(i) We will transform the environment, systems and conversations about living well, death and dying; pioneering new models of care

We continued to provide excellent care through our in-patient, community, day therapy and out-reach services. Total beneficiaries for 2023/24 were 2,143 people, incorporating patients (those with a diagnosis of a life limiting condition), their relatives and carers.

Adult services

A total of 1,426 adult patients were cared for in 2023/24, a total that incorporates those who access the in-patient unit, out-patient facilities, therapies and social work team, My Care Coordination Team and the hydrotherapy pool. Many patients use multiple services which ensures a patient-centred, bespoke plan of care is in place for them.

The My Care Co-ordination Team supported 1,171 patients in the year. The team operates a 24/7 support line and offers 8am to 5pm (seven days a week) co-ordination of packages of care for people living in Luton with a progressive, life-limiting illness. The team work with acute community, social care professionals and other voluntary organisations to support the patient to remain in their preferred place of care, wherever this should be.

The Wellbeing Centre (WBC) is the out-patient facility for adult patients which offers programmes of care that support patients to achieve their goals and maximise function and independence. There is also a rehabilitation team who work within the WBC who offer 1-1 sessions and group care.

The adult in-patient unit cared for 90 patients from Luton and south Bedfordshire, providing them with 1,329 bed nights.

Children’s services

A total of 386 children were cared for in 2023/24, a total that incorporates those who access the in-patient unit, community services, play services, therapies, social work team and the hydrotherapy pool. Many patients use multiple services which ensures a patient-centred, bespoke plan of care is in place for them.

The children’s community team provided those 384 children and their families with 3,315 community visits and 1,121 telephone calls.

The children’s play and activity service supported 164 children with programmes of care that included specialist and sensory play, symptom assessment and management, interaction and stimulation.

Throughout 2023/24, the children’s in-patient unit supported 67 children and their families by providing 272 bed nights. Admissions were for short breaks, symptom control, end-of-life care, perinatal care, crisis care, hospital transition and use of the bereavement suite.

Twenty seven children received their end-of-life care, being cared for in the place of their and their families choice.

Supportive care services

Our Social Work team consists of two specialist palliative care social workers and three assistants. As a team they cared for 217 adult patients and their families and 68 child patients and their families.

The Charity delivered its adult services contracts in Luton and South Bedfordshire and its children’s services contracts in Luton, Bedfordshire, Hertfordshire and Milton Keynes, to the satisfaction of all of our commissioners, who have renewed their contracts for 2022/23 and continue to work in collaboration with the charity.

Keech Hospice Care has continued to host a service run by the national charity Sense, which provides skills and independence training for teenagers and young adults with multi-sensory impairment. The Sense at Keech service has proved successful with both organisations sharing much learning and expertise.

Compassionate communities programme

Through a series of workshops delivered to the public, we aim to normalise conversations about death, dying and grief. It is hoped, that by supporting members of the public to talk with their loved ones about their preferences and wishes, more people can be cared for in the place of their choosing.

In addition, we work closely with the library service to develop a death positive library opportunity, with borough councils, large employers within the town, and sports and leisure facilities to promote awareness and conversations.

(ii) We will deliver leading education, innovation and research improving knowledge and skills everywhere, moving towards our aspiration of being a university teaching hospice

The education team are committed to delivering excellent education, training, and development for staff and volunteers and reaching out across Bedfordshire, Luton and Milton Keynes (BLMK) to health and social care professionals, our service-users and within our community. Our strategic objective is to deliver leading education, innovation and research improving knowledge and skills everywhere, moving towards our aspiration of being a university teaching hospice.

Our new look education offer, Keech Hospice Care Learning, launched over Adult Learners Week in November. This included the new logo, merchandise, website, and prospectus for 2024/25 www.keech.org.uk/learning/

The team has continued to expand with the introduction of two Practice Educators and three Clinial Coaches, allowing the team to expand the offer to staff and volunteers. The new staff bring a wealth of knowledge and skills including palliative, acute and community experience within children’s and adult services.

During 2023/24 we delivered 154 training sessions across Bedfordshire Luton and Milton Keynes, reaching 3,441 attendees including a scheduled of published learning opportunities and bespoke training sessions to pre and post register health and social care professionals, students, and the public.

We offer a full prospectus of training for foundation, intermediate and advanced tiers including the Essential and Principles of End-of-Life Care rolling programmes to registered and unregistered delegates introducing the core knowledge to support palliative patients. Other sessions include Communication, Oncology Series, Verification of Expected Death and roll out an Advance Care Plan training. These positively impact across the sector reaching into a range of settings including Trusts, Hospices and Care Homes.

Our training offers also include the Compassionate Communities workshops, encompassing Compassionate Friends and Digital Memories, and expanding our inclusive health series.

The Lecturer Practitioners, now recognised as Academic Fellows, lead bi-monthly evening masterclasses led by internationally recognised palliative specialists and researchers presenting the outcomes of our KEEPNET research, End of life care needs of the LGBTQIA+ community, Using the Ambitions Framework in Palliative and End of Life Care and Total Complexity, Total Uncertainty. In addition, we have introduced daytime masterclasses by those with lived experience. These groundbreaking sessions launched with the experiences of a Jenny Starkey, a MND patient, attracting over 90 attendees.

Our study days focussed on the various topics in palliative care of a patient and the latest research. It provides to opportunity to invite specialist speakers across the day. Topics included All Age Palliative Care, Pain, Challenging Conversations and Children’s sessions.

We continue to expand our academic connections working with our local colleges, Central Bedfordshire, Barnfield and Bedford College as well as a broad range of universities including Bedfordshire, Hertfordshire, and Cambridge. We are able to offer a range of placements, research opportunities and teaching.

Our work with universities has expanded across the faculties teaching to nursing, paramedic, public health, AHP and social work students. Over the last year we have delivered 30 sessions to 1490 students within Bedfordshire and Hertfordshire.

During 2023/24 we provided 72 internal training sessions reaching 783 staff across all our teams. In addition, a range of eLearning opportunities has attracted 2571 enrolments with mandatory training remaining mostly above benchmark. Staff also have access to wider opportunities such as conferences, role specific courses and webinars.

We have introduced new mandatory training the Patient Safety (PSIRF) and Oliver McGowen Autism and Learning Disability Training across our workforce. Other new workshops include disability awareness, debrief and Clinical Supervision Training.

Apprenticeship opportunities continue to be available across our teams including two Adult Nurses, one Strategic Leaders and three members of the fundraising team continuing the Diploma in Fundraising. Three Business Administration apprentices completed their programmes and secured opportunities within Keech Hospice Care.

Alongside our physical library a new Knowledge Hub is available on SharePoint with 27 topic areas offering a wealth of resources including research papers, videos, and podcasts.

We continue to expand our research activity working with universities and NIHR. Partnership work has included working with Dr Ben Bowers (University of Cambridge) regarding Views and experiences of Asian patients and their families of end-of-life anticipatory prescribing, University of Bedfordshire on the role of Community Connectors and University of East Anglia on Death Literacy - Mobilising knowledge of Death Literacy across non-clinical community networks. We have also joined to BMLK and East of England Research Networks to learn from others and expand our reach.

As part of our commitment to the wellbeing of our staff and volunteers our Mental Health Champions have delivered monthly Wellbeing Wednesday session using music, crafts, and games to aid mental wellbeing. Mindfulness session and access to wider support through our Employee Assistance Programme are also available.

Over the last year our Staff Engagement Committee gathered staff feedback, shaping our All Staff Away Day, catering, bereavement policies, internal communications, and wellbeing. The committee shared a ‘You said. we did’ poster demonstrating to difference the staff voice has made including additional wellbeing resources, catering changes, and the introduction of Keech and education newsletters.

Our Equity, Diversity and Inclusion (EDI) Group has developed a programme of activities throughout the year including events for Ramadan, Eid, Pride, Neurodiversity and Diwali which has been recognise as best practice and published by Hospice UK on their website and newsletters.

Our Compassionate Communities work continues to expand including a creative approach to encourage conversations regarding death, dying, bereavement and loss. Our Community Connector has trained and rolling out ‘No Barriers Here’ sessions using art and craft workshop to explore planning ahead and what matters to you. Our first play, ‘Blue Skies,’ in November attracted stakeholders and community members in the audience opening up meaningful and impactful conversations and insights.

Our Compassionate Communities team continues to expand our range of partners including Bedfordshire Police, Nevilles Funeral Directors, Blossoms, Alzheimer’s Society, and our local libraries. Engaging 1,645 people over the last year across a range of events, fairs, and meetings, as we work with Luton Council to become a Compassionate Town.

We have delivered tours and presentations to the community including the Council of Faiths. This has led to activities such as Friday Prayers and wellbeing walks. Wider tours and presentations to the public, students, funders, and supporters are available monthly.

Over the last year we have developed our Compassionate Neighbours offer due to launch in 2024/25. This is part of a social movement, matching trained volunteer Compassionate Neighbours with Community Members across Luton.

Hospice Week highlighted the work of our Community Connector and published on the Hospice UK Innovation Hub including additional articles on our Compassionate Communities activities and education offer.

Stakeholders have invited keech Hospice Care to present at including Public Health Conference, World Social Workday and Luton Marmot Town – 1 year on.

(iii) We will drive efficiency and effectiveness to ensure long term financial and environmental sustainability; becoming the charity of choice for our communities

We are a local charity with both local and national impact, a leading hospice and one of a small number in the UK caring for adults, children and their families. The Financial Report that follows shows how we have secured funding for the charity and used it to further the achievement of our objectives.

The impact of the cost-of-living crisis has created some challenges throughout 2023/24 and we have seen reduced income from fundraising this year. Whilst we understand the reasons, we continue to work diligently to maximise all our revenue streams and are extremely grateful to the support received from our local community and trusts as well as a number of generous gifts made in wills (legacies), total income in 2023/24 was £15,401k (2022/23: £13,395k).

We were delighted to see our retail income for 2023/24 increase significantly from the prior year, part of this growth was from the merger as we inherited 5 additional shops. Retail income increased to £5,969k from £5,250k in 2022/23. The income for 2022/23 also included a business interruption claim in the amount of £239k.

Operating retail profit remained consistent from 2022/23 to 2023/24 as there were increased costs associated with integration of the 5 inherited shops into the wider retail estate together with other cost pressures as previously highlighted.

Despite all the challenges with regards to the unstable rag market and increased estate overheads that have affected our retail we are pleased with our overall retail performance. We are thankful to our customers who continued to donate and shop with us, and we hope that we have continued to be an integral part of our local community.

Income from charitable activities, including statutory income, increased to £4,441k (2022/23: £3,328k). £983k (2022/23 £355k) of this increase relates to restricted fundraising donations that could only be spent specifically on our four charitable activities. We also received additional support from our local Integrated Care Boards for one-off funding that will not continue into 2024/25.

Total fundraised income from donations and legacies remained constant compared with the previous year £3,459k (2022/23: £3,466k). This includes £792k of assets gifted to the charity by North Bedfordshire Hospice Care Ltd following the merger. As detailed above we have received a great amount of restricted fundraising donations and these are allocated to our charitable activities income.

Of total fundraised income £1,102k was received from legacies. This area of income can change significantly from year to year (£1,146k in 2022/23, £4,258k in 2021/22, £1,325k in 2020/21 and £498k in 2019/20). Gifts in Wills continue to provide a vital area of funding.

Fundraising activity in 2023/24 continued to benefit from opportunities to grow our lottery which now stands at over 12,000 players weekly and planned capital projects supported by substantial donations from Trusts and Foundations, often supported by individuals as well as a number of generous gifts left to us in a will.

We are extremely grateful for all the support we received in the year from trusts and foundations, individual supporters of our charity, community groups, organisations, corporate partners, schools and colleges, families, friends and all those who helped where they could raising funds and awareness. You truly helped us continue, with both your financial support and your words of support, which have meant so much to us.

On behalf of all the adults, children and their families we continue to support, a massive thank you to all our funders and donors.

Sustainability

We aim to become a more environmentally sustainable organisation by ensuring our buildings operate efficiently and we continue to make use of technology to support remote working and reduced travelling, cost improvement and streamlined work practices to ensure we maximise the spend on our patient services. We have a new sustainability policy to ensure we comply with environmental legislation and deliver and actively promote good sustainable development pract]ices across all hospice activities.

(iv) We will be impactful with our digital, data and communication approaches, driving change

To ensure the long-term financial viability of the Charity we are focused on continuing to develop our key income streams and deepening engagement with supporters and stakeholder to increase the value and amplification of our work and the impact we make.

This year saw the commencement of a project to refresh our brand and communications to reflect the breadth and nature of our services to better engage our audiences. This includes the effective amalgamation of Bedford Daycare Hospice into Keech Hospice Care, following the merger of the two Hospices in 2023. This work will be ongoing throughout 2024.

2023/24 saw the first year of our three-year digital innovation roadmap, engaging external expertise to work with us to effectively audit our digital services and support the charity to ensure we have the foundations in place to support our significant innovation and optimisation plans. This will include systems, capabilities and capacity building over the coming three years.

At the beginning of 2024 we welcomed a new Data Manager to the team. She has been tasked to review our processes for data gathering to help improve efficiency. In 2024/25 we plan to introduce strategic reporting within SystmOne, this will greatly reduce the amount of time it takes to produce care reports as well as providing us with some ‘real time’ data. We are also introducing the Power BI to improve data insights across the organisation.

In September 2024 we will be presenting a new KPI dashboard to the Board, containing key objectives agreed by them and touching on each of the strategic aims.

(v) We will attract, retain and engage the best talent and provide opportunity to develop from the outset, valuing difference.

The trustees wish to record their thanks to all the staff and volunteers of the charity who are essential to the provision of high-quality care for our patients. Our people are our greatest asset, working together to deliver a service that is appreciated by our patients and their families or generating much-needed income.

The charity started the financial year employing an average of 266 members of staff (221 fulltime equivalent) and ended the year employing 315 people (253 full time equivalent). An average of 56% of our staff work less than full time.

The growth in staff numbers was largely due to the merger with Bedford Daycare Hospice, with 23 staff transferring to Keech on the 1 June. This followed a programme of consultation and communication with staff and volunteers at both Keech and Bedford Daycare Hospice, and the transfer went smoothly with all staff transferring and with very good retention in the year following the transfer.

We also are thankful for the support, commitment and dedication of approximately 1,400 volunteers working in different roles across care, retail, fundraising and support functions.

We have also seen growth in our volunteers numbers from 1,200 at the beginning of the year as we progress along our Volunteering Strategy which was put in place last year. One of the cornerstones of the volunteering strategy is to promote Equity, Diversity and Inclusion within our volunteering workforce and we have partnered with several organisations to increase the diversity of our volunteers including the University of Bedfordshire and Sense. We have seen considerable increases in volunteers from ethnically diverse backgrounds as well as increases from younger volunteers and volunteers with disabilities.

We ran a programme of events across our geographical area to thank for volunteers for their contribution to Keech and to keep them informed of developments and gain feedback to improve our volunteer offer.

Wellbeing of our staff and volunteers continues to be of the highest priority. Our Mental Health Champions programme continues to grow and we have recruited and trained Mental Health Champions from across the organisation so people in all areas of the business have someone they can talk to if they are struggling, and we have regular meetings of the champions to ensure that they are supported and the program is working effectively. We are now looking at introducing more champions to extend their reach. We also regularly send information and tips with regards to wellbeing to our staff and have introduced Wellbeing Wednesday, where staff are invited to a wellbeing session.

Our Staff Engagement Committee is now embedded in the organisation to ensure that our staff have a voice regarding key issues across the organisation. We have representation from across all areas of the hospice and focus each meeting on a key issue that is affecting staff. It is also used as a open forum for staff reps to bring any matters affecting staff directly to senior managers. At each meeting we cover a specific topic and over the last year we have looked at the merger with Bedford Daycare Hospice, internal communications, catering, bereavement policy and feedback and learning from our all staff away day.

Attracting and retaining the best people is our top priority which means offering a remuneration and reward package that is competitive and fair, but also sustainable. We continue to monitor our pay structures and movement within pay scales and ensured these are now benchmarked with the NHS and other relevant organisations. Our Equality Statement also reflects our intent to be more representative of the communities we serve which is a sentiment that is reflected in our values and underpins behaviours.

Recruitment continues to be a priority in all areas. We welcome applications for employment from all prospective employees regardless of disabilities and are committed to developing practices that not only meet the requirements of equalities legislation but which actively promote equality of opportunity and maximise the abilities, skills and experience of all employees. If an employee discloses that they have a disability, we will engage in a discussion with them to determine what they need to be successful in their role and seek to make reasonable adjustments to facilitate this. We continue to develop our new Applicant tracking System which not only stream lines the recruitment process for both applicants and recruiting managers, but also ensures applicants are anonymous throughout the shortlisting stage therefore removing any potential bias. We have brought in a new post of Recruitment Advisor to manage the recruitment process and to help source candidates.

Pay policy

All matters relating to pay are considered by the Remuneration Committee which makes recommendations to the Board of Trustees.

An extensive review of our pay structure and a full benchmarking exercise was conducted by an external pay consultant in 2021 and all staff are now on one pay scale (with the exception of Doctors who are paid in line with NHS speciality doctor scales). Progression for all staff on the pay scale is linked to a competency-based assessment. All grades may be eligible for an inflationary annual pay award, if this is affordable, and will be based upon continued benchmarking.

Senior management are also on the pay scale grade system. The Board of Trustees recognises that employment of first-class senior managers is vital if the hospice is to maximise the quality, efficiency and income of the charity and allow us to deliver our purpose. Senior management pay progression is reviewed by the Remuneration Committee. The pay ratio for the charity is less than 1 to 6, which means the highest paid employee is paid less than six times the lowest paid employee.

(vi) We will be expertly led, effectively governed, and a values driven learning organisation

Operating a charity in the current economic climate and with all the changes happening in the health and social care sector presents many challenges and requires strong welldeveloped leadership and governance. We continue to develop the Trustee Board and hospice management to ensure the charity operates at the highest level of effectiveness and efficiency. The Board has conducted an annual skills audit and a Board effectiveness audit. We have recruited some new trustees but we also now focusing on how we diversify the Board with Trustees who reflect our community and youth Trustees.

The restructure of our leadership team, creating some new Associate Director Roles, and a refreshed Strategy and Governance Committee has worked very well.

We continue to monitor ourselves against the Charity Governance Code (www.charitygovernancecode.org/en/front-page):

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In 2021 the Board conducted a review of governance against the new Charity Governance Code, this was followed by a facilitated review in July 2022 undertaken by an external expert. The results of this exercise were very positive and enabled a refreshed action plan to be compiled to ensure our continued improvement. Now, in 2024, our compliance with the Charity Governance Code is one of the KPI’s on our new Board Dashboard. To establish our compliance with the code we are completing a self-assessment against each of the standards.

Assessing performance

The charity produces quarterly corporate and performance dashboards which have been significantly updated last year and a quarterly quality report, reviewed by the senior leadership team and trustees, which provides a detailed focus on effectiveness, particularly on the number of patients using each service, patient demographics, incidents, complaints, patient experience surveys, results of internal audits, palliative outcome scores and a substantial number of other measures. Monthly meetings of our Operational Performance and Assurance Committee (comprising the senior leadership team and senior managers) are also held to manage and share the responsibility for the effectiveness and efficiency of the charity. We have started work to refresh our KPIs based on our new strategy.

The CEO’s performance targets are agreed annually by the Board, monitored regularly by the Chair, and performance reported bi-annually to the Board. The Chair and CEO meet monthly to discuss relevant issues.

Financial review

The detailed figures for the year ended 31 March 2024 are set out in the financial statements that follow this Trustees’ Report.

Expenditure

Excluding retail spend, expenditure was £9,271,000 (2023: £7,804,000) of which £8,263,000 (89%) was spent on our charitable activities (2023: £7,078,000 / 90%). The proportion of expenditure on hospice care services has remained constant between years which represents our focus on increasing the breadth and scope of our care services.

Overall expenditure was 4% more than budgeted for the year but this was driven by the additional costs of merging Bedford Daycare Hospice operations into the charity. Careful control and monitoring of costs throughout the year has ensured that excluding these operating costs we operated in line with budget.

The cost of activities for raising funds has increased by 38% which is due to costs incurred for the Wild in Art fundraising trail taking place in 2024/25. Our trading expenditure increased by 22% which was a combination of increasing costs caused by inflation including staffing costs, together with the expansion of our retail estate to include the five new shops inherited from the merger.

Income

The charity’s principal funding sources are: voluntary income (fundraising activities); retail income (sale of donated goods through shops and warehouse); income from the charity’s lottery; statutory income (service level contracts and grants from NHS, local authority and government programmes) and profit from trading subsidiaries which undertake activities including the sale of bought-in goods and fundraising under tripartite agreements.

Group consolidated income for the year totalled £15,402,000 (2023: £13,394,000), an increase of 15%. However, this includes £792,000 of assets donated by North Bedfordshire Hospice Care Ltd in June 2023, so the group consolidated income for the year, excluding these assets totals £14,610,000 (9% increase).

Donations and legacies totalled £3,460,000 (2023: £3,466,000) including legacy income of £1,102,000 (2023: £1,747,000). Retail income increased by 13% totalling £5,969,000 (2023: £5,250,000) with £430,000 of this increase relating to income from the five new retail shops. Income from charitable activities increased by 33% due to one-off non-recurring funding from local Integrated Care Boards and a higher level of restricted fundraising income that we are required to include in charitable activities income rather than donations and legacies.

Funds and reserve transfers

The Consolidated Statement of Financial Activities on page 36 shows an increase in funds (surplus) of £1,066,000, of which £792,000 is assets donated to Keech as part of the merger and supports the ongoing operation of the dedicated facilities in Bedford and £296,000 relates to an unrealised investment gain.

Unrestricted and undesignated funds have increased by £966,000 to £7,247,000 which is within in the target set in the Reserves Policy (see below).

We have transferred £278,000 to our general fund from our designated funds which are funds set aside by the Trustees for specific reasons, projects or initiatives as detailed in Note 26.

Balance Sheet

Total net assets at 31 March 2024 are £21,143,000 which includes group cash balances of £6,532,000. The carrying value of our fixed assets has increased by £441,000 which represents the capital investments made to our hydrotherapy pool changing rooms and IT infrastructure as well as the assets donated by North Bedfordshire Hospice Care Ltd. Investment in capital equipment has remained in line with budget.

Further details of the funds analysis can be found in notes 21, 22, 26 and 27 of the consolidated financial statements.

Reserves Policy

The trustees have reviewed the reliability of future income streams, the commitment to future expenditure and risks faced as a charity. The charity has determined that it needs reserves for the following reasons:

To fund shortfalls in income (whether statutory, retail, lottery, donations, legacies or other fundraising activities) when it does not reach expected levels. The charity is dependent on fundraised income as well as statutory funding. The fundraised income is subject to fluctuation as economic conditions change and statutory funding could be affected by government policy and the financial position of NHS commissioners;
To fund unexpected expenditure, for example when projects overrun or unplanned events occur. This could also be for unexpected building maintenance costs and to provide a degree of flexibility for innovation; and
To fund working capital. Most spend is salaries and therefore the timing of cash outflows is relatively fixed whereas both fundraised and statutory income fluctuate in terms of cash inflow over the year.

The Reserves Policy agreed by trustees sets a target for unrestricted undesignated reserves of between six and nine months of budgeted total operating costs less the budgeted direct costs of fundraising and trading.

It is not the charity’s aim to simply allow reserves to continue to build up as funds have been provided and donations have been made to be spent on care services. However, it is very difficult, highlighted by the effects of the Covid-19 pandemic, to predict with certainty the Charity’s income. By setting a range of six to nine months we are building in a tolerance that allows the charity time to manage short-term fluctuations in income without the need to reduce costs and services. The charity can then review its longer-term financial strategy and adjust income and expenditure plans, as required, to ensure the requirements of the reserves policy continue to be met.

For the year 2024/25, the policy target range is between £4.844m and £7.267m. This Reserves Policy allows the charity to continue to provide care of the expected quality to meet the needs of patients as well as aiding the development of income streams and reducing costs.

These reserves would not usually be used for major capital developments, which instead would normally be funded through additional capital appeals. Freehold land and buildings are held in a designated reserve called the Building Assets Fund.

By designating funds, the trustees aim to give a clear presentation of the unrestricted reserves available to the charity to meet its continuing operational commitments.

At the end of March 2024 the unrestricted undesignated reserves (free reserves) increased to £7.247m, representing 9 months of 2024/25 budgeted operating costs less the budgeted direct costs of fundraising and trading. This is in line with our reserves target. A deficit budget has been set for 2024/25 and we expect our unrestricted undesignated reserves to be within the reserves target range at the end of 2024/25.

It is worth noting that many charities do not exclude the direct costs of fundraising and trading and if we were to include those then our unrestricted undesignated reserves would represent under 6 months of total expenditure.

The current level of reserves and the designation of funds also allows the charity to continue to explore and develop its sources of income while monitoring and controlling costs so that, in future years, the charity can set budgets that maintain reserves in line with policy and continue to meet the charity’s strategic aims.

The level of reserves will be monitored regularly by the Audit & Risk Committee and the Board, and the policy will be reviewed by the main Board when the annual budget is approved. This will ensure that appropriate steps are in place to manage our reserve levels.

Risk management

The trustees of the charity, who are also the directors of Keech Hospice Care, have governance responsibility for the charity and its work. They are advised by the chief executive and the other members of the senior leadership team who also manage the operation of the hospice services.

The trustees are pleased to report that the charity’s internal financial controls conform to the guidelines issued by the Charity Commission. These controls help the trustees meet their legal duties to safeguard the charity’s assets, administer the charity’s finances and assets in a way that identifies and manages risk, and ensure the quality of financial reporting by keeping adequate accounting records and preparing timely and relevant financial information.

The trustees are also aware of the requirement to report more fully on risk management in the annual report and are aware of the guidance for directors of public listed companies contained within the Turnbull Report. As a result, they have adopted a formal risk management policy using the principles of good governance and the policy requirements of the Health and Social Care Act 2008. The trustees have developed a corporate risk register, which identifies risks to the charity in the areas of people, reputation and resilience and finance.

The register describes how each risk is managed, and the processes, procedures and actions that are in place to mitigate the risk. Each risk is given a score reflecting the inherent and residual risk. Significant risks are reviewed at every meeting of the Audit & Risk Committee, chaired by an independent lay member, which reports back to each trustee meeting. We also maintain and review an emerging risk log which includes issues that are perceived to be potentially significant but may not be fully understood and assessed. This satisfies the trustees that adequate controls and procedures are in place to mitigate these risks. The Audit & Risk Committee also submits a formal annual report to the trustees.

Trustees conduct regular formal ’trustee visits’. Although these are no longer required by the Care Quality Commission, the Board has decided to continue them as they have proven beneficial for the organisation and individual trustees in their role. Internal financial audits are also carried out.

Principal risks and uncertainties

The over-riding risk facing the charity is one of reputational damage, which could result from any of the following risks and/or lead to one of these risks arising. Beyond reputational risk, the four main areas of risk are:

clinical risk in the form of a major adverse clinical event
financial risk arising from unplanned and/or unavoidable substantial expenditure or substantial reduction in fundraising and/or retail and/or statutory funding, or as a result of poor budgetary control or fraud
information technology risk due to the system not being fit for purpose and outdated, a breach of data protection law, a failure of back-up procedures or an external cyber-attack on our systems

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We manage risk through our integrated governance structure as set out below which details the reporting lines and accountability of our various committees and groups:

Fundraising practice

Keech Hospice Care is committed to maintaining high standards of fundraising and retail activity. We are registered with the Fundraising Regulator and licensed by the Gambling Commission. We are members of the Institute of Fundraising, the Charity Retail Association, Hospice UK and Together For Short Lives. We are committed to the Fundraising Codes of Practice and our contracted third-party professional fundraising agency for new lottery players is also required to adhere to the Codes of Practice. Fundraisers who know or have reasonable grounds for believing that an individual lacks capacity to make a decision to donate will decline to take a donation from that individual. Each decision is considered on its own basis, as capacity can change from time to time. If a donation is found retrospectively to have been given by a person who lacked capacity at the time it was given, that donation will be returned. We also follow the Charity Commission’s guidance, Charity fundraising: a guide to trustee duties (CC20).

We received three fundraising complaints and eight retail complaints, all of which were resolved to the satisfaction of the individual. We promote an open culture to encourage reporting of any concerns. We provide our staff with a comprehensive programme of training, guidance and support, and monitor activity carried out on our behalf through weekly reporting, spot-checks and meetings. Our staff training includes basic bereavement support and safeguarding, and our culture promotes the key principles and behaviours of the Code of Practice (Legal, Open, Honest and Respectful).

Future activities

The Trustees and senior leaders are ambitious for the future of Keech Hospice Care. We envisage a time when people can receive high quality palliative and end of life care in the place of their choosing with each care setting prioritising those individual’s unique needs. We commit ourselves to a future where our care is dynamic, innovative and responsive. We will research and innovate new care delivery models to meet the needs of people with life-limiting illness, their family and carers. We want a future where people can live independently, with a good quality of life for as long as possible. We will help people cope with the reality of dying, death and bereavement and do so with compassion confidence and expertise. We will educate and support the public to have significant conversations and form plans led by our Compassionate Communities Programme. We will further improve our understanding of our diverse community through the community connector programme.

We believe we should shape our hospice care with systematic knowledge, be outcome and impact focused and support developments with robust evidence of effectiveness.

Therefore, the first steps of this strategy will be to devise and evaluate an investment and change management process.

Our services must dovetail with the NHS, local authorities, care homes, schools and children’s respite facilities; and the communities we serve should shape services.

We must also lead in both delivery and the education on what “excellent palliative care” is.

Keech Hospice Care has decided to adapt and re-invent our contribution to care in a way that recognises the challenges ahead but never shirks from the ambition to find ways of extending care, using influence, and identifying new opportunities to respond to need.

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HospiceUK wrote their Future Vision Programme, below, outlining considerations for hospices in future strategy and direction. The report draws together the views of all stakeholders in exploring future sustainability within the sector. They asked them to suggest ways in which Hospices might collaborate, make better use of technology, revise the current funding model and transform ways of working. In distilling the many views on the potential opportunities to create a more sustainable future for palliative and end of life care, they recognised that every Hospice is different. Each organisation is a product of their own unique history, local geography and community demography. Each has something to teach and something to learn.

We have ensured that we have been cognisant of this work in devising this new strategy.

The demand for specialist palliative and end of life care will rise. There is a growing vulnerability of those who will need care, as well as the increasing complexity of their needs. The pandemic has seen huge delays in screening and treatment adding to the numbers who will now need palliative care. We live in a diverse community and one where disadvantage is evident. For our services, Luton is of particular note. Luton is one of the 20% most deprived districts/unitary authorities in England and 39% of children in Luton live in poverty.

Life expectancy for both men and women is lower than the England average. Life expectancy is 9.7 years lower for men and 4.1 years lower for women in the most deprived areas of Luton than in the least deprived areas.

However, diversity and issues of deprivation is also true for our whole catchment the new PoPNat data produced by HospiceUK allows us to see our geographical patch and challenges.

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https://popnat.hospiceuk.org/Lite/Dashboard/735

https://popnat.hospiceuk.org/

People feel excluded by their gender, race, and the environment they chose to live in. As we strive to do our best, we notice a background of increasing public expectations for hospice care and charities in general to remain trustworthy, diverse and an inclusive organisation, we will be the cornerstone on which to build. The local system sees us increasingly as an anchor organisation and we take this role seriously in driving change. However, we will also battle the perception of hospice care which remains a challenge as we diversify to meet the changing needs of those who call on our services.

As we pioneer and innovate, we face difficulties and challenges, achieving a balanced budget, using our reserves to build resilience, controlling our costs impacted by rising inflation at this time, as well as the need for us to work in a new and more collaborative commissioning environment. The establishment of the Integrated Care System across Bedfordshire Luton and Milton Keynes not only brings opportunity, as the NHS now must legally commission palliative and end of life care, but also challenges as they look for new funding models likely to flow though the Integrated Care Boards.

How do we find success?

There are key principles we must follow to be successful. These include:

A responsibility to assess future needs for palliative and end of life care on a population basis.
Work as good and integrated partners, campaigners and educators across local health and care systems to enable us to make a difference on a larger scale.
Engaged and influencing at ICS, regional and national level.
Strive to reach more people through our care, income generation, marketing and communications and influence on other local health and social care services.
To be active and outward looking in developing new partnerships and understandings what might enable us to succeed.

Collaborating with other Hospices and providers to deliver seamless services and avoid duplication. Partnering or merging were appropriate.
Be both business focused and compassionate, ‘Hospice heart and a business brain’.
Have a strong reputation and be trustworthy and use our funds carefully ensuring maximum impact and showing integrity to our donors.
Build a financial model which supports investment towards a sustainable future.
Be environmentally aware and make greener choices.
Embrace innovative technology and a digital future, using our data to achieve insightful decisions.
Deliver excellence in all we do, modelling a leading charity.
Value, listen and engage our staff, volunteers and users in all we do.
Be true to our values and guided by them always.

Given the challenges ahead we now need to invest in the future, to enable us to explore new care delivery models, new income streams and technology, investing our income wisely. We need to develop our workforce, so they can deliver the differing portfolio of services the future will demand. Building a bright and resilient future. We must continue our engagement with the national organisations that exist to support our work.

In summary we must:

Continue to deliver outstanding care.
Prepare for significant change in the context of palliative and end of life care, growing numbers of bereaved and the economic challenges and uncertainty ahead.
Strengthen understanding of the contribution of hospice care as a significant partner in health delivery.
Be trustworthy and protect our reputation.
Become a beacon of excellence and contribute to the national and international body of knowledge.
Grow our base income to enable us to do more for those who need us remaining sustainable.
Show hospice care as a sustainable solution to future challenges in palliative and end of life care.
Strengthen the connection between us and our local health and social care systems and our local communities, a hospice for all.
Continue to be well-led and well governed.

Patients and families are also clear on what they expect from us.

Charity Merger

On the 1 June 2023 North Bedfordshire Hospice Care Ltd (trading as Bedford Daycare Hospice) merged into Keech Hospice Care following a process of strategic and financial due diligence. A full integration plan was created to ensure the operations of Bedford Daycare Hospice were effectively and efficiently combined and the strategic purpose behind the merger was pursued.

The merger has improved our financial sustainability but has also allowed further expansion of our services to our communities.

The Trustees’ Annual Report, which incorporates the Strategic Report was approved by the trustees on 25 September 2024, and is signed as authorised on its behalf by:

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Simon Ogden Chair of Trustees and Director Keech Hospice Care

Independent Auditor’s Report to the members of Keech Hospice Care

Opinion

We have audited the financial statements of Keech Hospice Care for the year ended 31 March 2024 which comprise the Group Statement of Financial Activities, The Group and Parent Charitable Company Balance Sheet, the Group Statement of Cash Flows and notes to the financial statements, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

In our opinion, the financial statements:

give a true and fair view of the state of the group’s and of the parent charitable company’s affairs as at 31 March 2024 and of the group’s and parent charitable company’s net movement in funds, including the income and expenditure, for the year then ended;
have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and
have been prepared in accordance with the requirements of the Companies Act 2006.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the group in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Conclusions relating to going concern

In auditing the financial statements, we have concluded that the trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate.

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the group's ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue.

Our responsibilities and the responsibilities of the trustees with respect to going concern are described in the relevant sections of this report.

Other information

The trustees are responsible for the other information. The other information comprises the information included in the Trustees’ Annual Report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon.

In connection with our audit of the financial statements, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard.

Opinions on other matters prescribed by the Companies Act 2006

In our opinion, based on the work undertaken in the course of the audit:

the information given in the Trustees’ Annual Report (which includes the strategic report and the directors’ report prepared for the purposes of company law) for the financial year for which the financial statements are prepared is consistent with the financial statements; and
the strategic report and the directors’ report included within the Trustees’ Annual Report have been prepared in accordance with applicable legal requirements.

Matters on which we are required to report by exception

In the light of the knowledge and understanding of the group and the parent charitable company and its environment obtained in the course of the audit, we have not identified material misstatements in the Trustees’ Annual Report (which incorporates the strategic report and the directors’ report).

We have nothing to report in respect of the following matters in relation to which the Companies Act 2006 requires us to report to you if, in our opinion:

adequate accounting records have not been kept by the group and parent charitable company; or
the group and parent charitable company financial statements are not in agreement with the accounting records and returns; or
certain disclosures of trustees’ remuneration specified by law are not made; or
we have not received all the information and explanations we require for our audit

Responsibilities of trustees for the financial statements

As explained more fully in the trustees’ responsibilities statement set out on pages 9 and 10, the trustees (who are also the directors of the charitable company for the purposes of company law) are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

In preparing the financial statements, the trustees are responsible for assessing the group’s and the parent charitable company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the trustees either intend to liquidate the group or the parent charitable company or to cease operations, or have no realistic alternative but to do so.

Auditor’s responsibilities for the audit of the financial statements

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect material misstatements in respect of irregularities, including fraud. The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below:

Based on our understanding of the group and the environment in which it operates, we identified that the principal risks of non-compliance with laws and regulations related to the use of restricted funds, and we considered the extent to which non-compliance might have a material effect on the financial statements. We also considered those laws and regulations that have a direct impact on the preparation of the financial statements such as Companies Act 2006 and the Charities Act 2011, Charities Statement of Recommended Practice (second edition 2019), and consider other factors such as income tax, payroll tax and sales tax.

We evaluated management’s incentives and opportunities for fraudulent manipulation of the financial statements (including the risk of override of controls), and determined that the principal risks were related to care quality compliance, gambling commission and compliance with employment law Audit procedures performed by the engagement team included:

Inspecting correspondence with regulators and tax authorities;
Discussions with management including consideration of known or suspected instances of non-compliance with laws and regulation and fraud;
- Evaluating management’s controls designed to prevent and detect irregularities;
Identifying and testing journals; and
Challenging assumptions and judgements made by management in their critical accounting estimates.

Because of the inherent limitations of an audit, there is a risk that we will not detect all irregularities, including those leading to a material misstatement in the financial statements or non-compliance with regulation. This risk increases the more that compliance with a law or regulation is removed from the events and transactions reflected in the financial statements, as we will be less likely to become aware of instances of non-compliance. The risk is also greater regarding irregularities occurring due to fraud rather than error, as fraud involves intentional concealment, forgery, collusion, omission or misrepresentation.

A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

Use of our report

This report is made solely to the charitable company's members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work has been undertaken so that we might state to the charitable company's members those matters we are required to state to them in an Auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charitable company and the charitable company's members, as a body, for our audit work, for this report, or for the opinions we have formed.

Serr

Siobhan Holmes (Senior Statutory Auditor) 10 Queen Street Place For and on behalf of Haysmacintyre LLP, Statutory Auditor London Date: 29 October 2024 EC4R 1AG

CO hospiceKeechcare

Consolidated Statement of Financial Activities

(including Income & Expenditure Account) for the year ended 31 March 2024

The results are derived from continuing activities. All gains and losses recognised in the year are included above. The surplus for the year comprises the net income for the year and was £1,066,000 (2023: £1,206,000 surplus).

The accompanying notes on pages 41-62 form an integral part of this consolidated statement of financial activities.

Balance Sheet as at 31 March 2024 Company number: 2904446

		Group	Charity	Group	Charity
		2024	2024	2023	2023
	Notes	£'000	£'000	£'000	£'000
FIXED ASSETS
Tangible assets	16	7,957	7,957	7,708	7,708
Investments	17	5,362	5,362	1,986	1,986
Investment Property	17	191	191	-	-
		13,510	13,510	9,694	9,694
CURRENT ASSETS
Stocks	18	18	-	15	-
Debtors	19	1,611	1,644	1,414	1,444
Cash at bank and in hand		6,532	6,512	9,598	9,578
Short-term deposits		533	533	507	507
		8,694	8,689	11,534	11,529
CREDITORS: amounts falling due within one year	20	(1,061)	(1,056)	(1,151)	(1,146)
Net current assets		7,633	7,633	10,383	10,383
Net assets	22	21,143	21,143	20,077	20,077
FUNDS
Unrestricted funds
General fund		7,438	7,438	6,281	6,281
Designated funds		12,958	12,958	13,457	13,457
Total unrestricted funds		20,396	20,396	19,738	19,738
Restricted funds		747	747	339	339
TOTAL FUNDS	26	21,143	21,143	20,077	20,077

The parent charity’s gross income for the year was £15,272,000 (2023: £13,289,000) and the net result for the year was £1,010,000 surplus (2023: £1,160,000 surplus)

The financial statements on pages 38-62 were approved and authorised for issue by the trustees on 25 September 2024 and signed on their behalf by:

anh

Simon Ogden Chair of Trustees

Consolidated Statement of Cash Flows for the year ended 31 March 2024

	2024	2024	2023	2023
	£'000	£'000	£'000	£'000
Cash flows from operating activities
Net income (expenditure) for the year		1,066		1,206
Investment income		(471)		(92)
Depreciation charges		507		494
(Profit) loss on sale of fixed assets		(8)		4
Decrease / (increase) in stock		(3)		(2)
(Increase) / decrease in debtors		(197)		2,825
Increase / (decrease) in creditors		(90)		56
Losses/(Gain) on investments		(295)		14
Net cash provided by (used in) operating activities		509		4,505
Cash flows from investing activities
Payments to acquire tangible fixed assets	(748)		(323)
Purchase of investments	(3,081)		(2,000)
Purchase of investment property	(191)		-
Bank interest received	245		79
Investment income	226		13
		(3,549)		(2,231)
Increase/(decrease) of cash in the year		(3,040)		2,274
Cash at 1 April		10,105		7,831
Increase/(decrease) of cash in the year		(3,040)		2,274
Cash at 31 March		7,065		10,105

Notes to the Accounts

1. Accounting policies

Accounting convention

The financial statements have been prepared in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice (SORP 2015, Second Edition, effective 1 January 2019) applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (effective 1 January 2015) - (Charities SORP FRS 102), the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) and the Companies Act 2006.

These financial statements consolidate the financial statements of the charity, its subsidiary Keech Hospice Care (Trading) Limited and its related company undertaking Pasque Charity (Trading) Limited. Transactions and balances between the charitable company and its subsidiary have been eliminated from the consolidated financial statements. Balances between the two companies are disclosed in the notes of the charitable company's balance sheet. A separate statement of financial activities, or income and expenditure account, for the charitable company itself is not presented because the charitable company has taken advantage of the exemptions afforded by section 408 of the Companies Act 2006.

The hospice meets the definition of a public benefit entity under FRS 102. Assets and liabilities are initially recognised at historical costs or transaction value unless otherwise stated in the relevant accounting policy note(s).

Currency

The Group’s functional currency and presentational currency is pounds sterling (GBP).

Title

The charitable company has an exemption under Paragraph 60 of the Companies Act 2006 from using “Limited” in the title.

Going concern

As detailed in the Trustees Report, there are no material uncertainties regarding the charity’s ability to continue in operation. The trustees have reviewed financial forecasts and are confident that the charity will continue as a going concern for the foreseeable future. The trustees also recognise that an adequate level of reserves supports and maintains the charity as a going concern by allowing the chief executive and senior leadership team a period to implement change or contingency plans to address any budgetary problems.

Fund accounting

General funds - General funds are unrestricted funds which are available for use at the discretion of the trustees in furtherance of the general objectives of the Charity and which have not been designated for other purposes.

Designated funds - Designated funds comprise unrestricted funds that have been set aside by the trustees for particular purposes.

Restricted Funds - Restricted funds are funds which are to be used in accordance with specific restrictions imposed by donors or which have been raised by the charity for particular purposes. A fair proportion of overheads are allocated to the specific funds where appropriate.

Investment income and gains are allocated to the appropriate fund.

Merger/Acquisition accounting

For any merger or acquisition we follow the rules set out in FRS 102 SORP and FRS 102. With the integration of North Bedfordshire Hospice Care Limited, there was no consideration paid and the charity’s operations were absorbed into the operations of Keech Hospice Care. Therefore, the relevant net assets were treated as a gift, in line with the substance of the transaction, and recognised as income.

Income

All income is included in the SOFA when the charity is legally entitled to the income and the amount can be quantified with reasonable accuracy. In particular, this includes the following.

Legacies : for legacies, entitlement is taken as the earlier of the date on which either probate has been granted, the estate has been finalised and notification has been made by the executor(s) to the charity that a distribution will be made, or when a distribution is received from the estate. Receipt of a legacy, in whole or in part, is only considered probable when the amount can be measured reliably and the charity has been notified of the executor’s intention to make a distribution. Where legacies have been notified to the charity, or the charity is aware of the granting of probate, and the criteria for income recognition have not been met, then the legacy is treated as a contingent asset and disclosed if material.
Donations : income is recognised when the funds are received by the charity.
Donated goods and services : donated professional services and donated facilities are recognised as income when the charity has control over the item or received the service, any conditions associated with the donation have been met, the receipt of economic benefit from the use by the charity of the item is probable and that economic benefit can be measured reliably. In accordance with the Charities SORP (FRS 102), volunteer time is not recognised so refer to the trustees’ Annual Report for more information about their contribution. On receipt, donated gifts, professional services and donated facilities are recognised on the basis of the value of the gift to the charity which is the amount the charity would have been willing to pay to obtain services or facilities of equivalent economic benefit on the open market; a corresponding amount is then recognised in expenditure in the period of receipt.

Expenditure

All expenditure is accounted for on an accruals basis and is recognised once there is a legal or constructive obligation to make a payment to a third party and has been classified under headings that aggregate all costs related to the category.

Fundraising costs are those incurred in seeking voluntary contributions and do not include the costs of disseminating information in support of the charitable activities.

Trading costs are those incurred in undertaking trading activities (including retail).
Cost of charitable activities are those which directly relate to activities which further the charitable objectives of the charity.
Governance costs include the cost of the audit of statutory accounts; the cost of trustee meetings; the cost of legal advice to trustees on constitutional or governance matters; and a charge for the salary cost of senior management to cover time spent on compliance with constitutional or statutory requirements. These have been allocated to activity cost categories on the basis of headcount within each activity.
Support costs include central functions and have been allocated to the four activity cost categories detailed above on a basis consistent with the use of resources.

Interest receivable

Interest on funds held on deposit is included when receivable and the amount can be measured reliably by the Charity; this is normally upon notification of the interest paid or payable by the bank.

Tangible fixed assets and depreciation

Tangible fixed assets costing more than £1,500 are capitalised and included at cost including any incidental expenses of acquisition. Depreciation is calculated so as to write off the cost of an asset, less estimated residual value, over the useful economic life of that asset, on a straight line basis, as follows:

straight line basis, as follows:
Freehold property (excluding land):	50 years
Leasehold property improvements:	5 years or the period of the lease
Care equipment:	4 to 10 years
Office equipment:	4 years
Fixtures and fittings:	4 to 10 years
Motor vehicles:	4 years

The carrying values of tangible fixed assets are reviewed for impairment should events or changes in circumstances indicate the carrying value may not be recoverable.

Investments

Assets held for investment purposes are included at market value at the balance sheet date. Net gains and losses arising on revaluations and disposals during the year are included in the Statement of Financial Activities.

Investment Properties

Property assets held for investment purposes are included at market value. The last valuation was carried out in May 2023 and it is intended that a new valuation will be undertaken when it is believed that a material change in value has occurred.

Stock

Stocks, which consist of purchased goods, are stated at the lower of cost and net realisable value after making an allowance for obsolete and slow-moving items. Cost is calculated on a first in, first out basis. Net realisable value represents the amounts recoverable on eventual sale less any costs incurred in getting the materials from their current location and condition to the point of sale. Items donated for resale or distribution are not included in the financial statements until they are sold or distributed.

Valuing donated goods

The Trustees consider that the valuation of goods donated for resale at the point of receipt is impractical, due to the high volume of low value items and the administrative costs involved in valuation. Goods donated for resale are therefore recognised in the accounts at the point of sale.

Debtors

Trade and other debtors are recognised at the settlement amount due. Prepayments are valued at the amount pre-paid.

Cash at bank and in hand

Cash at bank and cash in hand includes short term highly liquid investments with a short maturity of three months or less.

Creditors and provisions

Creditors and provisions are recognised where the charity has a present obligation resulting from a past event that will probably result in the transfer of funds to a third party and the amount due to settle the obligation can be measured or estimated reliably. Creditors and provisions are normally recognised at their settlement amount after allowing for any trade discounts due.

Financial instruments

The charity only has financial assets and financial liabilities that qualify as basic financial instruments. Basic financial instruments are initially recognised at transaction value and subsequently measured at their settlement value with the exception of bank loans which are subsequently measured at amortised cost using the effective interest method.

Operating lease agreements

Rentals applicable to operating leases, where substantially all of the benefits and risks of ownership remain with the lessor, are charged to the SOFA on a straight-line basis over the period of the lease.

Contribution to pension funds

The charity operates a defined contribution pension scheme for employees. The assets of the scheme are held separately from those of the charity. The annual contributions payable are charged to the statement of financial activities.

There are some employees who are members of the National Health Service Pension Scheme which is a multi-employer defined benefit scheme. The charity is unable to identify its share of the underlying assets and liabilities. It is therefore accounted for on a defined contribution basis. The annual contributions are charged to the statement of financial activities.

Taxation

The activities of Keech Hospice Care are exempt from Corporation Tax under Section 505 of the Income and Corporation Taxes Act 1988 to the extent that they are applied to the organisation's charitable objects. The group does not pay corporation tax because the policy of the subsidiary and related trading company is to pay taxable profits under gift aid to the charity.

Estimates and judgements

In applying the accounting policies, the Trustees have made accounting judgements, estimated and assumptions about the carrying amount of the assets and liabilities. These estimates and judgements are based on historical experience and are regularly reviewed. Those that have a material effect on the amounts recognised in the financial statements are discussed below:

Judgements

Impairment testing is carried out for all tangible assets at the year end date where there is an indication that impairment exists. An impairment loss is recognised where the carrying amount exceeds the asset’s recoverable amount.

Legacies are recognised when the criteria of entitlement, probability and certainty of the amount can be met.

All debtors are reviewed to determine if a bad debt provision is required.

Estimates

Depreciation methods, useful lives and residual values are reviewed at each balance sheet date.

Gifts in kind are included in the financial statements at their market value at the time of their receipt.

2. Company structure

The charity is a private company limited by guarantee incorporated in England and Wales. The members of the company are the trustees named on page 3. In the event of the charity being wound up, the liability in respect of the guarantee is limited to £10 per member of the charity. At 31 March 2024, the number of such guarantees was 9 (2023: 10).

3. Contingent liabilities

Sales of goods donated under the retail gift aid scheme are recognised as income at the point of sale. Technically, the sale proceeds, less commission, belong to the donor until 21 days elapse after we write to the donor to inform them of the sale. It is rare for a donor to ask for their sales proceeds to be returned but, at the year-end, there was £156,961 (2023: £217,230) of income that was within this 21-day timeframe so could potentially be asked to be returned. The accounts also include the £39,240 (2023: £54,307) of gift aid that is recoverable on these donations. At the date of signing the accounts, this timeframe had elapsed and £Nil (2023: £162) of this income had been returned to donors.

CO hospice care

4. (a) Donations and legacies (current year)

Included in donations and legacies are £26,881 (2023: £74,715) of gifts in kind.

On 1 June 2023 North Bedfordshire Hospice Care Ltd (NBHC) merged with Keech Hospice Care. The operations of NHBC were absorbed into Keech Hospice Care and no consideration was paid, therefore the net assets transferred from NBHC to Keech Hospice Care have been treated as a gift and included in donations and legacies.

(b) Donations and legacies (prior year)

5. Grants received

Grants are allocated across charitable activities are set out in Note 9.

CO hospice care

6. Other Operating Income

7. Investment Income

8. (a) Activities for generating funds (current year)

Trading operations and related companies

From 1 April 2010, the charity has traded through Keech Hospice Care (Trading) Ltd (company number 06941924), a company limited by shares registered in England and Wales as a wholly owned trading subsidiary of Keech Hospice Care. The company is used for nonprimary purpose trading activities, namely the sale of bought-in goods through the charity’s shops and fundraising under tripartite agreements.

Pasque Charity (Trading) Limited (company number 02362985) is the old trading company of the charity in full use until March 2009. This company was effectively dormant during the year.

Both Keech Hospice Care (Trading) Ltd and Pasque Charity (Trading) Limited have the same registered office as Keech Hospice Care.

All activities of the trading companies have been consolidated on a line-by-line basis in the consolidated statement of financial activities. A summary of the results of Keech Hospice Care (Trading) Ltd and Pasque Charity (Trading) Limited is shown below. The directors of both companies are Trevor Nash, Chandra Shekar (Trustee) and the Executive Director of Finance.

SoS Keech[hospice][care]

Amounts owed to the parent undertaking are shown in Note 19. Included within cost of sales and administration expenses above is a management charge of £14,406 (2023: £13,043) from the parent charity.

(b) Activities for generating funds (prior year)

CO hospice care

9. (a) Income from charitable activities (current year)

CO hospice care

(b) Income from charitable activities (prior year)

CO hospice care

10. (a) Analysis of Expenditure (current year)

The governance costs are allocated based on headcount across the different activity areas.

CO hospice care

(b) Analysis of Expenditure (prior year)

11. Analysis of staff costs

During the year, no employees were made redundant with redundancy payments totalling £Nil being made (2023, £Nil).

CO hospice care

The number of employees whose employee benefits amounted to over £60,000 in the year was as follows:

One of the employees included in the bandings above £60,000 have retirement benefits accruing under a defined contribution scheme (2023: one member). Payments to defined contribution schemes in the year in respect of those employees included in the bandings above £60,000 totalled £12,344 (2023: £11,470).

The hospice considers that the key management personnel comprises the trustees (who are unpaid) and the Executive Directors. Total employee benefits of the Executive Directors was £423,054 (2023: £354,729).

12. Staff numbers

The average monthly headcount (including bank staff) was 319 (2023: 286) and analysis of the employees by function was:

The hospice had an average of 1,384 volunteers during the year (2023: 1,200), of which 948 (2023: 750) worked in our retail operations and 436 (2023: 450) supported the charitable and administrative work of the hospice. We are extremely grateful for their efforts.

13. Pension costs

Contributions to the defined contribution pension scheme for the period were £296,000 (2023: £243,000). Contributions outstanding at the year-end totalled £58,000 (2023: £44,000).

Contributions to the National Health Service Pension Scheme for the period were £237,000 (2023: £196,000) and the agreed contribution rate was 14.3%. Contributions outstanding at the year-end totalled £33,000 (2023: £29,000).

CO hospice care

The NHS Pension Scheme is an unfunded occupational scheme backed by the Exchequer, which is open to all NHS employees and certain employees of other approved organisations. Keech Hospice Care is an approved organisation. The Scheme provides pensions, based on final salary, in varying circumstances for employees of participating employers. The Scheme receives contributions from employees and employers to defray the costs of pensions and other benefits.

From 1 April 2006, the NHS Business Services Authority (the Authority) has been the body responsible for the administration of the NHS Pension Scheme for England and Wales.

In support of the Authority, NHS employers are required to explain the Scheme to the employees. In addition, they submit pension data to the NHS Business Services Authority (NHSBSA). To ensure proper administration, the hospice outsources the management of this Scheme.

Every four years, the Government Actuary conducts a full actuarial review of contribution rates. In order to defray the costs of benefits, in 2023/24 employers paid contributions of 14.38% of pensionable pay and employees contributed on a tiered scale from 5%-14.5% of their pensionable pay, depending on total earnings. Further information on benefits can be obtained from the NHS Pension Scheme website.

14. Movement in total funds for the group

Movement in total funds is arrived at after charging:

15. Trustees’ remuneration and expenses

The trustees neither received nor waived any emoluments during the year.

One trustee received reimbursement of expenses of £40 during the year in their role as trustee (2023: one trustee received reimbursement of expenses of £304).

Trustees made voluntary donations totalling of £1,445 during the year (2023: £1,130).

CO hospice care

16. Tangible fixed assets

All of the above assets are used for charitable purposes.

17. Fixed Asset Investments (Charity and Group)

Investment Property (Charity and Group)

Investment Property (Charity and Group)	Investment Property (Charity and Group)
	Unrestricted	Restricted	Total	Unrestricted	Restricted		Total
	Funds	Funds	2024	Funds		Funds	2023
	£'000	£'000	£'000	£'000		£'000	£'000
Group and Charity
Market value as at 1 April	-	-	-	-		-	-
Investment Property Additions	191	-	191	-		-	-
Market value as at 31 March	191	-	191	-		-	-
Historical cost as at 31 March	-	-	-	-		-	-

CO hospice care

18. Stock

19. Debtors

20. Creditors: amounts falling due within one year

Movement on deferred income during the year:

	Group	Charity	Group	Charity
	2024	2024	2023	2023
	£'000	£'000	£'000	£'000
Balance at the beginning of the year	509	509	360	360
Amount released to income in the year	(447)	(447)	(197)	(197)
Amount deferred in the year	32	32	346	346
Balance at the end of the year	94	94	509	509

Income is deferred where income has been received in advance of the service being provided or delivered. The amounts held in deferred income at year end relate primarily to staff costs, where either the role has been recruited in the following financial year or where the service provided by members of staff is to occur in the next financial year.

CO hospice care

21. Analysis of net assets (current year)

	General	Designated	Restricted
	Funds	Funds	Funds	Total
	£'000	£'000	£'000	£'000
Tangible assets	-	7,957	-	7,957
Investments	362	5,000	-	5,362
Investment Property	191	-	-	191
Net current assets	6,884	-	747	7,632
	7,438	12,957	747	21,142

22. Analysis of net assets (prior year)

23. Capital Commitments

The charity had the following capital commitments at the year end, which are expected to fall due within one year:

Contracted	2024	2023
	£'000	£'000
Land and buildings	385	38
Fixtures and Fittings	-	39
Equipment	109	3
	494	80
Authorised but not contracted	2024	2023
	£'000	£'000
Land and buildings	-	-
Equipment	-	-
	-	-

24. Financial commitments

At 31 March, annual commitments under non-cancellable leases were as follows:

Group and charity	2024		2023
	Land and	Other	Land and	Other
	buildings		buildings
	£'000	£'000	£'000	£'000
Expiry date:
Within one year	663	34	523	45
1-5 years	1,320	44	830	41
Over five years	-	-	10	-
	1,983	78	1,363	86

One lease is in the name of Pasque Charity (Trading) Limited but is in use by the charity and the charity bears the commitment.

Two leases are in the name of North Bedfordshire Hospice Care Ltd but are in use by the charity and the charity bears the commitment.

25. Related parties transactions

Keech Hospice Care (Trading) Ltd, a wholly owned subsidiary of the charity, was charged by the charity, during the period, a management fee of £10,809 (2023: £9,933) and a fee for the use of the charity’s logo, name and data of £3,596 (2023: £3,110). The company has made a charitable donation of its taxable profits of £55,988 (2023: £45,596) to the charity. At 31 March 2024, the company owed £22,323 (2023: £25,923) to the charity.

Pasque Charity (Trading) Limited, a related company undertaking collects sums on behalf of the charity relating to the lottery. At 31 March 2024, the company owed £11,677 (2023: £3,867) to the charity.

There are no additional related party transactions to disclose for 2024 (2023: none).

There are no donations from related parties which are outside the normal course of business and no restricted donations from related parties.

SoS Keech[hospice][care]

26. Consolidated statement of funds (current year)

Designated funds

Building Improvements and Funds set aside for building improvements, maintenance and capital Infrastructure Fund expenditure. Legacy Equalisation Funds set aside to enable the hospice to manage the effect of annual fluctuations in legacy income. In years where legacy income is lower than budgeted the Trustees can release funds for revenue or capital expenditure. IT and Digital Innovation Funds set aside for utilising technology to improve outcomes for our patients, increase the flexibility of service provision, grow our income, and increase efficiency in our infrastructure. Environmental Investment Funds set aside to invest in projects that meet our sustainability policy, improve efficiency, reduce our impact on climate change and reduce costs. Service and Innovation Funds to allow the charity to invest in service development to meet the Development evolving requirements of palliative care or to generate income or reduce costs to support our charitable objectives. Retail Infrastructure Funds set aside for the refurbishment of our retail shops. Tangible fixed assets fund Net book value of tangible fixed assets (other than freehold property) held by the charity. Building assets fund Net book value of freehold property and work in progress on freehold property held by the charity. Restricted funds Adult revenue fund Income and expenditure which specifically relates to the provision of adult services. Hospice at Home Income received for provision of the Hospice at Home service. Adult social work fund Income received to provide an adult social worker service. Adult Living Appeal Income received to provide palliative care for adults. Adult activity funds Small miscellaneous restricted funds relating to adult services. Children's revenue fund Income and expenditure which specifically relates to the provision of children's services. Children's complementary Income received to provide a complementary therapy service for children. therapy Children’s development Income received to expand children’s services in Hertfordshire.

Children’s development Income received to expand children’s services in Hertfordshire. board Children's investments The market value of investments given for the provision of children's services.

Children's activity funds

Small miscellaneous restricted funds relating to children's services. Funds received to develop a courtyard garden for children on the children’s in-patient unit and those using day support.

Children’s courtyard capital Funds received to develop a courtyard garden for children on the children’s project in-patient unit and those using day support. Pension contribution Funds received from the NHS to offset increased employer pension costs. Other activity funds Other small miscellaneous restricted funds. Children's capital projects Grants received for capital projects within the children's in-patient unit.

SoS Keech[hospice][care]

Capital Projects - Both

Hydrotherapy Pool Appeal NHS England Grant

Funds received to carry out various capital projects across the hospice, including development of the Wellbeing Centre.

Funds received to improve the impact of the hydrotherapy pool by developing new specialist support and facilities.

Funds received from NHSE to children’s hospices for financial year 2023/2024.

27. Consolidated statement of funds (prior year)

28. Analysis of material transfers between funds

Transfers in the year relate to capital expenditure on fixed assets represented by a transfer from restricted or general funds to the relevant designated fund containing the assets. There are also transfers between unrestricted funds and designated funds representing either operating spend from those designated funds and/or reallocation of unrestricted funds to designated funds for future spend.

Report and Financial Statements Year ended 31 March 2024

Contents

About Keech Hospice Care

Trustees, officers and professional advisors

Trustees

Audit and Risk Committee

Trading companies

Senior Leadership Team

Executive directors

Registered Office

Auditor

Bankers

Investment Managers

Solicitors

Annual Report of the trustees

Directors’ Report

Objectives and activities

Objectives

Principal activities

Public benefit

Structure, governance and management

Day-to-day management

CO hospiceKeechcare

Investment policy and objectives

Trustees

Responsibilities of the trustees

Going concern

Auditors

SoS hospice care

Strategic Report

The charity’s vision, mission, values and philosophy of care

CO hospice care

Vision

Mission

Values

Philosophy of care

Strategic ambitions

Achievements and performance

(i) We will transform the environment, systems and conversations about living well, death and dying; pioneering new models of care

Adult services

Children’s services

Supportive care services

Compassionate communities programme

(ii) We will deliver leading education, innovation and research improving knowledge and skills everywhere, moving towards our aspiration of being a university teaching hospice

Sustainability

(v) We will attract, retain and engage the best talent and provide opportunity to develop from the outset, valuing difference.

Pay policy

(vi) We will be expertly led, effectively governed, and a values driven learning organisation

CO hospice care

Assessing performance

Financial review

Expenditure

Income

Funds and reserve transfers

Balance Sheet

Reserves Policy

Risk management

Principal risks and uncertainties

So hospice care

Fundraising practice

Future activities

CO hospice care

Co hospiceKeechcare

https://popnat.hospiceuk.org/

How do we find success?

Charity Merger

anh

Independent Auditor’s Report to the members of Keech Hospice Care

Opinion

Basis for opinion

Conclusions relating to going concern

Other information

Opinions on other matters prescribed by the Companies Act 2006

Matters on which we are required to report by exception

Responsibilities of trustees for the financial statements

Auditor’s responsibilities for the audit of the financial statements

Use of our report

Serr

CO hospiceKeechcare