2023-06-30-accounts

The London Pathway

Operating as Pathway

Annual Report and Financial Statements

Year ended 30 June 2023

Company Limited by Guarantee Registration Number 07210798 (England and Wales) Charity Registration Number 1138741

Contents

Reports
Reference and administrative details	3
Trustees’ report	4
Independent auditor’s report	25
Financial statements
Statement of financial activities	29
Balance sheet	30
Statement of cash flows	31
Principal accounting policies	32
Notes to the financial statements	35

Pathway

Trustees’ report Year ended 30 June 2023

Trustees	Lady Rhona Bradley
	Mr Martin Cheeseman
	Prof Yvonne Doyle CB -appointed 1 Dec 22
	Dr Vanya Gant
	Mr Richard Guest
	Prof Andrew Hayward -resigned 25 Oct 22
	Ms Cathy James OBE -resigned 3 July 23
	Sir Ian Kennedy -resigned 16 Jan 23
	Ms Joanne Land -appointed 27 Jan 23
	Prof Mohammed Sultan Mahmud -appointed 3 Jan 23
	Ms Leslie Ann Morphy OBE (Chair)
	Mr Anthony Omo - appointed 20 Jan 23
	Mr Stephen Robertson (Vice Chair)
	Mr Simon Tuttle
Chief Executive	Mr Alex Bax
Finance "Director" and Company	Ms Stephanie Swan
Secretary
Medical "Director" and Secretary to the	Dr Christopher Sargeant -appointed 1 Aug 22
Faculty for Homeless and Inclusion Health
Policy and Programmes “Director”	Ms Dee O’Connell
Registered office	4th 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 Year ended 30 June 2023

The trustees of the charity present their annual report and audited financial statements for the year ended 30 June 2023. This is the second full year following Pathway becoming a 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 32 to 34 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

This report has been prepared in accordance with Part 8 of the Charities Act 2011.

The financial statements have been prepared in accordance with the accounting policies set out on pages 32 to 34 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).

During the reporting period the charity was governed by a Memorandum and Articles of Association incorporated on 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 including a trustee representing Crisis UK’s Board of Trustees and is 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 trustee resigned from the charity during the year. A list of the current trustees is set out on page 1.

Small groups of Trustees are established and meet as required to discuss specific topics in year In 2022-23 two small groups have: i) finalised a risk policy and strategic risk register for the charity; and ii) to review the current pay arrangements given the current cost of living pressures. Recommendations from the sub-groups are taken to full Board meetings for decisions. The Chair of Trustees meets the Chief Executive regularly and the trustee charged with reviewing finances meets with the Finance and Administration Director before the full Board meeting.

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Trustees’ report Year ended 30 June 2023

Structure, Governance and Management (continued)

Key management personnel

Pathway’s key personnel are the Chief Executive, Finance and Administration Director, Medical Director and Policy and Programmes Director (newly appointed in 2022-23).

Following recommendations from key management personnel, the full Board reviewed the staff structure and remuneration of all current staff and vacant posts including the key personnel, and agreed the annual pay award. They subsequently reviewed the pay of the most junior posts and agreed an additional flat rate pay award for those staff. 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.

Recruitment, appointment and training of trustees

A trustee is a member of the Board of Trustees of the charity and a director of the charitable company for the purposes of the Companies Act 2006.

In accordance with Clause 12 of the Articles of Association of Pathway, the Trustees shall comprise of between eight and twelve Trustees who are appointed by the Trustees. The Trustees who were Trustees as at 1 July 2021 continued as Trustees of the Charity and no more than one Trustee appointed by Crisis UK was a Member Appointed Trustee. Each Trustee was 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 will 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.

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. New trustees are invited to an induction session with Pathway’s Chair and members of the Executive team.

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.

For the year 2022/23, there were eleven trustees. Professor Andrew Hayward resigned from the Board in October 2022, Sir Ian Kennedy resigned from the Board in January 2023 and Cathy James OBE resigned from the Board in July 2023.They were replaced by: Prof Yvonne Doyle CB (appointed December 2022; Prof Sultan Mahmud, Anthony Omo and Joanne Land (all appointed in January 2023).

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Trustees’ report Year ended 30 June 2023

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 draft budget and staff structure for Pathway were presented to Board of Trustees for discussion, and were approved by the Board at their April meeting. Progress reports were presented to the quarterly meetings of the Board. An additional strategic meeting was convened in June 2023 to discuss Pathway’s strategic direction, the proposed new five year strategic plan and the priorities for the forthcoming period.

New job descriptions, associated levels of remuneration and annual pay awards are submitted to the Board for discussion and approval.

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, a signed operational agreement with Crisis UK came into force, and minutes of the Board meeting confirmed as an accurate record by the Chair are submitted to Crisis UK.

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.

Three key risks for the Charity continue to be the loss of key personnel, insufficient funding to maintain the core charity and the economic impact of government policies, the recent pandemic and fall out from international political events. 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 Trustees are managing the risk of insufficient funding to maintain core staff by ensuring that grant and other charitable funding is sought; partnership and similar fees are reviewed regularly and increased by inflation; and by employing a Business Development Manager from November 2022.

3. The Trustees recognise that it is impossible to mitigate for national and international policies and pandemics, but they continue to keep abreast with developments and maintain Pathway’s reputation with Government and other National Strategic organisations.

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Trustees’ report Year ended 30 June 2023

Structure, Governance and Management (continued)

Risk management (continued)

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

The Trustees developed and approved a specific risk policy for Pathway during the year.

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 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.

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.

Implementation of Objectives

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. In formulating and applying these objects, the trustees have regard for the guidance of the Charity Commission on Public Benefit.

Pathway’s strategic plan in place for 2022-23 (its final year) sets the objectives as:

Over the next five years, capitalising on the certainty and increased capacity that flows from becoming part of the Crisis Group, Pathway will build on its position as:

• a recognised leader in the field of healthcare for people experiencing homelessness 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

• the leader of a growing cohort of dedicated, specialist professional health workers putting compassion at the heart of their practice, especially through development of The Faculty of Homeless and Inclusion Health

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Trustees’ report Year ended 30 June 2023

Objectives (continued)

Implementation of Objectives (continued)

In addition, Pathway and Crisis UK agreed a shared sub-set of objectives:

• 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

• 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 has agreed six strategic aims to deliver both sets of objectives:

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

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

3. To stimulate or lead research on gaps in care or 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

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

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance

Aim 1: To support existing Pathway hospital teams, foster more teams and build a national inclusion health care quality network

1. New hospital teams in Pathway Partnership Programme and network

• The new team in University Hospital Plymouth was established, launched and joined the Pathway Partnership Programme in August 2022.

• Kent and Medway CCG launched a six month pilot Pathway team in the Queen Elizabeth the Queen Mother Hospital in Margate in April 2022, and the pilot was extended to March 2023 with Pathway support. From April 2023, a Trust-wide service supporting more hospitals in East Kent has been funded and will be introduced in Autumn 2023 as part of the Pathway Partnership Programme.

• In 2022-23 five London Pathway teams were supported as part of the Pathway Partnership Programme in: St George’s, Tooting, Imperial (St Mary’s) and Chelsea and Westminster, Homerton, Hackney, Croydon Health Services NHS Trust, Outer North West / Ealing / Northwick Park, and three teams outside London: Hull, Leeds and Salford. The service in Croydon was suspended towards the end of 2022 due to lack of staff, and a revised service is being re-constituted with a proposed launch date of Autumn 2023. The service in Salford reluctantly withdrew from the Partnership Programme due to severely reduced funding.

• University College London Hospital has indicated its intention to sign up to Pathway’s Partnership Programme and a bespoke agreement has been prepared but is yet to be signed.

• The remaining eight existing teams (The Royal London, Brighton & Sussex University Hospital, Bradford Royal Infirmary, Manchester Royal Infirmary, King’s Health Partners, covering Guy’s and St Thomas’, King’s College Hospital and South London and the Maudsley, and Bristol Royal Infirmary) have not yet joined Pathway’s Partnership Programme, but are invited to attend the regular network events.

2. Pathway needs assessments

• The Devon-wide needs assessment (excluding Plymouth) was completed and submitted in December 2022. Discussions are underway about how to take forward the recommendations.

• The final needs assessment for Warwickshire was completed and submitted in December 2022. Commissioners are considering next steps.

• The local Inclusion Health Lead and Commissioners in Sheffield are working to secure funding to introduce a team following the needs assessment recommendations.

• Following lengthy discussions taking place in 2022-23, a city-wide needs assessment for people with Multiple and Complex Needs in Hull has been commissioned by Hull City Council. Pathway’s role is to concentrate on the acute Trust, with work scheduled to start in the summer and take until the early 2024.

• We hosted a day-long meeting of 12 representatives from Cardiff and Vale (the council, Health Board, public health, Primary Care) to learn about Pathway, the Faculty and Integrated Services. They are currently considering and seeking funding for a Wales-wide response to improving services for people experiencing homelessness, including Pathway teams.

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance (continued)

3. Refine and deliver a structured quality support package for Pathway hospital teams

• The online Pathway team support manual has been updated and refined throughout the year.

• Two network meetings and a series of regular online masterclasses on key topics have been held online in the year for all Pathway teams. Topics have included: brain Injury; adult safeguarding and homelessness; routes into housing for patients experiencing homelessness; gender based violence, abuse and homelessness; and reflective practice in action.

• Pathway teams have been supported to collect and analyse data from their work to support progress reports to commissioners and support business cases for ongoing funding.

• Pathway teams were given complimentary places to the Faculty for Homeless and Inclusion Health’s International Symposium in March 2023 and to the annual CPD in Inclusion Health sessions.

• Following Pathway’s success in winning the annual London Homeless Award, by using some of the prize we have funded reflective practice for the teams within the Pathway Partnership Programme.

4. Expand and improve access to specialist legal advice for homeless patients

• Existing and new Pathway teams, partner mental health services and TB outreach services have been provided with specialist Tier 2 legal advice service for targeted patients, funded by Trust for London

• Funding secured from St Martin’s in the Field Charity’s Frontline programme to expand the specialist Tier 2 legal advice service for Pathway teams outside of London and also for more in-depth and complex legal issues for Pathway teams across the UK

• Slides from an information session about the legal project were circulated to delegates of the Faculty for Homeless and Inclusion Health’s International Symposium in March 2023

• Legal advisors gave a presentation at one of the masterclasses held online to share knowledge and learning to Pathway Teams

Aim 2: To identify, develop, test, champion and replicate new clinical interventions and models of care for inclusion health groups, maximising any opportunities that flow from NHS policy and funding changes

1. End of Life care work

• Community of practice development : material covering a range of areas related to multiple exclusion homelessness and palliative care has been developed and is hosted on a platform developed by Marie Curie. These resources support the development of localised multiprofessional communities of practice to support people experiencing homelessness who have advanced ill health. There have been three facilitator training programmes and there are now five localised communities of practice running across the country with more expected over the coming months.

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance (continued)

1. End of Life care work (continued)

2. National ECHO network : an online forum for people working in homelessness and/or palliative care, to come together, devise a curriculum and meet monthly, funded through NIHR and is a collaboration between Marie Curie, Pathway and York University. A live database of projects around the country working to support people experiencing homelessness with palliative care needs is being developed.

3. A new Palliative and end of life care on-line toolkit has been developed which was commissioned by NHSE and is on NHS Futures, to a) support frontline non-health homelessness staff identify people experiencing homelessness who may have palliative care needs and b) to identify (from people experiencing homelessness with advanced ill health) the quality of care they are receiving and c) exploring following a death, views of frontline hostel staff on the quality of care received by their residents. These tools are still in draft form, but are available for general use. There are two sites currently using them to support evaluation and further refinement of the tools.

4. Development of an health and frailty assessment questionnaire for hostel staff to complete with their clients, The aim is to support hostel staff to advocate more effectively with GP's and adult social care providers, by using language that is familiar to health and social care. This work has been successfully completed in two hostels, showing that hostel staff are able to get excellent information by working with their clients. The work has been written up and submitted for publication. There is a follow on phase for this work supported by Marie Curie to work with primary care and social care professionals to explore the best way of this information being presented and used.

2. Medical Respite / Intermediate Care

• Following beds being commissioned at the Mildmay hospital for intermediate step down care for homeless patients across London, Pathway was commissioned to prepare a service review report by the Mildmay Mission Hospital. The report was delivered in late May, and made a series of recommendations as to how the service for homeless patients stepping down from hospitals across London might be improved. Meanwhile the Mildmay has been given notice that its Londonwide contract will not be renewed after the end of June, and that teams wishing to refer patients to the Mildmay thereafter will have to make the case for individual spot purchase of a bed on a case by case basis. We are working to support the Mildmay as they campaign to reverse this decision, which is likely to lead to the closure of the service.

• Secured intermediate care as a priority project in the DHSC/NHSE Health and Wellbeing Alliance. With strong sponsorship from the national intermediate care programme in NHSE, we are working with East Kent to analyse and provide solutions to their complex cases, with the aim of both improving provision locally and developing learning with national application.

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance (continued)

3. Policy and Practice for Integrated Care Systems

• In September 2022 we launched a major project to devise a learning programme for ICSs who want to improve their inclusion health services. The programme was run jointly with Groundswell and the King’s Fund. Following invitations to all ICB’s we received 15 expressions of interest and we selected seven ICSs to take part – Sussex, South Yorkshire, Norfolk and Waveney, North East London, Devon and Hampshire and the Isle of Wight. The chosen participants were selected on the basis of ensuring a mix of competence and interest. The programme consisted of six sessions and focussed on what ICSs need to do to serve inclusion health populations by drawing on the evidence base for successful inclusion health interventions, and demonstrated how they need to put in place the necessary building blocks for system change in their area. The programme was tailored to what the ICSs told us that they needed and wanted, with a strong emphasis on learning from each other and practical application in their local areas. Results and experiences from the project were shared at the Faculty for Homeless and Inclusion Health’s annual international symposium in March 2023 and also at the NHS Confederation Expo in June 2023. A report of the insights will be published in summer 2023. A second phase of the project for another group of ICSs, partly funded by NHS England, is planned and scheduled to start in Autumn 2023.

4. Safeguarding and mental capacity

• Our Nursing Fellow, Sam Dorney-Smith, developed and delivered an e-Learning tool to build the skills of A&E clinicians in meeting the needs of patients experiencing homelessness. This work drew strong support from stakeholders such as Royal College of Emergency Medicine and NHS England.

5. Type 2 Diabetes and Homelessness

• Pathway secured funding from the Burdett Institute for Nursing for a year-long project that aims to share knowledge and experiences of specialist diabetes nurses and inclusion health nurses in order to better support homeless patients who live with Type 2 diabetes. The first steering group meeting was held in April 2023, and the project will continue into 2024.

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

1. Pathway Fellows programme

• We have added to the Pathway Fellows during the year and they now number 21.

• Dr Gemma Ashwell is a GP at Bevan Healthcare in Bradford, where she has worked for the past seven years. She is the clinical lead for the homeless outreach team and the BRICSS Intermediate care hostel as well as the organization’s education lead. Since 2017 Gemma has worked as a Clinical Teaching Fellow at the University of Leeds, developing and delivering education on public health and primary care with a focus on addressing health inequities. Currently. she has a funded PhD Fellowship, at the University of Leeds - the

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Activities, Achievements and Performance (continued)

1. Pathway Fellows programme (continued)

• working title of her research is “‘The role of digital education in developing empathy, compassion, and social responsibility in undergraduate medical education: a focus on inclusion health”. The project aims to address attitudinal barriers by developing and evaluating an innovative digital educational tool that will be co-produced with medical students and people from inclusion health groups. The educational tool developed will be launched on a platform to be freely available for use by students and educators across the UK. Gemma has been invited to join the Faculty for Homeless and Inclusion Health’s Education Committee.

• Aliénor (Lili) Lemieux-Cumberlege is a Clinical Psychologist working across two Community Mental Health Teams in Edinburgh. In addition to completing a specialist Addiction Psychology placement during clinical training, Lili also previously worked in frontline homelessness services and recovery services in Canada and Scotland. Lili’s DClinPsych thesis involved two strands of work: 1) a systematic review of the implementation of Psychologically Informed Environments with staff in homelessness services, and 2) an empirical study on organisational and individual factors that may predict PTSD, secondary traumatic stress, and burnout in frontline workers. Lili’s current research focusses on interventions to support staff well-being and psychological thinking, including reflective practice and team formulation. She has a strong interest in Compassion Focused Therapy approaches to working with multiple exclusion and complex trauma, the factors affecting ‘drug of choice’, and LGBTQIA+ mental health. Lili helped Pathway design a survey of levels of secondary traumatic stress and burnout in Pathway teams and in the inclusion health workforce more widely. Lili is one of Pathway’s Research Fellows.

• Pathway Fellow John Conolly, specialist homeless psychotherapist, has continued to develop his work on trauma informed communications skills for frontline practitioners. In November he delivered two half day introductory training sessions on the NHS Futures platform to a combined audience of about 300. He presented on the value of active listening skills in work with people with profound and multiple psychological trauma at the Faculty for Homeless and Inclusion Health’s conference in March, and he also presented to a Royal Society of Medicine conference on trauma. John has also provided reflective practice sessions to Pathway teams in London, funded by the London Housing Awards prize money

• Using funding from the World Doctors Orchestra concerts we repeated our offer to fund Staff College Leadership Development programme places for our Pathway Fellows. Dr Rafi Rogans-Watson, Sarah Kaddour, and Dr Lucy Chiddick all expressed interest in the programme this year. Our primary care fellow Dr Aaminah Verity found the course in 2022 ‘brilliant, very challenging and very helpful, and confidence inspiring’.

2. Lived experience involvement

• Pathway’s Lived Experience volunteer group have been in great demand and have contributed to various research steering groups, and policy development exercises throughout the year.

• Representatives of Pathway’s Lived Experience group participated in training sessions for new Pathway teams and ran a session at the CPD half day in December and the whole day in early July

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Activities, Achievements and Performance (continued)

2. Lived experience involvement (continued)

• In January, members of the Pathway’s Lived Experience group who featured in the film “Home-Less?” were supported to attend the launch of the film and were joined by Victor Adebowale, President of the NHS Confederation and Ruth May, Chief Nursing Officer for England

• Members of Pathway’s Lived Experience Group were supported to attend and participate in the Faculty for Homeless and Inclusion Health’s International Symposium in March

• Members of Pathway’s Lived Experience Group joined core Pathway staff at the NHS Confederation Expo in Manchester in June 2023. Those who had participated in the film: “Home-less?” were ‘In Conversation’ with Victoria MacDonald, Channel 4 News Health Editor, after a live screening of the film.

• The Lived Experience group were supported to draft and submit a response to the Government’s consultation on the Major Conditions Strategy.

• A review of our lived experience work began in September 2022, by running a facilitated workshop also attended by Pathway trustee Stephen Robertson. The workshop generated important insights which included: the programme is highly valued by participants, particularly for its social aspect, its sense of inclusivity and the potential to be a part of making change happen. Many lived experience volunteers spoke strongly about their motivation to improve the wider system so that others do not face the difficulties they have; it was also clear that participants want more support to enable them to be more confident in playing a full part in Pathway’s activities e.g to achieve a sense of personal progress, as well as more dedicated support to help them develop and to make sense of the often complex environments they find themselves in (such as the annual conference or consultation events). Following this session, and in recognition of the importance of and value lived experience brings to every aspect of our work, we have appointed a new Lived Experience Programme Manager who will be refreshing our programme of work, methods of working and expanding our current small group of volunteers with lived experience during 2023-24.

1. Policy and research

• 2022/23 was the second year of Pathway as partner of the Homeless Health Consortium along with Homeless Link and Groundswell. The consortium is part of the Voluntary, Community and Social Enterprise’s (VCSE) Health and Wellbeing. Funding is for three years. In year 2, we developed and delivered an online training module for frontline staff in A&E aimed at improving responses to people experiencing homelessness, by focussing on mental capacity and self-neglect. The module was launched in May 2023, and was accompanied by a podcast of Pathway Fellow Sam Dorney-Smith with Elaine Goodwin, Emergency Care Improvement Lead for NHSE. Pathway advised on the other two Homeless Health Consortium/Health and Wellbeing Alliance projects – access to dentistry, led by Groundswell which involved our Pathway Fellow, Sarah Kaddour, and health training for homelessness sector staff, led by Homeless Link. The focus for Pathway for year 3 is on the provision of intermediate care, and the project is currently underway.

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Activities, Achievements and Performance (continued)

3. Policy and research

• The pilot phase of the NHSE&I funded Health Care Support Worker (HCSW) project (in conjunction with Groundswell, the RPSH and DWP) is completed. The five participating Trusts (Pennine Healthcare, Cumbria, Northumberland, Tyne & Wear NHS Trust, Black Country

NHS Trust, and North & East Hertfordshire NHS Trust and Portsmouth NHS Trusts) have all recruited people with lived experience to jobs. An evaluation report of the project was commissioned and received in October 2022, and includes positive findings on the strong partnership working underpinning the project and the experiences of the candidates/recruits.. Work has moved on and is ongoing to develop a toolkit for NHS employers – assembling best practice in employing people with histories of homelessness in the NHS.

• Pathway secured funding from the City of London to look at experiences and outcomes from the new London-wide detox beds provided by Guy’s and St Thomas’ NHS Foundation Trust funded by the Rough Sleeping Alcohol and Drug Treatment Grant. Pathway Fellow Dr Caroline Shulman is leading the work and has formed a project team around her. An interim report is currently being prepared.

• Pathway submitted a detailed response to the Government’s consultation on the Major Conditions Strategy. We also provided briefing to Faculty members to help them to respond more easily and we supported the Lived Experience group to draft and submit a response.

2. Joint Policy work with Crisis

• Legislation for prevention duty: Pathway and Crisis have looked again to understand if a legal ‘prevention duty’ is in fact the best way of achieving their goal of hospitals undertaking more homeless prevention activity. Pathway and Crisis have carried out a significant research and policy project to review how the existing Duty to Refer under the Homelessness Reduction Act is working in hospitals, as a first step towards understanding if a further duty is useful and necessary. There has been good engagement from hospital teams and the Royal Colleges of General Practice. Results of this work is scheduled to be published in Autumn 2023.

• Skylight Centres : Work has commenced to develop the blueprint for joint working between Skylight Centres and Pathway teams. In September 2022 Pathway and Crisis colleagues outlined their current service model and current issues and challenges in meeting patients/members' needs. A follow up meeting was held to look at Pathway's patient journey from referral to discharge from caseload in more detail, in order to consider opportunities for collaboration and joint working. A first meeting between Brent Skylight and Outer North West London Pathway Team (Ealing/Northwick Park hospitals) was held. There were positive exploratory discussions with the Crisis Skylight on Commercial Street (near the Hackney and Royal London Pathway teams), and options for collaboration included Crisis attendance at Pathway team MDTs, joint training and information sharing about clients/patients. Also, Crisis staff shadowed the Bristol Pathway team. However overall the project has not progressed as much as planned because Skylight Centres are undergoing restructuring which has caused

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Activities, Achievements and Performance (continued)

2. Joint Policy work with Crisis (continued)

• some disruption. Trustees from Pathway and Crisis have reinforced their keenness this work to continue into 2023-24 , and it likely to be subsumed into our new strategic priority of working at place.

• Research: Progress on a joint Homeless Inclusion Health Monitor research report has been slow because no responses were received to the Invitation to Tender for the scoping exercise. At the end of June 2023 we secured a consultant to lead this work and expect to have the first results ready for publication at the March 2024 Faculty for Homeless and Inclusion Health International Symposium.

Aim 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

1. Strategic Relationships and Influence on relevant and regulatory bodies

• Pathway’s Senior OT and Mental Health Practitioner presented at the Crisis/Royal College of Psychiatrists ‘No Health without Housing’ conference along with Homerton Pathway team colleagues in November 2022, on the Pathway model at the Hackney Centre for Mental Health.

• Professor Sir Steve Powis, NHS E Medical Director, spent an afternoon with the St George’s Pathway team in early June, at our invitation. Pathway’s Chief Executive and Medical Director had a follow-up hour with him subsequently. Among other things he advised Pathway to focus much of our system change efforts on the ICS and ICB layers of the system.

• Pathway’s Chief Executive and Head of Policy met with Dr Bola Owolabi, who suggested Pathway should connect efforts consistently to the systems’ statutory duties in relation to health inequalities, and to the NHS’s Core20Plu5 frame.

• Pathway’s head of Policy worked with NHS England to finalise their National Inclusion Health Framework, feeding in insights from our ICS programme and insights on inclusion health. This is due to be published in September 2023.

• Pathway’s Chief Executive and Faculty Fellows were joined by members of the student Faculty at a conference on Inclusion Health in the undergraduate curriculum held at Anglia Ruskin University.

2. Child and Adolescent Mental Health Services (CAMHS) to do more to prevent homelessness before it happens, among young people with teenage contacts with CAMHS services

• Work was undertaken to develop an engaging and creative curriculum to accompany the Mouse film in partnership with the art teacher at Simmons House CAMHS Unit (Haringey). This was piloted over six weeks at Simmons House in the summer 2022, with a challenging cohort of in-patients who were also resistant to teaching. They presented a very good test for the programme. The pilot was declared a success by the teachers that delivered the programme and particularly the extent to which the film stimulated discussion and

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance (continued)

engagement among particularly hard-to-reach young people. Further funding is required for the continuation and nationwide dissemination of the programme and bids for multi-year funding have been submitted and awaiting decision.

• Pathway’s work on the RESILIENT Critical Time Intervention has identified the need and opportunity to improve the health and welfare trajectories of vulnerable young people passing through the NHS Child & Adolescent Mental Healthcare system by transforming that system. We think an independent, multi-stage investigative commission, could: conduct research, drive ideation, and make recommendations for change; build consensus among health and social care services, governance and government bodies, and charitable funders, for the implementation of its recommendations; and at its conclusion found an independent activistlegacy body that will doggedly assert and coordinate the programme of implementation

• recommended in the commission’s final report. Scoping for the work concluded in 2021-22, and nine eminent participants renowned for their work in this area were invited to participate. The first round table discussion took place at the House of St Barnabas in November 2022, followed by in-depth discussions with contributors who could not attend. Funding to continue Commission is being sought as this is a long-term project.

Aim 5: To support and develop the Faculty of Homeless and Inclusion Health as the independent voice and national network for inclusion health professionals

1. Support the Faculty of Homeless & Inclusion Health to improve service quality for homeless and other marginalised groups of patients

• The Faculty supports a special interest group on mental health which has met three times during the year. The mailing list has 130 Members and the meetings are attended by 40-50 people where they hear about and discuss ‘hot topics’ such as safeguarding, mental capacity and self-neglect. Members plan to use the forum to influence inclusion health priorities around the country and to engage with the Royal College of Psychiatrists.

• Pathway has also developed a National OT Network for Homeless and Inclusion Health this year. It has 40 members, and meets quarterly when members explore research, professional development and education around Inclusion health, as well as best practice and using it as a support network.

• The students’ network which consists of around 20 members have met three times. Topics and speakers are agreed in advance and student members coordinate the meetings. The students developed and published on-line Inclusion Health educational resources during the year.

• A new Primary Care Inclusion Health network was established in the year, and has met three times.

• One whole Faculty meeting was held using internet technology.

• We have further developed the Faculty’s communications including use of social media (Twitter: 5,488 followers) and fortnightly electronic newsletters

• Faculty membership at July 2023 stands at 1,817 members.

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance (continued)

2. Inter-professional learning, education and training

• The MSc module in Inclusion Health developed by the Faculty for Homeless and Inclusion Health in partnership with University College London was run again in 2023. The annual Inclusion Health CPD event at the University of Brighton was run in December 2022 – half day, and in July 2023 – full day.

3. Continue to develop, coordinate and promote the annual Faculty international conference

• On 15 and 16 March 2023 we held the eleventh Faculty for Homeless and Inclusion Health international symposium over two days using a hybrid of in-person and internet technology: “Pathways from Homelessness 2023 – Making Integrated Systems Work”. The event was

attended by 423 delegates in total of which 279 were in person. The event was held in London, but there were also two smaller hubs which were attended by 32 delegates. Specific highlights included the key note address on day one from Dr Stephen Powis, Medical Director of NHS England, and on day two from Matt Downey MBE, Chief Executive of Crisis UK; the showing of a short information film ‘Home-Less?’ made by Pathway and funded by NHS England; plenary presentations from Dr Lade Smith CBE, President of the Royal College of Psychiatrists; Prof Andrea Williamson, Professor of General Practice and Inclusion Health at University of Glasgow; and Jane Milligan, Chief Executive of Devon Integrated Care System; a stimulating session of 10 short Pecha Kucha presentations on a diverse range of topics; and the closing panel session with Bola Akinwale, Matt Downie and our EBE panel. Our EBE’s played a significant role across the two days

Aim 6: To maintain a strong organisation and maximise the opportunities of joining together with Crisis

1. Business Sustainability

• The merger with Crisis with Pathway remaining a separate but subsidiary Charity, has not only given Pathway some financial sustainability but has also provided opportunities to do more for the beneficiaries that we have in common as we work more closely together.

• 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. In 2022/23 ten teams had signed our partnership agreement, an increase of two from 2021/24. However, Salford withdrew due to lack of funding although they hope to rejoin in the future; and Croydon halted their service during the year due to lack of staff and are planning to re-launch in the autumn. We are constantly updating the manual that accompanies the programme, and are currently undertaking a comprehensive review of our support offer.

• 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.

• Pathway secured grant from The Fidelity Foundation for the purpose of Business Development. A Business Development Manager was appointed and joined Pathway in November 2022. She has been leading work on: a range of bids to charitable foundations; review of the Pathway Partnership Service and offer including interviews with NHS Commissioners; the partnership with Carnall Farrar; and the work for NHS Confed Expo.

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance (continued)

2. Strategic and Business Planning

• Considerable work has been undertaken throughout the year to refine Pathway’s strategic priorities and develop a revised five year strategic plan. Following an initial discussion by Pathway’s Board of Trustees in April 2022, consultation took place with staff, lived experience group, Pathway Trustees and Fellows, partners, commissioners and critical friends together with colleagues from Crisis ensuring the proposed strategy aligns with theirs. The proposed strategy was submitted to Pathway trustees in June 2023, and again in July 2023 following further refinement. It was reviewed by the Crisis Board of Trustees in July 2023 and Pathway’s Board will formally adopt it in August.

3. Marketing Strategy and Communications

• We have continued to receive 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.

• Work has continued to comprehensively refresh Pathway’s website and the new look site will be available in the autumn.

• In June 2023 Pathway took a stand and a team of staff and Lived Experience volunteers to the NHS Confed Expo in Manchester in June. Pathway’s Head of Policy and Medical Director both hosted popular round-table discussions in an Office of Health Improvement and Diversity workshop session.

• Pathway took a stand to the London Network of Nurses and Midwives annual conference on 9th June 2023

4. Core Staffing Structure

• We have recruited staff to the agreed expanded core team during 2022/23 and now have a full complement of staff.

• We developed a system for performance review early in 2022, and this was implemented in 2022/23.

• We have recognised the value of reflective practice and have introduced a monthly online session for the core team that supports the work of the Pathway Partnerships Programme

• We said fond farewell to Dr Nigel Hewett at a celebration party in October 2022. Nigel retired as Pathway’s inaugural Medical Director at the end of June 2022. He is replaced by Dr Chris Sargeant who is also clinical lead for the Pathway Partnerships Programme and is the GP Lead at the legacy Pathway team in Brighton.

5. Fundraising

• We have renewed our partnership with management consultancy Carnall Farrar who have once again chosen Pathway to be the recipient of its social responsibility activities during 2023/24. They are providing in-kind support and are fundraising throughout the year for us.

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance (continued)

• Following the World Doctors’ Orchestra concerts, the Doctors’ Laboratory selected Pathway to be the recipient of its social responsibility activities during 2022/23 and have made regular donations from its fundraising activities.

• Pathway continued to be registered with the Fundraising Regulator

6. Awards

• We are thrilled to report that Pathway won the 2022 London Housing Foundation’s annual homelessness awards. Our submission focused on our input supporting the creation of five new teams in London over the last year: Croydon, St Georges, Imperial/Chelsea and Westminster, Ealing/Northwick Park, and the Homerton and Hackney Centre for Mental

Health. The award of £30,000 will be used to fund additional support to the London Pathway teams including reflective practice and a contribution towards Tier 2 legal advice.

7. Data Protection

• Pathway completed and submitted the NHS Digital Data Security and Protection Toolkit towards the end of the year. Part of this work required a register of data to be held and maintained and work is currently underway to produce a revised Data Security and Protection Policy which will be submitted to a future Board meeting for approval.

Pathway 20

Trustees’ report Year ended 30 June 2023

Review of financial position

Total income for the year amounted to £1,146,527 (2022 - £1,409,101). The associated expenditure for the period was £1,188,672 (2022 - £1,009,311). This gives a net deficit for the period of £42,415 (2022 - net surplus of £399,789). Total reserves to be carried forward to 2023/24 are £1,173,828 (2022 - £1,215,973).

The principal sources of funds in 2022/23 were:

	£
Crisis UK –a grant towards core funding for the year ended 30 June	500,000
2023 (restricted)
Fidelity Foundation– 1stpayment of a grant to fund the employment of	137,500
a Business Development Manager and associated direct costs (restricted)
St Martin in The Fields Charity’s Frontline Programme– 2nd	110,000
payment of three year grant for access to specialist legal casework for
Pathway hospital teams and for Tier 2 legal advice for Pathway’s team
outside London (restricted)
Trust for London– final payment of a three year grant to provide Tier 2	45,000
legal advice to Pathway’s London hospital teams and mental health teams
(restricted)
Burdett Trust for Nursing –first payment of a grant to share knowledge	35,222
and experiences of specialist diabetes nurses and inclusion health nurses
in better supporting homeless patients who live with Type 2 diabetes
City of London– a contract for the review of the pan-London’s Rough	35,014
Sleeping Drugs and Alcohol services run by Guy’s and St Thomas’s NHS
trust part of a larger payment of £159,877 (unrestricted)
Homeless Link– 2nd year of three year grant to be partner of the	28,284
Homeless Health Consortium, part of the VCSE Health and Well Being
Alliance (restricted)
Marie Curie– two small grants for work around palliative care for and	24,104
frailty in homeless people (restricted)

Just over 81.2% (£965,042) of the expenditure can be attributed directly to Pathway’s core activities, with 18.8% (£223,630) related to support work including governance of which £15,000 relates to the pro-bono legal support around trademarking Pathway’s logos. £NIL was paid for fundraising materials in 2022/23 (£218 for fundraising in 2021/22).

Reserves policy

At 30 June 2023 Pathway holds reserves of £1,173,828 (£551,997 restricted and £621,831 unrestricted). At their meeting in May 2023 the Trustees agreed to leave unchanged the reserves policy of retaining unrestricted reserves to cover four months basic overheads (estimated at £278,000). The unrestricted reserve of £621,831 includes £110,352 balance from the World Doctors Orchestra donation which is retained to support the development of younger Pathway Fellows and also to provide a programme of clinical grants, £189,067 from the final payment of

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance (continued)

Reserves policy (continued)

the core grant from the Oak Foundation which will be used to support the 2023/24 work programme, the London Homelessness Award £30,000 which will be used to provide reflective practice and some tier 2 legal advice to Pathway’s London hospital teams leaving a balance of £292,412 which therefore provides sufficient funds to cover management, administration and support costs and to respond to emergency situations for 2023/24. 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

We have developed a new five year strategic plan in collaboration with Crisis UK and with widespread consultation with partners and allied organisations. We will begin to work towards the aims and objectives set out in the plan.

Pathway’s revised overall objective is: To improve the health and end homelessness of the most excluded and vulnerable people

We have three main aims and three cross-cutting aims. These are:

1. Acute Care : To drive up standards of healthcare for people facing homelessness in hospital, ensuring a safe and effective discharge

2. Recovery : To ensure everyone has a safe place to recover

3. Prevention : To improve primary care to prevent homelessness and hospital admissions

Our cross cutting aims are to build Mental health and Place in all our work and to make the case for homeless and inclusion healthcare

Our planned ways of working include:

• Co-production with people with lived experience

• Securing policies needed for change

• Communicating and building relationships that bring homelessness and inclusion health into the mainstream

• Having a research strategy that supports our priorities

• Connecting and supporting our networks

• Growing a movement to campaign for change

• Driving system change in places

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Trustees’ report Year ended 30 June 2023

Activities, Achievements and Performance (continued)

Plans for Future Periods (continued)

We will deliver our new objectives by:

• Acute Care – ending the homelessness of the most vulnerable people:

• continue to develop the Pathway hospital model and its delivery

• spread the model to areas that need it most, including in psychiatric hospitals

Trustees agreed that this aim is the top priority for year 1 (2023/24)

• A safe place to recover – Intermediate and long term accommodation and care to sustain recovery and end homelessness

• advocate for provision of intermediate care through ICS’s and NHSE

• campaign at national level for more funding for greater provision of intermediate care

• Prevention – preventing homelessness and worsening health through primary care

• advocate for access to primary care for people experiencing homelessness

• Mental Health and Place and Making the case for homeless and inclusion healthcare

• Support for mental illness that can drive homelessness

• Work with ICS’s and PCN’s (places) – supporting local system change across the patient pathway, and aligning with new Crisis centres where possible

• Support and develop research to make the economic case for homeless and inclusion health, and explore how to combat stigma and discrimination.

Pathway 23

Trustees’ report Year ended 30 June 2023

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.

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 23 October 2023 and signed on its behalf by:

Leslie Morphy OBE Chair of Pathway

Pathway 24

Independent auditor’s report Year ended 30 June 2023

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

Opinion

We have audited the financial statements of The London Pathway (the ‘charitable company’) for the year ended 30 June 2023 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 2023 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.

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.

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Independent auditor’s report Year ended 30 June 2023

Other information (continued)

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.

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.

Pathway 26

Independent auditor’s report Year ended 30 June 2023

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;

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.

Pathway 27

Independent auditor’s report Year ended 30 June 2023

Use of this report

This report is made solely to the charitable company’s member, 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 member 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 member 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: 10 November 2023

Pathway 28

Statement of financial activities Year ended 30 June 2023 (Including an Income and Expenditure Account)

Notes	Un- restricted funds £	Restricted funds £	2023 Total £	Un- restricted funds £	Restricted funds £	2022 Total £
Income: Donations and legacies Income from charitable activities: . Grants 1 . Research and project income 1 Total income Expenditure: Expenditure on charitable activities 2 Total expenditure Net (expenditure) income and net movement in funds for the period 5 Reconciliation of funds Total funds brought forward at 1 July 2022 Total funds carried forward at 30 June 2023	56,101 - 195,901	2,436 888,756 3,333	58,537 888,756 199,234	190,437 250,000 144,553	1,127 748,441 74,542	191,564 998,441 219,095
	252,002	894,525	1,146,527	584,990	824,110	1,409,100
	283,094	905,578	1,188,672	183,502	825,809	1,009,311
	283,094	905,578	1,188,672	183,502	825,809	1,009,311
	(31,092) 652,923	(11,053) 563,050	(42,145) 1,215,973	401,488 251,435	(1,699) 564,749	399,789 816,184
	621,831	551,997	1,173,828	652,923	563,050	1,215,973

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 32 to 49 form part of these financial statements.

Pathway 29

Balance sheet 30 June 2023

Notes	30 June 2023 £	30 June 2023 £	30 June 2022 £	30 June 2022 £
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	115,093 1,326,773	1,173,828	108,705 1,258,315	1,215,973 652,923 563,050
	1,441,866 (268,038)		1,367,020 (151,047)
		621,831 551,997
		1,173,828		1,215,973

The accounting policies and notes on pages 32 to 49 form part of these financial statements.

These financial statements were approved by the Board of Trustees for issue on 23 October 2023 and signed on its behalf by:

Leslie Morphy OBE

Chair

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

Pathway 30

Statement of cash flows Year ended 30 June 2023

Notes	2023 £	2022 £
Cash flow from operating activities: Net cash provided by operating activities A Change in cash and cash equivalents in the period Cash and cash equivalents at 1 July 2022 B Cash and cash equivalents at 30 June 2023 B	68,458	360,970
	68,458 1,258,315	360,970 897,345
	1,326,773	1,258,315

Notes to the statement of cash flows for the year ended 30 June 2023.

A Reconciliation of net movement in funds to net cash provided by operating activities

B		2023 £	2022 £
	Net movement in funds (as per the statement of financial activities) Adjustments for: (Increase) decrease in debtors Increase (decrease) in creditors Net cashprovided by operating activities	(42,145) (6,388) 116,991	399,789 (44,958) 6,139
		68,458	360,970
	Analysis of cash and cash equivalents	2023 £	2022 £
	Cash at bank Total cash and cash equivalents	1,326,773	1,258,315
		1,326,773	1,258,315

Pathway 31

Principal accounting policies Year ended 30 June 2023

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 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 2023 the Trustees are satisfied that there will be sufficient future funds to allow the Charity to continue as a going concern.

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.

Pathway 32

Principal accounting policies Year ended 30 June 2023

Fund accounting (continued)

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 where it 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.

Pathway 33

Principal accounting policies Year ended 30 June 2023

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.

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.

Pathway 34

Notes to the financial statements: Year ended 30 June 2023

1. Income from charitable activities

Income from charitable activities
	Un- restricted funds £	Restricted funds £	Total 2022 £
Grants Crisis UK Fidelity Foundation St Martin-in-the Field Charity – Frontline Programme Trust for London Burdett Trust for Nursing VCSE Alliance Homeless Health Consortium via Homeless Link Marie Curie NHS England / Innovation Other grants Total grants Research and project income Pathway Partnership Fees (Hull, Salford, Leeds, Hackney, St George’s. Ealing, Imperial, Plymouth, East Kent) City of London Other projects Total research and project income 2023 Total funds from charitable activities	— — — — — — — — —	500,000 137.500 110,000 45,000 35,222 28,284 24,104 8,000 646	500,000 137.500 110,000 45,000 35,222 28,284 24,104 8,000 646
	—	888,756	888,756
	143,808 44,914 7,929	— — 3,333	143,808 44,914 11,262
	196,651	3,333	199,984
	196,651	892,089	1,088,740

Pathway 35

Notes to the financial statements: Year ended 30 June 2023

1. Income from charitable activities (continued)

Income from charitable activities(continued)
	Un- restricted funds £	Restricted funds £	Year to 30 June 2022 £
Grants Crisis UK The Oak Foundation St Martin-in-the Field Charity – Frontline Programme Trust for London Rayne Foundation VCSE Alliance Homeless Health Consortium via Homeless Link Texel Foundation NHS England / Innovation Other grants Total grants Research and project income Pathway Partnership Fees (Hull, Salford, Leeds, Hackney, St George’s. Ealing, Imperial) East Kent CCG Devon CCG University College London Hospital NHS Foundation Trust NHS NE London CCG Sheffield CCG Queen’s Nursing Institute Other projects Total research and project income 2022 Total funds from charitable activities	— 250,000 — — — — — — —	500,000 — 100,000 45,000 30,000 26,986 20,000 19,770 6,685	500,000 250,000 100,000 45,000 30,000 26,986 20,000 19,770 6,685
	250,000	748,441	998,441
	134,583 — — — — — — 9,970	— 23,500 20,000 13,800 7,862 5,000 4,380 —	134,583 23,500 20,000 13,800 7,862 5,000 4,380 9,970
	144,553	74,542	219,095
	394,553	822,983	1,217,536

Pathway 36

Notes to the financial statements: Year ended 30 June 2023

2. Expenditure

Expenditure
	Unrestricted funds £	Restricted funds £	Year to 30 June 2023 £
Charitable activities Direct costs Pay costs including staff costs Consultants’ fees Staff training and welfare Printing Patients’ costs Patients’ legal advice Travel and subsistence Catering Volunteer/Service User expenses Conference provision Marketing and design Stationery Telephone Total direct costs Support costs Pay costs including staff costs Consultants Recruitment costs Staff training and welfare Travel and subsistence Marketing and design Insurance Bank and payroll charges Catering Volunteer/Service User expenses Legal advice (pro-bono) Bad Debt write off IT Equipment Stationery Total support costs Fundraising costs Stationery Marketing and Design Total fundraising costs Governance costs Catering Printing Travel and subsistence Audit and accountancy fees Total governance costs 2023 Total expenditure	165,618 36,733 15,465 — 625 — 2,169 799 1,149 15,900 — 378 —	356,871 190,353 567 1,429 2,528 128,343 4,561 548 10,039 19,400 6,747 4,751 69	522,489 227,086 16,032 1,429 3,153 128,343 6,730 1,347 11,188 35,300 6,747 5,129 69
	238,836	726,206	965,042
	26,730 — — 1,978 — — — — 992 — 15,000 750 (1,192) —	138,936 10,893 1,862 2,703 41 3,372 5,535 1,370 2,483 386 3,403 922	165,666 10,893 1,862 4,681 41 3,372 5,535 1,370 3,475 386 15,000 750 2,211 922 216,164 — —
	44,258	171,906
	— —	— —
	—	—	—
	— — — —	84 5 314 7,063	84 5 314 7,063
	—	7,466	7,466
	283,094	905,578	1,188,672

Pathway 37

Notes to the financial statements: Year ended 30 June 2023

2. Expenditure (continued)

Expenditure(continued)
	Unrestricted funds £	Restricted funds £	Year to 30 June 2022 £
Charitable activities Direct costs Pay costs including staff costs Consultants’ fees Staff training Printing Patients’ costs Patients’ legal advice Travel and subsistence Catering Volunteer/Service User expenses Conference provision Marketing and design Stationery Telephone IT Equipment Equipment Costs – medical respite Total direct costs Support costs Pay costs including staff costs Recruitment costs Staff training Marketing and design Insurance Bank and payroll charges Catering Legal advice (pro-bono) IT Equipment Stationery Total support costs Fundraising costs Stationery Marketing and Design Total fundraising costs Governance costs Legal Fees (pro-bono) Catering Audit and accountancy fees Total governance costs 2022 Total expenditure	104,447 18,068 1,972 1,800 428 — 1,117 298 4,786 420 — 280 — — —	291,906 291,316 2,226 225 4,763 45,654 3,403 312 8,034 33,877 1,307 4,019 119 550 (3,093)	396,353 309,384 4,198 2,025 5,191 45,654 4,520 610 12,820 34,297 1,307 4,299 119 550 (3,093)
	133,616	684,618	818,234
	17,050 — 57 — — — — 27,208 — —	106,109 9,279 3,352 2,070 5,389 910 648 — 530 1,967	123,159 9,279 3,409 2,070 5,389 910 648 27,208 530 1,967 174,569 34 184
	44,315	130,254
	— —	34 184
	—	218	218
	5,571 — —	— 536 10,183	5,571 536 10,183
	5,571	10,719	16,290
	183,502	825,809	1,009,311

Pathway 38

Notes to the financial statements: Year ended 30 June 2023

3. Staff costs including key management personnel

Staff costs including key management personnel
	2023 £	2022 £ 445,195 42.256 12,245 499,696
Wages and salaries Social security costs Pension contributions	610,597 58,805 18,753
	688,155

One member of staff was seconded to the core team at a cost of £13,325 in 2022-23 (none in 2021-22).

In 2022-23, no member of staff was seconded from the Civil Service £nil (one in 2021-22: £18,750).

One employee earned over £80,000 in year ended 30 June 2023 with their salary band falling between £80,001 - £90,000 (one in 2021-22).

The average monthly number of employees (including key management personnel) during the year to 30 June 2023 was 16 (2022 – 13). On a full time equivalent basis, the number of employees was:

	2023 No.	2022 No.
Key Management (CEO, Medical Director & Finance Director) Senior Healthcare Navigator Coordinator / Healthcare Advisor Senior Clinician Senior Nurse and Occupational Therapist Policy Officer Communications Officer Senior Project Manager Project Manager Research and administration Business Development	2.6 0.6 0.1 1.4 0.8 0.7 1.2 1.0 2.6 0.4	1.7 0.6 0.2 1.2 0.4 0.7 0.7 1.0 1.7 —
	11.4	8.2

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, Medical Director and Director of Policy and Programmes.

The number of key management personnel in the year to 30 June 2023 was four (2022 – three) (Full time equivalent basis: 2.6 (2022: 1.7)).

The total emoluments received by the key management personnel in the year ending 2023:

	2023 £	2022 £
Salaries Employer’s NI & Pension contributions	214,863 30,525	146,876 19,445
	245,388	166,321

Pathway 39

Notes to the financial statements: Year ended 30 June 2023

4. Staff costs including key management personnel (continued)

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:

2023 £	2022 £
Auditors’ remuneration . Statutory audit services 8,800	7,200

6. Trustees’ expenses

£314 expenses for travel were paid to Trustees during the period (2022: £nil).

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.

9. Debtors

Debtors
	2023 £	2022 £
Trade debtors Accrued income Prepayments	17,250 17,271 80,572	67,110 3,809 37,786
	115,093	108,705

10. Creditors: amounts falling due within one year

Creditors: amounts falling due within one year
	2023 £	2022 £
Trade creditors Other creditors Taxes and social security Accruals Deferred income	25,793 7,860 61,090 15,265 158,030	21,766 9,179 27,598 15,837 76,667
	268,038	151,047

Deferred income represents Pathway Partnership income where the programme of support will be delivered in 2023/24.

Pathway 40

Notes to the financial statements: Year ended 30 June 2023

11. Unrestricted funds

Unrestricted funds
	At 1 July 2022 £	Income £	Expenditure £	At 30 June 2023 £
General unrestricted funds	652,923	252,002	(283,094)	621,831
	At 1 July 2021 £	Income £	Expenditure £	At 30 June 2022 £
General unrestricted funds	251,435	584,990	(183,502)	652,923

Pathway 41

Notes to the financial statements: Year ended 30 June 2023

12. Restricted funds

Restricted funds
	At 1 July 2022 £	Income £	Expenditure £	At 30 June 2023 £
Burdett Trust for Nursing Crisis UK Department of Health Grocers’ Company Health Education England Homeless Link (for VCSE Alliance) Institute of Public Policy Research Isla Foundation British Geriatrics Society London Catalyst Manchester Health & Social Care Partnership Marie Curie NHS Barking & Dagenham CCG NHS Devon CCG NHS England/Innovation NHS Kent and Medway CCG NHS NE London CCG NHS Plymouth CCG NHS Sheffield CCG Queen Mary University London Rayne Foundation Royal Borough of Kensington & Chelsea (West London ICS) Royal Free NHS Foundation Trust Royal Free & Hampstead NHS Foundation Trust St Martin in the Fields Charity Stephen Clark Charitable Settlement Texel Foundation The Clothworkers Company The Fidelity Foundation The Health Foundation The Oak Foundation Trust for London University College London Hospitals NHS Foundation Trust UCLH Friends Warwickshire County Council Donations for patients phones UCLH Donations for Faculty for Homeless & Inclusion Health – Faculty members Mental Health & Rough Sleeping Donation Donation for Patient Dignity – Outer NW London	— 32,032 10,557 4,500 2,645 19,198 1,094 5,919 5,700 323 5,810 6,867 3,975 14,284 151,467 7,181 7,336 3,228 4,604 2,350 39,456 650 35,000 — 86,256 3,233 23,552 9 — 22,481 21,320 19,527 2 818 10,481 1,258 6,805 3,132 —	35,222 500,000 — — — 28,284 646 — — — 24,104 — — 8,000 — — — — — — — — 3,333 110,000 — — — 137,500 — — 45,000 — — — — 1,936 — 500	(6,518) (465,863) — (4,500) — (36,899) (1,740) (5,144) (5,700) (202) (3,992) (11,040) (3,975) (11,708) (69,835) (7,181) (1,530) (3,228) (4,604) - (39,357) (650) - — (87,479) — (9,127) (9) (29,759) (1,328) (21,320) (62,714) (2) — (5,440) (1,258) — (3,132) (344)	28,704 66,169 10,557 — 2,645 10,583 — 775 — 121 1,818 19,931 — 2,576 89,632 — 5,806 — — 2,350 99 — 35,000 3,333 108,777 3,233 14,425 — 107,741 21,153 - 1,813 — 818 5,041 — 8,741 — 156
	563,050	894,525	(905,578)	551,997

Pathway 42

Notes to the financial statements: Year ended 30 June 2023

12. Restricted funds (continued)

Comparatives	At 1 July 2021 £	Income £	Expenditure £	At 30 June 2022 £
Crisis UK The Health Foundation Department of Health Royal Free NHS Foundation Trust Justlife Foundation Texel Foundation London Catalyst Clothworkers Company Warwickshire County Council The Oak Foundation Queen Mary University London Trust for London 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 NHS England/Innovation Marie Curie British Geriatrics Society Manchester Health & Social Care Partnership Royal Borough of Kensington & Chelsea (West London ICS) NHS Sheffield CCG NHS Devon CCG NHS Kent and Medway CCG St Martin in the Fields Charity Homeless Link (for VCSE Alliance) Institute of Public Policy Research NHS NE London CCG NHS Barking & Dagenham CCG NHS Plymouth CCG Greater London Authority Donation for Mouse Film Donations for patients phones UCLH Donations for Faculty for Homeless & Inclusion Health – Faculty members Hackney Council Mental Health & Rough Sleeping Donation	69,002 30,166 7,464 35,000 953 14,284 879 669 12,601 97,188 2,350 13,374 2,800 4,500 710 — 818 3,377 1,000 10,000 11,001 182,406 14,810 5,700 9,400 6,500 5,029 — — — — — — 4,450 4,900 1,329 1,786 1,258 5,677 236 3,132	500,000 — — — — 20,000 — — — — — 45,000 — — 13,800 4,380 — — — 30,000 — 19,770 — — — 3,500 5,000 20,000 23,500 100,000 26,985 3,185 7,862 — — — — — 1,128 — —	(536,970) (7,685) 3,093 — (953) (10,732) (556) (660) (2,120) (75,868) — (38,847) (155) — (14,508) (4,380) — (144) (1,000) (544) (5,082) (50,709) (7,943) — (3,590) (9,350) (5,425) (5,716) (16,319) (13,744) (7,787) (2,091) (526) (475) (1,672) (1,329) (1,786) — — (236) —	32,032 22,481 10,557 35,000 — 23,552 323 9 10,481 21,320 2,350 19,527 2,645 4,500 2 — 818 3,233 - 39,456 5,919 151,467 6,867 5,700 5,810 650 4,604 14,284 7,181 86,256 19,198 1,094 7,336 3,975 3,228 — — 1,258 6,805 — 3,132
	564,749	824,110	(825,809)	563,050

Pathway 43

Notes to the financial statements: Year ended 30 June 2023

12. Restricted funds (continued)

Burdett Nursing Foundation

In March 2023, a grant of £70,444 was approved for work on a year-long project that aims to share knowledge and experiences of specialist diabetes nurses and inclusion health nurses in order to better support homeless patients who live with Type 2 diabetes.

Crisis UK

Following the merger of Crisis and Pathway the core-funding grant of £500,000 was paid in four tranches. Agreement was received to carry forward the uncommitted balance of £66,168 earmarked for committed and priority policy projects agreed with Crisis.

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 consider ways to develop the medical respite and other step down options for homeless patients leaving hospital.

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 and again in 2022.

Health Education England

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.

Homeless Link

Funding for the second of three years as partner of the Homeless Health Consortium, part of the VCSE Health and Wellbeing Alliance. Other partners are Homeless Link (lead partner) and Groundswell. Projects in 2022/23 included development of an online training module for frontline staff in A&E aimed at improving responses to people experiencing homelessness, by focusing on mental capacity and self-neglect; and participation in a project around access to dentistry, led by Groundswell which involved Pathway Fellow, Sarah Kaddour, and a project on health training for homelessness sector staff, led by Homeless Link. Pathway’s main project for this programme in 2023/24 will focus on intermediate care.

Institute of Public Policy Research (IPPR)

Funding as a minor partner in a Lloyds Bank Foundation funded project to research the impact of Universal Credit on people with multiple complex needs. The IPPR was the lead partner who consulted Pathway’s Lived Experience group in their research, their findings and proposals

Pathway 44

Notes to the financial statements: Year ended 30 June 2023

12 Restricted funds (continued)

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 continued into 2022/23.

London Catalyst

In December 2021, a grant of £1,000 towards patient dignity for use by the Pathway teams in the Royal London Hospital and UCLH.

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.

Marie Curie

A grant of £14,810 for work on palliative care for people with unsettled status was made in March 2021. Work on the project began in February 2022.

A contribution of £12,748 from a larger NIHR grant held by Marie Curie was paid to Pathway for its role in a project researching end of life care for people experiencing homelessness.

In June 2023 a grant of £11,356 was made for Pathway to contribute to work on frailty in people experiencing homelessness.

NHS Barking and Dagenham CCG

In 2020 funding of £5,000 was provided to support the development of a needs assessment for a Pathway team at hospitals serving Barking and Dagenham.

NHS Devon CCG

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 whole of Devon excluding Plymouth. The needs assessment was completed in December 2022.

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 included identifying and addressing barriers to employment in the NHS, and the development of 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’. An additional grant of £8,000 was paid in February 2023.

Pathway 45

Notes to the financial statements: Year ended 30 June 2023

12 Restricted funds (continued)

NHS England / Innovation (continued)

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’. The film retitled ‘Home-Less?’ was launched in January 2023.

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 has been carried out by organisations in Hull and Birmingham, and work continues to spread the work.

NHS Kent and Medway CCG

Funding of £8,500 was paid for training and support of the pilot service in 2022/23.

NHS North East London CCG

Funding of £8,342 for participation in Pathway Fellow Dr Aaminah Verity’s study of how to improve access to primary care for inclusion health groups. Pathway’s EBE group acts at the lived experience sounding board for the study.

NHS Plymouth CCG

In June 2021 funding of £4,900 was provided to support the development of a needs assessment for a Pathway team at Plymouth hospital. The team became part of the Pathway Partnership Programme in August 2022.

NHS 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 final needs assessment was submitted to commissioners for consideration and discussions are ongoing.

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 take forward the needs assessment.

NHS Kent and Medway CCG

Funding of £8,500 was paid for training and support of the pilot service in 2022/23.

NHS North East London CCG

Funding of £8,342 for participation in Pathway Fellow Dr Aaminah Verity’s study of how to improve access to primary care for inclusion health groups. Pathway’s EBE group acts at the lived experience sounding board for the study.

Pathway 46

Notes to the financial statements: Year ended 30 June 2023

12 Restricted funds (continued)

NHS Plymouth CCG

In June 2021 funding of £4,900 was provided to support the development of a needs assessment for a Pathway team at Plymouth hospital. The team became part of the Pathway Partnership Programme in August 2022.

NHS 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 final needs assessment was submitted to commissioners for consideration and discussions are ongoing.

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 take forward the needs assessment.

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. The third payment is delayed pending securing addition funds from other charitable foundations.

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. An additional £3,500 was received in February 2022 to continue the work ahead of implementing a hospital team for St Mary’s and the Chelsea and Westminster.

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.

Royal Free and Hampstead NHS Trust

Provision of some arts work for the International Street Medicine Symposium.

St Martin in the Fields Charity

The grant of £300,000 grant from St Martin’s Charity Frontline Fund was awarded in December 2021 is to provide access to Tier 2 specialist legal advice to Pathway teams outside of London and to provide access to specialist case work for all Pathway teams. Contracts for services for year 2 have been issued to legal firms in spring and early summer 2023.

Pathway 47

Notes to the financial statements: Year ended 30 June 2023

12 Restricted funds (continued)

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.

Texel Foundation

A grant of £20,000 was awarded from October 2021 to support the work of the Faculty for Homeless and Inclusion Health.

The 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.

The Fidelity Foundation

In December 2022, the first tranche of funding from the agreed grant totaling £196,000 was paid. The funding is for a new business development role to support growth and to expand services to more hospitals.

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. 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.

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

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, and was completed in November

Trust for London

The grant of £135,000 grant awarded in March 2020 is to continue and extend the access to Tier 2 legal advice further to include two mental health teams. Contracts for services were renewed to legal firms in July 2022 for the third and final year.

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.

Pathway 48

Notes to the financial statements: Year ended 30 June 2023

12 Restricted funds (continued)

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. Four needs assessments have been completed and discussions are underway about next steps.

13. Analysis of net assets between funds

	Unrestricted funds £	Restricted funds £	Total 2023 £
Current assets Current liabilities 2023 net assets	843,184 (221,353)	598,682 (46,685)	1,441,866 (268,038)
	621,831	551,997	1,173,828
	Unrestricted funds £	Restricted funds £	Total 2022 £
Current assets Current liabilities 2022 net assets	736,095 (83,172)	630,925 (67,875)	1,367,020 (151,047)
	652,923	563,050	1,215,973

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

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

16. Member’s liability

Crisis UK as the sole member of the charitable company undertakes to contribute to the assets of the company in the event of it being wound up while it is a member or within one year after it ceases to be a member, not exceeding £1.

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