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2021-12-31-accounts

Working together to improve care and outcomes

Intensive Care National Audit and Research Centre Annual Report and Accounts | Year ended 31 December 2021

www.icnarc.org

Contents

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

About ICNARC

In the UK, each year, around 184,000[1] people are admitted to an adult general critical care unit.

At the Intensive Care National Audit and Research Centre (ICNARC), we work to ensure the best possible critical care by facilitating improvements in the structure, process, outcomes and experiences - for patients and for those who care for them.

We achieve this by developing and sharing information about the quality of critical care with those who finance, commission, manage, deliver and experience critical care (both within and outside the NHS) through our national clinical audit and through our national and international research.

Improving care and outcomes

At ICNARC, we believe that quality critical care has three main elements:

To find out more about ICNARC, please visit www.icnarc.org

1 Overall number of admissions to adult general critical care units in UK, excluding admissions to adult specialist, paediatric or neonatal critical care units.

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Message from the Chair

We began 2021 with the COVID-19 pandemic still front and centre in our own lives and in the day-to-day work of everyone in ICNARC. Although we were beginning to understand the disease and, crucially, had vaccines, it was still causing mayhem to the health and economy of the UK.

The daily, weekly and responsive reporting regime that Kathy Rowan, as Director of ICNARC, introduced from early-March 2020, alongside the management and coordination of sites and data for the global adaptive platform trial evaluating potential therapies for COVID-19 (REMAP-CAP) were still as valuable as ever to a Government that needed every aspect of intelligence on the behaviour of, and effective therapies for, the disease and on the response of the NHS.

This meant that, in many ways, 2021 was simply a repeat of 2020. But, as the novelty and excitement around ICNARC’s significant role in supporting all those planning, managing, organising and delivering critical care for patients with COVID-19 began to wear thin, the leadership role of keeping everyone motivated and focussed on the work-at-hand became ever more challenging. It is testament to her strength and resilience that Kathy was able to maintain the outputs of ICNARC during these challenges.

As Trustees, we were delighted and very proud when Kathy was awarded an OBE for her services to research and intensive care – as evidenced so clearly by her leadership of ICNARC during the pandemic. As she said at the time, the honour was not just for her, but for the entire organisation who produced an extraordinary response at a time of national and international challenge.

Sue James | Chair

Message from the Director

Once again, I start this message by paying huge tribute to all our colleagues/friends working in critical care teams across the UK (and internationally). Their heroic response to, and dedicated care for, the unprecedented numbers of people becoming critically ill with COVID-19 (and for their loved ones), in such extreme conditions, was and continues to be humbling. Thank you from all of us at ICNARC.

As we reach the end of 2021, again, I am so very proud of ICNARC and the role it played this year in supporting critical care, nationally and internationally. ICNARC is its staff and every individual member (including those who joined us during 2020 and 2021 – in these strange circumstances of virtual working) played their part in our COVID-19 response. ICNARC continued to step-up to meet the additional challenges and met them with the speed needed dictated by the continuing, ever-increasing numbers of patients becoming critically ill with COVID-19.

Senior leadership was vital. I would like to acknowledge the key roles played by the Senior Management Team – David Harrison (Head Statistician), Paul Mouncey (Head of Research) and Jane-Eve Straughton/Ian Chivers/Baz Bedrossian (Head of Operations) – in sharing this leadership.

It is a real credit to all ICNARC staff that not only did we deliver on our activities around COVID19 but, again, business-as-usual continued with: ongoing improvements to our operational infrastructure/systems; successful awarding of new research grants; and targets met across our research studies and our national clinical audits.

As we approach the era following the pandemic, I thank all those who helped us develop over the past 28 years into the agile organisation able to share important information so rapidly and so rigorously.

Kathy Rowan I Director

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Trustees report

Charitable Objects

“…the advancement of education in the organisation and practice of critical care (in particular, through the promotion of audit and research into critical care and the publication of the useful results of such audit and research) …”

“… research is concerned with discovering the right thing to do; audit with ensuring that it is done right …”

Richard Smith, former Editor-in-Chief, British Medical Journal

We achieve our Charitable Objects by…

…establishing quality through research

Read more about the important role ICNARC played in identifying effective care for patients critically ill with COVID-19 ( page 8 )

…assessing quality through audit

Read more about the important role ICNARC played in monitoring care and outcomes for patients critically ill with COVID-19 ( page 11 )

…promoting quality through sharing information Read more about how we rapidly analysed data and shared information, nationally and internationally, on patients critically ill with COVID-19 ( page 14 )

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COVID-19

In late 2019, an outbreak of a novel zoonotic coronavirus infection (severe acute respiratory syndrome coronavirus 2) began to emerge in humans with its epicentre in Wuhan, China.

On 30 January 2020, the WHO indicated a Public Health Emergency of International Concern. On 11 February 2020, the WHO announced “COVID-19” as the name for this new disease and, on 11 March 2020, the WHO declared a COVID-19 pandemic. The first cases of COVID-19 were reported in the United Kingdom (UK) in late January 2020.

To help inform planning of critical care services, both centrally and locally, ICNARC was well placed to rapidly collate, analyse and report data, weekly, on patients critically ill with confirmed COVID-19 by virtue of its ongoing co-ordination of the Case Mix Programme, the national clinical audit for adult critical care covering England, Wales and Northern Ireland.

To help support evaluation of therapeutic interventions to combat the challenge of COVID-19, both nationally and internationally, ICNARC was well placed to manage and co-ordinate research on patients critically ill, or likely to become critically ill, with COVID-19 by virtue of its ongoing UK co-ordination of the global Randomised Embedded Multifactorial Adaptive Platform trial for Community Acquired Pneumonia (REMAP-CAP) redirected to COVID-19.

As for 2020, responding to the global pandemic (UK epidemic), in the above two ways, continued to be the major focus of ICNARC’s actual activities in 2021.

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Progress against priorities for 2021

Three key themes underpin our priorities:

Work across all regions and nations of the UK and internationally

Diversify to embrace new methods and areas

Inspire, and be inspired by, the critical care community and ensure that what we do is what they need

Work across all regions and nations of the UK and internationally

Diversify to embrace new methods and areas

Inspire, and be inspired by, the critical care community and ensure that what we do is what they need

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Five important enablers underpin our priorities:

Governance

People and culture

Communication

Financial sustainability

Technology

Governance

People and culture

Communication

Financial sustainability

Technology

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Establishing quality through research

Research at ICNARC is conducted within our Clinical Trials Unit (CTU), a fully registered unit by the UK Clinical Research Collaboration. Our small CTU conducts a broad portfolio of research in critical care, both experimental (randomised clinical trials) and observational studies, applying quantitative and qualitative methods. We evaluate the care, outcomes and experiences of the critically ill with a view to informing best care, outcomes and experiences for future patients.

International Expert Panel, UK Clinical Research Collaboration

Research – 2021

Development of our research portfolio continued in adult and paediatric critical care.

Adult critical care research studies

Paediatric critical care research studies

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Research highlights – 2021

REMAP-CAP for COVID-19

Convalescent plasma

Therapeutic anticoagulation

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Our plans for research – 2022

To find out more about ICNARC’s research, please visit: - www.icnarc.org/our research

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Assessing quality through audit

Audit at ICNARC is conducted within our National Audit Programme. Through specification, management and analysis of accurate clinical audit data and from applying accurate risk prediction, we support health care providers to benchmark their care and outcomes with other providers to prompt quality improvement.

“ …without clinical audit, we don’t know how we are doing… ”

Professor Sir Nick Black, ex-Trustee, ICNARC

National Audit Programme

Our National Audit Programme currently encompasses four national clinical audits, with three operating within the NHS and registered on the NHS Quality Accounts.

Launched in 1994 (the foundation for ICNARC), the Case Mix Programme is the national clinical audit of patient outcomes from adult critical care – covering adult, general critical care units (combined intensive/high dependency care units) within and outside the NHS in England, Wales and Northern Ireland.

Launched in 2009 in collaboration with the Resuscitation Council (UK), the National Cardiac Arrest Audit is the national clinical audit of patient outcomes following in-hospital cardiac arrest in the UK.

Launched in 2010 in collaboration with the National Office of Clinical Audit in Ireland, the Irish National Intensive Care Unit Audit is the national clinical audit of patient outcomes from adult critical care units in the Republic of Ireland.

Launched in 2014 in collaboration with the Association for Cardiothoracic Anaesthesia and Critical Care, the Assessment of Risk in Cardiothoracic Intensive Care is the national clinical audit of patient outcomes from adult cardiothoracic critical care units in the UK.

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Audit highlights – 2021

Case Mix Programme

National Cardiac Arrest Audit

Irish National Intensive Care Unit Audit (INICUA)

Assessment of Risk in Cardiothoracic Intensive Care (ARCtIC)

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Our plans for audit – 2022

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Promoting quality through sharing information

We share information – results from our national clinical audits and from our research studies – through local, regional and national reporting (audit), through peer-reviewed scientific and other tailored outputs (research). We enhance our dissemination activities for our audit and research information through digital media and through presentations at local, regional, national and international meetings/conferences – both at our own and at others’ events.

We endeavour to ensure that relevant information reaches those experiencing, delivering, managing, commissioning and financing critical care in the UK. We believe that critical care should be based on rigorous, scientific evidence.

In 2021, our focus remained on COVID-19.

Sharing information highlights – 2021

To help inform planning of critical care services, both centrally and locally, ICNARC, was well placed to rapidly collate, analyse and report data on patients critically ill with confirmed COVID-19. Throughout 2021, reports on patients critically ill with confirmed COVID-19 were sent, daily, to senior colleagues within the NHS and weekly or monthly reports describing epidemiology and outcomes were disseminated widely, both directly to relevant individuals and, indirectly, online via the ICNARC website.

In addition to routine daily and weekly reporting, rapid ad hoc reports were prepared in response to specific requests from policymakers involved in planning of critical care services. Descriptive and risk-adjusted reports were disseminated, directly, to individual critical care units and networks. Important scientific information was also shared by ICNARC in preprints and in peer-reviewed scientific publications.

To help support evaluation of therapeutic interventions to combat the challenge of COVID-19, both nationally and internationally, ICNARC was well placed to manage and co-ordinate research on patients critically ill, or likely to become critically ill, with COVID-19. Important information on the effectiveness of new or existing therapies, generated from the global REMAP-CAP trial (redirected to COVID-19), were shared in peer-reviewed scientific publications.

COVID-19 outputs

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To support our sharing of data in a timely and secure manner, both during the pandemic and into the future, in 2021, ICNARC became a member organisation of the UK Health Data Research Alliance. Membership of the Alliance will help us to keep up to date with best practice in this fast-moving arena.

Other (non-COVID-19) sharing of important information from our Research and Audit activities also continued throughout 2021. With respect to research, publications from studies on our broad portfolio of research were accepted for publication in the scientific, peer-reviewed literature. With respect to audit, critical care units (including networks of units) and hospitals participating in our national clinical audits continued to receive their quarterly quality reports. Six dataset workshops and 19 dataset familiarisation sessions were held.

Other (non-COVID-19) outputs

Digital communications

Twitter – our followers continued to increase, with an additional 2,052 gained in 2021, with 82 ICNARC Tweets generating 1,416,500 impressions.

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Our plans for sharing information – 2022

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Financial review

The Board of Management (Trustees) has adopted the provisions of the Statement of Recommended Practice (SORP) Accounting and Reporting by Charities (FRS 102) in preparing ICNARC’s financial statements.

• Income

ICNARC is funded by our subscription-based national clinical audits and by successful awarding of research grants.

For the year ended 31 December 2021, ICNARC generated total income of £4,954,122, an increase of 29% on 2020.

Income includes £1,963,354 from audit subscriptions/activities, £2,888,701 from research grants and £102,067 from other data services.

Primary sources of income are subscriptions from participants, primarily NHS Trusts, participating in our national clinical audits and from research grants awarded by government and other funding bodies to conduct our research studies. In 2021, we also continued to receive income related to auditing, reporting and analyses to inform and support the COVID-19 pandemic.

• Expenditure

Total expenditure in 2021 was £3,622,187, an increase of 0.1% on 2020.

• Cash

At the end of the financial year, total cash reserves were £3,199,119, representing an increase of 165% on 2020 and mainly attributed to advance grant receipts and improved collection of receivables.

• Funds Carried Forward

Funds carried forward at the end of the financial year are £2,236,776. This represents an increase of 147% against the funds carried forward at the end of 2020.

Going concern

ICNARC continues to be well-placed to manage the business risks it faces. This position is supported by a robust cash flow position and proven ability to win new research grants.

We recognise the need to build our reserves to enable investment in improving our technology and security and to manage the impact of unplanned events.

The Board of Management (Trustees) has a reasonable expectation that ICNARC has sufficient resources and control mechanisms to continue operating for the foreseeable future and believes that there are no material uncertainties that call into doubt the ability of ICNARC to continue as a going-concern.

The financial impact of the COVID-19 pandemic on income has been reviewed and the projected cash flow, for the 24 months to December 2023, confirms that ICNARC has sufficient income to meet expenditure for the immediate and longer-term future.

There has been no need to access ICNARC’s reserves during the pandemic period.

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Remuneration

The salaries of ICNARC staff are periodically benchmarked against similar roles within organisations that engage in similar activities. ICNARC aims to set salaries as close to the median as possible to attract highly qualified staff. All roles are evaluated against agreed organisational criteria which determine the grade and salary for the role.

Key risks and uncertainties

The Board of Management (Trustees) has identified and reviewed the major risks to which ICNARC is exposed and established systems and procedures to manage those risks. This involves identifying potential risks and then assessing the likelihood of their occurrence and impact.

Where systems are already in place to mitigate these risks, schedules for regular monitoring and review have been adopted. Where systems are not already in place, deadlines have been set for their development by staff for approval by the Board of Management (Trustees).

Day-to-day management of the risks is delegated to the Director along with other members of the Senior Management Team (SMT) and these risks are reviewed regularly during the usual course of business.

The Board of Management (Trustees) considers the following to be the key risks on which ICNARC needs to focus:

• Insufficient financial resources

Risk : Significant deterioration in economic climate and public sector funding pressures resulting in reduction in income – UK and EU.

Mitigation: We continue to plan our budgets and aim to maintain sufficient reserves to cover short-term income downturns and support future investment. We achieve this by focusing on diversifying our income to have a mixed portfolio of funders, balanced with efficiency savings which are underpinned by robust financial management.

• Knowledge and skills

Risk: Attracting and retaining staff with management, scientific and information technology expertise as these are strategically important in ensuring ICNARC remains a leading organisation in emergency and critical care audit and research.

Mitigation: We manage this risk through a programme of mentoring and supporting key management, scientific and information technology staff, developing skills/expertise and reviewing our employment package for all staff.

• Technology and data security

Risk: Our technology underpins and powers our data upload, processing, and reporting for our national clinical audits and for our research studies. The ability to keep pace with, and update, our technology and to ensure that we adopt the necessary and appropriate security requirements, presents an ongoing challenge as we strive to embrace new and more efficient, digital technologies.

Mitigation: We have increased our investment in Technology and Information Governance expertise and continue to maintain our Section 251, DSP Toolkit and Cyber Essentials compliance. We have continued to conduct regular penetration tests and are working closely with our managed service providers and customers to ensure that we continue to adopt the best systems and processes to mitigate technology and data security risks.

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• COVID-19 pandemic

Risk : In 2021 the ongoing Covid-19 pandemic continued to impact income and expenditure.

Mitigation: ICNARC’s key role in analysing and reporting data during the pandemic has ensured sufficient income levels have been maintained to cover expenditure. We have also further diversified our income streams through developing our engagement with key international projects and expanding data linkages to new and established data havens.

Reserves

The Board of Management (Trustees) has a policy whereby unrestricted funds, not committed or invested in tangible fixed assets (the free reserve), held by the organisation should usually be between 25% and 50% of the annual resource expended in the General Fund. Whilst in 2021 this figure exceeded 80% the expectation is that it will reduce back down to previous levels with the planned investment in our technology strategy in the next two years.

At this level, the Board of Management (Trustees) feels that, in the event of a significant drop in funding due to any external/internal event(s) or fraudulent activity, ICNARC would still be able to continue current activities until new funding is secured. In 2021, the annual surplus of £1,331,935 allowed us to continue to make critical investments in our IT platform whilst also maintaining sufficient reserves to fall within our free reserve target.

The Unrestricted funds totalled £1,805,231 at the end of 2021 and includes £1,355,231 general funds and the designated Development Fund of £450,000 which has been set aside to invest in ICNARC’s technology strategy.The Board of Management (Trustees) have reviewed the level of reserves and concluded that the level of reserves is appropriate.

The budget for the 2022 financial year indicates a surplus which, if achieved, will be added to the General Reserve and remain within the Board’s policy target.

Fundraising

ICNARC does not raise funds from the public and no fundraising activities have been undertaken either by ICNARC or by other fundraisers on behalf of ICNARC.

Auditors

MHA MacIntyre Hudson are deemed to be re-appointed under section 487(2) of Companies Act 2006.

Status

The Company is a Registered Charity (1039417) and is exempt from income and corporation taxes under S466 Corporation Tax Act 2010 (CTA 2010).

Special exemptions

This Report of the Directors and Board of Management (Trustees) has been prepared in accordance with the special provisions under Part 15 of the Companies Act 2006 relating to small companies and the Charity has taken advantage of the small companies’ exemptions in preparing the Directors Report and the requirement to prepare a Strategic Report.

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Governance, structure and management

The Intensive Care National Audit and Research Centre (ICNARC) is a Company Limited by Guarantee and incorporated in England on 8 July 1994 and governed by its Memorandum and Articles of Association.

ICNARC’s Articles of Association provide for a limitation of member liability to £1. ICNARC is a Registered Charity in England and Wales.

Registered Name of Company: Intensive Care National Audit and Research Centre Company Number: 02946727 Registered Charity Number: 1039417 Registered Office: Napier House, 24 High Holborn, London WC1V 6AZ

Our Trustees

The Trustees form the Board of Management and are responsible for the governance and strategy of ICNARC. The Board of Management is made up of twelve Trustees, comprising a mix of health care and other professionals. The Board of Management (Trustees) has full legal responsibility for the actions of ICNARC. Trustees are appointed for a renewable term of three years and are the Directors of the Company for the purposes of the Companies Act 2006.

The Board of Management (Trustees) meets four to five times per year and delegates the day-to-day responsibility for running ICNARC to the Director, along with other members of the Senior Management Team (SMT). In 2018, an Audit & Risk Sub-Committee was established to assist the Board of Management (Trustees) in its duty to supervise the broad direction of ICNARC’s financial affairs and to ensure compliance with Company Law and Charity Commission best practice. The Board of Management (Trustees) acts as advisors to staff on business, health care and other issues and keeps the organisation up to date with developments within health care and other relevant fields. All Trustees give their time freely and no Trustee remuneration was paid in 2021.

We were pleased to appoint three new Trustees in April 2022, details of whom are provided on this page.

The Trustees serving during 2021 and into 2022 are:

Chair: Ms Susan James Trustees: Dr Tim Gould Dr Lisa Hinton Mr Paul Maddox (Treasurer) Prof David Menon Ms Carolyn Seet Dr Gareth Sellors Ms Susan James Prof Ruth Endacott

Ms Tracey Harrison

1 November 2021)

Dr Simon Baudouin (resigned 1 November 2021)

Dr Tamas Szkamany (appointed 28 April 2022)

Prof Richard Grieve (appointed 28 April 2022)

Dr Manu Shankar-Hari (appointed 28 April 2022)

Trustee vacancies are advertised, as necessary, and ICNARC may also approach individuals thought to have the appropriate skills and experience. New Trustees spend time with members of the SMT and other staff, as part of their induction, to learn more about the organisation and to understand how they can add value through their skills and experience. Trustees are also encouraged to take part in training opportunities, are invited to attend the Annual Meetings for our national clinical audits and, where relevant, represent ICNARC on external advisory groups.

On appointment, each Trustee completes a Declaration of Interests form which is held in a Register of Interests and updated annually. All conflicts are actively managed through early identification of potential areas of conflict and actions taken to manage these, where relevant. There were no related party transactions in the 2021 financial year.

Public Benefit

In shaping the objectives and activities for each year, the Board of Management (Trustees) considers the guidance of the Charity Commission on public benefit, including the guidance ‘Public Benefit: Running a Charity’. The nature of ICNARC’s public benefit is detailed on pages 4 to 16 of this report.

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Senior Management Team

The Director and other members of the SMT are responsible for the day-to-day running of ICNARC under authority delegated to them by the Board of Management (Trustees) and are collectively responsible for the management and operations of ICNARC.

Auditors/Bankers

The SMT is responsible for implementing the strategy and policies, agreed with the Board of Management (Trustees), and operate on a threeyear, rolling review. The SMT proposes an annual Business Plan and operating budget, for approval by the Board of Management (Trustees) and monitors financial performance and organisational risk, accordingly.

Remuneration for SMT members is reviewed annually by Trustees and benchmarked to similar roles and organisations.

Auditors MHA MacIntyre Hudson 2 London Wall Place London EC2Y 5AU

Bankers Unity Trust Bank plc 9 Brindley Place Birmingham B1 2BR

The SMT members serving during 2021 and into 2022 are:

Prof Kathryn Rowan Director

Prof David Harrison Head Statistician Mr Paul Mouncey Head of Research Ms Jane Eve Head of Operations (resigned February 2021) Straughton Mr Ian Chivers Interim Head of Operations (appointed February 2021, for six months) Mr Baz Bedrossian Interim Head of Operations (appointed July 2021)

Our staff

During 2021, ICNARC had an average paid workforce of 45 staff, located in our central London Office although during the pandemic largely working remotely from home.

ICNARC is an Equal Opportunities employer. We promote equality and diversity by:

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Statement of Trustees’ responsibilities

Trustees’ responsibilities in relation to the financial statements

The Trustees (who are also Directors of the Intensive Care National Audit and Research Centre for the purposes of Company Law) are responsible for preparing the Report of the Directors and Trustees 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 of the incoming resources and application of the resources, including the income and expenditure, of the Charitable Company for that period. In preparing those financial statements, the Trustees are required to:

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, hence, for taking reasonable steps for the prevention and detection of fraud and other irregularities.

In so far as the Trustees are aware:

In approving the Trustees’ Annual Report and Accounts in our capacity as Company Directors.

This report of the Trustees has been prepared taking advantage of the small companies exemption of section 415A of the Companies Act 2006.

Signed on behalf of the Board

Susan James

Chair

Date: 14 July 2022

Telephone: 020 7831 6878 Email: icnarc@icnarc.org Website: www.icnarc.org

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Independent Auditors’ report to the Members of the Intensive Care National Audit and Research Centre

Opinion

We have audited the financial statements of Intensive Care National Audit and Research Centre (the ‘charitable company’) for the year ended 31 December 2021 which comprise the Statement of Financial Activities, the Balance Sheet, the 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:

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 charitable company 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. Our evaluation of the Trustees’ assessment of the entity’s ability to continue to adopt the going concern basis of accounting included critical reviews of budgets and forecasts provided.

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 charitable company'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 annual report, other than the financial statements and our auditor’s report thereon. 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.

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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:

Matters on which we are required to report by exception

In the light of our knowledge and understanding of the charitable company and its environment obtained in the course of the audit, we have not identified material misstatements in 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:

Responsibilities of Trustees

As explained more fully in the Trustees’ responsibilities statement included in the Trustees’ Annual Report, 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 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 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

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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 specific procedures for this engagement and the extent to which these are capable of detecting irregularities, including fraud is detailed below:

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: https://www.frc.org.uk/Our-Work/Audit/Audit-and-assurance/Standards-andguidance/Standards-and-guidance-for-auditors/Auditors-responsibilities-for-audit/Description-of-auditorsresponsibilities-for-audit.aspx. This description forms part of our auditor’s report.

Use of this 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.

Rakesh Shaunak FCA (Senior Statutory Auditor) for and on behalf of

MHA MacIntyre Hudson Statutory Auditor London, United Kingdom

Date: 05/08/2022

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 25

Intensive Care National Audit and Research Centre

Statement of Financial Activities (Incorporating an Income and Expenditure account) For the year ended 31 December 2021

Notes
Income from:
Charitable activities
Participants' Cost Contribution (Audits)
7
Activities in promoting the Audits
7
Other services
7
Research Grants
2
Total
Expenditure on:
Charitable activities
Participants' Cost Contributions (Audits
5
Research
3
Total
5
Net income/(expenditure)
Transfers between funds
18
Net movement in funds
Total funds brought forward
Total funds carried forward
18		 Restricted
2021
2020
General
Development
Fund
£
£
£
£
£
1,739,316
-
201,373
1,940,689
2,220,100
22,665
-
-
22,665
16,247
88,441
-
13,626
102,067
33,205
-
-
2,888,701
2,888,701
1,582,809
Unrestricted Funds
1,850,422
-
3,103,700
4,954,122
3,852,361
1,065,665
-
215,683
1,281,348
1,848,862
-
-
2,340,839
2,340,839
1,769,192
1,065,665
-
2,556,522
3,622,187
3,618,054
784,757
-
547,178
1,331,935
234,307
-
-
-
-
-
784,757
-
547,178
1,331,935
234,307
570,474
450,000
(115,633)
904,841
670,534
1,355,231
450,000
431,545
2,236,776
904,841

All ICNARC's operations are classified as continuing.

ICNARC had no recognised gains or losses other than those included in the movement in funds for the year.

A statement on the movement of reserves appears in Note 17 of the financial statements.

The Notes on pages 29 to 43 form part of these accounts.

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 26

Intensive Care National Audit and Research Centre

Company registration number 02946727 Balance Sheet

For the year ended 31 December 2021

Notes
FIXED ASSETS
Tangible assets
11
CURRENT ASSETS
Debtors
12
Cash at bank and in hand
Cash deposit
Creditors
Amounts falling due within one year
Deferred income
Other payables
13		 Unrestricted
Restricted		 2021
2020
£
£
22,803
26,141
2,894,261
2,710,932
2,692,946
698,960
506,173
506,173
£
£
22,803
-
881,968
2,012,293
1,890,219
802,727
458,833
47,340
3,231,020
2,862,360
880,689
1,017,778
367,903
1,413,037		 6,093,380
3,916,064
1,898,467
1,229,788
1,780,940
1,682,576
1,248,592
2,430,815		 3,679,407
2,912,364
Net current assets 1,982,428
431,545		 2,413,973
1,003,700
Creditors: Amounts falling due in
greater than one year
14
Provisions for Liabilities
15
NET ASSETS
Represented by:
Unrestricted Funds
General Fund
18
Development Fund
18		 150,000
-
50,000
-
1,805,231
431,545		 150,000
75,000
50,000
50,000
2,236,776
904,842
1,355,231
450,000		 570,475
450,000
1,805,231
1,020,475
Restricted Fund
18		 431,545 431,545
(115,633)
2,236,776
904,842

The Trustees acknowledge their responsibilities for complying with the requirements of the Companies Act 2006 with respect to accounting records and preparation of financial statements. The financial statements have been prepared in accordance with the provisions applicable to entities subject to the small companies regime. The financial statements were approved and authorised for issue by the Trustees and signed on 14 July 2022 on their behalf by:

Susan James, Chair

The Notes on pages 29 to 43 form part of these accounts.

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 27

Intensive Care National Audit and Research Centre

Statement of Cash Flows For the year ended 31 December 2021

2021
2020
Cash used in operating activities
(Increase)/Decrease in debtors
(183,329)
(1,502,660)
Increase/(Decrease) in creditors
842,043
728,964
Depreciation charges
16,575
319,256
Surplus/(Deficit) less interest income
1,331,935
234,307
Net cash used in operating activities
2,007,224
(220,132)
Cash flow from investing activities
Interest income
-
-
Purchase of tangible fixed assets
(13,237)
(17,193)
Net cash provided by investing activities
(13,237)
(17,193)
Cash flow from financing activities
-
-
Increase (decrease) in cash and cash equivalents in the yea
1,993,986
(237,325)
Cash and cash equivalents at the beginning of the year
1,205,133
1,442,458
Cash and cash equivalents at end year
3,199,119
1,205,133		 2021
2020
Cash used in operating activities
(Increase)/Decrease in debtors
(183,329)
(1,502,660)
Increase/(Decrease) in creditors
842,043
728,964
Depreciation charges
16,575
319,256
Surplus/(Deficit) less interest income
1,331,935
234,307
Net cash used in operating activities
2,007,224
(220,132)
Cash flow from investing activities
Interest income
-
-
Purchase of tangible fixed assets
(13,237)
(17,193)
Net cash provided by investing activities
(13,237)
(17,193)
Cash flow from financing activities
-
-
Increase (decrease) in cash and cash equivalents in the yea
1,993,986
(237,325)
Cash and cash equivalents at the beginning of the year
1,205,133
1,442,458
Cash and cash equivalents at end year
3,199,119
1,205,133
ANALYSIS OF CASH AND CASH EQUIVALENTS
Cash in hand 2021
2020
£
£
3,199,119
1,205,133
3,199,119
1,205,133
ANALYSIS OF CHANGES IN NET DEBT
Cash at bank and in hand At 1 January
At 31 December
2021
Cash flows
2021
£
£
£
1,205,133
1,993,986
3,199,119
1,205,133
1,993,986
3,199,119

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 28

Notes to the Accounts

For the year ended 31 December 2021

Intensive Care National Audit and Research Centre (ICNARC) is a private company limited by guarantee registered in England and Wales and an incorporated charity registered with the Charity Commission. In the event of the charity being wound up, the liability in respect of the guarantee is limited to £1 per member of the charity. The address of the registered office is given on Page 20. The nature of the charity's operations and principal activities are detailed on pages 4-16. The charity is a public benefit entity as defined by FRS 102. The company registration is 2946727.

1 ACCOUNTING POLICIES

(a) The accounts have been prepared under the historical cost convention in accordance with the Companies Act 2006 and follow the recommendations in Accounting and Reporting by charities: Statement of Recommended Practices (SORP) applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS 102).

(b) The financial statements are prepared on a going concern basis. The Board of Management (Trustees) have considered the level of funds held and the expected level of income and expenditure for 12 months from authorising these financial statements. The budgeted income and expenditure are sufficient with the level of reserves for the charity to be able to continue as a going concern. The financial impact of the COVID-19 pandemic on income has been reviewed and the projected cash flow, for the 24 months to December 2023, confirms that ICNARC has sufficient income to meet expenditure for the immediate and for the longer-term future. There has been no need to access ICNARC’s reserves during this period. The accounts are prepared in sterling, which is the functional and presentational currency of the charity, rounded to the nearest £1.

(c) Interest is accounted for when receivable.

(d) Research Grant income is recognised when the Charity has entitlement to the funds and any performance conditions have been met. Any advance income over expenditure is held on the Statement of Financial Position as deferred income.

(e) The Annual Participants Cost Contributions (APCC) is invoiced on the anniversary date of joining. Any proportion of a current year income relating to the following year is treated as deferred income.

(f) The NCAA participants income is invoiced on the anniversary date of joining. Any proportion of current year income relating to the following years is treated as deferred income.

(g) Resources expended are recognised in the period in which they occur. Resources expended include attributable VAT which cannot be recovered.

(h) Resources expended are allocated to specific activity where the costs relate directly to that activity. The cost of the overall direction and administration, comprising of salary and overhead costs are apportioned on an estimate of staff time and resources used to support those activities.

(i) All fixed assets are initially recorded at cost and capitalised if costs exceed £1,000.

VAT which cannot be recovered.
(h) Resources expended are allocated to specific activity where the costs relate directly to that activity. The cost of the
overall direction and administration, comprising of salary and overhead costs are apportioned on an estimate of staff
time and resources used to support those activities.
(i) All fixed assets are initially recorded at cost and capitalised if costs exceed £1,000.		 VAT which cannot be recovered.
(h) Resources expended are allocated to specific activity where the costs relate directly to that activity. The cost of the
overall direction and administration, comprising of salary and overhead costs are apportioned on an estimate of staff
time and resources used to support those activities.
(i) All fixed assets are initially recorded at cost and capitalised if costs exceed £1,000.
(j) Depreciation is provided at the following annual rates to write off the cost of each asset on a straight-line basis over
its estimated life. Rates currently used on cost are:
Office fabrication 20%
Computer equipment 33%
Office equipment 33%
Office furniture 20%

(k) IT development is capitalised as an intangible asset where there are expected to be economic benefits flowing to the charity from the asset and the amount can be reliably measured. However, when changing requirements indicate significant revisions and improvements are required, the asset will be written down to reflect this. When a decision is taken to capitalise software development the rate of amortisation will be matched to the anticipated useful life.

(l) Unrestricted funds are subscriptions and other incoming resources receivable or generated for the objects of the organisation without further specified purpose and are available as general funds.

(m) Amortisation relates to third party computer software and is provided at an annual rate of 33%. IT development relates to investment in Platform X, and new database platform. This value was written down fully in 2020 to reflect the need for ongoing improvements.

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 29

Notes to the Accounts

For the year ended 31 December 2021 Continued

(n) Designated Funds are unrestricted funds earmarked by the Board of Management for a particular purpose (i.e. Development Fund).

(o) Restricted Funds are to be used for the specific purposes as laid down by the provider. Expenditure which meets these criteria is charged to the fund, together with a fair allocation of management and support costs.

(p) The charity operates a defined contribution pension scheme for its employees. The assets of the scheme are held separately from those of the charity. The annual contribution payable is charged to the income and expenditure account.

(q) Termination payments – Termination benefits, including redundancy costs, are recognized when the Charity has the obligation to pay the benefits and they can be reliably measured.

(r)Rentals applicable to operating leases where substantially all the benefits and risks of ownership remain with the lessor are charged in the income and expenditure account on a straight-line basis over the period of the lease.

(s) The Charity only has financial assets and financial liabilities of a kind that qualify as basic financial instruments. The financial assets and financial liabilities of the Charity are as follows:

Debtors – trade and other debtors are basic financial instruments and are debt instruments measured at amortised

cost as detailed in Note 12. Prepayments and research project grant receivables are not financial instruments. Cash at bank – is classified as a basic financial instrument and is measured at face value.

Liabilities – trade creditors, accruals and other creditors will be classified as financial instruments and are measured at amortised cost as detailed in Note 15. Taxation and social security are not included in the financial instruments’ disclosure. Deferred income is not deemed to be a financial liability, as the cash settlement has already taken place and there is simply an obligation to deliver charitable services rather than cash or another financial instrument.

(t) The following judgments (apart from those involving estimates) have been made in the process of applying the above accounting policies that have had the most significant effect on amounts recognised in the financial statements:

• The allocation of managing and support costs to specific activity. The key assumptions concerning the future and other key sources of estimation uncertainty at the reporting date that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year include:

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 30

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2021

(continued)

2 RESEARCH GRANTS

Restricted
Total
Total
General
Development
2021
2020
Grants:
CTU Infrastructure - NIHR
-
-
68,391
68,391
68,000
FEVER - NIHR HTA
-
-
-
-
28,858
MOSAIC - NIHR HTA
-
-
129,845
129,845
-
OPTIC-19 - COVID-19
Research Response
Fund - University of
Oxford
-
-
57,480
57,480
-
Risk II - NIHR HS&DR
-
-
-
22,880
COAST - JGHT
-
-
-
23,841
COAST Nutrition - EDCTP
-
-
96,796
96,796
65,639
RECoVER - EC
-
-
240,757
240,757
-
ECRAID-Base - EC
-
-
41,839
41,839
-
REMAP-CAP
(Convalescent Plasma) -
NIHR
-
-
171,696
171,696
-
REMAP-CAP
(PREPARE) - EC
-
-
113,096
113,096
205,659
Oxy-PICU - NIHR HTA
-
-
403,925
403,925
344,855
PICnIC - NIHR HTA
-
-
135,076
135,076
121,697
CAFE - NIHR HTA
-
-
-
33,368
FIRST -ABC - NIHR HTA
-
-
237,256
237,256
317,197
CIRCA - RC(UK)
-
-
20,098
20,098
14,923
PRESSURE - NIHR HTA
340,741
340,741
52,577
UK ROX - NIHR HTA
429,356
429,356
59,762
REMAP-CAP - NIHR
275,963
275,963
57,951
QResearch - Wellcome
-
-
62,421
QResearch COVID VAC
OX107 - HDR UK
49,170
49,170
-
Other
-
-
77,215
77,215
103,181
-
-
2,888,701
2,888,701
1,582,809
Unrestricted funds		 Total
2021
68,391
-
129,845
57,480
-
-
96,796
240,757
41,839
171,696
113,096
403,925
135,076
-
237,256
20,098
340,741
429,356
275,963
-
49,170
77,215		 Total
2020
68,000
28,858
-
-
22,880
23,841
65,639
-
-
-
205,659
344,855
121,697
33,368
317,197
14,923
52,577
59,762
57,951
62,421
-
103,181

All research income in 2020 was restricted.

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Page 31

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2021

(continued)

3 RESOURCES EXPENDITURE - RESEARCH

Restricted
Start date
Grant value
CTU Infrastructure - NIHR
09/01/2013
£800,636
FEVER - NIHR HTA
11/01/2016
£516,030
MOSAIC - NIHR HTA
01/03/2021
£1,710,519
OPTIC-19 - COVID-19
Research Response Fund -
University of Oxford
01/07/2020
£60,092
65 - NIHR HTA
03/01/2016
£1,071,497
Risk II - NIHR HS&DR
08/01/2016
£261,240
COAST - JGHT
10/01/2016
£278,636
COAST Nutrition - EDCTP
05/01/2018
£800,636
RECoVER - EC
11/06/2020
£609,850
ECRAID-Base - EC
01/03/2021
£523,696
REMAP-CAP (Convalescent
Plasma) - NIHR
01/04/2020
£171,696
REMAP-CAP (PREPARE) -
EC
01/01/2018
£284,772
Oxy-PICU - NIHR HTA
08/01/2019
£1,569,780
PICnIC - NIHR HTA
11/01/2019
£519,652
CAFE - NIHR HTA
02/01/2019
£298,562
FIRST -ABC - NIHR HTA
02/01/2019
£1,499,843
CIRCA - RC(UK)
06/01/2019
£70,719
PRESSURE - NIHR HTA
08/01/2020
£1,806,766
UK ROX - NIHR HTA
08/01/2020
£2,078,886
REMAP-CAP - NIHR
01/04/2020
£745,990
QResearch - Wellcome
03/01/2020
£83,228
QResearch COVID VAC
OX107 - HDR UK
08/01/2021
£49,170
Other
various
Unrestricted
Closed projects (Research)
4 RESTRICTED RESOURCES EXPENDITURE - AUDIT
National Cardiac Arrest Audit		 2021
£
68,391
-
116,540
47,361
-
-
-
63,335
240,757
41,839
171,696
55,950
310,342
113,713
-
174,618
20,098
272,514
337,073
184,017
-
42,044
80,553		 2020
£
68,000
28,858
-
-
16,393
22,880
75,807
99,100
-
-
-
262,805
364,835
138,351
45,460
317,197
14,923
52,577
59,762
57,951
62,421
-
81,872
2,340,839
1,769,192
(303,913)
-
2,036,926
1,769,192
2021
£
215,683		 2020
£
199,643

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 32

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2021

(continued)

5 TOTAL EXPENDITURE

Staff costs
Training
Recruitment
IT Development
Meetings - Audit
Board of Management &
committees
Travel
Premises
Legal/audit fees
Communications
Publications/printing
Post and carriage
Bank charges
Depreciation
Research expenditure
Other costs
Closed projects (Research)
Allocation of support costs		 Total
Total
Audit
Promoting
Data
Services
Support
costs
Governance
Research
grants
2021
2020
£
£
£
£
£
£
£
£
658,692
43,176
136,856
129,527
-
1,224,722
2,192,973
1,844,541
280
22
65
65
-
3,758
4,189
1,728
10,871
836
2,509
2,509
-
-
16,725
9,615
-
-
-
-
-
-
-
-
1,227
-
-
-
-
-
1,227
8,739
-
-
-
-
4,544
-
4,544
55
130
22
111
186
-
3,230
3,679
9,978
228,234
17,556
52,669
52,669
-
-
351,128
303,820
-
-
-
-
25,804
-
25,804
15,945
5,931
456
1,369
1,369
-
-
9,125
24,727
1,334
103
308
308
-
5,661
7,713
5,296
1,288
99
297
297
-
1,472
3,454
1,812
-
-
-
1,557
-
8
1,565
910
10,774
829
2,486
2,486
-
-
16,575
319,256
-
-
-
-
-
768,402
768,402
530,708
164,829
1,574
17,039
1,969
-
333,586
518,999
540,924
-
-
-
-
-
(303,913)
(303,913)
-
147,544
11,350
34,049
(192,942)
-
-
-
-
1,231,134
76,023
247,757
-
30,347
2,036,926
3,622,187
3,618,054
Audit expenditure includes
is the reallocated Manage
Operating leases costs tot		 unrestricted costs totalling £1,015,451 and restricted costs totalling £215,683. Allocation of support costs
ment and Administration after deduction for Governance and apportioned on the basisof staff costs.
alled £220,802 (£220,802 - 2020).

See appendix 1 on page 42 for 2020 comparative note.

6 GOVERNANCE

6 GOVERNANCE
Board of Management & committees
Legal and HR
Financial		 Unrestricted
Restricted
2021
2020
£
£
£
£
4,544
-
4,544
55
7,509
-
7,509
8,445
18,295
-
18,295
7,500
30,347
-
30,347
16,000

Travel and meeting costs were £4,544 of which, £804 (£55 - 2020) were reimbursed to 5 (4 - 2020) trustee members. Fees payable to the charity's auditors in respect of the audit and specialist advice were £12,895 (£7,500 - 2020). See appendix 2 on page 42 for 2020 comparative note.

7 INCOME

Incoming resources for charitable activities include: Unrestricted
Restricted
2021
2020
£
£
£
£
640,582
98,098
738,680
804,184
1,506,337
213,914
1,720,251
1,508,429
(753,183)
(110,639)
(863,822)
(738,680)
1,393,737
201,373
1,595,109
1,573,932
345,580
-
345,580
796,586
22,665
-
22,665
16,247
-
2,888,701
2,888,701
1,432,391
88,441
13,626
102,067
33,205
1,850,422
3,103,700
4,954,122
3,852,361
Audit Subscriptions deferred brought fwd
Audit Subscriptions received 2021
Less Audit Subscriptions deferred carried forward
Audit Subscriptions
COVID-19 income
Activities in promoting Audits
Research Grants
Other services
Incoming resources for charitable activities include:

Activities in promoting Audits include: software licensing £22,665 - (£14,637 - 2020), meeting, travel funding and speaker fees £19,721 - (£6,000 - 2020)

See appendix 3 on page 42 for 2020 comparative note.

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 33

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2021

(continued)

8 SURPLUS ON ORDINARY ACTIVITIES

8 SURPLUS ON ORDINARY ACTIVITIES
Unrestricted
Restricted
The surplus is stated after charging:		 2021
2020
£
£
16,575
-
12,895
-

Depreciation and amortisation
Auditors' remuneration		 £
£
16,575
319,256
12,895
7,650
Auditors' remuneration -
prior year under accrual
5,400
-		 5,400
2,250
9 STAFF COSTS AND NUMBERS
Salaries
Social security costs		 2021
2020
£
£
1,741,275
1,553,586
169,843
153,312
Pension 103,204
83,288
Seconded and agency staff 178,651
54,356
2,192,973
1,844,541
The number of employees receiving emoluments in excess of £60k:
£60,000 - £69,999
£70,000 - £79,999		 1
1
1
1
£80,000 - £89,000 -
-
£100,000 - £110,000 1
-
£110,000 - £120,000 -
1

The monthly average numbers employed during the year calculated on the basis of actual headcount:

Executive
Audit
Research		 No.
No.
1
1
11
10
13
10
Statistics
Data & Data Systems		 6
-
7
-
Statistics & IT Development -
11
Operations 7
8
45
40
The company operates a Group Personal Pension scheme. Contributions to the Group Personal

The company operates a Group Personal Pension scheme. Contributions to the Group Personal Pension Scheme in 2021 were £103,204 (£83,288 in 2020).

The amount of pension contribution to higher paid staff in 2021 was £22,793 (£23,384 in 2020).

The number of employees eligible to participate in the Group Personal Pension scheme at the end of 2021 is 45 (44 in 2020).

The number of employees auto-enrolled at the end of 2021 is 12 (13 in 2020).

The Trustees and Director are the key management personnel of the company. The Trustees, being in a voluntary position, receive no remuneration from the organisation (2020 Nil). The Director received total emoluments of £131,914 (2020: £136,963).

There were no contractual redundancy costs included in total salaries for 2021 (2020: £2,152).

10 TAXATION

The company is exempt from income and corporation taxes under S466 to S493 Corporation Tax Act 2010 (CTA 2010).

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 34

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2021

(continued)

11 TANGIBLE FIXED ASSETS
Cost at 1 January 2021
Additions
Disposals
At 31 December 2021
Depreciation at 1 January 2021		 Office
Computer
Office
Office
fabrication
equipment
equipment
furniture
Total
£
£
£
£
£
49,460
157,054
20,084
55,415
282,012
-
13,237
13,237
-
-
-
-
49,460
170,291
20,084
55,415
295,249
47,389
144,378
20,084
44,021
255,871
Depreciation for the period 651
11,913
4,011
16,575
Disposals
At 31 December 2021		 -
-
-
-
48,040
156,291
20,084
48,032
272,446
Net book value at 31 December 2021 1,420
14,000
-
7,383
22,803
Net book value at 31 December 2020
11a INTANGIBLE ASSETS
Cost at 1 January 2021
Additions
Disposals
At 31 December 2021
Amortisation at 1 January 2021		 2,071
12,676
-
11,394
26,141
Software
IT
Development
Total
£
£
£
45,400
248,521
293,921
-
-
-
-
-
-
45,400
248,521
293,921
45,400
248,521
293,921
Amortisation for the period -
-
-
Disposals
At 31 December 2021
Net book value at 31 December 2021
Net book value at 31 December 2020
12 DEBTORS
Trade debtors
Research projects
Prepayments		 -
-
-
45,400
248,521
293,921
-
-
-
-
-
-
Unrestricted
Restricted
2021
2020
£
£
£
£
779,932
-
779,932
1,372,280
-
2,012,293
2,012,293
1,211,262
102,036
-
102,036
127,390
881,968
2,012,293
2,894,261
2,710,932
See appendix 4 onpage 43 for 2020 comparative note.

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 35

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2021 (continued)

13 CREDITORS Unrestricted Restricted Restricted 2021 2020
£ £ £ £
Trade creditors 112,850 - 112,850 145,340
Other creditors 16,357 - 16,357 17,064
Accruals 93,799 1,413,037 1,506,836 1,294,138
Taxation & Social Security 144,897 - 144,897 226,035
Deferred income (note 16) 880,689 1,017,778 1,898,467 1,229,788
1,248,592 2,430,815 3,679,407 2,912,364
See appendix 5 on page 43 for 2020 comparative note.
14 CREDITORS: AMOUNTS FALLING DUE AFTER ONE YEAR
2021 2020
£ £
Dilapidations 150,000 75,000
150,000 75,000
The dilapidation provision recognises the obligation to restore existing offices to their original
state at the end of the new lease which expires in March 2027.
15 PROVISIONS FOR LIABILITIES
2021 2020
£ £
VAT Review 50,000 50,000
50,000 50,000
Despite work carried out in 2020 and 2021 to reconcile prior VAT liabilities, the provision for
VAT reflects the potential for VAT

16 DEFERRED INCOME

Deferred income comprises audit and research income payable annually and income deferred in the Clinical infrastructure fund.

infrastructure fund.
2021 2020
£ £
Balance at 1st January 2021 1,229,788 1,035,015
Amount released to incoming resources (1,229,788) (1,035,015)
Deferred audit 863,822 738,680
Deferred clinical infrastructure 16,609 17,000
Deferred research 1,001,169 289,703
Deferred other 16,867 184,405
Balance at 31 December 2021 1,898,467 1,229,788

Deferred other relates to COVID-19 income received in advance.

17 ANALYSIS OF NET ASSETS BETWEEN FUNDS

Unrestricted Funds Unrestricted Funds Restricted 2021 2020
General Designated
Funds
£ £ £ £ £
Fixed assets 22,803 - - 22,803 26,141
Current assets 2,781,020 450,000 2,862,360 6,093,380 3,916,066
Creditors due within one year (1,248,592) - (2,430,815) (3,679,407) (2,912,366)
Creditors due more than one year (200,000) - - (200,000) (125,000)
1,355,231 450,000 431,545 2,236,776 904,841

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page ~~36~~

Intensive Care National Audit and Research Centre

Notes to the Accounts For the year ended 31 December 2021

(continued)

18 RESERVES

The movement in the reserves were as follows:

At 1 Jan
At 31 Dec
Restricted Funds
Research Grants:		 2021
Income
Expenditure
Transfers
2021
£
£
£
£
£
CTU Infrastructure - NIHR -
68,391
(68,391)
-
MOSAIC - NIHR HTA
-
129,845
(116,540)
13,305
65 - NIHR HTA
(18,829)
-
-
(18,829)
OPTIC-19 - COVID-19 Research
Response Fund - University of
Oxford
-
57,480
(47,361)
10,118
COAST Nutrition - EDCTP
(33,461)
96,796
(63,335)
-
RECoVER - EC
240,757
(240,757)
-
ECRAID-Base - EC
41,839
(41,839)
-
REMAP-CAP (Convalescent Plasma) - NIHR
171,696
(171,696)
-
RRAM - NIHR HTA
(1,140)
-
-
(1,140)
REMAP-CAP (PREPARE) - EC
(57,146)
113,096
(55,950)
-
Oxy-PICU - NIHR HTA
PICnIC - NIHR HTA
CAFE - NIHR HTA
FIRST -ABC - NIHR HTA
CIRCA - RC(UK)
PRESSURE - NIHR HTA		 (19,980)
403,925
(310,342)
73,603
(16,654)
135,076
(113,713)
4,710
(12,093)
-
-
(12,093)
-
237,256
(174,618)
62,639
-
20,098
(20,098)
-
-
340,741
(272,514)
68,228
UK ROX - NIHR HTA -
429,356
(337,073)
92,283
REMAP-CAP - NIHR
QResearch COVID VAC OX107 -
HDR UK		 -
275,963
(184,017)
91,946
-
49,170
(42,044)
7,126
Other 21,309
77,215
(80,553)
17,972
Total grants (137,993)
2,888,701
(2,340,839)
-
409,869
Audit:
National Cardiac Arrest Audit 22,360
214,999
(215,683)
21,676
Total Restricted Funds (115,633)
3,103,700
(2,556,522)
-
431,545
Unrestricted Funds
Development Fund (designated)		 450,000
-
-
450,000
General Fund 570,474
1,850,422
(1,065,665)
-
1,355,231
1,020,474
1,850,422
(1,065,665)
-
1,805,231
At the end of the year 904,841
4,954,122
(3,622,187)
-
2,236,776

Purposes of restricted funds

Resourced against awarded scientific research grants. At times income is received in advance of expenditure. In the case of closed research grants funds are witheld until the funder deems the project to be satisfactorily closed. This may take up to 3 Some funding for research projects may not provide sufficient monies to cover all costs, including overheads, and result in a deficit being incurred. When such deficits arise they will be balanced from general funds on completion of the project if the corrected prior to completion. Please refer to the Acronyms table on page 39 for the description and purpose of the restricted funds.

Purpose of designated funds

The Development Fund was increased by £400,000 in 2020 to provide sufficient resources for the ongoing development of platform to collate and analyse national and comparative data for the audit of patient outcome for intensive care and high dependency care and the associated research therein. It will be expended over the next 2 years.

See appendix 6 on page 43 for 2020 comparative note.

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Intensive Care National Audit and Research Centre

Notes to the Accounts For the year ended 31 December 2021

(continued)

19 RELATED PARTY TRANSACTIONS

There are no related party transactions in the year (£0 - 2021) that require disclosure other than the Trustees' expenses in note 6.

20 ULTIMATE CONTROLLING PARTY

The Trustees are of the opinion that there is no one controlling party of the charitable company.

21 PENSION COMMITMENTS

The Charity operates a defined contributions pension scheme. The assets of the scheme are held separately from those of the Charity in an independently administered fund. The pension cost charge represents contributions payable by the Charity to the fund and amounted to £103,204 (2020: £83,288). Contributions totalling £16,357 (2020: £15,192) were payable to the fund as at 31 December 2021 and included in the Statement of Financial Position.

22 OPERATING LEASE COMMITMENTS

The total future minimum lease payments under non-recoverable operating leases for land, buildings and equipment are shown below, analysed according to the expiry date of the lease.

Land and buildings
Within one year
Between one and two years
Between three and five years
Over five years
Equipment
Within one year
Between one and two years
Between two and five years
Total		 2021
2020
£
£
70,826
169,983
169,983
42,496
509,949
-
28,331
-
779,089
212,479
2,378
2,378
2,378
2,378
1,188
3,567
5,944
8,323
785,033
220,802

23 CAPITAL COMMITMENTS

The next stage of ICNARC's infrastructure projects commenced in 2021 with the establishment of a new Data and Data Services team and upgrades and new developments of the IT Platform at an estimated future costs of circa £450,000. Funds to support this project have been designated.

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Intensive Care National Audit and Research Centre

Notes to the Accounts For the year ended 31 December 2021

(continued)

Acronyms used in the Financial Statements

Study acronym- Funder Name Description of study
CTU Infrastructure - NIHR Clinical trials unit Infrastructure
Funding		 Infrastructure (staff, training, etc.) funding for our
UKCRC registered clinical trials unit.
FEVER - NIHR HTA Fever management in critially ill
children with infection.		 Pilot, multicentre randomised clinical trial evaluating
a more permissive (a higher) temperature threshold
before starting temperature lowering treatments to
improve survival for critically ill children with known
or suspected infection.
65 - NIHR HTA Permissive hypotension in
critically ill patients aged 65 years
or over with vasodilatory
hypotension
Multicentre randomised clinical trial evaluating
permissive hypotension (a lower blood pressure) to
guide blood pressure raising drugs to improve
survival for critically ill adults, aged 65 years or
over, with vasodilatory hypotension.
Risk II - NIHR HS&DR Risk modelling for quality
improvement in the critically ill		 Statistical modelling to be able to predict longer-
term outcomes in critically ill adults.
COAST - JGHT Children’s Oxygen Administration
Strategies Trial		 Multicentre randomised clinical trial evaluating
permissive (a lower) oxygen saturation to guide
oxygen therapy to improve survival in critically ill
children with severe pneumonia.
COAST Nutrition - EDCTP Children’s Oxygen Administration
Strategies Trial - Nutrition		 Built on COAST, a multicentre clinical trial
evaluating additional nutritional support, post-
discharge from hospital, to improve survival in
crtically ill children recovering from severe
pneumonia.
RRAM - NIHR HTA Renal Replacement
Anticoagulant Management		 Observational study evaluating the implementation
of citrate anticoagulation for continuous renal
replacement therapy to improve survival for critcally
ill adults receiving continuous renal replacement
therapy.
REMAP-CAP (PREPARE) - EC Randomized, Embedded,
Multifactorial, Adaptive Platform
trial for Community-Acquired
Pneumonia (and COVID-19)		 International adaptive platform randomised clinical
trial evaluating multiple interventions to understand
the optimal treatment strategy to improve survival
for critically ill patients with community acquired
pneumonia, including COVID-19.
Oxy-PICU - NIHR HTA Randomised multicentre trial of
conservative versus liberal
oxygenation targets in critically ill
children		 Multicentre randomised clinical trial evaluating
permissive (a lower) oxygen saturation to guide
oxygen therapy to improve survival in critically ill
children who are receiving mechanical ventilation.

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Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2021

(continued)

Intensive Care National Audit and Research Centre
Notes to the Accounts
For the year ended 31 December 2021
(continued)		 Intensive Care National Audit and Research Centre
Notes to the Accounts
For the year ended 31 December 2021
(continued)		 Intensive Care National Audit and Research Centre
Notes to the Accounts
For the year ended 31 December 2021
(continued)
Acronyms used in the Financial Statements
Study acronym- Funder Name Description of study
PICnIC - NIHR HTA Paediatric Intensive Care and
Infection Control		 Pilot, multicentre randomised clinical trial evaluating an
infection control strategy to improve survival for critically ill
children who are receiving mechanical ventilation.
CAFE - NIHR HTA Critical care Atrial Fibrillation
Evaluation		 Literature review and database analysis to estimate how
effective current treatments for new onset atrial fibrilation (a
fast, irregular heartbeat) are when they occur in the critical
care unit.
FIRST-ABC - NIHR HTA FIRST-line support for
Assistance in Breathing in
Children		 Multicentre randomised clinical trial evaluating hi flow nasal
cannula (delivering oxygen via nasal prongs) to improve
recovery for critically ill children requiring non-invasive
respiratory support.
CIRCA - RC(UK) Critical Illness-Related Cardiac
Arrest		 Observational study to understand the frequency of patients
having a cardiac arrest in the critical care unit, their survival
and, for those that recover, their longer-term quality of life.
PRESSURE - NIHR HTA Evaluating the clinical and cost
effectiveness of using a more
permissive blood pressure target
to guide careful titration of
vasoactive agents in critically ill
children with hypotension:
PRotocolised Evaluation of
PermiSSive hypotension versus
Usual care(PRESSURE)		 Aims to find out the best blood pressure target to use for
children in paediatric intensive care units (PICUs). We plan to
conduct a clinical trial testing a lower blood pressure target
(depending upon age) in children with hypotension
against current usual practice.
UK ROX - NIHR HTA Evaluating the clinical and cost-
effectiveness of a conservative
approach to oxygen therapy for
invasively ventilated adults in
intensive care (UK ROX)		 Trial to find out whether using a lower oxygen target
(conservative oxygen
therapy) to guide oxygen treatment might lead to better
outcomes for patients when compared with the approach
currently used in NHS ICUs (usual oxygen therapy). The
study will include 16,500 patients from 100 UK NHS ICUs.
Patients will be randomly assigned to either the conservative
oxygen therapy or usual oxygen therapy group.
REMAP-CAP - NIHR Randomized, Embedded,
Multifactorial Adaptive Platform
Trial for Community-Acquired
Pneumonia		 A randomised controlled trial for patients admitted to the
intensive care unit (ICU) with severe
Community-Acquired Pneumonia (CAP). All patients with
severe CAP who are treated in an ICU will receive a
combination of multiple different treatments. For many of
these treatments, different options are available and used
variablyin current standard practice.
QResearch - Wellcome OX79 Coronavirus Record
Linkage Project - QResearch-
ICNARC COVID-19
Collaboration		 Link of QResearch, SystmOne and ICNARC CMP data to
look at the association between prior medication and
outcome for patients most severely affected by COVID-19
infections.

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Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2021

(continued)

Acronyms used in the Financial Statements

Study acronym- Funder Name
 Description of study
RECoVER - EC Rapid European COVID-
19/SARS-CoV-2 Emergency
Research response (RECOVER)		 The EU-funded RECoVER project constitutes a
comprehensive research response against SARS-CoV-
2, aiming to address patient and public health level
interventions buidling upon expertise from the the FP7
PREPARE project and will undertake clinical studies in
primary and hospital care as well as epidemiological
and biological investigations and modelling to fill
knowledge gaps on SARS-CoV-2 infectivity and
transmission.
ECRAID-Base - EC European Clinical Research
Alliance on Infectious
Diseases		 A pan-European, single-access, sustainable clinical
research network for infectious diseases, ECRAID is
intended to reduce the impact of infectious diseases on
individual and population health by generating rigorous
evidence to improve the diagnosis, prevention and
treatment of infections and to better respond to
infectious disease threats. The network will function as
the backbone of clinical research activities, providing an
efficient infrastructure capable
to perform all clinical trial aspects, from study design to
scientific publication.
MOSAIC - NIHR HTA Multicentre evaluation Of Sodium
bicarbonate in Acute kidney
Injury in Critical Care
Clinical trial to provide an evidence base for whether
using sodium bicarbonate to treat critically ill people with
acidosis and AKI improves survival and is cost-effective
for the NHS.
Other acronyms
CMP Case Mix Programme n/a
NCAA National Cardiac Arrest Audit n/a
INICUA Irish National Intensive Care Unit
Audit		 n/a
NIHR Research
y		 n/a
HSDR Research Programme n/a
HTA Health Technology Assessment
Programme		 n/a
JGHT Joint Global Health Trials n/a
EDCTP European and Developing
Countries Clinical Trials
Partnership		 n/a
EC European Commission n/a
APCC Annual Participants Cost
Contribution		 n/a

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 41

APPENDICES

2020 Comparatives

Appendix 1

5 TOTAL EXPENDITURE

Staff costs
Training
Recruitment
IT Development
Meetings - Audit
Board of Management &
committees
Travel
Premises
Legal/audit fees
Communications
Publications/printing
Post and carriage
Bank charges
Depreciation
Research expenditure
Other costs
Allocation of support costs		 Unrestricted
Restricted
Total
Total
Audit
Promoting
Data
Services
Support
costs
Governance
Audit
Research
grants
2020
2019
£
£
£
£
£
£
£
£
£
709,630
54,587
163,761
163,761
-
90,075
662,727
1,844,541
1,660,514
(502)
(39)
(116)
(116)
-
-
2,500
1,728
15,968
6,250
481
1,442
1,442
-
-
-
9,615
18,159
-
-
-
-
-
-
-
-
(55,592)
3,642
280
840
840
-
-
3,137
8,739
68,283
-
-

-
-
55
-
-
55
-
3,091
238
713
713
-
-
5,223
9,978
51,286
197,483
15,191
45,573
45,573
-
-
-
303,820
228,144
-
-
-
-
15,945
-
-
15,945
13,687
15,975
1,229
3,686
3,686
-
-
151
24,727
32,943
2,478
191
572
572
-
-
1,484
5,296
1,104
955
73
220
220
-
-
344
1,812
2,230
-
-
-
910
-
-
-
910
1,372
207,516
15,963
47,888
47,888
-
-
-
319,256
60,257
-
-
(44,626)
-
-
-
575,334
530,708
282,766
56,390
4,338
13,013
13,013
-
109,568
344,603
540,924
366,133
212,973
16,383
49,148
(278,504)
-
-
-
-
-
1,415,881
108,914
282,116
-
16,000
199,643
1,595,500
3,618,054
2,747,252

Allocation of support costs is the reallocated Management and Administration after deduction for Governance and on the basis of staff costs. Operating leases costs totalled £220,802 (£177,414 - 2019).

Appendix 2

6 GOVERNANCE

Appendix 2
6 GOVERNANCE
Board of Management & committees
Legal and HR
Financial		 Unrestricted
Restricted
2020
2019
£
£
£
£
55
-
55
6,946
8,445
-
8,445
8,858
7,500
-
7,500
4,829
16,000
-
16,000
20,633

Travel and meeting costs amounting to £55 (£6,946 - 2019) were reimbursed to 4 (9 - 2019) trustee members.

Fees payable to the charity's auditors in respect of the audit and specialist advice were £7,500 (£4,590 - 2019).

Appendix 3 7 INCOME

Appendix 3
7 INCOME
Incoming resources for charitable activities include: Unrestricted
Restricted
2021
2020
£
£
£
£
Audit Subscriptions deferred brought fwd 700,374
103,810
804,184
781,596
Audit Subscriptions received 2020
Less Audit Subscriptions deferred carried forward
Audit Subscriptions
COVID-19 income
Activities in promoting Audits
Research Grants
Other services
Incoming resources for charitable activities include:		 1,313,854
194,575
1,508,429
1,525,140
(640,582)
(98,098)
(738,680)
(804,184)
1,373,645
200,287
1,573,932
1,502,552
646,168
150,418
796,586
-
16,247
-
16,247
38,079
-
1,432,391
1,432,391
1,183,779
33,205
-
33,205
17,319
2,069,265
1,783,096
3,852,361
2,741,729

Activities in promoting Audits include: training £0 - (£6,175 - 2019) software licensing £14,637 - (£23,605 - 2019), meeting, travel funding and speaker fees £6,600 - (£8,299 - 2019)

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Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2021

(continued)

For Notes to the Ac
the year ended 31 D
(continued
Appendix 4
12 DEBTORS Unrestricted
Restricted		 2020
2019
£
£		 £
£
Trade debtors
Other debtors
Work in progress
Research projects
Prepayments		 1,372,280
-
-
-
-
-
-
1,211,262
127,390
-		 1,372,280
345,759
-
30,607
-
-
1,211,262
754,605
127,390
77,301
1,499,670
1,211,262		 2,710,932
1,208,272
2020
2019
Appendix 5
£
£
145,340
66,034
17,064
14,347
1,294,138
1,084,270
226,035
108,734
1,229,788
1,035,015
1,286,270
1,626,094		 2,912,364
2,308,400

Appendix 6

18 RESERVES

The movement in the reserves were as follows:

Restricted Funds
Research Grants:
CTU Infrastructure - NIHR
FEVER - NIHR HTA
65 - NIHR HTA
Risk II - NIHR HS&DR
COAST - JGHT
COAST Nutrition - EDCTP
RRAM - NIHR HTA
REMAP-CAP (PREPARE) - EC
Oxy-PICU - NIHR HTA
PICnIC - NIHR HTA
CAFE - NIHR HTA
FIRST -ABC - NIHR HTA
CIRCA - RC(UK)
PRESSURE - NIHR HTA
UK ROX - NIHR HTA
REMAP-CAP - NIHR
QResearch - Wellcome
Other
Total grants
Audit:
National Cardiac Arrest Audit
Total Restricted Funds
Unrestricted Funds
Development Fund (designated)
General Fund
At the end of the year		 At 1 Jan
At 31 Dec
2020
Income
Expenditure Transfers
2020
£
£
£
£
£
68,000
(68,000)
-
28,858
(28,858)
-
(2,436)
-
(16,393)
(18,829)
22,880
(22,880)
-
23,841
(75,807)
51,965
-
65,639
(99,100)
(33,461)
(1,140)
-
-
(1,140)
205,659
(262,805)
(57,146)
344,855
(364,835)
(19,980)
121,697
(138,351)
(16,654)
33,368
(45,460)
(12,093)
317,197
(317,197)
-
14,923
(14,923)
-
52,577
(52,577)
-
59,762
(59,762)
-
57,951
(57,951)
-
62,421
(62,421)
-
103,181
(81,872)
21,309
(3,576)
1,582,809
(1,769,192)
51,965
(137,993)
21,716
200,287
(199,643)
22,360
18,140
1,783,096
(1,968,835)
51,965
(115,633)
50,000
-
-
400,000
450,000
602,393
2,069,265
(1,649,219)
(451,965)
570,474
652,393
2,069,265
(1,649,219)
(51,965)
1,020,474
670,534
3,852,361
(3,618,054)
-
904,841

Purposes of restricted funds

Resourced against awarded scientific research grants. At times income is received in advance of expenditure. Some funding for research projects do not provide sufficient monies to cover all costs, including overheads, and result in a deficit being incurred.

When such deficits arise they will be balanced from general funds on completion of the project if the deficit is not corrected prior to completion.

Purpose of designated funds

The Development Fund has been increased by £400,000 in 2020 to provide sufficient resources for the ongoing development of the platform to collate and analyse national and comparative data for the audit of patient outcome for intensive care and high dependency care and the associated research therein. It will be expended over the next 2 years.

Intensive Care National Audit and Research Centre | Annual Report and Accounts 2021

Page 43