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2021-03-31-accounts

Company Number: 03056823 Charity number: 1046826

Isabel Hospice Limited Trustees’ Annual Report and Financial Statements For the Year Ended 31 March 2021

Trustees’ Annual Report for the Year Ended 31 March 2021

Trustees’ Annual Report and Financial Statements for the Year Ended 31 March 2021

Contents

Foreword from Chair…….…………………………………………………………………………………………………………………………4 Trustees’ Annual Report for the Year Ended 31 March 2021………………………………………………………………………………..5 Objectives and activities ...........................................................................................................................................5 Our Services During 2020/21 ...................................................................................................................................7 Community Care .......................................................................................................................................................7 Living Well ................................................................................................................................................................7 In-Patient Care .........................................................................................................................................................7 Hospice at Home ......................................................................................................................................................7 Medical services .......................................................................................................................................................7 Family Support .........................................................................................................................................................8 Education..................................................................................................................................................................8 Public Benefit ...........................................................................................................................................................9 Vision and Strategic aims .......................................................................................................................................10 Strategic Themes ....................................................................................................................................................10 Our Values ..............................................................................................................................................................12 Together we care ...................................................................................................................................................13 Achievements and performance ………………………………………………………………………………………………………………………13 Delivering and improving quality ………………………………………………………………………………………………………………………11 Objectives – progress and plans………………………………………………………………………………………………………………………..14 Patient Services ......................................................................................................................................................15 Finance ...................................................................................................................................................................23 Fundraising .............................................................................................................................................................24 Fundraising Landscape 2020/21 .............................................................................................................................25 Retail / Charity Shops .............................................................................................................................................26 Retail Landscape 2020/21 ......................................................................................................................................27 Our People ..............................................................................................................................................................27 Financial Review .....................................................................................................................................................30 COVID-19 Impact ....................................................................................................................................................31 Risk reserves ...........................................................................................................................................................32 Going Concern ........................................................................................................................................................32 Risk Management ...................................................................................................................................................33 Trustee recruitment ...............................................................................................................................................36 Executive Management ..........................................................................................................................................36 Investment policy ...................................................................................................................................................37 Fundraising Policy ...................................................................................................................................................37 Senior Executive Remuneration .............................................................................................................................37 Auditor……………………………………………………………………………………………………………………………………………………………..41

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Trustees’ Annual Report for the Year Ended 31 March 2021 Reference and administrative information…………………………………………………………………………………………….………….42 Independent Auditor’s Report……………………………………………………………………………………………….……….……………….. 44 Consolidated accounts……………………………………………………………………………………………..…………………………………..…..48 Statement of financial activities (incorporating an income and expenditure account) ………………………..…………….48 Balance sheet ......................................................................................................................................................... 49 Statement of cash flows ......................................................................................................................................... 50 Notes to the financial statements .......................................................................................................................... 51

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Trustees’ Annual Report for the Year Ended 31 March 2021

Foreword from the Chair

During 2020/21 we have responded to the considerable challenges presented by the coronavirus (COVID-19) pandemic. This has led us to modify clinical services, change some of our fundraising approaches, close our shops, change the way the Hospice and Retail Business operated to meet Government lockdown restrictions. We also put in place interim governance arrangements to ensure we were carefully monitoring the situation with particular regard to the finances of the Charity.

Financially, Isabel Hospice finished the year with a surplus of £2.4m. This was largely due to the receipt of much welcomed Government grants (Retail, Hospitality and Leisure Grants, Monies from NHS England (distributed by Hospice UK), Job Retention Scheme (Furlough Scheme), a substantial legacy for which we are extremely grateful, a successful “Fighting Fund Appeal” and delivering the planned cost reduction and efficiency initiatives.

During 2020/21, 1619 people used our services which was a decline on the previous year of 2339. This was largely due to the Living Well services being much reduced to meet Government restrictions. The number of patients cared for in our Inpatient Unit (IPU) and Hospice at Home increased. During the year we reallocated staff to the inpatient unit (IPU) when we opened extra beds to assist the NHS cope with the first surge of coronavirus (COVID-19). Our community support of patients increased with limited resources. This was enabled due to our staff developing remote and virtual operating practices for assessing and keeping in touch with patients, which allowed the staff to take a higher caseload. The care and support provided evaluated well, and will become part of business as usual going forwards.

During the year we revisited our strategy and identified a new vision of Outstanding Palliative Care for All . We identified three strategic themes to inform and drive everything we do to deliver the vision:

We also explored the possibility of a merger with Garden House Hospice Care (GHHC), a neighbouring Hospice. The Boards of both Hospices decided not to merge at this time, but in the interests of beneficiaries, would continue the strong commitment that they already have to collaborate.

Looking forward, the Charity faces a number of challenges. There could be increased demand for services as people who have not sought advice become sicker quicker. The effects of coronavirus on the economy could affect fundraising activities and retail contribution. The Charity will be looking at different ways of generating income from fundraising and the retail contribution and looking at whether it can turn some assets into additional income generation schemes.

The work of Isabel Hospice could not be delivered without the amazing staff and volunteers, and the support of the community. The Board would like to thank the staff for being responsive and agile in responding to the required changes and being compassionate to each other. We would like to thank the volunteers, some who took on different roles to meet the Charity’s needs, and our community for supporting us in all sorts of ways but in particular, by providing, the much needed funds to enable the Hospice to continue to deliver its services.

Rod Leggetter Chair

Date 9 September 2021

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Trustees’ Annual Report for the Year Ended 31 March 2021

Trustees’ Annual Report for the Year Ended 31 March 2021

The Trustees are pleased to present their annual report (which, for the purposes of company law, includes the strategic report and the directors’ report) and the audited financial statements for the year ended 31 March 2021.

These financial statements have been prepared in accordance with the Charities Act 2011, the Companies Act 2006, the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) and the Statement of Recommended Practice – Accounting and Reporting by Charities (SORP 2015). The financial statements include the results of the charity’s trading subsidiary, Isabel Hospice Trading Limited.

Objectives and activities

The charity’s purpose as set out in the objectives contained in the company’s memorandum of Association is “to provide palliative care and support for those suffering from life-limiting illnesses, as well as support for their families and carers, in the boroughs of Welwyn Hatfield and Broxbourne and the District of East Hertfordshire”.

To deliver this objective we provide a range of services to support patients and their families. Some of these services are illustrated in the following patient story.

Patient Story – Jean Lee

JEAN LEE

Jean lived with Gary, her eldest son and carer, in Ware; she had cancer and died on June 4, 2020 aged 73. Gary is a 55year-old primary school supply teacher. Our commitment to caring throughout the coronavirus crisis has meant that many of the patients we have supported over the past 12 months have avoided being admitted to hospital during what has been a particularly frightening time. Our Hospice at Home team has stood steadfast on the frontline out in our communities caring for vulnerable people in their own homes, while during the height of the pandemic, to help relieve the pressure on the NHS, we made six additional beds available on our In-Patient Unit, caring for those at the very end of their lives who had contracted Covid-19.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Gary Lee is one relative who knows his family’s experience could have been entirely different had the specialist care and support provided by Isabel Hospice been forced to stop because of the coronavirus outbreak. His mum Jean, who had cancer, may have been readmitted to hospital where she had already spent 10 distressing days without visitors, or Gary may have had to struggle on unsupported caring for his mother at home.

Despite his mum Jean’s initial reluctance to the Hospice’s involvement, our very special approach to care soon won her over, and she spent her final weeks safe and comforted in our care.

“ Mum was referred to [Hospice at Home] as an emergency case until other support could be put in place, but she was quite resistant to the idea at first,” Gary said. “But, when Sarah turned up that first morning she was absolutely wonderful with her and by the time she left a few hours later Mum was absolutely fine. Sarah just knew how to deal with grumpy old ladies who were in pain and completely won her round. Mum always called them ‘my girls’. She would sit in her chair and as soon as the gate opened and we could hear them coming up the path Mum would light up. There are certain things sons just can’t help with, and she loved having them come to help because she was so well cared for.”

After a few weeks of visits from the Hospice at Home Team, Jean told them one day her pain had gotten a lot worse, and it was suggested she came into the In-Patient Unit so they could help manage her painful leg and make her more comfortable.

“ Like most people, Mum thought the hospice was somewhere you go to die. So she was quite surprised when they explained they could help manage her pain, and in fact a high proportion of people then return home ,” Gary said.

“ She was still cross about the idea, but she went in and that first night [senior staff nurse] Chris sat with her reading her book and, by the morning, she’d softened and knew she was in the best place. She felt looked after, and I remember her telling me how much she loved the puddings!”

Over the next three weeks, Jean’s health deteriorated quickly and Gary described his mum as becoming “quieter and quieter” until eventually the family were told her time was drawing to a close. Gary, his brother Darren, and their former partners Ginette and Angela, who Jean had remained incredibly close to, were all there at the end.

“We were all there in the room with her, talking to her and just being together. Being in that cocoon somehow made something so gut wrenching - your mum dying in front of you - bearable. Everyone was so sympathetic, there was no rush to leave. It was clearly obvious they care so much and there is great pride in what they do. “For our family, it meant Mum’s passing wasn’t a terrible event, and it was your girls and organisation that made that possible. We will be eternally grateful Mum passed calmly, peacefully and painlessly with us by her side in a place she felt safe.”

Gary added: “The Hospice does something very special that society doesn’t value enough. Having a good death is important, and [Isabel] allows that to happen. We have no regrets and are very grateful that we belong to this very special group of people.”

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Trustees’ Annual Report for the Year Ended 31 March 2021

Our Services During 2020/21

During 2020/21 our services had to be modified in response to the Coronavirus pandemic that started to present in March 2020, with many services becoming remote and virtual. The changes to our services are described below.

Community
Care		 During the 20.21 year, Community development and Compassionate
Neighbours activities were required to respond to the changing needs
of people as the pandemic progressed. Relationships between
neighbours and matches became virtual and the Neighbours also
worked with the Living Well team to take over the telephone contact
of patients who could no longer access Living Well and who by then
had purely social needs. It is pleasing to note that Neighbours took
the initiative to develop further ways to assist those who were
shielding.
A further feature was the redeployment of both staff to the IPU team,
which was the priority for some months. For 6 months both staff were
working in the IPU which has had the consequence of a much deeper
understanding of the clinical staff’s work and vice versa. Once the
staff returned to their own roles, they have continued to recruit, train
and match neighbours. We have integrated community development
with bereavement support in the development of virtual Grief
Encounter Groups and continued to develop the Start the
Conversation Project with a wider health and social care
grouping. This project aims to take Advance Care Planning to the
community and empower people to make their own decisions.
Living Well This service offers a variety of options to support people living with
serious, long term and life limiting conditions, and their loved ones.
Since the pandemic began in March 2020, all group work has ceased
in the 4 locations. Virtual sessions, either live or pre-recorded have
been offered alongside telephone consultations. 1:1 face to face
consultations with Physiotherapy has continued in a Covid secure
fashion. As at March 2021, planning has begun to gradually
reintroduce group sessions.
In-Patient Care Our In-Patient Unit (IPU) based in Welwyn Garden City offers 8 beds
for specialist symptom management and end of life care. During the
height of the pandemic, we were funded for an extra 6 beds for 3
months, and an extra 2 beds for a further 3 months. Visiting has been
restricted to maintain a Covid secure environment, however we have
maintained access for families, particularly at the end of life.
Medical services A consultant supported team of doctors work as part of our clinical
services supporting every patient and professional in every aspect of
our patient care and educational programmes.
Family Support We offer a range of service to family and friends supporting them as
they cope with the terminal illness of a loved one and through into
bereavement. We provide one to one support for adults and children,
child and teen support groups, individual and group bereavement
support and spiritual care. Since March 2020, all family support work
has been delivered remotely. Children and young people have
adapted to this approach extremely well. Adult face to face visits

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Trustees’ Annual Report for the Year Ended 31 March 2021 have restarted when remote consultation is contraindicated.

Education We support our community and healthcare partners by providing an extensive range of clinical education programmes. This service enables the charity to share its knowledge, experience and expertise in specialist palliative care with other providers of care in the area, and contributes to our ambition to improve the end of life care for all people. Staff were redeployed to the IPU for several months and since returning to Education, the external – and most of the internal – education has been delivered remotely. This has proved to be successful for external education but less so for internal. In the last few months of the year, internal sessions face to face have been recommenced in Covid secure environments.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Public Benefit

The Trustees have reviewed the Charity Commission guidance on Public Benefit and are confident that the charity meets the requirements, specifically:

All services are provided free of charge irrespective of social, economic, ethnic or religious background and are for the public benefit. To fund these activities, the charity has to raise the majority of its funding from the communities it serves and we continue to rely on the generosity of local people through a wide range of fundraising and giving, including:

We also have a service contract with the East & North Herts Clinical Commissioning Group (CCG) that provides 28% of our income.

The charity continues to rely on support from over 325 volunteers who make a substantial contribution to income generation and service delivery. The charity could not provide its services without their time and skills.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Vision and Strategic aims

Refresh of Strategy

During 2020-21, the Charity reviewed and refreshed its Strategy and Vision. A Strategy for 2021-2016 has been identified. Both are described below.

Our Vision is

Outstanding Palliative Care for All

We will deliver outstanding palliative care through our services, and work in partnership with others including patients, GPs, NHS community providers, NHS acute hospitals, Nursing and Residential Homes, Carers, Patient’ Relatives and other Third Party Providers to enable them to deliver palliative care that meets patient needs. We need to remember that the provision of end of life care is the responsibility of statutory bodies, however, the hospice has a key contribution to this particularly in the area of specialist palliative care.

Strategic Themes

We have identified three strategic themes to inform and drive everything we do for the vision to be delivered, and these are;

The challenge we are addressing, what we will do and measures of success are summarised below. It should be noted that part of business processes is to undertake a situational analysis each year, and then check-in with our strategy to check it whether any changes need to be made to take forward and opportunities that present in the environment.

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Trustees’ Annual Report for the Year Ended 31 March 2021

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Trustees’ Annual Report for the Year Ended 31 March 2021

Our Values

Our values are at the heart of how we work in every setting – between staff, within teams, with volunteers, how we treat patients and families and how we engage with partner organisations and suppliers. These are:

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Trustees’ Annual Report for the Year Ended 31 March 2021

Together we care is our strapline captures the essence of our approach as a charitable hospice

Achievements and performance

The selected metrics listed below are illustrative of the scale and scope of the services provided. The charity’s multi-disciplinary teams of staff and volunteers deserve credit for the high standards of care provided. It should be noted that the numbers for the year ending March 2021 reflect services provided during the coronavirus pandemic.

March 2021 March 2020 March 2019 March 2018
Totalpeople using our services 1,694 2,339 1,855 1,555
Patients 1,318 1,834 1,441 n/a
Family support clients* 488 630 596 595
Patients receiving In–Patient Care 228 208 174 153
Hospice at Home 152 EHH 149 EHH
287 H@H		 139 EHH
298 H@H		 153 EHH
183 H@H
359 H@H
Patients cared for in their homes 1,286 1,273 1,602 (Non De-
duplicated)		 1,206
Patients cared for at Living Well 269 601 573 224
Attendances at Living Well sessions 1,715 6,334 6,078 4,227
Telephone,
face to face
and virtual
Cancer/ Other diagnosis 59%/41% 54%/46% 59%/41% 74%/26%
Average days from referral to death 133 days 120 days 106 days 90 days

*Family support clients – 285 were adult family members, 91 children (total 376) and 112 patients.

*Hospice at Home – Total patients de-duplicated across both services = 412

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Trustees’ Annual Report for the Year Ended 31 March 2021

Place of death

915 patients we were supporting died in the year. Of those where place of death was recorded:

2021 2020 2019 2018 2017
At home* 61% 59% 69% 64% 57%
In Patient Unit (IPU) 25% 22% 15% 19% 18%
Hospital 14% 19% 16% 17% 25%

*A further breakdown of home = 93% died at home and 7% died at a care home

Preferred Place of Death (PPD):

PPD Achieved for 2015/16 (prior to EHH) = 79% PPD achieved for 2016/2017 = 81% (EHH started November 2016) PPD achieved for 2017/2018 = 86% PPD achieved for 2018/2019 = 84% PPD achieved for 2019/2020 = 80% PPD achieved for 2020/2021 = 85%

Delivering and improving quality

Our Quality Account 2020/21 details our performance and achievements and the full report is available on our website. Feedback from the East & North Herts CCG included in the Quality Account was as follows:

“East and North Herts CCG (ENHCCG) has reviewed the information provided by Isabel Hospice and we believe this is a true reflection of performance during 2020/2021 based on the information submitted during the year as part of the ongoing quality monitoring process.

The Quality Priorities set out for 2021/22 continue to show a commitment to strive forward with quality improvement using a range of different projects and approaches. Over the next year they have identified some key areas for improvement such as further provision for care in patients’ own homes. This will enable residents in our CCG to remain at home with more complex needs than ever before if this is their final wish. Continued use of IT based analysis is being utilised to ensure that patient outcomes are monitored in real time which enhances care for all. There is a continued investment in their staff and training opportunities that in turn improve their knowledge and understanding of the patients’ needs. The staff survey will be used to ensure staff feel supported in their roles which again improves patient outcomes through low turnover of staff.

The hospice showed that they implemented the sepsis bundle by rolling this out to all staff in the Multidisciplinary Team. This had been designed specifically for hospice patients and utilised visual aids and prompt cards, helping to ensure early recognition which is key. Changes made to the drug charts indicate further the drive to provide the safest care possible.

Staff have continued to play a significant role not only at the hospice but throughout the CCG footprint by providing expert support and training to care homes throughout the Covid-19 Pandemic. This has included vital debriefing sessions for staff that have been particularly affected by Covid-19. They are also piloting attending family meetings virtually with the care homes to provide expert advice and support.

The focus shown on early identification of incidents and use of effective communication to staff (including benchmarking against other Hospices) has led to staff being able to identify and act upon trends quickly and responsively. Extending the ‘Views on care’ to the community has led to a greater understanding of what is important to the patient. It was pleasing to see that 100% of respondents felt the involvement of the clinical specialist nurse had provided benefits that increased their quality of life and that of the people caring for them.

During 2020/21 The Hospice had plans for implementing the Patient Safety Strategy – this was delayed due to Covid-19. However, an assessment was undertaken in March 2021 with a volunteer and a Trustee.

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Trustees’ Annual Report for the Year Ended 31 March 2021

These inspections give valuable insight into how the environment feels for the patients and is used to make improvements to benefits all that use the hospice.

For 2021/22 the Hospice priorities include improving the clinical IT system to aid record keeping. Updating the website to ensure access to the most up to date information and other sources of support will benefits many of our residents and their families. The focus on development and training for staff remains with a psychological skills training programme to equip the staff to respond to psychological stress appropriately and recognise the need to refer on when needed.

The CCG again looks forward to further enhancing the positive relationship that it has with the Hospice and the contribution the Hospice makes to the ongoing care of the residents of Hertfordshire.”

Objectives – progress and plans

Last year we set ourselves some specific objectives – our progress against each of these is shown in the tables below, together with some of our key objectives for 2021-22.

Patient Services

Patient Services
What we said we would do
2020-21		 What we achieved The benefits / impacts this has
had
Safe
Patient safetyremains a top
priority for the hospice and
integral to the definition of
quality. Isabel Hospice is
committed to embedding the
development of new programmes
introduced through the NHS
Patient Safety Strategy and
Framework. We will continue to
respond to and investigate patient
safety incidents through a revised
reporting template and
investigation form which allows
for effective analysis of patient
safety incidents.
Implementing Sepsis care bundle:
With increasing national interest
in Sepsis Care Bundles, we
planned to introduce this to the
Inpatient unit in order to more
effectively identify and respond to
Sepsis as a multidisciplinary team.		 The impact of COVID-19 has
affected the pace of the NHS
strategy implementation.
However, the hospice has
achieved the following in line
with the broader strategy:
➢ Enhanced incident reporting
templateto ensure clinical
staff provide detailed
information
➢ Simplified pressure ulcer
templatesand care planning
to improve staff
documentation
➢ Support safety culture across
the region by reporting
community incidents which
are fed back to the
healthcare organisation
involved and CCG for
learning
The hospice Education Specialist
Lead rolled out the Isabel Sepsis
Care Bundle which is specific for
hospice patients. This included a
visual flow chart and prompt
cardsproviding information
around recognition,
multidisciplinary approach,
management and review of
sepsis.		 ➢ Key and detailed
information is now
provided at the point of
reporting which has
assisted effective and swift
investigation
➢ Review of incidents at the
incident review meeting
show appropriate
documentation and care
planning in place for
pressure ulcers with no
further actions required
➢ External organisations have
welcomed the opportunity
to be alerted to safety
incidents involving their
staff so that learning can be
shared
Recognising sepsis in patients
within the hospice setting is
challenging given the clinical
conditions of many patients.
This bundle provides tools for
clinical staff to assist sepsis
screening and decision making
and highlights requirements for
effective communication.

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Trustees’ Annual Report for the Year Ended 31 March 2021

What we said we would do
2020-21		 What we achieved The benefits / impacts this has
had
Effective
Learning From COVID-19:
During the pandemic, we have
adapted the way we work to
maintain the safety of patients
and staff. As we move towards
the ‘new normal’ we will review
and evaluate those changes to
ensure we make the most of the
opportunities to do things
differently that we have been
offered.
Implementing PLACE – the NHS
environmental audit tool. The
assessments involve local people
who are not staff (known as
Patient Assessors) going into care
environments as part of teams to
assess how the environment
supports the provision of clinical
care.
1977		 COVID19 affected every part of
our clinical service. To continue to
provide an effective and safe
service to our patients and their
families, our Clinical Nurse
Specialist (CNS) and Living Well
Services moved to providing
support and clinical advice via
phone and virtual consultations.
We designed a survey to help
evaluate this change. We received
74 responses, 31 from CNS
caseload and 43 from Living Well
caseload.
Due to rigorous COVID19
restrictions, the PLACE
assessment did not take place
until March 2021. The
assessment was undertaken by a
Trustee and hospice volunteer to
assess the environment, building
and overall experience of the
hospice through the eyes of a
patient.		 The survey showed that in most
cases remote working had not
detracted from the support and
care provided to our patients with
93% stating that they were very
satisfied (83%)or satisfied (10%)
with the care and treatment
provided by our staff during the
pandemic and 81% felt that they
had been supported. Staff began
using an appointment system for
call/video consultations so
patients and their families were
prepared and face to face
consultations were undertaken
for patients with complex needs.
This survey provided evidence
that a blend of virtual and face to
face consultations is an effective
care option.
The hospice achieved the
following scores:
Cleanliness – 100%
Food – 100%
Privacy, dignity & wellbeing –
91%
Condition, appearance &
maintenance – 98%
Dementia – 80%
Disability – 81%
Scores which were below
optimum relate to Dementia and
Disability:
➢ Not all toilet doors were in a
single distinctive colour
➢ Hot/Cold taps colours worn
off
➢ Handrails not in a colour that
contrasts with the walls
➢ Availability of hearing loop
not clear
➢ Leaf catcher in guttering
hanging down
➢ More effective signage
required
These findings have been fed back
to the facilities team and IPU
Manager for action.

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Trustees’ Annual Report for the Year Ended 31 March 2021

What we said we would do 2020-21

What we achieved

The benefits / impacts this has had

What we said we would do
2020-21		 What we said we would do
2020-21		 What we achieved The benefits / impacts this has
had
Responsive
Bereavement Cafes:
We are planning to establish
open, drop in bereavement cafes
supported by the Community
Development manager with
volunteer support. These are to
be established in venues across
the patch to encourage local
friendships to develop. Again this
will depend on guidance related
to COVID-19.
Implementing Views on Care in
the Community:
Views on Care is a validated tool
which focuses on the patient’s
quality of life and perceived
impact of the palliative care
service. This will become an
integral assessment for our
community patients to help
ascertain our service user
experience in the community
setting.
Service Improvement Partnership
(SIP) for Patient Survey
Going forward, we will undertake
a Service Improvement
Partnership (SIP) project to
establish service users’ perception
of the question relating to the
opportunity to discuss wishes for
future care. This question is asked
within our IPU patient survey and
results are currently below what
we would expect. Our data shows
that the offer of Advance Care
Planning is provided to all
appropriatepatients. Byobtaining		 Working collaboratively, the
Family Support team, including
Bereavement Support Volunteers,
and the Community Development
Lead have refreshed the group
bereavement offer. This
comprises 6 planned sessions
with professional therapeutic
input and an end point. Users are
then supported to create or join
groups local to where they live
which are facilitated by a
Compassionate Neighbour until
such time as the group chooses to
stand alone.
The implementation of views on
care was initially met with some
resistance by the community
nursing team. The team raised
concerns about directly asking the
patient to complete the survey
whilst under their care. However,
through team discussion and
engagement, a solution was
agreed to send the questionnaire
to patients and carers on CNS
caseload whilst providing
anonymity. This would also
provide both a patient and carer
experience. We received 30
responses.
During the period of the survey,
only two respondents did not feel
they had the opportunity to
discuss wishes for future care:
➢ One was completed by a
family member but the
patient record showed that
advance care planning had
been discussed with the
patient
➢ One patient noted ‘haven't
been discharged yet so don't
know what the future is yet’.		 Covid 19 has interrupted the
running of these groups face to
face, although we have piloted
the approach virtually.
Planned impact will include
encouraging local support
networks, normalising the
experience of loss and
bereavement and the end of a
dependency on the hospice
support group.
The Views on care results showed:
80%of respondents felt that their
main problems and concerns had
got better
100% felt that involvement with
the Clinical Nurse Specialist had
provided benefit(2/3rds stated a
lot of benefit).
Patients and carers overall quality
of life had increased following
CNS involvement.
Respondent comments included:
Supportive; Helpful medication
advice; Compassion
It was also noted that whilst not
always possible, face to face visits
would have helped. This evidence
further supports the blended face
to face and virtual care model.
The question remains valid but
respondents need to be offered
the chance to provide further
information around this. Further
discussions with clinical staff and
the Ward Clerks indicated that
survey completion had been
hampered by COVID19
restrictions. Historically, the ward
clerks would hand patients and
their families the survey and
discuss completion. Due to
current restrictions, the paper
survey is left in the room with no

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Trustees’ Annual Report for the Year Ended 31 March 2021

What we said we would do
2020-21		 What we achieved The benefits / impacts this has
had
the views of our service users, we
can ascertain their understanding
and amend the question if
appropriate.		 Patient was discharged before
this could be discussed but
again the records showed
advance care planning had
been discussed.		 chance to have further
conversations.
The SIP provided a chance for us
to review the way in which we
obtain feedback from IPU service
users and how we can improve
this. This will form part of our
objectives for 2021-2022.
Well-Led
Implementing a visual and
immediate method of
communication across the
hospice
Effective communication is key
within any organisation but
particularly crucial within the
current climate. The hospice
currently communicates in a
variety of ways to staff however
this communication is sometimes
missed by clinical staff on varying
shifts, for a variety of reasons. We
wanted to explore ways to
provide a more visual and
immediate way of communicating
to staff across the hospice so that
they can keep up to date with the
latest developments.		 Quarterly patient safety
dashboardswere created showing
our safety performance across
three key aspects; patient falls,
medication errors and pressure
ulcers. Using the Hospice UK
benchmarking tool, visual graphs
containing information around
safety performance compared to
other hospices was provided to
staff on the unit via notice boards
and their team meetings.
The Head of Governance also
worked with the Head of
Marketing and Communications
to develop the Isabel Hospice
digital noticeboard. Available to
staff when they open a web
browser, this provides links to
useful clinical information such as
Covid19 guidance, IT contacts and
policies.
The CEO and Executive team have
implementedquarterly all staff
and volunteer zoom sessionsto
share information and
organisational progress.
All Executive team members
summarise the discussions at Exco
fortnightly and share with their
teams.
The CEO has prepared and
published‘Message from Helen’
which offers news and updates
across the service.
Following the Staff Survey, in
which communication scored		 Staff were able to easily identify
where there have been
improvements in patient safety
comparable to other hospices.
This was evident for both falls and
medication incidents. Also, to see
where we are above average for
pressure ulcer incidents. Further
investigation of this established
data discrepancies in the national
reporting of pressure ulcers to
Hospice UK. Further work will be
undertaken by the tissue viability
group to continually assess the
management of pressure ulcers
within the unit.
Follow up work is required to
establish the impact of the digital
noticeboard to determine what
aspects are helpful to staff and
what further information is
required. This will be addressed
in team meetings and the results
fed back to the Head of Marketing
and Communications.
These have been well attended
and feedback from staff is that
they find them very useful and
feel more valued as a result.
Feedback from staff is that they
appreciate this feedback
This messages are opened and
read by a higher percentage of
volunteers than staff (approx. 30%
of staff open this). This suggests
we need to invest in the
development of a culture of
communication beingtwo way.

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Trustees’ Annual Report for the Year Ended 31 March 2021

What we said we would do
2020-21		 What we achieved The benefits / impacts this has
had
poorly, Directors have held focus
group sessions outside their own
directorates, asking staff for their
ideas and suggestions to improve
communications.

Education in 2021/21

At the start of the year there was a well-planned transition to a new eLearning platform called Bluestream Academy. Bluestream provides many benefits and allows for a more robust system of recording and evidence. The next step is to move away from the volunteer work book for clinical volunteers and add them to our ELearning platform which again will provide clearer evidence of Statutory Mandatory training. Throughout this year clinical staff have managed their stat man training with conviction, allowing us to maintain our target of 95% uptake. The Education team has recently taken over the recording of non-clinical Statutory Mandatory monthly figures. It is hoped this will create a more seamless approach to statutory mandatory training across the organisation.

A new training landscape was created by the Coronavirus (COVID-19) pandemic. Initially some of the education team were recalled back into clinical work. Despite this, vital training was maintained. Our education team designed and delivered a four day training course for new Health care assistants (HCA) to support the extra beds in IPU. Practical moving and handling and staff development days remained face to face. The remaining training was delivered virtually. The Education team became adept at providing virtual interactive sessions and though numbers of attendees were initially small these numbers continue to rise. The virtual learning zone has increased in attendees as it is easier for people to fit these sessions into their working day. Of note, although numerous sessions were cancelled and the external programme commenced later in the year, attendance and number of sessions offered are not far behind previous years.

A virtual platform allowed delivery of training that was adapted to the challenges presented by Coronavirus (COVID-19) as well as to the needs of our community. This was especially so in Care Homes. Care Home Education adapted to virtual delivery instead of face to face. In collaboration with Garden House Hospice care (GHHC), education was provided to care homes around their needs and requirements. This approach meant that more carers were able to access the training and delivery spanned East and North Herts capturing a larger uptake of carers in one session. The sessions were adapted to be responsive to care home’s needs; this was driven by a daily or even hourly changing situation alongside the legislation and adaptions to care that were driven by the pandemic. Subjects delivered were varied and of late there has been an increased need for bereavement, loss and resilience support for staff. We have worked extremely closely with the Clinical Commissioning Group (CCG) and external providers during this year and these closer relationships have been very beneficial.

In terms of projects, delivery was maintained. The team supported projects on Learning disabilities, Health Care Partnerships Association (HCPA) End of Life Care Project and the Integrated Care System webinar projects. This was all delivered collaboratively with palliative educators in the other hospices and Hertfordshire Community Trust (HCT). Projects raised £11,130 for the hospice. We have led and project managed the production of psychological assessment skills training alongside GHHC, HCT, the Lister Hospital and our clinical psychologist in East and North Herts.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Unfortunately, our Isabel education team has diminished in numbers since March 2020. However, we are pleased to be working collaboratively with Garden House Hospice education team to ensure we could continue our external education programme (which has been published) and to become more unified to increase our joint external education approach. The pandemic has enabled a new vision of providing a blended approach of virtual and face to face learning. The team are excited to move this vision forward with the aim of reaching more people and ensuring that the importance of palliative care is foremost in the delivery of care. A summary of education is given below.

TRAINING TYPE NUMBER OF SESSIONS
DELIVERED		 NUMBER OF
ATTENDANCES		 INDIVIDUAL
ATTENDANCES
INTERNAL
Stat/Man
Clinical Professional
Development (includes
Junior Doctor Teaching)
Total Internal:		 47
36
83		 209
139
348		 Not recorded
Not recorded
176 individual
attendances at all internal
training
Volunteer Training 0 0 0
Isabel Hospice External
Education Programme		 30 312 214
PROJECTS
Compassionate
Neighbours
ICS
Total Projects:		 8
2
10		 34
77
111		 34
77
111
Patient Education 0 0 0
Training Sessions
Delivered Externally
(includes sessions
delivered for HCPA)		 79 650 not recorded
TOTAL NUMBERS: 202 1421 501 (note this does not
include the 650
attendances at external
sessions as individual
attendees were not
counted at sessions
delivered at HCPA)

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Trustees’ Annual Report for the Year Ended 31 March 2021

Clinical Quality Priorities and Visions for April 2021-March 2022

Building on the organisational strategic objectives, we have identified 4 clinical strategic objectives: Enable an outstanding patient journey Engage and integrate with the wider health and social economy Empower staff to deliver outstanding care

Engage to enable and empower a compassionate community

Our quality priorities and visions feed into these objectives.

Safe

Improve access of community patients to medical review

Now that the medical team has increased and is well settled, we aim to be able to offer more home based care for patients with complex or unstable symptoms who choose to remain at home. This will complement the support to the nursing teams via Specialist Multi-disciplinary meetings and caseload reviews.

Participate in the Hospice UK Falls Audit Programme

Hospice UK have invited hospices to participate in a national falls audit programme for the year 2021-2022. This detailed audit will audit falls activity and contributory factors. Being part of this national audit will provide a detailed analysis of a large amount of falls data. We will implement any recommendations to improve falls patient safety within Isabel.

Effective

Enable IPOS analysis at service level to drive improvement in patient outcomes in real time

Through the LHITS (Leathen Healthcare IT Solutions) tool, we will be able to breakdown patient outcomes by service. This will provide specific information for each cohort of patients being cared for by the different services within the hospice. This will enable us to address the concerns and problems faced by those patients and provide targeted interventions. We will also understand which patients are In an unstable phase and whether this is being addressed in a timely manner.

Streamline Patient Record Keeping SystmOne

The hospice moved to the patient electronic record keeping system, SystmOne from Crosscare in 2016. Throughout the last five years, it has been updated and tweaked but there are some aspects which are ineffective and duplicitous. In line with our clinical strategy to improve the patient journey, a SystmOne working group will be set up to streamline the current patient record keeping in SystmOne. Each clinical area will be represented and will be asked to engage their teams in consultation. The aim will be to provide a simple and effective system to aid clinical record keeping.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Caring

Implement the psychological skills training programme across all teams

Our nursing and Allied Health teams work closely with patients whose symptoms include psychological or emotional distress. Over time, we have seen an increasing reliance on referral to the Family Support team and a reluctance to engage with these symptoms. We have designed a training programme for all clinical staff to better equip them to respond to psychological distress, while at the same time identifying appropriate referrals to the specialists in the Family Support team.

Offer all staff the opportunity to attend a death café (new staff within first 6 months of employment) and the opportunity to complete an Advance Care plan with support

Our own staff need to benefit from working in a palliative care setting by developing resilience in the face of loss and grief. They also need to become ambassadors in their own communities, enabling and encouraging the wider discussion related to life being impermanent. To this end, we have identified that all staff, including non-clinical staff, would benefit from learning to talk openly about death and dying. Death Cafes have proven to be a gentle and positive way to facilitate and promote this and we plan to offer attendance to all new staff (and existing staff as capacity permits). Encouraging them to complete an Advance Care Plan is an extension of our work in the public health approach to palliative care.

Responsive

Review and update patient information

The ability for patients to access information is increasingly important. The website is a critical point of reference for patients and their families. This year, we will be redesigning the clinical information on our website to ensure that our service users can access contact, patient information leaflets and updated list of services for signposting (such as wills and practical assistance).

This review of patient information will also include a review of the welcome pack in the community and the IPU folder to ensure it is both contemporary and helpful.

Improve response rates for the IPU Survey

Currently, the IPU survey is a paper questionnaire which is left in the room for patients and their carers to complete. Response rates are around 30% which means there is a gap in feedback of patient experience.

Most people are now used to completing surveys on their phones and tablets which is both better for the environment and easier to complete. Through fundraising, the IPU was provided with digital tablets for both staff and patient use. We will be moving from a paper questionnaire to a digital one thus providing patients and their families an easier and more opportune way of completing the questionnaire. Results will be submitted directly to the Governance team and therefore any queries or issues the patient raises on the questionnaire can be fed back and addressed by staff straight away.

Well-led

All members of the Executive team have been tasked with identifying a plan to approach and address issues arising from their teams in the annual Birdsong Staff and Volunteer Engagement Survey. They will implement these plans and aim to improve satisfaction in areas that scored poorly.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Finance

What we said we would do in What we achieved What we achieved The benefits / impact this has
2020-2021 had
Drive culture of cost consciousness
across the organisation to ensure
costs are managed within budget.		 Total expenditure for the year was
£7.1m, 12% better than prior year.
Year-end cash balance of £2.8m, was
£2.1m better than prior year.		 Successful delivery of this objective,
which was a key part of the
Financial Turnaround program to
reverse the £1m deficit in previous
year, has contributed to the Hospice
recording a surplus of £2.4m for
the 20/21 financial year, a £2.9m
improvement onprioryear.
Complete recruitment of vacant
position in the finance team.		 Due to the uncertainty around the
merger of the Hospice during the year,
the recruitment of a permanent Head
of Finance was put on hold and an
Interim Project Accountant appointed
to provide high level support and first
line management to the team. There
was no impact on the performance and
deliverables from the team during the
year as a result of this uncertainty.
Following the decision by the
Board not to merge with
Garden House Hospice, the
current Interim role will now
be converted to a Head of
Finance position and
recruitment completed
following the end of the
current contract.
Our objectives for 2021-22 What we will achieve and how we will measure success
Deliver 21/22 budget as agreed by
Finance Committee and Board.		 21/22 Budget delivered.
Maintain solvency Aim to have available cash or liquid assets that are sufficient to
cover an average of 3 months operating expenditure.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Fundraising

What we said we’d do What we achieved The benefits / impact this
2020/21 has had
Fundraising income target of
£2.25million excluding legacy, by
continuing our more commercial
approach to fundraising with
focus on return on investment
and delivering new initiatives.		 Delivered income of £1.9m (excluding
legacies) which was short of budget
by £350k, entirely due to the
Coronavirus pandemic, which
decimated our events and much of
our community fundraising activity.
Our fundraising efforts during this
unprecedented year, combined with
cost saving initiatives, produced a
strong year, despite the ongoing
pandemic.
This was driven by a number of
factors:
• Delivering an Urgent Appeal our
‘Coronavirus Fighting Fund’
being delivered inside 3
weeks & generating >£150k.
• Continued strong performance
in Trusts & Grants.
• Growth in our ‘Lights of Love’
annual appeal.
• Virtual Events Fundraising.
• Strong In-Memory giving.
• Low lottery membership
attrition.
• Launch of new ‘Xmas Tree
Recycling’ initiative which
exceeded expectations.
• Re-shaped our Marketing &
Communications team and
focus, which has immediately
delivered results.
• Cost savings in terms of not
filling vacancies, other
initiatives and no event costs.
• Focus on Return on Investment
(ROI) and planning,
commercial focus.		 Delivered exceptional
income given the
Coronavirus pandemic,
which was ahead of
2019/20. This was also
further supported by
significant cost savings.
Teams coped well with
adjusting to new initiatives
and home working.
Our agility allowed us to
secure a high level of
income, which surpassed
initial forecasts as Covid hit.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Our objectives for 2021/22 What we will achieve and how we will measure success
Deliver fundraising budgeted income(exc.
Legacy)		 Deliver an income budget of £1.957k excluding
legacies. Continue on the success of the past year by
maintaining a commercially focused approach to our
breadth of fundraising activities. Developing a high
performing team that can flex to supporter needs and
trends,impact of thepandemic.
Deliver a supporter first cultureWith Gift Aid
at its heart.		 Further develop and enhance the supporter care team
of both volunteers and employees, whilst imbedding
processes that genuinely put supporters first and that
drives gift aid income,
throughout the team and organisation. In Fundraising
achieve a Gift Aid budget of £111k.
Develop a portfolio of new fundraisingevents and
community fundraising initiatives that appeals to all
audience types. To enhance existing relationships
and grow new ones. Take the learning from events
that transitioned to a virtual space.		 Plan a new program of events that is on trend and
marketable to new and existing supporters that
appeals in both the challenge and mass participation
events.
Drive community fundraising via further
investment and more pro-active commercial
approach, supported by relevant KPI’s and
approach.
Increase supportersthrough the outsourcing of
Isabel Hospice Lottery to Local Hospice Lottery.		 This transition to Local Hospice Lottery completed
at the end of March 2021 and will not only
improve the contribution to the charity from our
lottery program, but also support acquisition of
members, which is a significant objective for Isabel
goingforwards.

Fundraising Landscape 2021/22

At the end of the financial year, the ongoing Coronavirus pandemic presents an uncertain landscape for fundraising, given the continued restrictions, challenging economic climate and supporter confidence. As such, Isabel anticipates a further challenging year in 2021/22.

Isabel expects that its income from Community and Events fundraising will continue to be effected, particularly in the mass participation and community fundraising space. Plans are in place to mitigate this, however, until the year progresses and restrictions are lifted, this key area of fundraising will remain challenging.

Trusts and Foundation fundraising we expect to remain strong, due to the good relationship we have built with funders and the impactful clinical programs they support. Major Donors will also be a key area of focus, as we build an Ambassadors program in the lead up to our 40[th] Birthday in 2022, with the clear opportunities for fundraising and celebration this will create.

Our Appeals program in Spring & Christmas will remain crucial. The transfer of our lottery has proven successful and the key focus for it this year is significant member acquisition, via marketing and canvassing. Our plans to support inmemory fundraising, gift aid performance are strong, with continued focus on supporter care and return on investment being crucial. Underpinning all of our plans is our new approach to Marketing & Communications, as we seek to engage better and more effectively with our communities. Our new website will launch in late summer.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Retail / Charity Shops

The Retail/Charity shop business is overseen by the Board of Isabel Hospice Trading Limited, a subsidiary of the Charity. We had the following objectives.

What we said we’d do 2020/21 What we achieved The benefits / impact this
has had
Deliver Sales Budget Income Budget aspirations set
at the beginning of the year
were decimated by the Covid
19 Pandemic. Income of £1.9m
was achieved with a loss to the
charity of £53k.		 The Coronavirus pandemic had
a major impact on our ability to
generate income from our
Retail business, with our shops
closed for much of the year.
Our continued focus on our
successful Ebay business
during this period, plus
innovative ways of generating
stocks to sell, reducing costs
and central government
support; ensured that this
impact was minimised.
Continue to Drive Gift Aid Due to the restrictions of Covid-19
and the ‘contact less’ nature of our
operations and lack of volunteers;
this proved difficult
New tech, new processed and
training have been delivered
to return this to industry
standard levels post
pandemic.
Appoint a Director with
responsibility all Income
Generation activities including
Retail		 A Director of Income Generation
and Marketing was appointed in
March 2020		 This appointment was
present throughout Covid-19
pandemic and assisted with
developing an agile team. A
Retail Business Manager was
appointed in March 2021.
Support the retail team with
investment into training		 With much of the team on
Furlough throughout the year
opportunities were difficult to
implement this.		 Statutory/Mandatory
training levels of >80% were
achieved. Training has been
put in place for Shop
Managers e.g. pricing,
effective shop windows,
social media for promoting
sales.
Our objectives for 2021/22 What we will achieve and how we will measure success
Deliver Income and Contribution
Budget		 Deliver an income budget of £ £2,571k with a net contribution
to the charity of £247k.
Continue to drive gift aid Continue the good progress on gift aid within the retail space and
deliver a budget of £123.5k.
Increase average selling price Implement a new pricing strategy and increase our average selling
price by 20%.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Retail Landscape 2021/22

Virtually all retail analysts both in the charity and commercial space, fail to have a clear view on what the next financial year will bring in terms of retail performance, given the unprecedented situation ongoing and post the Coronavirus pandemic.

Whilst Isabel is optimistic that consumers will return and that supporters will continue to donate stock to our cause, it is clear it needs to evolve its retail operation further this year. Ebay and further e-commerce platforms will support our ambitions and the recruitment of a new Retail Business Manager in March 2021, will support delivery. Shops however remain vital and a return to our retail principles, value for money, excellent customer service and quality of stock will be vital.

Our People

Our people, both staff and volunteers are our greatest resource. During 2020/21 they have needed to respond to changes in working practices to accommodate national and local lockdown requirements. Also a number of staff were furloughed under the Government’s Coronavirus Job Retention Scheme. Some volunteers stepped down as either the services that they supported were withdrawn (e.g. Living Well Services and working in shops) or they were unable to support due to shielding. Shielding is the word used to describe how to protect those at highest risk of severe illness if they catch the COVID-19. During the 2020/21, all over 70 year olds were advised to shield.

During 2020/21 the Boards of Isabel What we achieved Hospice and Garden House Hospice Care appointed a Joint People Director who was asked to set up a Shared People Service. What we said we’d do 2020/21

The benefits / impact this has had

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Trustees’ Annual Report for the Year Ended 31 March 2021

were proud to volunteer for this charity.

Trustees’ Annual Report for the Year Ended 31 March 2021
were proud to volunteer
for this charity.
Understand our starting point and
continue to build the diversity of
our people, ensuring we are
reflective of the communities that
we serve and that we celebrate
diversity		 We were hoping to work with local
charities and ensure we reach a
wider audience to build the
diversity of our staff across all
characteristics of diversity as
defined by legislation. With COVID-
19 we had to reprioritise our People
work to implement guidance so the
planned work has not progressed		 See comments
Additional Work Undertaken in 2020/21
Introduced Flexi Furlough on three
occasions		 This particularly affected employees working in the Retail Business when
shops were shut on three occasions to comply with Government
lockdown requirements.
Health and Wellness for our Staff We relaunched the Employee Assistance Programme, which has led to a
greater support offering for both employees and managers. Managers
have been encouraged to have extra contact with staff to check on Health
and Wellbeingandprovide support aspossible.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Introducing a COVID-19 Testing
Programme for our Staff		 Polymerase Chain Reaction (PCR) and Lateral Flow Testing (LFT) of
asymptomatic staff and volunteers was introduced for clinical and non-
clinical staff as appropriate. A clear and consistent testing process and
follow-up for symptomatic staff and volunteers has been set up and is
beingmanaged.		 Polymerase Chain Reaction (PCR) and Lateral Flow Testing (LFT) of
asymptomatic staff and volunteers was introduced for clinical and non-
clinical staff as appropriate. A clear and consistent testing process and
follow-up for symptomatic staff and volunteers has been set up and is
beingmanaged.
Establishing a Shared People Service
for Isabel Hospice and Garden
House Hospice Care		 This involved the Joint People Director identify a structure, and
restructuring the two Human Resource and Volunteer Services
Departments of the two Hospices to form one Shared People Service.
After undertaking a review it has been agreed that each Hospice will
revert to havingits own People Service.
Our objectives for 2021/22 include: What we will achieve and how we will measure success
Re-establishing our own people service We are aiming for this to be in place by 1stJuly 2021. After being
in place for 6 months it will be reviewed/evaluated.
Implement a Reward and Recognition
Scheme for our Staff		 We are designing, in consultation with the Executive Team, a
voucher scheme to reward both individuals and teams. This will
reflect exceptional performance based on Isabel’s values and will
involve both nominations by colleagues/managers and decisions
by a panel of staff across the Hospice.
Have a particular focus on Recruitment of
Staff to identify innovative ways to recruit
all staff, but particularly clinical staff which
is particularly challenging		 Recruitment remains challenging for certain clinical roles. The
People Department will work closely with clinical team to respond
to needs and design innovative ways of recruiting additional
clinical staff.
Achieve a Consistent and Competitive Salary
Structure
In July 2021 we will initiate a project with Garden House Hospice
Care and Croners to achieve a competitive salary survey, to
benchmark our existing roles and ensure that our salaries are
competitive and consistent. This will in turn support a recruitment
strategy.

During the year many volunteers stepped down due to the coronavirus (COVID-19) restrictions; they either were not able to support due to medical reasons, or services such as Living Well Services were not delivered at the centres. We also have had a review of the volunteer data base. During the year, 325 volunteers gave an estimated time of 50,700 hours’ worth an estimated £451,737.

We are immensely proud of the support provided to the Hospice by our highly valued team of volunteers who give their time, expertise and support to the Hospice in a wide variety of areas from administration, retail, patient services and fundraising. Many who were able to volunteer changed roles to meet the needs of the Hospice. The Board of Trustees would like to thank all volunteers for all that they do. The Hospice would like to thank volunteers for all the support they have given.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Financial Review

The financial statements for the year ended 31[st] March 2021 comprise the results for the Charity and its wholly owned subsidiary Isabel Hospice Trading Ltd.

In a very challenging year, mainly driven by the reduction in operating income as a result of the COVID-19 pandemic, the Charity recorded a strong set of financial results for the 20/21 financial year with a net surplus of £2.4m, a significant improvement on the prior year deficit of £0.5m. This was mainly driven by receipt of Government support grants (Retail, Hospitality and Leisure Grants, NHS England, Job Retention / Furlough grants), material increase in legacy income and the successful delivery of the financial turnaround program that focussed on cost reductions, driving productivity and efficiency initiatives across the Hospice.

Income

Total income for the year increased by £1.9m (25%) to £9.4m. Included in these figures are government grants totalling £2.1m received as a result of the support package for Hospices impacted by the pandemic. The NHS awarded funding to allow the Hospice to make available bed capacity and community support from April 2020 to July 2020 to provide support to people with complex needs in the context of the COVID19 situation and to provide bed capacity and community support from November 2020 to March 2021 for the same purpose. Total funding received from this grant was £1.1m. An additional £1m of funding was received as part of the government’s Retail and hospitality leisure and furlough schemes.

Income from fundraising donations and recognised legacies (excluding lottery and event income) was up 74% to £3.4m (2020: £1.9m). The charity had a very good year with Legacy income with recognised income from this source increasing to £1.9m (2020: £0.7m). Legacies which were notified but not yet met the income recognition criteria amounted to £1.2m (2020: £1.6m), these have been treated as contingent assets and not recognised as part of income for the year.

Income from Charitable Activities was up 75% to £3.6m (2020: £2.0m) mainly driven by a 5% increase in funding from our core CCG contract and receipt of a number of COVID related government support grants.

Income from Other Trading Activities declined by 29% to £2.5m (2020: £3.6m). Key drivers of this decline were increase were a 62% decline in Charity Shop income to £1m (2020: £2.6m) and 58% decline in Fundraising event income to ££0.3m (2020; £0.6m). The high street remains a turbulent market and the COVID-19 pandemic had a significant impact on retail income at the end of the year with the closure of all shops including our ecommerce operations.

As a result of the successful delivery of the financial turnaround program to reverse the deficit recorded in previous year, total expenditure declined by 12% to £7.1m (2020: £8.1m). This program focused on driving efficient and prudent management of expenditure across the Hospice during the period.

At the end of the financial year, the Charity held net assets of £6.8m (2020: £4.4m). Net current assets increased to £3.5m (2020: £890k).

Total cash in hand available to the Hospice at the balance sheet date significantly increased by £2.1m to £2.8m (2020: £705k). This was mainly driven by the increase in income from government and legacy receipts, successful delivery of our financial turnaround program and focus on prudent management of cash throughout the year.

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Trustees’ Annual Report for the Year Ended 31 March 2021

----- Start of picture text -----
Cash Balances £'000 Actual Prior Year
2,779 3,046 3,208 3,291 3,049 2,834 3,354 3,251 3,042 2,811 2,943 2,790
Apr- 20 May- 20 Jun- 20 Jul- 20 Aug- 20 Sep- 20 Oct- 20 Nov- 20 Dec- 20 Jan- 21 Feb- 21 Mar- 21
----- End of picture text -----

Total funds for the Hospice at the end of the year was £6.8m (2020: 4.4m). Our unrestricted funds comprise of a £1.1m in general funds, £3.8m of designated funds and £0.4m of revaluation reserves. Our restricted funds comprise of endowment funds of £836k and other restricted funds of £0.7m.

COVID-19 Impact

The COVID-19 pandemic impacted both fundraising and retail activities with income from these activities declining by £1.8m throughout 2020/21 financial year.

Throughout 2020/21, the Hospice instituted a monthly reforecasting process to measure and mitigate the potential financial impact throughout the year and ensure our plans to provide excellent patient care continued.

The financial results delivered in the financial review section provide further details of the success of the risk mitigation measures implemented as a result of the pandemic.

For the 2021/22 financial year, a quarterly reforecasting process has now been implemented to provide further assurance on delivery of in year budget to key stakeholders of the Charity.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Risk reserves

The trustees have chosen to adopt a risk based approach to income streams in setting a target level for risk reserves, making an assessment of the amount of each income line which could be at risk in any one year. This approach fits hand in hand with our review of strategic risks and provides a funding mitigation for many of the risks identified. The reserves also specifically recognize the risks associated with planned growth / development of new income streams.

Following a review of its Risk Reserve policy and targets at the end of the last financial year, the Trustees set a new target of £1.1m to manage the risk of potential fluctuations or underperformance in key income streams. Following the strong financial performance and positive turnaround in its financial results for the 2021 financial year, the Charity has now fully replenished it’s Risk Reserve fund back to £1.1m and also increased it’s free reserve position to £1.5m.

Working Capital and Cashflow

A vital factor for any organisation is having sufficient working capital and cashflow – this varies between organisations based on the nature of income streams and expenditure. We have benefitted for many years by our NHS Clinical Commissioning Group (CCG) contract paying us the full contract amount (c£1.8m) in one lump sum at the beginning of each year. The NHS CCG has indicated that going forwards there will be quarterly upfront payments.

We produce a cashflow forecast and monitor our cashflow position monthly to provide additional scrutiny of our cash performance and reserves. Our year end cash position improved significantly by 296% to £2.8m as a result of the prudent management of cash during the period. This position has provided the Charity with at least 5months cover for operational working capital requirements, the strongest cash position the Charity has delivered for a number of years.

Going Concern

The trustees recognise the requirement to assess the going concern of the Charity.

The Charity has sufficient working capital to provide a contingency if required and the trustees are satisfied that there are no unmanaged material uncertainties impacting the Charity’s ability to remain a going concern, and so can conclude there is a reasonable expectation that the Charity will be a going concern for at least 12 months from the signing of this report and accounts.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Risk Management

During 2020/21 the Isabel Hospice Charity Board met monthly and considered the Risk Register initially monthly and then every other month towards the end of the financial year. The Finance & Risk committee met monthly to consider the finances and towards the end of the year has reverted to quarterly, which is the usual frequency of meetings. One of its roles is to oversee the risk management functions of each of the Board’s sub committees. Each of these committees is responsible for maintaining active risk registers and monitoring management and mitigation actions. The risk registers are reviewed by the Finance & Risk committee which provides assurance to the charity Board. Major risks are identified according to their likelihood and potential impact. There will be a particular focus on Board Sub Committee Risk Registers in 2020/21

Strategic risks are reviewed as part of the Board’s strategic review cycle and the key strategic risks are combined with high rated operational risks and a heat map produced to provide a clear visual representation of the charity’s top risks. In response to the COVID-19 pandemic, short, medium and long term/strategic risks were identified with mitigations which have been reviewed monthly by the Board. A summary as at May 2021 is given below.

Short Term and Longer Terms Strategic Risks – May 2021

Risks Impact of unmanaged risk Actions to manage / mitigate
Short Term
1. Shortages of Clinical Staff due to
vacancies. This is a challenge
affecting all health care providers		 Reduction in clinical
services.		 •
Active Recruitment.
•
Look at new ways of recruiting clinical
staff e.g. recruiting Nursing Associates
•
Increase numbers of staff on the Bank
2. Delayed Income from CCG for
2021/22 as Isabel Hospice does not
have signed contract. This is
because NHS Planning and Priorities
Guidance was to CCGs late March.		 Cash will not meet
forecast.		 •
HG chasing CCG. Fortunately we have
cash if money from CCG is delayed.
3. Introduction of further COVID-19
Lock-Down Restrictions due to
increased cases and NHS are unable
to manage		 Lead to reduction in
contribution from the
Trading Company
(due to closure of
shops) and
cancellation of
Fundraising Events		 Continue to build e-bay Operations and
Stock as possible
Medium Term
4. Unable to maintain the longer
term sustainability of the Hospice		 Hospice and its
services would no
longer exist		 •
Careful and frequent forecasting to
establish financial position (short
term)
•
Collaboration with other
organisations to share some services

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Trustees’ Annual Report for the Year Ended 31 March 2021

5. Learning and advantages of remote
working are lost		 Missed
opportunity to
embed efficiencies
and savings		 Review of working practices and continue
those that offer savings and increased
effectiveness and productivity e.g.
•
Increase in Home Working
•
Virtual Meetings throughout
the organisation
•
Virtual Education
•
Virtual assessment, care and
support of patients and family
members
6. Few opportunities for expenditure
savings through reduction in people
costs with current ways of operating.
Limited ability to
reduce
costs/expenditure
if this is needed.		 Invest in technology to improve the
efficiency of operations during 2021/22
Longer Term/Strategic
Political
7. Value of CCG Funding reduces Unclear what the
funding
arrangements will
be while NHS
recovers from
COVID-19. There is
some intelligence to
suggest that GPs in
Primary Care
Networks may have
greater influence on
Hospice Funding		 Maintain strong relationship with CCG-
share impact of the work IH is doing
Develop good relationships with GPs and
NHS providers – Acute and Community
Link any service developments to the
needs of NHS and seek additional support
for new projects it will reduce hence risk
reduced.
Economy
8. Low/no/negative economic growth Reduction in giving
by individual
donors &
corporates		 Continue to develop diverse fundraising
portfolio
Build supporter base
Increase Legacy Giving
Sociological
9 .Increased demand for Hospice
Services:
•
Older people living longer with
more health issues
•
Population growth (also
opportunity for increase of
donors)		 Unable to meet
increasing need for
services
More people dying in
hospital unnecessarily
leading to worse EOL
experience		 Identify more efficient ways of
supporting people working in
collaboration with partners
e.g. Day Service Work
Technology
10. Not optimizing functionality of
systems to drive business		 Constraints on service
development
Constraints on
fundraising effectiveness
Less engaged donors
(choose other orgs to
support)		 Consider ways that Technology could help
to improve the efficiency and effectiveness
of our operations

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Trustees’ Annual Report for the Year Ended 31 March 2021

11. Not developing new digital
solutions		 Missed opportunities
for supporter
engagement & income
generation Not
embracing emerging e-
health options
Higher costs to
deliver services –
lower VFM		 Collaborate other hospices
Develop staff culture to generate ideas
Invest in right resource to enable
development of new digital solutions
12. Lack of effective Systems
Integration		 Drain on resources
due to manual
processes
Potentially constrains
futureplannedgrowth		 Develop plan to integrate key systems
Post Covid-19 as resources allow.

Exploring Collaboration and Merger

The Strategic Oversight Group (SOG) with representatives from Garden House Hospice Care and Isabel Hospice met until January 2021. The Isabel Hospice Board at its meeting on 2[nd] December 2020 took the decision that it in principle supported a merger with Garden House Hospice Care, subject to further work and outstanding queries being addressed. At the meeting on 7[th] April 2021, it was concluded that merger at this time was not appropriate and collaboration would be sought. The following announcement was disseminated to staff and volunteers.

" Over the last four years, the staff, volunteers and trustees of Garden House and Isabel Hospices have worked closely on a number of projects. Since April 2020, this work has involved exploring a possible merger of the two organisations.

Although this has been a useful exercise, the Boards of Trustees of both hospices, with the full support of their CEOs, have decided not to merge at this time. In the interests of beneficiaries, our hospices share a strong commitment to collaborate with each other and will continue to do so .”

Structure, governance and management

Isabel Hospice Limited is a registered charity and a company limited by guarantee without share capital and is governed by its memorandum and articles of association. The group includes a wholly owned subsidiary company, Isabel Hospice Trading Limited, through which its retail trading activities are carried out.

The charity works in partnership with local GPs, the CCG, local NHS hospitals and many other health care providers, residential nursing homes and care homes to ensure the highest quality care and support for our patients and their families.

The Board of Trustees normally operates a quarterly meeting cycle with sub committees meeting in the 4 weeks before the main Board meeting. The sub committees have specific Terms of Reference which include oversight of key areas of the charity’s work. These are:

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Trustees’ Annual Report for the Year Ended 31 March 2021

The retail operations are governed separately by the Board of Directors of our Trading Company, Isabel Hospice Trading Ltd, which comprises some directors who are also trustees of the hospice charity and some external directors who bring specific retail experience.

During 2020/21 the Charity put in place interim Governance arrangements to respond to the pandemic. These included monthly Charity Board Meetings and Twice Monthly Trading Board Meetings. The Board agreed to revert back to the usual Governance business cycle of quarterly meetings in April 2021.

The Board also held 2 away days during the year with the Executive directors to consider the changing external environment which led to a refresh of the Strategy and Vision for the hospice.

Board Performance

The Board aims to continuously improve its effectiveness. At the end of each meeting there is a reflection on what went well and what could have gone better.

Trustee recruitment

There has not been any Trustee recruitment in2020/21.

Trustee remuneration

Trustees’ travel expenses are reimbursed if claimed. No trustee was remunerated during the year and no trustee had a beneficial interest in any contract with the charity or its subsidiary during the year.

Trustee liability

The liability of each trustee, in the event of winding up, is limited to £10.

Executive Management

The trustees delegate day-to-day management of the charity to the Chief Executive and through that person to the Executive team.

The following changed occurred to the Executive Team:

Last year we reported that the CEO would explore with other Hospices whether they could assist in providing consultant cover as we had been unsuccessful in recruiting a consultant. Arrangements have been put in place with Garden House Hospice Care and St Clare’s Hospice to provide consultant cover.

The Board and CEO is considering arrangements for leadership of Fundraising and Retail, with the Director of Income Generation Departing. Both Departments have strong leads. The Board is confident that we have a strong senior executive team in place to lead Isabel Hospice through the next stage of its development.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Investment policy

The trustees have the power to make investments that are consistent with the aims and objectives of the charity. Surplus resources are currently held in easy access accounts given the low interest rates and cash requirements of the organisation.

Fundraising Policy

The trustees recognise that the charity could not deliver its services without the support of the local community. It is the charity’s policy to form positive relationships with donors and it therefore seeks to adhere to high quality fundraising standards. In addition the charity does not accept donations from donors with interests that might conflict with the mission of the charity.

Senior Executive Remuneration

The charity approach to pay policy is consistent for our staff and the Executive team. Our policy is designed to enable us to attract, retain and motivate high performing Executive team members. It also aims to demonstrate to our stakeholders (particularly funders and service users) that our pay levels are set to support delivery of the charity's aims and are an effective use of charitable funds.

The objectives of our pay policy are to:

The charity publishes the salary of its key management personnel within its annual report. The number of staff paid over £60,000 is also published in accordance with the charity accounting requirements.

Executive pay is reviewed on an annual basis by the People Committee and is subject to approval by the Board of Trustees, which is responsible for ensuring proper application of our pay policy.

Future

The Hospice Board agreed a deficit budget for 2021-22 of £465k. This is expected to be a challenging year mainly driven mainly by post COVID effect on our income generation activities and no expectation of further support from the government. Filling key vacant Executive roles will also be key to ensuring the Hospice can drive forward initiatives to reduce the deficit. Other initiatives including careful control of expenditure and cash management will continue to be monitored closely to support with the deficit reduction plan.

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Trustees’ Annual Report for the Year Ended 31 March 2021

Fundraising Procedures Disclosure

1 Isabel Hospice accounts to 31 March 2021

Our approach to fundraising

Isabel Hospice is registered with the Fundraising Regulator. Our income is generated predominately thanks to the support of our community, including legacies, gifts in memory of family members who have died in our care, regular donations, our lottery, and individual fundraisers raising income at our events or their own events.

Fundraising practices

As part of our commitment to best practice, Isabel Hospice adheres to the fundraising Codes of Practice set by the Fundraising Regulator and the Institute of Fundraising. We aim to ensure that our fundraising is respectful, open, honest and accountable to the public.

We have a clearly documented complaints procedure in place, enabling any concerns regarding our fundraising activities to be responded to quickly. During the year, there have been no instances of non-compliance with the requirements of the fundraising code of practise.

We have a transparent policy regarding fundraising with vulnerable individuals. This fundraising policy clearly states all steps that should be followed in order to protect vulnerable people when offering support to the charity, ensuring that they have the relevant capacity to enable them to make the decision to donate.

Fundraising practices review

All fundraising practices are framed within the values and principles of Isabel Hospice. Where expenditure is required to generate income, there is an analysis of the return on investment to ensure the organisation is able to make informed decisions regarding activities.

The fundraising team are internal and the organisation only uses third party fundraising organisations following significant levels of due diligence and regulatory checks.

Where we partner with corporates, due diligence is conducted on the organisations and the amount of time and effort we as a charity needed to put in, versus the income we would likely receive. Clear parameters and responsibilities are then agreed between partners.

We have ensured we are in line with the GDPR data protection regulations and all other relevant codes of conduct.

Fundraising strategy and plan.

Our fundraising strategy and plan is reviewed and approved by the Trustees annually. Isabel Hospice is the brand name for our fundraising activities.

Supporters of Isabel Hospice are a key element in the fundraising activities and we are committed to employing a transparent and ethical approach to all our fundraising activities.

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Trustees’ Annual Report for the Year Ended 31 March 2021

To help guarantee the availability of continuing funds to fund the work of Isabel Hospice, we aim to maintain a broad base of funding sources.

Isabel Hospice does not pressure supporters to make gifts and respects decisions to stop giving. The regulatory landscape for fundraising is evolving and we will continue to monitor and adapt with these changes.

When we work with suppliers and agencies we ensure that they are fully registered with all the appropriate regulatory bodies, reviewing all their policies as part of our robust procurement due-diligence process.

We monitor and record any complaints resulting from our fundraising practices, and an annual report is provided to our Fundraising Committee.

Fundraising, Communications and Marketing

Total voluntary income was £3.4m (2020: £1.9m). Most voluntary income comes from the following sources: Legacies, Donations in Memoriam, Trusts and Events and Lottery Income.

Regulation

Isabel Hospice is registered with the Fundraising Regulator, follows the Regulator’s Code of Fundraising Practice and abides by its Fundraising Promise.

Additionally, three members of the Fundraising, Team are members of the Institute of Fundraising. Supporters have the option to request no further mailings and we abide by such requests immediately.

Individuals

Legacies make up a substantial proportion of Isabel Hospice’s voluntary income. Legacies are hard to predict, but not accidental, being the result of good service and good publicity from the charity.

Donations in Memoriam

We continued to receive support from individuals and their families who support Isabel Hospice in memory of their loved ones who were cared for by the Hospice.

Events

We organised a number of successful fundraising events in the year including the Isabel Hospice ‘Bubble Rush’, On-your-bike bike ride around Bishops Stortford, Bridges of London sponsored walk, challenge adventure in the Canadian Rockies, over 11 participants in the London Marathon, sponsored skydiving and abseiling.

Lottery

Our in-house lottery continues to be well supported, with over 7,200 members and continues to generate significant income for the Hospice.

Communications and Marketing work

The team worked closely with others to market Isabel Hospice’s services. We developed and widely implemented a new visual identity, multiple newspaper articles, advertising, newsletters and significant increase in our digital social media presence on twitter, Instagram, Facebook.

Page 39

Trustees’ Annual Report for the Year Ended 31 March 2021

Legal framework and statement of trustees’ responsibilities

The trustees (who are also directors of Isabel Hospice Limited for the purposes of company law) are responsible for preparing the trustees’ annual report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).

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

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

In so far as the trustees are aware:

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

Members of the charity guarantee to contribute an amount not exceeding £1 to the assets of the charity in the event of winding up. The total number of such guarantees at 31 March 2021 was 9 (2020: 11). The trustees are members of the charity but this entitles them only to voting rights. The trustees have no beneficial interest in the charity.

Page 40

Trustees’ Annual Report for the Year Ended 31 March 2021

Auditor

Sayer Vincent LLP were appointed as the charitable company's auditor during the year.

So far as the trustees are aware, there is no relevant audit information of which the charitable company’s auditors are 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.

The trustees’ annual report has been approved by the trustees on 9[th] September 2021 and signed on their behalf by

R A Leggetter CHAIRMAN OF TRUSTEES

Page 41

Trustees’ Annual Report for the Year Ended 31 March 2021

Trustees’ Annual Report for the Year Ended 31 March 2021

REFERENCE AND ADMINISTRATIVE INFORMATION

TRUSTEES: R A Leggetter (Chairman) The trustees are also members and S Reddy (Vice Chair) directors of the company K Warnell J Quinn S Fuell D Perry T Philpott A Reeve I Williams K Ray (Resigned 2[nd] June 2020) S Wade (Resigned 2[nd] June 2020)

SECRETARY:

H Glenister

SENIOR MANAGEMENT

H Glenister – CEO T Koramoa – Director of Finance & Resources E Paske - Director of Clinical Services E Jarrold – People Director (Resigned 17[th] July 2020) B Turner – Joint People Director (Joined 15[th] June 2020 and Resigned 5th March 2021) L Hopley- Interim Joint People Director (5[th] February 2021)

D Badger – Director of Income Generation and Marketing (Resigned 31[st] March 2021)

REGISTERED OFFICE: 61 Bridge Road East Welwyn Garden City Hertfordshire AL7 1JR COMPANY REGISTERED NUMBER: 03056823 (England and Wales) COUNTRY OF INCORPORATION: United Kingdom CHARITY REGISTERED NUMBER: 1046826 COUNTRY OF REGISTRATION: England and Wales

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Trustees’ Annual Report for the Year Ended 31 March 2021

AUDITORS: Sayer Vincent Sayer Vincent LLP Invicta House 108-114 Golden Lane London EC1Y 0TL PRINCIPAL BANKERS: The Co-operative Bank St Paul’s House 10 Warwick Lane London EC4M 7BP

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Independent Auditor’s Report to the members of Isabel Hospice Limited

Opinion

We have audited the financial statements of Isabel Hospice Limited (the ‘parent charitable company’) and its subsidiary (the ‘group’) for the year ended 31 March 2021 which comprise the consolidated statement of financial activities, the group and parent charitable company balance sheets, the consolidated statement of cash flows and the 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 FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

In our opinion, the financial statements:

Basis for opinion

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

Conclusions relating to going concern

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

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 Isabel Hospice Limited’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 other information comprises the information included in the trustees’ annual report, including the strategic report, other than the group financial statements and our auditor’s report thereon. The trustees are responsible for the other information contained within the annual report. Our opinion on the group 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. Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the group financial statements or our knowledge obtained in the course of 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 group 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.

Page 44

Independent Auditor’s Report to the members of Isabel Hospice Limited

Opinions on other matters prescribed by the Companies Act 2006

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

Matters on which we are required to report by exception

In the light of the knowledge and understanding of the group and the parent charitable company and their environment obtained in the course of the audit, we have not identified material misstatements in the trustees’ annual report, including the strategic report.

We have nothing to report in respect of the following matters in relation to which the Companies Act 2006 and Charities Act 2011 requires us to report to you if, in our opinion:

Responsibilities of trustees

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

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

Auditor’s responsibilities for the audit of the financial statements

We have been appointed auditor under the Companies Act 2006 and section 151 of the Charites Act 2011 and report in accordance with those Acts.

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

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

Capability of the audit in detecting irregularities

In identifying and assessing risks of material misstatement in respect of irregularities, including fraud and noncompliance with laws and regulations, our procedures included the following:

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Independent Auditor’s Report to the members of Isabel Hospice Limited

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 is available on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities . This description forms part of our auditor’s report.

Use of our report

This report is made solely to the charitable company's members as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006 and section 144 of the Charities Act 2011 and regulations made under section 154 of that Act. 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.

Judith Miller (Senior statutory auditor) 4 October 2021 for and on behalf of Sayer Vincent LLP, Statutory Auditor Invicta House, 108-114 Golden Lane, LONDON, EC1Y 0TL

Sayer Vincent LLP is eligible to act as auditor in terms of section 1212 of the Companies Act 2006

Page 46

Isabel Hospice Limited

Consolidated statement of financial activities (incorporating an income and expenditure account)

For the year ended 31 March 2021

Unrestricted
Note
£'000
Income
2
2,992
3
2,125
4
2,531
7,648
5
3,209
1,981
5
5,190
(7)
2,451
20
6
2,477
Reconciliation of funds:
2,815
5,292
Donations and legacies
Charitable activities
Other trading activities
Total income
Expenditure on:
Raising funds
Charitable activities
Total expenditure
Transfers between funds
2,458
Net income/ (expenditure)
Total funds carried forward
Net expenditure before other
recognised gains and losses
Gains / (losses) on investments
Net movement in funds
Total funds brought forward
Gain on disposal of investment
property		 Unrestricted
Note
£'000
Income
2
2,992
3
2,125
4
2,531
7,648
5
3,209
1,981
5
5,190
(7)
2,451
20
6
2,477
Reconciliation of funds:
2,815
5,292
Donations and legacies
Charitable activities
Other trading activities
Total income
Expenditure on:
Raising funds
Charitable activities
Total expenditure
Transfers between funds
2,458
Net income/ (expenditure)
Total funds carried forward
Net expenditure before other
recognised gains and losses
Gains / (losses) on investments
Net movement in funds
Total funds brought forward
Gain on disposal of investment
property		 Restricted
£'000
360
1,436
-		 Endowment
£'000
-
-
-		 2021

Total
£'000
3,352
3,561
2,531		 Unrestricted
£'000
1,425
2,036
3,587		 Restricted Endowment
£'000
£'000
500
-
-
-
-
-
500
-
-
-
523
-
523
-
-
-
(23)
-
-
-
-
-
(23)
-
780
836
757
836
-
(23)		 Restricted Endowment
£'000
£'000
500
-
-
-
-
-
500
-
-
-
523
-
523
-
-
-
(23)
-
-
-
-
-
(23)
-
780
836
757
836
-
(23)		 2020

Total
£'000
1,925
2,036
3,587
7,648 1,796 - 9,444 7,048 500 - 7,548
3,209
1,981		 -
1,863		 -
-		 3,209
3,844		 3,555
3,982		 -
523		 -
-		 3,555
4,505
5,190 1,863 - 7,053 7,537 523 - 8,060
(7)
2,458		 7
(67)		 -
-		 -
2,391		 -
(489)		 -
(23)		 -
-		 -
(512)
2,451
20
6		 (60)
-
-		 -
-
-		 2,391
20
6		 (489)
33
-		 (23)
-
-		 -
-
-		 (512)
33
-
2,477
2,815		 (60)
757		 -
836		 2,417
4,408		 (456)
3,271		 (23)
780		 -
836		 (479)
4,887
5,292 697 836 6,825 2,815 757 836 4,408

All of the above results are derived from continuing activities. There were no other recognised gains or losses other than those stated above. Movements in funds are disclosed in note 19.

Page 47

Isabel Hospice Limited

Company no. 03056823

Balance sheets

As at 31 March 2021

2021
2020
Note
£'000
£'000
Fixed assets:
10
3,054
3,257
11
-
285
12
318
-
3,372
3,542
Current assets:
1
11
13
1,104
519
2,792
705
3,896
1,235
Liabilities:
14
419
345
3,477
890
6,849
4,432
Provision for liabilities
15
24
24
6,825
4,408
19
1,783
(56)
3,509
2,509
-
362
Total unrestricted funds
5,292
2,815
836
836
697
757
6,825
4,408
Tangible assets
The group
Investment properties
Investments
Stock
Debtors
Cash at bank and in hand
Creditors: amounts falling due within one year
Unrestricted income funds:
Net current assets
Total assets less current liabilities
Total net assets
Funds:
General funds
Designated funds
Revaluation reserve
Endowment funds
Restricted funds
Total funds		 2021
2020
Note
£'000
£'000
Fixed assets:
10
3,054
3,257
11
-
285
12
318
-
3,372
3,542
Current assets:
1
11
13
1,104
519
2,792
705
3,896
1,235
Liabilities:
14
419
345
3,477
890
6,849
4,432
Provision for liabilities
15
24
24
6,825
4,408
19
1,783
(56)
3,509
2,509
-
362
Total unrestricted funds
5,292
2,815
836
836
697
757
6,825
4,408
Tangible assets
The group
Investment properties
Investments
Stock
Debtors
Cash at bank and in hand
Creditors: amounts falling due within one year
Unrestricted income funds:
Net current assets
Total assets less current liabilities
Total net assets
Funds:
General funds
Designated funds
Revaluation reserve
Endowment funds
Restricted funds
Total funds		 2021
2020
Note
£'000
£'000
Fixed assets:
10
3,054
3,257
11
-
285
12
318
-
3,372
3,542
Current assets:
1
11
13
1,104
519
2,792
705
3,896
1,235
Liabilities:
14
419
345
3,477
890
6,849
4,432
Provision for liabilities
15
24
24
6,825
4,408
19
1,783
(56)
3,509
2,509
-
362
Total unrestricted funds
5,292
2,815
836
836
697
757
6,825
4,408
Tangible assets
The group
Investment properties
Investments
Stock
Debtors
Cash at bank and in hand
Creditors: amounts falling due within one year
Unrestricted income funds:
Net current assets
Total assets less current liabilities
Total net assets
Funds:
General funds
Designated funds
Revaluation reserve
Endowment funds
Restricted funds
Total funds		 2021
2020
£'000
£'000
2,923
3,079
-
285
318
-
3,241
3,364
-
-
1,154
648
2,716
543
3,870
1,191
351
267
3,519
924
6,760
4,288
-
-
6,760
4,288
1,719
(176)
3,509
2,509
-
362
5,228
2,695
836
836
697
757
6,760
4,288
The charity		 2021
2020
£'000
£'000
2,923
3,079
-
285
318
-
3,241
3,364
-
-
1,154
648
2,716
543
3,870
1,191
351
267
3,519
924
6,760
4,288
-
-
6,760
4,288
1,719
(176)
3,509
2,509
-
362
5,228
2,695
836
836
697
757
6,760
4,288
The charity
3,372
1
1,104
2,792		 3,542
11
519
705		 3,241
-
1,154
2,716		 3,364
-
648
543
3,896
419		 1,235
345		 3,870
351		 1,191
267
3,477 890 3,519 924
6,849
24		 4,432
24		 6,760
-		 4,288
-
6,825 4,408 6,760 4,288
1,783
3,509
-		 (56)
2,509
362		 1,719
3,509
-		 (176)
2,509
362
5,292 2,815 5,228 2,695
836
697		 836
757		 836
697		 836
757
6,825 4,408 6,760 4,288

Approved by the trustees on 9 September 2021 and signed on their behalf by

Rod Leggetter Chairman of Trustees

Page 48

Isabel Hospice Limited

Consolidated statement of cash flows

For the year ended 31 March 2021

Note
£'000
Net cash provided by operating activities
(99)
22
(619)
307
305
Notes to the cash flow statement
Reconciliation of net income to net cash flow from operating activities
Net income (expenditure)
(as per statement of financial activities)
Adjustments for:
Depreciation charges
(Gains)/losses on investments
Profit on sale of investment property
Decrease in stocks
(Increase)/decrease in debtors
Increase/(decrease) in creditors
Increase in provisions
Net cash provided by operating activities
Cash flows from operating activities
Cash flows from investing activities:
Purchase of property, plant and equipment
Purchase of investments
Proceeds from disposal of property, plant and equipment
Proceeds from sale of investment property
Net cash (used in)/ provided by investing activities
Proceeds from the sale of investments
Change in cash and cash equivalents in the year
Cash and cash equivalents at the beginning of the year
Cash and cash equivalents at the end of the year		 £'000
(99)
22
(619)
307
305		 £'000
2,170
(84)
2021		 £'000
£'000
287
(39)
117
-
-
263
341
628
77
705
2021
2020
£'000
£'000
2,417
(512)
280
292
(6)
-
(20)
-
10
-
(585)
680
74
(176)
-
3
2,170
287
2020		 £'000
£'000
287
(39)
117
-
-
263
341
628
77
705
2021
2020
£'000
£'000
2,417
(512)
280
292
(6)
-
(20)
-
10
-
(585)
680
74
(176)
-
3
2,170
287
2020
2021
£'000
2,417
280
(6)
(20)
10
(585)
74
-
2,086
705		 628
77
2,791 705
2020
£'000
(512)
292
-
-
-
680
(176)
3
2,170 287

Page 49

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

1 Accounting policies

a) Statutory information

Isabel Hospice is a charitable company limited by guarantee and is incorporated in England and Wales. The registered office address is 61 Bridge Road East, Welwyn Garden City, Hertfordshire, AL7 1JR.

b) Basis of preparation

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

These financial statements consolidate the results of the charitable company and its subsidiary Isabel Hospice Trading Limited on a line by line basis. The trading company is limited by guarantee and is therefore not owned by the charity. Nonetheless its results have been consolidated as it trades for the benefit of the charity and the two companies are managed on a unified basis. Transactions and balances between the charitable company and its subsidiary have been eliminated from the consolidated financial statements. Balances between the two companies are disclosed in the notes of the charitable company's balance sheet. A separate statement of financial activities for the charitable company itself is not presented because the charitable company has taken advantage of the exemptions afforded by section 408 of the Companies Act 2006.

Assets and liabilities are initially recognised at historical cost or transaction value unless otherwise stated in the relevant accounting policy or note.

In applying the financial reporting framework, the trustees have made a number of subjective judgements, for example in respect of significant accounting estimates. Estimates and judgements are continually evaluated and are based on historical experience and other factors, including expectations of future events that are believed to be reasonable under the circumstances. The nature of the estimation means the actual outcomes could differ from those estimates. Any significant estimates and judgements affecting these financial statements are detailed within the relevant accounting policy below.

c) Public benefit entity

The charity meets the definition of a public benefit entity under FRS 102.

d) Going concern

The trustees recognise the requirement to assess the going concern of the Charity. Following a challenging 2019/20, the Charity recorded a significant surplus of £2.5m (over £2.6m better than prior year) for the 2020/21 financial year. This result has enabled the Hospice to boost its free reserves position and also replenish its risk reserve to the minimum required of £1.1m.

Efficient management of cash during the year also resulted in the Charity recording a cash balance at the end of March 2021 of £2.7m (up £2m on prior year) further improving the its liquidity and cash position and providing additional resilience to mitigate any liquidity risks. The outlook for the next financial year from a cash perspective also remains very positive with a cash balance of £2.8m forecasted to be delivered 12 months after the sign off date.

The Charity owns the freehold for its Head Office building - Milan House. Due to the current limited space requirements for staff as a result of hybrid working arrangements, the sale of Milan House is also to help the Hospice take advantage of a development opportunity and concurrently find a more suitable charitable base and to ensure that the Charity obtains best value for its assets, the Board of Trustees have accepted an offer for the sale of Milan House of £3m subject to planning permission. The sale is expected to be concluded within the next twelve months and proceeds of this sale is expected to provide additional cash to boost the Hospice's liquidity and cash reserves.

The Charity has sufficient working capital to provide a contingency if required and the trustees are satisfied that there are no unmanaged material uncertainties impacting the Charity’s ability to remain a going concern for the coming 12 months.

Page 50

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

1 Accounting policies (continued)

e) Income

Income (which excludes VAT) is recognised when the charity has entitlement to the funds, any performance conditions attached to the income have been met, it is probable that the income will be received and that the amount can be measured reliably. Income is only deferred when the charity has to fulfil conditions before becoming entitled to it or when there donor has specified that the income is to be expended in a future period.

  1. Clothing and other items donated for resale are included as incoming resources when they are sold.

  2. Facilities, services and assets donated for use by the Charity are recognised as incoming resources, at their value to the Charity, when receivable. No amounts are included in the financial statements for the very substantial assistance provided by volunteers.

  3. Income from the lottery operated by the Charity is recognised as members participate in draws.

  4. For legacies, entitlement is taken as the earlier of the date on which either: the charity is aware that probate has been granted, the estate has been finalised and notification has been made by the executor(s) to the charity that a distribution will be made, or when a distribution is received from the estate. Receipt of a legacy, in whole or in part, is only considered probable when the amount can be measured reliably and the charity has been notified of the executor’s intention to make a distribution. Where legacies have been notified to the charity, or the charity is aware of the granting of probate, and the criteria for income recognition have not been met, then the legacy is a treated as a contingent asset and disclosed if material.

  5. Income from fundraising events organised by the Charity centrally are recognised when funds are received.

  6. Income from charitable activities comes from service contracts and grants and is subject to specific performance conditions. Such income is recognised as it is earned.

  7. Income from government and other grants, whether ‘capital’ grants or ‘revenue’ grants, is recognised when the charity has entitlement to the funds, any performance conditions attached to the grants have been met, it is probable that the income will be received and the amount can be measured reliably and is not deferred.

f) Donations of gifts, services and facilities

Donated professional services and donated facilities are recognised as income when the charity has control over the item or received the service, any conditions associated with the donation have been met, the receipt of economic benefit from the use by the charity of the item is probable and that economic benefit can be measured reliably. In accordance with the Charities SORP (FRS 102), volunteer time is not recognised so refer to the trustees’ annual report for more information about their contribution.

On receipt, donated gifts, professional services and donated facilities are recognised on the basis of the value of the gift to the charity which is the amount the charity would have been willing to pay to obtain services or facilities of equivalent economic benefit on the open market; a corresponding amount is then recognised in expenditure in the period of receipt.

g) Interest receivable

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

h) Fund accounting

Restricted funds are to be used for specific purposes as laid down by the donor. Expenditure which meets these criteria is charged to the fund.

Unrestricted funds are donations and other incoming resources received or generated for the charitable purposes. Designated funds are unrestricted funds earmarked by the trustees for particular purposes.

Endowment fund is an expendable endowment arising from a legacy to the Hospice. The legacy gives the trustees discretionary powers to use the endowment to fund capital projects. Any income from the endowment is unrestricted and may be used for the general purposes of the charity.

Page 51

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

1 Accounting policies (continued)

i) Expenditure and irrecoverable VAT

Irrecoverable VAT is charged as a cost against the activity for which the expenditure was incurred.

j) Allocation of support costs

Resources expended are allocated to the particular activity where the cost relates directly to that activity. However, the cost of overall direction and administration of each activity, comprising the salary and overhead costs of the central function, is apportioned based on staff time, of the amount attributable to each activity.

Where information about the aims, objectives and projects of the charity is provided to potential beneficiaries, the costs associated with this publicity are allocated to charitable expenditure.

Support and governance costs are re-allocated to each of the activities based on direct costs attributable to each activity.

k) Operating leases

Rental charges are charged on a straight line basis over the term of the lease.

l) Tangible fixed assets

Items of equipment are capitalised where the purchase price exceeds £1,000. Depreciation costs are allocated to activities on the basis of the use of the related assets in those activities. Assets are reviewed for impairment if circumstances indicate their carrying value may exceed their net realisable value and value in use.

Depreciation is provided at rates calculated to write down the cost of each asset to its estimated residual value over its expected useful life. The depreciation rates in use are as follows:

on a straight- line basis over the shorter of duration of the lease and useful economic life. at varying rates between 10% and 33% on cost.

The group’s policy is to revalue freehold and long leasehold shops periodically so that their carrying value in the accounts represents market value. The gains and losses arising from these revaluations are unrealised and are disclosed separately in the SOFA.

The group’s policy is to depreciate revalued properties over a period not exceeding fifty years but, as the residual values of the properties is very high, the cumulative charge for depreciation is immaterial and therefore no charge is included in these accounts.

The group does not revalue freehold properties used for direct charitable purposes. These buildings (but not land), and related improvements, are depreciated over their estimated useful lives, which have been assessed to vary between ten and fifty years.

Page 52

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

1 Accounting policies (continued)

m) Investment properties

Investment properties are measured initially at cost and subsequently included in the balance sheet at fair value. Investment properties are not depreciated. Any change in fair value is recognised in the statement of financial activities. The valuation method used to determine fair value will be stated in the notes to the accounts.

n) Investments in subsidiaries

Investments in subsidiaries are at cost.

o) Listed investments

Investments are a form of basic financial instrument and are initially recognised at their transaction value and subsequently measured at their fair value as at the balance sheet date using the closing quoted market price. Any change in fair value will be recognised in the statement of financial activities. Investment gains and losses, whether realised or unrealised, are combined and shown in the heading “Net gains/(losses) on investments” in the statement of financial activities. The charity does not acquire put options, derivatives or other complex financial instruments.

p) Stocks

Stocks are stated at the lower of cost and net realisable value. In general, cost is determined on a first in first out basis and includes transport and handling costs. Net realisable value is the price at which stocks can be sold in the normal course of business after allowing for the costs of realisation. Provision is made where necessary for obsolete, slow moving and defective stocks. Donated items of stock, held for distribution or resale, are recognised at fair value which is the amount the charity would have been willing to pay for the items on the open market.

q) Debtors

Trade and other debtors are recognised at the settlement amount due after any trade discount offered. Prepayments are valued at the amount prepaid net of any trade discounts due.

r) Cash at bank and in hand

Cash at bank and cash in hand includes cash and short term highly liquid investments with a short maturity of three months or less from the date of acquisition or opening of the deposit or similar account.

s) Creditors and provisions

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

t) Financial instruments

The charity only has financial assets and financial liabilities of a kind that qualify as basic financial instruments. Basic financial instruments are initially recognised at transaction value and subsequently measured at their settlement value with the exception of bank loans which are subsequently measured at amortised cost using the effective interest method. Non-basic financial instruments are measured at fair value with any gain or loss going to the statement of financial activities. Full details are given in the financial instruments note.

u) Pensions

The group contributes to a number of defined contribution pension schemes and to the NHS pension scheme.

The NHS pension scheme is a multi-employer defined benefit scheme and the assets of the scheme are held separately from those of the charities in an independently administered fund. The Charity is unable to identify its share of this scheme’s assets and liabilities and is therefore, as permitted by FRS 102, treated as if it were a defined contribution pension scheme. Pension contributions payable for the year to the various pension schemes are charged to the SOFA.

Page 53

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

2 Income from donations and legacies

Income from donations and legacies
Other donations
Legacies
Donations in memoriam		 Unrestricted
£'000
1,941
199
852		 £'000
-
-
360
Restricted		 2021
Total
£'000
1,941
199
1,212		 Unrestricted
£'000
710
203
512		 £'000
-
-
500
Restricted		 2020
Total
£'000
710
203
1,012
2,992 360 3,352 1,425 500 1,925

Contingent assets, relating to legacies which have been notified but do not yet meet the income recognition criteria detailed in note 1 of the financial statements, amount to £1,233,000 (2020: £1,586,500).

3 Income from charitable activities

Income from charitable activities
Main CCG contract
Other NHS income
Provision of staff and sundry other income		 Unrestricted
£'000
1,877
5
243		 £'000
-
-
1,436
Restricted		 2021
Total
£'000
1,877
5
1,679		 Unrestricted
£'000
1,784
133
119		 £'000
-
-
-
Restricted		 2020
Total
£'000
1,784
133
119
2,125 1,436 3,561 2,036 - 2,036

The total amount claimed under the government Job retention scheme is £526,808 (2020: nil), this is split between retail in note 4 - £440,141 and other areas of the charity in provision of staff above - £86,667.

4 Income from other trading activities

Income from other trading activities
Fundraising events
Charity shop income
Lottery income
Retail, Hospitality and Leisure Government Grants		 Unrestricted
£'000
254
993
332
952		 £'000
-
-
-
-
Restricted		 2021
Total
£'000
254
993
332
952		 Unrestricted
£'000
611
2,603
373
-		 £'000
-
-
-
-
Restricted		 2020
Total
£'000
611
2,603
373
-
2,531 - 2,531 3,587 - 3,587

Page 54

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

5a Analysis of expenditure (current year)

Payroll
Premises
Lottery prizes
Shop expenses
Transport
Event costs
Medical Supplies
Catering
Other Costs
Other Staff costs
Support costs
Governance costs
Total expenditure 2021
Total expenditure 2020		 Raising funds
£'000
1,588
549
77
192
19
60
-
-
120
22		 Charitable activities Charitable activities Governance
costs
£'000
-
-
-
-
-
-
-
-
-
-		 Support
costs
£'000
794
101
-
-
-
-
-
-
305
80		 2021 Total
£'000
4,840
910
77
192
19
60
75
97
568
215		 2020 Total
£'000
5,328
949
78
234
52
83
74
109
727
426
Medical
£'000
167
-
-
-
-
-
36
-
3
69		 In-Patient Care
£'000
981
225
-
-
-
-
39
97
123
13		 Community
Care
£'000
994
35
-
-
-
-
-
-
12
16		 Support
Services
£'000
316
-
-
-
-
-
-
-
5
15
2,627
582
-		 275
61
-		 1,478
328
-		 1,057
234
-		 336
75
-		 -
-
-		 1,280
(1,280)
-		 7,053
-
-		 8,060
3,209 336 1,806 1,291 411 - - 7,053 8,060
3,555 422 1,717 1,752 614 - -

Page 55

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

5b Analysis of expenditure (prior year)

Payroll
Premises
Lottery prizes
Shop expenses
Transport
Event costs
Medical Supplies
Catering
Other Costs
Other Staff costs
Support costs
Governance costs
Total expenditure 2020		 Raising funds
£'000
1,722
512
78
234
52
83
-
-
181
64		 Charitable activities Charitable activities Governance
costs
£'000
-
-
-
-
-
-
-
-
-
-		 Support
costs
£'000
896
89
-
-
-
-
-
-
360
82		 2020 Total
£'000
5,328
949
78
234
52
83
74
109
727
426
Medical
£'000
129
-
-
-
-
-
39
-
1
178		 In-Patient Care
£'000
881
250
-
-
-
-
35
109
117
21		 Community
Care
£'000
1,253
98
-
-
-
-
-
-
49
42		 Support
Services
£'000
447
-
-
-
-
-
-
-
19
39
2,926
629
-		 347
75
-		 1,413
304
-		 1,442
310
-		 505
109
-		 -
-
-		 1,427
(1,427)
-		 8,060
-
-
3,555 422 1,717 1,752 614 - - 8,060

Page 56

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

6 Net income/ (expenditure)

This is stated after charging:

2021 2020
£'000 £'000
Depreciation - owned assets 280 292
Operating leases - rent 402 337
Auditor's remuneration (excluding VAT):
Statutory audit 22 22
Non-audit services 7 7

Staff costs were as follows:

Salaries and wages
Redundancy and termination costs
Social security costs
Pension contributions		 2021
£'000
4,277
42
291
230		 2020
£'000
4,753
-
323
252
4,840 5,328

The average number of employees, including part-time staff, analysed by function was:

Charitable activities
Medical
In-Patient Care
Community Care
Total
£60,000 - £69,999
£70,000 - £79,999
Other Patient Services
Total
Costs of raising funds
Fundraising
Charity shops
Support Services
£80,000 - £89,999
£90,000 - £99,999
£120,000 - £129,999		 FTE
2021
No:
2
25
27
9		 Headcount
2021
No:
7
54
38
13		 FTE
2020
No:
2
27
35
15		 Headcount
2020
No:
11
64
53
20
63 112 79 148
13
48
18		 14
74
22		 20
53
23		 22
93
29
79 110 96 144
2021
No.
1
1
2
-
-		 2020
No.
1
1
2
-
1

For one of these employees (2020: one employee), the charity made a pension contribution of £2,480 (2020: £2,462) to a defined pension contribution scheme.

Total employee benefits received by key management personnel amounted to £436,064 (2020: £501,687).

Page 57

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

8 Trustee remuneration and related party transactions

Trustees' expenses represents the payment or reimbursement of travel and subsistence costs totalling £5,389 (2020: £6,031) incurred by 6 (2020: 5) members relating to attendance at meetings of the trustees.

The aggregate value of all unrestricted donations from related parties (excluding the gift aid receivable from Isabel Hospice Limited) amounted to £1,715 (2020: £1,737). In 2021, Rod Leggetter (Trustee) donated £nil (2020: £3,242) for restricted events.

9 Taxation

The charity is exempt from corporation tax as all its income is charitable and is applied for charitable purposes. The charity's trading subsidiary Isabel Hospice Trading distributes under Gift Aid available profits to the parent charity. Its charge to corporation tax in the year was:

2021 2020 £'000 £'000 - - UK corporation tax at 19%

Page 58

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

10 Tangible fixed assets

Cost or valuation
At the start of the year
Additions in year
Disposals in year
At the end of the year
The group
At the end of the year
Net book value
At the end of the year
At the start of the year
Depreciation
At the start of the year
Charge for the year
Eliminated on disposal		 Freehold
property
£'000
4,332
-
(460)		 Short
leasehold
property
£'000
789
-
(26)		 Plant
machinery
equipment
and vehicles
£'000
947
99
(545)		 Total
£'000
6,068
99
(1,031)
3,872 763 501 5,136
1,468
117
(444)		 565
37
(23)		 778
126
(542)		 2,811
280
(1,009)
1,141 579 362 2,082
2,731 184 139 3,054
2,864 224 169 3,257

The charity

The charity
At the start of the year
Additions in year
Disposals in year
At the end of the year
Cost
At the end of the year
Net book value
At the end of the year
At the start of the year
Depreciation
At the start of the year
Charge for the year
Eliminated on disposal		 Freehold
property
£'000
4,333
-
(460)		 Short
leasehold
property
£'000
309
-
(18)		 Plant
machinery
equipment
and vehicles
£'000
655
86
(393)		 Total
£'000
5,297
86
(871)
3,873 291 348 4,512
1,469
117
(444)		 210
17
(18)		 539
89
(390)		 2,218
223
(852)
1,142 209 238 1,589
2,731 82 110 2,923
2,864 99 116 3,079

All of the above assets are used for charitable purposes.

Page 59

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

11 Investment properties

Fair value at the start of the year
Disposals
Fair value at the end of the year		 2021
2020
£'000
£'000
285
515
(285)
(230)
The group		 2021
2020
£'000
£'000
285
515
(285)
(230)
The group		 2021
2020
£'000
£'000
285
515
(285)
(230)
-
285
The charity		 2021
2020
£'000
£'000
285
515
(285)
(230)
-
285
The charity
- 285 - 285

The investment property was sold in the year. The net sale proceeds of the property was £304,549 resulting in a profit of £19,549.

12 Investments

Investments
Fair value at the start of the year
Additions at cost
Disposal proceeds
Net gain / (loss) on change in fair value
Fair value at the end of the year		 2021
2020
£'000
£'000
-
-
619
-
(307)
-
6
-
The group		 2021
2020
£'000
£'000
-
-
619
-
(307)
-
6
-
318
-
The charity
318 - 318 -

Investments comprise:

Due from Isabel Hospice Trading Limited
Shares listed on the London Stock Exchange
Debtors: amounts falling due within one year
Trade debtors
Prepayments
Other debtors
Accrued income		 2021
2020
£
£
318
-
2021
2020
£'000
£'000
77
42
150
120
58
127
819
230
-
-
The group
The group		 2021
2020
£
£
318
-
2021
2020
£'000
£'000
77
42
150
120
58
127
819
230
-
-
The group
The group		 2021
2020
£
£
318
-
2021
2020
£'000
£'000
72
30
54
31
57
63
764
281
207
243
1,154
648
The charity
The charity		 2021
2020
£
£
318
-
2021
2020
£'000
£'000
72
30
54
31
57
63
764
281
207
243
1,154
648
The charity
The charity
1,104 519 1,154 648

13 Debtors: amounts falling due within one year

Page 60

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

14 Creditors: amounts falling due within one year

Creditors: amounts falling due within one year
Trade creditors
Other creditors
Taxation and social security
Accruals
Deferred income (note 16)		 2021
2020
£'000
£'000
98
91
23
20
124
136
102
34
72
64
The group		 2021
2020
£'000
£'000
67
49
23
20
104
114
86
20
71
64
351
267
The charity
419 345 351 267

15 Provisions for liabilities

At 1 April 2020
Utilised during the year
At 31 March 2021		 2021
2020
£'000
£'000
24
21
-
3
The group		 2021
2020
£'000
£'000
24
21
-
3
The group		 2021
2020
£'000
£'000
-
-
-
-
-
-
The charity		 2021
2020
£'000
£'000
-
-
-
-
-
-
The charity
24 24 - -

All leased premises are kept in a good state of repair. The subsidiary Trading company has obligations under its leases to redecorate periodically and to leave the premises in a previously-agreed condition. Having assessed the current condition of all leased premises, the Directors of the Trading Company consider that, at the balance sheet date, the cost of any such remedial works would not exceed £24,360 (2020: £24,360) and so a provision for this sum has been included in these accounts.

16 Deferred income

Deferred income of £72k represents lottery receipts for draws that have not taken place at the balance sheet date (2021: £60k, 2020: £64k), and lottery licence fee income (2021: £12k, 2020: nil).

Balance at the beginning of the year
Amount released to income in the year
Amount deferred in the year
Balance at the end of the year		 2021
2020
£
£
64
68
(64)
(68)
72
64
The group		 2021
2020
£
£
64
68
(64)
(68)
72
64
The group		 2021
2020
£
£
64
68
(64)
(68)
72
64
72
64
The charity		 2021
2020
£
£
64
68
(64)
(68)
72
64
72
64
The charity
72 64 72 64

Page 61

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

17 Pension commitments

NHS Pension Scheme

The charity operate an NHS Pension Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employees, general practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable each body to identify its share of the underlying scheme assets and liabilities. Therefore the scheme is accounted for as if it were a defined contribution scheme.

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State for Health and Social Care in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in each scheme is taken as equal to the contributions payable to that scheme for the accounting period.

In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

a) Accounting valuation

A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2021, is based on valuation data as 31 March 2020, updated to 31 March 2021 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.

The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.

b) Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience), and to recommend contribution rates payable by employees and employers.

The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at 31 March 2016. The results of this valuation set the employer contribution rate payable from April 2019 to 20.6% of pensionable pay. The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer cost cap that was set following the 2012 valuation. In January 2019, the Government announced a pause to the cost control element of the 2016 valuations, due to the uncertainty around member benefits caused by the discrimination ruling relating to the McCloud case.

The Government subsequently announced in July 2020 that the pause had been lifted, and so the cost control element of the 2016 valuations could be completed. The Government has set out that the costs of remedy of the discrimination will be included in this process. HMT valuation directions will set out the technical detail of how the costs of remedy will be included in the valuation process. The Government has also confirmed that the Government Actuary is reviewing the cost control mechanism (as was originally announced in 2018). The review will assess whether the cost control mechanism is working in line with original government objectives and reported to Government in April 2021. The findings of this review will not impact the 2016 valuations, with the aim for any changes to the cost cap mechanism to be made in time for the completion of the 2020 actuarial valuations.

Page 62

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

18a
General
funds
Designated
funds
£'000
£'000
318
2,409
1,489
1,100
(24)
-
1,783
3,509
Analysis of group net assets between funds (current year)
Fixed assets
Net current assets
Provisions for liabilities
Net assets at 31 March 2021		 18a
General
funds
Designated
funds
£'000
£'000
318
2,409
1,489
1,100
(24)
-
1,783
3,509
Analysis of group net assets between funds (current year)
Fixed assets
Net current assets
Provisions for liabilities
Net assets at 31 March 2021		 18a
General
funds
Designated
funds
£'000
£'000
318
2,409
1,489
1,100
(24)
-
1,783
3,509
Analysis of group net assets between funds (current year)
Fixed assets
Net current assets
Provisions for liabilities
Net assets at 31 March 2021		 Revaluation
Reserve
£'000
-
-
-		 Restricted
funds
£'000
645
52
-		 Endowment
funds
£'000
-
836
-		 Total funds
£'000
3,372
3,477
(24)
1,783 3,509 - 697 836 6,825

18b Analysis of group net assets between funds (prior year)

Fixed assets
Net current assets
Provisions for liabilities
Net assets at 31 March 2020		 General
funds
£'000
-
(32)
(24)		 Designated
funds
£'000
2,509
-
-		 Revaluation
Reserve
£'000
362
-
-		 Restricted
funds
£'000
671
86
-		 Endowment
funds
£'000
-
836
-		 Total funds
£'000
3,542
890
(24)
(56) 2,509 362 757 836 4,408

Page 63

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

19a Movements in funds (current year)

Movements in funds (current year)
Hospice UK
Total restricted funds
Risk Reserve Fund
Endowment funds
Restricted funds:
Capital development funds:
Building appeal
Day Services
Training
General funds
Designated funds:
Service delivery funds
Community Services Big Lottery Fund
Equipment
Family Support
Other
Total funds
Fixed Asset fund
Revaluation reserve
Total unrestricted funds		 £'000
836
At 1 April
2020		 £'000
-
Income &
gains		 £'000
-
Expenditure
& losses		 £'000
-
Transfers		 £'000
836
At 31
March
2021
-
671
35
22
(7)
3
17
16		 1,436
-
27
20
42
5
266
-		 (1,436)
(26)
(62)
(42)
(42)
(8)
(247)
-		 -
-
-
-
7
-
-
-		 -
645
-
-
-
-
36
16
757 1,796 (1,863) 7 697
(56)
2,509
-
362		 7,673
-
-
-		 (5,190)
-
-
-		 (645)
(100)
1,100
(362)		 1,783
2,409
1,100
-
2,815 7,673 (5,190) (7) 5,292
4,408 9,469 (7,053) - 6,825

The narrative to explain the purpose of each fund is given at the foot of the note below.

Page 64

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

19b Movements in funds (prior year)

Total restricted funds
Risk Reserve Fund
Endowment funds
Restricted funds:
Capital development funds:
Building appeal
Training
General funds
Designated funds:
Fixed Asset fund
Service delivery funds
Community Services Big Lottery Fund
Equipment
Family Support
Day Services
Other
Total funds
Revaluation reserve
Total unrestricted funds		 £'000
836
At 1 April
2019		 £'000
-
Income &
gains		 £'000
-
Expenditure
& losses		 £'000
-
Transfers		 £'000
836
At 31
March
2020
697
12
16
1
-
20
34		 12
62
36
32
8
346
4		 (38)
(39)
(30)
(40)
(5)
(349)
(22)		 -
-
-
-
-
-
-		 671
35
22
(7)
3
17
16
780 500 (523) - 757
(174)
3,116
-
329		 7,048
-
-
33		 (7,258)
(279)
-
-		 328
(328)
-
-		 (56)
2,509
-
362
3,271 7,081 (7,537) - 2,815
4,887 7,581 (8,060) - 4,408

General funds

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

Designated funds

The Fixed Asset fund is represented by fixed assets, net of associated liabilities and after deducting amounts included within the revaluation reserve and those other assets where use has been restricted. Transfers are made between funds to maintain the carrying value.

As a result of the material surplus generated by the Charity in the 2020/21 financial year, the Trustees have decided to allocate some of the surplus to replenish the Risk Reserve Fund up to the minum required of £1.1m.

Revaluation reserve

The Revaluation Reserve comprises the movement that arose when a freehold property and a long leasehold property used by the trading subsidiary as shops were revalued. These investment properties have now been disposed of an therefore a transfer from the revaluation reserves to general funds has been recognised.

Page 65

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

19 Movement in funds (continued)

Endowment funds

The endowment fund is an expendable endowment arising from a legacy to the Hospice. The legacy gives the trustees discretionary powers to use the endowment to fund capital projects. Any income from the endowment is unrestricted and may be used for the general purposes of the charity.

Restricted funds

The Building Appeal fund represents the proceeds of a special appeal that have been utilised to construct an annex to the InPatient Unit. The balance is reduced as the related assets are depreciated.

The Community Services fund comprises a grant from the Big Lottery Fund to help expand a “hospice at home” service and various small grants to help fund the provision of patient care in the community and at home. The grants are principally used principally to help pay the staff employed for those purposes.

The Equipment Fund comprises donations and grants received to purchase specific items of equipment.

The Family Support fund has been established by a grant from BBC Children In Need and other smaller grants to help fund the provision of bereavement counselling. Again the grants are principally used to help pay the staff employed for that purpose.

The Day Services fund is represented by grants received to help fund the provision of specific services at the Charity's day centres.

The Training fund was established from grants received to assist with the provision of clinical training of doctors and nurses throughout the charity.

Hospice UK Grant awarded funding to allow the hospice to make available bed capacity and community support from April 2020 to July 2020 to provide support to people with complex needs in the context of the COVID-19 situation and to provide bed capacity and community support from November 2020 to March 2021 for the same purpose.

Transfer of funds relate general funds cover of over spend on restricted projects and replenishment of the Risk Reserve Fund.

Page 66

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

20 Isabel Hospice Trading Limited

The principal activity of Isabel Hospice Trading Limited (whose company number is 02417607) is the sale of purchased and donated articles. A summary of the trading results is shown below:

Gift aid distribution to the charity
Total retained earnings carried forward
Turnover and other operating income
Cost of sales and administrative costs
Net profit
Total retained earnings brought forward
(Loss) /Profit for the financial year		 2021
£'000
1,945
(1,998)		 2020
£'000
2,602
(2,245)
(53)
147
(53)
-		 357
147
357
(357)
94 147

During the year, the trading company paid to the Parent Charity £160,000 (2020: £160,000) for property rent and support services provided by Charity.

The assets and liabilities of the trading subsidiary were:

Tangible assets
Current assets
Creditors within one year
Provisions for liabilities
Aggregate net assets		 2021
£'000
159
234
(275)
(24)		 2020
£'000
206
338
(373)
(24)
94 147

21 Parent charity

The parent charity's gross income and the results for the year are disclosed as follows:

2021 2020
£'000 £'000
Gross income 7,660 5,814
Result for the year 2,474 (136)

22 Operating lease commitments

The following payments are committed to be made by the group and the Charity for land and buildings:

Less than one year
One to five years
Over five years		 2021
2020
£'000
£'000
337
295
993
658
1,295
62
Group		 2021
2020
£'000
£'000
337
295
993
658
1,295
62
Group		 2021
2020
£'000
£'000
22
22
64
64
4
19
90
105
Charity		 2021
2020
£'000
£'000
22
22
64
64
4
19
90
105
Charity
2,625 1,015 90 105

In the year ended 31 March 2020, the group reviewed its operating lease commitments, resulting in a restatement to the prior year. This change had no impact on the prior year's primary financial statements.

Page 67

Isabel Hospice Limited

Notes to the financial statements

For the year ended 31 March 2021

23 Legal status of the charity

The Charity is a company limited by guarantee and has no share capital. The liability of each member in the event of winding up is limited to £10.

24 Post balance sheet event

Following a review of the Charity's property portfolio and in a bid to maximise the return on assets, the Board have accepted an offer for the sale of the Head Office building (Milan House). This transaction is expected to be completed by the end of the next financial year 2021/22.

Page 68