# **ANNUAL REPORT AND ACCOUNTS** ## **FOR THE YEAR ENDED 31ST DECEMBER 2021** 38-43 Lincoln's Inn Fields London, WC2A 3PE Registered Charity No. 1066994 Company Registration No. 3482958 Company limited by guarantee. Company Registration No. 3482958 (England and Wales). Registered Office Address as above ## **CONTENT PAGE** President’s Foreword 2 Trustees Annual Report 4 BOA Strategic Objectives 5 Governance 18 Financial Review 26 Statement of financial statements 38 Balance Sheet 39 Cash Flow Statement 40 Notes to financial statements 41 Reference and administrative detail 58 ## **PRESIDENT'S FOREWORD** This annual report reflects back on a year when our members began to return to some form of normality and focus on tackling our ever-growing waiting lists only to be hit by the OMICRON wave of COVID-19. As a consequence, our aim to influence, engage and collaborate nationally, regionally and locally with partner and stakeholder organisations has remained a major priority. We have worked closely with a range of organisations and relevant national clinical directors to continue to stress the need to Whitehall, Cardiff, Holyrood and Belfast for sufficient resource and targeted surgical capacity, particularly through the introduction of surgical hubs to tackle waiting lists and provide better care for patients. It has been important through this difficult period to maintain our focus on educating, training and developing our specialty. Trainees have had a particularly difficult time as they have not been able to gain the surgical experience that they need, and we will need well trained consultants more than ever before to support the recovery. Having moved our education activity and course delivery online due to the pandemic, we have reviewed our courses to grow and develop our offering with a view to utilising a variety of means to deliver content. We have piloted a new – and sold out – virtual medico-legal course, while new casting courses ran in person for T&O trainees during the year to maintain the level of skilled casting technicians. During 2021 we developed a dedicated area of the website for SAS members and we launched our well-being resources on-line here, recognising that if we don’t take wellbeing seriously now as so many colleagues are affected by the experience of the past couple of years, we will only be storing up further problems for the future. **John Skinner President** **Bob Handley Immediate Past President** As part of our commitment to equality and diversity, we also published a range of well-received resources to support parenthood in T&O here. We strongly believe that T&O should be an inclusive surgical profession that inspires, attracts and retains the best talent. Time out for parents raising a family should not be seen as a barrier to progression. We understand there is much to be done but believe this will help us move forward in a positive direction. We were delighted to be able to launch our new BOA membership app for members to have easy access to BOA latest news, updates, standards and guidance, JTO publications and BOA Annual Congress. Since launch there have been nearly 3k downloads. This is part of our ongoing commitment to sustainability and reducing our carbon imprint going forward. In May, we were pleased to move into our new offices in the new RCS England building and we continue to adopt a hybrid approach to working, providing flexibility and opportunity to our members to join events on-line. As part of this project, we had to find a new home for our archives. Our honorary archivist has done a fantastic job cataloguing over 100 years of BOA history. This collection now resides with the Borthwick Institute and we are partnering with them to make this fantastic resource available for future surgeons, and anyone else interested in researching orthopaedics. Finally, we were delighted to hold our Congress in person this year. Thanks has to go to the Scottish Government in awarding us ‘Gateway status’, which enabled us to run a COVID-secure event with just under 2,000 attendees across the three days of Congress. It was a joy to be back together with our colleagues and friends face-to-face. Not forgetting to mention the ‘Bob Handley Bridge Building Competition’ - a serious team building exercise culminating in a tense final morning testing the loadbearing capacity of the bridges. 2 ## **TRUSTEES ANNUAL REPORT** ## Charitable Objectives ## Public Benefit The BOA is established for the advancement for the public benefit of Science, Art and Practice of Orthopaedic Surgery with the aim of bringing relief to patients of all ages suffering from the effects of injury or disorders of the musculoskeletal system. As a Surgical Specialty Association for Trauma and Orthopaedics in the UK we provide national leadership, a unifying focus, and a charitable endeavor by: Caring for Patients, Supporting Surgeons. The trustees confirm that they have complied with their duty in Section 17 of the Charities Act 2011 to have due regard to the public benefit guidance by the Charity Commission for England and Wales. The trustees further confirm that the activities of the Charity are carried out, in line with its objects, for the public benefit as described below. Our principal concern is to ensure that patients under our care receive high quality treatment. In order to achieve this, we must support trauma and orthopaedic surgeons throughout their careers. As a charity we also care for patients by raising funds for and promoting research into musculoskeletal disorders. We also operate a benevolent fund to support our members in their time of need. 3 ## **BOA STRATEGIC PRIORITIES** ## **Promote the highest standards of patient care** - Share responsibility for the patient pathway from prevention to treatment and rehabilitation. - Promote relevant data collection and analysis, ethical innovation and patient safety. - Promote and help sustain high quality research in Trauma and Orthopaedics. Identify means of quality improvement and reducing variation. Identify and promote mechanisms for peer support. - Include patients and those who support them in making decisions about their care. ## **Influence, engage and collaborate** Forge strong and lastings relationships with all those involved in the care of patients with musculoskeletal disease or injury. - Proactively engage with all the national, regional and local stakeholders in patient care. - Represent and support all sub-specialties in Trauma and Orthopaedics and collaborate on policy and standards development. - Support our members, proactively seek their views and clearly communicate the work of the BOA and its outcomes. - Develop BOA strategic international partnerships with a particular focus on activities in the less economically developed countries. ## **Educate, train and develop** Promote and support a career in Trauma and Orthopaedic Surgery. Encourage the development of a diverse workforce. Support surgeons in all aspects and at all stages of their careers. - Support the clinical and professional development of the entire Trauma and Orthopaedic team. - Encourage and inspire students to become Trauma and Orthopaedic surgeons. ## **Demonstrate the highest standards in our organisation** Promote fairness, accountability and resilience. Work in an open and inclusive way. - Ensure there is no tolerance of discrimination, harassment, bullying and undermining. - Communicate clearly, decisively and promptly. Invest, train and develop our staff. - Embed good governance across our organisation, for our finances, data, membership and other processes. 4 ## **ACTIVITIES AND ACHIEVEMENTS** For us, like very many others, 2021 was (like 2020) another unprecedented year, as a result of the wide-reaching effects of the COVID-19 pandemic. We continued to adapt our working practices, adjust our organisational priorities and focus on changes and challenges for the T&O workforce and patients. The serious challenges in recovery of elective services have led to a huge range of activity to seek to address this. The challenges to the working lives of our membership have continued to be very significant too – our work has varied from publishing a suite of resources on wellbeing and burnout, to supporting trainees affected by the lack of training opportunities during the pandemic. We have again worked tirelessly over the year to support our members and care for patients in the rapidly changing context of the pandemic. ## Influencing and Engagement During 2021, the COVID-19 pandemic continued to dominate the health landscape, and we continued our extensive engagement on issues relating to it. Our COVIDrelated work covered a wide range of issues. The following are examples: ## **BOA resources included:** - BOA and Specialist Society Position paper on caring for patients awaiting surgery (May 2021) Statements to respond to NHS England publication of waiting times - Statement to respond to RCS England’s ‘New Deal for Surgery’ ## **Engaged with NHS England and others on:** Restoring elective NHS services - Patient-initiated follow-up proposals Shared decision making proposals Referral optimisation - Future ‘bounce-back’ of referrals post-pandemic ## **Conference presentations:** Significant coverage at BOA Congress, including key note from Steve Powis Future Surgery Show presentation by Prof John Skinner Engagement with partner and stakeholder organisations was a major priority as a consequence of the pandemic. We worked closely with: - The British Orthopaedic Directors Society (BODS), who held regular Zoom calls with their membership, with involvement from BOA Executive members. - NHS England’s Best MSK Health programme, overseen by Musculoskeletal (MSK) National Clinical Director Andrew Bennett, and with core input from BOA Exec and staff members. The orthopaedic specialist societies. - Relevant National Clinical Directors at NHS England, through the formation of a BOA Orthopaedic Strategy Group. - The Federation of Surgical Specialty Associations (FSSA)and the Royal Colleges of Surgeons on surgery-wide issues. - The Arthritis and Musculoskeletal Alliance. 5 Aside from COVID-related publications, during the course of 2021 we produced documentation and media responses on: A device safety alert from MHRA - Findings from newly published research - Latest developments with the Private Healthcare Information Network (PHIN) and publication of surgeon and hospital data We responded to 16 formal consultations and numerous other requests for advice and expertise, including from NICE and NHS England. There were two significant MHRA consultations on ‘The Future Regulation of Medical Devices in the UK’, and ‘Point of Care Manufacturing’ to which we submitted responses. Our BOAST (BOA Standard) documents are one of our most popular resources on our website. In 2021, we published the following new or updated BOASTs: Diagnosis & Management of Arterial Injuries Associated with Extremity Fractures and Dislocations Cervical Spine Clearance in the Trauma Patient Early Management of the Paediatric Forearm Fracture Peripheral Nerve Injury Providing a Continuous Safe Elective Orthopaedic Environment The Safe Use of Intraoperative Tourniquets ## BOA Standards (BOASTs): **28 BOASTs now available in total** **During the year over 55k page views of BOAST landing page, 37k views of Trauma BOAST page and 226k individual BOAST views** 6 ## Digital This year, we developed a new BOA membership app for members to have easy access to BOA latest news, updates, standards and guidance, JTO publications and BOA Annual Congress. Since launch, there have been nearly 3k downloads. The majority of downloads have been in the run up to the BOA Annual Congress, where there was a 100% download rate of the app from delegates at the event. During 2021, we developed a dedicated area of the website for SAS members, and created new sections on the website for parenthood guidance and wellbeing resources. The Transient Journal, the BOA’s blog-like resource for publishing contributions from our members and others within the T&O profession, has had over 24k unique views of all Transient Journal articles over the course of the year and 29 articles were published. Members are continuing to engage with the My BOA website platform, which gives them the ability to update their contact details, download invoices and certificates and access the members’ directory. It was the eighth most visited page of the website with over 34k visits. Our social media engagement has continued to grow over the course of the year and we have seen major spikes in engagement during specific campaigns such as National Careers Week, International Women’s Day, Pride Month and during the BOA Annual Congress. **Twitter: LinkedIn:** -18.9k followers **-** 8.6k followers -11% increase -14% increase **Facebook:** -5.5k followers -16% increase **Instagram: -** 1.6k followers - 44% increase ## **Website** 21k monthly visitors to the website Over 260k in total for the year Page views averaged over 150k per month Over 1.8 million views for the year Most visited pages on the website - BOA Annual Congress - over 79k page views - BOA Standards for Trauma and Orthopaedics Over 55k page views - Trauma BOASTs – over 37k views 7 ## Membership Membership has remained relatively steady throughout the year at just over 5,000. We are grateful to our members for their continued support during the year and sought every opportunity to provide support, advice and guidance to manage the ongoing impacts of the pandemic. We are continuing to engage with Consultants, SAS, Foundation Year and Medical Student members as a priority. Membership in all categories was largely static throughout the year, with the biggest shift being Post CCT members moving to Home Fellow. There was also a large drop in the number of members with outstanding payments at the end of the year. This drop is due to the improved mechanisms put in place to ensure subscription payments are received sooner, with members being lapsed for nonpayment earlier in the year from three months instead of the previous nine months grace period. The mechanism for online voting has contributed to an increase in the percentage of members voting to over 20% last year from a multi-year average of 14%. A motion was passed at the 2021 AGM to expand voting rights to SAS Surgeon – 11+, so expanding the members entitled to vote from Home Fellows, Home Members, SAS Surgeon - Y16+, and Post CCT members. We hope to build on the online voting engagement we have had in the past two years and continue to drive awareness of the Council opportunities and the candidates standing. We aim to attract a diverse range of candidates to deliver a breadth of representation, which proved successful in attracting a more diverse group of nominations in 2021 and elected members to Council. We continued to work closely with the Specialist Societies, including joint publications and consultation responses, and attendance by both staff and senior council members at Specialist Society meetings. 8 ## Diversity and Inclusion The BOA’s diversity and inclusion strategy and action plan sets out the BOA commitment to embedding the principles of diversity and inclusion across its core objectives, thus providing equal opportunities and eliminating discrimination in all areas. ## The strategy set out objectives in the following areas: **----- Start of picture text -----**
Commitment and Communication
Leadership
Congress and educational events
Recruitment
Career Support
**----- End of picture text -----**
## Underpinned by seven key principles: 1. We are committed to equality of access to a T&O career and to the services of the Association. 2. The following groups are under-represented within T&O and the BOA itself: -Women -Black Asian and Minority Ethnic -Disability -LGBTQ+ 3. We expect all orthopaedic surgeons to maintain a work environment that values and respects diversity. 4. All interactions with colleagues, staff, patients, and families should reflect the values of fairness, dignity, and respect. 5. We will review our practices and procedures regularly to monitor progress. 6. We will promote the diversity of our organisation. 7. If failings are demonstrated, we will address them. The BOA undertook a survey to better understand the demographics of our membership as committed to in our Diversity and Inclusion Strategy. This data will be used to help us better understand and target activities to encourage diversity within the T&O community. The survey had a 30% response rate. We will be regularly reviewing our membership to ensure we maintain an overview of our demographics. We also launched a range of resources to support parenthood in T&O. The two documents - a Statement of Expectations on Pregnancy and Parental Leave in T&O, and a guide to support educational supervisors and trainers -together with wider information and support for expectant surgeons and parents are available on the BOA website. We strongly believe that time out for parents raising a family should not be seen as a barrier to progression in T&O. 9 ## Education and Careers The 2021 cohort of the BOA ‘Future Leaders Programme’ completed the programme virtually, but were also able to meet up in person at our Congress for a celebration of their work. Despite the adjustments, the feedback from the programme was very positive and demand for the 2022 cohort was high. Thirty-five delegates will form the 2022 cohort, including two BOA-funded places for female applicants as part of our diversity and inclusion agenda. Due to the pandemic, a number of those awarded travelling fellowships in 2019 and 2020 had not been able to travel as expected. With the lifting of restrictions, several were able to travel in the latter half of 2021 and we expect that all will be able to travel by early 2022. In addition, we were very pleased to award 12 grants in December 2021 to undertake these valuable fellowships during 2022. We have been very grateful to our sponsors, including Zimmer Biomet, Postgraduate Orthopaedics and Heraeus for their support and understanding in the adjustments made to the programme. In January 2021, Ortho Update (previously the Instructional Course) was modified to better suit remote delivery with a one-day format and was successfully delivered virtually for the first time. We were joined by 107 delegates, who reported favourably on the change. TOTs (Training Orthopaedic Trainers) and TOES (Training Orthopaedic Educational Supervisors) continued to be popular in the now wellestablished virtual format. As part of our commitment to support the roll out of the new curriculum, 436 delegates attended our 12 free of charge regional v-TOES courses in 2021. A further 121 joined our regularly scheduled v-TOTs and v-TOES over 9 courses. For the first time in 2021, the BOA piloted a medico-legal course. The 33 attendees - senior trainees, new and experienced consultants and SAS doctors - enjoyed case-based discussions and a mock coroner’s inquest. We will look to repeat this sell-out course in 2022, with the possibility of holding some course dates face-to-face. As part of the move to our new offices, we also had to find a new home for our archives. This was the culmination of a three-year project, led by our honorary archivist, to sort and catalogue over 100 years of BOA history. This collection now resides with the Borthwick Institute and we are partnering with them to make this fantastic resource available for future surgeons, and anyone else interested in researching orthopaedics. 10 The UK and Ireland In-Training Exam (UKITE) ran in December 2021 for candidates from the UK, Ireland, and South Africa, joined for the first time by 6 candidates from Malta. In total 806 candidates took the exam in the UK and Ireland (762 ST1-8, 47 SAS surgeons/other) and a further 146 candidates in South Africa. Overall exam reliability (KR20) was 0.8501, which is a high level of reliability. Exam question development, paper setting, and delivery continue to be performed through the integrated Ripley system, providing a streamlined pathway for delivery to candidates similar to the FRCS exam. The online experience was well received by participants with 78% of responses to the post exam survey being very positive. Following candidate comments, we will develop enhanced feedback and learning opportunities for the delegates for 2022. Casting courses continued to run during the year, albeit with a reduced capacity of 12 rather than the normal 16 for most of the year and moving back up to 16 from October. Maintaining the level of skilled casting technicians was a key priority and during the year, 56 casting technicians were awarded the BCC and 186 BCC holders were recertified. In 2021, we began a new course offering for T&O Surgical Trainees, with two successfully run in September and October 2021 with a maximum capacity of 21. We have taken the opportunity in 2021 to conduct a ‘stocktake’ of our educational activity. This reviewed what we are currently offering, for whom, how often and at what cost, and gathered feedback from members and delegates about our work. We identified some gaps in our educational offering, particularly the under-representation of SAS doctors. Our SAS career development position statement launched at a dedicated session at Congress 2021 recognises the important and differing needs of SAS colleagues and the BOA commitment to build specific resource to assist with SAS career development on our website. Towards the end of 2021, we supported the launch of the British Orthopaedic Medical Students Association (BOMSA) to connect and nurture future leaders in orthopaedics. 11 ## Annual Congress 1714 total delegates 372 digital access attendees over three days On demand content was played 5178 times Despite COVID restrictions continuing across the UK, we were still able to run an ‘in person’ Congress reverting back to the usual format running over four days between 20th – 24th September 2021. Congress attracted 1714 total delegates across the main period. New to 2021 was the introduction of recorded content covering the whole of Congress, which was then made available to delegates via our website and the BOA app shortly after the live sessions took place. This was in part to reach all those delegates that were unable to travel due to COVID or COVID restrictions or who did not want to travel. With this change came a new digital access ticket, which saw 372 digital-only access attendees over the Congress period. While support from Industry seemed rather uncertain at the beginning of 2021, the annual exhibition returned in Aberdeen after its absence from the programme in 2020. It was supported by 76 industry partners and two industry sponsored webinars were successfully delivered. The programme at Congress returned to its usual format with a mix of BOA-led plenary sessions and keynote lectures, as well as revalidation sessions organised by the BOA’s affiliated specialist societies, sessions directly supporting medical students, and free paper presentations. The theme this year was Infection and was covered in a number of keynote sessions, including; ‘Infection Revalidation’, ‘Infection: Research and Diagnosis’ and ‘Infection: General Clinical’. COVID was still a big theme with the presidential guest lecture ‘COVID-19: Lessons and Challenges’ and BOA led sessions ‘Elective Care Restart and Recovery: Where Are We Now and What Have We Learnt?’ and ‘Elective Recovery, the Workforce and Training’. Diversity and education were again included throughout the programme in vital areas. Wider sessions also included topics such as ‘Using Perioperative Care and GIRFT to Fix the Health Crisis’, ‘Knowledge Into Practice – Trials in Orthopaedic Trauma’, ‘Simple ankle fractures in complicated patients – what do we really know?’ and ‘Guilty or Not Guilty; Cases of Potential Medical Negligence’. 12 ## Research Developing clinical research infrastructure in T&O surgery across the UK is an endeavour that goes hand in hand with the BOA mission – Caring for Patients, Supporting Surgeons. The BOA was delighted to award funding to two new Clinical Trials Units, following a competitive process. These grants commenced on 1st June 2021 and are expected to run for three years, at Exeter Clinical Trials Unit and Nottingham Clinical Trials Unit. This follows a highly successful six-year partnership with the University of York, from 2014 to 2020. Both centres will focus on identifying and developing new and existing T&O researchers, continuing the growth of high-quality T&O research in the UK, and developing new and innovative trials that deliver answers to important clinical questions in T&O. In addition, we funded two grants towards establishing James Lind Alliance Priority Setting Partnership (PSP). These were for the following projects: Problematic Hip Replacement First-Time Soft Tissue Knee Injuries 13 ## Fundraising The main fundraising aim of the BOA is to directly support the research grant programme, although we are also fortunate to receive legacies supporting the general work of the Association. In 2021, we received just over £207k from legacies, with £130.7k dedicated to research and a further £76.3k supporting the wider spectrum of activities across the BOA, including education, influencing and engagement. This is a vital income stream for the BOA and we are very grateful to those who remember us within their will. Fundraising is predominantly through public donations (cash appeals) and support from specific fundraising challenge events. The 2021 public Christmas appeal raised over £8,000. We were delighted to restart challenge events post-pandemic with five runners in the London Marathon raising over £10,000. All fundraising activities for the BOA are carried out by the Association staff. The Association does not use professional fundraisers or have any commercial participators. Fundraising activities have been covered across the broader team while we review staffing and are monitored by the Head of Events and the COO, with overall oversight by the trustees. No complaints relating to fundraising activities have been received by the Association during this financial period. However, the Association has put in place procedures that would be followed in the event of a complaint being received with the initial response being the responsibility of the Director of Communications and Operations. Any continuing issues would then be passed to the trustees to determine what further action might be required. The Association does not currently subscribe to any specific fundraising standards or schemes for fundraising regulation but considers that it has set appropriate standards for the operation and management of its fundraising activities. In particular, the Association considers that its processes and controls should ensure that vulnerable people and other members of the public are protected from any unreasonable intrusion on a person’s privacy and that no fundraising activities would be unreasonably persistent or place undue pressure on a person to give money or other property. 14 ## Patient Engagement The BOA is keen to ensure that it has a clear and focused patient involvement and engagement strategy and that input is facilitated in the most effective way, enhancing the work of the BOA but also utilising patient time and experience effectively. During 2021, we secured the involvement of a Versus Arthritis representative in our Orthopaedic Committee, and representatives from The Royal Osteoporosis Society and Day One charity for our Trauma Committee. This has provided valuable input from a patient perspective, and we will continue to review this model over the coming months and years. Throughout the year we have continued to work closely with all three of these charities, as well as the Arthritis and Musculoskeletal Alliance (ARMA), providing mutual support, feedback and advice as needed. We have particularly worked with Versus Arthritis on issues facing patients experiencing very long waits for elective care. This has been of increased importance to highlight the increasingly difficult position that patients are in due to the suspension of elective surgery. ## Finance and Resources The benevolent fund awarded two grants during the year. Continued integration of the CRM with the finance system and streamlining of processes, including moving to paperless Direct Debits was due to take place during the year. This process was delayed due to the pandemic and is scheduled to go live in 2022. 15 ## Future Developments for 2022 For 2022 the following areas of activity were highlighted as a priority, some of these are the continuation of core support that we look to provide for our members every year. Develop and deliver a policy and public affairs strategy for the BOA to promote an informed and credible leadership voice on key issues for the specialty, all in collaboration with lead clinicians within the BOA structure. - Proactively work on advice and support for clinicians and patients with a key focus on resuming elective operating and tackling waiting lists. Support the implementation of the Best MSK initiative across all its work streams, with a particular focus on those that relate to T&O, and support the development and delivery of new models of working. - Development of a more proactive role in global orthopaedics, enhancing and supporting delivery of key services and educational support within developing countries (continued from 2020). - Enhanced engagement with our members through further development of the membership app and a variety of social media platforms, including use of Instagram and dedicated campaigns to mark or support key awareness days. - Implementation of the diversity and inclusion strategy and accompanying action plan, particularly the new Culture and Diversity Champions, who will be hosting regional culture/DEI events, showcasing DEI at both BOA and BOTA Congresses and undertaking research together as a network. Continuous improvements of the website to enhance the member experience and to provide information and support for future T&O surgeons. - Implementation of new systems for finance processing. - Enhanced engagement with and support of medical student societies to raise awareness of the specialty and provide good quality educational opportunities. - Continue building our resources to assist with SAS career development, developing T&O for the website, webinars and other specific resources. - Explore returning to face-to-face learning events on a case-by-case basis to assess demand/preferences, starting with our popular medico-legal course in the first instance. - Continue the Future Leaders Programme, supporting 30 T&O surgeons with the passion to be future leaders within their specialty, and to influence positive change within the profession. 16 - Deliver the revised and updated BOA Ortho Update course to provide curriculum driven clinical updates and critical condition assessment opportunities to T&O trainees and SAS surgeons. - Continued delivery of BOA Elective Care and NHFD Reviews with a view to developing lessons learned and using this to drive improvements. - A focus on developing new and innovative benefits for our members and membership drives to continue to increase in our membership with a particular focus on existing consultants working in the NHS and also SAS surgeons, who remain an under-represented cohort. - Review and development of fundraising approach to provide greater cross organisational opportunities and maximise income. - Continued focus on improving risk management and business continuity processes. Continuing to work with key partners and stakeholders, including ARMA and Versus Arthritis, in the development of broader MSK networks: the focus here remains on knowledge sharing, competencies of the community based multidisciplinary MSK team, data and metrics, and generic pathways. Continuing our work to develop a clinical research infrastructure in T&O surgery across the UK through funding of three Surgical Specialty Leads and two Clinical Trials Units. - Launch the new joint research fellowship (with Orthopaedic Research UK (ORUK)), with the goal of developing a pipeline of research-active orthopaedic surgeons. The pilot scheme will award two fellowships of up to £65k for a project in any area of orthopaedics. Continue the work with archive partners to explore options for access and proactive use of the BOA collection. - Continued collaborative work with NHS England and NHS Improvement in relation to tariff, best practice tariff and blended payments, and how these work and apply to T&O procedures. 17 ## Governance The British Orthopaedic Association (BOA) is a registered Charity (Reg. 1066994) and a Company (Reg. 3482958). Limited by Guarantee. Not having a Share Capital, in terms of the Companies Act 2006, we are governed by the Memorandum and Articles of Association, which came into force on 12 December 1997, and by our Rules, as published on our website. The trustees are responsible for the overall governance of the Association and are the ultimate decision-making authority responsible for the strategy, financial, organisation and business matters of the Association. The full Council, including trustees and ex-officio positions, are responsible for matters of professional strategy and policy to inform trustee decisions and strategic priorities for the Association. The Executive is formed of the President, Vice President, Vice President Elect, Honorary Secretary and Honorary Treasurer supported by the Chief Operating Officer and the Senior Management Team. The trustee body will delegate certain tasks to the Executive group with outcomes reported regularly at trustee only Council meetings, these include resolution of staffing issues, pay and remuneration, benevolent fund decisions, project oversight and investment reviews. Pay and remuneration levels of the Association’s key management personnel are set by the Executive (and reported to the trustees) based on market analysis provided by the HR advisors. The trustees govern the Association in line with the Nolan principles of public life and the Charity Governance code launched in 2017 and updated in 2020. One of the key updates to the principles of the Code was the expansion of principle six to cover equality, diversion and inclusion. This development aligns with the BOA’s diversity and inclusion strategy and action plan launched in summer 2020. In particular, the focus on attracting and retaining a more diverse board of trustees and committees is a key objective within our strategy. As identified in previous years the activities of the BOA are also reviewed against the Code and a continuing need to develop our risk management and reporting, Council and trustee induction and fundraising strategies. 18 ## Council The Council is the governing body of the Association and the elected members of the Council are its trustees. The 2021 Council consists of a maximum of 12 elected surgical fellows; 6 elected officers, two lay trustees (September onwards) and up to 12 ex-officio members representing specific interests. Trustees have voting rights; holders of exofficio posts do not. In 2021 the full Council consisted of 31 members (with some serving in a dual capacity i.e. both elected and ex-officio). The Council was constituted of: - 6 officer roles at any one time, - 14 other trustee roles at any one time (incl. elected members of Council and appointed lay trustees), and 12 purely ex-officio roles. At the 2021 AGM, Bertie Leigh and Paul Buckley were appointed as lay trustees in accordance with Article 34 of the Memorandum and Articles of Association. Both appointments have been made to support the ongoing development and enhancement of the BOA’s governance processes, including bringing relevant (non-clinical) experience onto the Council. Elected trustees are elected by a ballot each serving for three years. Four of the elected trustees shall retire each year and thereafter shall be eligible for re-election after one year’s retirement. At the 2021 AGM, it was voted to change the Rules of the Association so that four of the elected trustees shall retire each year and thereafter shall be eligible for reelection for a further period of three years, up to a maximum of six years in total. Thereafter, the holder of this office shall not be eligible for reappointment to the same office. Each year, Fellows of the Association are invited to nominate candidates for Council, each nomination must be proposed and seconded by a Fellow of the Association and endorsed with the candidate’s written consent to stand. In the event of an equality of votes, the Council will determine the candidate(s) for election by a majority vote. All new trustees are issued with the Charity Commission booklet on their duties and responsibilities. They also receive a pack of briefing papers as recommended by the Charity Commission; are asked to sign the Trustees’ Conflict of Interest form; and to provide information for the Register of Interests. They are also given a comprehensive induction process, including a presentation covering our full range of business and desk-side briefings by the BOA staff. A staff of 17 supports strategy and policy development; communications and media engagement; education and research programmes; financial planning, budgeting and management; fundraising and public engagement; information systems; event management; membership issues and benefits; and specialist societies. 19 ## Specialist Societies We could not fulfil our objectives without the collaboration of our 22 affiliated Specialist Societies. These are of huge importance to us as key contributors to our Annual Congress, clinical guidelines, commissioning guidance, trauma advisory sheets, overall policy development and delivery of change within the profession. ## **The Specialist Societies comprise:** - British Association for Surgery of the Knee (BASK) British Association of Spinal Surgeons (BASS) British Elbow and Shoulder Society (BESS) British Hip Society (BHS) - British Indian Orthopaedic Society (BIOS) British Limb Reconstruction Society (BLRS) British Orthopaedic Foot and Ankle Society (BOFAS) British Orthopaedic Oncology Society (BOOS) British Orthopaedic Specialists Association (BOSA) British Orthopaedic Sports Trauma and Arthroscopy Association (BOSTAA) - British Orthopaedic Trainees Association (BOTA) - British Society for Children’s Orthopaedic Surgery (BSCOS) - British Scoliosis Society (BSS) - British Society for Surgery of the Hand (BSSH) British Trauma Society (BTS) - Computer Assisted Orthopaedic Surgery Society (CAOS) - Combined Services Orthopaedic Society (CSOS) Orthopaedic Trauma Society (OTS) - Rheumatoid Arthritis Surgical Society (RASS) - Society for Back Pain Research (SBPR) - United Kingdom Spine Societies Board (UKSSB) World Orthopaedic Concern (WOC) 20 ## **BOA Membership Statistics** The following gender statistics represent the entire BOA membership at end‐2021 as reported by members into the BOA CRM system. ## **BOA Membership Female** **Breakdown of Females by Membership Category** **----- Start of picture text -----**
Female
Total : 662
**----- End of picture text -----**
Consultant (Incl Hon Fellows) (7%) Locum Consultant (6%) SAS (4%) Post CCT (20%) Trainee (24%) Foundation Doctor (28%) Medical Student (35%) Overseas (3%) Allied Professionals (64%) Retired (2%) ## **BOA Membership Male** **Breakdown of Males by Membership Category** **----- Start of picture text -----**
Male
Total : 4241
**----- End of picture text -----**
Consultant (Incl Hon Fellows) (93%) Locum Consultant (94%) SAS (96%) Post CCT (80%) Trainee (76%) Foundation Doctor (72%) Medical Student (65%) Overseas (97%) Allied Professionals (36%) Retired (98%) 21 ## **BOA Total Members % Male/Female** **----- Start of picture text -----**
100
90 88 87 86
80
70
60
50
40
30
20 12 13 14
10
0
Male Female
2019 2020 2021
**----- End of picture text -----**
## **% of Overall Male/Female by Membership Grade** **----- Start of picture text -----**
Consultant (Incl Hon Fellows) 7 93
Locum Consultant 6 94
SAS 4 96
Post CCT 20 80
Trainee 24 76
Foundation Doctor Medical 28 72
Student 35 65
Overseas 3 97
Allied Professionals 64 36
Retired 2 98
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Female Male
**----- End of picture text -----**
22 ## **BOA Diversity Statistics** The BOA conducted a survey with the membership in 2020 as part of our Diversity and Inclusion Strategy. The following statistics are from 1407 respondents which represents 21% of the current membership. **----- Start of picture text -----**
% of Survey Respondents by Membership Grade
35%
30%
25%
20%
15%
10%
5%
0%
Consultant Locum SAS Post CCT Trainee (core Foundation Medical Allied International
(Incl Hon Consultant and above) Year Student Professionals
fellows)
**----- End of picture text -----**
**----- Start of picture text -----**
Ethnicity
% of Survey Respondents
Arab / Arab British 0.86
Asian / Asian British ‐ Chinese 2.78
Asian / Asian British ‐ Indian 16.49
Asian / Asian British – Pakistani 3.07
Asian / Asian British – Bangladeshi 0.93
Black/Black British ‐ African Black/ 1.43
Black British ‐ British Black/Black 0.64
British ‐ Caribbean Mixed White 0.57
and Asian 1.43
Mixed White and Black African 0.50
Mixed White and Black Caribbean 0.29
White ‐ English 43.83
White ‐ Gypsy or Irish Traveller 0.21
White ‐ Irish 3.00
White ‐ Northern Irish 2.28
White ‐ Scottish 4.85
White ‐ Welsh 2.86
Other 12.56
Prefer not to disclose 1.43
0 5 10 15 20 25 30 35 40 45 50
**----- End of picture text -----**
23 **----- Start of picture text -----**
Sexual Orientation
% of Survey Respondents
0 10 20 30 40 50 60 70 80 90 100
Consultant Locum
Consultant SAS
Post CCT
Trainee…
Foundation Year
Medical Student
Allied Professionals
International
Heterosexual or straight Gay and Lesbian Bisexual Prefer to self describe Prefer not to disclose
**----- End of picture text -----**
**Disabilities Identified % Survey Respondents** 0 2 4 6 8 10 12 14 16 18 20 Consultant locum consultant SAS Post CCT Trainee (core onwards) Foundation Year Medical Student Allied Professionals International Hearing (e.g. due to deafness or partial hearing) Learning or concentrating or remembering Mental Health Mobility, such as difficulty walking short distances, climbing stairs, lifting and carrying objects Social or behavioural issues (e.g. due to neuro diverse conditions such as Autism, Attention Deficit Disorder or Asperger’s Syndrome) Stamina or breathing difficulty Vision (e.g. due to blindness or partial sight) 24 ## **Socio‐economic Background % Survey Respondents** **----- Start of picture text -----**
Consultant Locum
Consultant SAS
Post CCT
Trainee…
Foundation Year
Medical Student
Allied Professionals
International
0 10 20 30 40 50 60 70 80 90 100
Lower Medium Higher Prefer not to say
**----- End of picture text -----**
## **2021 BOA Council** 25 ## **Financial Review** Overall we made a surplus of £733.4k this was in part due to legacy income of £207.1k received during the year. ## **Incoming Resources** There was a total increase in income in 2021 of £502k, this is an increase in unrestricted income of £559.6k and a decrease in total restricted income of £57.6k compared to the 2020 figures. Restricted legacy income increased from £18.2k in 2020 to £130.7k in the year, an increase of £112.5k. Unrestricted legacy income of £76.3k was received in 2021 (2020: £81.9k). Legacy income is variable but our policy is to promote legacy income by direct advertisements to the profession at large through the Journal of Trauma and Orthopaedics and through appeals to our public supporter base. We have a contract with Smee and Ford to monitor other possible sources of legacies. Income derived from fundraising activities decreased by £1.6k to £51.5k (2020: £53.1k). Investment income from bank interest deposits and dividends received decreased by £2.2k from £110.9k in 2020 to £108.7k in 2021. Dividend income decreased by £2.2k. Our two principal income streams are membership subscriptions and our Annual Congress: - Membership income increased in 2021 as our membership grew. - The Annual Congress income increased by £476.5k due to being able to hold a face‐to‐face meeting in Aberdeen. ## **Resources expended** There was a small decrease in fundraising expenses in the year of £12.4k from £63.9k to £51.5k. There was a total increase in expenditure in 2021 of £318.7k, this is an increase in unrestricted expenditure of £473.5k and a decrease in restricted expenditure of £155.1k compared to 2020. This is attributable principally to: - Holding a face‐to‐face Annual Congress - All casting courses being held again with space restrictions ## **Summary** In conclusion, the result for the year before net investment gain was a surplus of £357k in contrast to a gain in 2020 of £173.5k. ## **Reserves Policy** The primary aim of our reserves policy is to hold sufficient funds to maintain our long‐term sustainability and manage short‐term volatility in income or liquidity. This is to ensure that we can: - Continue to meet our financial commitments; - Balance sound investment with good liquidity management; and - Avoid short‐term decisions to the detriment of our longer‐term vision. 26 Accordingly we aim to: - Accumulate and sustain unrestricted reserves equivalent to six months running costs between £1.2 ‐ £1.5 million; and - Maintain funds to cover future strategic developments. Our reserves total £7.06 million made up of unrestricted, restricted and endowment reserves. Having aimed for an unrestricted reserve total of £2.6 million at the end of 2021 our actual reserve was £3.5 million (2020: £3.07 million). This includes free reserves of £2.3 million. Having reviewed the position, our Trustees are satisfied that this level of reserves is appropriate, given the economic outlook. The BOA also has restricted reserves of £2.3 million and endowment reserves of £1.2 million. More detail is provided on page 49. ## **Investments** Our Trust Deed states that monies for investment shall be invested in the name of the Company by the trustees in any investments permitted by law for the investment of Trust Funds. The trustees may at any time and from time to time vary such investments for others of like nature. Investments held for our Strategic Fund and its designated funds could, if necessary, be realised within a short space of time to meet unforeseen commitments incurred by the Association, such as legal, other consultancy or professional expenses. Investments held for our Benevolent Fund are maintained to support possible future claims. ## **Investment Policy** In general our policy is for the funds to be managed to obtain best returns from both bank interest and dividend income. We discuss portfolio construction and asset allocation regularly with our investment advisers, and interest rates are compared with others available in the market place to ensure they are competitive. Our investment policy objectives are met by investing prudently in a broad range of fixed interest securities and equities which are quoted on a recognised Investment Exchange, unit trusts, and OEICs (open ended investment companies) which are authorised under the Financial Services and Markets Act 2000. All our funds have ethical restrictions on investments in any company whose principal business is the manufacture or supply of, or trading in, armaments and tobacco products. No initial investment should exceed 10% of the total value of the funds under management. No ‘pooled’ investment should represent more than 15% of the overall portfolio when purchased. The funds should not be invested in high risk investments including warrants, futures, contracts for difference, options and other type of derivatives unless such investments are used to moderate risk. ## **Investment Performance** The ARC Steady Growth Index which represents average charity performance had a growth of +12.3% (net of fees) for 2021. Over 2021 the BOA had four portfolios following balanced mandates Strategic Fund +10.9%, Benevolent Fund +11.1%, Soli Lam Fund +10.4% and Chatterjee Fund +10.1%. Our primary focus during these turbulent times was to ensure that the charity’s short‐term liabilities were being met, and secondly that the portfolios remained well positioned to provide good growth prospects in the longer term. 27 For each of the non‐cash funds we have adopted a cautious, balanced approach and will continue to do so throughout 2021 with a focus on longer term returns. ## **Unrestricted investment income** Our aim is to maximise this source of funding to subsidise expenditure on fellowships, awards and prizes, representational and governance costs for which we do not have specific income streams. Total unrestricted investment income earned in the year was £58.5k (2020: £52.6k). ## **Restricted investment income** Restricted investment income of £50.1k (2020: £58.3k) earned in the year is split between three funds, the Benevolent Fund, the Soli Lam Scholarship Fund, the Ram Kumar Chatterjee Fund: - Benevolent Fund income for the year was £10.3k (2020: £10.6k) - Investment income from the Soli Lam Endowment Fund was £29.3k (2020: £42.7k) - Investment income from the Ram Kumar Chatterjee Fund was £10.5k (2020: £13.1k) ## **Risk Management** The trustees have overall responsibility for managing the risks of the charity, ensuring that the risk appetite of the association is fully understood and reflected in our practices and processes. The risk register has been reviewed and updated in light of the developments from the COVID pandemic. The major risks are considered to be: |**Area**|**Risk**|**Mitigation**| |---|---|---| |**Business**
**Continuity**|Ineffective Business Continuity planning
in event of significant disruption (e.g.
pandemic or fire within local vicinity)
compromises the ability of the BOA to
function effectively.|General agreed processes in place

IT system based on laptops and effectively supports
remote working

Use of Zoom, Skype etc. to facilitate regular
communications with staff, Council and others.

Contact details held for all key RCS and Building
Personnel

Centralised staff database (cloud hosted) to support
contact with all staff

Cloud based CRM system supports management of
all membership functions

Staff and Exec What’s App groups allow prompt
communication and quick updates

HR support company providing regular guidance on
how to manage all aspects of the staffing situation
and absences from the office| ||Responding to workplace risks in a
pandemic (including further waves)|
Ensure compliance with latest government
guidance

Policies on attendance by employees who are
infected, or are suspected to be infected in place;

Good ICT infrastructure in place to facilitate
remote working;| 28 |||
RCS plan for frequent and effective cleaning of the
workplace;

Staff advised and aware of RCS requirement for
distancing and hygienic behaviour

Move to hybrid model of working with staff return
to office on regular basis| |---|---|---| |||| |**Membership**|Loss of Membership Subscription
Income ‐ economic pressures and
general perceptions of reduced BOA
relevance, effectiveness and member
focus result in significantly reduced
subscription income
Failure to engage effectively with the
Green Agenda results in criticism and
disaffection amongst members|
Increase in communications and diversification of
offer

Providing dedicated and relevant support to
members through targeted communications and
guidance

Ensuring BOA ‘products’ meet the needs of
members and reflect changing circumstances
(developments in guidance, support and congress
format)

Sustained external and internal communications
focus through the Journal of Trauma and
Orthopaedics (JTO), monthly newsmails and
Presidential mails

Increased social media presence and use of
new/emerging platforms

Dedicated membership drives on targeted grades

Continued to focus on and enhance SAS offering

Enhanced relationship with members through CRM

Engagement at Specialist Society meetings through
the BOA exhibition stand and Executive member
presence

Take steps towards a carbon neutral Congress

Go paperless ‐ hard copy programme book
removed

more hybrid content

agreements with Congress suppliers and venues

encourage environmental awareness and
promotion through member activities| |**Financial**|A reduction in the value of investment
assets is sufficient to undermine the
charity’s strategic objectives
Expenditure on project exceeds budget
undermining financial stability.|
Use of Investment Company to monitor investment
assets and adjust according trustee approach to risk
and the current financial need of the BOA

Regular review by trustees of value of investments
and advice sought on the potential for market
recovery following COVID‐19

Adjusted activity to reflect impact of COVID‐19 and
potential for projects funded through investments
to be postponed until investment income recovers

Trustee approval required for new or expansion of
major projects

Monthly finance reports against agreed priorities
enable effective management of income and
expenditure| 29 |**Operational**|Processing failures, fraud, or major
incidents, impede the charity’s ability to
function effectively, and thus to deliver
its charitable objectives.|
Fraud awareness in all staff

Online fraud awareness provided through Hiscox
insurance

Anti‐bribery and anti‐corruption policy in place

Development of core process documentation to
support all areas

Robust IT approach through outsourced providers
including, infrastructure, new website and new
CRM

Appropriate insurance arrangements inplace| |---|---|---| |**Compliance**|A failure to comply with charity law, the
general law,requirements of GDPR and|
Robust HR policies and procedures and support via
externalproviders| 30 |**Area**|**Risk**|**Mitigation**| |---|---|---| ||the founding Trust Deed, compromises
the charity’s status and its future.|
GDPR training undertaken by all staff and policies in
place

Data retention schedule developed

Process for dealing with data subject access
requests in place and accessible by staff in online
system| Ensuring that these, and other risks, are managed appropriately is central to the trustees’ governance, which is the subject of continuing attention. Systems and procedures for risk management are reviewed at trustees’ meetings, a risk register is updated regularly, and the performance of the professional managers employed to manage the charity’s substantial investment assets is monitored closely. Ensuring that these, and other risks, are managed appropriately is central to the trustees’ governance, which is the subject of continuing attention. Systems and procedures for risk management are reviewed at trustees’ meetings, a risk register is updated regularly, and the performance of the professional managers employed to manage the charity’s substantial investment assets is monitored closely. ## _**Grant Policy**_ _As described in last year’s report, our grant policy changed in 2014 when we shifted from a focus on small pump priming grants for basic science research to a single consolidated grant of circa £60k per annum over a three year period to fund the BOA Orthopaedic Surgery Research Centre (BOSRC) at the York Trials Unit. The York Trials Unit funding has come to an end and two new centres in Nottingham and Exeter have been awarded grants of circa £40k per annum over the next three years. The aim of the BOSRC is to increase substantially the profile of T&O research._ ## _**Going Concern**_ _The potential for disruption to our business from the pandemic, lockdowns, quarantine restrictions and social distancing measures has been considered by the trustees and a review of the finances undertaken accordingly. During 2021 the budget was re‐forecast on a regular basis to assess any changes in income or expenditure and our financial resilience in the face of further disrupted revenues and activities._ _Membership income has remained broadly stable. We have worked hard to provide our members with support, guidance and alternatives to the key benefits from membership, including the Congress and to date this has proved successful. Much of our course delivery has moved online, with positive feedback from the delegates, and can remain there for the foreseeable future. Our exam is already held online and has not been disrupted._ _A draft budget for 2022 has been created to reflect activity as it is currently planned. As with 2021 we have conducted cash flow analysis, and the budget will be regularly reviewed and updated to reflect emerging situations, and to enable us to take prompt action to manage and minimise any further adverse impact on our financial position. The charity has reviewed its forecasts and cash flow analysis for the period up to 31 December 2023._ _The trustees are satisfied that our income and demand for services are broadly stable, and can be delivered in an effective way to meet the needs of the members, but we will also be conducting a membership survey during the year to assess their views and any changes required._ 31 _The BOA has cash reserves and has no requirement for external funding. The Trustees have a reasonable expectation that the BOA has adequate resources to continue in operational existence for the foreseeable future and therefore there are no material uncertainties over the Charity’s financial viability. They continue to consider the going concern basis of accounting is appropriate in preparing the annual financial statements._ 32 Statement of Trustees, Responsibilities The trustees are responsible for preparing the report of the trustees and the financial statements irh accordance with applicable law and regulations. Company law requires the trustee5 to prepare financial statements for each financial year in accordance with United Kingdom Generally Accepted Accounting Prartice (United Kingdom Accounting Standards) and applicable law. This report has been prepared in accordance with the special provisions for small companies under Part 15 of the Companies Act 2006. Under company law the trustees must not appfove the financial statement5 unless they are satisfied that they give a true and fair view of the stste of affairs of the charitable cornpany and of its net incomingloutgoing resources for that period. In preparing these financial statements, the trustees are required to= select suitable accounting policies and then apply them consistently. make judgments and estimates that are reasonable and prudent- stste whether applicable accounting standards have been followed. subject to any rnaterial departures disclosed and explained in the financial statements- and prepare the financial statements on the going concern basis unles5 It is Inappropriate to presume that the charity will continue to operate. The trustees are responsible for keeping proper accounting records that are sufficient to show and explain the charitable company's transaction5 and disc105e with reasonable accuracy at any time the financial position of the charitable company and enable them to ensure that the financial statement5 comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularitie5. So far as each trustee is aware, there is no relevant audrt inforniation of which the company's auditors are unaware. and each trustee has taken all the steps that he or she ought to have taken 35 a company director in order to make himself or herself aware of any relevant audit information and to establish that the company's auditors are aware of that information. Auditors Crowe U.K LLP has indicated its willingness to be reappointed as statutory auditors. This report was approved by the trustees of the Charity on 29 June 2022, in their capacity as company directors. and signed on its behalf by the President, John Skinner and Honorary Treasurer. Mark Bowditch. John Skinner MBBS, FRCS. FRCS {Orth} President Date of approval: 29 June 2022 ## **Independent Auditor ’ s Report to the Members of The British Orthopaedic Association** ## **Opinion** We have audited the financial statements of The British Orthopaedic Association (‘the charitable company’) for the year ended 31 December 2021 which comprise the Statement of Financial Activities, the Balance Sheet, the Cash Flow Statement and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102. The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice). In our opinion the financial statements: - give a true and fair view of the state of the charitable company’s affairs as at 31 December 2021 and of income and expenditure, for the year then ended; - have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and - have been prepared in accordance with the requirements of the Companies Act 2006. ## **Basis for opinion** We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the charitable company in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. ## **Conclusions relating to going concern** In auditing the financial statements, we have concluded that the trustee's 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 the charitable company to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue. Our responsibilities and the responsibilities of the trustees with respect to going concern are described in the relevant sections of this report. ## **Other information** The trustees are responsible for the other information contained within the annual report. The other information comprises the information included in the annual report, other than the financial statements and our auditor’s 34 report thereon. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. ## **Opinions on other matters prescribed by the Companies Act 2006** In our opinion based on the work undertaken in the course of our audit - the information given in the trustees’ report, which includes the directors’ report prepared for the purposes of company law, for the financial year for which the financial statements are prepared is consistent with the financial statements; and - the directors’ report included within the trustees’ report have been prepared in accordance with applicable legal requirements. ## **Matters on which we are required to report by exception** In light of the knowledge and understanding of the charitable company and their environment obtained in the course of the audit, we have not identified material misstatements in the directors’ report included within the trustees’ report. We have nothing to report in respect of the following matters in relation to which the Companies Act 2006 requires us to report to you if, in our opinion: - adequate and proper accounting records have not been kept; or - the financial statements are not in agreement with the accounting records and returns; or - certain disclosures of trustees' remuneration specified by law are not made; or - we have not received all the information and explanations we require for our audit; or - the trustees were not entitled to prepare the financial statements in accordance with the small companies regime and take advantage of the small companies’ exemptions in preparing the trustees’ directors’ report and from the requirement to prepare a strategic report. ## **Responsibilities of trustees** As explained more fully in the trustees’ responsibilities statement set out on page 24, the trustees (who are also the directors of the charitable company for the purposes of company law) are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the trustees determine is necessary to enable the preparation of financial statements that are free from material 35 misstatement, whether due to fraud or error. In preparing the financial statements, the trustees are responsible for assessing the charitable company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the trustees either intend to liquidate the charitable company or to cease operations, or have no realistic alternative but to do so. ## **Auditor ’ s responsibilities for the audit of the financial statements** Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. Details of the extent to which the audit was considered capable of detecting irregularities, including fraud and non‐ compliance with laws and regulations are set out below. A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. ## **Extent to which the audit was considered capable of detecting irregularities, including fraud** Irregularities, including fraud, are instances of non‐compliance with laws and regulations. We identified and assessed the risks of material misstatement of the financial statements from irregularities, whether due to fraud or error, and discussed these between our audit team members. We then designed and performed audit procedures responsive to those risks, including obtaining audit evidence sufficient and appropriate to provide a basis for our opinion. We obtained an understanding of the legal and regulatory frameworks within which the charitable company operates, focusing on those laws and regulations that have a direct effect on the determination of material amounts and disclosures in the financial statements. The laws and regulations we considered in this context were the Companies Act 2006 together with the Charities SORP (FRS 102). We assessed the required compliance with these laws and regulations as part of our audit procedures on the related financial statement items. In addition, we considered provisions of other laws and regulations that do not have a direct effect on the financial statements but compliance with which might be fundamental to the charitable company’s ability to operate or to avoid a material penalty. We also considered the opportunities and incentives that may exist within the charitable company for fraud. The laws and regulations we considered in this context for the UK operations were General Data Protection Regulation (GDPR). Auditing standards limit the required audit procedures to identify non‐compliance with these laws and regulations to enquiry of the Trustees and other management and inspection of regulatory and legal correspondence, if any. 36 We Identified the greatest risk of material impact on the financial statements from irregularities, including fraud and the override of controls by Management. Our audit procedures to respond to these risks included enquiries of managernent and the Board of Trustees about their own identification and assessment of the risks of irregularitie5, sample testing on the posting of journals. reviewing accounting estimates for biases. reviewing regulatory correspondence with the Charity Commission and reading minutes of meetings of those charged with governance. Owing to the inherent limitations of an audit. there is an unavoidable risk that we may not have detected some material misstaternent5 in the financial statements. even though we have properly planned and performed ovr audit in accordance v4ith auditing standards. For example. the furthef removed non-compliance with laws and regulations lirregularitiesl Is from the events and transactions reflected in the financ¢al statements. the less likely the Inherently limited procedures required by auditing standards would identify rt. In addition. as with any audit. there remained a higher risk of non-detection of irregularities. as these may involve collusion, forgery. intentional omissions, misrepresentations, or the override of internal controls. We are not respons¥ble for preventing non-compliance and cannot be expected to detect non-compliance with all laws and regulations. Use of our report Thi5 report is made solely to the charitable company's members. a5 a Ix)(ty. in accordante with Chapter 3 of Part 16 of the Companies Act 2Crf]6. Our audit work has been undertaken so that we might state to the charitable company'5 members those matters we are required to state to them in an aLbdito¢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 Compan￿5 members a5 a body, for our audit work. for this report, or for the opinions we have formed. AndrewThomas Senior Statutory Auditor For and on behalf of Crowe U.K. LLP Statutory Auditor London 37 ## **Statement of Financial Activities** ## **British Orthopaedic Association: Statement of Financial Activities (including income and expenditure account) for the year ended at 31 December 2021** |**Note**
**Income and endowments from:**
**Voluntary income:**
Donations and legacies
**Charitable activities:**
Membership
Education
Professional Practice
Representation
**Other Trading Activities**
**Investment Income**
**2**
**Total income and endowments**
**Expenditure on**
Raising funds
**Charitable activities:**
Membership
Education
Professional Practice
Representation
Research
Grants
Other Trading Activities
Other Costs
**Total expenditure**
**3**
Net Gains/(losses) on investment
Transfer between funds
**Net movement in funds**
**5**
Total funds brought forward
Total funds carried forward
**12**|**Unrestricted**
**funds**

**£’000**|**Restricted**
**funds**
**Endowment**
**funds**
**£’000**
**£’000**|**Restricted**
**funds**
**Endowment**
**funds**
**£’000**
**£’000**|**Total**
**funds**
**2021**
**£’000**|||**Total**
**funds**
**2020**
**£’000**| |---|---|---|---|---|---|---|---| ||76.9
1,395.7
1,078.5
33.7
‐
53.6
58.5|182.2
60.5
117.0
25.0
‐
4.2
50.2|‐
‐
‐
‐
‐
‐
‐|259.1
1,456.2
1,195.5
58.7
‐
57.8
108.7
3,136.0
100.9
507.1
1,665.2
244.3
63.5
22.5
58.6
116.9
‐
2,779.0
376.4
‐
733.4
6,324.9
7,058.3|||153.8
1,689.7
571.9
99.7
‐
8.0
110.9| ||2,696.9|439.1|‐||||2,634.0| ||22.6
485.3
1,470.0
236.3
63.5
22.5
‐
116.9
‐|58.8
21.8
195.2
8.0
‐
‐
58.6
‐
‐|19.5
‐
‐
‐
‐
‐
‐
‐
‐||||111.7
482.7
1,189.0
294.9
57.5
15.2
183.2
126.1
‐| ||2,417.1|342.4|19.5||||2,460.3| ||207.7
(13.9)
473.6|43.7
13.9
154.3|125.0
‐
105.5||||(48.1)
‐
125.6| ||3,072.6|2,151.8|1,100.5||||6,199.3| ||3,546.2|2,306.1|1,206.0||||6,324.9| All of the above results derive from continuing activities. The Association has no other recognised gains and losses other than those stated above. The accompanying notes numbered 1 to 17 form part of these financial statements. 38 Balance Sheet (Company Regi5tr3tion No. 34829581 British Orthopaedic Association Balance Sheet as of 31 December 2021 BOA 2021 BOA 2020 Note Fixed 355ets Tangible assets Intangible assets Investments 16.3 94.5 4.177.2 4,271.7 4,457.4 4,475.8 Current asseis STocks Debtors Cash at bank and in hand 12.5 676.5 2,834.3 3.523.3 571.2 2,163.0 2,743.7 Creditor5.' Amounts falling due within one year io 1940.81 1668.01 Net current assets 2.582.5 2.075.7 C￿dItOrs.. Amounts fallin8 due after more ihan one year 122.51 Net assets or liabilities excluding pension asset or liability Total net assets or liabilities 2,582.5 7,058.3 2.053.2 6,324.9 Representèd by: Unrestricted funds Restricted funds Endowment Funds Total Fvnds 3,546.2 2.306.1 1.206.0 7.058.3 3,072.6 2,151.8 1,100.5 6,324.9 13 The financial statemenis are prepared in accordance wth the special prowisions of Part 15 of the Companie5 Act 2006 relating to small companies and in accordance with the Financial Reporting Standard IFRS1021 leffective 01 January 20151 Approved by the Trustees OTr 29 June 2022 and signed on its behalf by- Trustee John Skinner MBBS, FRCS, FRCS Iorthl Trustee Ma¥k Bowditch BSC. FRCS ITr&Orthl. FRCSEd The accompanyin8 notes numbered I to 17 form part of these financial statements ## **Cash Flow Statement** ## **British Orthopaedic Association Statement of Cash Flows For the year ended 31 December 2021** |**Cash flows from operating activities:**
Net cash used in operating activities (Note 1)
**Cash flows from investing activities:**
Dividends and interest from investments
Proceeds from the sale of tangible fixed assets
Purchase of intangible fixed assets
Proceeds from sale of investments
Purchase of investments
**Net cash provided by (used in) investing activities**
**Change in cash and cash equivalents in the reporting period**
Cash and cash equivalents at 1 January (Note 2)
**Cash and cash equivalents at 31 December (Note 2)**
**Note 1 to the cash flow statement**
**Reconciliation of changes in resources to net cash inflow/(outflow) from operating activities**
Net income / (expenditure) for the year per the SOFA
**Adjustments for:**
Depreciation charges
Losses/(gains) on investments
Dividends and interest from investments
Loss/(profit) on the sale of fixed assets
Decease/(increase) in stocks
Decrease/(increase) in debtors
(Decrease)/increase in creditors
**Net cash used in operating activities**
**Note 2 to the consolidated cash flow statement**
**Analysis of Cash and Cash equivalents**
Cash at bank and in hand
**Total Cash and Cash equivalents**|**2021**

**£’000**

467.8
109.6
‐
(2.3)
1,029.9
(933.7)

**203.5**
**671.3**

2,163.0

**2,834.3**
**2021**
**£’000**
733.4
78.4
(376.4)
(109.6)
‐
(3.0)
(21.6)
166.6

**467.8**
**2021**
**£’000**

2,834.3

**2,834.3**|**2020**

**£’000**|**2020**

**£’000**| |---|---|---|---| |||161.3
110.9
‐
(15.3)
952.7
(1,033.8)|| |||
**14.5**
**175.8**

1,987.2|| |||
**2,163.0**|| |||**2020**
**£’000**
125.7
113.3
48.0
(110.9)
4.1
0.1
(80.7)
61.7|**2020**
**£’000**| |||**161.3**
**2020**
**£’000**

2,163.0|**161.3**| ||||**2020**
**£’000**| |||
**2,163.0**|| The accompanying notes numbered 1 to 17 form part of these financial statements 40 ## **Notes to the Financial Statements** ## **Note 1: Accounting policies** The principal accounting policies are summarised below. The accounting policies have been applied consistently throughout the year and the preceding year. ## _a) Company information:_ The Charity is a Public Benefit Entity registered as a charity in England and Wales and a company limited by guarantee. It was incorporated on 12 December 1997 (company number: 3482958) and registered as a charity on 19 December 1997 (charity number: 1066994). ## _b) Basis of preparation_ The financial statements have been prepared under the historical cost convention in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS102), the Companies Act 2006 and the 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), effective from 1 January 2015, and the Charities Act 2011. British Orthopaedic Association constitutes a public benefit entity as defined by FRS 102. The functional currency of the Charity is considered to be GBP because that is the currency of the primary economic environment in which the Charity operates. The financial statements have been prepared on a going concern basis. The disruption that the pandemic, lockdowns, quarantine restrictions and social distancing measures may cause to our professional and business activities for an indeterminate period has created some financial uncertainty. The British Orthopaedic Association has undertaken a robust review of its immediate financial position and its financial resilience in the face of future disrupted revenues and activities for the period up to 31 December 2023. A provisional budget for the new year was prepared in the autumn, and this involved a thorough and prudent reassessment of the impact of the outbreak and government restrictions on our revenue streams. The trustees concluded that our primary revenue streams were broadly resilient, that demand remained stable and that most of our courses have been delivered virtually or under socially distancing measures. With our membership directly impacted by the coronavirus outbreak, this crisis has also demonstrated the value that the British Orthopaedic Association can provide for its members and membership revenue have held up well. The budget will be regularly reviewed and updated to reflect emerging situations, and to enable the British Orthopaedic Association to take prompt action to manage and minimise any further adverse impact on its financial position. After reviewing the Charity's forecasts and projections, the trustees have a reasonable expectation that it has adequate resources to continue in operational existence for the foreseeable future. The Charity is of the opinion there are no material uncertainties over its ongoing financial viability and therefore continue to adopt the going concern basis on their consolidated accounts. ## _c) Critical accounting judgements and key sources of estimation uncertainty_ In the application of the charity’s accounting policies, which are described in this note, Trustees are required to make judgements, estimates, assumptions about the carrying values of assets and liabilities that are not readily apparent from other sources. The estimates and underlying assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from these estimates. The estimates and underlying assumptions are reviewed on an on‐going basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period, or in the period of the revision and future periods. In the view of the Trustees, no assumptions concerning the future or estimation uncertainty affecting assets and liabilities at the balance sheet date are likely to result in a material adjustment to their carrying amounts in the next financial year. 41 The principal accounting policies adopted, judgements and key sources of estimation uncertainty in the presentation of the financial statements are as follows: ## _d) Company status_ The Charity is a company limited by guarantee. The Trustees are Directors of the Company and in the event of the Charity being wound up; the liability in respect of the guarantee is limited to £1 per member of the Charity. ## _e) Membership subscriptions_ Subscriptions are accounted for in the year in which they become due in full when received except when subscriptions received are for multiple years, in which case those additional years are deferred until the commencement of the appropriate accounting period. Outstanding amounts at the year‐end that are considered to be recoverable are shown on the balance sheet. ## _f) Investment_ Investments are stated at mid‐market value at the balance sheet date. Gains are calculated based on the difference between the closing market value or sales proceeds and the purchase price or opening market value. Investment income is credited on a receivable basis ## _g) Fund accounting_ Unrestricted funds comprise accumulated surpluses and deficits on general funds that are available for use at the discretion of the Trustees in furtherance of the general objectives of the Association and that have not been designated for other purposes. Designated funds comprise unrestricted funds that have been set aside at the discretion of the Trustees for specific purposes. The purpose and use of the designated funds is set out in the notes to the financial statements. Restricted funds are funds subject to restrictions imposed by donors or the nature of the appeal. The funds are not therefore available for work performed by British Orthopaedic Association other than that specified by the donor. Endowment funds are comprised of bequests to the BOA which have been invested on the request of the donor to provide on‐going fellowships and awards. The income from the endowment funds, Soli Lam Fund and Chatterjee Funds is regarded as restricted. See page 49 for further details. ## _h) Donations and legacies_ Donations and legacies are included in full in the Statement of Financial Activities when the Charity is legally entitled to the income, when receipt is probable and when the amount can be quantified with sufficient reliability. ## _i) Expenditure_ Charitable expenditure comprises expenditure related to the direct furtherance of the Association’s charitable objectives. Where costs cannot be directly attributed they have been allocated to activities on a basis consistent with use of the resources. Representation costs cover attendances by the President in his formal capacity at meetings of sister associations and travel and accommodation expenses of nominated British Orthopaedic Association representatives on relevant external organisations. Staff costs are allocated on the percentage of time spent by staff on each project or aspect of the Association’s charitable objectives. Support costs comprise the operational costs of rent, overheads, IT, telephone, mailing, printing and stationery etc. that have not been directly allocated to projects or charitable activities. They contain some staff costs and are allocated on the same basis as staff costs on time spent by personnel on projects or charitable activities with the aim of ensuring that those costs remaining within governance relate to the strategic as opposed to day to day management of the charity’s activities. Governance costs include those incurred in the governance of its assets and are primarily associated with constitutional and statutory requirements. They are included within the statement of financial activities as a separate component of support costs. Grants are charged to the statement of financial activities when a legal or constructive obligation exists notwithstanding that they may be paid in future accounting periods 42 ## _j) Stocks_ Stocks are stated at the lower of cost and net realisable value. They consist of medals, cups, ties and publications. Publications are only included in stocks if they have a quantifiable lifespan beyond the year in which they are produced. ## _k) Tangible fixed assets_ Tangible fixed assets costing more than £1,000 have been capitalised. They are stated at cost and amortised over their estimated useful lives on a straight line basis as follows: Computer equipment ‐ 33% per annum Office equipment ‐ 10% per annum Office refurbishment ‐ 20% per annum ## _l) Intangible fixed assets_ Intangible fixed assets costing more than £1,000 have been capitalised. Intangible fixed assets represent software costs capitalised in accordance with FRS102. These are stated at historical cost and amortised on a straight line basis over the period which revenue is expected to be generated (3 years). Amortisation is recognised in the statement of financial activities as part of expenditure and is allocated across the expenditure headings on the same basis as Support & Governance costs ## _m) Operating leases_ Rentals under operating leases are charged on a straight‐line basis over the lease term, even if the payments are not made on such a basis. Benefits received and receivable as an incentive to sign an operating lease are similarly spread on a straight‐line basis over the lease term. ## _n) Pensions_ The British Orthopaedic Association is a Participating Employer in SAUL. The actuarial valuation applies to SAUL as a whole; the market value of SAUL's assets was £3,205 million representing 102% of the liabilities for benefits accrued up to 31 March 2017. It is not possible to identify an individual Employer's share of the underlying assets and liabilities of SAUL. The British Orthopaedic Association accounts for its participation in SAUL as if it were a defined contribution scheme and pension costs are based on the amounts actually paid (i.e. cash amounts) in accordance with paragraphs 28.11 of FRS 102. ## _o) Taxation_ The British Orthopaedic Association is a registered charity. As such its sources of income and gains, received under Section 466 to 493 Corporation Tax Act 2010, are potentially exempt from taxation to the extent that they are applied exclusively to its charitable objectives. No tax charge has arisen in the year. ## _p) Financial instruments_ Financial assets and financial liabilities are recognised when the Trust becomes a party to the contractual provisions of the instrument. Additionally, all financial assets and liabilities are classified according to the substance of the contractual arrangements entered into. Financial assets and liabilities are initially measured at transaction price (including transaction costs) and are subsequently re‐measured where applicable at amortised cost except for investments which are subsequently measured at fair value with gains and losses recognised in the Statement of Financial Activities. 43 ## **Note 2: Investment income** Investment income for the year was derived from the following sources : |Government Bonds
Bonds
Equities
Total dividends receivable
Bank Interest Receivable|**2021**
**Unrestricted**
**Funds**
**£’000**
**2021**
**Restricted**
**Funds**
**£’000**
**2021**
**Total**
**Funds**
**£’000**
**2020**
**Total**
**Funds**
**£’000**| |---|---| ||1.3
1.1
2.4
3.8
11.9
10.0
21.9
21.8
45.3
39.1
84.4
82.2| ||58.5
50.2
108.7
107.8
0.1
0.8
0.9
**3.1**| ||**58.6**
**51.0**
**109.6**
**110.9**| ## **Note 3: Expenditure** |**Expenditure on:**
Fundraising
**Charitable activities:**
Membership
Education
Professional Practice
Representation
Research
Grants
Other Trading Activities
Other Costs
**Total expenditure**
Expenditure in support
of activities|**Direct**
**Costs**
**Grants**
**Staff**
**Costs**
**Support**
**Costs**
**Total**
**Costs**
**Total**
**Costs**
**(Note 16)**
**(Note 4)**
**2021**
**2020**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**| |---|---| ||48.7
‐
16.3
35.9
100.9
111.7
360.2
‐
39.6
107.3
507.1
482.7
887.5
‐
236.0
541.7
1,665.2
1,189.0
16.8
‐
70.4
157.1
244.3
294.9
38.6
‐
7.8
17.1
63.5
57.5
1.5
‐
6.6
14.4
22.5
15.2
‐
37.6
6.6
14.4
58.6
183.2
23.4
‐
39.1
54.4
116.9
126.1
‐
‐
‐
‐
‐
‐| ||1,376.7
37.6
422.4
942.3
2,779.0
2,460.3
479.2
‐
463.1
(942.3)
‐
‐| ||**1,855.9**
**37.6**
**885.5**
**‐**
**2,779.0**
**2,460.3**| 44 ## **Note 4: Support costs** |Expenditure On:
Raising funds
Charitable activities:
Membership
Education
Professional Practice
Representation
Research
Grants
Other
**Total Expenditure**
**Governance Costs**
Professional Fees
Travel and subsistence
Staff Costs
Support Costs|**Premises**
**Office**
**IT &**
**Finance**
**Sundry**
**Governance**
**BHS**
**Support**
**2021**
**2020**
**Man**
**Comms**
**Costs**
**Total**
**Total**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**|**Premises**
**Office**
**IT &**
**Finance**
**Sundry**
**Governance**
**BHS**
**Support**
**2021**
**2020**
**Man**
**Comms**
**Costs**
**Total**
**Total**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**| |---|---|---| ||3.5
1.6
10.1
6.4
1.0
13.2
‐
35.8
49.2
8.7
4.0
24.4
15.6
2.4
32.1
20.4
107.6
103.1
51.9
23.1
145.7
93.0
14.1
191.2
22.7
541.7
527.2
15.5
6.9
43.5
27.7
4.2
57.0
2.3
157.1
201.1
1.7
0.8
4.8
3.1
0.5
6.3
‐
17.2
18.8
1.4
0.6
4.0
2.6
0.4
5.3
‐
14.3
10.8
1.4
0.6
4.0
2.6
0.4
5.3
‐
14.3
12.6
8.6
3.8
24.2
15.4
2.3
‐
‐
54.3
65.0|| ||**92.7**
**41.4**
**260.7**
**166.4**
**25.3**
**310.4**
**45.4**
**942.3**
**987.8**|| |||**2021**
**2020**
**£’000**
**£’000**
27.2
37.0
7.0
7.3
115.6
111.7
160.6
177.1
**310.4**
**333.1**| ## **Grants Awarded** The Trustees are permitted to award grants to further the aims of the Association as described in the Report of the Trustees. |Outstanding liabilities at the start of the year
Awarded during the year
Benevolence grants awarded during the year
Paid during the year
Cancelled grants
Grants falling due within one year
Grants falling due after more than one year|**2021**
**£’000**
**2020**
**£’000**| |---|---| ||167.1
98.5
8.0
148.0
29.3
17.6| ||204.4
264.1
(106.0)
(97.0)

‐
‐| ||98.4
167.1| ||98.4
144.6
‐
22.5| ||98.4
167.1| During the year we awarded two research grants totalling £8k and two benevolent grants totalling £29.3k. The research grants were: Two grants to James Lind Alliance Priority Setting Partnerships of £4k and discussed in the Annual Report section on Research on page 31. 45 ## **Grant Commitment** At 17 December 2020, grants approved amounting to £156.4k, for the 2021 year‐end this amount remains unchanged due to Covid causing delays to the grant. These grants fall due to be paid more than 12 months after the balance sheet date have not been accounted for as they are subject to conditions that have not been met at the year‐end. ## **Note 5: Net incoming resources** |Net incoming resources are stated after charging:
Audit fees
Depreciation / Amortisation
Operating lease rentals: plant & machinery
Operating lease rentals: other|**2021**
**2020**| |---|---| ||**£’000**
**£’000**
25.2
31.2
78.4
113.3
0.2
1.7
‐
62.8| ||103.8
209.0| ## **Note 6: Tangible fixed assets** |**Cost**
At 1 January 2021
Additions
Disposals
At 31 December 2021
**Depreciation**
At 1 January 2021
Charges for the year
Disposals
At 31 December 2021
**Net book value**
At 31 December 2021
At 31 December 2020|**Office**
**equipment**
**Total**
**£’000**
**£’000**| |---|---| ||3.9
3.9
2.3
2.3
‐
‐| ||6.2
6.2| ||3.9
3.9
0.2
0.2
‐
‐| ||4.1
4.1| ||| ||2.1
2.1| ||‐
‐| 46 ## **Note 7: Intangible fixed assets** |**Cost**
At 1 January 2021
Additions
Disposals
At 31 December 2021
**Depreciation**
At 1 January 2021
Charge for year
Disposals
At 31 December 2021
**Net Book value**
At 31 December 2021
At 31 December 2020|**BHS**
**Website**
**Website**
**Database**
**Total**
**£’000**
**£’000**
**£’000**
**£’000**| |---|---| ||15.3
89.2
230.9
335.4
‐
‐
‐
‐
‐
‐
‐
‐| ||15.3
89.2
230.9
335.4| ||‐
67.5
173.4
240.9
5.1
17.7
55.4
78.2
‐
‐
‐
‐| ||5.1
85.2
228.8
319.1| ||| ||10.2
4.0
2.1
16.3| ||15.3
21.7
57.5
94.5| ## **Note 8: Investments** |Market Value at 1 January 2021
Additions at cost excl. S/Brokers cash
Disposals at market proceeds
Net investment (loss)/gain

**Market value at 31 December 2021**

**Historical Cost at 31 December 2021**|**2021**
**£’000**
**2020**
**£’000**
4,177.2
4,144.1
933.6
1,033.7
(1,029.8)
(952.7)
376.4
(47.9)| |---|---| ||**4,457.4**
**4,177.2**
3,285.3
3,091.9| ## **Historical Cost at 31 December 2021** |**Investments held with Investec Wealth & Investment**
Fixed Interest
UK Equities
Overseas Equities
Property
Alternative Assets
**Market value at 31 December 2021**|**2021**
**£’000**
**%**
684.6
15%
1,634.6
37%
1,518.9
34%
191.0
4%

428.3
10%
**4,457.4**|**2020**
**£’000**
**%**
715.1
17%
1,591.5
38%
1,249.5
30%
268.2
6%

352.9
9%
**4,177.2**| |---|---|---| 47 ## **Note 9: Debtors** |Trade Debtors
Other debtors
Prepayments
Accrued Income
Value added tax
Gift Aid recoverable
Members’ subscriptions in arrears|**2021**
**2020**
**£’000**
**£’000**| |---|---| ||89.7
0.9
0.2
0.1
405.7
460.9
92.8
55.8
53.9
8.2
31.5
44.0
2.7
1.3| ||676.5
571.2| Debtors include a Bad debt provision of £0 (2020: £0k) Bad debts written off in 2021 £0k (2020: £9.6k) ## **Note 10: Creditors; amounts falling due within one year** |Trade Creditors
Social Security
Sundry Creditors
Accruals
Deferred Income
JA Research grants|**2021**
**2020**
**£’000**
**£’000**| |---|---| ||144.7
152.5
28.8
33.4
25.8
49.9
484.1
146.3
163.0
141.3
94.4
144.6| ||940.8
668.0| ## **Movement on deferred income** |1 January 2021
Released in the year
Deferred in the year
31 December 2021|**Total**
**2021**
**£’000**| |---|---| ||141.3
(141.3)
163.0| ||163.0| In 2021, the deferred income of £15.6k related to course registrations for courses due to take place in the first half of 2021, £60.7k related to membership subscription income, £43.5k relates to exhibition income for the BHS meeting and £43.1k relates to BHS registry research funding. 48 ## **Note 11: Creditors: Amounts falling due in more than one year** |Grants Payable – Research Grants|**2021**
**£’000**
**2020**
**£’000**| |---|---| ||‐
22.5| ## **Note 12: Net assets by funds** |Unrestricted funds
Restricted funds
Endowment funds|**Tangible**
**fixed assets**
**Intangible**
**fixed assets**
**Fixed assets**
**investments**
**Other net**
**assets**
**Total**
**2021**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**| |---|---| ||2.1
1.0
2,386.4
1,156.7
3,546.2
‐
15.3
480.0
1,810.8
2,306.1
‐
‐
1,591.0
(385.0)
1,206.0| ||2.1
16.3
4,457.4
2,582.5
7,058.3| ## **Comparative net assets by fund** |Unrestricted funds
Restricted funds
Endowment funds|**Tangible**
**fixed assets**
**Intangible**
**fixed**
**assets**
**Fixed assets**
**investments**
**Other net**
**assets**
**Total**
**2020**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**| |---|---| ||‐
79.2
2,245.5
747.9
3,072.6
‐
15.3
461.9
1,674.6
2,151.8
‐
‐
1,469.8
(369.3)
1,100.5| ||‐
94.5
4,177.2
2,053.2
6,324.9| 49 ## **Note 13: Total funds** |**General Funds**
**Restricted Funds**
Benevolent Fund
Research Fund
Casting Co‐ordinator
Howard Steel Foundation
Naughton Dunn Memorial Lecture Fund
Grants
British Hip Society
Soli Lam Spinal Fellowship
Soli Lam Orthopaedic Fellowship
Chatterjee Fellowship
Zimmer Fellowship
Andrew Sprowson Fellowship
ABC Fellowship
Post‐Graduate Orthopaedics Travelling Fellowship
**Endowment Fund**
Chatterjee Fund
Soli Lam Spinal Fellowship Fund
Soli Lam Orthopaedic Fellowship Fund|**1‐Jan‐**
**2021**
**Income**
**Expenditure**
**Transfers**
**between**
**funds**
**Net**
**investment**
**gain/(loss)**
**31‐Dec‐**
**2021**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**| |---|---| ||3,072.6
2,696.9
(2,417.1)
(13.9)
207.7
3,546.2| ||504.2
11.1
(36.9)
‐
43.7
522.1
1,024.0
180.9
(80.6)
11.6
‐
1,135.9
‐
4.2
(18.1)
13.9
‐
‐
37.8
‐
‐
‐
‐
37.8
7.2
‐
‐
‐
‐
7.2
11.6
‐
‐
(11.6)
‐
‐
303.5
199.0
(116.4)
‐
‐
386.1
62.7
10.9
(22.1)
‐
‐
51.5
126.8
18.5
(32.1)
‐
‐
113.2
67.5
10.5
(32.0)
‐
‐
46.0
6.5
‐
(0.2)
‐
‐
6.3
‐
1.5
(1.5)
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
2.5
(2.5)
‐
‐
‐| ||2,151.8
439.1
(342.4)
13.9
43.7
2,306.1| ||293.3
‐
(6.8)
‐
34.1
320.6
247.7
‐
(4.7)
‐
33.6
276.6
559.5
‐
(8.0)
‐
57.3
608.8| ||1,100.5
‐
(19.5)
‐
125.0
1,206.0| ||| ||6,324.9
3,136
(2,779.0)
‐
376.4
7,058.3| 50 ## **Comparative total funds** |**General Funds**
**Restricted Funds**
Benevolent Fund
Research Fund
Casting Co‐ordinator
Howard Steel Foundation
Naughton Dunn Memorial Lecture Fund
Grants
British Hip Society
Soli Lam Spinal Fellowship
Soli Lam Orthopaedic Fellowship
Chatterjee Fellowship
Zimmer Fellowship
Andrew Sprowson Fellowship
ABC Fellowship
Post‐Graduate Orthopaedics Travelling Fellowship
**Endowment Fund**
Chatterjee Fund
Soli Lam Spinal Fellowship Fund
Soli Lam Orthopaedic Fellowship Fund|**1‐Jan‐**
**2020**
**Income**
**Expenditure**
**Transfers**
**between**
**funds**
**Net**
**investment**
**gain/(loss)**
**31‐Dec‐**
**2020**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**
**£’000**| |---|---| ||2,852.4
2,137.3
(1,943.6)
(2.1)
28.6
3,072.6| ||498.1
24.1
(24.9)
‐
6.9
504.2
1,193.7
59.8
(229.5)
‐
‐
1,024.0
5.6
5.3
(12.5)
1.6
‐
‐
37.8
‐
‐
‐
‐
37.8
7.2
‐
‐
‐
‐
7.2
11.6
‐
‐
‐
‐
11.6
140.2
351.2
(187.9)
‐
‐
303.5
57.7
12.1
(7.1)
‐
‐
62.7
112.6
20.6
(6.4)
‐
‐
126.8
62.3
13.1
(7.9)
‐
‐
67.5
16.8
7.0
(17.3)
‐
‐
6.5
‐
1.5
(1.5)
‐
‐
‐
‐
‐
(0.5)
0.5
‐
‐
‐
2.0
(2.0)
‐
‐
‐| ||2,143.6
496.7
(497.5)
2.1
6.9
2,151.8| ||320.4
‐
(6.9)
‐
(20.2)
293.3
275.6
‐
(4.5)
‐
(23.4)
247.7
607.3
‐
(7.8)
‐
(40.0)
559.5| ||1,203.3
‐
(19.2)
‐
(83.6)
1,100.5| ||| ||6,199.3
2,634.0
(2,460.3)
‐
(48.1)
6,324.9| 51 ## **Note 13: Total funds (cont.)** ## **Benevolent Fund** The fund exists to meet any successful claims for relief from poverty or distress that might arise from eligible members of the British Orthopaedic Association. ## **Joint Action (JA) Research Fund** Joint Action was established to raise funds for orthopaedic research and to award grants to successful applicants. ## **E‐Learning Fund** This fund was originally received to fund the development of the electronic logbook for trainees. The remaining funds have been used to fund the development of the e‐learning platform. ## **Casting Co‐ordinator Fund** This fund existed to pay the salary of the Casting Co‐ordinator. Funds will still be received for this purpose but will now form part of the ‘other restricted funds’ received by BOA. ## **Howard Steel Foundation** Funds were received over a period of years from Dr Howard Steel that were restricted to pay an honorarium to a speaker whose speech content at the Annual Congress was of a non‐orthopaedic nature. The first lecture took place at the Association’s 1998 Annual Congress in Dublin. ## **Naughton Dunn Memorial Lecture Fund** The fund was established from a donation received from Mrs Ethel Dunn to sponsor an annual memorial lecture in memory of her husband, a former President of the Association. ## **Grants (ex Wishbone)** Donations received for orthopaedic research and for the awarding of research grants. Transferred to Joint Action Research Fund. ## **British Hip Society** The British Hip Society has come under the BOA umbrella as an autonomous Trust with their investments and other funds being accounted for as a restricted item with in the BOA accounts. ## **Other restricted funds** From time to time we receive funds for specific purposes. In this year they include the, the ABC, Zimmer, Singhal and Andrew Sprowson travelling fellowships and Quality Outcomes. ## **Endowment Fund** An endowment of £300.0k was received in 2006 from Mr Soli Lam, a BOA member, the income from which was to support an annual fellowship in spinal surgery. The terms allow for a Spinal fellowship dependent on the returns from the capital. An endowment legacy of £529.1k was received from the estate of Mr Soli Lam in 2013; the income from this endowment is to support an annual traveling orthopaedic fellowship. ## **Transfers** The restricted funds for Casting Co‐ordinator exceeded the funding held as a result the BOA General Fund covered the costs. The restricted fund for the Grants was transferred to the Research fund which has similar research aims. 52 ## **Note 14: Operating lease commitments** At 31 December 2020 the Association had annual commitments under non‐cancellable operating leases as follows: |Payment date:
Within one year
Between two and five years
Over five years|**Land and**
**buildings**
**2021**
**Other**
**Land and**
**buildings**
**2020**
**Other**
**£’000**
**£’000**
**£’000**
**£’000**| |---|---| ||52.7
‐
81.8
‐
‐
‐
‐
‐
‐
‐
‐
‐| ||52.7
‐
81.8
‐| ## **Note 15: Staff Costs** |Wages and salaries
Social Security costs
Pension costs
Other staff costs|**2021**
**2020**

**£’000**
**£’000**
723.1
692.1
52.1
66.6
106.6
104.1
3.7
19.5| |---|---| ||885.5
882.3| In 2021, there were no redundancy and termination payments (2020: £0). Termination payment totals now include National Insurance payments. The number of employees whose emoluments as defined for tax purposes amounted to over £60,000 in the year was as follows: |£60,000 ‐ £70,000
£70,000 ‐ £80,000
£80,000 ‐ £90,000|**2021**
**2020**
**Number**
**Number**
2
1
‐
‐

1
1| |---|---| ||
3
2| The total remuneration to key management for the year was £410.4k (2020: £437.9k) The average number of persons employed by the charity (excluding council members), during the year was as follows: |Office and Administration|**2021**
**2020**
**Number**
**Number**| |---|---| ||16
17| 53 No Trustee received remuneration during the year (2020: Nil). Out of pocket expenses for travel, subsistence and accommodation paid to 9 Trustees (2020: 13) were (0.7k) (2020: £24.5k), this is as a result of a £3.6k refund on air tickets being received. Trustee expenses invoiced directly to the British Orthopaedic Association for travel, subsistence and accommodation were £0.6k (2020: £20.5k) This includes outstanding amounts at the year‐end of £0.2k (2020: £0) ## **Pension Scheme** The British Orthopaedic Association participates in the Superannuation Arrangements of the University of London ("SAUL"), which is a centralised defined benefit scheme within the United Kingdom and is contracted‐out of the Second State Pension (prior to April 2016). SAUL is an independently‐managed pension scheme for the non‐academic staff of over 50 colleges and institutions with links to higher education. Pension benefits accrued within SAUL currently build up on either a Final Salary basis or a Career Average Revalued Earnings ("CARE") basis. The British Orthopaedic Association is not expected to be liable to SAUL for any other current participating employer's obligations under the Rules of SAUL, but in the event of an insolvency event of any participating employer within SAUL, an amount of any pension shortfall (which cannot otherwise be recovered) in respect of that employer, may be spread across the remaining participating employers and reflected in the next actuarial valuation. ## **Funding Policy** SAUL's statutory funding objective is to have sufficient and appropriate assets to meet the costs incurred by the Trustee in paying SAUL's benefits as they fall due (the "Technical Provisions"). The Trustee adopts assumptions which, taken as a whole, are intended to be sufficiently prudent for pensions and benefits already in payment to continue to be paid and for the commitments which arise from Members' accrued pension rights to be met. The Technical Provisions assumptions include appropriate margins to allow for the possibility of events turning out worse than expected. However, the funding method and assumptions did not completely remove the risk that the Technical Provisions could be insufficient to provide benefits in the future. A formal actuarial valuation of SAUL is carried out every three years by a professionally qualified and independent actuary. The last actuarial valuation was carried out with an effective date of 31 March 2020. Informal reviews of SAUL's position, reflecting changes in market conditions, cash flow information and new accrual of benefits, are carried out between formal valuations. The funding principles were agreed by the Trustee and employers in June 2021 and are due to be reviewed at SAUL’s next formal valuation in 2023. At the 31 March 2020 valuation SAUL was 94% funded on its Technical Provisions basis. However, market movements following the valuation date were positive and the Trustee and the Employers agreed to allow for post‐valuation experience up to 30 April 2021. As SAUL was in surplus on its Technical Provisions basis at that date, no deficit contributions were required. However, the Trustee and the Employers have agreed that the ongoing Employers contributions will increase from a rate of 16% of CARE Salaries to 19% of CARE Salaries from 1 April 2022 and to 21% from 1 January 2023. ## **Accounting Policy** The British Orthopaedic Association is a Participating Employer in SAUL. The actuarial valuation applies to SAUL as a whole; and does not identify surpluses or deficits applicable to individual employers. As a whole, the market value of SAUL’s assets was at 31 March 2020 was £3,612 million representing 94% of the liabilities. The market value of SAUL’s assets was at 33 April 2020 was £4,369 million representing 109% of the estimated liabilities. It is not possible to identify and individual Employer’s share of the underlying assets and liabilities of SAUL. The British Orthopaedic Association accounts for its participation in SAUL as if it were a defined contribution scheme and pension costs 54 are based on the amounts actually paid (i.e. cash amounts) in accordance with paragraphs 28.11 of FRS 102. Although there was a Technical Provisions deficit at 31 March 2020, allowing for post valuation experience to 30 April 2021, SAUL had a Technical Provision surplus. Therefore, no deficit contributions were required following the 2020 valuation and there is no defined benefit liability (i.e. the present value of any deficit contributions due to SAUL) to be recognised by the British Orthopaedic Association. SAUL is subject to triennial valuations by professionally qualified and independent actuaries. The last available valuation was carried out as at 31 March 2020 using the projected unit credit method in which the actuarial liability makes allowance for projected earnings. The main assumptions used to assess the technical provisions were: |**Latest actuarial valuation**|**31.03.2020**|**31.03.2017**| |---|---|---| |Investment return per annum|1.05%|1.96%| |Salary scale increase per annum|2.70%|3.39%| |Pension increases per annum|2.49%|2.49%| |Market value of assets|£3,612 Million|£3,205 Million| |Liabilities at date of last valuation|£3,829 Million|£3,149 Million| |(Deficit)/surplus in scheme|(£217 Million)|£56 Million| |Proportion of accrued benefits covered by the actuarial value|94%|102%| |**The total pension cost for the Association was:**
Contributions to SAUL
Other Pension Costs
Pension Deficit Provision
**Total Pension cost**|**Year ended**
**31‐Dec‐21**
**£’000**
106.6
‐
‐
**106.6**|**Year ended**
**31‐Dec‐20**
**£’000**
111.4
‐
‐| |---|---|---| |||**111.4**| The employers contribute 16% of salaries, staff members’ contribute 6.0% of salaries. It is not possible to identify the Association’s share of the underlying assets and liabilities of the scheme. Therefore contributions are accounted for as if SAUL were a defined contribution scheme and pension costs are equal to the contribution payable for the year in accordance with FRS102. ## **Note 16: Related Parties** There have been no related party transactions in the reporting period that require disclosure. 55 ## **Note 17: Comparative Statement of Financial Activity** ## **British Orthopaedic Association: Statement of Financial Activities (including income and expenditure account) for the year ended at 31 December 2020** |**Note**
**Income and endowments from:**
**Voluntary income:**
Donations and legacies
**Charitable activities:**
Membership
Education
Professional Practice
Representation
Grant
**Other Trading Activities**
**Investment Income**
**2**
**Total income and endowments**
**Expenditure on**
Raising funds
**Charitable activities:**
Membership
Education
Professional Practice
Representation
Research
Grants
**Other**
**Total expenditure**
**3**
Net Gains/(losses) on investment
Transfer between funds
**Net movement in funds**
Total funds brought forward
Total funds carried forward
**12**|**Unrestricted**
**funds**
**Restricted**
**funds**
**Endowment**
**funds**
**Total**
**funds 2020**
**£’000**
**£’000**
**£’000**
**£’000**| |---|---| ||82.5
71.3
‐
153.8
1,373.3
316.4
‐
1,689.7
555.7
16.2
‐
571.9
65.7
34.0
‐
99.7
‐
‐
‐
‐
‐
‐
‐
‐
7.5
0.5
‐
8.0
52.6
58.3
‐
110.9| ||2,137.3
496.7
‐
2,634.0| ||21.4
71.2
19.2
111.8
477.6
5.1
‐
482.7
959.7
229.3
‐
1,189.0
286.2
8.7
‐
294.9
57.5
‐
‐
57.5
15.2
‐
‐
15.2
‐
183.1
‐
183.1
126.0
0.1
‐
126.1| ||1,943.5
497.5
19.2
2,460.2| ||28.7
6.9
(83.6)
(48.0)
(2.1)
2.1
‐
‐| ||220.1
8.1
(102.8)
125.4| ||2,852.4
2,143.6
1,203.3
6,199.3| ||3,072.6
2,151.7
1,100.5
6,324.8| 56 ## **Reference and Administrative Detail** ## **Trustees and Senior Staff** ## **Officers of Council** Robert Handley President to 23/09/21, then Past President John Skinner Vice President to 23/09/21, then President Deborah Eastwood Vice President elect to 23/09/21 Simon Hodkinson Honorary Secretary from 01/01/20 to 31/12/2021, then Vice President elect from 23/09/21 Mark Bowditch Honorary Treasurer from 01/01/21 ## **Elected Members of Council** |**2018 – 2020**|**2019 – 2021**|**2020‐2022**|**2021‐2023**| |---|---|---|---| |P Giannoudis
R Morgan‐Jones
H Simpson
D Tennent|G Giddins
R Gregory
F Monsell
A Stephen|C Esler
A Hui
A Manktelow
I McNab|Fares Haddad
Amar Rangan
Sarah Stapley
Hiro Tanaka| ## **Honorary Posts** Archivist I B M Stephen ## **Key Management** Chief Operating Officer Director of Finance Director of Policy and Programmes Director of Communications and Operations J Clarke E Fry J Trusler A Heninger ## **Registered Address** British Orthopaedic Association At the Royal College of Surgeons 38‐43 Lincoln’s Inn Fields London WC2A 3PE ## **Charity Registration Number** 1066994 ## **Company Registration Number** 3482958 ## **Bankers** National Westminster Bank PLC Marylebone and Harley Street Branch P O Box 2021 10 Marylebone High Street London W1A 1FH ## **Auditor** Crowe U.K. LLP 55 Ludgate Hill London EC4M 7JW 57 ## **Solicitors** Bircham Dyson Bell LLP 50 Broadway London SW1 0BL ## **Investment Advisors** Investec Wealth Management 2 Gresham Street London EC2 7QN ## **Employment Advisors** Ellis Whittam Ltd Woodhouse Aldford Cheshire CH3 6JD HR Inspire 64‐68 Akeman Street, Tring, Hertfordshire HP23 6AF 58 British Orthopaedic Association, 35‐43 Lincoln’s Inn Fields, London, WC2A 3PE Tel: 020 7405 6507 Registered Charity No.1066994 Company Limited by Guarantee Company Registration No.3482958