## **Working together to improve care and outcomes**
**Intensive Care National Audit and Research Centre** Annual Report and Accounts | Year ended 31 December 2024
www.icnarc.org
## **Contents**
About ICNARC .............................................................................................. 3 Trustees report ............................................................................................. 4 Strategic Objectives for 2024-26 ................................................................... 5 Progress against strategic priorities for 2024 ............................................... 6 Establishing quality through research .......................................................... 9 Research highlights - 2024 ...................................................................... 10 Our plans for research - 2025 .................................................................. 12 Assessing quality through audit .................................................................. 13 Audit highlights - 2024 ............................................................................. 14 Our plans for audit - 2025 ........................................................................ 16 Promoting quality through sharing information ........................................... 17 Our plans for sharing information – 2025 ................................................ 20 Enabling quality through technology innovations ......................................... 21 Our plans for sharing information – 2025 ................................................ 22 Financial review ......................................................................................... 23 Governance, structure and management ................................................ 26 Statement of Trustees’ responsibilities .................................................... 28 Independent auditor’s report to the Members of the Intensive Care National Audit and Research Centre ........................................................... 29 Financial statements Statement of Financial Activities ............................................................. 32 Balance Sheet ........................................................................................ 33 Statement of Cash Flows ....................................................................... 34 Notes to the Accounts ............................................................................ 35
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024
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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 2024
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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 2024. 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 9)
…assessing quality through audit
Read more about how we are developing and expanding our national clinical audits within our National Audit Programme (page 13)
…promoting quality through sharing information
Read more about how we are analysing data and sharing information (page 17)
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 4
## **Strategic Objectives for 2024-26**
ICNARC’s strategic objectives for 2024-2026 are built around our core organisational values: _rigorous, collaborative, innovative and integrity._
The four main strategic objectives are underpinned by seven foundations which define the way we wish to work at ICNARC.
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The four main strategic objectives are underpinned by seven foundations which define the way we wish to work at ICNARC.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024
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## **Progress against strategic priorities for 2024**
Our annual strategic priorities are defined in our business plan, which details the key deliverables against our overall strategic objectives and foundations.
## Strategic Objectives
## **1 Offer a flexible programme of audits of structure, process, outcome and experience that is able to adapt rapidly**
- Substantial work on Structure audit for units completed and to be distributed in early 2025
- Second Pilot of the Cardiogenic Shock Module in progress
- Family Satisfaction Audit pilot undertaken
- Clinical Audit Group application approved for linking our clinical audits to long term outcomes
- Initial work on a clinical audit enterprise data model and flexible reporting platform completed
## **2 Maintain a balanced portfolio of clinical and applied methodological research**
- A documented pipeline of applications in place for randomised clinical trials, methodological studies and secondary analysis of routine data put in place
- Majority of research studies delivering to time and target
- International collaborations progressing with Australia (T4P, PIVOTAL, MOSAICC) and Canada (T4P, blood pressure trial, PIVOTAL)
## **3 Increase the value of our audit and research by providing secondary analyses and curated datasets that are findable, accessible, interoperable and reusable**
- Initial work on establishing Metadata for public facing inventory of audit and research data assets completed
- Delivery plan agreed for live platform for audit customers to interrogate their own data
- Case Mix Programme data prepared for onboarding to TBI-REPORTER platform
- Trusted research/secure data environments identified and prioritised
## **4 Maximise the impact of our work through active knowledge mobilisation**
- Knowledge mobilisation plans embedded in all projects
- Initial work completed on system to proactively identify quality improvement projects from the audits and provide baseline for subsequent annual increases
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 6
Foundations
## **1 Financially sustainable**
_Ensure work is underpinned by clear and sustainable business model_
- Initial work carried out on the business models for proposed new clinical audits
- Charging policy for data analysis requests revised and approved
## **2 Driven by innovation**
_Adopt new approaches to delivering our work_
- Attendance at the International Clinical Trials Methodology Conference, and federated platform trials workshop generated potential collaborations, including discussions with Canada regarding harmonising paediatric platform trials
- Attending conferences on industry leading technology including Azure, AI and enterprise data management. Membership of Digital Health Networks, Global Health Network, UK CRC IS network.
## **3 Maximising the use of technology**
_Enhance efficiency and responsiveness through use of cutting-edge technology_
- Initial draft of Artificial Intelligence Strategy completed and prioritisation framework in place. Feasibility assessment for CoPilot for Microsoft 365 complete
- Atlassian Cloud computing platform implemented
- Review completed on a plan for sustainable long-term IT architecture for our clinical audit systems
- Review completed on the standardisation and alignment of systems used across the organisation
- A number of previously manual processes and data integrity processes have been automated. Ongoing projects to automate further processes in progress.
## **4 Effective communications**
_Engage with key external stakeholders_
- Stakeholder mapping completed alongside initial development of an overall communications plan
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 7
## **5 People-focused working culture**
_Identify and develop talent both internally and externally_
- Internal line management training programme established
- Four research fellowships in place during the year
## **6 Indispensable to the community**
_Work with patients, carers and the public; policymakers and commissioners; and health and care professionals to ensure what we do is deemed important to the community_
- A patient and public network created of former patients – full steering group to be established in 2025
- Commenced involvement of an Independent Data Access Oversight Committee
- Wider stakeholder engagement carried out including with NHS England
## **7 Good governance**
_The work of ICNARC is underpinned by good governance_
- Full Business planning process established
- Departmental data inventories completed
- Initial work on revised risk management framework commenced
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 8
## **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. Through collaboration with patients and health care providers, we design, conduct, analyse and disseminate high-quality, innovative research in adult and paediatric critical care. 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 – 2024
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research research research research
4 grants 2 studies 7 studies 1 studies
awarded in commenced in ongoing in completed in
2024 2024 2024 2024
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Development of our research portfolio continues in adult and paediatric critical care.
## Adult critical care research studies
- Awarded Commenced Ongoing Completed • TITAN-TBI • REMAP-CAP • T4P • UK-ROX • EXAKT • MOSAICC
Paediatric critical care research studies
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Awarded Commenced Ongoing Completed
• PIVOTAL • Oxy-PICU • PRESSURE • PICU platform
• Oxy-PICU Neurodevelopmen • GASTRIC-PICU development
t
Neurodevelopment
•
• Combining
Combining
treatment effects
treatment effects
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**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 9
Research highlights – 2024
## Successful funding awards for research methodologists
- Two successful funding applications under NIHR call for research methodologists: `o` Oxy-PICU neurodevelopment outcomes `o` Combining treatment effects
- _Oxy-PICU neurodevelopment outcomes_ will follow-up patients enrolled in the recently completed, ICNARC-led, Oxy-PICU randomised clinical trial (RCT) to understand the impact on longer-term development of children enrolled in the trial.
- The main results of OXY-PICU showed benefit of reducing exposure to additional oxygen for critically ill children, but this will allow us to check that there is no longerterm impact
- _Combining treatment effects_ aims to combine data from the recently completed, ICNARC-led, First-ABC RCT and its ‘target trial’ using routine data.
- In a target trial, RCT framework is applied to routinely collected observational (nonrandomised) data to prevent potential biases that can occur with observational studies.
- Using a Bayesian statistical approach, we will explore when and how these two types of data (RCT and target trial) can be successfully combined to correctly answer questions which cannot be answered by the RCT data alone.
- Funded by the NIHR, both projects started in October 2024.
## Paediatric Intensive Care Adaptive Platform Trial (PIVOTAL) funding award
- A multi-centre, randomised, Bayesian adaptive platform trial in critically ill children.
- As an adaptive platform trial, PIVOTAL allows multiple research questions and interventions to be tested at the same time.
- The adaptive design also allows for additional interventions and research questions deemed important by health care professionals and patients to be added in future.
- This may allow for more questions to be answered, more efficiently and mean that successful therapies can be identified quickly with a view to informing and establishing appropriate national clinical standards in the shortest possible time frame.
- The overall aim of the PIVOTAL platform is to simultaneously evaluate the clinical and cost-effectiveness of multiple interventions in critically ill children. Initial interventions to be tested include:
- different intravenous sedative strategies;
- conservative fluid administration; and
- restrictive red blood cell transfusion.
- Funded by the National Institute for Health and Care Research (NIHR) following successful completion of the PICU platform development grant.
- Funding was awarded in August 2024 for the work to start in January 2025.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 10
Patient recruitment complete for UK-ROX and EXAKT studies
- Patient recruitment into both studies was complete in late 2024.
- UK-ROX is a large-scale randomised clinical trial (RCT) trying to find out if using a lower oxygen saturation target (conservative oxygen therapy) to guide oxygen treatment might lead to better outcomes for patients when compared with the more liberal approach currently used in NHS ICUs (usual oxygen therapy).
- Recruitment of the 16,500 patients for the UK-ROX RCT was completed from 97 hospitals in England, Wales and Northern Ireland.
- EXAKT was conducted as a study within the UK-ROX RCT and aimed to find out whether skin tone affects the accuracy of pulse oximeters (a clip that is placed on a fingertip to measure the amount of oxygen in a person’s blood).
- An increasing number of studies have shown that for people with darker (pigmented) skin tones, pulse oximeters may over-estimate their true oxygen level. Over-estimation of oxygen levels could under-estimate the seriousness of a person’s illness, leading to them not receiving the correct treatment early enough.
- Recruitment of the 900 patients for the EXAKT study was completed from 24 ICUs participating in the UK-ROX trial.
- Dissemination of the results from these two studies is planned for mid-2025 and will have a large and immediate impact on clinical practice and on patient outcomes in the NHS and worldwide.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 11
## Our plans for research – 2025
- 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 prioritise identification of opportunities for funding to monitor the implementation of research study results through national audit or other routinely collected data.
- • We will continue to strengthen our clinical trials unit infrastructure, through appointment of a Quality Assurance Manager, 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 2024 Page 12
## **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 2024 Page 13
## Audit highlights – 2024
## Case Mix Programme (CMP)
- 288 NHS/non-NHS adult critical care units participating
- Over 200,000 critical care admission records submitted and validated
- Unit Reports updated with new analysis including utilising daily intervention and organ support data for the first time
- Critical Care Network Reports (NQRs) produced and now distributed to networks twice a year
- CMP Public Report 2022-23 published, the first public report for the CMP since the COVID-19 pandemic (during which public reporting was on hold)
- Report includes Comparative Unit Report, revamped CMP Summary Statistics and our first CMP highlights infographic
- New ICNARC model for predicted risk of acute hospital mortality developed based on Version 4.0 dataset, to be rolled out into reports in 2025
- Permissions now in place for CMP to link to other datasets for longer-term outcome analysis (e.g. one year survival), and for CMP to be used as a Research Database
- Second pilot of Cardiogenic Shock Module completed along with planning for wider rollout as an optional module for all CMP units
-
## National Cardiac Arrest Audit
- 208 hospitals participating
- 14,000 resuscitation event records submitted and validated
- Pilot of NCAA in Republic of Ireland up and running from April 2024-March 2025; 9 hospitals participating
- First NCAA Public Report, for 2022-23 data, published, the first time NCAA comparative hospital data have been publicly released, a landmark in NCAA’s growth as a national clinical audit
- Report includes revamped NCAA overall and paediatric Summary Statistics and our first NCAA highlights infographic
- New data submission and validation web portal successfully released, and all hospitals transitioned from old portal
- Preparation underway for update to NCAA Dataset Version 2.0 in 2025, a key step in the development of NCAA which will see additional data collected on existing frailty, treatment escalation plans, and interventions undertaken during the arrest event
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 14
Irish National Intensive Care Unit Audit
- 29 adult critical care units participating; phase 2 of recruitment now complete
- Over 16,500 critical care admission records submitted and validated
- Unit, Hospital Group and overall INICUA reports updated, and new Version 4.0 Quality Indicators launched
Family Satisfaction Audit (in development)
- Phase two of an initial pilot was completed in two units
- Permissions now in place to link CMP data with family member responses
- Development of a Family Satisfaction Report is underway
- Following results from the first pilot, a decision has been made to pilot a new process in 2025
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024
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Our plans for audit – 2025
- 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 develop key performance indicators for our audits, to better monitor participation and the resourcing required to run and continually improve our audits
- We will continue to develop and upgrade our audit platform, including the staged development and release of a new online reporting platform in 2025
- We will release NCAA Dataset Version 2.0
- We will publish 2023-24 Public Reports for the CMP and the NCAA
- We will roll out the new Version 4.0 risk model for the CMP and the INICUA to all levels of reporting
- We will enhance our Quality Improvement (QI) work for both the CMP and the NCAA, publishing our first QI plans and developing further QI resources for participating units and hospitals
- We will continue to develop the content of our national clinical audits, including introducing longer-term outcomes
- We will continue rolling out the Cardiogenic Shock Module for the CMP
- We will continue to develop 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 2024 Page 16
## **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 – 2024
In 2024, we continued to develop reporting on the Case Mix Programme (CMP) Dataset Version 4.0 data. The full Version 4.0 quarterly critical care unit reports, developed in 2023 for the CMP with new and updated quality indicators for adult critical care, were incorporated into reporting for the Irish National ICU Audit (INICUA). A new ICNARC model, for predicting risk of acute hospital mortality in critical care admissions, was developed, and validated, using the Version 4.0 data and will be rolled out to all levels of CMP and INICUA reporting in 2025.
Audit reporting
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CMP NCAA INICUA
quarterly quarterly quarterly
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In 2024 we also published the first Public Report for the CMP since the pandemic, and the very first NCAA Public Report, a landmark step in the NCAA’s growth as a national clinical audit. Both were based on 2022-23 data, whilst 2023-24 data were also locked, and outlier management processes undertaken for both audits, in preparation for 2023-24 Public Reports. The comparative unit/hospital reports for the 2023-24 Public Reports are due for publication in the first quarter of 2025, whilst the summary statistics will be the first data to be developed and presented on a new online reporting platform.
The Case Mix Programme Annual Meeting 2024 took place in May with over 350 delegates attending.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 17
## We also held:
- four online data collection workshops, four online data submission and validation webinars, and one reporting webinar for the CMP;
- an overall update webinar, Paediatric update webinar and a reporting webinar for the NCAA; and
- one face-to-face workshop for the INICUA in Dublin, along with one online workshop; INICUA units are also invited to attend CMP workshops and webinars.
Recordings of the online webinars and workshops are released via YouTube, and links distributed, 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, including Critical Care Reviews 2024 (results of the OXYPICU randomised controlled trial) and the 7[th] International Clinical Trials Methodology Conference (methodological research conducted to support design of the PIVOTAL platform trial).
Peer-reviewed scientific publications
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26 20 319
peer-reviewed
publications in ICNARC external
2024 authors co-authors
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We continued to provide education, training and support to clinical and non-clinical researchers through hosting or working collaboratively with them. In 2024, Mr Walton Charles completed his NIHR Predoctoral Fellowship and resumed full-time employment in a new Research Associate role contributing to both Research and Statistics team activities, we continued to support Professor Manu Shankar-Hari in his NIHR Clinician Scientist Award, continued hosting Ms Claire Mills as part of her NIHR Development and Skills Enhancement Award, continued supporting Ms Elisa Giallongo as part of her doctoral training at the London School of Hygiene Tropical Medicine, began hosting Dr Alex Warren as part of his NIHR Doctoral Training Fellowship and Dr Xavier Chapalain as part of his post-doctoral training at Brest University Hospital (France), began supporting Dr Vishnu Vijayakumar as part of his doctoral training at King’s College London, and began supporting Dr Cathy McKenzie in her NIHR Senior Clinical Practitioner Research Award based at University of Southampton **.**
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 18
## Digital communications
In May 2024 we published our new website. The website was received well by our stakeholders and provides those looking for information about ICNARC and our services a much clearer picture. The website was presented at Health Data Research (HDR) UK’s transparency showcase due to the significant work put in to ensure that we provide transparent data access. One of the ways in which we did this was by creating enhanced data access request documentation and an interactive guidance tool. These developments were published in the International Journal of Population Data Science.
Patient and public involvement and engagement
During 2024 we focussed on the development and growth of our Patient and Public Network so that we could strengthen patient and public involvement (PPI) across the organisation. Ensuring that the patient voice is representative of the diverse population included within our audits and clinical trials was a key focus. The growth of the network came with a focussed training package which is offered to our patient and public representatives.
The network inputted into several projects – this included the development of the website, which has had a significant impact. This included ensuring that our new website, is accessible, understandable and included content which was important to patients. They also supported the development of a glossary of data terminology which was published on the site, and co-designed a number of infographics.
Other activities that the network have been involved in included: oversight of data access requests, as part of a newly established Independent Data Access Oversight Committee; adding the patient voice to our National Cardiac Arrest Audit Steering Group; additional involvement in development of research applications; and consultations about communications with bereaved families for our clinical trials.
We continued our ongoing relationships with intensive care patient support charities such as ICUSteps and the Critical Care Support Network and continued to share the important work taking place within our audits and research amongst members of these groups.
This activity is in addition to the ongoing patient involvement in our research studies and patient representation on our Board of Trustees.
_“…It’s in the public/patient interest … and that outweighs any potential disadvantages…”_
## **Former critical care patient**
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 19
Our plans for sharing information – 2025
- We will develop our Quality Improvement resources for our audits, increasing understanding of reports among participating hospitals and units
- We will release our first interactive online reports for our audits, increasing accessibility of our Public Report data, and begin developing an interactive online reporting platform for organisations participating in our clinical 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 implement knowledge mobilisation and dissemination plans across the organisation
- We will continue to work with patients, families and the public, in all our activities, as we look to hold our first Patient and Public Advisory Group Meeting
- We will establish mechanisms to monitor research outputs that use ICNARC data and support dissemination of their findings
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 20
## **Enabling quality through technology innovations**
Our IT systems form the foundation of all audit and research activities. From data collection, data processing to statistical analysis, these systems play a crucial part in keeping our data safe and delivering our services.
We ensure that these systems are performing at optimum levels, are able to adapt to a changing environment, ensure maximum value for money and are secure.
Our IT strategy is to replace legacy systems and promote use of cloud. This technology transformation programme (The Insights Programme) started in 2024 and is planned to be completed by the end of 2026. This technology transformation includes:
- Replacing legacy systems with cloud-based technologies for improved service delivery.
- Moving our data files to cloud based technologies such as SharePoint and OneDrive.
- Moving applications from the Data Centre to cloud focussed Saas applications or Azure.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024
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## Technology Transformation Highlights – 2024
- Formulated a Migration to cloud strategy.
- Started moving applications to the cloud.
- Commenced Insights Technology Transformation Programme.
Our plans for technology transformation – 2025
- Azure environment ready to host new systems
- • Implement code management
- • Standardise Project Management across the organisation
- • Publish external facing Data Dictionary
- • Publish external facing Reporting Portal
- • Build the platforms required to host our flagship Audits
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024
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## **Financial review**
The Board of Management (Trustees) has adopted the provisions of the Statement of Recommended Practice (SORP) Accounting and Reporting by Charities (FRS 102) in preparing ICNARC’s financial statements.
## Income
ICNARC is funded by our subscription-based national clinical audits and by successful awarding of research grants.
For the year ended 31 December 2024, ICNARC generated total income of £5,249,732 a decrease of 13% on 2023.
Income includes £1,998,329 from audit subscriptions/activities, £3,035,760 from research grants and £108,209 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 2024 was £5,692,245, an increase of 3% on 2023.
## Net result for the year
The overall net result for the year was a deficit of £442,513, compared to a surplus of £400,246 in 2023. This is partly due to investment in new technology, but plans to address this deficit will be formulated in the coming year.
## Cash and cash investments
At the end of the financial year total cash held was £1,116,682 along with £3,500,000 of funds held in fixed term cash investments. This compares to the 2023 totals of £5,178,645 cash and £506,204 held in fixed term cash investments. The change in the profile of the our cash and fixed term investments reflects the focus on achieving the best possible return whilst minimising risk, protecting the capital invested.
## Funds carried forward
Funds carried forward at the end of the financial year are £2,905,576. This represents a decrease of 13% against the funds carried forward at the end of 2023.
## 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 2024 Page 23
## 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 Leadership Team (SLT) 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 multi-year programme of work to ensure that the systems and infrastructure that underpin all our work are fit for purpose and appropriate for the future.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 24
## Reserves
The Board of Management (Trustees) has a policy whereby reserves are maintained at a level which enables the charity to manage financial risk, income volatility and to be able to invest in the technology required to maintain and improve the services that ICNARC provides.
Unrestricted funds, not committed or invested in tangible fixed assets (the free reserve), held by the organisation should usually be between 25% and 60% of the annual resource expended in the General Fund.
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.
Unrestricted funds totalled £2,976,495 at the end of 2024 and includes £2,781,085 of general funds and the designated Development Fund of £195,410 which has been set aside to invest in ICNARC’s technology strategy. In addition, we are committed to a major technology transformation programme (The Insights programme) to replace legacy systems and promote use of cloud. This programme has a committed budget of £1.5m.
|programme) to replace legacy systems and
of £1.5m.|promote use of cloud.|
|---|---|
|General fund|£2.8m|
|Insights Programme budget|(£1.5m)|
|Total uncommitted general funds|**£1.3m**|
|||
|2025 budgeted General Fund expenditure|£2.6m|
|Reserves policy lower limit|**£0.65m**|
|Reserves policy upper limit|**£1.3m**|
The Board of Management (Trustees) have reviewed the level of reserves currently held and concluded that this falls within the limits set by the reserves policy.
ICNARC’s reserves are either held in cash or fixed term 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 12, 16, 20 and 22.
## 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 tax under S466 Corporation Tax Act 2010 (CTA 2010).
## Special exemptions
This Report of the Directors and Board of Management (Trustees) has been prepared in accordance with the special provisions under Part 15 of the Companies Act 2006 relating to small companies and the Charity has taken advantage of the small companies’ exemptions in preparing the Directors Report and the requirement to prepare a Strategic Report.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 25
## Governance, structure and management
The Intensive Care National Audit and Research Centre (ICNARC) is a Company Limited by Guarantee incorporated in England on 8 July 1994 and governed by its Memorandum and Articles of Association.
ICNARC’s Articles of Association provide for a limitation of member liability to £1. ICNARC is a Registered Charity in England and Wales.
**Registered Name of Company:** Intensive Care National Audit and Research Centre **Company Number:** 02946727 **Registered Charity Number:** 1039417 **Registered Office:** Napier House, 24 High Holborn, London WC1V 6AZ
## Our Trustees
The Trustees form the Board of Management and are responsible for the governance and strategy of ICNARC. The Board of Management is made up of thirteen 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 Leadership Team (SLT). 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 2024.
## **The Trustees serving during 2024 and into 2025 are:**
**Chair:** Ms Susan James
**Trustees:** Dr Tim Gould Dr Lisa Hinton Prof David Menon Dr Gareth Sellors Ms Susan James Prof Ruth Endacott Prof Tamas Szakmany Prof Richard Grieve Prof Manu Shankar-Hari Ms Vikki Williams Mr Gary Morley (Treasurer) Mr Hemang Patel
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 SLT 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.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 26
## Trustees’ Indemnities
Trustees benefit from indemnity insurance to cover the liability of the Trustees which by virtue of any rule of law would otherwise attach to them in respect of any negligence, default or breach of trust or breach of duty of which they may be guilty in relation to the Charity. The cost of this insurance in the year has been included within total insurance costs.
## Public Benefit
In shaping the objectives and activities for each year, the Board of Management (Trustees) considers the guidance of the Charity Commission on public benefit, including the guidance ‘Public Benefit: Running a Charity’. The nature of ICNARC’s public benefit is detailed on pages 4 to 15 of this report.
## Senior 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 2024 and into 2025 are:**
Prof David Harrison Co-Director Mr Paul Mouncey Co-Director Mr Peter Hyde Chief Operating Officer Lindsay Hannigan Chief Information Officer
## Our staff
During 2024, ICNARC had an average paid workforce of 62 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 2024 Page 27
## 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.
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: 24 June 2025
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 2024 Page 28
## Independent Auditor’s 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 2024 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 2024, 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 2024 Page 29
## **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;
- Enquiry of management about any instances of non-compliance with laws and regulations;
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 30
- 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: 30 July 2025
MHA is the trading name of MHA Audit Services LLP, a limited liability partnership in England and Wales (registered number OC455542)
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 31
## **Intensive Care National Audit and Research Centre**
Statement of Financial Activities (Incorporating an Income and Expenditure account) For the year ended 31 December 2024
|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
2024
2023
General
Development
Fund
£
£
£
£
£
107,434
-
-
107,434
8,543
1,744,032
-
236,168
1,980,200
1,861,419
18,129
-
-
18,129
18,825
108,209
-
-
108,209
86,918
1,425
-
3,034,335
3,035,760
3,961,298
Unrestricted Funds|
|---|---|
||1,979,229
-
3,270,503
5,249,732
5,937,003
2,062,854
208,134
269,785
2,540,773
1,626,419
118,082
-
3,033,390
3,151,472
3,910,338|
||2,180,936
208,134
3,303,175
5,692,245
5,536,757|
||(201,707)
(208,134)
(32,672)
(442,513)
400,246|
||-
-
-
-
-|
||(201,707)
(208,134)
(32,672)
(442,513)
400,246|
||2,982,792
403,544
(38,247)
3,348,089
2,947,843|
||2,781,085
195,410
(70,919)
2,905,576
3,348,089|
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 35 to 48 form part of these accounts.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 32
## **Intensive Care National Audit and Research Centre**
## Company Registration number 02946727 Balance Sheet For the year ended 31 December 2024
||Notes|Unrestricted|Restricted|2024|2023|
|---|---|---|---|---|---|
|||£|£|£|£|
|**FIXED ASSETS**||||||
|Tangible assets|11|24,098|-|24,098|30,713|
|**INTANGIBLE ASSETS**|11a|-|-|-|-|
|**CURRENT ASSETS**||||||
|Debtors|12|1,118,112|1,344,065|2,462,177|1,878,224|
|Cash at bank and in hand||1,066,411|50,271|1,116,682|5,684,849|
|Investments||2,489,673|1,010,327|3,500,000|-|
|||4,674,196|2,404,663|7,078,859|7,563,073|
|**Creditors**||||||
|Amounts falling due within one year||||||
|Deferred income||1,065,342|90,604|1,155,946|1,303,960|
|Other payables||506,457|2,384,978|2,891,435|2,791,737|
||13|1,571,799|2,475,582|4,047,381|4,095,697|
|Net current assets||3,102,397|(70,919)|3,031,478|3,467,376|
|Creditors: Amounts falling due in||||||
|greater than one year|14|150,000|-|150,000|150,000|
|**NET ASSETS**||2,976,495|(70,919)|2,905,576|3,348,089|
|**Represented by:**||||||
|Unrestricted Funds||||||
|General Fund|17|2,781,085||2,781,085|2,982,792|
|Development Fund (Designated)|17|195,410||195,410|403,544|
|||2,976,495||2,976,495|3,386,336|
|Restricted Fund|17|-|(70,919)|(70,919)|(38,247)|
|||||2,905,576|3,348,089|
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 24 June 2025 on their behalf by:
Susan James, Chair
The Notes on pages 35 to 48 form part of these accounts.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 33
## **Intensive Care National Audit and Research Centre**
## Statement of Cash Flows For the year ended 31 December 2024
|**Cash used in operating activities**|2024
2023|
|---|---|
|Surplus/(Deficit) less interest income|(549,947)
391,703|
|(Increase)/Decrease in debtors
Increase/(Decrease) in creditors
Depreciation charges
**Net cash used in operating activities**
**Cash flow from investing activities**
Interest income|(583,953)
(34,410)
(48,316)
(101,711)
25,509
24,886
(1,156,707)
280,468
107,434
8,543|
|Amounts invested in longterm deposits|(3,500,000)
-|
|Purchase of tangible fixed assets
**Net cash provided by investing activities**|(18,894)
(31,677)
(3,411,460)
(23,134)|
|Increase (decrease) in cash and cash equivalents in the year|(4,568,167)
257,334|
|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**|5,684,849
5,427,515
**1,116,682**
**5,684,849**
2024
2023
£
£
1,116,682
5,684,849
1,116,682
5,684,849
At 1 January
At 31 December
2024
Cash flows
2024
£
£
£|
|Cash at bank and in hand|5,684,849
(4,568,167)
1,116,682|
|||
||5,684,849
(4,568,167)
1,116,682|
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 34
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts For the year ended 31 December 2024
Intensive Care National Audit and Research Centre (ICNARC) is a private company limited by guarantee registered in England and Wales and a charity registered with the Charity Commission. In the event of the charity being wound up, the liability in respect of the guarantee is limited to £1 per member of the charity. The address of the registered office is given on Page 20. The nature of the charity's operations and principal activities are detailed on pages 4-16. The charity is a public benefit entity as defined by FRS 102. The company registration is 02946727.
## 1 ACCOUNTING POLICIES
(a) The accounts have been prepared under the historical cost convention in accordance with the Companies Act 2006 and follow the recommendations in Accounting and Reporting by charities: Statement of Recommended Practices (SORP) applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS 102). (b) The financial statements are prepared on a going concern basis. The Board of Management (Trustees) have considered the level of funds held and the expected level of income and expenditure for 12 months from authorising these financial statements. The budgeted income and expenditure are sufficient with the level of reserves for the charity to be able to continue as a going concern. The accounts are prepared in sterling, which is the functional and presentational currency of the charity, rounded to the nearest £1.
(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 premises cost and resources used to support those activities.
(i) All fixed assets are initially recorded at cost and capitalised if costs exceed £1,000.
|(i) All fixed assets are initially recorded at cost and capitalised if costs exceed £1,000.
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 premises cost and resources used to support those
activities.|(i) All fixed assets are initially recorded at cost and capitalised if costs exceed £1,000.
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 premises cost and resources used to support those
activities.|
|---|---|
|(j) Depreciation is provided at the following annual rates to write off the cost of each asset on a straight-line basis over its estimated life. Rates||
|currently used on cost are:||
|Office fabrication|20%|
|Computer equipment|33%|
|Office equipment|33%|
|Office furniture|20%|
(k) 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.
(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.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 35
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts For the year ended 31 December 2024
## continued
(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.
Cash investment – On the basis of cashflow projections, surplus cash is invested to achieve the best possible return whilst minimising risk, protecting the capital invested, adhering to and preserving the values of the Charity. This is achieved through fixed-term deposits, short and long term, with the Charity's nominated banks.
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 2024 Page 36
## **Intensive Care National Audit and Research Centre**
Notes to the Accounts For the year ended 31 December 2024
(continued)
## **2 INCOME**
|**2 INCOME**|||
|---|---|---|
|**Incoming resources for charitable activities include:**
Audit Subscriptions deferred brought fwd
Audit Subscriptions received 2024
Less Audit Subscriptions deferred carried forward
Audit Subscriptions
Data/COVID-19 income
Activities in promoting Audits
Research Grants
Other services
**Incoming resources for charitable activities include:**||Unrestricted
Restricted
2024
2023
£
£
£
£
835,058
119,628
954,686
907,138
1,731,428
251,704
1,983,132
1,781,974
(902,810)
(135,164)
(1,037,974)
(954,686)|
|||1,663,676
236,168
1,899,844
1,734,426
80,356
-
80,356
126,993
18,129
-
18,129
18,825
1,425
3,034,335
3,035,760
3,961,298
108,209
-
108,209
86,918|
|||1,871,795
3,270,503
5,142,298
5,928,460|
||||
Activities in promoting Audits include: software licensing £18,129 - (2023: £18,825), meeting, travel funding and speaker fees £nil - (2023:£254)
See appendix 1 on page 47 for 2023 comparative note.
## **3 RESEARCH GRANTS**
|Other
Other Research
Oxy-PICU - NIHR HTA
FIRST -ABC - NIHR HTA
CIRCA - RC(UK)
REMAP-CAP - NIHR
EXAKT - NIHR -HTA
**Grants:**
Optic - Delirium PDG-NIHR-Researcher-Led
Cluster trials - UKRI - MRC
MecROX-NIHR-EME
BACHb-NIHR-HTA
REMAP-CAP (ECRAID-Base) - EC HORIZON 2020
PRESSURE - NIHR HTA
UK ROX - NIHR HTA
Oxy PICU 2 - NIHR-HTA
EXAKT-NIHR-HTA
GASTRIC-PICU-NIHR-HTA
WAL Walton Charles Predoc Fellowship-NIHR
PICU Platform-NIHR-HTA
OXY-PICU ND-NIHR-RFPB
Combining Data-NIHR-RFPB
CNU COAST Nutrition - EDCTP
T4P (Threshold for Platelets)-NIHR-HTA
Airways-3 - NIHR-HTA
MOSAICC-NIHR-HTA
OPTICAL-NIHR-HSDR
CTU Infrastructure - NIHR
REMAP-CAP (RECoVER) - EC HORIZON 2020
REMAP-CAP-FLU-NIHR
SEISMIC-R-NIHR
TBI-Reporter-UKRI-MRC
MAP-CLD-NIHR-HS&DR|Restricted
Total
Total
General
Development
2024
2023
-
-
394,608
394,608
482,514
-
-
240,381
240,381
528,929
-
-
35,573
35,573
-
-
-
25,209
25,209
-
-
-
693,728
693,728
456,879
-
-
24,991
24,991
44,429
-
-
17,601
17,601
181,579
-
-
7,703
7,703
-
-
-
17,562
17,562
-
-
-
85,350
85,350
83,534
-
-
24,019
24,019
49,008
-
-
537,303
537,303
365,846
-
-
12,343
12,343
23,606
-
-
540,229
540,229
375,419
-
-
5,975
5,975
21,657
-
-
298,529
298,529
264,806
-
-
21,932
21,932
8,310
-
-
5,179
5,179
2,685
-
-
5,917
5,917
-
-
-
5,093
5,093
-
-
-
22,782
22,782
-
-
-
6,644
6,644
-
-
-
8,576
8,576
-
-
-
-
-
75,310
-
-
-
-
128,793
-
-
-
-
337,817
-
-
-
-
132,442
-
-
-
-
11,993
-
-
-
-
166,390
-
-
-
-
205,066
-
-
(2,892)
(2,892)
14,286
1,425
-
-
1,425
-
Unrestricted funds|
|---|---|
||1,425
-
3,034,335
3,035,760
3,961,298|
All research income in 2023, £3,961,298, was restricted.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 37
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts For the year ended 31 December 2024
(continued)
## **4 TOTAL EXPENDITURE**
**==> picture [523 x 281] intentionally omitted <==**
**----- Start of picture text -----**
|||||||||
|---|---|---|---|---|---|---|---|
|Total|Total|
|Support|Research|
|Audit|Promoting|Data|2024|2023|
|costs|grants|
|£|£|£|£|£|£|£|
|Staff costs|1,059,157|62,689|195,160|199,161|1,804,108|3,320,275|2,952,335|
|Training|20,473|1,574|4,724|4,724|14,548|46,043|42,738|
|Recruitment|1,368|105|315|315|1,414|3,517|44,429|
|Meetings|29,959|2,304|6,914|8,333|17,805|65,315|79,416|
|Governance|-|-|-|38,363|-|38,363|36,019|
|Travel|4,848|372|1,118|1,119|17,025|24,482|24,984|
|Premises|92,799|6,744|20,242|15,151|86,175|221,111|244,761|
|-|-|-|-|
|Legal/professional fees|3,261|3,261|6,500|
|Communications|2,522|193|582|582|2,758|6,637|6,120|
|Publications/printing|(227)|(18)|(51)|(54)|12,842|12,492|10,080|
|Post and carriage|1,319|113|341|341|3,518|5,632|3,101|
|Bank charges|-|-|-|1,762|24|1,786|1,536|
|-|
|Depreciation|16,580|1,274|3,827|3,828|25,509|24,886|
|-|-|-|-|
|Research expenditure|1,060,761|1,060,761|1,393,616|
|IT|299,972|21,780|58,263|59,352|128,656|568,023|484,688|
|Administration and consultancy|142,022|10,827|32,497|32,496|(1,423)|216,419|229,217|
|Other Research|118,082|-|-|-|(118,082)|-|-|
|Historic accrual write-off|47,205|3,630|10,892|10,892|-|72,619|-|
|-|-|-|-|-|-|
|Closed projects (Research)|(47,669)|
|Allocation of support costs|296,840|19,875|59,650|(376,365)|-|-|-|
|2,132,919|131,462|394,474|-|3,033,390|5,692,245|5,536,757|
**----- End of picture text -----**
Audit expenditure £2,132,919 includes unrestricted costs totalling £1,863,134 and restricted costs totalling £269,785. Allocation of support costs is the reallocated Management and Administration after deduction for Governance and apportioned on the basis of premises costs.
See appendix 2 on page 47 for 2023 comparative note.
## **5 GOVERNANCE**
**==> picture [523 x 63] intentionally omitted <==**
**----- Start of picture text -----**
||||||
|---|---|---|---|---|
|Unrestricted|Restricted|2024|2023|
|£|£|£|£|
|-|
|Board of Management & committees|1,946|1,946|6,345|
|-|
|Legal and HR|18,267|18,267|12,349|
|Financial|18,150|-|18,150|17,325|
|38,363|-|38,363|36,019|
**----- End of picture text -----**
Travel and meeting costs were £1,946 of which, £1,159 (2023: £2,257) were reimbursed to 8 (2023: 9) trustee members. Fees payable to the charity's auditors in respect of the audit and specialist advice were £18,150 (2023: £17,325). See appendix 3 on page 47 for 2023 comparative note.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 38
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts
## For the year ended 31 December 2024
(continued)
## **6 RESOURCES EXPENDITURE - RESEARCH**
|**Restricted**
Start date
Grant value
08/01/2020
£1,806,766
08/01/2020
£2,078,886
08/01/2019
£1,569,780
01/03/2022
£586,200
01/09/2022
£1,952,721
01/09/2022
£83,465
01/03/2023
£204,795
01/10/2024
£257,141
01/10/2024
£202,626
01/03/2021
£523,696
-
05/01/2018
£800,636
01/01/2022
£1,925,146
01/01/2022
£64,155
23/09/2020
£17,802
01/03/2021
£1,710,519
08/01/2021
£49,170
-
01/04/2022
£27,632
01/12/2022
£780,859
01/05/2023
£36,106
01/10/2023
£58,754
01/05/2023
£5,916
03/04/2023
£13,966
01/01/2025
£5,508,262
01/12/2022
£31,918
01/04/2023
£24,134
01/11/2023
£18,137
09/01/2013
£800,636
01/07/2020
£60,092
11/06/2020
£609,850
11/01/2019
£519,652
02/01/2019
£1,499,843
06/01/2019
£70,719
01/04/2020
£745,990
various
**Unrestricted**
Other Research
Closed projects (Research)
**7 RESTRICTED RESOURCES EXPENDITURE - AUDIT**
National Cardiac Arrest Audit
REMAP-CAP - NIHR
Other Research (Historic accrual write off)
Other
OPTIC-19 - COVID-19 Research Response Fund -
University of Oxford
REMAP-CAP (RECoVER) - EC HORIZON 2020
PICnIC - NIHR HTA
FIRST -ABC - NIHR HTA
CIRCA - RC(UK)
PIVOTAL
MecROX-NIHR-EME
BACHb-NIHR-HTA
OPTICAL-NIHR-HSDR
CTU Infrastructure - NIHR
REMAP-CAP-FLU - NIHR
SEISMIC-R - NIHR
TBI-Reporter-UKRI-MRC
Optic - Delirium PDG-NIHR-Researcher-Led
Cluster trials - UKRI - MRC
CLASSIC - NIHR-HTA
MOSAICC - NIHR HTA
QResearch COVID VAC OX107 - HDR UK
COAST - JGHT
MAP-CLD-NIHR-HS&DR
REMAP-CAP (ECRAID-Base) - EC HORIZON 2020
CON REMAP CAP Convalescent Plasma
COAST Nutrition - EDCTP
T4P (Threshold for Platelets)-NIHR-HTA
Airways-3 - NIHR-HTA
GASTRIC-PICU-NIHR-HTA
Walton Charles Predoc Fellowship-NIHR
PICU Platform - NIHR HTA
OXY-PICU ND-NIHR-RFPB
Combining Data-NIHR-RFPB
PRESSURE - NIHR HTA
UK ROX - NIHR HTA
Oxy-PICU - NIHR HTA
EXAKT - NIHR -HTA|2024
2023
£
£
396,774
482,514
263,881
528,929
35,573
337,818
25,209
205,066
695,895
456,879
24,957
44,429
21,748
181,579
7,703
-
17,562
-
85,350
83,534
(10,034)
-
24,019
49,008
539,469
365,846
12,343
23,606
-
(187)
542,394
375,419
-
(10,479)
(36,044)
-
13,139
9,432
298,529
264,806
21,932
8,310
5,179
2,685
5,963
-
5,093
-
158
-
22,782
-
6,644
-
8,576
-
-
75,310
-
-
-
128,793
-
(453)
-
134,060
-
11,993
-
164,008
-
-
(1,404)
35,102|
|---|---|
||3,033,390
3,958,007|
||118,082
-
-
(47,669)|
||3,151,472
3,910,338|
||2024
2023
£
£
269,785
249,984|
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 39
## **Intensive Care National Audit and Research Centre** Notes to the Accounts For the year ended 31 December 2024
(continued)
## **8 SURPLUS ON ORDINARY ACTIVITIES**
|Unrestricted
Restricted
£
£
25,509
-
18,150
-
**9 STAFF COSTS AND NUMBERS**
Salaries
Social security costs
Pension
Seconded and agency staff
Auditors' remuneration
Depreciation and amortisation
The surplus is stated after charging:||2024
£
25,509
18,150
2024
£
2,816,377
272,219
205,678
26,000|2023
£
24,886
17,325
2023
£
2,406,655
236,191
149,864
159,625|
|---|---|---|---|
|||3,320,274|2,952,335|
The number of employees receiving emoluments in excess of £60k (does not include employer pension):
|£60,000 - £69,999|2|3|
|---|---|---|
|£70,000 - £79,999|3|2|
|£80,000 - £89,999|3|2|
|£90,000 - £99,000|1|-|
|£100,000 - £109,999|-|-|
|£110,000 - £119,999|-|-|
|£120,000 - £129,999|-|1|
The monthly average numbers employed during the year calculated on the basis of actual headcount:
|Executive
Audit
Research
Statistics
Data & Data Systems
Operations|No.
No.
4
4
9
10
21
21
8
7
12
5
8
9|
|---|---|
||62
56|
The company operates a Group Personal Pension scheme. Contributions to the Group Personal Pension Scheme in 2024 were £186,422 (£149,864 in 2023).
The amount of pension contribution to higher paid staff in 2024 was £60,404 (£53,123 in 2023). The number of employees eligible to participate in the Group Personal Pension scheme at the end of 2024 is 62 (56 in 2023) and the total number participating is 58 (51 in 2023)
The number of employees auto-enrolled during 2024 is 8 (12 in 2023).
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 (2023: Nil).
The Co-Directors received total emoluments of £192,242 (2023: £153,455).
Contractual redundancy costs included in total salaries for 2024 is £nil (2023: £nil).
## **10 TAXATION**
The company is exempt from income and corporation taxes under S466 to S493 Corporation Tax Act 2010 (CTA 2010).
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 40
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts
For the year ended 31 December 2024
(continued)
|**11 TANGIBLE FIXED ASSETS**|Office
Computer
Office
Office
fabrication
equipment
equipment
furniture
Total|Office
Computer
Office
Office
fabrication
equipment
equipment
furniture
Total|Office
Computer
Office
Office
fabrication
equipment
equipment
furniture
Total|
|---|---|---|---|
||£
£|£|£
£|
|Cost at 1 January 2024|32,407
100,067|8,939|55,415
196,828|
|Additions|-
18,894|-|-
18,894|
|Disposals|-
-|-|-
-|
|At 31 December 2024|32,407
118,961|8,939|55,415
215,722|
|||||
|Depreciation at 1 January 2024|32,073
69,688|8,939|55,415
166,115|
|Depreciation for the period
Disposals|334
25,175
-
-|-
-|-
25,509
-
-|
|At 31 December 2024|32,407
94,863|8,939|55,415
191,624|
|||||
|Net book value at 31 December 2024|-
24,098|-|-
24,098|
|Net book value at 31 December 2023
**11a INTANGIBLE ASSETS**
Cost at 1 January 2024
Additions
Disposals
At 31 December 2024
Amortisation at 1 January 2024|334
30,379|-|-
30,713|
||IT
Development
Software||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 2024
Net book value at 31 December 2024|-
-||-|
||45,400
248,521||293,921|
||-
-||-|
|Net book value at 31 December 2023|-
-||-|
|**12 DEBTORS**
Trade debtors
Other debtors
Research projects
Prepayments|Unrestricted
Restricted
2024
£
£
£
907,094
-
907,094
72,686
-
72,686
-
1,344,065
1,344,065
138,332
-
138,332|||
See appendix 4 on page 47 for 2023 comparative note.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 41
## **Intensive Care National Audit and Research Centre**
Notes to the Accounts For the year ended 31 December 2024
(continued)
|**13 CREDITORS**|Unrestricted
Restricted|2024|2023|
|---|---|---|---|
||£
£|£|£|
|Trade creditors
Other creditors
Accruals
Taxation & Social Security
Deferred income (note 15)|160,756
-
160,756
80,200
-
80,200
115,353
2,384,978
2,500,331
150,148
-
150,148
1,065,342
90,604
1,155,946||258,352
49,742
2,343,163
140,480
1,303,960|
||1,571,799
2,475,582
4,047,381||4,095,697|
See appendix 5 on page 48 for 2023 comparative note.
## **14 CREDITORS: AMOUNTS FALLING DUE AFTER ONE YEAR**
|Dilapidations||2024
£
150,000|2023
£
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 2024
Amount released to incoming resources
Deferred audit
Deferred research
Deferred other
Balance at 31 December 2024|2024
2023
£
£
1,303,960
2,052,751
(1,303,960)
(2,052,751)
1,037,974
954,686
90,604
335,366
27,368
13,908|
|---|---|
||1,155,946
1,303,960|
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
2024
2023
General
Designated
Funds
£
£
£
£
£
24,098
-
-
24,098
30,713
4,478,786
195,410
2,404,663
7,078,859
7,563,073
(1,571,799)
-
(2,475,582)
(4,047,381)
(4,095,697)
(150,000)
-
-
(150,000)
(150,000)
Unrestricted Funds|
|---|---|
||2,781,085
195,410
(70,919)
2,905,576
3,348,089|
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 42
## **Intensive Care National Audit and Research Centre**
## Notes to the Accounts For the year ended 31 December 2024
(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:|2024
Income
Expenditure
Transfers
2024|
||£
£
£
£
£|
|PRESSURE - NIHR HTA
UK ROX - NIHR HTA
Oxy PICU 2 - NIHR-HTA
EXAKT-NIHR-HTA|-
394,608
(396,774)
(2,166)
-
240,381
(263,881)
(23,500)
(1,261)
35,573
(35,573)
(1,261)
-
25,209
(25,209)
-|
|GASTRIC-PICU-NIHR-HTA|-
693,728
(695,895)
(2,167)|
|T4P (Threshold for Platelets)-NIHR-HTA
Airways-3 - NIHR-HTA
CLASSIC - NIHR-HTA
MOSAICC-NIHR-HTA
OXY-PICU ND-NIHR-RFPB
Combining Data-NIHR-RFPB
REMAP-CAP (ECRAID-Base) - EC HORIZON 2020
CON REMAP CAP Convalescent Plasma
CNU COAST Nutrition - EDCTP
WAL Walton Charles Predoc Fellowship-NIHR
PICU Platform-NIHR-HTA|-
24,991
(24,957)
34
-
17,601
(21,748)
(4,147)
-
7,703
(7,703)
-
-
17,562
(17,562)
-
-
85,350
(85,350)
-
-
-
10,034
10,034
-
24,019
(24,019)
-
-
537,303
(539,469)
(2,166)
-
12,343
(12,343)
-
2,721
-
-
2,721
-
540,229
(542,394)
(2,165)|
|QResearch COVID VAC OX107 - HDR UK|10,479
-
-
10,479|
|Optic - Delirium PDG-NIHR-Researcher-Led
Cluster trials - UKRI - MRC
COAST - JGHT
MAP-CLD-NIHR-HS&DR
REMAP-CAP-FLU-NIHR
SEISMIC-R-NIHR
TBI-Reporter-UKRI-MRC|-
-
36,044
36,044
-
5,975
(13,139)
(7,164)
-
298,529
(298,529)
-
-
21,932
(21,932)
-
-
5,179
(5,179)
-
-
5,917
(5,963)
(46)
-
5,093
(5,093)
-|
|OPTICAL-NIHR-HSDR
PIVOTAL
MecROX-NIHR-EME
BACHb-NIHR-HTA|-
-
(158)
(158)
-
22,782
(22,782)
-
-
6,644
(6,644)
-
-
8,576
(8,576)
-|
|Other|5,870
(2,892)
1,404
4,382|
|||
|Total grants|17,809
3,034,335
(3,033,390)
-
18,754|
|Audit:||
|National Cardiac Arrest Audit|(56,056)
236,168
(269,785)
(89,673)|
|Total Restricted Funds|(38,247)
3,270,503
(3,303,175)
-
(70,919)|
|Unrestricted Funds||
|Development Fund (designated)|403,544
-
(208,134)
195,410|
|General Fund|2,982,792
1,979,229
(2,180,936)
2,781,085|
|At the end of the year|3,386,336
1,979,229
(2,389,070)
-
2,976,495|
||3,348,089
5,249,732
(5,692,245)
-
2,905,576|
## 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 withheld 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 45 and 46 for the description and purpose of the restricted funds.
## Purpose of designated funds
The development fund, for the ongoing development of the technology that underpins our national clinical audits and research currently stands at £195,410. It will be expended over the next 5 years. See appendix 6 on page 48 for 2023 comparative note.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 43
## **Intensive Care National Audit and Research Centre**
Notes to the Accounts For the year ended 31 December 2024
(continued)
## **18 RELATED PARTY TRANSACTIONS**
There are no related party transactions in the year (£0 - 2023) 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 from those of the Charity in an independently administered fund. The pension cost charge representsfrom 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 £186,422 (2023: £149,864).
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 £50,560 (2023: £24,844) were payable at 31 December 2024 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 £138,804 (2023: £138,364)
|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|2024
2023|
|---|---|
||£
£
169,983
169,983
169,983
169,983
28,331
198,314
-
-|
||368,297
538,280
440
1,189
440
-
147
-|
||1,027
1,189
369,324
539,469|
## **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 technology that underpins our clinical audits and research at an estimated future costs of £195,410. 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 2024 Page 44
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 45
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 46
## **Intensive Care National Audit and Research Centre**
Notes to the Accounts For the year ended 31 December 2024 (continued)
## **APPENDICES 2023 Comparatives**
## **Appendix 1**
## **2 INCOME**
|**Incoming resources for charitable**
**activities include:**|Unrestricted
£|Restricted
2023
2022
£
£
£
110,402
907,138
863,822
212,508
1,781,974
1,748,418
(119,628)
(954,686)
(907,138)
203,282
1,734,426
1,705,103
-
126,993
140,809
-
18,825
21,586
3,961,298
3,961,298
3,026,633
4,739
86,918
187,803
4,169,319
5,928,460
5,081,933|
|---|---|---|
|Audit Subscriptions deferred brought fwd|796,736||
|Audit Subscriptions received 2023
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:**|1,569,466
(835,058)||
||1,531,144
126,993
18,825
-
82,179||
||1,759,141||
||||
Activities in promoting Audits include: software licensing £18,129 - (2023: £18,825), meeting, travel funding and speaker fees £nil - (2023:£254)
## **Appendix 2 4 TOTAL EXPENDITURE**
|Staff costs
Training
Recruitment
Meetings
Governance
Travel
Premises
Legal/professional fees
Communications
Publications/printing
Post and carriage
Bank charges
Depreciation
Research expenditure
IT
Administration and consultancy
Closed projects (Research)
Allocation of support costs|Total
Total|
|---|---|
||Audit
Promoting
Data
Support costsResearch
grants
2023
2022
£
£
£
£
£
£
£
604,273
29,591
103,197
99,869
2,115,405
2,952,335
2,568,660
19,041
1,464
4,393
4,393
13,447
42,738
4,017
22,740
1,749
5,247
5,248
9,445
44,429
36,054
29,381
2,114
6,341
7,356
34,224
79,416
22,600
-
-
-
36,019
-
36,019
25,822
5,286
404
1,216
1,216
16,862
24,984
13,806
92,131
6,693
20,087
14,997
110,853
244,761
223,088
-
-
-
6,500
6,500
-
2,562
197
592
592
2,177
6,120
17,922
(2,135)
(165)
(493)
(493)
13,366
10,080
10,004
235
18
55
55
2,738
3,101
1,506
-
-
-
1,454
82
1,536
2,099
4,522
346
1,044
1,045
17,929
24,886
17,717
-
-
-
-
1,393,616
1,393,616
1,084,819
191,009
13,398
33,118
34,207
212,956
484,688
315,597
143,952
10,975
32,942
32,942
8,406
229,217
156,885
-
-
-
-
(47,669)
(47,669)
(127,267)|
||191,166
11,931
35,803
(238,900)
-
-
-|
||1,304,163
78,715
243,542
-
3,910,337
5,536,757
4,373,329|
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.
## **Appendix 3**
## **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
25,822|
|---|---|---|---|
|||36,019||
|||||
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).
|**Appendix 4**|||
|---|---|---|
|**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||
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 47
## **Intensive Care National Audit and Research Centre**
Notes to the Accounts For the year ended 31 December 2024 (continued)
**APPENDICES 2023 Comparatives** continued
||**APPENDICES**
**2023 Comparatives**
continued|
|---|---|
|**Appendix 5**||
|**13 CREDITORS**|Unrestricted
Restricted
2023
2022|
||£
£
£
£|
|Trade creditors
Other creditors
Accruals
Taxation & Social Security
Deferred income (note 16)|258,352
-
258,352
211,289
49,742
-
49,742
33,648
106,000
2,237,163
2,343,163
1,777,000
140,480
-
140,480
122,720
968,594
335,366
1,303,960
2,052,751|
||1,523,168
2,572,529
4,095,697
4,197,408|
## **Appendix 6**
## **17 RESERVES**
The movement in the reserves were as follows:
|**Appendix 6**
**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|-
375,419
(375,419)
-|
|PICU Platform - NIHR HTA
65 - NIHR HTA
REMAP-CAP (RECoVER) - EC HORIZON 2020
COAST Nutrition - EDCTP
REMAP-CAP (ECRAID-Base) - EC HORIZON 2020
REMAP-CAP-FLU - NIHR
RRAM - NIHR HTA
Oxy-PICU - NIHR HTA
PICnIC - NIHR HTA
CAFE - NIHR HTA
FIRST -ABC - NIHR HTA
CIRCA - RC(UK)
PRESSURE - NIHR HTA|(18,829)
-
-
18,829
-
-
49,008
(49,008)
-
-
128,793 (128,793)
-
-
83,534
(83,534)
-
-
264,806
(264,806)
-
-
181,579
(181,579)
-
(1,140)
-
-
1,140
-
(1,260)
337,817
(337,818)
(1,261)
-
-
453
(453)
-
(12,093)
-
-
12,093
-
1,618
132,442
(134,060)
-
-
11,993
(11,993)
-
-
482,514
(482,514)
-|
|Airways-3 - NIHR-HTA
CLASSIC - NIHR-HTA
SEISMIC-R - NIHR
UK ROX - NIHR HTA
REMAP-CAP - NIHR
EXAKT - NIHR -HTA
GASTRIC-PICU-NIHR-HTA
Walton Charles Predoc Fellowship-NIHR
T4P (Threshold for Platelets)-NIHR-HTA
MAP-CLD-NIHR-HS&DR
QResearch COVID VAC OX107 - HDR UK|-
528,929
(528,929)
-
(2,382)
166,390
(164,008)
-
-
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
(12,225)
21,657
(9,432)
-
-
-
10,479
10,479
-
8,310
(8,310)
-|
|TBI-Reporter-UKRI-MRC|-
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:||
|(14,093)
208,021
(249,984)
(56,056)
National Cardiac Arrest
Audit||
|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|
||2,979,026
1,767,684
(1,328,766)
(31,608)
3,386,336|
|At the end of the year|2,947,843
5,937,003
(5,536,757)
-
3,348,089|
|Purposes of restricted funds
Purpose of designated funds
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.
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.||
The development fund, for the ongoing development of the technology that underpins our national clinical audits and research currently stands at £403,544. It will be expended over the next 5 years.
**Intensive Care National Audit and Research Centre |** Annual Report and Accounts for the year to 31 December 2024 Page 48