2021-06-30-accounts

The London Pathway

Operating as Pathway

Annual Report and Financial Statements

For the 15-month period ended 30 June 2021

Company Limited by Guarantee Registration Number 07210798 (England and Wales)

Charity Registration Number 1138741

Reference and administrative details

Reports

Reports
Reference and administrative details	Error!
Bookmark not defined.
Trustees’ report	2
Independent auditor’s report	24
Financial statements
Statement of financial activities	28
Balance sheet	29
Statement of cash flows	30
Notes to the financial statements	31

Pathway

Reference and administrative details

Trustees Lady Rhona Bradley Mr Martin Cheeseman (Appointed 1 July 2021) Prof Steve Field (Appointed 15 July 2020) Dr Vanya Gant Mr Richard Guest Prof Andrew Hayward Ms Cathy James OBE Sir Ian Kennedy Ms Leslie Ann Morphy OBE (Chair) Mr Stephen Robertson (Vice Chair) Mr Simon Tuttle Chief Executive Mr Alex Bax Finance "Director" and Company Secretary Ms Stephanie Swan Medical "Director" Dr Nigel Hewett Registered office 5th Floor East 250 Euston Road London, NW1 2PG Company registration number 07210798 (England and Wales) Charity registration number 1138741 Auditor Buzzacott LLP 130 Wood Street London EC2V 6DL Bankers The Co-operative Bank Business Customer Services PO Box 250 Skelmersdale WN8 6WT

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Trustees’ report: 15-month period ended 30 June 2021

The Trustees of the Charity present their annual report and audited financial statements for the 15-month period ended 30 June 2021.

The Charity’s financial period was extended by three months to align future financial years in line with Crisis UK, who from 1 July 2021 became the sole Member. From the same date, Pathway became a wholly owned subsidiary of Crisis UK whilst retaining its stand-alone charitable status.

This report has been prepared in accordance with Part 8 of the Charities Act 2011 and constitutes a directors’ report for the purposes of company law.

The financial statements have been prepared in accordance with the accounting policies set out on pages 31 to 33 of the attached financial statements and comply with The London Pathway’s Memorandum and Articles of Association, applicable laws and Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS 102)

Structure, Governance and Management

Governing document

During the reporting period the Charity was governed by a Memorandum and Articles of Association incorporated on 1 April 2010. The Articles of Association have been replaced by a revised set of Articles from 1 July 2021 when Crisis UK became The London Pathway’s sole Member.

The Charity is constituted as a charitable company limited by guarantee and has no share capital. Its company registration number is 07210798.

The Charity has adopted the trading name of ‘Pathway’ to reflect its expansion into geographical areas outside London.

Organisation structure

Pathway is managed by a number of Trustees and administered by officers who deal with the operation of the charitable company. The Trustees meet quarterly, and any new Trustees are appointed with the agreement of the current Trustees. One new Trustee was appointed in 2020/21, and a Trustee representing Crisis UK’s Board of Trustees was appointed on 1 July 2021. A list of the current Trustees is set out on page 1.

A small group of Trustees is convened and meets annually to review pay and make recommendations of pay increases to the full Board.

Key management personnel

Pathway’s key personnel are the Chief Executive, Finance Director, and Medical Director. The Board reviewed the staff structure and remuneration of all current staff and vacant posts in 2020/21 including the key personnel, and ratified the annual pay award by the full Board. The benchmarks used to assess pay are either the NHS Agenda for Change pay rates for Pathway staff working in hospitals or National Joint Council (NJC) pay scales for all other posts.

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Trustees’ report: 15-month period ended 30 June 2021

Structure, Governance and Management (continued)

Recruitment, appointment and training of Trustees

For the period of these accounts, a Trustee is a member of the Board of Trustees of the charitable company and director for the purposes of the Companies Act 2006. In accordance with Clause 11 of the Articles of Association of Pathway, Trustees may appoint a person who is willing to act as a Trustee for such a term as they shall see fit, usually a maximum of three years per term, either to fill a vacancy or as an additional Trustee. There is a minimum requirement of three Trustees. At the end of a term of office, the Trustees can reappoint the Trustee. There shall be no limit to the number of times a Trustee may be reappointed. If the number of Trustees shall fall below three, the remaining Trustees may act only for the purposes of appointing new or additional Trustees.

A Trustee may resign from his/her post by written notice to the Trustees. Clause 12 of the Articles provides conditions in which a Trustee’s term of office automatically terminates.

For the financial year 2020/21, there were 10 Trustees. Professor Stephen Field was formally appointed as a Trustee on 15 July 2020.

From 1 July 2021

Following Crisis UK becoming Pathway’s sole, single Member and in accordance with Clause 12 of the revised Articles of Association of Pathway, the Trustees shall comprise of between eight and twelve Trustees who are appointed by the Trustees. The Trustees who are Trustees as at 1 July 2021 shall continue as Trustees of the Charity; and no more than one Trustee appointed by Crisis UK will be a Member Appointed Trustee. Each Trustee shall be appointed for a three year term. At the end of each term a Trustee shall retire from office but may be re-appointed by the body that appointed them. No Trustee shall serve in office for more than nine consecutive years provided, but in exceptional circumstances a Trustee may be reappointed annually thereafter if it is in the best interests of the Charity to do so, and the Trustees resolve unanimously that they be reappointed.

A Trustee may resign from his/her post by written notice to the Trustees. Clause 13 of the Articles provides conditions in which a Trustee’s term of office automatically terminates.

Martin Cheeseman was appointed the Member Appointed Trustee from 1 July 2021.

Each Trustee is provided with an information pack which provides details on the duties and roles of Charity Trustees, a copy of Pathway's constitution, the strategic plan, the previous year’s annual accounts and the standing orders and standing financial instructions.

Potential Trustees are invited to attend up to three board meetings as observers, and prior to their appointment to the Board they meet the Chair and senior officers of Pathway to discuss the Charity’s aims, objectives and direction.

Trustees are kept up to date regularly with changes relating to Charity legislation by the circulation of newsletters from the Charity Commission.

Members of the Board of Trustees have no beneficial interest in the charitable company.

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Trustees’ report: 15-month period ended 30 June 2021

Structure, Governance and Management (continued)

- Organisation and decision making process

Running of the day-to-day activities of the Charity is delegated to the Chief Executive and his senior team. This helps the Trustees govern more effectively, although they remain collectively responsible for the Charity.

Levels of expenditure delegated to officers are set out in the standing financial instructions.

The proposed strategic direction, plan and draft budget for Pathway are presented to Board of Trustees for discussion at a meeting early in the calendar year and are finalised and approved by the Board at their Spring meeting. Progress reports are presented to the quarterly meetings of the Board.

During 2020/21 additional Board meetings were convened to discuss the proposed new arrangement for Crisis UK to become Pathway’s single member.

New job descriptions, associated levels of remuneration and annual pay awards were submitted to the Remuneration Sub-Committee for discussion, following which the Chair of the SubCommittee made recommendations for approval to the full board.

Where decisions are required between meetings these are carried out through urgent action procedures, and depending on the decision required, this may be through written contact with every Trustee or with the Chair and Vice Chair. All urgent decisions taken between meetings are reported to the Board at the next possible meeting for ratification.

From 1 July 2021

Pathway and Crisis have agreed and signed an operating agreement which sets out the terms on which they will work together to allocate funds and resources for the benefit of people who are experiencing homelessness or at risk of becoming homeless and the manner in which Crisis will oversee the operations of Pathway as part of the Crisis group.

Risk management

The Trustees have assessed the major risks Pathway is exposed to, in particular those relating to the specific operational areas of the Charity, its assets and its finances.

Two key risks for the Charity continue to be the loss of key personnel and the impact of the continuing pandemic. These are addressed as follows:

1. The Trustees manage the risks that might ensue at the loss of key personnel by ensuring staff are supported, paid appropriately and that their knowledge of systems is shared with other staff members and the Board of Trustees. Trustees also intend to introduce succession planning wherever possible.

2. The Covid-19 pandemic was a risk throughout the reporting period and continues to be a risk going forward. At all times, Pathway has followed the advice from the Government and the medical experts, and took a number of actions to address the Covid-19 pandemic some of which continue:

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Trustees’ report: 15-month period ended 30 June 2021

Structure, Governance and Management (continued)

Risk management (continued)

• several Pathway staff and Fellows mobilised to partner work with the Greater London Authority, Healthy London Partnership and a number of homeless charities to move large numbers of homeless people into hotels from winter night shelters, No Second Night Out Hubs and other settings. They provided medical cover alongside colleagues from UCLH’s Find and Treat Team and a specialist homeless GP practice to triage each individual before a hotel room was allocated. Negotiations are ongoing with the Healthy London Partnership and the NHS to agree funding to support Pathway’s input to this activity. Similar activity has been led by our Pathway Fellow and his colleagues at the specialist homeless GP practice in Brighton;

• we produced special newsletters outlining the latest advice and concerns about Covid-19 were produced and circulated to the 2,000+ members of the Faculty for Homeless and Inclusion Health and also a Covid-19 blog was installed on the website to update readers on latest thinking, advice and activity;

• from 16 March 2020, ahead of the national lockdown and to ensure social distancing, it was decided that staff should work from home as far as is practicable and regular meetings are held by video conference including full Board meetings and this arrangement remains in place; and

• the Board acknowledge that the continuing pandemic may cause uncertainty and impact on how Pathway operates for the foreseeable future. However, Pathway is fortunate to have significant committed grant funding in place for 2021/22 and is not reliant on donations or income of a variable nature. In addition to the financial certainty the new arrangement with Crisis UK brings, the Board and Executive team will continue to work hard to ensure sufficient additional funding is available to continue its core programme of work and will review cash reserves and liquidity over the ensuing year to ensure that Pathway can continue to operate for the foreseeable future.

The Trustees believe that they have established effective systems to mitigate these and other operational and business risks which are kept under review.

Objectives

Objects of the Charity and Principal Activities

The objects of the Charity are to advance such purposes as are charitable for the advancement of healthcare for, and for the relief of need of people often excluded from society, including, but not exclusively, homeless people, alcoholics, drug users and those suffering from mental or physical health problems (excluded people) by, but not exclusively:

• a) the development of targeted healthcare and nursing support for excluded people;

• b) the provision of follow-up support after their discharge from hospital; and

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Trustees’ report: 15-month period ended 30 June 2021

Objectives (continued)

Objects of the Charity and Principal Activities (continued)

• c) the provision of healthcare-related education and training for excluded people and for staff and volunteers working with excluded people.

From 1 July 2021

In the revised Articles of Association adopted on 1 July 2021, the objects of the Charity were revised to:

The Objects of the Charity (the 'Objects') are to advance such purposes as are charitable for the advancement of healthcare for, and for the relief of need of, people experiencing homelessness or at risk of homelessness and others often excluded from society, including, but not exclusively, alcoholics, drug users and those suffering from mental or physical health problems ('excluded people') by, but not exclusively:

• (a) the development of targeted healthcare and nursing support for excluded people;

• (b) the provision of follow-up support after their discharge from hospital; and

• (c) the provision of healthcare-related education and training for excluded people and for staff and volunteers working with excluded people.

Objectives for the Period

It is the intention of the Trustees that funding should be secured and used to work on advancing healthcare services for homeless people and other excluded groups. The Trustees confirm they have complied with the duty in section 47(5) of the Charities Act to have due regard to public benefit guidance published by the Charity Commission.

Pathway will maintain its position as:

• a recognised leader in the field of healthcare for homeless people and other multiply excluded groups;

• an organisation that puts service users at its centre;

• an agent of change working within and in partnership with the NHS and other services; and as

• the host of the Faculty for Homeless and Inclusion Health, a network bringing together health, housing and social care professionals working with excluded people and also people with lived experience who wish to contribute to their work.

During the reporting period, Pathway continued to work towards the agreed five strategic aims to deliver its objectives:

1. To support, strengthen and spread our existing service models and networks;

2. To develop the variety of services operating within the Pathway network;

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Trustees’ report: 15-month period ended 30 June 2021

Objectives (continued)

Objectives for the Period (continued)

1. To research, test and evaluate new and additional services and build the evidence around homeless and inclusion health;

2. To provide support to and develop further the Faculty for Homeless and Inclusion Health – including potentially establishing it as a free standing organisation; and

3. To maintain a strong organisation.

Activities, Achievements and Performance

The ongoing pandemic has impacted on our activities in our eleventh year of operation, but the main activities and achievements for each of the aims have been:

Aim 1: To support, strengthen and spread our existing service models and networks

Pathway Teams funded on a permanent basis

• Pathway has supported services for homeless patients at 12 hospitals (University College Hospital, The Royal London, Brighton & Sussex University Hospital, Bradford Royal Infirmary, Leeds General Infirmary, Manchester Royal Infirmary, King’s Health Partners, covering Guy’s and St Thomas’, King’s College Hospital and South London and the Maudsley, Hull Royal Infirmary, Bristol Royal Infirmary and Salford Royal Hospital. Funding has been secured for the work to continue into 2021/22.

Support provided to existing Pathway teams

• Reflective practice continued to be provided for staff in Brighton and London Pathway teams helping staff address the emotional impact of their work.

• Regular Faculty email updates are sent to Pathway teams - these include new learning materials and Covid-19 updates.

• Faculty meetings are open to and were well attended by Pathway Teams – include specific new learning presentations and discussion – and were held by Zoom due to Covid-19 restrictions.

• Regular - about quarterly - meetings were held for Pathway teams, these were held remotely on Zoom. Agendas covered: experiences and updates of each team, presentations from guest speakers and opportunities to discuss and network with each other.

• Three years of funding from Trust for London was secured to provide Tier 2 legal advice to our teams at UCLH, Royal London, SLAM and King's and we have added TB Find and Treat and FOCUS and START street mental health teams as recipients of advice. Contracts began in July 2020.

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Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 1: To support, strengthen and spread our existing service models and networks (continued)

Spread of Pathway service models and networks

• Hull is the first team operating under the social franchise programme, now rebranded the Pathway Partnership Programme, and 2020 was its first year of operation. The team has received the programme of support as agreed in the operational agreement and have reported that they have found it valuable. A report of the progress of the first twelve months of the team was published and can be read on Pathway’s website.

• We secured funding from winter pressures funding to introduce a pilot Pathway team into St Mary's Hospital, part of Imperial College Healthcare NHS trust. The team started work in late January 2020 but was withdrawn in early March when Covid-19 hit. However, the production of an evaluation report of the work done in the short amount of time convinced Imperial's Integrated Care Programme Director that Pathway teams are needed across the Trust. Funding has been secured to introduce a team in St Mary’s and also to cover the Chelsea and Westminster hospital and this should start to operate in late 2021 and will be part of our Pathway Partnership Programme.

• Needs assessments are currently in preparation for Sheffield, four hospitals in Warwickshire, and Barking and Dagenham.

• A business case was developed for a service in Newham hospital, and there are ongoing discussions about establishing a Pathway team.

• Following the production of a needs assessment commissioned by Hackney for the Homerton hospital, funding was secured to establish a Pathway hospital team. It is expected to be operational in late 2021 and will be part of our Pathway Partnership Programme.

• Following locally conducted needs assessments which were supported by Pathway, St George’s Hospital, Tooting and Croydon have secured funding to establish a Pathway hospital team. They are expected to be operational in late 2021 and will be part of our Pathway Partnership Programme.

• Following approaches from commissioners, clinicians and other people working in or responsible for inclusion health, we are discussing the need for Pathway teams across the country including: Oxford, Cambridge, Birmingham, Bath, Southampton, Nottingham, Royal Free London, Exeter, Torbay, Southend, and Doncaster. These are all at different stages, some have collected data or undertaken local needs assessments already and are ready to build a business case, whilst others are yet to start reviewing data to decide whether there are sufficient homeless patients to require a Pathway team.

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Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 1: To support, strengthen and spread our existing service models and networks (continued)

Spread of Pathway service models and networks (continued)

• Manchester Health and Social Care Partnership and Plymouth Hospital NHS Trust have commissioned advice from the core Pathway team on inclusion health on a 'call off' basis. Plymouth have completed a needs assessment and are building a business case for the establishment of a Pathway team.

• We continue to update the operational manual and promotional documents as part of the project to spread Pathway’s hospital model. We have changed the emphasis away from ‘social franchising’ and now use the term Pathway Partnership Programme to emphasise the arrangement is around support and collaborative working. We currently have 13 sites – three operational teams, four confirmed teams, and six potential teams accessing the on-line manual.

• We developed three short e-learning modules about Inclusion Health in hospital, these are available free of charge on our website.

Covid-19

• We have been involved in the response to Covid-19 for people experiencing homelessness since the start of the pandemic in March 2020 - sitting on daily meetings of the London Homeless Health Programme Board and subsequently the weekly meetings of the 'London Homeless Integrated Care System Partnership Board' which includes broad representation from the five London STP/ICS's. We shared news and information about Covid-19 by sending weekly Covid-19 updates to Faculty members, having a separate Covid-19 section on our website and also maintaining a blog on our website.

• In March 2020, London’s specialist homelessness clinicians and partners issued an open letter to NHSE London Region, PHE London Region and the Mayor of London asking for support to ensure that care for homeless and excluded people across London is delivered equitably and to the highest possible clinical standards during the Covid 19 epidemic and this is published on our website.

• We have worked closely with Find and Treat - providing mobile phones for homeless patients in hotels - so that clinicians could carry out consultations - the phones were funded by donations that we secured from Amazon and the Health Foundation.

• We secured funding from Crisis to purchase PPE for staff supporting homeless patients in hotels - the delay in receiving this meant that it was not available during the first wave but was utilised subsequently.

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Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 1: To support, strengthen and spread our existing service models and networks (continued)

Covid-19 (continued)

• Professor Andrew Hayward (Pathway Trustee) and Dr Al Story (Find and Treat) created a Test, Triage, Cohort, Care plan for people experiencing homeless being brought into accommodation. When the GLA began procuring hotels during the first wave, three Pathway clinical fellows and colleagues from the Great Chapel Street homeless practice, and the Find and Treat team, stepped in to try and make sure medical cover was in place as large numbers of people were moved to hotels from Winter Night Shelters, No Second Night Out Hubs and other settings.

• Pathway endorsed advice from Professor Andrew Hayward and Dr Al Story that projects offering dormitory style accommodation should not be allowed to re-open until the UK infection rate is close to zero. Crisis and other Charity sector partners used this argument to buttress their campaigns for proper, permanent accommodation offers to be made to everyone. In his capacity as secretary of the Faculty for Homeless and Inclusion Health Dr Nigel Hewett wrote formally to Public Health England endorsing this position and asking for clear national guidance to reinforce the position.

• Setting up a facility for Covid-19 positive homeless patients proved problematic. The first hotel that was established was declared unsafe by clinicians, and subsequently a number of beds were secured in the Mildmay hospital for these patients. These are still being commissioned during the ongoing pandemic.

• Pathway's Nursing Fellow provided clinical input to two Covid-19 prevent hotels in London during the first wave and wrote a brief health needs assessment of the clients in the hotels on two days in May. The report was published on Pathway’s website.

• Pathway Clinical Fellow and colleagues at ARCH health were heavily involved in supporting work in Brighton to bring people experiencing homelessness in when the City Council declared it would house all rough sleepers during the lockdown periods. A report of the Pathway Team in Brighton and Hove response to the first wave of the Covid-19 pandemic was published on Pathway’s website. Bradford and Hull were also successful in supporting work to bring homeless people in.

• In early October 2020, we, together with Crisis and the main homelessness charities and the Royal College of Physicians and leading health sector organisations wrote to the Prime Minister asking for further Government funding during the next phase of the pandemic to head off the risks of communal winter night shelters re-opening, as the only provision available for people on the streets. Further funding of £15m was made available in mid-November to bring Homeless People in during the second wave and to secure hotel beds once again.

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Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 1: To support, strengthen and spread our existing service models and networks

Covid-19 (continued)

• In London, Find and Treat’s testing programme found more cases of coronavirus infection in the homeless population after Christmas than in the whole of the pandemic up to that point. By mid-December data on the higher rate of transmission of the Alpha variant was becoming clear. Prof Andrew Hayward and Dr Al Storey took the lead in producing a statement, published on our web site, highlighting the possible dangerous consequences for the homeless sector. Following the publication of the statement, Pathway together with Crisis convened the leading homeless sector CEOs for a discussion to emphasise the seriousness of the situation and the very high risks of large scale outbreaks in our population. Over the Christmas period Crisis drafted a jointly backed note which reached Secretary of State Robert Jenrick on 31 December. A further £10m funding was announced on 8 January and a letter sent to all English local authorities asking them again to bring people in, however without clarity in relation to No Recourse to Public Funds patients, who continue to be a huge challenge to services. Towards the end of January, London still had 800 people in hotels and there were plans to open another 150 beds but with no confirmed funding beyond the end of March.

• We published a rapid position statement in early December making the case for inclusion health populations to be given reasonable priority in access to vaccinations, particularly due to the increased risks of outbreaks in any groups living in shared accommodation settings (like hostels or hotels) and the relative clinical vulnerability of our population. Prof Andrew Hayward presented to the JCVI on 21 January and amended guidance was subsequently issued that advised that people experiencing homelessness, and not otherwise already covered in guidance, should be included in priority group 6 and offered vaccinations immediately.

Aim 2: To develop the variety of services operating within the Pathway network

Medical Respite Provision

• Pathway Teams that have access to step down beds to support patients further when they are discharged from hospital include: UCLH, Royal London, Bradford and Hull.

• We looked closely at the possibility of securing the Mildmay Hospital as a London-wide step down facility, but commissioners thought the operational costs were prohibitive. Subsequently, some beds there have been commissioned by the NHS for step down as part of the Covid-19 response.

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Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 2: To develop the variety of services operating within the Pathway network (continued)

Medical Students Training

• Two remote learning sessions for SSC students from UCL have been arranged for February and March 2021 with five students attending. The ongoing pandemic has meant that in person student placements have not been possible during 2020-21.

Mental Health

• Mental illness in people experiencing homelessness is common and a key reason for attendance at emergency departments and admission to hospital. A paper was published in the Journal of Mental Health. It describes how the KHP Pathway homeless team impacted use and cost of health and wider services and can be viewed on Pathway’s website. The Pathway model had never been adopted by a mental health hospital before this, and there had never been an economic analysis to evaluate service use before and after intervention.

• Resilient One - The Mouse project: The film has been well received by young people and clinicians at Simmons House CAMHS unit in Haringey. Final editing is now under way to respond to their comments. The completion of the film was delayed due to Covid-19. Mental health colleagues have asked if we might find a way to help them create more ‘exclusion prevention’ materials for use by CAMHS colleagues, and we are seeking further funding to facilitate this work. The ambition is to distribute the phase one pilot materials to a wider set of CAMHS units, to build on clinical engagement and engagement with the young people to specify topics for further development, and potentially to commission a structured review of longer-term outcomes for young people ‘ageing out’ of adolescent mental health services, particularly their risks of homelessness and their other support needs.

• The initial pilot set of ‘trauma informed communications skills’ training sessions were completed. All teams who received the training (homeless sector workers, an A&E nurse cohort, some community dentists) found it extremely valuable. The report of the pilot project was published in July 2020 and can be found on our website The next stage of the work is to consider how to make the training more widely available, perhaps through some kind of ‘trainthe-trainer’ initiative.

• In August 2020, a Department of Health Official asked Pathway’s Medical Director to rapidly develop a generic specification for a standard homeless and inclusion health mental health team as part of a submission to the comprehensive spending review. He convened a group of leading inclusion health mental health practitioners to prepare this within 48 hours of the request. The document is based on evidence from effective services around the UK, together with research output. We do not know where the CSR submission has got to, but we published the resulting document on our website anyway.

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Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 3: To research, test and evaluate new and additional services and build the evidence around homeless and inclusion health

Frailty and Ageing in Homeless population

• In September 2020, we published a ground breaking study of premature ageing among the residents of a medium support needs hostel in London undertaken by Pathway’s Clinical Research – Frailty Fellow. This work has the potential to be very influential in shifting views of homeless patients. The study used internationally valid frailty measures to assess the residents. The average age of participants in the group was 55.7; their levels of frailty matched those found in 89 year olds in the general population. On average they were found to have 7.2 long term conditions, far in excess of the average for even the oldest people in the general population. The publication can be found on our website. Additional funding has been secured from the Isla Foundation and the British Geriatric Society to further build on this work over the next twelve months. Work will include the development and testing a series of frailty-based training interventions with staff at two high support needs hostels in Tower Hamlets.

End of Life and Palliative Care

• Pathway’s Senior Clinical Research (End of Life Care) Fellow is testing the next stage of work, funded by the Oak Foundation, on end of life care with palliative care colleagues in Croydon. A key component of the work is bringing NHS palliative care networks skills and expertise together with the homelessness sector.

• Additional funding was secured from NHS England’s palliative care team to pilot a webinar based multi-disciplinary training and support programme in two locations: Hull and Birmingham. The hope is that the work will develop standing ‘communities of practice’ around homeless end of life issues and embed a multi-disciplinary care co-ordination approach that joins up palliative care, inclusion health and other relevant NHS and charitable services. The project will evaluate the success of this approach and explore how we could replicate the work further.

Experts by Experience

• The Experts by Experience group convened for the March 2020 conference was supported during 2020 to participate in shaping the programme for the March 2021 conference. As well as joining panel sessions with the Junior Minister for Housing, England's Chief Nurse, and the new NHS national director for health inequalities, the group members led their own session at the 2021 conference, chaired by NHS England's Head of Public Participation.

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Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 3: To research, test and evaluate new and additional services and build the evidence around homeless and inclusion health (continued)

Experts by Experience (continued)

• Due to Covid-19 restrictions, the group could no longer meet in person and weekly meetings have been held on Zoom. It is currently a small group of five or six enthusiastic and knowledgeable EBE's who take support from each other. They have welcomed regular 'guest' speakers and/or researchers or staff from other projects who want to talk to 'real' people with lived experience to their meetings because the group is hungry to learn and participate.

• We have reviewed relevant research and work in other organisations where Experts by Experience are involved, much of which is drawn from mental health projects where there has been a bigger drive to incorporate lived experience. We have produced a short best practice document which is published on our website.

Legal Advice to Pathway Teams

• A report setting out the outcomes achieved of the pilot project of Pathway’s London teams having access to legal advice was published on our website in April 2020. The project aimed to assist destitute homeless patients who might benefit from legal advice and support during their hospital stay, in preparation for discharge and, in some cases, after leaving hospital.

Health-led Street Outreach

• We co-branded and published a new guidance document on health-led street outreach produced by a partnership between the London Network of Nurses and Midwives, Queen's Nursing Institute and Pathway.

Pathway Fellows

• We have continued to add to and support the work of our group of Pathway Fellows and there are now 18 fellows.

Strategic relationships

NHS England (NHSE)

• Through the pandemic we have built close working relationships with NHSE's Head of Public Participation who has taken on a lead role for inclusion health populations. Our EbE group have attended a series of online events for and with her on topics including the role of community pharmacy and the impact of digital by default on access to primary care. She has been connecting us with other bits of NHSE especially teams working on the Primary Care Networks. Most recently we have been helping to shape a pilot inclusion health training course for primary care networks.

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Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 3: To research, test and evaluate new and additional services and build the evidence around homeless and inclusion health (continued)

Strategic relationships (continued)

NHS England (NHSE) (continued)

• NHSE have also now appointed the first national ‘inclusion health’ nurse and she is in regular contact with Pathway’s Nursing Fellow and has also attended on of the Pathway Teams' meetings to hear and learn about their work in hospitals across the country.

• Pathway’s Senior Clinical Research (End of Life Care) Fellow secured funding from NHSE to create a short film, current working title: ‘Someone Please Listen’. The aim of the film is to introduce all NHS staff to some of the issues people experiencing homelessness and those vulnerable face when they attend hospital. Pathway’s Senior Clinical Research Fellow and the film-maker held a lively and informative working session over Zoom with our group of EbE’s to discuss the concept. Production of the film has been delayed by the pandemic.

• NHSE have grant funded a substantial project to explore the viability of recruiting people with lived experience of homelessness to be Health Care Support Workers (HSCW) in NHS Hospitals. This project forms part of a drive to recruit significant numbers of HSCW’s to the NHS. There are three partners commissioned to work together on the project: Pathway, Groundswell and Royal Society for Public Health and the aim is to work with seven trusts across England. The project is scheduled to take 12 months.

Health Education England (HEE)

• We continue to work at influencing HEE and the development of inclusion health training at a national level. Following the release of a series of new training materials on the E-Learning for Health portal, some of which we helped to develop, we found they were not presented as a coherent programme. HEE awarded Pathway a grant to map the training resources available and this work concluded in early 2021.

Department of Health and Social Care

• The official in charge of securing and allocating the two year £15 million homeless out-ofhospital care fund consulted Pathway about ideas on how this could be best deployed to gain maximum impact. We supported a number of partners to put funding proposals for both phases of the deployment, and some of the phase 2 funding has been awarded for several new Pathway teams across London including St Mary’s, Croydon and St George’s.

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Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 4: To provide support to and develop further the Faculty for Homeless and Inclusion Health - including potentially establishing it as a free standing organisation

Faculty Membership

• Following a 'clean up' of the Faculty membership list, in July 2020 the membership stood at 1,300. However, membership continues to grow and at July 2021 the membership stands at 1,425.

Faculty Meetings

• Due to Covid-19 restrictions faculty meetings have been run on Zoom and this has proved a successful medium with many more people able to attend.

• We have welcomed many guest speakers to the Faculty meetings and topics covered have included: the transformations to Edinburgh Access Practice’s services through Covid; a doctor from the National Addictions Centre and the Maudsley speaking about the Londonwide addictions service changes introduced to dramatically shift access to drug treatment services during the pandemic; a GP working in Lewisham who has an interest in improving access for vulnerable patients and her recent research covering total triage and by default remote consulting; three speakers, including a specialist nurse from Gloucester about how to make use of the adult safeguarding regime to improve outcomes for homeless patients.

• Following a successful session on mental health at the Faculty for Homeless and Inclusion Health’s conference, we convened a Faculty working group meeting on mental health. The ambition is to try and pull together a supportive network for the large numbers of newly commissioned specialist homeless mental health out-reach services that have been commissioned over the last 18 months.

Faculty for Homeless and Inclusion Health's 9th Annual Symposia

• The Faculty for Homeless and Inclusion Health’s annual conference: “Pathway's from Homelessness 2021: Everyone Always In?” ran from 8-11 March 2021 all on-line. There were over 60 speakers across three main days and with just over 500 people attending the plenary sessions at the peak. Speakers included: Eddie Hughes MP, Parliamentary Under Secretaryof-State for Housing and Rough Sleeping, Andy Burnham, Mayor of Greater Manchester, Ruth May, Chief Nursing Officer for England and Dr Bola Owolabe, NHSE Director for Health Inequalities. Dr Al Storey, Prof Andrew Hayward and Dr Austin O-Carroll (Dublin) presented a Covid reflections session. The Prof. Aidan Halligan Memorial Lecture was a free to air session given by Prof Monica Lakhanpaul. It focused on homeless children and families; a theme picked up in specialist sessions throughout the event.

16

Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 4: To provide support to and develop further the Faculty for Homeless and Inclusion Health - including potentially establishing it as a free standing organisation (continued)

Faculty Newsletters

• The Faculty newsletter has been produced and sent out at fortnightly intervals during the period along with special newsletters concentrating on Covid-19 issues and developments.

On-line training

• Six free on-line training units are available on Pathway's website for professionals with an interest in the health needs of people who are homeless, people who sell sex, Gypsies and travellers and vulnerable migrants. Each module, comprising video lectures from the popular Homeless and Inclusion Health Symposium events, focuses on a different area of inclusion health, and is designed for a specific audience, with some overlaps. the topics covered are: health Inequalities; health commissioning for excluded groups; housing commissioning for excluded groups; homelessness and health - an introduction for practitioners and service providers; mental health, substance misuse and homelessness; and drug and alcohol use and homelessness.

Faculty Standards and other publications

• Street Outreach guidelines prepared in partnership with the Queen's Nursing Institute and London Network of Nurses and Midwives have been added as a new appendix to the latest version of the Standards.

• The HRA (Housing Reduction Act) referral form was incorporated as part of the Standards and made available separately on The Faculty Standards page of Pathway's website.

• We published a range of studies, briefing, advice and statements led by Members of the Faculty including Covid-19 related – all of these publications can be found on our website.

Aim 5: To maintain a strong organisation

Business Sustainability

• We concentrated on two areas to ensure business and financial sustainability during the period. These are:

17

Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Aim 5: To maintain a strong organisation (continued)

Business Sustainability (continued)

1. Merger with Crisis with Pathway remaining a separate but subsidiary Charity. This will give financial sustainability for at least the next five years but will also provide opportunities to do more for the beneficiaries that we have in common as we work more closely together. We worked through the principles and legal arrangements over the reporting period and both boards and the Charity Commission approved the new arrangements which became operational on 1 July 2021. We received substantial pro-bono legal advice from Clifford Chance the value of which has been included in the accounts, and we are truly grateful for their generous support.

2. Pathway Partnership Programme (previously known as Social Franchise of Pathway Hospital Team Model). We intend to continue to roll out our model using this programme and as reported under Aim 1 we are making progress with new teams. Currently there are five teams who have signed our partnership/social franchise agreement. We are constantly updating the manual that accompanies the programme. We have also reviewed the way we handle the different aspects of the model roll out, separating out the needs and business case aspects from the implementation of the new team.

3. We continued to receive donations from new Members to the Faculty as part of our voluntary contributions scheme, but these are not yet sufficient to cover the cost of the Faculty.

Marketing Strategy

• We developed further marketing materials for the roll out of Pathway hospital team model as part of the Pathway Partnership Programme

• We are receiving pro-bono legal support from Wiggin LLP to help us trademark our Pathway logos - this work is ongoing, and the value of the support is included in the accounts. We are truly grateful for their ongoing generous support with this work.

• the Pathway website was refreshed during the period and a regular Covid-19 blog added.

New Strategic Plan

• We developed a new five year strategic plan alongside our negotiations with Crisis UK.

Core Staffing Structure

• We reviewed our core staffing structure against our strategic plan as part of our strategic plan development and budget process in early 2021.

18

Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Policies and Procedures

• we revised and strengthened our Safeguarding policy and procedures in 2020 and required core staff to have a DBS and undertake on-line safeguarding training.

Review of financial position

The gross income for the period amounted to £1,346,915 (Year to 31 March 2020 - £730,625). The associated expenditure for the period was £1,062,162 (Year to 31 March 2020 - £807,069). This gives a net surplus for the period of £284,753 (Year to 31 March 2020 - net surplus of £76,444). Total reserves to be carried forward to 2021/22 are £816,184 (31 March 2020 - £531,431).

The principal sources of funds in 2020/21 were:

he principal sources of funds in 2020/21 were:
	£
The Health Foundation– payment of grant to continue the exploration of	205,915
social franchising and licensing as a way of spreading Pathway’s hospital
team model (restricted)
The Oak Foundation –2ndand final payment of grant to build on the end of	156,031
life care research project for homeless people by developing further,
implementing and evaluating the training programme for agencies working
with homeless people.
NHS England / Innovation –grant for work on recruitment of people with	150,000
lived experience of homelessness as Health Care Support Workers in seven
NHS Trusts across England (restricted)
Crisis UK –a grant towards core funding for the quarter ended 30 June	125,000
2021 (restricted)
University College London Hospitals NHS Foundation Trust– payment	102,694
to support four sessions per week of a specialist homeless GP for the
hospital’s homeless team and six months pay of Care Navigator (restricted)
Texel Foundation –2nd payment of a two year core grant focused on the	50,000
Faculty for Homeless and Inclusion Health and Experts by Experience
(restricted)
Trust for London– 1stpayments of a three year grant to provide Tier 2 legal	45,000
advice to Pathway’s London hospital teams and mental health teams
(restricted)
Crisis UK –a grant towards procurement of PPE during pandemic	39,718
(restricted)
The Oak Foundation– Covid related donation (unrestricted)	38,500
Healthy London Partnership- reimbursement of the cost of additional time	31,330
Pathway core staff and Fellows put into the initial Covid-19 response

19

Trustees’ report: 15-month period ended 30 June 2021

Activities, Achievements and Performance (continued)

Review of financial position (continued)

Rayne Foundation – 1[st] payment of a three year grant towards the 30,000 production of the Mouse training film and associated materials for young people with mental health issues and further work on Resilient project (restricted) The Health Foundation – donation for mobile phones for Covid homeless 25,000 patients Queens Nursing Institute – secondment of Pathway’s Nursing Fellow for 25,826 one day per week (restricted)

Just under 77% (£817,667) of the expenditure can be attributed directly to Pathway’s core activities, with just over 23% (£244,495) related to support work including governance of which £69,296 relates to the pro-bono legal advice about the merger with Crisis and £12,562 relates to pro-bono legal support around trademarking Pathway’s logos. No payment was made to a consultant for fundraising activities in 2020/21 (£nil in 2019/20).

Reserves policy

At 30 June 2021 Pathway holds reserves of £816,184 (£564,749 restricted and £251,435 unrestricted). At their meeting in May 2021 the Trustees agreed to leave unchanged the reserves policy of retaining unrestricted reserves to cover four months basic overheads (estimated at £246,227). The unrestricted reserve of £251,435 therefore provides sufficient funds to cover management, administration and support costs and to respond to emergency situations for 2021/22. Restricted reserves are balances of funding secured for specific projects, where the funding organisation requires the funding to be used on this work, and where work is continuing. Pathway records specific costs against these funds as they are incurred.

Plans for Future Periods

The statement announcing the merger of Pathway and Crisis UK confirmed the charities would work together to ensure that the health service, through all its contacts with people experiencing homelessness, fulfils its potential in actively resolving homelessness. They will continue to advocate for policy responses to homelessness that save lives, reduce health inequalities, and promote positive health outcomes for people who are homeless.

The merger aims to:

• Increase the number of dedicated hospital teams that work with patients who are homeless across the country, to ensure they receive better quality care and are not discharged from hospital into homelessness.

• Work with the NHS and wider health and social care services to help them prevent homelessness through evidence-based programmes such as Housing First and Critical Time Interventions that will ensure people get the support they need to leave homelessness behind for good.

20

Trustees’ report: 15-month period ended 30 June 2021

Plans for Future Periods (continued)

• Campaign for the changes needed to save lives and demonstrate the positive health outcomes of immediate access to good quality emergency accommodation.

• Fill in knowledge gaps in inclusion health and homelessness research, including how to improve services, narrow health inequalities, assess the impact of government policies and the solutions needed to end homelessness for good.

Pathway’s new strategic plan sets our six aims which we will work towards:

1. to support existing Pathway hospital teams, foster more teams and build a national inclusion health care quality network;

2. to identify, test, champion and replicate new clinical interventions and models of care for inclusion health groups, maximizing any opportunities that flow from NHS policy and funding changes;

3. to stimulate or lead research on gaps in care and evidence, better service structures and new interventions working with NHS organisations, academia and the wider health sector and research sector;

4. to use evidence and the authority of clinical and lived experience perspectives to increase our national influence and drive widespread, systemic change across the UK health and social care sectors;

5. to support and develop the Faculty of Homeless and Inclusion Health as the independent voice and national network for inclusion health professionals; and

6. to maintain a strong organisation and maximise the opportunities of joining together with Crisis.

We will do this by:

• continuing to work to spread the Pathway hospital team model through our Pathway Partnership Programme and thereby secure a sustainable income stream for the core Pathway Charity;

• developing a programme to support Child and Adolescent Mental Health Services to do more to prevent homelessness before it happens among young people with teenage contacts with CAMHS services;

• promoting further our scheme for Faculty members and supporters to make voluntary donations to support the activities and to grow its membership;

• working with Crisis to produce and publish an annual homeless and health review and will seek to generate high media profile for it;

• completing further needs assessments for medical respite and develop standards, metrics and outcome indicators for good quality medical respite provision; and

21

Trustees’ report: 15-month period ended 30 June 2021

Plans for Future Periods (continued)

• building our core team and use the increased capacity to fulfil the ambitious aims set out in our strategic plan.

Statement of Trustees' Responsibilities

The Trustees (who in this reporting period are also directors of Pathway for the purposes of company law) are responsible for preparing the Trustees’ report and financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).

Company law requires the Trustees to prepare financial statements for each financial period which give a true and fair view of the state of affairs of the charitable company and of the income and expenditure of the charitable company for that period.

In preparing these financial statements, the Trustees are required to:

• select suitable accounting policies and then apply them consistently;

• observe the methods and principles in the Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable to the United Kingdom and Republic of Ireland (FRS 102);

• make judgements and estimates that are reasonable and prudent;

• state whether applicable United Kingdom Accounting Standards have been followed, subject to any material departures disclosed and explained in the financial statements; and

• prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charitable company will continue in operation.

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

Each of the Trustees confirms that:

• so far as the Trustee is aware, there is no relevant audit information of which the charitable company’s auditor is unaware; and

• the Trustee has taken all the steps that he/she ought to have taken as a Trustee in order to make himself/herself aware of any relevant audit information and to establish that the charitable company’s auditor is aware of that information.

This confirmation is given and should be interpreted in accordance with the provisions of s418 of the Companies Act 2006.

22

Trustees’ report: 15-month period ended 30 June 2021

Statement of Trustees' Responsibilities (continued)

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

The above report has been prepared in accordance with the special provisions of Part 15 of the Companies Act 2006 relating to small companies.

Approved and authorised by the Board of Trustees on 11 October 2021 and signed on its behalf by:

----- Start of picture text -----
Leslie Morphy OBE
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Chair of Pathway

23

Independent auditor’s report: 15-month period ended 31 March 2021

Independent auditor’s report to the members of The London Pathway

Opinion

We have audited the financial statements of The London Pathway (the ‘charitable company’) for the 15-month period ended 30 June 2021 which comprise the statement of financial activities, the balance sheet, the statement of cash flows, the principal accounting policies and the notes to the financial statements. 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 30 June 2021 and of its income and expenditure for the period 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 Trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate.

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the charitable company’s ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue.

Our responsibilities and the responsibilities of the Trustees with respect to going concern are described in the relevant sections of this report.

24

Independent auditor’s report: 15-month period ended 31 March 2021

Other information

The other information comprises the information included in the annual report and financial statements, other than the financial statements and our auditor’s report thereon. The Trustees are responsible for the other information contained within the annual report and financial statements. 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 course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the 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 the audit:

• the information given in the Trustees’ report, which is also the directors’ report for the purposes of company law, for the financial period for which the financial statements are prepared is consistent with the financial statements; and

• the Trustees’ report, which is also the directors’ report for the purposes of company law, has been prepared in accordance with applicable legal requirements.

Matters on which we are required to report by exception

In the light of the knowledge and understanding of the charitable company and its environment obtained in the course of the audit, we have not identified material misstatements in the 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 accounting records have not been kept, or returns adequate for our audit have not been received from branches not visited by us; or

• the financial statements are not in agreement with the accounting records and returns; or

• certain disclosures of 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’ report and from the requirement to prepare a strategic report.

25

Independent auditor’s report: 15-month period ended 31 March 2021

Responsibilities of Trustees

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

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

Auditor’s responsibilities for the audit of the financial statements

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

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

• We obtained an understanding of the legal and regulatory frameworks that are applicable to the charitable company and determined that the most significant are the Companies Act 2006, the Charities SORP FRS 102, the Charities Act 2011 and those in relation to safeguarding specifically in the context of safeguarding adults and adult protection.

• We understood how the charitable company is complying with those legal and regulatory frameworks by making inquiries to management and those responsible for legal, compliance and governance procedures. We corroborated our inquiries through our review of Trustee meetings and papers provided to the Trustees.

• We assessed the susceptibility of the charitable company’s financial statements to material misstatements, including how fraud might occur. Audit procedures performed by the engagement team included:

• Identifying and assessing the design and implementation of controls in place to prevent and detect fraud;

• Challenging assumptions and judgments made by management and the Trustees in its significant accounting estimates;

• Identifying and testing journal entries, in particular adjustments made at the periodend for financial statement preparation; and

• Assessing the extent of compliance with relevant laws and regulations by reviewing correspondence with regulators and legal advisors;

26

Independent auditor’s report: 15-month period ended 31 March 2021

A further description of our responsibilities for the audit of the accounts is located on the Financial Reporting Council’s website at www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

Use of this report

This report is made solely to the charitable company’s members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work has been undertaken so that we might state to the charitable company's members those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charitable company and the charitable company's members as a body, for our audit work, for this report, or for the opinions we have formed.

Katharine Patel (Senior Statutory Auditor) For and on behalf of Buzzacott LLP, Statutory Auditor 130 Wood Street London EC2V 6DL

Date: 5 November 2021

27

Statement of financial activities: 15-month period ended 30 June 2021 (Including an Income and Expenditure Account)

Notes	Un- restricted funds £	Restricted funds £	15-month period to 30 June 2021 Total £	Un- restricted funds £	Restricted funds £	Year ended 31 March 2020 Total £
Income: Donations and legacies Income from charitable activities Grants 2 Research and project income 2 Total income Expenditure: Expenditure on charitable activities 3 Total expenditure Net income (expenditure) and net movement in funds for the period 5 Reconciliation of funds Total funds brought forward at 1 April 2020 Total funds carried forward at 30 June 2021	120,438 38,500 52,252	37,029 918,466 180,230	157,467 956,966 232,482	38,479 250,000 36,310	11,821 268,776 125,239	50,300 518,776 161,549
	211,190	1,135,725	1,346,915	324,789	405,836	730,625
	286,859	775,303	1,062,162	257,928	549,141	807,069
	286,859	775,303	1,062,162	257,928	549,141	807,069
	(75,669) 327,104	360,422 204,327	284,753 531,431	66,861 260,243	(143,305) 347,632	(76,444) 607,875
	251,435	564,749	816,184	327,104	204,327	531,431

The statement of financial activities includes all gains and losses recognised in the period.

All income and expenditure derived from continuing activities in the above two financial periods.

The accounting policies and notes on pages 31 to 49 form part of these financial statements.

28

Balance sheet: 30 June 2021

Note	30 June 2021 £	30 June 2021 £	31 March 2020 £	31 March 2020 £
Current assets Debtors 9 Cash at bank Liabilities Creditors falling due within one year 10 Net assets The funds of the Charity Unrestricted funds 11 Restricted funds 12 Total Charity funds 13	63,747 897,345	816,184	66,165 520,028	531,431
	961,092 (144,908)		586,193 (54,762)
		251,435 564,749		327,104 204,327
		816,184		531,431

The accounting policies and notes on pages 31 to 49 form part of these financial statements.

These financial statements were approved by the Board of Trustees for issue on 11 October 2021 and signed on its behalf by:

Leslie Morphy OBE

Chair

The London Pathway, Charity Registration no 1138741 Company Registration No: 07210798

29

Statement of cash flows: 15-month period ended 30 June 2021

A B	Notes	15-month period to 30 June 2021 £	Year ended 31 March 2020 £
	Cash flow from operating activities: Net cash provided by (used in) operating activities A Change in cash and cash equivalents in the period Cash and cash equivalents at 1 April 2020 B Cash and cash equivalents at 30 June 2021 B	377,317	(91,869)
		377,317 520,028	(91,869) 611,897
		897,345	520,028
	Net movement in funds (as per the statement of financial activities) Adjustments for: Decrease (increase) in debtors Increase (decrease) in creditors **Net cash provided by (used in) operating activities **	284,753 2,418 90,146	(76,444) (13,994) (1,431)
		377,317	(91,869)
	Analysis of cash and cash equivalents	30 June 2021 £	31 March 2020 £
	Cash at bank Total cash and cash equivalents	**897,345 **	520,028
		897,345	520,028

30

Notes to the financial statements: 15-month period ended 30 June 2021

1. Accounting policies

The principal accounting policies adopted, judgements and key sources of estimation uncertainty in the preparation of the financial statements are laid out below.

Basis of preparation

The financial statements have been prepared in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS 102) (Charities SORP FRS 102) and the Charities Act 2011. The financial statements have been prepared under the historical cost except for the modification to a fair value basis as specified in the accounting policies below.

The Charity constitutes a public benefit entity as defined by FRS 102.

All financial information is presented in British Pounds Sterling (£), the Charity’s functional currency, and has been rounded to the nearest pound (£).

Critical accounting estimates and judgements

The preparation of financial statements requires the use of certain critical accounting estimates and judgements. It also requires the Trustees’ to exercise judgement in the process of applying accounting policies. Estimates and judgements are continually evaluated and are based on historical experience and other factors, including an expectation of future events that are believed to be reasonable under the circumstances. Although these estimates are based on the Trustees’ best knowledge of the amount, event or actions, actual results may differ from those estimates.

There are no areas requiring the use of estimates and critical judgements that may significantly impact on the Charity’s financial activities and financial position.

Assessment of going concern

The Trustees have assessed whether the use of the going concern assumption is appropriate in preparing these financial statements. The Trustees have made this assessment in respect to a period of one year from the date of approval of these financial statements.

The Charity has prepared forecasts and budgets for a three year period to 2024/25 which provide the Trustees with detailed costs for Pathway projects currently undertaken and proposed, together with an indication of how projected costs could be scaled back should funding levels fall. The Trustees and the management team are currently in discussion with both existing and prospective funding bodies regarding future grant awards and are optimistic that further funding will be available to meet future expenditure and allow the Charity to meet its liabilities as they fall due. Having considered the Charity’s budget forecasts and the Charity’s cash reserves at 30 June 2021 of £897,345, the Trustees are satisfied that there will be sufficient future funds to allow the Charity to continue as a going concern.

31

Notes to the financial statements: 15-month period ended 30 June 2021

1. Accounting policies (continued)

Fund accounting

Unrestricted funds are funds which are available for use at the discretion of the Trustees in furtherance of the general objectives of the charitable company and which have not been designated for other purposes.

Restricted funds are funds which are to be used in accordance with specific restrictions imposed by the donors. The aim and use of each restricted fund are set out in the notes to the financial statements. Expenditure incurred in fulfilling the objective of each restricted fund is charged against the fund balance and shown in the relevant expenditure category in the Charity’s statement of financial activities.

Income

Income from donations is recognised in the period in which the Charity becomes entitled to the donation and where receipt is probable and its amount can be measured reliably.

Income from grants is recognised when the Charity has entitlement to the funds, any performance conditions attached to the grant have been met, it is probable that the income will be received and the amount can be measured reliably and is not deferred.

Income for the provision of commissioned research and other projects is recognised when the Charity is entitled to receipt, any performance conditions have been met and the amount can be measured reliably.

Income from Pathway Partnership agreements in which the Charity provides a programme of support to hospital teams following the Pathway model is recognised as services are provided under the terms of the agreement.

Income from donated services are recognised at fair value provided that the value can be reliable measured. Fair value is determined by reference to the open market price that the Charity would pay for the services provided.

Expenditure

Expenditure is recognised once there is a legal or constructive obligation to make a payment to a third party, it is probable that settlement will be required and the amount of the obligation can be measured reliably. It includes VAT which cannot be recovered.

Expenditure on charitable activities

Expenditure on charitable activities includes the costs of delivering the Pathway services and other activities undertaken for the purposes of the Charity. Included is the direct cost of the Pathway service and an apportionment of support costs.

Support and governance costs

Support costs are those functions that assist the work of the Charity but do not directly undertake charitable activities. Support costs include administration, personnel and governance costs. Governance costs include audit costs and legal costs relating to the Charity’s compliance with regulation and good practice.

32

Notes to the financial statements: 15-month period ended 30 June 2021

1. Accounting policies (continued)

Financial instruments

The Charity only holds basic financial instruments as defined in FRS102. The financial assets and financial labilities and their measurement basis is as follows:

Financial assets – trade debtors, other debtors and accrued income are basic financial instruments and are debt instruments measured at amortised cost as detailed in note 9. Prepayments are not financial instruments.

Cash at bank – is classified as a basic financial instrument and is measured at face value.

Financial liabilities – trade creditors and accrued expenses are financial instruments and are measured at amortised cost as detailed in note 10.

Financial assets and liabilities

Financial assets and financial liabilities are recognised in the balance sheet when the Charity becomes party to the contractual provisions of the instrument.

Debtors

Trade and other debtors are initially recognised at their settlement amount and subsequently at amortised cost or their recoverable amount. Impairment provisions are recognised when there is objective evidence, such as significant financial difficulties on the part of the counterparty or default or a significant delay in payment, that the Charity will be unable to collect all of the amounts due.

Prepayments are valued at the amount prepaid.

Cash at bank

Cash at bank represents cash that is available on demand or has a maturity of less than three months from balance sheet date. Deposits for more than three months but less than one year are disclosed as short term deposits.

Creditors and provisions

Creditors and provisions are recognised when there is an obligation at the balance sheet date as a result of a past event, it is probable that a transfer of economic benefit will be required in settlement, and the amount of the settlement can be measured or estimated reliably.

Creditors and provisions are initially recognised at fair value, being the amount the Charity anticipates it will pay to settle the debt, and subsequently at amortised cost.

Pensions

Employer’s contributions in respect of defined contribution pension schemes are charged to the statement of financial activities in the year in which they are payable to the scheme.

33

Notes to the financial statements: 15-month period ended 30 June 2021

1. Accounting policies (continued)

Short term employment benefits

Short term employment benefits such as salaries and compensated absences (holiday pay) are recognised as an expense in the year in which the employees render service to the Charity. Any unused benefits are accrued and measured at the amount the Charity expects to pay to the employees to settle the unused entitlements.

2. Income from charitable activities

	Unrestricted funds £	Restricted funds £	15-month period to 30 June 2021 £
Grants The Health Foundation NHS England / Innovation The Oak Foundation Crisis UK Texel Foundation Trust for London Rayne Foundation Isla Foundation Marie Curie Health Education England Manchester Health & Social Care Partnership Other grants Total grants Research and project income University College London Hospital NHS Foundation Trust Pathway Partnership Fees (Hull, Salford, Leeds, Hackney, Croydon) NHS NE London CSU (Healthy London Partnership) Queen’s Nursing Institute Guy’s & St Thomas’ Hospital NHS Foundation Trust Sheffield CCG Other projects Total research and project income 2021 Total funds from charitable activities	— — 38,500 — — — — — — — — —	205,915 199,532 156,031 164,718 50,000 45,000 30,000 18,260 14,810 10,000 10,000 14,200	205,915 199,532 194,531 164,718 50,000 45,000 30,000 18,260 14,810 10,000 10,000 14,200
	38,500	918,466	956,966
	— 33,750 — — 16,667 — 1,835	102,694 — 31,330 25,826 — 10,000 10,380	102,694 33,750 31,330 25,826 16,667 10,000 12,215
	52,252	180,230	232,482
	90,752	1,098,696	1,189,448

34

Notes to the financial statements: 15-month period ended 30 June 2021

2. Income from charitable activities (continued)

Income from charitable activities(continued)
Comparative period	Unrestricted funds £	Restricted funds £	Year ended 31 March 2020 £
Grants The Oak Foundation The Health Foundation Texel Foundation Clothworkers Company Greater London Authority DW Trust Queen Mary University London Other grants Total grants Research and project income University College London Hospitals NHS Foundation Trust Guy’s & St Thomas’ NHS Foundation Trust Hackney Council Warwickshire County Council Queen’s Nursing Institute Other projects Total research and project income 2020 Total funds from charitable activities	250,000 — — — — — — —	— 178,373 50,000 32,000 12,832 7,500 (19,299) 7,370	250,000 178,373 50,000 32,000 12,832 7,500 (19,299) 7,370
	250,000	268,776	518,776
	— 20,000 — 800 — 15,510	72,420 — 20,000 20,000 12,819 —	72,420 20,000 20,000 20,800 12,819 15,510
	36,310	125,239	161,549
	286,310	394,015	680,325

35

Notes to the financial statements: 15-month period ended 30 June 2021

3. Expenditure

Expenditure
	Unrestricted funds £	Restricted funds £	15-month period to 30 June 2021 £
Charitable activities Direct costs Pay costs including staff costs Consultants’ fees Staff training Printing Patients’ costs Patients’ legal advice Hospital Teams – incentive grants Travel and subsistence Catering Volunteer/Service User expenses Conference provision Marketing and design Stationery Insurance Equipment Costs – PPE Total direct costs Support costs Pay costs including staff costs Staff training Marketing and design Insurance Bank and payroll charges Legal advice (pro-bono) Stationery Total support costs Governance costs Legal Fees (pro-bono) Audit and accountancy fees Total governance costs 2021 Total expenditure	95,996 1,650 3,259 222 4,412 — — — — (125) — — 38 — —	215,192 296,220 2,675 806 10,699 26,666 100,000 1,333 640 6,113 5,000 2,870 3,947 336 39,718	311,188 297,870 5,934 1,028 15,111 26,666 100,000 1,333 640 5,988 5,000 2,870 3,985 336 39,718
	105,452	712,215	817,667
	84,610 209 — 4,920 955 12,562 499	57,238 114 3,505 — 181 — —	141,848 323 3,505 4,920 1,136 12,562 499
	103,755	61,038	164,793
	69,296 8,356	— 2,050	69,296 10,406
	77,652	2,050	79,702
	286,859	775,303	1,062,162

36

Notes to the financial statements: 15-month period ended 30 June 2021

3. Expenditure (continued)

Expenditure(continued)
Comparative period	Unrestricted funds £	Restricted funds £	Year ended 31 March 2020 £
Charitable activities Direct costs Pay costs including staff costs Consultants’ fees Staff training Printing Patients’ costs Patients’ legal advice Telephone Travel and subsistence Catering Volunteer/Service User expenses Conference provision Marketing and design Stationery Staff uniforms Total direct costs Support costs Pay costs including staff costs Staff recruitment Consultants’ fees Marketing and design Catering Legal advice Printing Insurance Bank and payroll charges Stationery Total support costs Governance costs Trustees’ expenses Audit and accountancy fees Total governance costs 2020 Total expenditure	99,098 4,961 8,893 — 65 — 10 1,808 48 1,170 21,196 678 — 68	208,809 250,400 2,048 1,503 6,184 11,787 — 3,979 3,886 4,109 5,000 6,551 1,003 —	307,907 255,361 10,941 1,503 6,249 11,787 10 5,787 3,934 5,279 26,196 7,229 1,003 68
	137,995	505,259	643,254
	92,733 2,400 400 — 3,500 5,000 360 5,711 870 495	37,000 — — 6,882 — — — — — —	129,733 2,400 400 6,882 3,500 5,000 360 5,711 870 495
	111,469	43,882	155,351
	191 8,273	— —	191 8,273
	8,464	—	8,464
	257,928	549,141	807,069

37

Notes to the financial statements: 15-month period ended 30 June 2021

4. Staff costs including key management personnel

Staff costs including key management personnel
	15-month period to 30 June 2021 £	Year ended 31 March 2020 £
Wages and salaries Social security costs Pension contributions	409,562 33,091 10,796	392,382 34,374 10,293
	453,449	437,049

One member of staff was seconded from SLAM’s Pathway team to the core team for one day per week from 1 April to mid August 2020 (one in 2020).

In 2021, no wages and salary costs arose from secondments secured from the Civil Service (2020: £22,000).

One employee earned over £80,000 in the 15-month period to 30 June 2021 with their salary band falling between £60,001 - £90,000. On an annualised basis, the salary banding would have between £60,001-£70,000. In the year ended 31 March 2020, the banding was £60,001 - £70,000.

The average monthly number of employees (including key management personnel) during the 15month period to 30 June 2021 was nine (2020 – nine). On a full time equivalent basis, the number of employees was:

	15-month period to 30 June 2021 No	Year ended 31 March 2020 No
Care Navigators Key Management (CEO, Medical Director & Finance Director) Senior Healthcare Navigator Coordinator / Healthcare Advisor Senior Nurse Communications Officer Project Manager Research and administration	0.4 1.6 0.6 0.8 0.8 1.0 1.1	1.1 1.6 0.6 0.7 0.8 1.0 2.0
	6.3	7.8

Key management personnel

Key management personnel are those persons having authority and responsibility for planning, directing and controlling the activities of the Charity and are represented by the Trustees and the Executive Management Team, which comprise the Chief Executive, Finance and Administration Director and the Medical Director.

The number of key management personnel in the 15-month period to 30 June 2021 was three (2020 – three) (Full time equivalent basis:1.6 (2020: 1.6)).

38

Notes to the financial statements: 15-month period ended 30 June 2021

4. Staff costs including key management personnel (continued)

The total emoluments received by the key management personnel in the 15-month period was:

Salaries Employer’s NI & Pension contributions	15-month period to 30 June 2021 £ 165,782 20,957 186,739	Year ended 31 March 2020 £ 132,234 16,590 148,824

Trustees’ remuneration

None of the Trustees nor any persons connected with them received any remuneration as a result of them holding the office of Trustee during the current period or preceding year.

5. Net movement in funds

This is stated after charging:

	15-month period to 30 June 2021 £	Year ended 31 March 2020 £
Auditors’ remuneration . Statutory audit services	8,490	8,200

6. Trustees’ expenses

No expenses were paid to Trustees during the period (2020: £191 to one Trustee).

7. Trustees’ indemnity insurance

The charitable company purchased insurance to cover the Trustees for costs and expenses incurred in respect of claims arising out of an actual or alleged wrongful act committed in good faith. It is not possible to identify separately the cost of the indemnity insurance.

8. Taxation

Pathway is a registered Charity and therefore is not liable to income tax or corporation tax on income derived from its charitable activities, as it falls within the various exemptions available to registered charities.

39

Notes to the financial statements: 15-month period ended 30 June 2021

9. Debtors

Debtors
	30 June 2021 £	31 March 2020 £
Trade debtors Accrued income Prepayments	750 30,972 32,025	63,708 652 1,805
	63,747	66,165
Creditors: amounts falling due within one year	30 June 2021 £	31 March 2020 £
Trade creditors Accruals Deferred income	39,879 73,779 31,250	32,192 22,570 —
	144,908	54,762

10. Creditors: amounts falling due within one year

Deferred income represents Pathway Partnership income where the programme of support will be delivered in 2021/22.

11. Unrestricted funds

	At 1 April 2020 £	Income £	Expenditure £	At 30 June 2021 £
General unrestricted funds	327,104	211,190	(286,859)	251,435
	At 1 April 2019 £	Income £	Expenditure £	At 31 March 2020 £
General unrestricted funds	260,243	324,789	(257,928)	327,104

40

Notes to the financial statements: 15-month period ended 30 June 2021

12. Restricted funds

Greater London Authority The Health Foundation Department of Health Royal Free NHS Foundation Trust Justlife Foundation The Coop, Homed and other – Donations for Brighton Texel Foundation London Catalyst Clothworkers Company Warwickshire County Council Mental Health & Rough Sleeping Donation Hackney Council Crisis UK The Oak Foundation Queen Mary University London Trust for London AB Charitable Trust Health Education England Grocers’ Company University College London Hospitals NHS Foundation Trust Queen’s Nursing Institute UCLH Friends Stephen Clark Charitable Settlement London Solicitors Company Rayne Foundation Isla Foundation Marie Curie British Geriatrics Society NHS England/Innovation Manchester Health & Social Care Partnership Royal Borough of Kensington & Chelsea (West London ICS) NHS NE London CSY (Healthy London Partnership) Sheffield CCG Barking & Dagenham CCG Plymouth CCG NE London CCG Donation for Mouse Film Donations for patients phones UCLH Donations for Faculty for Homeless & Inclusion Health Faculty Members donations	At 1 April 2020 £	Income £	Expenditure £ (2,706) (240,397) — — (732) (4,763) (49,787) (1,649) (15,565) (6,324) — (7,025) (99,851) (77,647) — (31,670) (2,765) (14,830) — (101,984) 25,826 — (252) — (20,000) (7,259) — — (17,126) (600) (1,000) (31,330) (4,971) (550) — (480) (8,214) — — —	At 30 June 2021 £
	4,035 39,648 7,464 35,000 1,685 4,763 14,071 1,528 16,234 18,925 3,132 7,261 4,135 18,804 2,350 44 2,765 7,630 4,500 — — 818 3,629 1,000 — — — — — — — — — — — — — 1,258 3,648 —	— 230,915 — — — — 50,000 1,000 — — — — 164,718 156,031 — 45,000 - 10,000- — 102,694 25,826 — — — 30,000 18,260 14,810 5,700 199,532 10,000 7,500 31,330 10,000 5,000 4,900 480 10,000 — — 2,029		1,329 30,166 7,464 35,000 953 — 14,284 879 669 12,601 3,132 236 69,002 97,188 2,350 13,374 — 2,800 4,500 710 — 818 3,377 1,000 10,000 11,001 14,810 5,700 182,406 9,400 6,500 — 5,029 4,450 4,900 — 1,786 1,258 3,648 2,029
	204,327	1,135,725	(775,303)	564,747

41

Notes to the financial statements: 15-month period ended 30 June 2021

12. Restricted funds (continued)

Comparative period	At 1 April 2019 £	Income £	Expenditure £	At 31 March 2020 £
Greater London Authority The Health Foundation Department of Health Royal Free NHS Foundation Trust Justlife Foundation The Coop, Homed and other – Donations for Brighton Texel Foundation London Catalyst Clothworkers Company Warwickshire County Council Mental Health & Rough Sleeping Donation Hackney Council John Ellerman Foundation Crisis UK The Oak Foundation Lankelly Chase Foundation Queen Mary University London Trust for London AB Charitable Trust Health Education England DW Trust UCLH Charities Tesco Bags of Help Grocers’ Company University College London Hospitals NHS Foundation Trust The Burdett Trust for Nursing Queen’s Nursing Institute UCLH Friends Stephen Clark Charitable Settlement University College London London Solicitors Company Austin & Hope Pilkington Trust Donations for patients phones UCLH Donations for Faculty for Homeless & Inclusion Health	— — 17,564 35,000 3,768 2,050 — 585 — — 3,132 — 2,545 917 138,679 26,850 28,074 1,144 12,179 43,058 — — 1,136 4,500 15,225 2,942 — 1,088 3,629 1,900 1,000 100 450 117	12,832 178,373 — — — 6,141 50,000 1,000 32,000 20,000 — 20,000 — 5,000 — — (19,299) — — — 7,500 420 950 — 72,420 — 12,819 — — — — — 1,000 4,680	(8,797) (138,725) (10,100) — (2,083) (3,428) (35,929) (57) (15,766) (1,075) — (12,739) (2,545) (1,782) (119,875) (26,850) (6,425) (1,100) (9,414) (35,428) (7,500) (420) (2,086) —- (87,645) (2,942) (12,819) (270) — (1,900) — (100) (192) (1,149)	4,035 39,648 7,464 35,000 1,685 4,763 14,071 1,528 16,234 18,925 3,132 7,261 — 4,135 18,804 — 2,350 44 2,765 7,630 — — — 4,500 — — — 818 3,629 — 1,000 — 1,258 3,648
	347,632	405,836	(549,141)	204,327

42

Notes to the financial statements: 15-month period ended 30 June 2021

12. Restricted funds (continued)

Greater London Authority

The grant paid for support and evaluation of a short-term pilot Pathway Homeless team in St Mary’s Hospital funded by Cold Weather Funding. The pilot was cut short due to Covid-19. Work to produce communication material is ongoing.

The Health Foundation

Funding of £389,430 was awarded to continue the exploration of social franchising and licensing into the validation phase of spreading Pathway’s hospital team model and to secure a sustainable funding stream for the core Charity. The funding was for the period March 2019 to August 2020, although an extension to the project was agreed to the end of March 2021 because of the delays caused by the outbreak of Covid-19. A small amount of funding remains which relates to committed legal work associated with branding and updating of the website now renamed Pathway Partnership Programme rather than Social Franchising.

In addition, The Health Foundation provided £25,000 to fund mobile phones for homeless patients to support ongoing communication with them during the pandemic.

Department of Health

In October 2013, a grant of £469,145 was secured from the Department of Health’s Homeless Hospital Discharge Fund to develop a pilot medical respite centre. Work continued during 2015/16 to develop, launch and implement a pilot project Pathway to Home. Reports of Pathway’s work on medical respite were published in 2016, and a seminar to showcase and discuss various studies was held in January 2017. Work continues to investigate ways to develop the medical respite and other step down options for homeless patients leaving hospital.

Royal Free NHS Foundation Trust

In December 2017, the Royal Free NHS Foundation Trust agreed that the funds being held for a pilot service in their hospital of £20,000 plus a £15,000 creditor could be used to explore and develop provision for homeless patients leaving the hospital.

Justlife Foundation

In April 2014 the collaborative partnership led by Justlife Foundation was awarded funding from Brighton and Hove NHS Clinical Commissioning Group (CCG) to continue the service Pathway+ in Brighton. As lead partner, Justlife Foundation received the funding and paid Pathway on a staged basis. The service was re-tendered during 2016, and Arch Health CIC won the contract from 1 February 2017. The remaining funds held by Pathway from Justlife Foundation for the Brighton service paid for miscellaneous expenses and reflective practice for the team.

The Cooperative Society

The Pathway Homeless Hospital Team in Brighton was chosen to be a recipient of the local Cooperative Community funding for the year ending October 2019, and a donation of £6,141 was made to the homeless patients’ dignity fund. This paid for a range of items for the patients seen by the Brighton Pathway Team, including clothes, mobile phones, key deposits, travel costs, initial food supplies on discharge from hospital and small treats during the hospital admission such as confectionary and newspapers.

43

Notes to the financial statements: 15-month period ended 30 June 2021

12. Restricted funds (continued)

Texel Foundation

A grant of £100,000 over two years was awarded from 1 April 2019 to support the work of the Faculty for Homeless and Inclusion Health, and payments were made quarterly in advance.

London Catalyst

The balance of the grant at 1 April 2020 was used to purchase smart phones for homeless people who were identified as needing to self-isolate due to Covid-19 following their relocation to hotels. A phone enables them to have consultations with clinical personnel. In December 2021, a further grant of £1,000 towards patient dignity for use by the Pathway teams in the Royal London Hospital and UCLH.

Clothworkers Company

A grant of £32,000 was made in June 2019 to support and train homeless people to teach professionals about homelessness, give voice to the most excluded and speak out about homelessness. Work commenced on this project in autumn 2019.

Warwickshire County Council

Funding of £20,000 was provided for the development of needs assessments and associated business cases for Pathway teams at four hospitals across the county. Two needs assessments have been completed and work continues on the remaining two.

Hackney Council

Funding of £20,000 was provided for the development of a needs assessment and associated business case for a Pathway team at hospitals serving the borough. The business case was accepted and funding has been secured to create a team in the Homerton Hospital. Hackney CCG signed Pathway’s Partnership agreement, and Pathway is supporting the creation of the team.

Crisis

At the start of the pandemic there was concern among Pathway clinicians that there was a shortage of suitable PPE equipment. Crisis provided funding of £39,718 for the procurement of some equipment.

Following the negotiations for the merger of Crisis and Pathway and before the formal arrangement had been finalised, Crisis made a core-funding grant of £125,000 for the final quarter of 2020/21. Agreement was received to carry forward the uncommitted balance of £34,800 to be earmarked for the Resilient One project.

The balance of £2,167 of the previous year’s grant to support Experts by Experience at the Faculty for Homeless and Inclusion Health’s conference has been carried forward for the 2022 conference.

44

Notes to the financial statements: 15-month period ended 30 June 2021

12. Restricted funds (continued)

The Oak Foundation

In September 2018 The Oak Foundation approved a grant of £337,668 over two years to build on the research end of life care project for homeless people by developing further, implementing and evaluating the training programme for agencies working with homeless people. The project, entitled Palliative Care Training, commenced in September 2018. There has been slippage in the project and as a result the deadline for the project has been extended, with the second tranche of funding paid in April 2020 following the submission of the first monitoring report. Work continues on the project with the agreement of the funder.

Queen Mary University London (QMUL)

In September 2018, QMUL paid £29,600 to Pathway which is a grant awarded by Barts Charity for an assessment of needs for a Pathway team in Newham hospital. Work commenced in December 2018 and a draft needs assessment and business case were completed towards the end of 2019. The cost of GP input was lower than estimated, and £19,299 of unspent funding was repaid to QMUL in February 2020. The remaining balance of funding is being held to publish and launch the final version of the needs assessment.

Trust for London

The grant of £135,000 grant awarded in March 2020 is to continue and extend the work further to include two mental health teams. Contracts for services were issued to legal firms in July 2020 and teams are able to access tier 2 legal advice.

AB Charitable Trust

In November 2018, AB Charitable Trust awarded a grant of £15,000 for the continued provision of legal advice to homeless people in hospital on housing and other related issues in UCLH and Pathway patients in the south London hospitals. The balance of funding was spent on specialist legal advice related to patients who have ‘No recourse to public funds’.

Health Education England

In March 2016, Health Education England provided a grant of £48,350 towards project ‘Resilient 1’ the production of an educational film and materials aimed at preventing homelessness among vulnerable young people with severe mental illness. The materials will be used to provide training and participatory engagement resources to the staff of Tier 4 CAMHS units across the UK. Work started on the project in April 2016 and continued following the award of a further grant of £46,525 by Health Education England in 2017/18. Filming on location took place in 2019, and further editing is taking place.

A grant of £17,400 from Health Education England was paid to Pathway in March 2018 for the provision of the 2[nd] National Socially Inclusive Dentistry conference which was held in Birmingham in December 2018. The balance of funding is earmarked for the Oral Health sub-group of the Faculty for Homeless and Inclusion Health.

A grant of £20,000 to develop e-learning modules in inclusion health was paid to Pathway in March 2019, and the modules were finalised in spring 2020.

A grant of £10,000 was paid in November 2020 to map the availability of inclusion health learning resources. Work was completed in April 2021.

45

Notes to the financial statements: 15-month period ended 30 June 2021

12. Restricted funds (continued)

Grocers’ Company

In February 2018, the Grocers’ Company awarded a grant to Pathway for the development and piloting of a Mental Health and Trauma training resource. Work on the project began in 2018, and pilots of the training module were run throughout 2019. Discussions are continuing how to take this work forward.

University College London Hospitals NHS Foundation Trust

UCLH NHS Foundation Trust approved a business case in 2013 to fund four sessions a week of a GP for its Pathway led hospital homeless team and also to provide a second nurse for the service. The funding pays for the GP’s services, and in 2020-21 they also provided funding for a Care Navigator for six months following which the post became redundant. Funding is being provided for GP sessions until the new integrated care consultant takes up post later in 2021 and that postholder will take clinical responsibility for the UCLH Pathway team.

Queen’s Nursing Institute

An agreement to second Pathway’s Nursing Fellow for one day per week to support partnership working at the Queen’s Nursing Institute (QNI) was extended until the end of September 2021.

In addition, £5,000 funding was provided for specialist GP input into the evaluation of the QNI’s work on homelessness.

UCLH Friends

A grant of £4,880 was agreed to produce and publish a handbook that could be given to homeless patients attending or admitted to UCLH. The booklet was launched in the autumn 2018 and was reprinted in May 2019. Residual funding is held for further reprints of the booklet.

Stephen Clarke Charitable Settlement

In October 2018, Pathway received a grant of £4,000 towards the cost of supporting the work of the Pathway team in Bristol.

City of London Solicitors’ Company

In February 2019, the City of London Solicitors’ Company awarded a grant of £1,000 towards the continued provision of legal advice to homeless people in hospital on housing and other related issues in London hospitals where there is a Pathway team.

Rayne Foundation

In March 2021 funding of £90,000 spread over three years was awarded for the further development of the Resilient work to prevent children and young people under the care of CAMHS from becoming homeless.

Isla Foundation and British Geriatrics Society

Funding of £18,260 was received in January 2021 from Isla Foundation and £5,700 in March 2021 from the British Geriatrics Society for work to develop and test a reproducible screening tool and short frailty questionnaire for reporting presence of frailty amongst residents in hostels. The work is expected to be concluded before the end of the calendar year.

46

Notes to the financial statements: 15-month period ended 30 June 2021

12. Restricted funds (continued)

NHS England / Innovation

In March 2021, Pathway received £150,000 grant funding for a project - ‘Pathways to inclusive employment’ - to work with seven NHS Trusts to recruit people with personal experience of homelessness to train as Health Care Support Workers. The work will include identifying and addressing barriers to employment in the NHS, and to develop a policy and practice toolkit for wider application and adoption of evaluated processes. The project is in partnership with Groundswell and the Royal Society for Public Health who have received separate grant funding and have separate roles. Pathway is responsible for Pathway’s to inclusive employment’

In August 2020, a small grant of £9,950 was made for call off policy advice on homeless and inclusion health.

Early in 2021, grant funding of £19,732 was provided to make an information film for NHS staff about the experiences of homeless patients attending hospital called ‘Someone Please Listen’. Filming has been delayed due to Covid-19 restrictions but should restart in summer 2021.

In March 2021, grant funding of £19,850 was approved for the further development and testing of webinars about end of life and palliative care for people living in hostels. The testing is being carried out by organisations in Hull and Birmingham.

Marie Curie

A grant of £14,810 for work on palliative care for people with unsettled status was made in March 2021. The project has been delayed pending recruitment of a research associate but is planned to begin in September 2021

Manchester Health and Social Care Partnership

Funding of £10,000 was provided at the beginning of 2021 to provide call off policy advice and support on homeless and inclusion health.

Royal Borough of Kensington and Chelsea (West London ICS)

Grant funding of £7,500 received in June 2021 for a study collecting and analysing baseline data about homeless patients attending hospital which will be used to assess what additional services are required in the wider West London area.

NHS North East London CSY (Healthy London Partnership)

Funding of £31,330 received for the significant additional work in the first wave of the Covid-19 pandemic by Alex Bax, Pathway’s CEO and Pathway Fellows Sam Dorney-Smith and Zana Khan.

Sheffield CCG

Funding of £15,000 was provided for the development of a needs assessment and associated business case for a Pathway team at hospitals serving the Sheffield area. The draft needs assessment is currently being revised and should be ready for publication before the autumn.

47

Notes to the financial statements: 15-month period ended 30 June 2021

12. Restricted funds (continued)

Barking and Dagenham CCG

Funding of £5,000 was provided to support the development of a needs assessment for a Pathway team. The needs assessment was delayed due to the pandemic but is nearing completion.

Plymouth CCG

Funding of £4,900 was provided to support the development of a needs assessment for a Pathway team. Currently work is underway on a business case for a service.

Donation for Mouse Film

A legacy donation of £15,000 from the estate of Miss Ros Bax was received in March 2021. Of this, £10,000 was a restricted contribution towards the completion of the training film: The Mouse which is aimed at preventing homelessness in young people accessing CAMHS services.

13. Analysis of net assets between funds

Analysis of net assets between funds
	Unrestricted funds £	Restricted funds £	Total 30 June 2021 £
Current assets Current liabilities 2021 net assets	296,438 (45,005)	664,654 (99,905)	961,092 (144,908)
	251,435	564,749	816,184
Comparatives	Unrestricted funds £	Restricted funds £	Total 31 March 2020 £
Current assets Current liabilities 2020 net assets	347,000 (19,896)	239,193 (34,866)	586,193 (54,762)
	327,104	204,327	531,431

14. Related party transactions

No transactions have taken place with organisations in which a member of the board of Trustees has an interest.

15. Controlling party

The Trustees made up the membership of the charitable company. There was no overall controlling party in the period being reported.

From 1 July 2021, Crisis UK is the controlling party by virtue of being the sole member.

16. Members’ liability

Each member of the charitable company undertakes to contribute to the assets of the company in the event of it being wound up while he/she is a member or within one year after he/she ceases to be a member, not exceeding £1.

48

Notes to the financial statements: 15-month period ended 30 June 2021

17. Post balance sheet events

On 1 July 2021, Crisis UK became Pathway’s sole Member and all previous members resigned although they remain Trustees and Directors of the Charity and charitable company. A signed operating agreement between Crisis UK and Pathway came into force from that date.

Pathway remains a separate registered Charity but is subsidiary of Crisis UK. Crisis UK has appointed one of its Trustees, Martin Cheeseman, to the Pathway’s Board of Trustees.

49