Oins Integrated Neurological Services Annual ReportandAccounts 2022123 CoinpAny Numbei.: 5292539 INTF.GIIA'fF.D NI,:1111()I,()('IC.'Al. Sli Iivic:r.s ANNUAI, IIF.P()II'I' ANI) ACCOUN'J'S ()ii'rHF. YF.AII F,Nl)r.i) 31 MAIICI12023 1107273 iJr.GBIES Chartered Ac¢oiiiilAnts 9 ljoiihill Sireel Loiidoii IC2A 4DJ INTfi.GIIATED NEUIIOLOGICAL SERVICCI S CONTF,NTS PAge No. Aiiiiiial Rei)oi't ()I' IIIL Ti'ii8lees 29 13alai)c¢ Slieel 30 Sialeiiieiit of Casl) F loii's 31 Notes lo Ilie Accoiiiits 32-41 Ii)depeiideiil Exaimiiiei s Repoit 42 INTEGRATED NEUROLOGICAL SERVICES LFGAL AND ADfviINISTRATIVE INFORMATION PAII'oiis Ilobiii Joivit OBE Sei8c Louri¢ 'lic Baroiiess Wilkii)s Sir Williftiii Well8 Foun(leJ' Pi-e51ilcnt: Vice PITsi(lenl: Eleanor Kii)iiear Dr. Elizabeil) Grove ljoHI'il of Ti'i151ees Aiiii¢ Goivg11, Cliaii. Jclei. Rogei's, Vi¢c CIIHII. I cifci. Sayii'ell Jp, fcA '] I'easiii'ei. Leii, (il'a), Clietaii Vyas Cjary Noriiil¢ 11 l)Iigald Milldr SILV¢ Williiiiii .1 essa Jaiiie Neil friislees Jlilie Illalii)51e)' fioi)i Mni'cl) 2022 Kareli Pearcc Iroiii Sepleiiibci. 2022 Aili'iJJor Neiirologi¢&l Coiisiiliaiil: Dr. Peler Baiii, MB135 MA MD fRCP Seiiloi. Msiiingei)ieiit Cliicf Lxcciilive - 8nrAlI Vines ChArlty NAnie Inlegraled Neiiiological Sei'vices 1107273 Coini?Aii.I' RegistrAlioii Niiiiibei. 5292539 Oi)ci'nlioii•il Ceilti'e Aiiil 82 Hamiiloii Road Ileglilei'e(l A(Idi'ess Tiyickeiiliain Middlesex TW2 SQ8 '] ¢1.. 020 87S5 4000 F&x'. 020 8755 4003 Einail.. adiiiiii@iiis.oi.g.lik Website: IviYiv.iiis.org.Iik Iiideilenilent Exaniinei's Begbies Cliartered Accoiinlaiils aiid Registered Auditois 9 Bonliill Street Londoii EC2A 4DJ Aiikei CAf Bai)k l.iii)iled West Mftlliiig Keiil MC19 4TA HSEIC 67 (ieorge Sireel Riclimond'l'W9 1 HG ## Chair’s Report I have great pleasure in sharing with you this Annual Report and within it a summary of a year’s work of Integrated Neurological Services (INS), especially with this being our 30[th] year. The demand for INS’s services is greater than ever, referrals are increasing, and INS is reaching and supporting more people, with 506 clients and 160 carers supported by staff and volunteers, this is a 32% increase of clients supported over last twelve months, and, we have seen increases year on year. The key priority for INS over the last twelve months, has been to provide our growing number of service users with the support they need. We have achieved this by our investment in building and training a bank of full and part-time therapists, both staff and volunteers, enabling a greater service flexibility. There has also been a greater complexity of client needs requiring support in order to live as independently as possible, this is a factor of earlier referrals and intervention. The adaptability, expertise and commitment of both staff and volunteers, has been proved in the continued ability of INS to provide the level of support now needed. We have continued to expand our working model for INS satellites to reach more service users, and therefore provide further accessible centres for neuro support, information, and advice, with a physical presence in areas where this has previously not been the case. Developing further working partnerships with other organisations has enabled INS to reach more service users, and provide wider support to the community, as we have done in Barnes, Brentford and Feltham. In addition, INS’s digital strategy is steadily progressing, building skills and capabilities in technology and data management, to increase digital service delivery. This enables greater fundraising and communications capabilities, most recently in the development of a new website and online services. The development of diverse funding streams to ensure greater financial stability and sustainability for INS into the future, has also been part of the progress of a successful strategy for INS over this last year. We at INS give our thanks to the funders, donors, Friends and partners, for the support that has enabled our successful service delivery to our clients. I would also like to take this opportunity to thank the staff and volunteers, for their continued fantastic loyalty and commitment to innovation, and to delivering client services over this last year. ## **Anne Gowan** Chair of Trustees Integrated Neurological Services Annual Report & Accounts 2022/23 3 ## The INS Approach _**“ Amazing service and forever growing.”**_ ## **Vision** Adults with neurological conditions and their carers can access long-term, professional and peer support in the community, helping to manage symptoms, increase independence and live well with their condition. ## **Mission** We provide holistic therapy, social and emotional support tailored to the rehabilitation needs of adults with neurological conditions and their carers, empowering them to maximise their abilities and live life to the full. 4 Integrated Neurological Services Annual Report & Accounts 2022/23 ## Our Values ## **Professional** At INS, our workplace strategy is to build a range of skilled staff and volunteers to meet the changing needs of service users. Our multidisciplinary team includes professional therapists covering neuro physiotherapy, occupational therapy and speech and language therapy as well as qualified counsellors. All professional staff are registered with the Health and Care Professions Council (HCPC) or the British Association for Counselling and Psychotherapy (BACP). ## **Collaborative** To increase our impact, we work with universities and colleges to deliver training and placement opportunities to future health and care professionals. We continually seek to enhance our service by developing partnerships with voluntary and statutory organisations. We aim to collaborate with partners to bring the widest range of opportunities and expertise to the INS community. ## **Caring** ## **Inclusive** Services are co-designed with our services users and delivered using a multi-disciplinary approach, providing a truly integrated service which looks at people’s physical, emotional, and social wellbeing. We offer a hybrid and satellite model to increase access to INS support. At INS, staff and volunteers work to create a safe, supportive and inclusive environment for all our service users, both adults with neurological conditions and their carers, whatever their ability. Our aim is to promote a caring, friendly and accessible space where people feel comfortable to have therapy and socialise. ## **Empowering** _**“** I really appreciate the help_ We want everyone in the INS community to feel appreciated, supported and motivated, empowering them to value their abilities and achieve their goals. _I've been getting after my stroke. INS support their patients physically and mentally,_ _**the team are caring and understanding. It's like being in a family.”**_ Integrated Neurological Services Annual Report & Accounts 2022/23 5 ## Our Aims and Objectives For 30 years, INS has been providing rehabilitation, social and emotional support to adults in Hounslow, Richmond and surrounding boroughs who have been diagnosed with a neurological condition, such as Parkinson’s, Multiple Sclerosis, Stroke or brain injury. We also provide support and advice to help family carers cope with the challenges of their role. Affordable long-term care in the community, which people need to prevent their condition from deteriorating, is not available on the NHS. INS support starts when time-limited NHS services end. With overstretched NHS resources, we also help to bridge the gap between hospital discharge and community rehabilitation. Our holistic approach covers people’s physical, social and emotional needs. The INS team assess the whole person to help with physical, cognitive and communication issues and improve people’s independence, confidence and social participation. . _**“ Being part of INS makes me feel that there is support for me,** which makes a huge difference in my ability to cope, and I don’t feel so isolated.”_ Neurological conditions are life-changing because they cause long-term disability and can affect people’s ability to live independently. Some conditions improve over time with the right care and rehabilitation, others will get worse. Our aim is to enable more people with a neurological condition to access our integrated clinical care and social support, so they can manage their symptoms, make the most of opportunities available to them and live well with their condition. We work closely with statutory and voluntary organisations to enhance long-term care in the community for those with neurological conditions. We want to advance education and training to support people with these conditions and their carers. To achieve this, we run education programmes for medical students to help them understand the impact of living with a neurological condition, and also provide work placements for clinical, counselling and other students. 6 Integrated Neurological Services Annual Report & Accounts 2022/23 ## Our Achievements **Over 660 32% 12,236** Service users Increase in Client and carer supported referrals received interventions Last year we supported over 660 service users, with an increase of 32% in new referrals, with over 20 received each month. We have also seen more people returning to use INS services following the pandemic. In addition, due to delays in diagnosis and long waiting lists for treatment, we are having to intervene earlier in the care pathway for those recently diagnosed or discharged from hospital, with up to 26 week waiting lists for NHS community rehabilitation in areas like physiotherapy, occupational therapy or speech and language therapy. The INS team has been dealing with more complex cases, which has affected our waiting lists, but our workplace strategy has enabled us to provide new service users with clinical therapy support in their rehabilitation journey, which makes a real difference to them living as well as possible with their condition, and to those caring for them. Some waiting lists are longer due to this increase in new referrals, but we have introduced a triage system to identify the most urgent. In addition, most of our groups are operating at full capacity and we are continuing our strategy of providing more accessible services through INS satellites in local community venues. Although most services are now delivered face-to-face, we continue to offer a hybrid model, as there is still a demand for virtual services for some therapy and activity groups or counselling sessions. We regularly assess service users’ delivery preferences, which has resulted in some groups running face-to-face or virtually on alternative weeks, to accommodate different needs. **Total clients and carers supported** **Total number of interventions** **----- Start of picture text -----**
2020-2021 2021-2022 2022-2023
T OT A L C LI E NT S T OT A L C A RE RS
S UP P ORT E D S UP P ORT E D 2020 - 2021 2021 - 2022 2 0 2 2- 2023
12236
506
10780
9654
412
301
157 160
107
**----- End of picture text -----**
7 Integrated Neurological Services Annual Report & Accounts 2022/23 ## Who Do We Support? We have seen a 32% increase in referrals from the previous year, 36% of which are referrals for Hounslow-based Stroke clients. Hounslow referrals account for 55% of referrals in the past year, followed by 35.6% from Richmond borough. _Total numbers of clients supported 22/23 by condition. Word size proportional to number of referrals received._ Our programme includes around 25 weekly face-to-face or online groups as well as over 20 weekly individual sessions with our neuro physiotherapists, occupational therapists, speech and language therapist, exercise lead, activities co-ordinators and professional volunteer counsellors. New groups are piloted and then developed based on service user feedback. With the increase in new referrals, we have also seen a rise in the number of home visits, for both assessments and therapy sessions. This is often due to people having mobility or transport issues or needing support in their home environment. During this period, our small team carried out 126 home visits across Richmond and Hounslow boroughs. Over the past 12 months, service users with neurological conditions and their carers have had 1,873 therapy and counselling sessions, including 203 initial assessments. All our individual sessions are free of charge, including the initial assessment following a referral. Service users have had 4,224 group attendances, either face-to-face, online or by phone. The majority of those using our services are older, with around 70% aged over 60 years and many in their 70s and 80s, however we also provide specific services for younger adults. **Interventions by borough** 8 Integrated Neurological Services Annual Report & Accounts 2022/23 _**“** I have Parkinson's and have been coming to INS since 2012._ _**Every time I come here, I feel positive, and my mood lifts up. It's like my second home.”**_ Through our satellite community venues in Barnes and Feltham, we have been able to improve access to our services for those who live on the far sides of the boroughs, as well as for individuals living just outside the borough boundaries. 9% of referrals received last year originated outside of the boroughs of Richmond and Hounslow. These referrals mostly come from the surrounding boroughs of Kingston, Merton, Ealing, and Wandsworth. 9 Integrated Neurological Services Annual Report & Accounts 2022/23 _Reasons for referrals 22/23 as described by referrer. Word size proportional to number of times word used across all referrals._ **----- Start of picture text -----**
Other 9.4% Hounslow 55%
**----- End of picture text -----**
Physiotherapy and condition-specific exercise classes remain among the most common reasons for referrals received in the past year, particularly for Stroke and Parkinson’s group classes, together with professional and peerled social and emotional support and Speech and Language Therapy for communication issues. Increasingly, long waiting lists for NHS and community support are cited alongside end of time-limited NHS service provision. All our services are developed in response to service user need and feedback. For example, in response to many requests for balance support, our Exercise Lead started a pilot Balance and Strength group at our Hounslow satellite in April 2023, which has proved very successful. **----- Start of picture text -----**
Richmond
35.6%
Referrals by borough and
condition 01/04/2022 – 31/03/2023
**----- End of picture text -----**
_**“ INS continues to step in** where the NHS discharges patients.”_ **----- Start of picture text -----**
10
**----- End of picture text -----**
## Satellites Over the last year, we have developed our long-term strategy to provide INS services through satellites in community centres in less accessible parts of Hounslow and Richmond boroughs, colocating services with other local partners where possible. _INS service users attending a weekly neuro exercise class at the Age UK centre in Barnes run by one of our neuro physiotherapists. Ctrl + Click to open this video in browser_ ## **Richmond** Our first INS satellite was piloted two years ago, at the Barnes Green Centre, for service users who find it difficult to attend activities at our Twickenham base. Over the past year, we have run a weekly neuro exercise group for seated and standing exercise as well as a block of yoga sessions. We also offer individual therapy sessions, and INS staff work with service users to offer advice on a range of issues. Groups and activities have received positive feedback; with 100% of attendees saying they would ‘Definitely recommend the Neuro exercise group to others’, as well as requests for more yoga sessions. We have also continued working in partnership with Otakar Kraus Music Trust to deliver music therapy sessions. Providing an accessible satellite for neuro services has helped raise awareness of the support we can offer and means we have been able to attract new services users, with a 40% increase in Barnes last year. For future developments, with transport an issue for service users, a target area for another Richmond satellite would be a community centre venue in Ham. 11 Integrated Neurological Services Annual Report & Accounts 2022/23 _INS in Hounslow. Ctrl + Click to open this video in browser_ ## **Hounslow** In 2022, we were awarded a 15-month grant from Hounslow Council’s Thriving Communities Revenue Fund and Integrated Care Partnership, to deliver services one day a week, based at the Age UK Southville Community Centre (SCC) in Feltham, helping us to reach more service users. Over the grant period, 60 service users attended a range of therapy and activity groups as well as social and emotional support and education sessions at our Feltham community venue. People enjoyed socialising with others facing similar challenges and peer support was very valuable in engaging new service users, supported by our Hub coordinator. Our evaluation shows it can take a long time for people to build their confidence and meet others, however this is what those attending the INS satellite valued most. In 2022, we also received a grant from Hounslow Council to take part in a survey and report on access to wellbeing services in the borough. We consulted with 43 Hounslow service users (including adults with neurological conditions and carers), including a number attending SCC. The research has shaped our understanding of the needs of the Hounslow community and has helped us to further tailor the services we provide at our Feltham satellite, such as recruiting client volunteers for peer support and providing accessible transport information. ## _**“ There is now a place full of friendly faces that no longer see my struggles but just see me.”**_ 12 Integrated Neurological Services Annual Report & Accounts 2022/23 We have run a diverse programme since the launch of the Feltham satellite, as well as hosting information and awareness days. This has included Yoga, chair-based dance exercise, cognitive therapy, groups to help communicate with confidence, and activity sessions for photography, creative writing and crafts. These groups are well attended with positive feedback from service users. 100% of Yoga group participants stated that they would definitely attend further sessions, with the group described as. supportive, relaxing and inclusive of different abilities. _**“** Since joining the ‘Living_ _Well’ neuro hub I have turned my life around._ _**I am now part of a fantastic community of like-minded individuals who support each other during those darker days.”**_ Services are designed to include both adults with neurological conditions and the person who cares for them, which means carers can enjoy the activity as sessions are supervised by INS staff and volunteers so their cared for person can have support if needed. Since starting our Hounslow satellite, new referrals of Hounslow residents from various sources have increased by over 30%. Building on the success of our Feltham centre, we were awarded a grant in December 2022 to develop and expand our satellite model in Hounslow, with a new venue delivering services once a week at the Musical Museum in Brentford. We aim to reach clients and carers on the eastern side of Hounslow borough and respond to the increasing number of referrals from this area. _**“** A big range of activities, and_ _**I’m able to participate in something regularly which promotes and supports my rehabilitation.”**_ Integrated Neurological Services Annual Report & Accounts 2022/23 13 ## Spotlight on Communication _**“ One of INS’s strongest points is the variety of groups that are on offer and the diversity of the participants’ backgrounds and interests.”**_ In May 2022, we recruited an experienced Speech and Language Therapist (SLT) to the INS multidisciplinary team. We can help people with impaired speech and language to become more independent through individual sessions and therapy-led groups which enable them to practice and improve their communication skills in a safe and supported environment. Over the last 9 months, we have been building our programme of communication group courses, from smaller therapy-led groups with a higher ratio of staff to service users, to drop-in activity and conversation groups for those who may need extra time and support to communicate. Some new groups, such as our Singing group, can provide stepping stones to give people the confidence to join activities in the community, such as a local choir. We want to provide a pathway so people can progress from individual or communication group therapy to participating in communicationfriendly groups, where they can practice their skills in a supported environment with others facing similar challenges. Integrated Neurological Services Annual Report & Accounts 2022/23 14 We run a variety of communication friendly groups, including Communicate with Confidence, Talking Parkinson’s, Local History, Singing, and our drop in Communication Café. To make our services more accessible, we are applying for accreditation with Communication Access UK. We will be placed on a national directory of communication friendly organisations and will display the Communication Access symbol on our communications. _**Case study: A Stroke survivor, who was referred to INS after experiencing aphasia and a deterioration in their language and cognitive skills, was able to make great improvements after receiving exercise support and speech and language therapy. INS supported them to find a mobile phone that they could use to maintain their independence, and they thrived in the Communicate with Confidence group. Their ongoing support plan includes an Occupational Therapy assessment, continued physiotherapy, participation in Open Gym sessions, and inclusion in the Local History group. Their family carer will receive support and education sessions as well.**_ Integrated Neurological Services Annual Report & Accounts 2022/23 15 ## Open Gym Our staff training strategy helps people to develop additional skills, and last year our Rehabilitation Instructor was promoted to the role of Exercise Lead, coordinating our Exercise programme with a variety of different groups, as well as supervising our popular Open Gym sessions. We have increased the number of weekly Open Gym sessions from three to four sessions per week, in response to the increased number of exercise referrals received. Open Gym sessions were developed for adults with neurological conditions to exercise independently or with their carers, with support from our Exercise Lead, Session assistants and volunteers, depending on their ability level. Typically, the Open Gym is used by service users to continue prescribed exercise programmes or work on specific goals which have been agreed with our physiotherapists. Feedback for these sessions is very positive, with 80% of survey respondents stating that the Open Gym sessions were ‘Excellent’, 20% stating they were ‘Good’ and 100% rating our Exercise Lead as ‘Excellent’. _**Case study: A client who has Parkinson’s has been able to improve his memory, speech, and swallowing, after attending Music Therapy and the Talking Parkinson’s communication group. He also gained confidence in his singing ability after joining the weekly Singing group and attended exercise sessions to slow down his Parkinson’s progression, receiving a home exercise programme. He addressed memory and attention challenges by attending the Occupational Therapy-led ‘Train Your Brain’ group.**_ Integrated Neurological Services Annual Report & Accounts 2022/23 16 ## Events Last year, we were able to host more face-to-face events to engage with INS communities in Hounslow and Richmond. These events are important to increase awareness about the services we offer and provide an excellent opportunity to celebrate and learn about the needs of our community. In June 2022, we held a Carers’ Celebration Day at INS, which focused on wellbeing. Sara Challice, award-winning author of the book ‘Who Cares? How to take care of yourself whilst caring for a loved one’ spoke about her journey of becoming a carer and gave a reading from her book. Jess West, a massage therapist, provided mini neck and shoulder massages. We also hosted a Carers’ Week celebration at our satellite in Feltham, where author and carer Catherine Jessop discussed writing techniques and gave a talk about life as a carer. The session was shared by Lyn Hammond from Hounslow’s My Independence Carers Information Service who gave an update on carers’ services in the borough. In June, we also celebrated Volunteers’ Week by inviting INS volunteers to join us to celebrate their work and thank them for their essential support. The event was an opportunity for volunteers who may not have worked together yet to meet, and to involve them in our planning for the months ahead. In December, we held another event to thank our volunteers and spend some time hearing from staff about different aspects of our work and ways to get involved. 17 Integrated Neurological Services Annual Report & Accounts 2022/23 In July, we held an exhibition of portraits of INS service users, staff, and volunteers, taken by local photographer Peter Swann, as part of creative group activities for our Expanding Horizons programme. Over 40 people attended the exhibition at our Twickenham premises, which provided an excellent opportunity to connect with the wider community and invite service users to share their stories. Sarah Vines, our CEO, was invited to speak at Hounslow Council’s celebration of International Day of Persons with Disabilities in December 2022. An INS service user with Multiple Sclerosis also gave an inspiring talk about his personal experience of living with a neurological condition. 18 Integrated Neurological Services Annual Report & Accounts 2022/23 ## The Team INS has a Board of 12 trustees, with a team of 9.2 FTE staff, who are supported by around 20 regular volunteers in therapy and activity sessions, office administration and fundraising. Over the last year, with recruitment challenges, increased demand for services and rising costs, we have continued developing a staffing strategy which is flexible, responsive and able to adapt to different circumstances. This includes building a bank of permanent and temporary, full time and part time therapists and assistants. ## **Trustee Spotlight** We have recruited and trained several parttime session assistants who work with a range of therapy and activity groups, including delivery at our satellites, to provide additional support to service users with different abilities. This helps us deliver essential services in the most flexible way possible, ensuring continuous, professional support, as well as adding a range of skills to our multidisciplinary team. We also employ qualified teachers or work with partners to deliver specific activities, for example new groups such as Yoga or Singing, both very popular, as well as chair-based dance exercise with local charity Move into Wellbeing and music therapy with Otakar Kraus Music Trust. This year, two new Trustees, Karen Pearce and Julie Walmsley joined the Board, bringing clinical and HR expertise to their roles respectively. ## **Thoughts of a retiring Trustee** My involvement with INS began 11 years ago, mentoring the speech therapist, as that was my professional background. That led to a request to join the Trustee Board. Although hesitant to accept, due to lack of Trustee experience, it has turned out to be an immensely rewarding experience. INS’s compactness and uniqueness means that personal relationships are important, and the variety of backgrounds and skills of staff, trustees and volunteers has kept me interested and learning throughout my tenure. _**“There have been hard times, with difficult decisions to make, but one never did it alone. The reward has been seeing and hearing about the benefits the patients have received from the flexible and individualised care that INS offers.”**_ I thoroughly recommend being a Trustee in such a respected local organisation and will continue to support INS in any other way I can. **Sue Stevens, Chair of the Clinical Committee** 19 Integrated Neurological Services Annual Report & Accounts 2022/23 _**“ The organisation is very supportive to clients and volunteers.** As a volunteer I have had good and very rewarding experiences. I would like to learn more about the neurological conditions as to know more helps to work with clients.”_ ## **Volunteer Support** Our work would not be possible without the dedicated support of so many volunteers; our longest serving volunteer has been with us for over 25 years. Between October 2021 and March 2023, we recruited 40 volunteers to support INS in a variety of roles. This has included 16 volunteer Therapy Group assistants and 8 Activity Group assistants, who provide much-needed support in group settings, enabling more participants and better engagement with each service user. All volunteers are invited to take part in relevant staff training. Peer support volunteers are INS service users who are able to apply their first-hand experience of living with a neurological condition to a mutual support-style role, and who also wish to support events or regular INS activities. Our current peer support volunteers provide invaluable assistance at our weekly Feltham satellite and have assisted with events such as the Quiz Night and the Photography Exhibition. They also take part in information and awareness events and support our teaching programme for medical students. Development of our digital strategy has been supported by three expert database, IT and website volunteers. This has included the successful upgrade of our Salesforce database. with improved data evaluation and more accurate reporting on how we support service users, as well as identifying emerging needs, which helps us allocate resources more effectively. **Volunteers recruited October 2021 – March 2023** With the support of an IT volunteer, we are in the process of replacing our old server with a cloud-based version, which will give us better data security and the ability to scale up. We are also working with an expert website volunteer to redevelop our website and move to a cloudbased platform, which will help improve our engagement with all INS stakeholders. Our new website will launch at the end of September 2023. Expert volunteers also lead some of our creative groups like Art and Crafts and last year we were able to run a very successful series of online Art Appreciation sessions, which enabled a larger group to attend, including service users who are housebound. 20 Integrated Neurological Services Annual Report & Accounts 2022/23 ## **Student Counsellors** Our counselling service continues to be free of charge and is provided by four professional volunteer counsellors and five student volunteer counsellors who are training for their qualification. We offer a hybrid service provision of online, face-to-face, and telephone counselling as the best way to meet the varying needs of our service users. Counselling services are monitored through evaluation forms completed by service users at the end of their course. 75% of individuals who answered confirmed that they found the counselling sessions to be worthwhile, whilst 15% who answered found the sessions to be fairly useful. _**“ I found it incredibly helpful to understand the patients’**_ _**and carers’ perspectives and hear their stories.”**_ _**Case study: A brain injury survivor has been able to return to work and after accessing our counselling, OT, and physiotherapy services. She also accessed peer support at the drop-in coffee mornings and events at the INS satellite in Feltham. She joined cognitive groups, Yoga, and physiotherapy to improve her balance and fatigue management, as well as 1:1 Occupational Therapy support. She expressed appreciation for the value, support, and camaraderie provided by the staff.**_ ## **Medical School Training** _**“ The INS team have been incredibly warm, supportive and inclusive from the start of my volunteering.** I continue to learn from them and am made to feel that I am part of the team. There is a great atmosphere in the offices, and it feels that there is constantly something interesting going on and that everyone is engaged with what they are doing.”_ We have an annual contract to provide weekly teaching sessions to medical students at St. George’s Hospital involving service users with lived experience of neuro-disability and caring for someone with a neurological condition, with over 300 students receiving online training each year. These sessions have been positively received by both the students and the INS service users who take part, with all students who were surveyed agreeing that being taught by patients in the community with lived experience, helps them to empathise with their situation more easily, and finding that the sessions effectively complemented the teaching they receive at St George’s. Integrated Neurological Services Annual Report & Accounts 2022/23 21 ## **Student Placements** We have been able to offer much-needed work placements to students from St. Mary’s, Brunel, and other universities which they find hard to get; this year we have had 3-month placements for two physiotherapy, two speech and language and one occupational therapy student, as well as shorter-term placements in areas like business and administration; our volunteer student counsellors from Richmond College are also training for their qualification. These students provide additional support to help us deliver services, for example physiotherapy students worked to improve our triage process to identify the most urgent cases and speech and language students helped to pilot new groups like Singing. - _**“** I have discovered not only the importance of exercise for_ _managing these conditions_ _**but how exercise groups are beneficial for people in different ways.”**_ _**“** I believe the holistic rehabilitation provided at INS is an amazing way to bring people together and increase social relationships while helping to manage symptoms in a positive environment.”_ Integrated Neurological Services Annual Report & Accounts 2022/23 22 ## Working with Partners INS continues to deliver the Richmond CILS contract in a partnership of 20 local charities, supporting adults of all ages to live independently, improve wellbeing and stay connected with their local community. This partnership aims to deliver advice, support and signposting to residents in Richmond borough. INS is also part of the Carers Hub Service, led by Richmond Carers Centre, commissioned by Richmond Council to provide services for carers in the borough. Both contracts have been extended for up to two years. Our clinical team also liaises with community neuro rehabilitation teams and GPs over referrals and treatment. Having accessible INS venues in local venues like the Barnes Green Centre helps to raise awareness of neuro support we can offer and engage new service users. Last year, a range of Hounslow statutory and voluntary partners also delivered sessions at our Feltham satellite on various topics, with different initiatives developed in response to demand; the most recent has been three pilot clinics for people with Parkinson’s run by the Hounslow Neurology Specialist Allied Health Practitioner. Partner sessions have included Hounslow Council’s Falls Prevention service, LBH Carers Service, energy advice from the Green Doctors, and transport advice for people with disabilities from QEF. 23 Integrated Neurological Services Annual Report & Accounts 2022/23 Our first two ‘Awareness’ days’, covering Parkinson’s and Stroke, which we ran with Parkinson’s UK and the Stroke Association, meant we could provide expertise from national organisations at local level; more events are planned to cover other conditions, including Multiple Sclerosis and MND. Our Parkinson’s Awareness Day in October 2022 was attended by 91 people, including INS service users, other Hounslow residents, and local organisations. Our Hounslow satellite coordinator works closely with the Hounslow Stroke Association, who we partner with to deliver the Stroke contract, and in January 2023, we ran a successful information day together, with 29 people attending. We were also funded through the Jubilee Sports England fund to partner with Move into Wellbeing, a local charity who offer chair-based dance exercise, and a further grant funded a specialist Yoga teacher to deliver courses at all INS venues and online. We also continue to work with The Queen Elizabeth’s Foundation (QEF) to offer monthly driving assessments for service users at INS. _**“ “ “** It was the first time since I The informal and friendly Fantastic day! was diagnosed with atmosphere overcame any Informational and Parkinson’s to be amongst hesitancy I had about inspiring.” those patients with an attending.” identical diagnosis. Awesome!”_ Integrated Neurological Services Annual Report & Accounts 2022/23 24 ## Equality, Diversity and Inclusion Equality, diversity and inclusion are central to all INS services. We aim to support people with neurological conditions to overcome the barriers to their full inclusion and participation in society by focusing on abilities and not disabilities. For service users, our integrated approach enables us to identify and reduce barriers which contribute to people with neurological conditions experiencing hardship and distress; these can be physical, cultural, financial, psychological or social. INS works with all our service users, including adults with neurological conditions and their carers, to evaluate the effectiveness of our services and ensure they are co-produced, person-centred and respond to need. Our quarterly service user group, INSight, which includes representatives from services users, staff, volunteers and trustees, reviews current services and new developments. We ensure that views and opinions from this meeting inform service development and design, with outcomes then fed back to the group. This supports an ongoing process of engagement. As an employer, INS respects and values the diversity of our staff and volunteers. Our Trustees and CEO are responsible for our commitment to equality and diversity and creating an inclusive culture throughout INS. As part of our ongoing commitment to developing EDI at INS, in April 2023, staff, volunteers and students attended a Diversity and Inclusion training day run by a qualified INS volunteer. 25 Integrated Neurological Services Annual Report & Accounts 2022/23 ## Looking ahead – ## Strategic aims for 2023/24 INS continues our strategic development to make the charity as resilient and agile as possible, so we can respond to future challenges and ensure a secure and sustainable service. Following our Strategy Day in August 2023, we identified the following as key priorities: - Manage resources and demand from our increasing number of new service users to ensure sustainable growth within our capabilities. - Develop a multi-skilled workforce which is adaptable, flexible and responsive to meet changing needs and demand. - Ongoing review of our service provision and delivery to increasing service users through building and training a team of full and part-time, permanent and temporary, therapists, staff and volunteers. - Develop an adaptable working model for our ‘INS satellites’, to reach more people and provide accessible services in places where people need neuro support. - Increase partnerships with external providers to reach more service users, supplement our resources and provide wider expertise to the INS community. - Develop our digital strategy to build skills and capabilities in technology, including a new website and IT systems, to help manage resources and achieve strategic aims. - Build and diversify current funding and resources to ensure financial support for strategic aims. - Develop our profile with statutory services and act as an influencer on behalf of the INS community within local health service changes. Integrated Neurological Services Annual Report & Accounts 2022/23 26 ## Fundraising Events ## **INS Quiz Night** This year we were able to hold our INS Quiz Night in person at St Luke’s Church in Kew, having previously run an online event due to the pandemic. The quiz was hosted by Keith Severs and raised over **£2,300** . ## **Lucy Muentes’ Marathon** INS supporter Lucy Muentes took part in the London Marathon in 2022 and raised a sum of **£262** to support our work. We would like to thank our generous regular donors for their vital support of our work. We would also like to extend our gratitude to all those who donate and fundraise for us in memory of family or friends who have been part of the INS community. Thanks also to our volunteers and trustees, to the Friends of INS, and all those who have supported us this year. ## **Sarah Vines’ Winter Walk** Our CEO, Sarah, participated in the Ultra Challenge London Winter Walk in January to fundraise for us, raising a total of **£1,223** . ## **INS Bridge Night** The Friends of INS hosted another successful face-to-face Bridge Night, raising a total of **£1,159** for INS. Integrated Neurological Services Annual Report & Accounts 2022/23 28 ## Fundraising INS is very grateful to receive grants from a number of charitable Trusts and Foundations to support our work. ## **Community Support** We were delighted to have the support of the following organisations in 2022-2023: ## **Radnor House School** ## **Trusts and Foundations** During 2022-2023, INS was awarded grants from the following organisations: - Ashcroft Charitable Trust - Awards for All - Basil Samuel Charitable Trust - Barnes Fund - Chapman Charitable Trust - Dyers’ Company Charitable Trust - Girdlers’ Company Charitable Trust - • Hampton Fund - Hounslow Thriving Communities Fund - James Tudor Foundation - John Horseman Trust - Lambert Charitable Trust - Leathersellers’ Foundation - Marsh Charitable Trust - Munro Charitable Trust - PF Charitable Trust - Richmond Parish Lands Charity - Rowan Bentall Charitable Trust - Screwfix Foundation - Sir Jules Thorn Charitable Trust - Sports England Queen’s Jubilee Activity Fund Friends of Radnor House School Twickenham raised £5,250 for INS as one of the school’s supported charities for the year. ## **Crafter’s Companion** The team at Crafter’s Companion donated supplies for use in INS Expanding Horizons Crafts sessions. ## **St Margarets Catholic Church** The congregation of St Margarets Catholic church raised £4,000 in support of INS for their Lenten Project. ## **Sutton Winson** Twickenham insurance broker, Sutton Winson, continued to support INS as their chosen charity this year, by fundraising and spending a day transforming our Summer House and garden space. We are also grateful for donations from The Rotary Club Twickenham, Middlesex Provincial Relief Fund, Squire’s Garden Centres and Waitrose Twickenham Community Matters Scheme. - Steel Charitable Trust - Vandervell Foundation 27 Integrated Neurological Services Annual Report & Accounts 2022/23 IntÈ8rated Neurologlcal Seyvlces evlew of financlal esults Ii)lep,ialed NeurologScol Services IINSI made a deficlt for Ilie ye.ar of f 59,8831?021122- a 5LirplLlS ol r51,5371. In 2022123 INS returned to a lull level of Jellvitie5 after the disruptlons C(Il15od by tlic Covid i)diidemic. Tlie Inain caiise of the deflclt Ih 2022123 was an iiicrease in staff costs to F411,000 whlcli Is 22% li1￿her tlian In ?0211??. One of the Inalor effects of the Covl(I paiideiiilc was Ilie sliorlage uf sIIK ff Iii Ilie liedlili 5e¢lor aiid Ihls In)pacted sisnificaiitly 01) IWS. l-'Iiril)ei' comiiiei)ts on tliis increase are set OLIt bLIow, Braloful foi. tl)Is siii)i)ort. Overiill, Iliei'e Wfl.4 .£lllli11 (lo.¢i'Pil£i) 511 Ii)r.oi))o wl)Icl) ¥elle¢ls the ever Inore conii)etilive envlionineiil for I'¢ilsliiB l(11111s aiiil (loiiatinn£. %tiiflli)E anil oxi)eii(litiiro Tlie avei-iige full-tiine eqiiivalent sla(( nun)Iier5111 Il)P yPcll' werp Iiliic. wlilc.l) is 01)e 11]￿l'e In 20221?3 we faced a challenRe coverliix Inateriilly leavo for a koy i)l)yslotlierai)y i)osl. -I'l11s teinporary ai)(l agci)cy stafl more tlioi) 11511al to covor slaflliig gaps. Tliis resiilted in hiEher Slalf costs. Oi) the otller l)aiid, we were also successful Ii) buildliio up our staff bank durlnE tlie yeai. aii(l ihis provldes a goo(J plaiform for Inaiiouin8 our staff costs in tlie current and fLilure yeai's. Otlier costs SLiclI as prein15e5 and ofllce costs also Iiicreased bul at a mucli lower rate. INS coi)tiiiues to Inaiiage ils expendliure carefiilly aiiii seek to Inli)ii)iiie costs wl)erever posslble. A5 noled above, INS depeiids Lipon ur¢ints iiid (loiiatlons, and fiiiidraisiiig is a core Bctivity. It continues to foc(Is Its resoui'ces oil Iiursiili)u appropiiate 01?poitui)Itie51ii order to maxlinlse Its offectiveness In tl?15 acllvlty. In tlie currei)t yeai, 93 peiice In every pound ralsed was spend on Its ¢l)arltable actlvltles, ReseTve5 Mie Trustees have revlewed Its reserves pollcy, taklng èccount of tl)e current iii)certaln economlc clrcumslaiices and ilie fuiidln8 challenges withln tl)e charitable sector. They have agreed a pollcy to seek to bulld towards holdln6 slx monthg expciidllure In unrestricted reserves. Th15 wlll lieli) INS plon prudently for the future and slren8lhen Ils svstainability. Tlie level of unrestrlcted reserves at 31 March 2023 wo5 £163,77212021122- £232,007). In ddllloi), INS l)as deslgn3ted an amount of £20,000 to ¢over potential costs on Its maln pre1￿1seS. 127) Responslbllltle5 of the Board of Trustees The Tru81e&s arb r68pollsiblo for i)reparlng the Roport of Ihe Tiuslegs and the Ilnanclal slalernr#i)Is In accordance wllh gppllcablo law aiid Unlled Klnydom Accouiillng Slaiid4rds Iunlled l(Ingdom Goi)eially Ac¢ei)led Ac¢ounling Pracuce), .loes lo propare Ilnanclal slolomenl$ oach CoiMI)aiiy law reoiilr6s Ilio t3ourd of Irii" rinai)¢lal year wlilcli olve o Irlie an(1 falr vleiv of1110 81ale of Ilie alfalr8 of the cliaillaljle coinpaiiy as at tho balaiicé sheet dale and 01 118 IncoinlnJ( resources and appllcatlon of reso(IrLos, Incliidliig Iiiconio aiid 6xi)eiidiluTo, for the finaiiclal year. In preparing 11106e linanclul 61alomaiils, IIIG T¥uslG6s sliould follow bosl pratiliLg aiid.. bolecl siill£il)lo accoiiiilliig po5iclos aii(I Ilieii ai)i)ly Iliein coi)%lslei)Ily. ii)alle 816p$ for th8 PTeveiilloii and delecllon of fraiid and olhor ifreoularilie8. Thls roporl ha8 bpoii proi)arod Iii AcGordai)ce wllli Ilie Statement of Recommonded Pracllce,. Accounllng arid Reporlliig by CliaTilies aiid In aGcordaiic6 wllli the 8peolal provlslons ol Parl 15 of Ilie Companles Act 2008 relallng to small enlllles. Approved by the Board of Trustees on 15 November 2023 aiid sl8ned 01) Its bel)alf by Steve Willlams Triistee, INS 1281 INTF.C.RA'fF.D NEUIIOLOCICAL SF.RVICF.S STATEMCI NT OF FINANCIAL ACTIVITIES FOR 'I'iif, YEAR ENDF.D 31 MARCH 2023 2023 2022 Dcsigiiiiloil TotAI Tol*l Fllii(Is Noles Iiieoiiie fi-oill:. 158.406 46,709 15,538 1,388 222,041 278,544 325,231 15.538 1.388 580,701 24(Tr.00() 331,913 15.582 27 Q'.l)ui'ilable acliviliL 278,522 358,660 593,531 F.xi)eiiilliiiit uii: 41,610 107,815 149,425 41,610 598,974 640,584 34,430 507.564 541.994 Cliai'ilable aclivilies Totwl 491,159 491,159 Net {expeii(Iltiii'e)lincome 72,616 (132,499) (59.883) 51,537 Ti'aiisfei. belivecii fiiiiils (140,851) (68,235) 140.851 8.352 Net nioi'cnieiil iii fiiiicls (59,883) 51.537 Recoii¢illnl1011 or riin(Is I'otal fiiii(Is broiiglil foi-l%'8rd Tot#1 fiiii(Is cAI'J'ie(I foiThYAI'(I 232,007 163,772 14.892 23.244 20.000 20,000 266.899 207.016 215.362 266,899 (29) CoiiipRlky Nuiiibei.: 5292539 INT)EGRATED NKUROLOGleAL,8LI ItVICLrs BALANCE SllbET AS AT 31 MARCH 2023 2023 2022 'ole rilxeil ll$$els '1'ft118ible &%sels 10 7,030 8,214 CiiYi'¢ihl nssels l)cli1015 9,505 2S4,216 263,121 15,879 2l)1,135 313.014 LiAbS111ies Cr¢dil01s fnlliiig Illic 12 (61,735) 199,986 £201,016 (54,329) 258,685 £ 266.899 Nel ciii'i eiit 1ssels Nel Assels 15 15 Is 23,244 163.172 20,000 £207,016 14,892 232,007 20,000 £ 266,899 Dcsigiihl￿l rtiii(Is rinr Ilie >*aY eiidii)g.3 l Maycli 2023 111¢ coii)P811y iyas eiiliiled io ¢x¢niplioM iiiNler se¢tloii 477 of Il Coii)pfiiiies Act 2006 itliliiig to siiiall coiiipaiiies. Tlie In￿lIbe￿lIeve I￿1 required Ilie coinpniiy to obiniii ali ftiidil In gLcui'dRii¢e ivilli sc¢lioLi 476 of Ilio Coiiipoiiios A¢1 2006. Tlie IllreF1015 n¢kiioivledge Ilieii. I￿SpOils1￿1[￿I1cS for ¢oii)plyin8 willi 1110 ITqlhtreii)¢nl$ of ihe Act iyiili iyspecl lo ae¢oiiiiliiig Ircoixls aii(I (lie i)repai&lioii of n¢coiiiils. Tliese accounts Imvc bc¢n prepftNI iii necordaDco iylili Ili¢ pl￿¥1$10￿S npi)licablo Io ¢oii)P#i1ie> $iibj¢¢l lo Ilie sii)nll ¢oinpniii8s r¢giiii¢. TILC ac¢oiiiil$ iY¢i'c npi)I'oved b>1 Ili¢ bolid of(lircoloiB oli /s z3 8n(I siwicd 011 ils bgliolf Dli'¢¢loi' niill Ti'iislec S Willtanis (30) IiYTF.GRATI,:D NEUIIOLOGICAL SERVICF,S STATF.MENT OF CASH FLOWS FOR THF. YEAR ENDCI D 31 MARCH 2023 2023 2022 Casli tloii's fiDllI 01)ci'llliiigi cliiiilies.. NLI Ciisll i)r()I'ided b}, 01)eratiiig Iiclii'ities (iiole I beloiy) (44,3Q7) 1,388 27 (4? 1)19) 297,135 2511,216 7R,4C)2 218,673 297,135 Casli aild LMS11 ¢qiiii'AILiil% al Illl iii(l ()f ilic )'¢AI' Nol¢s lo Ilic qlateiiieiil nl'cHsli Ili)Iv8 Recoi)cilialion ofilel iiicoiiiv lo i)el ¢#sli lloiv fioii) opcraliiig aclivilics 2023 2022 N¢1 (defi¢iiy incoiD¢ for tlie year (a5 per slateinenl or riiianciRI aeliiiiti¢s) (59,883) 51,537 Adjlisliiieiils for.. Depreciatioii cliarges Iiileresl r¢¢eived De¢i'eas¢/(Iiici'e8s¢) iii Ilebiors Iiici'eAsel(Decrease) ii) credi101s AdditlOllS to filed issels 3,131 (1,388) 6,374 9,406 (1.947) (44,307) 2,748 (27) 58.673 (31,673) (2,823) 78.435 Nel casli i)IDiiide(I b)1 opei'alii)g Hctivities (31) INTEGRATED NEUIIOL()GICAL SEIIVICES NOTES TO THE ACCOUNTS FOR THE YEAR NDEI D 31 MAIICII 2023 i) (i) Accoiiiitiiig policies ( A ) ]Jnsi¥ of iiicoiiiiliiig Tli¢ fiiiniiciHI staleiiieiils l)avc bceii i)I'ci)lliid ii) ccor(laiice iviili Ili¢ Cliarilies: Sialeiiieiil of Reeoi)1111¢i1(l¢d Practice (ai)i)licablc lo cliai'ilies i)I'¢i)lli'iiigi Ilicii. aecoiii)18 ii) aceoi'(laiicc ii'iil) Ilie fii)ai)ClAI Ilci)01liiig SIHiidail aiiplicable iii tlic UK aiid Rei)iiblic of Ii'claiid (I-. IIS 102)) (issiicd iii ()clob¢r 2019)- (Cliarilies SOIII) (FRS 102)), l-lie Fiiiaiicial Keportiiig Si&i)dard ai)plical)Ic ii) IIIL IIK aii(I Ilei)Iiblic of Ir¢I￿lId (FRS 102) oiid ihe Coiiipaiiies Act 2006. Integratc(l Neiirological Services iiieels Ilie Ilcfiiiilioii ol-a piibli¢ beiiclil ¢iililJT uiidci. l.'IlS 102. Asscts aiid liclbililie5 arc initiall J, IEcogiiisecl al l)islDricRI co81 or IrRii8aclioii vAlii¢ iiiil¢ss ( b ) Cloiiig coJicei' -I'lie Iriislccs coiisid¢r Ilial Iliere are iio iiinleriRI iincertaiiities aboiil Ilie Lliiirily's abilily lo ( ¢ ) Flliiil IiLL'oiiiiliiig Uiircsli'iclcd fiii)ds are available lo lis¢ 01 tlie discretioii of ilie Iriislees iii liii'ilieraiiLC ol'ilie gcnei'RI objeclivcs ofilic charit),. Resli'icle(I liiiids Hi'c siibject to I'esli'iclioiis 011 tlieir cxi)eiiditLire iiiiposc(I by Ilie (loiior or Ihroiigli leniis of Ilie api)eal. Desigiinled fliiids llave been created to proiiide for filli1￿ dilapidalioiis on tli¢ leascd i>roperty. ( d ) Incoiiilng Itsollrces In lit]¢ ii'iili p￿vIOuS i)raclice. ii)coiiiing r¢sources ii)cliided iii Ilic Fiiiaiicial Accoiiiils Ivheii Ilie iiicome is receiyed aiid Ilie aiiioiint cali Il)erefor¢ be accuralely qiiai11ificd. Doiinlioiis. legacies Ri)d gift5 are iiicliided iii fiill iii Ilic Sialenieiil of Fiiian¢i&l Aclivilics iyheii rec¢iv8ble. Resli'i¢lc(l incoiiie froiii graiits ai)Il coiilracls received iii advance of related fulurc cosls is Iirale(l as defei'i'ed iiicoiiie (Note 13). Reslricted incoiile froin graiils is Lised as specified by (lie grAiilor. D¢l8ils of IEslricl¢d grants rc provided in Note 17. Jiicoiiic g>eiieratcd fiY)iii c111( I'ilable c1eiiiiilies is priii)ai'ily froi)) co1)Ir￿¢t5, ii,Iiicli arc Irealed as resli'iclc(l iii¢oiiie niid Iised as 5iiccilie(I by Ilic coiilrncl. Doi)aleil sci'viccs ai'¢ iiicliidcd al Ilieir Yaliie iYli¢r¢ Ihis cali b¢ quantifie(l. Tlie valiie of s¢rvices i)rovi(led by voliii)leeis lius Iiol beeii ii)cliided in these accoiiiits. (32) INTEGRATED NEUROLOGICAL SF,RVICES NOTES TO THE ACCOUNTS FOR'fHF. YEAR NDf.D 31 MARCH 2023 {CONTINUF.D) ( e ) Ilesoiii'ces exi)eiide(I Eipeiidiliire is recogJii5ed 011 ali accriial l)egiq a4 a lial)ilily 14 iii¢iii'i'e(l. V Al. 11,Iiicli cai)i)ol bc r¢¢ovei'c(l is recorded as pol'l of Ili¢ expciidiliire to ivliicli il rclales. 511cli aciii'ities Iliid also Iliosc costs ol'aii iiidirect iMluir Iie¢essai'Ji lo siii)i)o1l Ilieii), ii)Llii(liiig oipei'iiaiiLe costs. All ci)s1s lli'e nllocalcil l)Llii'ccii tlie exi)cii(liliire ctltegori¢% i)filic Sol.'A 01) a basi5 desigiied to oIIIcis ar¢ Ni)Ix)rtioi)e