2022-12-31-accounts

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Working together to improve care and outcomes

Intensive Care National Audit and Research Centre Annual Report and Accounts | Year ended 31 December 2022

www.icnarc.org

About ICNARC …………………………………………………………………….2 Messages from the Chair and Director .......................................................... 3 Trustees report ............................................................................................. 4 Progress against priorities for 2022 ............................................................... 5 Establishing quality through research .......................................................... 7 Research highlights - 2022 ........................................................................ 8 Our plans for research - 2023 .................................................................... 9 Assessing quality through audit .................................................................. 10 Audit highlights - 2022 ............................................................................. 11 Our plans for audit - 2023 ........................................................................ 12 Promoting quality through sharing information ........................................... 13 Our plans for sharing information – 2023 ................................................ 15 Financial review ......................................................................................... 16 Governance, structure and management ................................................ 19 Statement of Trustees’ responsibilities .................................................... 22 Independent auditor’s report to the Members of the Intensive Care National Audit and Research Centre ........................................................... 23 Financial statements Statement of Financial Activities ............................................................. 26 Balance Sheet ........................................................................................ 27 Statement of Cash Flows ....................................................................... 28 Notes to the Accounts ............................................................................ 29

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 1

About ICNARC

In the UK, each year, over 200,000 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, outcome and experience – for patients and for those who care for them.

We achieve this by creating and sharing information about the quality of critical care to those who finance, commission, manage, deliver and experience critical care (both within and outside the NHS) through our national clinical audits and through our clinical and health services research studies.

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

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022

Page 2

Message from the Chair

Sue James | Chair

2022 marked the development of a new normal for ICNARC. We began to return to research studies that had been temporarily suspended during the pandemic, and to grapple with a rapidly rising cost of living, and possible significant cuts in government research funding. We carried out this refresh and reset work whilst coming to terms with our own new ways of working as described by the Director, Kathy Rowan, in her message.

A number of our clinical and academic Trustees retired during 2022, and we embarked on a recruitment process to replace them and to add strength and depth to our Board. ICNARC’s high profile, as a result of the work carried out during the COVID-19 pandemic generated a wide interest in these posts, and we were fortunate to be able to recruit three new clinical and academic Trustees, who are based throughout the UK, and who have all worked with ICNARC in the context of their own research portfolios.

Peter Hyde’s appointment, as our first Chief Operating Officer, has enabled us to consolidate our operational governance arrangements, and to ensure that the day-to-day management of ICNARC is undertaken effectively. This enabled Trustees to continue to support the Director’s reduction in her direct hours working for ICNARC as part of her ongoing secondment (since October 2021) to the National Institute for Health and Care Research as the Programme Director for the Health & Social Care Delivery Research programme – a first step in her plans to stepdown as ICNARC Director.

I am most grateful to all our staff for their skill, professionalism and enthusiasm and look forward to them continuing to deliver ICNARC’s highly valued work as we change and adapt to a post-pandemic world.

Message from the Director

Kathy Rowan I Director

The legacy and ongoing shadow of the COVID19 pandemic remained apparent during 2022…

Staff well-being remained at the top of the Senior Management Team’s priorities and central to our ongoing recovery. To encourage communication (with staff predominantly working virtually as 2022 dawned…), ICNARC continued its quarterly, in-person, staff meetings – held at an external location – with agendas covering review and actions informed by our business planning. 2022 also saw the return of in-person, social events. Additionally, recognising the very difficult economic climate, as Director, I secured an early, mid-year, inflation-adjusted salary increase for all staff.

2022 saw the planning, structuring and realisation of hybrid working – a very different way of working from pre-pandemic – which was formally introduced in July 2022 for review in 2023. In November 2022, ICNARC was pleased to welcome the appointment of a full-time Chief Operating Officer – Mr Peter Hyde.

While the start of 2022 continued, as 2021, with producing regular and ad hoc analyses on patients critically ill with COVID-19 (for the Cabinet Office, the Department of Health & Social Care, NHS England/Devolved Nations, etc.), getting our audit, research and data services back on track and planning for the future were a major focus with, from mid-year, staff able to attend and present at national and international meetings/conferences. ICNARC also hosted/co-hosted our reinstated, in-person, annual meetings for staff from hospitals participating in our audit, research and data services. 2022 also saw active re-engagement with all our important stakeholder organisations, including my presenting data on the impact of critical care to the All-Party Parliamentary Group for the Intensive Care Society.

Finally, on a personal note, 2022 saw me pick up my OBE (with my mentor of 35 years in attendance to witness…) and my formal declaration of my intention to step down as Director in 2023…

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 3

Trustees report

The Trustees present their Annual Report together with the audited financial statements of the Charity for the year ended 31 December 2022. The Trustees confirm that the Annual Report and financial statements of the Charity comply with the current statutory requirements, the requirements of the company's governing document and the provisions of the Statement of Recommended Practice (SORP), applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102). Since the Charity qualifies as small under section 383, the strategic report required of medium and large companies under The Companies Act 2006 (Strategic Report and Director's Report) Regulations 2013 is not required.

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 how we are developing and expanding our research portfolio within our Clinical Trials Unit (page 7)

…assessing quality through audit

Read more about how we are developing and expanding our national clinical audits within our National Audit Programme (page 10)

…promoting quality through sharing information

Read more about how we are analysing data and sharing information (page 13)

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 4

Progress against priorities for 2022

Three key themes underpin our priorities:

Work across all regions and nations of the UK and internationally

extending our reach will increase the impact of our activities

Diversify to embrace new methods and areas

as care for the critically ill evolves, our activities will respond

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

co-design and co-production will increase the value of our activities

Work across all regions and nations of the UK and internationally

Maintained our national clinical audits
Grew our research portfolio in both adult and paediatric critical care
Re-established research studies paused by funders during the COVID-19 pandemic
Continued to work internationally to facilitate UK co-ordination of the global trial REMAP-CAP

Diversify to embrace new methods and areas

Enhanced our scientific culture with mentoring, teaching, conference participation and seminars
Adapted to the hybrid world with a mixture of a return to in person annual meetings alongside an enhancement of online ways of working such as webinars

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

Maintained and continued to develop our internal and external, national and international collaborations
Maintained patient, carer and public involvement and engagement in all our work

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 5

Five important enablers underpin our priorities:

Governance

good governance will underpin all we do

People and culture

a high-performance culture and a stimulating, rewarding environment will attract and retain staff

Communication

good communication with key audiences will increase our potential for impact

Financial sustainability

good business and financial planning will underpin all we do

Technology

transforming technology will make us more efficient and responsive

Governance

 Continued to improve regulatory infrastructure, systems and processes

 Established Pension Governance Committee as Board sub-committee

People and culture

 Transitioned back to office working, adopting a hybrid model

 Reviewed and improved staff benefits package

Communication

 Commenced project to create new ICNARC website

 Recommenced in person annual meetings for our national clinical audits

Financial sustainability

 Continued to improve our financial systems to improve accountability

Technology

 Continued to improve our IT infrastructure/systems

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 6

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.

“…the unit provided clear evidence of operational experience in the design and delivery of large-scale multicentre clinical trials…”

International Expert Panel, UK Clinical Research Collaboration

Research – 2022

----- Start of picture text -----
research research research research
2 grants 4 studies 9 studies 2 studies
awarded in commenced in ongoing in completed in
2022 2022 2022 2022
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Development of our research portfolio continues in adult and paediatric critical care.

Adult critical care research studies

Awarded Commenced Ongoing Completed  EXAKT  T4P  CIRCA  TEAM  REMAP-CAP Flu  EXAKT  REMAP-CAP  CLASSIC  REMAP-CAP Flu  UK-ROX  MOSAICC

Paediatric critical care research studies

----- Start of picture text -----
Awarded Commenced Ongoing
  GASTRIC-PICU  COAST-Nutrition 
 FIRST-ABC

Oxy-PICU
 PICnIC
 PRESSURE
----- End of picture text -----

Completed

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 7

Research highlights – 2022

FIRST-ABC Step-Up clinical trial

Randomised, multicentre randomised trial in acutely ill children assessed to require non-invasive respiratory support
Second trial under a master protocol evaluating first-line use of high-flow nasal cannula therapy (HFNC) compared to continuous positive airway pressure (CPAP)
HFNC has become a popular mode of non-invasive respiratory support due to its ease of use, perceived greater patient comfort
600 children enrolled across 24 paediatric critical care units
HFNC was observed to be no worse that CPAP
On average children were free of respiratory support within 52.9 hours for HFNC compared to 47.9 hours for CPAP
Funded by the National Institute for Health and Care Research (NIHR)
Published in the Journal of the American Medical Association

Regional citrate anticoagulation

Approximately 10% of critically ill patients receive kidney replacement therapy (KRT)
Since 2012, many intensive care units (ICUs) have transitioned from systemic heparin anticoagulation (SHA) to regional citrate anticoagulation (RCA) for continuous KRT
We evaluated the clinical and health economic impacts of ICU transition to RCA through analysis of routinely collected data
61% of ICUs had transitioned to RCA
69,001 patients who received continuous KRT were analysed
No change in 90-day mortality, but increased in length of ICU stay and organ support associated with transition to RCA
Costs increased with RCA
Funded by the NIHR
Published in the Journal of Critical Care

Risk Modelling II

It is important to better understand the risk factors for, and long-term consequences of, critical illness
Routinely collected data used for information on risk factors and additional outcome measures to improve risk models used to underpin national clinical audits
965,576 admissions in CMP and 83,939 resuscitation team visits in NCAA linked with UK Renal Registry, National Diabetes Audit, National Adult Cardiac Surgery Audit, Hospital Episode Statistics and Office for National Statistics death registration by NHS Digital
Risk models developed included: mortality up to 1 year; development of end-stage renal disease; development of type 2 diabetes; and hospital resource use and costs for critical care admissions; for adult cardiothoracic care; and for inhospital cardiac arrest
Funded by the NIHR
Published in the NIHR Health and Social Care Delivery Research Journal

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 8

Our plans for research – 2023

We will prioritise identification, and development of studies using new methodologies, such as a platform trial in paediatric critical care.
We will work with our research sites, funders and Sponsors to effectively progress our research studies (after delays due to COVID-19).
We will continue to partner with patients, carers and the public in the design and management of our research studies and promote equality, diversity and inclusion.
We will continue to strengthen our clinical trials unit infrastructure to ensure delivery of high quality clinical trials.
We will continue to increase the efficiency of our research, including maximising the use of routinely collected data.
We will continue to identify priority areas for research and potential new funders to ensure a balanced research pipeline.
We will continue to lead and collaborate on national and international research studies into adult and paediatric emergency and critical care.
We will continue to aim for the highest level of impact from our research studies.
We will continue to support/provide working opportunities for clinical/non-clinical associates/researchers and invest in our/others’ research studies through academic collaboration and citizenship.

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

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 9

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 (and 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 for Cardiothoracic Intensive Care is the national clinical audit of patient outcomes from adult cardiothoracic critical care units in the UK.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 10

Audit highlights – 2022

Case Mix Programme

290 NHS/non-NHS adult critical care units participating
200,000 critical care admission records submitted and validated
90% of critical care units transitioned to Version 4.0 of the dataset
Received exemption from the national data opt-out

National Cardiac Arrest Audit

193 hospitals participating
13,000 team visit records submitted and validated
Dataset update released, incorporating change to modified Rankin Scale as functional outcome measure
Received exemption from the national data opt-out

Irish National Intensive Care Unit Audit

26 adult critical care units participating
11,000 critical care admission records submitted and validated
All units transitioned to Version 4.0 of the dataset, bringing collected data closer in line with that collected for the Case Mix Programme

Assessment of Risk in Cardiothoracic Intensive Care

ARCtIC continued, embedded within the Case Mix Programme
28 specialist cardiothoracic critical care units participating

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 11

Our plans for audit – 2023

We will continue to maintain and increase coverage of our national clinical audits and, where appropriate, continue to develop and extend our audit services, including our audit pilots.
We will continue to develop our collaborations with the Resuscitation Council UK, the National Office of Clinical Audit in Ireland and the Association for Cardiothoracic Anaesthesia and Critical Care.
We will continue to develop and upgrade our audit platform.
We will complete the transition of the National Cardiac Arrest Audit (NCAA) to Platform X.
We will continue to develop the content of our national clinical audits, including introducing longer term outcomes.
We will develop and implement a family satisfaction audit.

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

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 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), and through peerreviewed 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 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.

Sharing information highlights – 2022

In 2022, our focus shifted from COVID-19 back to normal routine activities. However, COVID-19 public reporting continued – moving from weekly to monthly and then quarterly as the numbers of patients critically ill with COVID-19 reduced.

Audit reporting

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1,086 667 80 21
CMP/ARCtIC NCAA INICUA Weekly/monthly/
quarterly quarterly quarterly quarterly
critical care unit hospital critical care unit COVID-19
reports reports reports reports
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With the end to the pandemic, there was also a return to face-to-face events and we were pleased to host the first Case Mix Programme Annual Meeting for three years, as well as a successful National Cardiac Arrest Audit Annual Meeting, which ran as a parallel session alongside the Resuscitation Council UK Conference.

We also held:

two online webinars, four online data collection workshops and 16 online dataset familiarisation sessions for the Case Mix Programme;
one training webinar on the dataset update for the National Cardiac Arrest Audit; and
one face-to-face and three online data collection workshops for the Irish National ICU Audit.

Recordings of the online webinars and workshops were released via YouTube to maximise the accessibility to all those participating in the audits.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 13

Results of studies on our broad portfolio of research were accepted for publication in the scientific, peer-reviewed literature and were presented at national and international conferences.

Peer-reviewed scientific publications

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32 20 470
peer-reviewed
publications in ICNARC external
2022 authors co-authors
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We continued to provide education, training and support to clinical and non-clinical researchers through hosting or working collaboratively with them. In 2022, we continued to support Professor Manu Shankar-Hari in his NIHR Clinician Scientist Award, we supported Dr Walton Charles as host institution for his NIHR Predoctoral Fellowship, and we hosted Dr Colin McArthur from Auckland City Hospital, New Zealand on a visiting sabbatical.

Digital communications

During 2022, we commenced the tendering process for the development of our new website, to ensure we present accurate, up-to-date and accessible information on our work.

Patient and public involvement and engagement

During 2022, we conducted a patient and public engagement exercise – organised with one of our important patient/public stakeholder organisations, ICUsteps (www.icusteps.org), the intensive care patient support charity – to gauge the level of support for the exemption of ICNARC’s audits from the national data opt-out. All attendees strongly supported exemption.

“…It’s in the public/patient interest … and that outweighs any potential disadvantages…”

Former critical care patient

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 14

Our plans for sharing information – 2023

We will update our audit reports to make the best use of the data collected in the current datasets.
We will begin the process of developing dynamic online reports for our audits.
As a member of the UK Health Data Research Alliance, we will continue to improve our data sharing processes to ensure our data are findable, accessible, interoperable and reusable.
We will complete the re-development of our website.
We will continue to work with patients, families and the public, in all our activities, as we look to enhance patient and public involvement and engagement organisation-wide.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 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 2022, ICNARC generated total income of £5,084,396, an increase of 3% on 2021.

Income includes £1,867,497 from audit subscriptions/activities, £3,026,633 from research grants and £187,803 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 major funding bodies to conduct our research studies. In 2022, we also continued to receive income related to auditing, reporting and analyses to inform and support the COVID-19 pandemic.

Expenditure

Total expenditure in 2022 was £4,373,329, an increase of 21% on 2021.

Cash

At the end of the financial year, total cash reserves were £5,427,513 representing an increase of 70% on 2021 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 £2,947,843. This represents an increase of 32% against the funds carried forward at the end of 2021.

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 now have a healthy level of reserves to enable investment in improving our technology and security and to manage the impact of unplanned events. The growth of these reserves had long been recognised as a necessity to ensure our long-term financial viability.

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.

Remuneration

The salaries of ICNARC staff, including key management personnel, 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 in order to attract highly qualified staff. All roles are evaluated against agreed organisational criteria which determine the grade and salary for the role.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 16

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 or loss of a key income stream, 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. Over recent years we have increased our level of reserves which has long been recognised as a necessity to enable investment in improving our technology and security and to manage the impact of unplanned events.

 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, alongside successfully participating in a NHS Digital audit. 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.

 Transition to new Director

Risk: In 2022 ICNARC’s founding and longstanding Director announced her intention to step down, with recruitment for the new director taking place in 2023. Irrespective of how well the recruitment of, and transition to, the new Director progresses the change will inevitably result in a period of instability and uncertainty for ICNARC.

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Mitigation: Thorough recruitment process involving the support of an external search agency. Engagement and involvement of the Board of Management and all key stakeholders. Timely recruitment process allowing an appropriate handover.

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% (£1,105m - £2,211m) of the annual resource expended in the General Fund. Whilst in 2022 this figure exceeds the higher threshold, the expectation is that it will reduce down with the planned, and long recognised as necessary, investment in our technology and security strategy and general infrastructure in the next five 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 2022, the annual surplus of £713,367 allowed us to continue to make critical investments in our IT platform whilst also maintaining a sufficient level of underlying reserves.

The Unrestricted funds totalled £2,981,326 at the end of 2022 and includes £2,564,826 general funds and the designated Development Fund of £416,500 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, though the level held currently exceeds the formal policy, the level of reserves is appropriate given how the increased reserves have arisen and the plans to invest in the technology strategy. Over the coming year we will review our reserves policy, alongside wider work on the organisation’s strategy and longer term financial projections to ensure that it continues to be robust, appropriate and risk based.

The budget for the 2023 financial year indicates a small surplus which, if achieved, will be added to the General Reserve and remain within the Board’s policy target.

Over the coming year we will review our reserves policy, alongside wider work on the organisation’s strategy and longer term financial projections to ensure that it continues to be robust, appropriate and risk based.

ICNARC’s reserves are either held in cash or cash deposits.

Plans for future periods

ICNARC will continue to develop its two main areas of work, audit and research in future periods, building on the lessons learned during the COVID-19 pandemic. Detailed plans for the coming year have been detailed in the relevant section of the trustees’ report on pages 9,12 and 15 above.

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.

Status

The Company is a Registered Charity (No. 1039417) and is exempt from income and corporation taxed 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.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 18

Governance, structure and management

The Intensive Care National Audit and Research Centre (ICNARC) is a Company Limited by Guarantee 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 2022.

The Trustees serving during 2022 and into 2023 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 (resigned 27 October 2022) Dr Tamas Szakmany (appointed 28 April 2022) Prof Richard Grieve (appointed 28 April 2022) Prof Manu Shankar-Hari (appointed 28 April 2022) Ms Vikki Williams (appointed 1 May 2023)

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.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 19

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.

Trustees’ Indemnities

Trustees benefit from indemnity insurance to cover the liability of the Trustees which by virtue of any rule of law would otherwise attach to them in respect of any negligence, default or breach of trust or breach of duty of which they may be guilty in relation to the Charity. The cost of this insurance in the year has been included within total insurance costs.

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 15 of this report.

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.

The SMT is responsible for implementing the strategy and policies, agreed with the Board of Management (Trustees), and operate on a three-year, 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.

The SMT members serving during 2022 and into 2023 are:

Prof Kathryn Rowan Director

Prof David Harrison Head Statistician

Mr Paul Mouncey Head of Research

Mr Baz Bedrossian Interim Head of Operations (appointed July 2021, resigned November 2022)

Mr Peter Hyde Chief Operating Officer (appointed November 2022)

Our staff

During 2022, ICNARC had an average paid workforce of 50 staff, located in our central London Office although the majority mix working in the office with remote working as part of our hybrid working policy. ICNARC is an Equal Opportunities employer. We promote equality and diversity by:

selecting for employment, promotion, training or any other benefit, on the basis of aptitude and ability;
not tolerating any form of intimidation, bullying or harassment;
recognising and valuing individual differences and contributions;
providing a work environment that promotes dignity and respect to all; and
regularly reviewing employment policies, practices and procedures to ensure fairness.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 20

Auditors/Bankers

Auditors: MHA (formally MacIntyre Hudson) 2 London Wall Place London EC2Y 5AU Bankers: Unity Trust Bank plc 9 Brindley Place Birmingham B1 2BR

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022

Page 21

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:

select suitable accounting policies and then apply them consistently;
observe the methods and principles in the Charities Statement of Recommended Practice SORP 2019 (FRS 102);
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, hence, for taking reasonable steps for the prevention and detection of fraud and other irregularities.

In so far as the Trustees are aware:

there is no relevant audit information of which the Charitable Company’s auditor is unaware; and the Trustees have taken all steps that they ought to have taken to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information.

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: 31 July 2023

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

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 22

Independent auditors’ report to the Trustees 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 2022 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:

give a true and fair view of the state of the charitable company’s affairs as at 31 December 2022, and of its incoming resources and application of resources, including its 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 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.

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.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 23

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’ report (incorporating the Directors’ report) for the financial year for which the financial statements are prepared is consistent with the financial statements; and
the Directors’ report has been prepared in accordance with applicable legal requirements.

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:

adequate accounting records have not been kept, or returns adequate for our audit have not been received from branches not visited by us; or
the financial statements are not in agreement with the accounting records and returns; or
certain disclosures of Directors’ remuneration specified by law are not made; or
we have not received all the information and explanations we require for our audit; or
the Trustees were not entitled to prepare the financial statements in accordance with the small companies’ regime and take advantage of the small companies’ exemptions in preparing the Directors’ report and from the requirement to prepare a strategic report.

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 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:

Obtaining an understanding of the legal and regulatory frameworks that the entity operates in, focusing on those laws and regulations that had a direct effect on the financial statements;

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 24

Enquiry of management and those charged with governance to identify any instances of known or suspected instances of fraud;
Enquiry of management and those charged with governance around actual and potential litigation and claims;
Enquiry of management about any instances of non-compliance with laws and regulations;
Reviewing the control systems in place and testing the effectiveness of the controls;
Performing audit work over the risk of management override of controls, including testing of journal entries and other adjustments for appropriateness;
Evaluating the business rationale of significant transactions outside the normal course of business;
Reviewing accounting estimates for bias;
Reviewing minutes of meetings of those charged with governance;
Reviewing financial statement disclosures and testing to supporting documentation to assess compliance with applicable laws and regulations.

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-and-guidance/Standardsand-guidance-for-auditors/Auditors-responsibilities-for-audit/Description-of-auditors-responsibilities-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, Statutory Auditor London, United Kingdom

Date: 28 September 2023

MHA is the trading name of MacIntyre Hudson LLP, a limited liability partnership in England and Wales (registered number OC312313)

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 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 2022

	Notes	Unrestricted Funds	Unrestricted Funds	Restricted	2022	2021
		General	Development Fund
		£	£	£	£	£
Income from:
Investment income - bank interest		2,463	-	-	2,463	-
Charitable activities
Participants' Cost Contribution (Audits)	2	1,647,157	-	198,754	1,845,911	1,940,689
Activities in promoting the Audits	2	21,586	-	-	21,586	22,665
Other services	2	187,803	-	-	187,803	102,067
Research Grants	3	-	-	3,026,633	3,026,633	2,888,701
Total		1,859,009	-	3,225,387	5,084,396	4,954,122
Expenditure on:
Charitable activities
Participants' Cost Contributions (Audits)	4	651,714	33,500	234,523	919,737	1,281,348
Research	6	-	-	3,453,592	3,453,592	2,340,839
Total	5	651,714	33,500	3,688,115	4,373,329	3,622,187
Net income/(expenditure)		1,207,295	(33,500)	(462,728)	711,067	1,331,935
Transfers between funds	18	-	-	-	-	-
Net movement in funds		1,207,295	(33,500)	(462,728)	711,067	1,331,935
Total funds brought forward		1,355,231	450,000	431,545	2,236,776	904,841
Total funds carried forward	18	2,562,526	416,500	(31,183)	2,947,843	2,236,776

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 on reserves appears as Note 17 to 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 for the year to 31 December 2022 Page 26

Intensive Care National Audit and Research Centre

Company Registration number 02946727

Balance Sheet

For the year ended 31 December 2022

----- Start of picture text -----
Notes Unrestricted Restricted 2022 2021
£ £ £ £
FIXED ASSETS
Tangible assets 11 23,922 - 23,922 22,803
CURRENT ASSETS
Debtors 12 873,001 970,815 1,843,816 2,894,261
Cash at bank and in hand 3,177,753 1,743,527 4,921,280 2,692,946
Cash deposit 478,326 27,907 506,233 506,173
4,529,080 2,742,249 7,271,329 6,093,380
Creditors
Amounts falling due within one year
Deferred income 923,923 1,128,828 2,052,751 1,898,467
Other payables 500,053 1,644,604 2,144,657 1,780,940
13 1,423,976 2,773,432 4,197,408 3,679,407
Net current assets 3,105,104 (31,183) 3,073,921 2,413,973
Creditors: Amounts falling due in
greater than one year 14 150,000 - 150,000 150,000
Provisions for Liabilities 15 - - - 50,000
NET ASSETS 2,979,026 (31,183) 2,947,843 2,236,776
Represented by:
Unrestricted Funds
General Fund 18 2,562,526 1,355,231
Development Fund (Designated) 18 416,500 450,000
2,979,026 1,805,231
Restricted Fund 18 (31,183) (31,183) 431,545
2,947,843 2,236,776
----- End of picture text -----

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 31 July 2023 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 for the year to 31 December 2022 Page 27

Intensive Care National Audit and Research Centre

Statement of Cash Flows For the year ended 31 December 2022

----- Start of picture text -----
2022 2021
Cash used in operating activities
Surplus/(Deficit) less interest income 708,604 1,331,935
(Increase)/Decrease in debtors 1,050,445 (183,329)
Increase/(Decrease) in creditors 468,001 842,043
Depreciation charges 17,717 16,575
Net cash used in operating activities 2,244,767 2,007,224
Cash flow from investing activities
Interest income 2,463 -
Purchase of tangible fixed assets (18,834) (13,237)
----- End of picture text -----

Net cash provided by investing activities Increase (decrease) in cash and cash equivalents in the year Cash and cash equivalents at the beginning of the year Cash and cash equivalents at end year ANALYSIS OF CASH AND CASH EQUIVALENTS Cash in hand ANALYSIS OF CHANGES IN NET DEBT Cash at bank and in hand	(16,371) (13,237) 2,228,396 1,993,986 3,199,119 1,205,133 5,427,515 3,199,119 2022 2,021 £ £ 5,427,515 3,199,119 5,427,515 3,199,119 At 1 January At 31 December 2022 Cash flows 2022 £ £ £ 3,199,119 2,228,396 5,427,515
	3,199,119 2,228,396 5,427,515

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 28

Intensive Care National Audit and Research Centre Notes to the Accounts For the year ended 31 December 2022

Intensive Care National Audit and Research Centre (ICNARC) is a private company limited by guarantee registered in England and Wales and a 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 02946727.

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 accounts are prepared in sterling, which is the functional and presentational currency of the charity, rounded to the nearest £1.

(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 National Cardiac Arrest Audit (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. (j) Depreciation is provided at the following annual rates to write off the cost of each asset on a straightline 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%. (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.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 29

Intensive Care National Audit and Research Centre

Notes to the Accounts For the year ended 31 December 2022 Continued

(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 assessment of Useful Economic Life and the capitalisation threshold of Tangible and Intangible Fixed Assets.

· The release of the £50k VAT provision made in 2020 as all issues are now resolved.

· 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:

· Changes to ICNARC’s plans to invest significantly in the further development of its IT platform and infrastructure resulting in the write down of intangible assets and the designation of funds to support the further development required. Investment in client-facing tools continues to provide enhanced functionality and continued stability as the number of users increases.

(u) There exist no material uncertainties in these accounts and there is a strong pipeline of activity.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 30

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2022

(continued)

2 INCOME

2 INCOME
Incoming resources for charitable activities include: Audit Subscriptions deferred brought fwd Audit Subscriptions received 2022 Less Audit Subscriptions deferred carried forward Audit Subscriptions Data/COVID-19 income Activities in promoting Audits Research Grants Other services Incoming resources for charitable activities include:		Unrestricted Restricted 2022 2021 £ £ £ £ 753,183 110,639 863,822 738,680 1,549,902 198,517 1,748,418 1,720,251 (796,736) (110,402) (907,138) (863,822)
		1,506,349 198,754 1,705,103 1,595,109 140,809 - 140,809 345,580 21,586 - 21,586 22,665 - 3,026,633 3,026,633 2,888,701 187,803 - 187,803 102,067
		1,856,546 3,225,387 5,081,933 4,954,122

Activities in promoting Audits include: software licensing £21,586 - (£22,665 - 2021), meeting, travel funding and speaker fees £780 - (£19,721 - 2021)

See appendix 1 on page 41 for 2021 comparative note.

3 RESEARCH GRANTS

ESEARCH GRANTS
	Unrestricted funds		Restricted	Total	Total
	General	Development		2022	2021
Grants:
CTU Infrastructure - NIHR	-	-	75,882	75,882	68,391
MOSAICC - NIHR HTA	-	-	181,118	181,118	129,845
OPTIC-19 - COVID-19
Research Response Fund -
University of Oxford	-	-	2,612	2,612	57,480
COAST Nutrition - EDCTP	-	-	61,472	61,472	96,796
REMAP-CAP (RECoVER) -
EC HORIZON 2020	-	-	259,820	259,820	240,757
REMAP-CAP (ECRAID-Base)
- EC HORIZON 2020	-	-	158,637	158,637	41,839
REMAP-CAP (Convalescent
Plasma) - NIHR	-	-	-	-	171,696
REMAP-CAP (PREPARE) -
EC FP7	-	-	-	-	113,096
Oxy-PICU - NIHR HTA	-	-	391,578	391,578	403,925
PICnIC - NIHR HTA	-	-	39,400	39,400	135,076
FIRST -ABC - NIHR HTA	-	-	278,463	278,463	237,256
CIRCA - RC(UK)	-	-	3,130	3,130	20,098
PRESSURE - NIHR HTA	-	-	218,131	218,131	340,741
UK ROX - NIHR HTA	-	-	410,779	410,779	429,356
REMAP-CAP - NIHR	-	-	110,520	110,520	275,963
EXAKT - NIHR -HTA	-	-	365,387	365,387	-
GASTRIC-PICU-NIHR-HTA	-	-	129,589	129,589	-
Walton Charles Predoc Fellowship-NIHR		-	14,045	14,045	-
T4P (Threshold for
Platelets)-NIHR-HTA	-	-	249,383	249,383	-
Airways-3 - NIHR-HTA	-	-	14,921	14,921	-
CLASSIC - NIHR-HTA	-	-	2,721	2,721	-
QResearch COVID VAC
OX107 - HDR UK	-	-	1	1	49,170
Other	-	-	59,044	59,044	77,215
	-	-	3,026,633	3,026,633	2,888,701

All research income in 2021, £2,888,701, was restricted.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 31

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2022

(continued)

4 TOTAL EXPENDITURE

Staff costs Training Recruitment Meetings Governance Travel Premises Communications	Total Total	Total Total
	Audit Promoting Data Support costs Research grants 2022 2021 £ £ £ £ £ £ £ 359,250 10,734 39,531 32,202 2,126,943 2,568,660 2,192,973 1,861 143 430 429 1,154 4,017 4,189 20,485 1,576 4,727 4,727 4,539 36,054 16,725 11,635 748 2,246 2,260 5,711 22,600 1,227 - - - 25,822 - 25,822 30,347 3,815 207 621 621 8,542 13,806 3,679 68,521 5,271 15,813 15,813 117,670 223,088 351,128 11,650 896 2,688 2,688 - 17,922 9,125
Publications/printing	2,617 201 604 604 5,978 10,004 7,713
Post and carriage Bank charges Depreciation Research expenditure	- - - - 1,506 1,506 3,454 - - - 1,892 207 2,099 1,565 11,516 886 2,658 2,657 - 17,717 16,575 - - - - 1,084,819 1,084,819 768,402
IT Administration and consultancy	106,284 7,917 23,752 23,751 153,893 315,597 305,573 139,650 10,659 31,973 31,973 (57,370) 156,885 213,425
Closed projects (Research) - - - - (127,267) (127,267) (303,913) Allocation of support costs 117,295 7,035 21,109 (145,439) - - - 854,579 46,273 146,152 - 3,326,325 4,373,329 3,622,188
	854,579 46,273 146,152 - 3,326,325 4,373,329	3,622,188

Audit expenditure includes unrestricted costs totalling £620,056 and restricted costs totalling £234,523. Allocation of support costs is the reallocated Management and Administration after deduction for Governance and apportioned on the basis of staff costs. See appendix 2 on page 41 for 2021 comparative note.

5 GOVERNANCE

5 GOVERNANCE
Board of Management & committees Legal and HR Financial		Unrestricted £ 1,983 7,339 16,500	Restricted 2022 2021 £ £ £ - 1,983 4,544 - 7,339 7,509 - 16,500 18,295
		25,822	- 25,822 30,347

Travel and meeting costs were £1,983 of which, £1,668 (£804 - 2021) were reimbursed to 8 (5 - 2021) trustee members. Fees payable to the charity's auditors in respect of the audit and specialist advice were £14,200 (£12,895 - 2021). See appendix 3 on page 41 for 2021 comparative note.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 32

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2022

(continued)

6 RESOURCES EXPENDITURE - RESEARCH

	2022 £ 75,882 194,423 12,731 61,472 259,820 158,637 - - 466,441 44,109 339,483 3,130 286,359 503,062 204,848 365,387 129,589 14,045 249,383 14,921 187 12,225 7,127 50,331	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
3,453,592 2,340,841
(127,267) (303,913)
3,326,325 2,036,928
	2022 £ 234,523	2021 £ 215,683

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 33

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2022

(continued)

8 SURPLUS ON ORDINARY ACTIVITIES Unrestricted Restricted £ £ 17,717 - Depreciation and amortisation The surplus is stated after charging:	2022 2021 £ £ 17,717 16,575
16,500 - Auditors' remuneration	16,500 12,895
Auditors' remuneration - prior year under accrual - -	- 5,400
9 STAFF COSTS AND NUMBERS Salaries Social security costs	2022 2021 £ £ 2,050,618 1,741,275 217,733 169,843
Pension	123,746 103,204
Seconded and agency staff 176,563 178,651 2,568,660 2,192,973 The number of employees receiving emoluments in excess of £60k: 3 1 1 1 - - - 1 1 - £60,000 - £69,999 £70,000 - £79,999 £80,000 - £89,000 £100,000 - £110,000 £110,000 - £120,000

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

----- Start of picture text -----
No. No.
Executive 3 1
Audit 9 11
Research 17 13
Statistics 7 6
Data & Data Systems 7 7
Operations 7 7
50 45
----- End of picture text -----

The company operates a Group Personal Pension scheme. Contributions to the Group Personal Pension Scheme in 2022 were £123,746 (£103,204 in 2021).

The amount of pension contribution to higher paid staff in 2022 was £25,518 (£22,793 in 2021). The number of employees eligible to participate in the Group Personal Pension scheme at the end of 2022 is 50 (45 in 2021).

The number of employees auto-enrolled at the end of 2022 is 19 (12 in 2021).

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 (2021: Nil). The Director received total emoluments of £144,641 (2021: £131,914).

Contractual redundancy costs included in total salaries for 2022 is £5,509 (2021: Nil).

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 for the year to 31 December 2022 Page 34

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2022

(continued)

11 TANGIBLE FIXED ASSETS Cost at 1 January 2022 Additions Disposals At 31 December 2022 Depreciation at 1 January 2022	Office Computer Office Office fabrication equipment equipment furniture Total
	£ £ £ £ £ 49,460 170,291 20,084 55,415 295,250 - 18,834 - - 18,834 - - - - -
	49,460 189,125 20,084 55,415 314,084
	48,039 156,291 20,084 48,031 272,445
Depreciation for the period	651 13,055 - 4,011 17,717
Disposals	- - - - -
At 31 December 2022	48,690 169,346 20,084 52,042 290,162

Net book value at 31 December 2022	770 19,779 - 3,373 23,922
Net book value at 31 December 2021 12 DEBTORS Trade debtors Research projects Prepayments	1,420 14,000 - 7,383 22,803
	Unrestricted Restricted 2022 2021 £ £ £ £ 803,046 - 803,046 779,932 - 970,815 970,815 2,012,293 69,955 - 69,955 102,036 873,001 970,815 1,843,816 2,894,261

See appendix 4 on page 42 for 2021 comparative note.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 35

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2022

(continued)

13 CREDITORS	Unrestricted Restricted 2022 2021
	£ £ £ £
Trade creditors Other creditors Accruals Taxation & Social Security Deferred income (note 16)	211,289 - 211,289 112,850 33,648 - 33,648 16,357 132,396 1,644,604 1,777,000 1,506,836 122,720 - 122,720 144,897 923,923 1,128,828 2,052,751 1,898,467
	1,423,976 2,773,432 4,197,408 3,679,407

See appendix 5 on page 42 for 2021 comparative note.

14 CREDITORS: AMOUNTS FALLING DUE AFTER ONE YEAR

14 CREDITORS: AMOUNTS FALLING DUE AFTER ONE YEAR
	2022	2021
	£	£
Dilapidations	150,000	150,000
	150,000	150,000
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
	2022	2021
	£	£
VAT Review	-	50,000
	-	50,000

Provisions made in 2020 have been released as all matters have been resolved.

16 DEFERRED INCOME

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

Balance at 1st January 2022 Amount released to incoming resources Deferred audit Deferred clinical infrastructure Deferred research Deferred other Balance at 31 December 2022	2022 2021 £ £ 1,898,467 1,229,788 (1,898,467) (1,229,788) 907,138 863,822 - 16,609 1,128,828 1,001,169 16,785 16,867
	2,052,751 1,898,467

Deferred other relates to software developer and data services access to Platform X income received in advance.

17 ANALYSIS OF NET ASSETS BETWEEN FUNDS

Fixed assets Current assets Creditors due within one year Creditors due more than one year	Restricted 2022 2021 General Designated Funds £ £ £ £ £ 23,922 - - 23,922 22,803 4,112,580 416,500 2,742,249 7,271,329 6,093,380 (1,423,976) - (2,773,432) (4,197,408) (3,679,407) (150,000) - - (150,000) (200,000) Unrestricted Funds
	2,562,526 416,500 (31,183) 2,947,843 2,236,776

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 36

Intensive Care National Audit and Research Centre Notes to the Accounts For the year ended 31 December 2022

(continued)

18 RESERVES

The movement in the reserves were as follows:

18 RESERVES The movement in the reserves were as follows:
	At 1 Jan At 31 Dec
Restricted Funds Research Grants:	2022 Income Expenditure Transfers 2022
	£ £ £ £ £
CTU Infrastructure - NIHR	- 75,882 (75,882) -
MOSAICC - NIHR HTA 65 - NIHR HTA	13,305 181,118 (194,423) - (18,829) - - (18,829)
OPTIC-19 - COVID-19 Research Response Fund - University of Oxford	10,119 2,612 (12,731) -
COAST Nutrition - EDCTP	- 61,472 (61,472) -
REMAP-CAP (RECoVER) - EC HORIZON 2020	- 259,820 (259,820) -
REMAP-CAP (ECRAID-Base) - EC HORIZON 2020 RRAM - NIHR HTA	- 158,637 (158,637) - (1,140) - - (1,140)
Oxy-PICU - NIHR HTA	73,603 391,578 (466,441) (1,260)
PICnIC - NIHR HTA	4,709 39,400 (44,109) -
CAFE - NIHR HTA FIRST -ABC - NIHR HTA CIRCA - RC(UK) PRESSURE - NIHR HTA UK ROX - NIHR HTA REMAP-CAP - NIHR	(12,093) - - (12,093) 62,638 278,463 (339,483) 1,618 - 3,130 (3,130) - 68,228 218,131 (286,359) - 92,283 410,779 (503,062) - 91,946 110,520 (204,848) (2,382)
QResearch COVID VAC OX107 - HDR UK	7,126 1 (7,127) -
EXAKT - NIHR -HTA GASTRIC-PICU-NIHR-HTA Walton Charles Predoc Fellowship-NIHR T4P (Threshold for Platelets)-NIHR-HTA Airways-3 - NIHR-HTA CLASSIC - NIHR-HTA MAP-CLD-NIHR-HS&DR	- 365,387 (365,387) - - 129,589 (129,589) - - 14,045 (14,045) - - 249,383 (249,383) - - 14,921 (14,921) - - 2,721 (187) 2,534 - - (12,225) (12,225)
Other	17,972 59,044 (50,331) 26,685

Total grants	409,869 3,026,633 (3,453,592) - (17,090)
Audit:
National Cardiac Arrest Audit	21,676 198,754 (234,523) (14,093)
Total Restricted Funds	431,545 3,225,387 (3,688,115) - (31,183)
Unrestricted Funds
Development Fund (designated)	450,000 - (33,500) 416,500
General Fund	1,355,231 1,859,009 (651,714) - 2,562,526
At the end of the year	1,805,231 1,859,009 (685,214) - 2,979,026
	2,236,776 5,084,396 (4,373,329) - 2,947,843

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 years.

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 prior to completion. Please refer to the acronyms table on pages 35 and 36 for the description and purpose of the restricted funds.

Purpose of designated funds

The development fund, for the ongoing development of the platform that underpins our national clinical audits and research currently stands at £416,500. It will be expended over the next 5 years.

See appendix 6 on page 43 for 2021 comparative note.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 37

Intensive Care National Audit and Research Centre

Notes to the Accounts For the year ended 31 December 2022

(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 5.

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 £123,746 (2021: £103,204). Contributions totalling £22,045 (2021: £16,357) were payable to the fund as at 31 December 2022 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	2022 2021
	£ £ 169,983 70,826 169,983 169,983 368,297 509,949 - 28,331
	708,263 779,089 2,378 2,378 1,189 2,378 - 1,188
	3,567 5,944 711,829 785,033

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 £416,500. Funds to support this project have been designated.

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 38

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2022

(continued)

Acronyms used in the Financial Statements

----- Start of picture text -----
Study acronym - Funder Name Description of study
CTU Infrastructure - NIHR Clinical trials unit Infrastructure Infrastructure (staff, training, etc.) funding for our UKCRC
Funding registered clinical trials unit.
Multicentre randomised clinical trial evaluating permissive
Permissive hypotension in critically ill
65 - NIHR HTA patients aged 65 years or over with hypotension (a lower blood pressure) to guide blood pressure
raising drugs to improve survival for critically ill adults, aged 65
vasodilatory hypotension
years or over, with vasodilatory hypotension.
Built on COAST, a multicentre clinical trial evaluating additional
COAST Nutrition - EDCTP Children’s Oxygen Administration nutritional support, post-discharge from hospital, to improve
Strategies Trial - Nutrition survival in critically ill children recovering from severe
pneumonia.
Observational study evaluating the implementation of citrate
RRAM - NIHR HTA Renal Replacement Anticoagulant anticoagulation for continuous renal replacement therapy to
Management improve survival for critically ill adults receiving continuous renal
replacement therapy.
Randomized, Embedded, International adaptive platform randomised clinical trial
Multifactorial, Adaptive Platform trial evaluating multiple interventions to understand the optimal
REMAP-CAP (PREPARE) - EC
for Community-Acquired Pneumonia treatment strategy to improve survival for critically ill patients
(and COVID-19) with community acquired pneumonia, including COVID-19.
Randomised multicentre trial of Multicentre randomised clinical trial evaluating permissive (a
conservative versus liberal lower) oxygen saturation to guide oxygen therapy to improve
Oxy-PICU - NIHR HTA
oxygenation targets in critically ill survival in critically ill children who are receiving mechanical
children ventilation.
Paediatric Intensive Care and Pilot, multicentre randomised clinical trial evaluating an infection
PICnIC - NIHR HTA Infection Control control strategy to improve survival for critically ill children who
are receiving mechanical ventilation.
Literature review and database analysis to estimate how
CAFE - NIHR HTA Critical care Atrial Fibrillation effective current treatments for new onset atrial fibrillation (a
Evaluation fast, irregular heartbeat) are when they occur in the critical care
unit.
Multicentre randomised clinical trial evaluating hi flow nasal
FIRST-ABC - NIHR HTA FIRST-line support for Assistance in cannula (delivering oxygen via nasal prongs) to improve
Breathing in Children recovery for critically ill children requiring non-invasive
respiratory support.
Critical Illness-Related Cardiac Observational study to understand the frequency of patients
CIRCA - RC(UK) Arrest having a cardiac arrest in the critical care unit, their survival and,
for those that recover, their longer-term quality of life.
Evaluating the clinical and cost
effectiveness of using a more
permissive blood pressure target to Aims to find out the best blood pressure target to use for
guide careful titration of vasoactive children in paediatric intensive care units (PICUs). We plan to
PRESSURE - NIHR HTA agents in critically ill children with conduct a clinical trial testing a lower blood pressure target
hypotension: PRotocolised (depending upon age) in children with hypotension
Evaluation of PermiSSive against current usual practice.
hypotension versus Usual care
(PRESSURE)
Trial to find out whether using a lower oxygen target
(conservative oxygen
Evaluating the clinical and cost-
effectiveness of a conservative therapy) to guide oxygen treatment might lead to better
UK ROX - NIHR HTA approach to oxygen therapy for outcomes for patients when compared with the approach
currently used in NHS ICUs (usual oxygen therapy). The study
invasively ventilated adults in
will include 16,500 patients from 100 UK NHS ICUs.
intensive care (UK ROX)
Patients will be randomly assigned to either the conservative
oxygen therapy or usual oxygen therapy group.
A randomised controlled trial for patients admitted to the
intensive care unit (ICU) with severe
Randomized, Embedded, Community-Acquired Pneumonia (CAP). All patients with severe
REMAP-CAP - NIHR Multifactorial Adaptive Platform Trial CAP who are treated in an ICU will receive a
for Community-Acquired Pneumonia combination of multiple different treatments. For many of these
treatments, different options are available and used
variably in current standard practice.
----- End of picture text -----

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 39

Intensive Care National Audit and Research Centre

Notes to the Accounts

For the year ended 31 December 2022 (continued)

----- Start of picture text -----
Acronyms used in the Financial Statements
Study acronym - Funder Name Description of study
OX79 Coronavirus Record Linkage Link of QResearch, SystmOne and ICNARC CMP data to look
QResearch - Wellcome Project - QResearch- at the association between prior medication and outcome for
ICNARC COVID-19 Collaboration patients most severely affected by COVID-19 infections.
The EU-funded RECoVER project constitutes a comprehensive
research response against SARS-CoV-2, aiming to address
Rapid European COVID- patient and public health level interventions building upon
RECoVER - EC 19/SARS-CoV-2 Emergency expertise from the FP7 PREPARE project and will undertake
Research response (RECOVER) 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.
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
European Clinical Research Alliance
ECRAID-Base - EC on Infectious diagnosis, prevention and treatment of infections and to better
respond to infectious disease threats. The network will function
Diseases
as the backbone of clinical research activities, providing an
efficient infrastructure capable
to perform all clinical trial aspects, from study design to scientific
publication.
Multicentre evaluation Of Sodium Clinical trial to provide an evidence base for whether using
MOSAIC - NIHR HTA bicarbonate in Acute kidney Injury in sodium bicarbonate to treat critically ill people with acidosis and
Critical Care AKI improves survival and is cost-effective for the NHS.
EXAKT - NIHR-HTA EXAKT (study within the UK-ROX A study within a trial to determine the effect of skin tone on the
trial). diagnostic accuracy of pulse oximeters.
A randomised controlled trial of no routine gastric residual
GASTRIC-PICU - NIHR-HTA The GASTRIC-PICU study. monitoring to guide enteral feeding in paediatric intensive care
units.
A prospective randomised trial to define the platelet count below
T4P - NIHR-HTA The Thresholds for Platelets (T4P) trial. which critically ill patients should receive a platelet transfusion
prior to an invasive procedure.
Randomised trial of the clinical and cost effectiveness of a
AIRWAYS-3 - NIHR-HTA The AIRWAYS-3 trial. supraglottic airway device versus tracheal intubation during in-
hospital cardiac arrest (AIRWAYS-3).
CLASSIC The CLASSIC trial. The Conservative vs. Liberal Approach to fluid therapy of Septic
Shock in Intensive Care.
Other acronyms
CMP Case Mix Programme n/a
NCAA National Cardiac Arrest Audit n/a
Irish National Intensive Care Unit
INICUA n/a
Audit
National Institute for Health
NIHR n/a
Research
HSDR Health Services & Delivery Research n/a
Programme
HTA Health Technology Assessment n/a
Programme
JGHT Joint Global Health Trials n/a
EDCTP European and Developing Countries n/a
Clinical Trials Partnership
EC European Commission n/a
APCC Annual Participants Cost n/a
Contribution
----- End of picture text -----

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 40

Intensive Care National Audit and Research Centre

Notes to the Accounts For the year ended 31 December 2022

(continued)

APPENDICES

2021 Comparatives

Appendix 1 2 INCOME

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

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

Appendix 2 4 TOTAL EXPENDITURE

Appendix 2 4 TOTAL EXPENDITURE
	Unrestricted Restricted Total Total
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	Audit Promoting Data Services Support costs Governanc e 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 unrestricted costs totalling £1,015,451 and restricted costs totalling £215,683. Allocation of support costs is the reallocated Management and Administration after deduction for Governance and apportioned on the basisof staff costs.

Appendix 3 5 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).

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 41

Intensive Care National Audit and Research Centre

Notes to the Accounts For the year ended 31 December 2022 (continued)

APPENDICES

2021 Comparatives

Appendix 4
12 DEBTORS Trade debtors Other debtors Research projects Prepayments	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
Appendix 5
13 CREDITORS Unrestricted 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

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 42

Intensive Care National Audit and Research Centre Notes to the Accounts For the year ended 31 December 2022

(continued)

APPENDICES

2021 Comparatives

Appendix 6 18 RESERVES

The movement in the reserves were as follows:

Appendix 6 18 RESERVES The movement in the reserves were as follows:	Appendix 6 18 RESERVES The movement in the reserves were as follows:
At 1 Jan At 31 Dec 2021 Income Expenditure Transfers 2021 Restricted Funds £ £ £ £ £ Research Grants: 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 (19,980) 403,925 (310,342) 73,603 PICnIC - NIHR HTA (16,654) 135,076 (113,713) 4,709.58 CAFE - NIHR HTA (12,093) - - (12,093) FIRST -ABC - NIHR HTA - 237,256 (174,618) 62,639 CIRCA - RC(UK) - 20,098 (20,098) - PRESSURE - NIHR HTA - 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 Other	- 275,963 (184,017) 91,946 - 49,170 (42,044) 7,126 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 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 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 has been increased by £400,000 in 2020 to provide sufficient resources for the ongoing of the platform to collate and analyse national and comparative data for the audit of patient outcome for intensive

Intensive Care National Audit and Research Centre | Annual Report and Accounts for the year to 31 December 2022 Page 43

Working together to improve care and outcomes

Contents

About ICNARC

Message from the Chair

Sue James | Chair

Message from the Director

Kathy Rowan I Director

Trustees report

Charitable Objects

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

We achieve our Charitable Objects by…

Progress against priorities for 2022

Three key themes underpin our priorities:

Five important enablers underpin our priorities:

Governance

Communication

Financial sustainability

Technology

Governance

People and culture

Communication

Financial sustainability

Technology

Establishing quality through research

International Expert Panel, UK Clinical Research Collaboration

Research – 2022

Adult critical care research studies

Completed

FIRST-ABC Step-Up clinical trial

Regional citrate anticoagulation

Risk Modelling II

Our plans for research – 2023

Assessing quality through audit

Professor Sir Nick Black, ex-Trustee, ICNARC

National Audit Programme

National Cardiac Arrest Audit

Irish National Intensive Care Unit Audit

Assessment of Risk in Cardiothoracic Intensive Care

Promoting quality through sharing information

Sharing information highlights – 2022

Digital communications

Former critical care patient

Financial review

Income

Expenditure

Cash

Funds carried forward

Going concern

Remuneration

Key risks and uncertainties

 Insufficient financial resources

 Knowledge and skills

 Technology and data security

 Transition to new Director

Reserves

Plans for future periods

Fundraising

Status

Special exemptions

Governance, structure and management

Our Trustees

The Trustees serving during 2022 and into 2023 are:

Trustees’ Indemnities

Public Benefit

Senior Management Team

The SMT members serving during 2022 and into 2023 are:

Our staff

Auditors/Bankers

Statement of Trustees’ responsibilities

Trustees’ responsibilities in relation to the financial statements

Independent auditors’ report to the Trustees of the Intensive Care National Audit and Research Centre

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

Auditor’s responsibilities for the audit of the financial statements