## **Working together to improve care and outcomes**
**Intensive Care National Audit and Research Centre** Annual Report and Accounts | Year ended 31 December 2023
www.icnarc.org
**Contents** About ICNARC …………………………………………………………………….3 Trustees report ............................................................................................. 4 Progress against priorities for 2023 ............................................................... 5 Strategic Objectives for 2024-26 ................................................................... 7 Establishing quality through research .......................................................... 8 Research highlights - 2023 ........................................................................ 9 Our plans for research - 2024 .................................................................. 11 Assessing quality through audit .................................................................. 12 Audit highlights - 2023 ............................................................................. 13 Our plans for audit - 2024 ........................................................................ 14 Promoting quality through sharing information ........................................... 15 Our plans for sharing information – 2024 ................................................ 17 Financial review ......................................................................................... 18 Governance, structure and management ................................................ 20 Statement of Trustees’ responsibilities .................................................... 23 Independent auditor’s report to the Members of the Intensive Care National Audit and Research Centre ........................................................... 24 Financial statements Statement of Financial Activities ............................................................. 27 Balance Sheet ........................................................................................ 28 Statement of Cash Flows ....................................................................... 29 Notes to the Accounts ............................................................................ 30
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023
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## **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 2023
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## **Trustees report**
The Trustees present their Annual Report together with the audited financial statements of the Charity for the year ended 31 December 2023. 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 12)
…promoting quality through sharing information
Read more about how we are analysing data and sharing information (page 15)
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 4
## **Progress against priorities for 2023**
## 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
- 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
- Combined 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 2023 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
## People and culture
- Commenced a programme of training for line managers
- Reviewed salary and remuneration structure
## Communication
- Progressed with the project to create new ICNARC website
- Carried out 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 2023 Page 6
## **Strategic Objectives for 2024-26**
## ICNARC recently developed its strategic objectives for 2024-2026, built around our core organisational values: _rigorous, collaborative, innovative and integrity_
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023
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## **Establishing quality through research**
Research at ICNARC is conducted within our Clinical Trials Unit (CTU), a fully registered unit by the UK Clinical Research Collaboration. Our small CTU conducts a broad portfolio of research in critical care, both experimental (randomised clinical trials) and observational studies, applying quantitative and qualitative methods. We evaluate the care, outcomes and experiences of the critically ill with a view to informing best care, outcomes and experiences for future patients.
- _“…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 – 2023
**----- Start of picture text -----**
research research research research
1 grants 1 studies 7 studies 5 studies
awarded in commenced in ongoing in completed in
2023 2023 2023 2023
**----- End of picture text -----**
Development of our research portfolio continues in adult and paediatric critical care.
Adult critical care research studies
Awarded Commenced
- Ongoing Completed • REMAP-CAP • CIRCA • T4P • UK-ROX • EXAKT • MOSAICC
Paediatric critical care research studies
- Awarded Commenced Ongoing • PICU Platform • PICU Platform • PRESSURE Development Grant Development Grant • GASTRIC-PICU
- Completed • Oxy-PICU
- • PICnIC
- COAST-Nutrition
- FIRST-ABC
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 8
Research highlights – 2023
## Oxy-PICU randomised clinical trial
- Randomised, multicentre trial of conservative versus liberal oxygenation targets in critically ill children.
- The optimal target for systemic oxygenation in critically ill children is unknown.
- Liberal oxygenation is widely practiced, but has been associated with harm in paediatric patients.
- Conservative oxygen may prevent harm from liberal oxygenation but may increase exposure to potentially harmful hypoxia (low oxygen).
- Oxy-PICU aimed to determine whether a conservative oxygenation target (SpO2 88–92%) would reduce duration of organ support or incidence of death when compared with current practice of a liberal oxygenation target (SpO2 >94%) among critically ill children.
- 2040 children enrolled across 15 participating paediatric critical care units
- A conservative oxygenation target of 88-92% was associated with a 6% greater probability of a better outcome in terms of the duration of organ support or death compared with the current practice of liberal oxygenation.
- Although not statistically significant, use of a conservative oxygenation target was also likely to reduce incremental costs at 30 days.
- Funded by the National Institute for Health and Care Research (NIHR).
- Presented at Critical Care Reviews 2023 with accompanying live stream of presentation.
- Published in the Lancet.
## Development of a Platform Trial in Paediatric Intensive Care
- Mixed-methods study to complete preparatory work necessary for establishing an adaptive platform trial in paediatric intensive care.
- The current way of conducting randomised clinical trials in paediatric intensive care is inefficient and costly takes a long time to answer important research questions and identify the best treatments for critically ill children.
- In contrast, novel designs such as an adaptive platform trials, allows multiple research questions and treatments to be tested at the same time.
- This may allow for more questions to be answered, more efficiently and in less time.
- Using a mixed-methods approach comprising linked Work Packages to:
- explore parent, young people’s and PICU staff perspectives on the platform trial design, agree important research questions and outcomes; and
- develop the methods and the approach allow the trial to make ‘adaptations’ and determined triggers for concluding when a treatment does or does not work.
- Funded by the National Institute for Health and Care Research (NIHR).
- Funding award commenced in March 2023 with funding application for conduct of PICU platform trial informed by development work submitted in November 2023.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 9
- Use of selective gut decontamination in critically ill children: PICnIC
- Parallel-group pilot cluster-randomised controlled trial with an integrated mixedmethods study in paediatric intensive care.
- Healthcare-associated infections caused by the spread of bacteria from the digestive tract into other organs, such as the lung (causing ventilator-associated pneumonia) or bloodstream (causing sepsis), can be life-threatening.
- In adults, data suggest the use of selective decontamination of the digestive tract (SDD) - an infection prevention measure that stops the growth of bacteria in the digestive tract - may reduce the incidence of healthcare-associated infections.
- SDD has not been evaluated in the paediatric intensive care unit population.
- PICnIC aimed to determine the feasibility of conducting a multicentre, clusterrandomised controlled trial in critically ill children comparing selective decontamination of the digestive tract with standard infection control.
- A total of 368 children (85% of all those who were eligible) were enrolled in the PICnIC pilot cluster-randomised controlled trial across six paediatric intensive care units: 207 in the baseline (usual care) phase and 161 in the intervention period.
- In sites delivering SDD, 98% of children received at least one dose of selective decontamination of the digestive tract.
- Consent for the collection of additional swabs was low (44%), though data completeness for potential outcomes, including microbiology data from routine clinical swab testing, was excellent.
- A definitive multicentre trial of SDD and including proposed consent methods was acceptable to parents and staff with adaptations, including training to improve consent and communication, the administration protocol for the paste and ecology monitoring.
- PICnIC's findings indicate that a definitive cluster-randomised controlled trial in selective decontamination of the digestive tract in paediatric intensive care units is feasible with the inclusion modifications.
- Funded by the National Institute for Health and Care Research (NIHR)
- Published in Scientific Reports and NIHR Health Technology Assessment
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 10
## Our plans for research – 2024
- We will prioritise identification of priority areas for research, the development of studies using new methodologies, and potential new funders to ensure a balanced research portfolio and pipeline.
- We will prioritise identification of opportunities to expand our international collaboration.
- 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 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/research/
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 11
## **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 three national clinical audits, with two operating within the NHS and registered on the NHS Quality Accounts.
The Case Mix Programme (CMP), launched in 1994 (and the foundation for ICNARC), is the national clinical audit of patient outcomes from adult critical care. The CMP is open to NHS and non-NHS providers in England, Wales and Northern Ireland, including both general and specialist units at all levels of critical care.
The National Cardiac Arrest Audit (NCAA), launched in 2009, is the national clinical audit of in-hospital cardiac arrests in the UK and Ireland, and is a collaboration between the Resuscitation Council UK (RCUK) and ICNARC. The NCAA is open to all NHS and non-NHS acute hospitals in England, Scotland, Wales, Northern Ireland and Republic of Ireland
The Irish National Intensive Care Unit Audit (INICUA), launched in 2010 in collaboration with the National Office of Clinical Audit in Ireland, is the national clinical audit of patient outcomes from adult critical care units in the Republic of Ireland.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 12
Audit highlights – 2023
Case Mix Programme
- 289 NHS/non-NHS adult critical care units participating
- 200,000 critical care admission records submitted and validated
- All critical care units transitioned to Version 4.0 of the dataset
- Full exemption from the national data opt-out confirmed
- Unit reports updated and new Version 4.0 Quality Indicators launched
- ICNARC model for predicted risk of acute hospital mortality recalibrated to ensure fair comparisons, including for admissions with COVID-19
- Preparation underway for the CMP Public Report 2022-23 – the first CMP Public Report since the COVID-19 pandemic
- 3-month pilot completed for Cardiogenic Shock Module
- Initial pilot of Family satisfaction audit completed; second pilot planned for early 2024
## National Cardiac Arrest Audit
- 188 hospitals participating
- 13,000 team visit records submitted and validated
- Plans in place for Republic of Ireland 2024 pilot
- New web portal, Platform X, in development for 2024 release
- Full exemption from the national data opt-out confirmed
- NCAA risk models for predicting return of spontaneous circulation >20 minutes and survival to hospital discharge recalibrated to ensure fair comparisons
- Preparation underway for NCAA Public Report 2022-23 – the first time the NCAA results will be publicly released
## Irish National Intensive Care Unit Audit
- 29 adult critical care units participating; phase 2 of recruitment now complete
- 14,000 critical care admission records submitted and validated
- Recalibrated ICNARC model for predicted risk of acute hospital mortality incorporated into reports to ensure fair comparisons
- Reports updated to utilise Version 4.0 data
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 13
Our plans for audit – 2024
- 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 and the National Office of Clinical Audit in Ireland.
- We will continue to develop and upgrade our audit platform, including specifying and beginning development on an online reporting platform.
- We will complete the transition of the NCAA to Platform X.
- We will publish Public Reports for the CMP and the NCAA.
- We will develop a new Version 4.0 risk model for the CMP and the INICUA and incorporate this into the CMP reports.
- We will continue to develop the content of our national clinical audits, including introducing longer term outcomes.
- We will continue to develop and implement a cardiogenic shock module for the CMP and a family satisfaction audit.
To find out more about ICNARC’s audit, please visit: www.icnarc.org/audit/
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 14
## **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 – 2023
In 2023, we began to make full use of the new Case Mix Programme (CMP) Dataset Version 4.0 data, developing full Version 4.0 quarterly critical care unit reports with new and updated quality indicators for adult critical care. The ICNARC model for riskadjusted acute hospital mortality was also recalibrated to ensure fair comparisons and the 2023 model was incorporated into CMP and Irish National ICU Audit (INICUA) reports. Reports for INICUA were also updated to use Version 4.0 data. National Cardiac Arrest Audit (NCAA) risk models for predicting return of spontaneous circulation >20 minutes and survival to hospital discharge were also recalibrated and incorporated into reports.
Audit reporting
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1,155 620 125
CMP NCAA INICUA
quarterly quarterly quarterly
critical care unit hospital critical care unit
reports reports reports
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In 2023 we also began preparations for a return to public reporting for the CMP, and developing the first NCAA Public Report, an important step for the audit. 2022-23 data were locked for both audits and outlier management processes completed, with reports due for publication in the first quarter of 2024.
The Case Mix Programme Annual Meeting 2023 took place in April with over 350 delegates attending.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 15
We also held:
- four online data collection workshops, three online data submission and validation webinars, and one reporting webinar for the CMP;
- two reporting webinars for the NCAA; and
- two face-to-face workshops for the INICUA in Dublin; INICUA units are also invited to attend CMP workshops and webinars.
Recordings of the online webinars and workshops were released via YouTube to maximise the accessibility to all those participating in the audits.
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
25 19 364 peer-reviewed publications in ICNARC external 2023 authors co-authors
We continued to provide education, training and support to clinical and non-clinical researchers through hosting or working collaboratively with them. In 2023, we continued to support Professor Manu Shankar-Hari in his NIHR Clinician Scientist Award, we continued to support Mr Walton Charles as host institution for his NIHR Predoctoral Fellowship, we hosted Dr Colin McArthur from Auckland City Hospital, New Zealand on a visiting sabbatical, and we began hosting Ms Claire Mills as part of her NIHR Development and Skills Enhancement Award.
## Digital communications
In 2023 we worked alongside an agency to design and develop our new website. We drafted new content and infographics to streamline our messaging, we made it easier for people to navigate the site and find the information they are looking for. We ensured that we are communicating how our data are used transparently and created an interactive tool to provide guidance for those looking to apply to use ICNARC data. The new website launched in May 2024.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 16
Patient and public involvement and engagement
During 2023 we focussed on several ongoing projects which required immediate input from former patients and the public. We had a short-term plan in place to expand our patient representative group and hold consultations for these projects. We contacted patient representatives that had previously worked with us, and recruited additional individuals identified through social media or the intensive care patient support charity ICUSteps (www.icusteps.org).
The priority projects included consultations on exemption from the national data optout for the Case Mix Programme (CMP) and National Cardiac Arrest Audit (NCAA); data transparency in the website project; and regarding the use of data where no explicit consent is in place for the clinical trials. This work was in addition to our preexisting PPIE activity, patient and public representation on our Board of Management and ongoing patient involvement in our research studies. In 2023 approximately 50 patient and public representatives were involved in our studies.
_“…It’s in the public/patient interest … and that outweighs any potential disadvantages…”_
## **Former critical care patient**
Our plans for sharing information – 2024
- 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 2023 Page 17
## **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 2023, ICNARC generated total income of £5,937,003 an increase of 16% on 2022.
Income includes £1,880,244 from audit subscriptions/activities, £3,961,298 from research grants and £86,918 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.
## Expenditure
Total expenditure in 2023 was £5,536,757, an increase of 27% on 2022.
## Cash
At the end of the financial year, total cash reserves were £5,684,849, which is broadly in line with the level held in the prior year. The level of cash held attributable to advance grant receipts and continued strong collection of receivables.
## Funds carried forward
Funds carried forward at the end of the financial year are £3,348,089. This represents an increase of 14% against the funds carried forward at the end of 2022.
## 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 2023 Page 18
## 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 Co-Directors 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:
## • **Political and Funding environment**
**Risk:** A change in the political and funding environment adversely affecting ICNARC’s independence or financial stability
**Mitigation:** We proactively maintain strong relationships with key stakeholders and funders. We continue to plan our budgets and aim to maintain sufficient reserves to cover any income downturns, given the variable nature of our research funding 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. We are undertaking a review of all our technology in 2024 to ensure that we have a roadmap that is appropriate for the future.
## Reserves
The Board of Management (Trustees) has a policy whereby unrestricted funds, not committed or invested in tangible fixed assets (the free reserve), held by the organisation should usually be between 25% and 50% of the annual resource expended in the General Fund. Whilst in 2023 this figure exceeds the higher threshold,
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 19
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.
The Unrestricted funds totalled £3,386,336 at the end of 2023 and includes £2,982,792 general funds and the designated Development Fund of £403,544 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.
The budget for the 2024 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 complete a full review our reserves policy, in light of plans to invest in the technology that underpins ICNARC’s work, 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. Detailed plans for the coming year have been detailed in the relevant section of the trustees’ report on pages 7, 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.
## 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|
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 20
## 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 Co-Directors, 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 2023.
## **The Trustees serving during 2023 and into 2024 are:**
**Chair:** Ms Susan James
**Trustees:** Dr Tim Gould Dr Lisa Hinton Mr Paul Maddox (Treasurer) (resigned 20 July 2023) Prof David Menon Ms Carolyn Seet (resigned 20 September 2023) Dr Gareth Sellors Ms Susan James Prof Ruth Endacott Prof Tamas Szakmany Prof Richard Grieve Prof Manu Shankar-Hari Ms Vikki Williams (appointed 1 May 2023) Mr Gary Morley (Treasurer) (appointed 26 October 2023) Mr Hemang Patel (appointed 1 December 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.
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.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 21
## Senior Leadership Team
The Co-Directors and other members of the SLT 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 SLT is responsible for implementing the strategy and policies, agreed with the Board of Management (Trustees), and operate on a three-year, rolling review. The SLT 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 SLT members is reviewed annually by Trustees and benchmarked to similar roles and organisations.
## **The SLT members serving during 2023 and into 2024 are:**
Prof David Harrison Co-Director Mr Paul Mouncey Co-Director Mr Peter Hyde Chief Operating Officer
Lindsay Hannigan Chief Information Officer Prof Kathryn Rowan Director (until 30 September 2023)
## Our staff
During 2023, ICNARC had an average paid workforce of 56 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.
## Auditors/Bankers
**Auditors:** MHA Building 4 Foundation Park Roxborough Way Maidenhead SL6 3UD
**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 2023 Page 22
## 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. Under company law the Trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of the affairs of the charitable company and of its incoming resources and application of resources, including its income and expenditure, 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 are sufficient to show and explain the Charitable Company’s transactions and 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.
The Trustees are responsible for the maintenance and integrity of the corporate and financial information included on the Charitable Company’s website. Legislation in the United Kingdom governing the preparation and dissemination of the financial statements may differ from legislation in other jurisdictions.
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: 8 November 2024
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 2023 Page 23
## 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 2023 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 and the Charities SORP 2019).
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 2023, 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 and the Charities SORP 2019.
## **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 United Kingdom, including the Financial Reporting Council’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 this gives rise to a material misstatement in the financial statements themselves. 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 2023 Page 24
## **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;
- 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;
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 25
- 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.
## **Carina Ralfs PhD MSci (Hons) FCA (Senior Statutory Auditor)**
for and on behalf of MHA, Statutory Auditor Maidenhead, United Kingdom
> Date: 08 November 2024
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 2023 Page 26
## **Intensive Care National Audit and Research Centre**
Statement of Financial Activities (Incorporating an Income and Expenditure account) For the year ended 31 December 2023
|Notes
**Income from:**
Investment income - bank interest
**Charitable activities**
Participants' Cost Contribution (Audits)
2
Activities in promoting the Audits
2
Other services
2
Research Grants
3
**Total**
**Expenditure on:**
**Charitable activities**
Participants' Cost Contributions (Audits)
Research
6
**Total**
4
**Net income/(expenditure)**
Transfers between funds
17
**Net movement in funds**
Total funds brought forward
**Total funds carried forward**
17|Restricted
2023
2022
General
Development
Fund
£
£
£
£
£
8,543
-
-
8,543
2,463
1,658,137
-
203,282
1,861,419
1,845,911
18,825
-
-
18,825
21,586
82,179
-
4,739
86,918
187,803
-
-
3,961,298
3,961,298
3,026,633
UnrestrictedFunds|
|---|---|
||1,767,684
-
4,169,319
5,937,003
5,084,396
1,363,479
12,956
249,984
1,626,419
919,737
(47,669)
-
3,958,007
3,910,338
3,453,592|
||1,315,810
12,956
4,207,991
5,536,757
4,373,329|
||451,874
(12,956)
(38,672)
400,246
711,067|
||(31,608)
-
31,608
-
-|
||420,266
(12,956)
(7,064)
400,246
711,067|
||2,562,526
416,500
(31,183)
2,947,843
2,236,776|
||2,982,792
403,544
(38,247)
3,348,089
2,947,843|
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 30 to 44 form part of these accounts.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 27
## **Intensive Care National Audit and Research Centre**
## Company Registration number 02946727 Balance Sheet
For the year ended 31 December 2023
||Notes|Unrestricted|Restricted|2023|2022|
|---|---|---|---|---|---|
|||£|£|£|£|
|**FIXED ASSETS**||||||
|Tangible assets|11|30,713|-|30,713|23,922|
|**INTANGIBLE ASSETS**|11a|-|-|-|-|
|**CURRENT ASSETS**||||||
|Debtors|12|904,081|974,143|1,878,224|1,843,816|
|Cash at bank and in hand||3,645,148|1,533,497|5,178,645|4,921,280|
|Cash deposit||479,562|26,642|506,204|506,233|
|||5,028,791|2,534,282|7,563,073|7,271,329|
|**Creditors**||||||
|Amounts falling due within one year||||||
|Deferred income||968,594|335,366|1,303,960|2,052,751|
|Other payables||554,574|2,237,163|2,791,737|2,144,657|
||13|1,523,168|2,572,529|4,095,697|4,197,408|
|Net current assets||3,505,623|(38,247)|3,467,376|3,073,921|
|Creditors: Amounts falling due in||||||
|greater than one year|14|150,000|-|150,000|150,000|
|**NET ASSETS**||3,386,336|(38,247)|3,348,089|2,947,843|
|**Represented by:**||||||
|Unrestricted Funds||||||
|General Fund|17|2,982,792||2,982,792|2,562,526|
|Development Fund (Designated)|17|403,544||403,544|416,500|
|||3,386,336||3,386,336|2,979,026|
|Restricted Fund|17|-|(38,247)|(38,247)|(31,183)|
|||||3,348,089|2,947,843|
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 08 November 2024 on their behalf by:
## Susan James, Chair
The Notes on pages 30 to 44 form part of these accounts.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 28
## **Intensive Care National Audit and Research Centre**
## Statement of Cash Flows For the year ended 31 December 2023
|**Cash used in operating activities**|2023
2022|
|---|---|
|Surplus/(Deficit) less interest income|391,703
708,604|
|(Increase)/Decrease in debtors
Increase/(Decrease) in creditors
Depreciation charges
**Net cash used in operating activities**
**Cash flow from investing activities**|(34,410)
1,050,445
(101,711)
468,001
24,886
17,717
280,468
2,244,767|
|Interest income|8,543
2,463|
|Purchase of tangible fixed assets
**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|(31,677)
(18,834)
(23,134)
(16,371)
257,334
2,228,396
5,427,515
3,199,119
**5,684,849**
**5,427,515**
2023
2022
£
£
5,684,849
5,427,515
5,684,849
5,427,515
At 1 January
At 31 December
2023
Cash flows
2023
£
£
£
5,427,515
257,334
5,684,849|
||5,427,515
257,334
5,684,849|
|||
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 29
**Intensive Care National Audit and Research Centre**
Notes to the Accounts
For the year ended 31 December 2023
**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. (c) Interest is accounted for when receivable. (d) Research Grant income is recognised when the Charity has entitlement to the funds and any performance conditions have been met. Any advance income over expenditure is held on the Statement of Financial Position as deferred income. (e) The Annual Participants Cost Contributions (APCC) is invoiced on the anniversary date of joining. Any proportion of a current year income relating to the following year is treated as deferred income. (f) The 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) Intangible assets - IT developments are capitalised as intangible assets where they 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. (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.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 30
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts continued For the year ended 31 December 2023
(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 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 2023 Page 31
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts
## For the year ended 31 December 2023
(continued)
## **2 INCOME**
|**2 INCOME**|||
|---|---|---|
|**Incoming resources for charitable activities include:**||Unrestricted
Restricted
2023
2022
£
£
£
£|
|Audit Subscriptions deferred brought fwd
Audit Subscriptions received 2023||796,736
110,402
907,138
863,822
1,569,466
212,508
1,781,974
1,748,418|
|Less Audit Subscriptions deferred carried forward||(835,058)
(119,628)
(954,686)
(907,138)|
|Audit Subscriptions||1,531,144
203,282
1,734,426
1,705,103
126,993
-
126,993
140,809
18,825
-
18,825
21,586
-
3,961,298
3,961,298
3,026,633
82,179
4,739
86,918
187,803|
|Data/COVID-19 income
Activities in promoting Audits
Research Grants
Other services|||
|**Incoming resources for charitable activities include:**||1,759,141
4,169,319
5,928,460
5,081,933|
||||
Activities in promoting Audits include: software licensing £18,825 - (£21,586 - 2022), meeting, travel funding and speaker fees £254 - (£780 - 2022)
See appendix 1 on page 42 for 2022 comparative note.
## **3 RESEARCH GRANTS**
|**ESEARCH GRANTS**|**ESEARCH GRANTS**|**ESEARCH GRANTS**||||
|---|---|---|---|---|---|
|Unrestricted funds|||Restricted|Total|Total|
|General||Development||2023|2022|
|**Grants:**||||||
|CTU Infrastructure - NIHR|-|-|75,310|75,310|75,882|
|MOSAICC - NIHR HTA|-|-|375,419|375,419|181,118|
|OPTIC-19 - COVID-19||||||
|Research Response Fund -||||||
|University of Oxford|-|-|-|-|2,612|
|COAST Nutrition - EDCTP|-|-|49,008|49,008|61,472|
|REMAP-CAP (RECoVER) -||||||
|EC HORIZON 2020|-|-|128,793|128,793|259,820|
|REMAP-CAP (ECRAID-Base)||||||
|- EC HORIZON 2020|-|-|83,534|83,534|158,637|
|REMAP-CAP-FLU-NIHR|-|-|264,806|264,806|-|
|PICU Platform-NIHR-HTA|-|-|181,579|181,579|-|
|Oxy-PICU - NIHR HTA|-|-|337,817|337,817|391,578|
|PICnIC - NIHR HTA|-|-|-|-|39,400|
|FIRST -ABC - NIHR HTA|-|-|132,442|132,442|278,463|
|CIRCA - RC(UK)|-|-|11,993|11,993|3,130|
|PRESSURE - NIHR HTA|-|-|482,514|482,514|218,131|
|UK ROX - NIHR HTA|-|-|528,929|528,929|410,779|
|REMAP-CAP - NIHR|-|-|166,390|166,390|110,520|
|EXAKT - NIHR -HTA|-|-|205,066|205,066|365,387|
|GASTRIC-PICU-NIHR-HTA|-|-|456,879|456,879|129,589|
|Walton Charles Predoc Fellowship-NIHR||-|44,429|44,429|14,045|
|T4P (Threshold for||||||
|Platelets)-NIHR-HTA|-|-|365,846|365,846|249,383|
|Airways-3 - NIHR-HTA|-|-|23,606|23,606|14,921|
|CLASSIC - NIHR-HTA|-|-|-|-|2,721|
|MAP-CLD-NIHR-HS&DR|-|-|21,657|21,657|-|
|QResearch COVID VAC||||||
|OX107 - HDR UK|-|-|-|-|1|
|SEISMIC-R-NIHR|-|-|8,310|8,310|-|
|TBI-Reporter-UKRI-MRC|-|-|2,685|2,685|-|
|QResearch COVID VAC||||||
|OX107 - HDR UK||||||
|Other|-|-|14,286|14,286|59,044|
||-|-|3,961,298|3,961,298|3,026,633|
All research income in 2022, £3,026,633, was restricted.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 32
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts For the year ended 31 December 2023
(continued)
## **4 TOTAL EXPENDITURE**
**----- Start of picture text -----**
Total Total
Support Research
Audit Promoting Data 2023 2022
costs grants
£ £ £ £ £ £ £
Staff costs 604,273 29,591 103,197 99,869 2,115,405 2,952,335 2,568,660
Training 19,041 1,464 4,393 4,393 13,447 42,738 4,017
Recruitment 22,740 1,749 5,247 5,248 9,445 44,429 36,054
Meetings 29,381 2,114 6,341 7,356 34,224 79,416 22,600
Governance - - - 36,019 - 36,019 25,822
Travel 5,286 404 1,216 1,216 16,862 24,984 13,806
Premises 92,131 6,693 20,087 14,997 110,853 244,761 223,088
- - - -
Legal/professional fees 6,500 6,500
Communications 2,562 197 592 592 2,177 6,120 17,922
Publications/printing (2,135) (165) (493) (493) 13,366 10,080 10,004
Post and carriage 235 18 55 55 2,738 3,101 1,506
Bank charges - - - 1,454 82 1,536 2,099
Depreciation 4,522 346 1,044 1,045 17,929 24,886 17,717
- - - -
Research expenditure 1,393,616 1,393,616 1,084,819
IT 191,009 13,398 33,118 34,207 212,956 484,688 315,597
Administration and consultanc 143,952 10,975 32,942 32,942 8,406 229,217 156,885
- - - -
Closed projects (Research) (47,669) (47,669) (127,267)
Allocation of support costs 191,166 11,931 35,803 (238,900) - - -
1,304,163 78,715 243,542 - 3,910,337 5,536,757 4,373,329
**----- End of picture text -----**
Audit expenditure includes unrestricted costs totalling £1,054,179 and restricted costs totalling £249,984. 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 42 for 2022 comparative note.
## **5 GOVERNANCE**
|**5 GOVERNANCE**||||
|---|---|---|---|
|Board of Management & committees
Legal and HR
Financial||Unrestricted
£
6,345
12,349
17,325|Restricted
2023
2022
£
£
£
-
6,345
1,983
-
12,349
7,339
-
17,325
16,500|
|||36,019|-
36,019
25,822|
Travel and meeting costs were £6,345 of which, £2,257 (£1,668 - 2022) were reimbursed to 9 (8 - 2022) trustee members. Fees payable to the charity's auditors in respect of the audit and specialist advice were £17,325 (£16,500 - 2022). See appendix 3 on page 42 for 2022 comparative note.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 33
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts For the year ended 31 December 2023
(continued)
## **6 RESOURCES EXPENDITURE - RESEARCH**
|**Restricted**
Start date
Grant value
CTU Infrastructure - NIHR
09/01/2013
£800,636
MOSAICC - NIHR HTA
01/03/2021
£1,710,519
OPTIC-19 - COVID-19
Research Response Fund -
University of Oxford
01/07/2020
£60,092
COAST Nutrition - EDCTP
05/01/2018
£800,636
REMAP-CAP (RECoVER) -
EC HORIZON 2020
11/06/2020
£609,850
REMAP-CAP (ECRAID-Base)
- EC HORIZON 2020
01/03/2021
£523,696
REMAP-CAP-FLU - NIHR
01/12/2022
£780,859
PICU Platform - NIHR HTA
01/03/2023
£204,795
Oxy-PICU - NIHR HTA
08/01/2019
£1,569,780
PICnIC - NIHR HTA
11/01/2019
£519,652
FIRST -ABC - NIHR HTA
02/01/2019
£1,499,843
CIRCA - RC(UK)
06/01/2019
£70,719
PRESSURE - NIHR HTA
08/01/2020
£1,806,766
UK ROX - NIHR HTA
08/01/2020
£2,078,886
REMAP-CAP - NIHR
01/04/2020
£745,990
EXAKT - NIHR -HTA
01/03/2022
£586,200
GASTRIC-PICU-NIHR-HTA
01/09/2022
£1,952,721
Walton Charles Predoc Fellowship-NIHR
01/09/2022
£83,465
T4P (Threshold for Platelets)-NIHR-HTA
01/01/2022
£1,925,146
Airways-3 - NIHR-HTA
01/01/2022
£64,155
CLASSIC - NIHR-HTA
23/09/2020
£17,802
MAP-CLD-NIHR-HS&DR
01/04/2022
£27,632
QResearch COVID VAC
OX107 - HDR UK
08/01/2021
£49,170
SEISMIC-R - NIHR
01/05/2023
£36,106
TBI-Reporter-UKRI-MRC
01/10/2023
£58,754
Other
various
**Unrestricted**
Closed projects (Research)
**7 RESTRICTED RESOURCES EXPENDITURE - AUDIT**
National Cardiac Arrest Audit||2023
£
75,310
375,419
-
49,008
128,793
83,534
264,806
181,579
337,818
(453)
134,060
11,993
482,514
528,929
164,008
205,066
456,879
44,429
365,846
23,606
(187)
9,432
(10,479)
8,310
2,685
35,102|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|
|---|---|---|---|
||3,958,007
3,453,592|||
||(47,669)
(127,267)|||
||3,910,338
3,326,325|||
|||2023
£
249,984|2022
£
234,523|
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 34
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts
## For the year ended 31 December 2023
(continued)
|**8 SURPLUS ON ORDINARY ACTIVITIES**||||
|---|---|---|---|
|Unrestricted
Restricted
The surplus is stated after charging:||2023|2022|
|£
£
24,886
-
Depreciation and amortisation
||£
24,886|£
17,717|
|17,325
-
Auditors' remuneration||17,325|16,500|
|Auditors' remuneration - prior
year under accrual
-
-||-|2,000|
|**9 STAFF COSTS AND NUMBERS**
Salaries
Social security costs||2023
£
2,406,655
236,191|2022
£
2,050,618
217,733|
|Pension||149,864|123,746|
|Seconded and agency staff||159,625|176,563
2,568,660|
|||2,952,335||
|The number of employees receiving emoluments in excess of £60k:
£60,000 - £69,999
£70,000 - £79,999||3
2|3
1|
|£80,000 - £89,999||2|-|
|£100,000 - £109,999
£110,000 - £119,999
£120,000 - £129,999||-
-
1|-
1
-|
|||||
The monthly average numbers employed during the year calculated on the basis of actual headcount:
|Executive
Audit
Research|No.
No.
4
3
10
9
21
17|
|---|---|
|Statistics
Data & Data Systems|7
7
5
7|
|Operations|9
7
56
50|
|||
|The company operates a Group Personal Pension scheme. Contributions to the Group Personal||
The company operates a Group Personal Pension scheme. Contributions to the Group Personal Pension Scheme in 2023 were £149,864 (£123,746 in 2022).
The amount of pension contribution to higher paid staff in 2023 was £53,123 (£25,518 in 2022). The number of employees eligible to participate in the Group Personal Pension scheme at the end of 2023 is 56 (50 in 2022) and the total number participating is 51 (39 in 2022) The number of employees auto-enrolled during 2023 is 12 (19 in 2022).
The Trustees and Co-Directors are the key management personnel of the company. The Trustees, being in a voluntary position, receive no remuneration from the organisation (2022: Nil). The Director/Co-Directors received total emoluments of £153,455 (2022: £144,641).
Contractual redundancy costs included in total salaries for 2023 is £nil (2022: £5,509).
## **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 2023 Page 35
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts
## For the year ended 31 December 2023
(continued)
|**11 TANGIBLE FIXED ASSETS**
Cost at 1 January 2023
Additions
Disposals
At 31 December 2023
Depreciation at 1 January 2023|Office
Computer
Office
Office
fabrication
equipment
equipment
furniture
Total|
|---|---|
||£
£
£
£
£
49,460
189,125
20,084
55,415
314,084
-
31,677
-
-
31,677
(17,053)
(120,735)
(11,145)
-
(148,933)|
||32,407
100,067
8,939
55,415
196,828|
||48,690
169,346
20,084
52,042
290,162|
|Depreciation for the period|436
21,077
-
3,373
24,886|
|Disposals|(17,053)
(120,735)
(11,145)
-
(148,933)|
|At 31 December 2023|32,073
69,688
8,939
55,415
166,115|
|||
|Net book value at 31 December 2023
Net book value at 31 December 2022
**11a INTANGIBLE ASSETS**
Cost at 1 January 2023
Additions
Disposals
At 31 December 2023
Amortisation at 1 January 2023|334
30,379
-
-
30,713
770
19,779
-
3,373
23,922|
||Software
IT
Development
Total|
||£
£
£
45,400
248,521
293,921
-
-
-
-
-
-|
||45,400
248,521
293,921|
||45,400
248,521
293,921|
|
Amortisation for the period|-
-
-|
|Disposals
At 31 December 2023
Net book value at 31 December 2023
Net book value at 31 December 2022|-
-
-|
||45,400
248,521
293,921|
||-
-
-|
||-
-
-|
**----- Start of picture text -----**
Net book value at 31 December 2022 - - -
12 DEBTORS Unrestricted Restricted 2023 2022
£ £ £ £
Trade debtors 815,899 - 815,899 803,046
-
Research projects 974,143 974,143 970,815
Prepayments 88,182 - 88,182 69,955
904,081 974,143 1,878,224 1,843,816
**----- End of picture text -----**
See appendix 4 on page 43 for 2022 comparative note.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 36
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts For the year ended 31 December 2023
(continued)
**----- Start of picture text -----**
13 CREDITORS Unrestricted Restricted 2023 2022
£ £ £ £
Trade creditors 258,352 - 258,352 211,289
Other creditors 49,742 - 49,742 33,648
Accruals 106,000 2,237,163 2,343,163 1,777,000
-
Taxation & Social Security 140,480 140,480 122,720
Deferred income (note 15) 968,594 335,366 1,303,960 2,052,751
1,523,168 2,572,529 4,095,697 4,197,408
**----- End of picture text -----**
See appendix 5 on page 43 for 2022 comparative note.
## **14 CREDITORS: AMOUNTS FALLING DUE AFTER ONE YEAR**
|Dilapidations||2023
£
150,000|2022
£
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 lease which expires in March 2027.
## **15 DEFERRED INCOME**
Deferred income comprises audit and research income payable annually and income deferred in the Clinical infrastructure fund.
|Balance at 1st January 2023
Amount released to incoming resources
Deferred audit
Deferred research
Deferred other
Balance at 31 December 2023|2023
2022
£
£
2,052,751
1,898,467
(2,052,751)
(1,898,467)
954,686
907,138
335,366
1,128,828
13,908
16,785|
|---|---|
||1,303,960
2,052,751|
Deferred other relates to software developer and data services access to Platform X income received in advance.
## **16 ANALYSIS OF NET ASSETS BETWEEN FUNDS**
|Fixed assets
Current assets
Creditors due within one year
Creditors due more than one year|Restricted
2023
2022
General
Designated
Funds
£
£
£
£
£
30,713
-
-
30,713
23,922
4,625,247
403,544
2,534,282
7,563,073
7,271,329
(1,523,168)
-
(2,572,529)
(4,095,697)
(4,197,408)
(150,000)
-
-
(150,000)
(150,000)
UnrestrictedFunds|
|---|---|
||2,982,792
403,544
(38,247)
3,348,089
2,947,843|
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 37
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts For the year ended 31 December 2023
(continued)
## **17 RESERVES**
The movement in the reserves were as follows:
|**17 RESERVES**
The movement in the reserves were as follows:||
|---|---|
||At 1 Jan
At 31 Dec|
|Restricted Funds
Research Grants:|2023
Income
Expenditure
Transfers
2023|
||£
£
£
£
£|
|CTU Infrastructure - NIHR|-
75,310
(75,310)
-|
|MOSAICC - NIHR HTA
65 - NIHR HTA
COAST Nutrition - EDCTP|-
375,419
(375,419)
-
(18,829)
-
-
18,829
-
-
49,008
(49,008)
-|
|REMAP-CAP (RECoVER) - EC HORIZON 2020|-
128,793
(128,793)
-|
|REMAP-CAP (ECRAID-Base) - EC HORIZON 2020
REMAP-CAP-FLU - NIHR
PICU Platform - NIHR HTA
RRAM - NIHR HTA|-
83,534
(83,534)
-
-
264,806
(264,806)
-
-
181,579
(181,579)
-
(1,140)
-
-
1,140
-|
|Oxy-PICU - NIHR HTA|(1,260)
337,817
(337,818)
(1,261)|
|PICnIC - NIHR HTA|-
-
453
(453)
-|
|CAFE - NIHR HTA
FIRST -ABC - NIHR HTA
CIRCA - RC(UK)
PRESSURE - NIHR HTA
UK ROX - NIHR HTA|(12,093)
-
-
12,093
-
1,618
132,442
(134,060)
-
-
11,993
(11,993)
-
-
482,514
(482,514)
-
-
528,929
(528,929)
-|
|REMAP-CAP - NIHR|(2,382)
166,390
(164,008)
-|
|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|-
205,066
(205,066)
-
-
456,879
(456,879)
-
-
44,429
(44,429)
-
-
365,846
(365,846)
-
-
23,606
(23,606)
-
2,534
-
187
2,721|
|MAP-CLD-NIHR-HS&DR
QResearch COVID VAC OX107 - HDR UK
SEISMIC-R - NIHR
TBI-Reporter-UKRI-MRC|(12,225)
21,657
(9,432)
-
-
-
10,479
10,479
-
8,310
(8,310)
-
-
2,685
(2,685)
-|
|Other|26,686
14,286
(35,102)
5,870|
|||
|Total grants|(17,090)
3,961,298
(3,958,007)
31,608
17,809|
|Audit:||
|National Cardiac Arrest Audit|(14,093)
208,021
(249,984)
(56,056)|
|Total Restricted Funds|(31,183)
4,169,319
(4,207,991)
31,608
(38,247)|
|Unrestricted Funds||
|Development Fund (designated)|416,500
-
(12,956)
403,544|
|General Fund|2,562,526
1,767,684
(1,315,810)
(31,608)
2,982,792|
|At the end of the year|2,979,026
1,767,684
(1,328,766)
(31,608)
3,386,336|
||2,947,843
5,937,003
(5,536,757)
-
3,348,089|
## 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 corrected prior to completion. Please refer to the acronyms table on pages 40 and 41 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 £403,544. It will be expended over the next 5 years.
See appendix 6 on page 44 for 2022 comparative note.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 38
**Intensive Care National Audit and Research Centre**
Notes to the Accounts For the year ended 31 December 2023
(continued)
## **18 RELATED PARTY TRANSACTIONS**
There are no related party transactions in the year (£0 - 2022) that require disclosure other than the Trustees' expenses in note 5.
## **19 ULTIMATE CONTROLLING PARTY**
The Trustees are of the opinion that there is no one controlling party of the charitable company.
## **20 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 £149,864 (2021: £123,746). The Charity's staff work across activities and between restricted and unrestricted funds, this is reflected in the allocation of pension liability and expense.
Contributions totalling £24,844 (2022: £22,045) were payable to the fund as at 31 December 2023 and included in the Statement of Financial Position.
## **21 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. The costs during the year totalled £138,364 (2022: £159,117)
|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|2023
2022|
|---|---|
||£
£
169,983
169,983
169,983
169,983
198,314
368,297
-
-|
||538,280
708,263
1,189
2,378
-
1,189
-
-|
||1,189
3,567
539,469
711,829|
## **22 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 £403,544. 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 2023 Page 39
## **Intensive Care National Audit and Research Centre**
Notes to the Accounts For the year ended 31 December 2023
(continued)
|**Intensive Care National Audit and Research Centre**
Notes to the Accounts
For the year ended 31 December 2023
(continued)|**Intensive Care National Audit and Research Centre**
Notes to the Accounts
For the year ended 31 December 2023
(continued)|**Intensive Care National Audit and Research Centre**
Notes to the Accounts
For the year ended 31 December 2023
(continued)|
|---|---|---|
|**Acronyms used inthe Financial Statements (continued)**|||
|**Study acronym - Funder**|**Name**|**Description of study**|
|CTU Infrastructure - NIHR|Clinical trials unit Infrastructure Funding|Infrastructure (staff, training, etc.) funding for our UKCRC registered clinical
trials unit.|
|65 - NIHR HTA|Permissive hypotension in critically ill patients aged
65 years or over with vasodilatory hypotension|Multicentre randomised clinical trial evaluating permissive hypotension (a
lower blood pressure) to guide blood pressure raising drugs to improve survival
for critically ill adults, aged 65 years or over, with vasodilatory hypotension.|
|COAST Nutrition - EDCTP|Children’s Oxygen Administration Strategies Trial -
Nutrition|Built on COAST, a multicentre clinical trial evaluating additional nutritional
support, post-discharge from hospital, to improve survival in crtically ill children
recoveringfromsevere pneumonia.|
|RRAM - NIHR HTA|Renal Replacement Anticoagulant Management|Observational study evaluating the implementation of citrate anticoagulation for
continuous renal replacement therapy to improve survival for critcally ill adults
receiving continuousrenal replacement therapy.|
|REMAP-CAP
(PREPARE) - EC FP|Randomized, Embedded, Multifactorial, Adaptive
Platform trial for Community-Acquired Pneumonia (and
COVID-19)|
International adaptive platform randomised clinical trial evaluating multiple
interventions to understand the optimal treatment strategy to improve survival
for critically ill patients with community acquired pneumonia, including COVID-
19.|
|Oxy-PICU - NIHR HTA|Randomised multicentre trial of conservative versus
liberal oxygenation targets in critically ill children|Multicentre randomised clinical trial evaluating permissive (a lower) oxygen
saturation to guide oxygen therapy to improve survival in critically ill children
who arereceivingmechanical ventilation.|
|PICnIC - NIHR HTA|Paediatric Intensive Care and Infection Control|Pilot, multicentre randomised clinical trial evaluating an infection control
strategy to improve survival for critically ill children who are receiving
mechanical ventilation.|
|CAFE - NIHR HTA|Critical care Atrial Fibrillation Evaluation|Literature review and database analysis to estimate how effective current
treatments for new onset atrial fibrilation (a fast, irregular heartbeat) are when
they occur inthe criticalcare unit.|
|FIRST-ABC - NIHR HTA|FIRST-line support for Assistance in Breathing in
Children|Multicentre randomised clinical trial evaluating hi flow nasal cannula (delivering
oxygen via nasal prongs) to improve recovery for critically ill children requiring
non-invasiverespiratory support.|
|CIRCA - RC(UK)|Critical Illness-Related Cardiac Arrest|Observational study to understand the frequency of patients having a cardiac
arrest in the critical care unit, their survival and, for those that recover, their
longer-termquality of life.|
|PRESSURE - NIHR HTA|Evaluating the clinical and cost effectiveness of using
a more permissive blood pressure target to guide
careful titration of vasoactive agents in critically ill
children with hypotension: PRotocolised Evaluation of
PermiSSive hypotension versus Usual care
(PRESSURE)|Aims to find out the best blood pressure target to use for children in paediatric
intensive care units (PICUs). We plan to conduct a clinical trial testing a lower
blood pressure target (depending upon age) in children with hypotension
against current usual practice.|
|UK ROX - NIHR HTA|Evaluating the clinical and cost-effectiveness of a
conservative approach to oxygen therapy for invasively
ventilated adults in intensive care (UK ROX)|Trial to find out whether using a lower oxygen target (conservative oxygen
therapy) to guide oxygen treatment might lead to better outcomes for patients
when compared with the approach currently used in NHS ICUs (usual oxygen
therapy). The study will include 16,500 patients from 100 UK NHS ICUs.
Patients will be randomly assigned to either the conservative oxygen therapy
orusualoxygentherapy group.|
|REMAP-CAP - NIHR|Randomized, Embedded, Multifactorial Adaptive
Platform Trial for Community-Acquired Pneumonia|A randomised controlled trial for patients admitted to the intensive care unit
(ICU) with severe Community-Acquired Pneumonia (CAP). All patients with
severe CAP who are treated in an ICU will receive a combination of multiple
different treatments. For many of these treatments, different options are
available and usedvariablyincurrent standard practice.|
|QResearch - Wellcome|OX79 Coronavirus Record Linkage Project -
QResearch-
ICNARC COVID-19 Collaboration|Link of QResearch, SystmOne and ICNARC CMP data to look at the
association between prior medication and outcome for patients most severely
affected by COVID-19infections.|
|REMAP-CAP (RECoVER)
- EC HORIZON 2020|Rapid European COVID-
19/SARS-CoV-2 Emergency Research response
(RECOVER)|The EU-funded RECoVER project constitutes a comprehensive research
response against SARS-CoV-2, aiming to address patient and public health
level interventions buidling upon expertise from the the FP7 PREPARE project
and will undertake clinical studies in primary and hospital care as well as
epidemiological and biological investigations and modelling to fill knowledge
gaps onSARS-CoV-2 infectivity and transmission.|
|REMAP-CAP (ECRAID-
Base) - EC HORIZON
2020|European Clinical Research Alliance on Infectious
Diseases|A pan-European, single-access, sustainable clinical research network for
infectious diseases, ECRAID is intended to reduce the impact of infectious
diseases on individual and population health by generating rigorous evidence
to improve the diagnosis, prevention and treatment of infections and to better
respond to infectious disease threats. The network will function as the
backbone of clinical research activities, providing an efficient infrastructure
capable to perform all clinical trial aspects, from study design to scientific
publication.|
|MOSAICC - NIHR HTA|Multicentre evaluation Of Sodium bicarbonate in Acute
kidney Injury in Critical Care|Clinical trial to provide an evidence base for whether using sodium bicarbonate
to treat critically ill people with acidosis and AKI improves survival and is cost-
effectivefortheNHS.|
|EXAKT - NIHR-HTA|EXAKT (study within the UK-ROX trial).|A study within a trial to determine the effect of skin tone on the diagnostic
accuracy ofpulse oximeters.|
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 40
## **Intensive Care National Audit and Research Centre**
Notes to the Accounts For the year ended 31 December 2023
(continued)
**----- Start of picture text -----**
Acronyms used in the Financial Statements (continued)
Study acronym - Funder Name Description of study
A randomised controlled trial of no routine gastric residual monitoring to guide
GASTRIC-PICU - NIHR-HTA The GASTRIC-PICU study.
enteral feeding in paediatric intensive care units.
A prospective randomised trial to define the platelet count below which
T4P - NIHR-HTA The Thresholds for Platelets (T4P) trial. critically ill patients should receive a platelet transfusion prior to an invasive
procedure.
�Randomised trial of the clinical and cost effectiveness of a supraglottic
AIRWAYS-3 - NIHR-HTA The AIRWAYS-3 trial. airway device versus tracheal intubation during in-hospital cardiac arrest
(AIRWAYS-3).
The Conservative vs. Liberal Approach to fluid therapy of Septic Shock in
CLASSIC - NIHR-HTA The CLASSIC trial.
Intensive Care.
A Randomised, Embedded, Multi-factorial, Adaptive A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for
REMAP-CAP-FLU - NIHR Platform Trial for Community-Acquired Pneumonia assessing immune modulation and anti-virals for hospiatlised and critically ill
(REMAP-CAP) – Influenza patients with influenza
A mixed-methods study to complete the targeted preparatory work necessary
Development of a Platform Trial in Paediatric Intensive
PICU Platform - NIHR HTA for the establishment of a Bayesian, randomised, multifactorial, adaptive,
Care
platform trial for paediatric intensive care
A Study to Evaluate the Introduction of new Staffing A mixed methods study including a realist evaluation to identify the the key
SEISMIC-R - NIHR
Models in Intensive Care: a realist evaluation components of an optimal nurse staffing model for deployment in ICU.
The UK-TBI REpository and data PORTal Enabling Research platform for traumatic brain injury including a repository for TBI and
TBI-Reporter-UKRI-MRC
discoveRy biomarker data and a network for research
Other acronyms
CMP Case Mix Programme n/a
NCAA National Cardiac Arrest Audit n/a
INICUA Irish National Intensive Care Unit Audit n/a
NIHR National Institute for Health Research n/a
HSDR Health Services & Delivery Research Programme n/a
HTA Health Technology Assessment Programme n/a
JGHT Joint Global Health Trials n/a
European and Developing Countries Clinical Trials
EDCTP Partnership n/a
EC European Commission n/a
APCC Annual Participants Cost Contribution n/a
**----- End of picture text -----**
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 41
## **Intensive Care National Audit and Research Centre** Notes to the Accounts For the year ended 31 December 2023
(continued)
## **APPENDICES**
## **2022 Comparatives**
## **Appendix 1 2 INCOME**
|**Appendix 1**
**2 INCOME**|||
|---|---|---|
|Investment income
**Incoming resources for charitable activities include:**||Unrestricted
Restricted
2022
2021
£
£
£
£
-
-
-
-|
|Audit Subscriptions deferred brought fwd||753,183
110,639
863,822
738,680|
|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:**||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)
## **Appendix 2**
## **4 TOTAL EXPENDITURE**
**----- Start of picture text -----**
Total Total
Support Research
Audit Promoting Data 2022 2021
costs grants
£ £ £ £ £ £ £
Staff costs 359,250 10,734 39,531 32,202 2,126,943 2,568,660 2,192,973
Training 1,861 143 430 429 1,154 4,017 4,189
Recruitment 20,485 1,576 4,727 4,727 4,539 36,054 16,725
Meetings 11,635 748 2,246 2,260 5,711 22,600 1,227
Governance - - - 25,822 - 25,822 30,347
Travel 3,815 207 621 621 8,542 13,806 3,679
Premises 68,521 5,271 15,813 15,813 117,670 223,088 351,128
Communications 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 1,506 1,506 3,454
Bank charges - - - 1,892 207 2,099 1,565
Depreciation 11,516 886 2,658 2,657 - 17,717 16,575
- - - -
Research expenditure 1,084,819 1,084,819 768,402
IT 106,284 7,917 23,752 23,751 153,893 315,597 305,573
Administration and consultanc 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
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.
**----- End of picture text -----**
## **Appendix 3**
## **5 GOVERNANCE**
|Board of Management & committees
Legal and HR
Financial|Unrestricted
Restricted
2022
2021
£
£
£
£
1,983
-
1,983
4,544
7,339
-
7,339
7,509
16,500
-
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).
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 42
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts
## For the year ended 31 December 2023
(continued)
## **APPENDICES**
## **2022 Comparatives**
**----- Start of picture text -----**
Appendix 4
12 DEBTORS Unrestricted Restricted 2022 2021
£ £ £ £
Trade debtors 803,046 - 803,046 779,932
-
Research projects 970,815 970,815 2,012,293
Prepayments 69,955 - 69,955 102,036
873,001 970,815 1,843,816 2,894,261
Appendix 5
13 CREDITORS Unrestricted Restricted 2022 2021
£ £ £ £
Trade creditors 211,289 - 211,289 112,850
Other creditors 33,648 - 33,648 16,357
Accruals 132,396 1,644,604 1,777,000 1,506,836
-
Taxation & Social Security 122,720 122,720 144,897
Deferred income (note 16) 923,923 1,128,828 2,052,751 1,898,467
1,423,976 2,773,432 4,197,408 3,679,407
**----- End of picture text -----**
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 43
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts For the year ended 31 December 2023
(continued)
## **APPENDICES**
## **2022 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:||
|---|---|
||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
OPTIC-19 - COVID-19 Research
Response Fund - University of Oxford
COAST Nutrition - EDCTP
REMAP-CAP (RECoVER) - EC HORIZON
2020
REMAP-CAP (ECRAID-Base) - EC
HORIZON 2020
RRAM - NIHR HTA
Oxy-PICU - NIHR HTA|13,305
181,118
(194,423)
-
(18,829)
-
-
(18,829)
10,119
2,612
(12,731)
-
-
61,472
(61,472)
-
-
259,820
(259,820)
-
-
158,637
(158,637)
-
(1,140)
-
-
(1,140.00)
73,603
391,578
(466,441)
(1,260)|
|PICnIC - NIHR HTA
CAFE - NIHR HTA
FIRST -ABC - NIHR HTA
CIRCA - RC(UK)
PRESSURE - NIHR HTA
UK ROX - NIHR HTA|4,709
39,400
(44,109)
-
(12,093)
-
-
12,092.60
-
62,638
278,463
(339,483)
1,618.00
-
3,130
(3,130)
-
68,228
218,131
(286,359)
-
92,283
410,779
(503,062)
-|
|REMAP-CAP - NIHR
QResearch COVID VAC OX107 - HDR
UK
EXAKT - NIHR -HTA
GASTRIC-PICU-NIHR-HTA
Walton Charles Predoc Fellowship-NIHR
T4P (Threshold for Platelets)-NIHR-HTA
Airways-3 - NIHR-HTA|91,946
110,520
(204,848)
(2,382)
7,126
1
(7,127)
-
-
365,387
(365,387)
-
-
129,589
(129,589)
-
-
14,045
(14,045)
-
-
249,383
(249,383)
-
-
14,921
(14,921)
-|
|CLASSIC - NIHR-HTA
MAP-CLD-NIHR-HS&DR|-
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 g p j p g g incurred. When such deficits arise they will be balanced from general funds on completion of the project if the deficit is not corrected prior to completion. 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
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2023 Page 44