St John of Jerusalem
Eye Hospital Group
ANNUAL
REPORT
2021


## SAVING SIGHT CHANGING LIVES 

St John of Jerusalem Eye Hospital Group is the only charitable provider of expert eye care in East Jerusalem, Gaza and the West Bank. Our aim is to end preventable blindness throughout the oPt. We have been treating patients in the region regardless of their ethnicity, religion, social class or ability to pay for 140 years. Our sightsaving work is carried out against challenging odds to the highest international standards. 

## Contents 

- 3 Chairman and CEO’s Introduction 4 About Us 5 Hospitaller’s Report 6 Snapshot of 2021 7 Patient Centred Services 9 Spotlight On: Continuity of Care and Systems Strengthening 10 Excellence, Education & Innovation 14 Spotlight on the St John Ophthalmic Association 15 Celine’s Story 16 Investing in our people 17 Nursing in Gaza 18 Good Governance & Partnerships 19 Sustainability 20 Trustees and Committee Members 24 Governance Structure 25 The Chief Executive 25 Public Benefit 26 Strategic Report: Strategic Vision 29 Strategic Report: Financial Review 32 Statement of Trustees' Responsibilities 33 Fundraising Statement 34 Stakeholder Engagement 36 Independent Auditors' Report 38 SJEHG Financial Statements 54 Professional Advisers & Administrative Information 55 Thank You 

GLOSSARY: JCI - Joint Commission International; the gold-standard for healthcare worldwide. NGO - nongovernmental organisation. NIS - New Israeli Shekel. oPt - occupied Palestinian territories. SJEHG - St John of Jerusalem Eye Hospital Group; this refers to all our entities. SOA – St John Ophthalmic Association, UNRWA - United Nations Relief and Works Agency, the UN branch responsible for Palestinian refugees. USAID - United States Agency for International Development 

_All uncredited photos throughout this Annual Report have been taken by staff of SJEHG. All the images used in this report are of actual SJEHG staff and patients and they have given their consent._ 

St John of Jerusalem Eye Hospital Group Company no: 7355619, Charity no: 1139527 Registered Office: 4 Charterhouse Mews, London, EC1M 6BB 

## Chairman & CEO Introduction 

The uncertainty and disruption of the Covid-19 global pandemic, continue to affect us all, but that hasn’t stopped this year being one with lots to celebrate for the St John of Jerusalem Eye Hospital Group (SJEHG). Most importantly, our patient reach has returned to pre-pandemic levels with almost 134,600 patients seen and 6,500 major operations (a SJEHG record) delivered across the Group. 

This growth is partly thanks to the excellent vaccination campaign, which has kept infection rates under control and therefore minimised movement restrictions and disruptions to normal life. Across our services we remain vigilant in our efforts to keep Covid infections at bay – and we are delighted to report another year with no cross-contamination within our clinics and hospitals. 

**Sir Andrew Cash and Dr Ahmad Ma'ali in the Jerusalem Hospital Gardens** 

These successes would not have been possible without the tremendous efforts from our staff. Delivering high-quality care, despite the many challenges faced daily, is not easy. We thank you all for your efforts to deliver one of SJEHG’s most impactful years yet. 

Of course, having a team delivering such high-calibre care, does not come without investment in training and education. Continued professional development is offered to all staff where needed. We were delighted to enable three new fellowships for our medical team at neighbouring Israeli institutions. This will ensure that we can continue to deliver all ophthalmic subspecialties using local teams, instead of what was, until relatively recently, delivered by expatriates. Ultimately this ensures a continuity of care for our population, especially during times of crisis. 

We continue to work to ensure the sustainability of our services. Thanks to measured sacrifices across all departments, we were able to reduce our expenditure by almost £700,000 against the against the 2021 budget.  We also were delighted to have an increase in both patient related income (£600,000) and voluntary income (£1.9m) as compared to our 2021 annual operational budget. This puts us in a strong position going into 2022, where we hope to build on what has been achieved this year, as well as celebrate our 140th year in operation! 

Thank you to the Priories of St John who continue to make up 32% of our overall voluntary income. We would especially like to thank the US Priory for increasing their donation to $2.4 million this year; their heartfelt passion for our cause is unwavering and truly appreciated. 

Thank you also to our excellent fundraising Guild, whose countless volunteer hours enabled us to have several opportunities to celebrate our achievements together in 2021. The return of the everpopular Gift of Sight fair was a particular highlight. 

There is nothing quite like witnessing the miracle of a person regaining their sight. This is a miracle you, all our supporters, enable us to achieve for hundreds of people each day across the Holy Land. Thank you. 



Sir Andrew Cash OBE Dr Ahmad Ma’ali Chairman CEO 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## About Us 

## Mission Statement: 

St John of Jerusalem Eye Hospital Group exists as a centre of excellence providing ophthalmic care of high quality to the people of the Holy Land irrespective of race, religion, social class or ability to pay.’ Vision: 

We work to eliminate avoidable blindness in the Holy Land and to be recognised as the leader in the provision of quality eye care in Jerusalem, the West Bank and Gaza. 

## Values: 

**Compassion -** Providing eye care with empathy and willingness to promote wellbeing. 

**Accountability** - Accepting responsibility for continuous performance & improvement, embracing change & seeking new opportunities to serve. 

**Respect** - Honouring the dignity and diversity of each person. 

**Excellence** - Providing exceptionally high quality and advanced care. 

## Strategic Aims 

**Patient-Centred Services** – Commitment to accessible and quality eye care. 

**Excellence, Education, and Innovation** – Developing a centre of excellence for eye health education, research, and innovation. 

**Investing in our People** - Promoting supportive working environments whilst developing a sustainable, skilled workforce. 

**Good Governance and Partnerships** – Strengthening our governance practices and partnerships to ensure best practice and maintain our heritage and reputation. 

**Sustainability** – Diversifying and strengthening our financial sustainability to ensure our mission can continue to the future. 

## Hospitaller’s Report 

International Partnerships and Excellence in Medicine 

SJEHG serves a population of over 5.2 million Palestinians across East Jerusalem, the West Bank, and the Gaza Strip, with over three quarters of patients in Gaza being refugees. The Palestinian population is a young one, with almost a third under the age of 10, and the overall prevalence of blindness is an order of magnitude higher than that of the UK. 

annual performance within 20 months of the onset of a global pandemic is indeed an incredible achievement. 

of patients in Gaza being One recent addition to refugees. The Palestinian SJEHG’s services is the clinic population is a young one, with in Kufor Aqab, one of the two almost a third under the age of largest Arab neighbourhoods in 10, and the overall prevalence North Jerusalem, and located of blindness is an order of beyond the security fence. magnitude higher than that of Considered an extension the UK. of ‘Outreach’, the clinic was originally established in The main causes of sight loss response to unaddressed and ‘legal blindness’ among clinical needs resulting from Palestinian adults aged 50 frequent lockdowns over 2020 years or older are cataract and and 2021. This year, due to refractive error (being treatable rising demand, SJEHG has with surgery and glasses increased its commitment to respectively), and diabetic the Kufor Aqab clinic from one retinopathy (DR). These were to three days each week. the findings of the 2019 Rapid Assessment of Avoidable In 2021, SJEHG trained six inBlindness (RAAB) study, which house ophthalmic residents and predicted that a staggering supported three regional clinical 30% of Palestinian adults Fellowships in glaucoma, over the age of 50 have visual paediatrics and oculoplastics, impairment to a Snellen acuity with Israeli colleagues. These of 6/12 or worse – lower than Three subspecialties are of legal driving standards in the vital importance given the UK. 

In 2021, SJEHG trained six inhouse ophthalmic residents and supported three regional clinical Fellowships in glaucoma, paediatrics and oculoplastics, with Israeli colleagues. These Three subspecialties are of vital importance given the large paediatric population, and the dearth of glaucoma specialists for the Palestinian population. Furthermore, our clinical and laboratory research continued apace, with 10 peerreviewed published citations in 2021 alone. Finally, and despite the severe restrictions in international travel (and therefore postgraduate opportunities), SJEHG continued its series of on-line live webinars through the SOA, and further details on this and 

Despite a challenging year, as the pandemic gradually waned in 2021, SJEHG recovered its clinical activities. All our centres all continued to provide eye care despite periodic staff shortages, lagging vaccination rates for some of our patients in the West Bank and Gaza and, of course, the violence in Gaza itself in May 2021. But by any international medical standard, the recovery of our 


other academic activities are given on page 14. 

The support for our staff underpins our mission to ‘… exist as a centre of excellence providing ophthalmic care of high quality to the people of the Holy Land irrespective of race, religion, social class or ability to pay.’  It follows that the commitment of SJEHG and all its supporters to clinical and nursing excellence underpins our vision that ‘SJEHG will work to eliminate avoidable blindness in the Holy Land and be recognised as the leader in the provision of quality eye care in Jerusalem, Gaza Strip and the West Bank.’ 

It is only through the unwavering commitment of our staff, Priories, supporters, and Trustees that we are able to deliver this high-quality ophthalmic care in the face of considerable odds, year on year. Thank you. 


David H. Verity, MD MA BM KStJ BCh FRCOphth Order Hospitaller, Chair, SOA 

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## Snapshot of 2021 

We reached almost 134,600 patients, performed almost 6,500 major surgeries, and employed 260 people across      our services.* 

Jerusalem Hospital We treated almost 52,300 patients in our East Jerusalem Hospital and performed over 3,600 major operations. 180 staff members, including 115 TULKAREM medical, allied health and nursing ANABTA professionals. TEL AVIV 

## Anabta Clinic 

We treated almost 16,500 outpatients at our Anabta Clinic and performed 27 major operations from the clinic. 

16 staff members including 11 medical, allied health and nursing professionals 

## Muristan Clinic** 

## Gaza Hospital 

We saw over 550 patients in 2021 in our mobile Old City screening programme and Muristan Clinic. 

We treated over 33,900 patients and performed over 2,100 major operations. 

45 staff members, including 36 medical, allied health and nursing professionals. 

Hebron Hospital Our Hebron Hospital saw over 14,500 patients and performed over 700 major surgeries. 19 staff members including 15 medical, allied health and nursing professionals. 

Mobile Outreach Services (Gaza)*** Our outreach services reached over 5,000 patients via our Mobile Outreach Programme. 

Mobile Outreach Services (West Bank)** Our Mobile Outreach Programme and our new Kufor Aqab Jerusalem Outreach Clinic screened almost 11,800 patients. 


**----- Start of picture text -----**<br>
Running Costs 2021 covered by % needing  % covered<br>fundraising  by patient<br>£'000 activities income<br>Jerusalem Hospital  7,447  50%  50%<br>Muristan   58  99%  1%<br>Outreach (inc Kufr Aqab) 199  86%  14%<br>Hebron   681  26%  74%<br>Gaza  1,322  36%  64%<br>Anabta   480  34%  66%<br>**----- End of picture text -----**<br>


*Staff numbers do not include four London staff. 

**Muristan and West Bank Mobile Outreach Services staff are counted in our Jerusalem Hospital figures. 

*** Gazan Mobile Services staff are counted in our Gaza Hospital figures. 

## Patient Centred Services 

We performed 13% more major Surgeries surgeries than in 2020. 13% 

surgical referrals. In Gaza we are working to increase local sub-specialist capacity to enable the mostly locked-in population constant access to the best possible eye care. 

## Quality Eye Care 

## Accessibility 

A commitment to the highest standards of quality and comprehensive eye care is vital to ensure the greatest chance of treating or managing each patient successfully. 

We are committed to reaching the most isolated and marginalised communities in the oPt. 

The Covid-19 global pandemic pandemic was a continued concern in 2021.  Vitally we ensured everybody was aware of and implemented the necessary preventive precautions. This involved communicating our protocols for dealing with the pandemic for both patients and staff via lectures, posters, leaflets and reminders. We maintained coordination and contact with Ministry of Health to ensure that we are up to date and well informed. 

Prevention and early treatment of eye conditions are vital. This is because many eye conditions, if left untreated, cause permanent vision loss. Delivering accessible eye health services in the oPt carries with it unique problems, as the movement of people, even for medical care, is limited by checkpoints, permit systems and the Separation Wall. 

We take this commitment seriously. We were the first Palestinian hospital to achieve Joint Commission International accreditation which is the most stringent certificate awarded to hospitals throughout the world, reflecting the highest standard of excellence in medical care. We are independently reviewed on our JCI accreditation every three years and have continuously achieved 97% or higher. Much of our teaching activities was to JCI standards and the up dated policies and procedures based on the most recent edition. 

We work to ensure that as many patients as possible receive eye care through mobile outreach, screening services, and hospitals and clinics strategically located across the West Bank and Gaza. We also make sure that our patients adhere to any referrals for advanced treatments at our hospitals by helping them navigate permit requirements, transport, and accommodation for longer stays. 

At our core, our values of policies and procedures based on compassion, accountability, the most recent edition. respect and excellence drives the ethos of care across our services Our Jerusalem Hospital is also – ensuring that each patient is the only Palestinian healthcare not just given first-rate medical provider to have locally trained treatment but are treated with specialists in all subspecialties of dignity and empathy at every step ophthalmology (except oncology), of their journey with us. and each of our satellite centres receive regular visits from our specialists for treatment or 

We are working to increase equity in our care by ensuring those who are often left behind get access to the care they need. With this aim, in 2021 we began using our Mobile Outreach to specifically target groups across the oPt which represent communities which often struggle to access care – such as disability and female advocacy groups. We are excited to track an increase in these demographics reaching and benefitting from our care. 


59% of patients were delayed or denied access to ophthalmic treatment outside of Gaza in 2021. Similar issues persist for West Bank patients. This is why it is vital to strengthen our local capacity. 

Accessibility *WHO EMRO Monthly Support on Health access, December 2021 59% 

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## Spotlight On: 

## Continuity of Care and Systems Strengthening 

SJEHG has been focussed on improving the ophthalmic care of the Palestinian population since we began almost 140 years ago. However, alone we can only do so much. To truly offer the most accessible care to our population it is vital to work with the wider community to strengthen access to ophthalmic services across the oPt. 

In 2021 we were therefore delighted to launch a four-year programme which will take sustainable eye health to the most marginalised communities across the West Bank and Gaza. This programme is specifically targeting refugee communities who access health through the United Nations Relief and Works Agency (UNRWA). These communities make up the most impoverished populations across the oPt and are the people most likely to fall through the cracks of the health system. 

The programme aims to offer expanded and sustainable eye health by training almost 100 UNRWA doctors across the West Bank and Gaza in primary eye care. This will ensure that they can sufficiently diagnose and manage basic eye health conditions and refer on to SJEHG centres where needed. It will also utilise our existing outreach service to target specific population groups who often miss out on eye care by collaborating with local community advocacy groups for those with disabilities and other groups. 

Specific screening will be introduced to target Diabetic Retinopathy (DR) in UNRWA communities through training UNRWA nurses. These nurses will be trained on using state-ofthe-art handheld retinal imaging cameras to diagnose DR in the Palestinian refugee population. DR is the single fastest growing cause of blindness in the oPt, and it is vital that it is caught early to ensure that patients do not needlessly go blind. 

Cooperation and Development via Johanniter Unfall Hilfe and CBM, the Australian NGO Cooperation Program (ANCP) via the Fred Hollows Foundation and the Lions Club International Foundation (LCIF). In 2021 we began our training activities, and we are incredibly excited to bring eye health to tens of thousands across the oPt with this programme in the coming years. 

By training UNRWA nurses **“This programme is** and doctors, we are promoting **providing innovative** and advancing the principle of Universal Health Coverage across **sustainable solutions** the Palestinian population. Not **to combat avoidable** only will this increase access to **blindness in Palestine.** eye health across the oPt, for our **The programme will** most vulnerable communities, it will also take the burden off our **build the capacity of** ophthalmic doctors and nurses to **local medical workforce** focus on more advanced cases. **to respond to the increasing need for** The programme also aims to **preventative and curative** introduce Small Incision Cataract **eye care for a population** Surgery (SICS) at SJEHG facilities through training two **that cannot afford such** ophthalmologists in the West **services. We are hopeful** Bank and Gaza. The introduction **that this approach will** of SICS will make cataract **prove to be effective and** surgery more affordable without **eventually be expanded** compromising quality and surgical outcomes.  This will ensure that **into the national health** those who are referred from **strategy.” David Dahdal** the UNRWA centres, and those **– SJEHG Director of** accessing SJEHG services **Development and Grants** generally, receive the best possible care. 

This programme is generously funded by the German Federal Ministry for Economic 

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> St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 9 



## Excellence, Education, & Innovation 

**Only 19 qualified** Lack of **ophthalmologists** Specialists **per 1 million** 19 per **population in the oPt (compared to** 1 million **49 in the UK), this trend is reflected across all eye health specialists** 

Excellence in clinical and academic postgraduate medicine lie at the heart of all successful tertiary referral hospitals. A vibrant postgraduate culture drives innovation, inspires staff, builds trust and loyalty and attracts supporters and patients alike. 

In this regard, SJEHG is no different to any other teaching hospital. With over 150 nurses, doctors and Allied Health Professionals (AHPs), it is as large as other units and, as importantly, deals with a complex demographic and pathology base. In another regard, SJEHG is entirely unlike any other hospital. It lies at the heart of one of the most respected humanitarian organisations in the world, with an ethos stretching back to the Hospitaller Knights and their predecessors in the eight century AD. One thousand years after the first hospice in Jerusalem, and almost 140 years after the modern Order was established, SJEHG continues to flourish. 

## Education 

There is a shortage of both nursing and medical professionals across the oPt, and this shortage is even more pronounced in eye care – there are only 19 ophthalmologists per million of the population (compared to 49 per million in the UK). To combat this, and ensure that we remain ophthalmic leaders, we provide world-class education to the next generation of Palestinian eye health professionals. 

**Nursing and Allied Health:** We offer up to ten places each year at our prestigious Sir Stephen Miller School of Nursing. This is complemented by a training programme for ophthalmic assistants in Gaza, as well as training general community health workers to identify and refer eye conditions to SJEHG centres. Since the 1980s, we have trained over 200 ophthalmic nurses and nursing assistants in both Jerusalem and Gaza. Those who stay with us have opportunities for further career development. Several our graduates go on to train 

as allied health specialists such as orthoptists or retinal diagnostics. 

**Medical:** Our ability to offer all subspecialties of eye care (excluding oncology) is achieved through our Medical Residency Programme and Joint Teaching Programme. Our Residency Programme is the only training opportunity offered to Palestinians to specialise in ophthalmology. Once qualified, our specialists will work across our services and are given the opportunity to undertake fellowships in subspecialties at St John or at one of our partner organisations. This highlevel experience is essential if our staff are to tackle the complex and advanced pathology which can occur in Palestinian patients. 

## Highlights 

Three orthoptist assistants passed the Israeli certification exam. 

Three doctors began fellowships in oculoplastic, paediatrics and glaucoma. 

Medical Residency programme: one graduated, one graduates early next year, and one has competed her 3rd year. Three new residents enrolled in the programme. 

Our School of Nursing was unfortunately suspended for 2021/2022 due to the Covid pandemic but is due to reopen in late 2022. 

Mandatory training was conducted on life support and cardiac life support. 

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- Autologous cornea regeneration in collaboration with Radboud University 

• Development of topical eye-drops therapeutics to replace cataract surgery in collaboration with Tel-Aviv University 

**Genetics Research:** Since 2016, we have been conducting extensive research into inherited retinal disease across the oPt. This was, until 2019, ‘Peace for Sight’ - a joint project between SJEHG and Hadassah Medical Hospital funded by the German Johanniter Unfall Hilfe (Johanniter Aid for Accident services) and the European Union Peacebuilding Initiative. This project allowed us to train a dedicated genetics research team and establish the oPt’s first ever retinal genetics laboratory. 

In 2021, we recruited 130 new families to the research, with almost 600 families having been recruited since the project started. We also published three papers with other international centres on the research and have been chosen as one of 12 centres who will be involved in a gene therapy trial for retinitis pigmentosa. 

**Diabetic retinopathy is now one of the leading causes of blindness in the oPt - up from 8.3% of the overall causes of blindness in 2008 to 24% in 2018.** 

Diab ~~ete~~ s 24% 

## Research and Innovation 

We work to deliver a service which reflects current population needs and provides state-of-the-art high quality treatment for those who require it. We do this by researching our population needs and ensuring that our specialists collaborate on developing ophthalmic best practice with their cohorts across the globe. 

**Clinical Research:** Our clinical research efforts grew in 2021 with the establishment of the St John Ophthalmic Associations’ Ophthalmic Research Advisory Committee and the introduction of the role of Clinical Research Coordinator in Jerusalem. These new initiatives reflect a wider strategic aim of SJEHG to encourage high-quality clinical research at SJEHG. 

All peer-reviewed citations from SJEHG doctors are now tabulated on the research section of the SOA website, with ten quality publications published in 2021 alone. Our Covid-19 case series was a novel publication - we published the first case of intermediate uveitis post Covid-19 illness worldwide. 

## **Ongoing Clinical Research initiatives include:** 

- Multicentre study on Behget vasculitis 

- Study of the genetic risk of diabetic retinopathy in the oPt in collaboration with Al Quds University 

- Uveitis in paediatric arthritis in collaboration with Al-Najah University 

- Glaucoma Research (6 projects underway) 

- Collaboration with Hadassah Academy College focusing on Keratoconus 

- Retinopathy of Prematurity Screening Programme (see page 15) 


**----- Start of picture text -----**<br>
Genetics<br>50%<br>**----- End of picture text -----**<br>


**The isolation and desire to preserve cultural traditions and retain property within the family has led to a rise in intra-familial marriage – which causes high levels of genetic eye disease. 50% of marriages in the oPt are intrafamilial.** 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## Spotlight on: 

## St John Ophthalmic Association 

With ophthalmology being an important strand of The Order of St John's work, an increasing number of distinguished international ophthalmologists are involved in St John. In 2015, a group of members from across the Order formed a working party to support SJEHG as well as coordinate this growing international interest and the St John Ophthalmic Association (SOA) was born. In 2020 it became an incorporated company under the aegis and governance of SJEHG, with its own board of Directors, and is now formed of 5 international hubs with 10 Chapters. 

Despite the disruption of the Covid pandemic, the SOA has grown in recent years. It ran the Neuro Orbital Master Class symposium in London in early 2020, uniting over 90 experts from 10 countries to discuss a raft of complex multi-specialty sight-threatening pathologies. With the advent of lockdown, it switched to a series of virtual St John Ophthalmic Case Series meetings. These continued in 2021 with the Canadian, Australian, and English chapters of the Association, and were joined by ophthalmologists, supporters, and various national leaders from across The Order.  Future such meetings include SOA-Africa, Singapore, Cyprus and India. These Masterclasses offer an incredible opportunity for doctors from SJEHG to share learnings with their colleagues across the world. 


Other educational elements to the SOA’s digital work include ‘Cutting Edge’, a series of short online lectures and the Lexicon project, an on-line ophthalmic dictionary. The SOA also promotes clinical and laboratory research at SJEHG. One example is the recent formation of the international Ophthalmic Research Advisory Committee based in the Australian Priory. This was established to support our SJEHG doctors with their research ideas, helping them through the planning, writing and publication phases. Another example is the purchase, through the SOA, of the tissue storage freezer required for our on-going retinal genetics research. 

Advanced subspecialty Fellowship experience is now an integral part of ophthalmic training. Thanks to the generosity of its donors, the SOA has been able to promote two such posts in 2021 (see page 16) with further Fellowship opportunities planned for 2022. 

The SOA, now in its seventh year, is working hard to support SJEHG's strategic goal of ‘Excellence, Education and Innovation – Developing a centre of excellence for eye health education, research and innovation.’ Thanks to the support and dedication of the board, our staff, and professionals around the Priories, we have made significant strides in 2021, and the SOA looks forward to playing its part in strengthening and developing this strategy in the years ahead. 

## **Aims of the St John Ophthalmic Association:** 

1. to support teaching, training and research in SJEHG. 2. to promote the international academic profile and reputation of the work of SJEHG. 

3. to coordinate the growing ophthalmic base across St John, to strengthen the profile and reputation of the wider Order of St John. 

## Celine's Story 


We are developing our screening programme for retinopathy of prematurity (ROP), a disorder which affects as many as 60% of premature infants. The smaller the baby, the more likely it is to develop ROP. Infants with ROP are also considered to be at higher risk of developing certain eye problems later in life, such as near-sightedness (myopia), crossed eyes (strabismus), lazy eye (amblyopia) and glaucoma. If untreated, the condition can lead to irreversible blindness. This is why it is vital to screen as early as possible. 

In 2021, SJEHG partnered with major hospitals in Jerusalem (Makassed, St Joseph, Red Crescent), and Bethlehem (Holy Family) and Hebron (Red Crescent) to conduct screening services on premature infants on a much higher level than we had done previously. Thanks to funding from the RTW Charitable Foundation, this includes stateof-the-art digital imaging and telemedicine, which means that screening can be done by a technician, releasing clinicians to focus on remote diagnosis and treatment of identified cases. The greatest need is in Gaza, with an increasing number of neonatal units, and we are working to procure further mobile camera systems for the area. 

“It was so hard to lose our babies, but it made us all the more empowered to fight for Celine to have the best life possible” Wa’fa, Celine’s mother explains. 

Across the year, our team screened almost 300 premature babies for the condition. One baby was Celine. 

Celine’s parents were desperate for children but unfortunately struggled to conceive. They eventually sought IVF and were delighted to learn they were pregnant with four children. With multiple-child pregnancy comes greater risk. Unfortunately, only six months into the pregnancy, the babies were born prematurely. Only one of the four survived – Celine. 

“My daughter is now 2 and a half years old. She loves exploring her surroundings and is so smart. She has just started kindergarten. We are so thankful to St John and all of her care team for ensuring she had the opportunity to thrive. I can’t wait to see what kind of person she will become.” 

Celine had several issues from being born prematurely and was in neonatal ICU for months. Her parents had to move from their home in Gaza to the West Bank to ensure easier access to her treatments. Part of her care involved ensuring her eyes developed properly, as she was born with ROP. Our specialist Dr Mohammad Daraghmeh was with her every step of her journey to care. 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



Maysoun’s Story Nursing in Gaza: 

## Investing in our people 


**----- Start of picture text -----**<br>
Staff nurse Ahmad Odeh with Head of our Jerusalem Hospital<br>surgical department Jamil Abu Hani<br>**----- End of picture text -----**<br>


and Dr Haneen Shalaldeh was appointed as a specialist in our Kufor Aqab clinic. All three are graduates of the St John residency programme. Staff are trained and coached to be multi skilled in their departments by working on a rotational basis where possible, without affecting quality. Internal training is conducted on a regular basis which is essential for staff continuous development. We have morning lectures for doctors and nurses to increase their knowledge and discuss special cases and recently introduced the SOA Case Study series (see page 14). We also hold regular mandatory training in First Aid, and other social topics such as Sexual Harassment in the Workplace. 

Our staff are our most valuable asset. We are dedicated to creating an atmosphere which cultivates respect, development, transparency, and well-being for all our employees. We will continue to conduct our salary scale study, with plans to introduce a transparent salary scale by 2023. 

As they are currently relatively underrepresented at senior levels, we are also placing a distinct focus on encouraging our female and disabled staff members into management and development opportunities. In 2021, Dr Salam Iriqat was promoted to junior consultant and appointed as the group research lead. Dr Raja’ Al-Masri started her oculoplastic fellowship 

We continue to reward staff for their distinguished performance through the “Employee of the Month” nominations as well as nominations and promotions within The Order of St John. 

Maysoun is one of our theatre nurses in our Gaza Hospital. She received training to be an ophthalmic nurse through our training scheme and has been working at the hospital for over six years. This is her story. 


use of my social media skills to give remote care where it was needed and possible. 

“I am so proud to be a member of the St John Family. It was my dream to work here, and it continues to deliver on that dream every day. 

There is nothing better than helping a person regain their sight, and I am lucky enough to see this every day in the theatre. One woman that sticks out to me is a lady who came in almost fully blinded with cataracts in both her eyes – she hadn’t been able to see for over five years. I got to witness the moment she saw her children again for the first time, and for her to see that her boys had grown into men. There was so much happiness in the room that day. 

I was born and raised in Gaza – my parents are originally from Jafa and had to move after the 1948 war. We settled here. Part of my motivation to become a nurse was the injuries I’ve seen occur from the conflicts I’ve lived through. I wanted to be part of the solution. When we are not in conflict, Gaza is the most beautiful place in the world. 


Thank you to all the supporters of St John who enable me and my colleagues and I to continue our work – you are helping us to change lives every day.” 

I feel incredibly well supported at St John. Especially as a woman at work. A female in Gaza can often face social issues, but this has been the opposite at St John. They are constantly encouraging me to develop my skillset and improve in my quality of care. 

**My favourite hobby is cooking and sharing my recipes on social media. If you want a taste of Palestinian culture, and the beauty of Gaza please do give my page a follow. @sonadaban** 

COVID was a particular challenge for us all. At first, I felt quite hopeless as to how to help our people when we had to be so careful. However, this grew to pride when we managed to increase on our surgeries delivered, even during such a hard time! I also made 

**Father Wala' with daughter Janat and son Mohammad in our Jerusalem Hospital.** 

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## Good Governance & Partnerships 

SJEHG continues to seek operating to the correct level. partnership opportunities in As such, we are registered the Middle East and globally. with official charity bodies in the UK and are independently Technical Support and audited each year. To see our Grant Partnerships: full fundraising statement, see There are a number of other page 33, to see our Independent development organisations who Auditors' report from PwC see collaborate with SJEHG on eye page 36. 

There are a number of other development organisations who collaborate with SJEHG on eye health projects across the oPt. We rely on their expertise or influence to deliver our services at the highest level. Several of these bodies are also donors, to see a full list of major donors in 2021 refer to page 55. 







St John Family: SJEHG 



enjoys a unique position as a foundation member of The Most Venerable Order of the Hospital of St John of Jerusalem, which was given a Royal Charter by Queen Victoria in 1888. Our Sovereign Head is Her Majesty Queen Elizabeth II, and our Grand Prior is HRH Duke of Gloucester. Being a founding member of one of the world’s biggest providers of healthcare gives SJEHG access to partnership with Order of St John, Johanniter International and the Alliance of the Orders of St John. Together, and alongside several other international bodies, we collaborate on best practice for clinical governance, sustainability and more. 













## Quality and Transparency: 

Through our commitment to quality eye care (see page 7) we have been accredited by the ISO 9001:2015 (Accreditation for Quality Control) and JCI International and are subject to regular external audits to ensure that we are adhering to their gold-standard for quality healthcare. We take transparency very seriously, following all UK guidelines to ensure both our accounting and fundraising practices are 






We rely on our reputation to enable us to deliver our services further and to a higher standard than anyone else in the region. 

Local: Our strategic partnerships with local health networks are vital to ensure an integrated approach to eye health. We have a Memorandum of Understanding in place with the Ministry of Health in both the West Bank and Gaza, to guarantee patients who present with eye conditions at general clinics are referred to us for specialist treatment. 





Training: Both our Sir Stephen Miller School of Nursing and our Medical Residency Programme are internationally accredited, ensuring that our staff are trained to the highest possible standard. Our medical team benefit from opportunities to train in subspecialties internationally, and regularly collaborate on medical research with their cohort across the globe (see page 12). This collaboration has been encouraged by the introduction of the St John Ophthalmic Association (see page 14) 




**----- Start of picture text -----**<br>
40%<br>Other<br>Voluntary<br>40% Income<br>Patient<br>Related<br>Income<br>19%<br>Priory<br>Income<br>1%<br>**----- End of picture text -----**<br>


## Sustainability 

## Statement of Financial Activities 2021 

|**Incoming Resources: **£13.3m|GBP<br>£000|$000<br>USD|**%**|
|---|---|---|---|
|Patient Related Income|5,337|7,365|40|
|Priory Income|2,505|3,457|19|
|Other VoluntaryIncome|5,362|7,400|40|
|Investment & Other Income|140|193|1|
|Total|13,344<br>|18,415||
|||||
|||||
|**Resources Expended:  **£10.9m|GBP<br>£000|USD<br>$000|**%**|
|Charitable Activities|10,159|14,019|93|
|Cost of GeneratingFunds|533|736|5|
|Governance and Other Expenditure|196|270|2|
|Total|10,888|<br>15,025||



Investment Income 


**----- Start of picture text -----**<br>
93%<br>Charitable<br>Activities<br>2%<br>Governance<br>**----- End of picture text -----**<br>


**5%** Cost of Generating Funds 

## **Thanks to the continued support of our donors, we can provide high-quality eye care to thousands of people each year.** 

at subsidised rates, or for Our St John Family remain a vital free, to ensure that money donor and, in 2021, gave 32% of is not a barrier in their eye our voluntary income. To all our health journey. Poverty rates donors, and especially our major are currently 36% in the West donors, we thank you for your Bank, including East Jerusalem, generosity (please see a full list and 64% in Gaza.* Our donors of major donors on page 55). remain vital for us to be able to deliver eye health to those _*Source: UN OCHA “Occupied_ who need it most – the most _Palestinian Territory (oPt)_ marginalised, underprivileged _Humanitarian Needs Overview_ and at risk. They also allow us to _2021” Dec 2020_ preserve our rich heritage, which reflects the almost 1,000-yearold tradition for The Order of St John of delivering health care in the Holy Land. 

The Palestinian need for eyecare only continues to grow, and with it brings a vital requirement to source new methods of funding. 

As part of our 2020-22 strategy, we are committing to diversifying our sources of funding by looking to increase our income from private and medically insured patients. We will do this by remaining an innovative and competitive leader in private eye care across the oPt. There will always remain a large portion of our patients who will need eye care given 

18 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## Trustees and Committee Members 

The trustees of the charity, who are also the directors for the purposes of company law, during the year and, at the time of this report, are listed below: 


Sir Andrew Cash OBE KStJ _(Chairman)_ 

## ••••• 

Sir Andrew joined the NHS as a fast-track graduate management trainee and has been a chief executive for more than 20 years. He has worked at the local, regional and national level. He has worked by invite at the Department of Health, Whitehall on a number of occasions. He is a visiting Professor in Leadership Development at the Universities of York and Sheffield. Sir Andrew was Chief Executive of Sheffield Teaching Hospitals NHS Foundation Trust from 2004 to 2018 and is currently the part time Chief Executive of the South Yorkshire and Bassetlaw Integrated Care System. He joined the SJEHG Board as Chair in September 2018. 

Mr David H Verity KStJ, MA (Oxon), MD (Lon), BM BCh, FRCOphth _(Order Hospitaller)_ 

## •••• 

David Verity was appointed to the Board in June 2016 and became the Order's Hospitaller in September 2018. He is a surgeon at Moorfields Eye Hospital, the President of the British Oculoplastic Surgery Society, the Treasurer for the European Society (ESOPRS), and immediate past Editor in-Chief 

of the international journal ‘ORBIT’. In 2015, with the ophthalmic Hospitallers of the Order, he founded the St John Ophthalmic Association (SOA), a professional organisation dedicated to the postgraduate work of SJEHG. The SOA is formed of 5 world-wide hubs, engaging medical expertise across the Priories and supporting our staff with training courses and medical exchanges. As a surgeon, he also undertakes regular working visits to our hospitals in Jerusalem and Gaza. 

## Mr Chris Hoult FCA 

_(Treasurer and Company Secretary)_ 

## •••••••• 

Chris Hoult joined the Board of Trustees in January 2022 as Treasurer bringing over 25 years of board level experience in roles that have encompassed Finance, IT, Procurement, Estates and Facilities as well as international trading which included 2 years spent living and working in Denmark. 

> our hospitals in Jerusalem and Gaza. He qualified as a Chartered Accountant in 1987 and since Mr Nicholas Goulding then he has worked in a variety 

> CStJ BSc FCA CTA (Fellow) ATT of commercial and not-for-profit 

> _(Treasurer and Company Secretary)_ organisations including 4 years •••••••• as the Director of Finance of Nicholas Goulding is SJEHG’s Plymouth Hospitals NHS Trust Treasurer and Secretary. He is and 9 years advising NHS a Chartered Accountant and organisations in London on major Chartered Tax Adviser and is a strategic reorganisation projects. former partner with KPMG LLP. He is Honorary Treasurer of The He is currently the Director HM Tower of London Chapels of Finance of Royal Voluntary Royal Foundation, The Honourable Service a UK focused charity that Company of Air Pilots, St Lawrence promotes volunteering as well with St Swithun Winchester, as supporting the NHS and its Winchester Deanery Synod and patients. a Governor of Lord Wandsworth 

> College. He was first appointed Dr Maged Abu-Ramadan to the board in August 2012 and KStJ MD FRCSEd 

> retired in December 2021. •••••• 

He is currently the Director of Finance of Royal Voluntary Service a UK focused charity that promotes volunteering as well as supporting the NHS and its patients. 

## •••••• 

Dr Maged Abu-Ramadan is a resident of Gaza, a Senior Consultant Ophthalmic Surgeon, and the Founder and President of 

the Palestinian Ophthalmological Society. In 2005 he was made Mayor of Gaza. He is the Treasurer of the Middle East Africa Council of Ophthalmology, and the Chairman of Coastal Municipalities Water Utility. Previously, he was the Palestinian Authority Director General of Hospitals General Administration and the Director General of the International Cooperation Department of the Ministry of Health. Maged became a member of the board in April 2013. 

## Mrs Avey Bhatia RGN, MPA 

## •••• 

Avey Bhatia is Chief Nurse at Guy’s and St Thomas’ Trust. Avey qualified in 1991 and her clinical experience includes theatres, general intensive care, coronary care and cardiothoracic nursing. She held various staff nurse and sister posts at hospitals in London before becoming Chief Nurse and Director of Infection Prevention and Control at St George's University Hospitals NHS Foundation Trust in 2017. Avey holds a postgraduate diploma in health services management and a Masters in Public Administration. She is also the Trust’s Director of Patient Experience, and the executive lead for adults’ and children’s safeguarding, and for 

Liveryman of the Clothworker’s and 

infection, prevention and control. Beyond Guy’s and St Thomas’, Avey is Vice President for the Florence Nightingale Foundation and Honorary Vice President of The Nightingale Fellowship. Avey joined the Board in January 2022. 

Pattenmaker’s Companies and is a member of the Knights Templar. Jamie has been involved with the Order of St John for over 40 years as a member of the Ceremonial Staff and is currently the Sword Bearer. He joined the board in 2017. 

Ms Susan Dingwall OStJ LLM DipLP 

## HE Diane Corner OBE 

## •••••• 

> Susan Dingwall is a partner and •• General Counsel of the international Diane Corner has been British law firm, Norton Rose Fulbright LLP, Consul-General in Jerusalem specialising in risk and insurance since July 2021. Diane was British issues. Prior to becoming General Ambassador to the Democratic Counsel, she led the firm’s awardRepublic of Congo (2013-14) winning Islamic insurance practice and prior to that British High and is a recognised expert in her Commissioner to Tanzania. From field by the leading directories.  She 2014-17 Diane was Deputy first joined the Board in August 2011 Special Representative of the and retired in December 2021. UN Secretary-General (Political and Protection of Civilians) in the Mr Jamie Ingham Clark CStJ FCA Central African Republic. Other •••••• diplomatic postings have included Jamie Ingham Clark is a Chartered Kuala Lumpur (1985-88), New Accountant and pursued a career York (1989), Berlin (1994-98), in the Lloyd’s insurance market, Harare (2001-3) and Sierra Leone where he had many years board (2008-9). Diane holds a BAHons experience as either Finance or in French and Politics from the Compliance Director. He was first University of Bristol, and an MA elected to the Court of Common in International Relations and Council (the local authority for the Contemporary War from King’s City of London) in 2013 and was College London. She also has a the Chairman of its Finance diploma from the NATO Defence Committee until March 2022.. College Senior College which she He sits on a number of other attended in 2000. Diane joined the committees within the City. He is a Board in July 2021. 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## Miss Helen Dodds (Helen Forsyth) 

## •••••• 

Helen is an international lawyer and board member with over 30 years’ experience in the legal and financial services sectors. She is a solicitor, a CEDR accredited mediator and a Senior Honorary Fellow of the British Institute of International and Comparative Law. Helen is currently also a board member of the UK Human Tissue Authority, a director of LegalUK and a member of the development board of the Bingham Centre for the Rule of Law. Previously she was Global Head of Legal, Dispute Resolution at Standard Chartered Bank, and a non-executive director of the London Court of International Arbitration. She joined the Board in January 2022. 

## HE Philip Hall OStJ OBE 

## •• 

Philip Hall was British Consul General in Jerusalem from 2017 to July 2021. Before this, he led the Spending Review at the Foreign & Commonwealth Office. From 2012 to 2015, he headed the FCO’s Counter Proliferation Department, leading the UK Government’s work to prevent the spread of chemical, biological and nuclear weapons. He was Defence Counsellor in the UK Delegation to NATO from 2008 to 2012 and headed the FCO’s Middle East Peace Process Section from 1999-2001. He is a solicitor, completed postgraduate studies in European law and integration in Germany, and has a Masters in Public Policy from the London School of Economics. Philip resigned in July 2021. 

## Mr Paul Hackwood 

## ••• 

Paul Hackwood is CEO and General Secretary of Toc H, a national Community Development Charity. Paul is ordained in the Church of England and a Canon at Leicester Cathedral. He is a trustee of the Henry Smith Charity 

where he chairs the Clergy and Christian Projects grant making committee. He was recently appointed as a fellow of the Edward Cadbury Centre for the Public Understanding of Religion at the University of Birmingham. Paul joined the Board in January 2022 and chairs the Fundraising Committee. 

2018 until the appointment of Sir Andrew Cash in September 2018. He first joined the board in June 2011. During the pandemic the decision was taken to extend his term of office until the autumn of 2022 given the value in a period of uncertainty of his long experience with SJEHG. 

managing partner of the London office between 2007 and 2011 and worked in the Madrid office between 1994 and 2000. Upon retirement from Freshfields he became General Counsel of England 2015, the organising committee for the Rugby World Cup. Tim joined the Board in November 2019. 

## Dr David E.I. Pyott CBE, OStJ 

## Mrs Ismat Levin 

## Mr John Macaskill OStJ 

## ••• 

Dr David Pyott is the former Chairman and CEO of Allergan Inc. During his tenure, Allergan was transformed from a small eye care business with about $1 billion in sales to a global company, with sales over $7 billion. Dr Pyott is a member of the Board of several U.S. pharmaceutical companies and a member of the Supervisory Board of Royal Philips. He is Deputy Chairman of the Board of Governors of London Business School, a Trustee of the California Institute of Technology, President of the newly created Ophthalmology Foundation, successor to the International Council of Ophthalmology Foundation, President of the Advisory Board of the Foundation of the American Academy of Ophthalmology and is also involved on the Boards of many other U.S. and international eyecare charities. Dr Pyott and his wife, Molly, are Members of the Priory of the USA and stalwart supporters of SJEHG. Dr Pyott joined the Board in October 2020. 

## ••• 

## •••• 

Ismat Levin trained and practiced as a solicitor at City law firm Dentons following which she has spent 25 years as General Counsel for commercial, international growth and technology-led industries listed on NASDAQ or in private equity contexts.  She has substantial experience of intellectual property licensing, governance, risk management and regulation. Ismat has served as a committee member for the Royal College of Radiologists (20162020) and since April 2015 as a Magistrate on the North West London Bench.  In February 2022, Ismat joined the Board of LXi REIT plc, a real estate investment trust and FTSE 250 company, listed on the London Stock Exchange, as Non-Executive Director. Ismat joined the Board in January 2022 and Chairs the Digital and IT Committee. 

John Macaskill was a Founding Partner and Managing Director of Groton Partners, a Private Equity firm based in New York. Mr Macaskill joined Groton Partners in March 2005 and focused his efforts on alternative investments, including Private Equity. Mr Macaskill is a General Partner in a number of private equity and real estate funds and has spent the last forty years in the financial services industry in New York and London. He is a member (retired) of the Institute of Chartered Accountants of Scotland, and a Chapter Member of the Priory in the United States of the Order of St John. He joined the board in January 2018. He has been appointed as the treasurer of the Priory of the USA. 

## Mr Guy Morton KStJ MA 

## ••••••••• 

Guy Morton is a solicitor and was, the USA and stalwart supporters of Mr Timothy Jones until his retirement, a partner in SJEHG. Dr Pyott joined the Board ••••• Freshfields Bruckhaus Deringer in October 2020. Tim Jones is a retired solicitor, LLP, with a practice specialising in Chair of the trustees of banking and financial law and the Ms Nicki Shaw OStJ homelessness charity The regulation of financial markets. He •••• Connection at St Martins, a was Joint Senior Partner of the Nicki Shaw is Chief Executive trustee of the Safer London firm from 2006 to 2010. He has of Princess Alice Hospice. She charity and of the National served on European Commission previously worked at the British Botanic Garden of Wales, consultative groups relating to Heart Foundation, latterly as a director of the Sport and financial law reform and has Programme Director for Prevention Recreation Alliance and a represented the United Kingdom and Care. Her career has spanned school governor. Tim was in relation to international the commercial, regulatory formerly a partner in the law firm law reform initiatives at the and voluntary sectors. She has Freshfields Bruckhaus Deringer Hague Conference on Private participated in a number of national LLP working on a wide range International Law and UNIDROIT. forums including the Palliative of corporate and commercial Mr Morton was appointed as Care Funding Review and the projects internationally. He was Acting Chairman from January DH Advisory Group on Health at 

Work. Nicki joined the board in September 2012 and retired in December 2021. 

## Mr Kevin Custis 

• Kevin is a registered trust and estate practitioner, Legal Executive and the chair of the London Central Branch of the Society of Trust and Estate Practitioners (STEP). 

## Mr Herbert von Bose 

## ••• 

Herbert von Bose is a lawyer and has worked for the European Commission in Brussels since 1983 where he rose to become the Director for Industrial Technologies. He joined the Johanniterorden in 1984 and was chairman of the Brussels Johanniter Group from 2002 to 2012. Since 2014, he has been Governing Commander of the Balley and is responsible for international affairs. Herbert joined the board in June 2014. 

## Mr Paul Double LVO, OStJ 

Paul is a barrister and the Remembrancer at the City of London. 

## Mrs Anzo Francis MStJ 

## • 

Anzo is an ICAEW Chartered Accountant and Director of Finance of Water & Sanitation for the Urban Poor. 

## Mr Timothy Walker CB, MStJ 

• Timothy is a retired British Civil Servant, formerly serving as Director General of the Health and Safety Executive. 

Co-opted Committee members who are Not trustees 

## Mr Ken Baksh 

## Ms Caroline Trewhitt 

• Ken is an investment consultant with over 40 years’ experience. 

## •• 

Caroline is a financial services executive with over 20 years experience leading strategic change and corporate development projects in both large and small organisations 

## Mrs Georgie Brookes MStJ 

> Georgie has been a Guild Member organisations for 20 years. Formerly at Mayfair Capital and currently Finance KEY: Manager at the Mango Tree OSP. •[Board ] Mr Thomas E.K. Cerruti Esq, OStJ •[Steering ] • •[Finance ] Thomas is a lawyer, Executive •[Audit ] Director of the Shiley Foundation, 

> and trustee. He is a member of the • 

> Priory of the USA. • 

•[Investment ] •[Clinical Governance ] •[Fundraising, Marketing ] & Communication •[Strategy & Planning ] •[Payroll and Remuneration ] •[Human Resources ][Honours & Awards] SOA[Guild Liaison] Digital and IT 

## Mrs Julia Corkey MStJ 

Julia became Chairman of the SJEHG Guild in March 2021. She was a senior British public servant for over 20 years and is currently Chief Executive of ICC Belfast, Waterfront and Ulster Halls. 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## Governance Structure 

Board SJEHG is a company limited by guarantee in England. The Committees: Order of St John is the sole member of the Charity and Steering appoints the Chairman of the Board of Trustees. The Board Finance manages the business and Audit affairs of SJEHG and usually meets three times a year, as Investment does the Steering Committee, Clinical Governance with at least one meeting at the Hospital in Jerusalem. For Fundraising, Marketing the past two years all meetings & Communication have been held virtually due to the Covid-19 pandemic. The Strategy & Planning Board reviews the performance Payroll and Remuneration of SJEHG and, in particular, the performance of the hospital in Human Resources Jerusalem, Gaza, Hebron and Honours & Awards the Anabta and Muristan Clinics, as well as the Mobile Outreach SOA Programme. The Board also Guild Liaison considers and approves the operational and capital budgets. Digital and IT The Board Committees focus, in detail, on their areas of The Committee Terms of responsibility and report back to Reference were updated the Board. The Board is aware in 2021. of the codification of directors’ duties under the Companies Act 

2006 and takes these duties into account in consideration of SJEHG’s activities and within its Articles of Association. New Trustees are selected by the Board to maintain an appropriate balance of skills, experience and diversity. Trustees are appointed for a term of three years and may be reappointed for two further terms of three years but are not normally eligible for a further reappointment. 

Four current trustees left the Board of Trustees in 2021/2022 after serving a nine-year term. Six new trustees have been recruited to replace them who were appointed throughout 2021 and in January 2022. 

An induction programme is in place for new Trustees. The Board of Trustees delegates responsibility for the daily management of the Charity to the Chief Executive, Dr Ahmad Ma’ali and the SJEHG senior management team. 

## The Chief Executive 

infection control and clinical services coordinator, and gained a master’s degree in Public Health Management at Al Quds University in 2003. 

## Dr Ahmad Ma’ali 

CStJ PhD MPH BSN PGCE ENB, CEO 

•••••••••• _[CEO]_ Dr Ahmad Ma’ali joined the SJEHG family in 1990 as a student nurse, successfully completing his secondment at Greenwich University in 1996 followed by a sixmonth postgraduate specialist ophthalmic nursing course at London’s Moorfields Eye Hospital. In 1999, he was certified with a Nurse Tutor Diploma by the Bolton Institute. Thereafter, he returned to Jerusalem where he assumed the role as clinic Charge Nurse for one year, and in 2000 took responsibility for course leadership at the Sir Stephen Miller School of Nursing. He was also responsible for 

In May 2009, Dr Ma’ali made SJEHG history as the first Palestinian Nursing Director. In 2017, he attained a PhD in advanced Nursing practice at De Montfort University and, after 10 years as Director of Nursing and Allied Health Professions building relations with staff, students and patients, he was appointed as an interim Joint CEO with Peter Khoury in September 2017. In May 2019 Dr Ma'ali became our first Palestinian CEO. 

Bank and Gaza without regard to ethnicity, religion, social class, or ability to pay. 

## Public Benefit 

## The Public Benefits from SJEHG’s activities are: 

The Trustees have given due regard to the Charity Commission's General Guidance on public benefit when planning the Charity's activities. Our Annual Report sets out our activities, achievements, and performance during the year, which are directly related to the objects and purposes for which SJEHG exists. SJEHG achieves its principal objectives through the delivery of services to members of the public in Jerusalem, the West 

a. the provision and development of clinical and surgical ophthalmic services to patients at the hospitals in Jerusalem, Gaza and Hebron, the Anabta and Muristan Clinics and the Mobile Outreach Programme; 

b. the exemption of patients' charges when the relevant authority does not finance the treatment and the patient 


is unable to pay all or part themselves; 

c. the teaching and training activities at SJEHG, which enhance the quality of service delivered and increase the pool of qualified ophthalmologists, specialist nurses and allied health professionals within the region; 

d. the research into endemic diseases affecting the Palestinian population; and 

e. our services enhance education and employment prospects and contribute to economic growth. 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## Strategic Report 

Strategic Vision: January 2020 to December 2022 

Our three-year strategic plan 2020 - 2022 will enable us to attain our mission as a centre of excellence providing ophthalmic care of high quality to the people of the Holy Land irrespective of race, creed, social class or ability to pay. This strategy will enable us to continue Saving Sight, Changing Lives and to uphold our CARE values: 

vision to work with partners to sharing our knowledge on eliminate causes of avoidable genetics research and findings blindness in the Holy Land from the SOA annual summit through five distinct strategic aims: and disseminating the results from our Rapid Assessment of Patient-Centered Services Avoidable Blindness. By the end Putting patients first - reaching of 2022, we will produce at least out to the most isolated and 10 scientific publications and marginalized individuals in our have assured that our six medical community and ensuring quality residents are successful in their national exams. 

Patient-Centered Services Putting patients first - reaching out to the most isolated and marginalized individuals in our community and ensuring quality care and patient safety. 

SJEHG will build on its JCI Investing in our People re-accreditation to continually Investing in our most valuable strengthen standards and asset – our staff. Promoting protocols on quality care local talent and supportive and patient safety. Patient working environments, whilst satisfaction surveys and audits developing training opportunities will be conducted and we towards a sustainable, talented will develop our paediatric workforce. services in Gaza. Our priority is to establish outreach services Our staff are our most valuable to overcome permit related asset, and we will continue to accessibility issues and patients empower and support them located in more isolated to reach their full potential. communities. We will create a culture of transparency, initiate a hospitalExcellence, Education, wide pay scale and ensure and Innovation employees have an annual The country’s main provider development plan in response of ophthalmic training for the to appraisal processes. Female medical, nursing and allied health staff will be encouraged to sector, leading on excellence in take leadership roles and research, innovation and medical we will facilitate training and education. fellowship opportunities in Gaza and Jerusalem for corneal to We are the main provider of oculoplastic specialisms. 

## Care 

## Compassion 

Providing eye care with empathy and willingness to promote wellbeing 

## Accountability 

Accepting responsibility for continuous performance & improvement, embracing change & seeking new opportunities to serve 

We are the main provider of medical, nursing and allied health professionals’ ophthalmic training in the country. We will seek funding for clinical research, and to achieve the American Council of Medical Graduate Education accreditation. We will capitalise on our achievements in research, innovation and education by 

## Respect 

Good Governance and Partnerships Building international partnerships and strengthening governance structures to mitigate risks and ensure best practice. 

Honouring the dignity and diversity of each person 

## Excellence 

Providing exceptionally high quality and advanced care 

The strategy outlines our clear 


funding across patient, major donors and Priories income. We will do this by reviewing contracts with all Israeli sick funds, implementing nonclinical income generating projects and competing for paying customers with services driven efficient hospital-wide processes. We aim to increase hospital related income from 53% to 57% by 2022. 

The hospital management will further strengthen its governance structure across its sites and continue to conduct audits to control risks and prevent any undesired outcomes.  We also aim to strengthen partnerships with major donors and pertinent service providers and stakeholders such as Palestinian Ministry of Health, Afoula Hospital, as well as brokering agreements with hospitals in Israel and overseas. 

## Sustainability 

Building on a decade of overall growth by diversifying our funding sources so that we continue to reach more patients with quality services and ensure a financially secure future. 

We have expanded our services over the past 10 years to reach more patients and we will sustain these achievements by diversifying our sources of 

26 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 




## Strategic Report Financial Review: Achievements and Performance in 2021 

costs which makes up 58% 

costs which makes up 58% During 2021, the PA has of the total cost (2020, 56%). continued to face major financial Operating costs were contained difficulties that have resulted through the continuation in the inability of their ministry of enhanced cost controls of health to make sufficient, introduced in earlier years as regular and timely payments to well as the actions taken by the Group, Additionally, due to trustees and management to the political unrest within the minimise the financial impact of region, there are doubts about the pandemic. the ability of the PA to continue paying the hospital on a regular Costs of generating funds basis. Funding this level of constituted 5% (2020, 6%) of debt impacts on SJEHG’s cash total resources expended and flows and it is ameliorated is the costs of the Londonto a certain extent when the based fundraising team and the European Union and others Jerusalem-based fundraising pay a substantial part of the PA and projects team in addition to outstanding debt. Conversely, carrying out various fundraising SJEHG benefits from the events. Governance costs receipt of voluntary income, amounted to 2% (2020, 1%) of in particular for restricted the total resources expended purposes, in advance of the and reflect the international related expenditure, usually for nature of the charity’s activities capital projects. and governance arrangements. 

**For the year ended 31 December 2021, incoming resources amounted to £13.3m, (2020, £10.7m) while resources expended amounted to £10.9m (2020, £10.5m). This resulted in a surplus of £2.4m (2020, £0.2m deficit) before taking into account realised and unrealised gains on investments of £0.9m and exchange gains of £0.3m. Overall fund balances accordingly increased by £3.6m in the year.** 

During the year, patientrelated income increased as the hospital resumed its normal working levels post Covid-19 pandemic which imposed movement restrictions and resulted in a decline in the number of patients seen and treated by the hospital in 2020. Within voluntary income, donations from St John Priories increased from £2.1m in 2020 to £2.5m in 2021. 

The investment portfolio is held Total voluntary income increased as a means of earning income to £7.9m (2020, £6.1m) to support operational activities representing 59% (2020, 57%) and as reserves to ensure that of the incoming resources. SJEHG can continue to fulfil Donations included £0.6m its charitable objectives, while (2020, £0.2m) restricted for maintaining the real value of capital projects and medical capital over the medium to long equipment, in addition to £2.5m term. The investment objectives (2020, £2.1m) donated by the include aiming for lower volatility Priories of The Order of St John. than equity markets, higher Overall, the value of capital diversification and only a modest projects completed during the exposure to illiquid assets. The year amounted to £0.6m. Investment Committee reviews the portfolio’s strategy and Funds generated from charitable performance with the investment activities (mainly patient income) manager on a regular basis. amounted to £5.3m and constituted 40% (2020, 41%) of total incoming resources. The remaining 1% (2020, 2%) incoming resources related to income from investments. 

Expenditure on charitable activities amounted to £10.2m, being 93% (2020, 93%) of total resources expended. These costs include running the hospitals in Jerusalem, Hebron and Gaza, the Anabta Clinic, the Muristan Clinic, Kufr Aqab clinic and two Mobile Outreach Units, the cost of teaching and training during the year for doctors, nurses and allied health professionals, and the running costs of the genetics laboratory and the refractive suite. The expenditure on charitable activities is primarily personnel 

28 St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## Strategic Report 

Financial Review: Achievements and Performance in 2021 

continues to be financial. The position has been exacerbated by Covid-19, Brexit and the impact of the continuing reduction in value of Sterling against the Israeli Shekel, by changes to the statutory level of minimum wages in Israel, and also by the political situation in the region. SJEHG relies heavily on voluntary income received mainly from donors in the Middle East, Europe, the United Kingdom and the United States. In the current global financial situation, it remains a great challenge to continue to attract core funding from existing and new sources. The fundraising strategy includes a focus on endowment and legacy giving in order to mitigate this risk as well as a focus on major gifts for core costs. 

## Reserves 

At 31 December 2021, SJEHG had total funds of £22.6m (2020, £19m). This comprised permanent endowments of £7.6m (2020, £7.0m), £0.5m (2020, £0.5m) in restricted income funds, and £14.5m (2020, £11.5m) in unrestricted reserves, of which £8.3m (2020, £5.5m) is available to meet the normal operating needs of SJEHG. 

## Reserves Policy 

The Board of Trustees reviews annually the need for reserves in line with the guidance issued by the Charity Commission and considers that, in the context of the political and economic situation in the region in which SJEHG operates, unrestricted reserves need to be maintained, when circumstances allow, to equate to at least six months running costs (equivalent to £5.5m) to ensure that SJEHG can continue to run efficiently with adequate working capital. It is intended to achieve this through a continuing focus on cost-cutting, revenue generation, the introduction of new sources of revenue, and enhanced fundraising activity in order to ensure financial resilience and sustainability for the future.. 

Liquidity is a recurring issue, especially with the prolonged payment pattern of the PA for its working capital needs. SJEHG therefore sets aside a portion of the investment portfolio as a cash deposit, in order to ensure meeting the working capital needs. International currency exchange movements are an additional risk. It should be recognised that exchange gains do not represent realisable income which are capable of being utilised by SJEHG, as they largely reflect the translation into Sterling of the Israeli Shekel value of the Hospital premises. 

## Principal Risks and Uncertainties 

Operationally, patient and staff access to Jerusalem is crucial to the continuation of our ability to provide eye care services in the oPt. Working in a volatile region has inherent risks. Gaza has its own risks. The situation could escalate at any time as instability and strife continue to affect the neighbouring countries, a particular current concern. 

A comprehensive risk management policy is in place with a risk register of all clinical, operational, financial, external, political and governance risks. The risk register is regularly reviewed by the relevant committees and the Board, with particular focus on residual risks. A key risk which SJEHG faces 

## Going Concern 

Since March 2020 and the on-set of Covid-19 in Israel and the occupied Palestinian Territories (oPt), the Board of Trustees and Management have been working on flexible plans, both operational and financial, to seek to secure the continued viability of the organisation. 

We currently remain confident about our future, but these are very challenging and unprecedented times for SJEHG and society in general; and are likely to remain so for quite some time to come. We plan to work closely with all our global partners and supporters to seek to ensure that we continue to serve our patients in the most efficient and safe manner. 

Detailed, yet adaptable, business plans have been prepared, and financial budgets and cash flow models are aligned to those plans. These plans are clearly dependent upon a variety and number of key assumptions, some of which are inter-related. For example, national and local Government decisions (such as measures taken by Governments to mitigate the impacts of the Covid-19 global pandemic on public health), travel and border restrictions, social distancing, capacity in our hospitals, the demand from our patients, our ability (and that of the PA) to obtain funding and donations, our fixed and variable cost structure; to note just a few. Further details of the Group's principal risks and uncertainties are set out opposite. 

The plans and models have been prepared for the period to December 2023, which is a period of at least 12 months from the date of approval of the financial statements. For the Board of Trustees to have a reasonable expectation of the Group's financial viability to December 2023, the Trustees have also identified several challenging, yet reasonably plausible, downside scenarios based on information 

currently identified as a result of the impact of Covid-19 (sensitivity analysis). Sensitivity analyses and modelling have been performed on the key assumption alongside the financial effects thereon. 

The Trustees continue to review and will implement any possible mitigations in order to seek to reduce the financial impact of these downside scenarios – maintaining a balance between supporting the activity that is crucial to delivering the objects of the charity, whilst ensuring the long-term financial sustainability of the Group. 

Under these current downside scenarios, with no further mitigations which may be available to the Group, the Trustees’ project to have sufficient liquidity through the period to December 2023. 

Further details of the above are set out in Note 1 to the financial statements. 

After consideration of the detailed, yet adaptable, business plans, financial budgets, cash flow modelling aligned to those plans and scenarios, and the overlaid sensitivity analyses, the Trustees consider that the Group has adequate resources to continue in operational existence for the foreseeable future, being a minimum period of at least 12-months from the date when the financial statements are approved. 

Based on all of the above, the Board of Trustees are confident in the Group's ability to remain as a going concern and have, therefore, prepared the financial statements on a going concern basis of accounting. 

Nevertheless, the Trustees fully acknowledge that there is a level of uncertainty, which is likely to persist for some time, given the key assumptions and the financial modelling referred to above. 

Remuneration Policy More detailed information is set out below, but the key features All roles within SJEHG are which can obscure the financial evaluated in order to determine difficulties/pressures on the where they fit on our pay scale. operating budget are– The salaries within the scale • capital donations are treated are determined by the market as income (in accordance with rates for an equivalent position. the Charities Statement of In exceptional cases, where the Recommended Accounting market information supports it, Practice), salaries may be above the top of • exchange rate variations: these the band. Each year, the payroll have recently arisen mainly from budget is reviewed, based on the depreciation of the Pound legislative, statutory and market Sterling against the operating changes, using a range of sources currency (Israeli Shekel) which and taking account of affordability, has been a continuous process all as part of the annual budgetary over at least the last six years, process. and have also included a 

- capital donations are treated as income (in accordance with the Charities Statement of Recommended Accounting Practice), 

- exchange rate variations: these have recently arisen mainly from the depreciation of the Pound Sterling against the operating currency (Israeli Shekel) which has been a continuous process over at least the last six years, and have also included a depreciation of the US Dollar against the Israeli Shekel, 

Management consult with the Finance, the Human Resources, and the Pay and Remuneration Committees of the Board, and a pay review proposal is submitted to the Board, which makes the decision on the proposal. Staff costs are set out in note 6 of the financial statements. 

• The exchange gains or losses apparent from the annual results shown in the financial statements do not represent realisable amounts which are capable of being utilised by SJEHG. They are largely derived from the translation into Pound Sterling of the Hospital premises with an unchanged Shekel valuation. 

## Guide to SJEHG’S Finances 

The aim of this note is to summarise the key points to an understanding of the complexities and vulnerabilities of SJEHG's financial position. 

## Table of Adjustments 2021 


**----- Start of picture text -----**<br>
          in £'000<br>Net incoming resources per Statutory Accounts   3,626<br>Reconciling Items<br>Donations for Capital Projects   (633)<br>Unrealised Gain on Investments   (898)<br>Exchange Gain    (272)<br>Net Operating Results    1,823<br>Less: Outstanding Restricted Income    (197)<br>Actual Net Operating Results   1,626<br>**----- End of picture text -----**<br>


30 

31 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## Statement of Trustees' Responsibilities 

The Trustees (who are also directors of St John of Jerusalem Eye Hospital Group for the purposes of company law) are responsible for preparing the Trustees’ Annual Report (including the Strategic Report) and the financial statements in accordance with applicable law and regulation. 

principles in the Statement of Recommended Practice: Accounting and Reporting by Charities (2019); 

company’s website. Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions. 

• make judgments and estimates that are reasonable and prudent; 

• state whether applicable In so far as the Trustees are UK Accounting Standards, aware at the time of approving comprising FRS 102, have the Trustees’ Annual Report: been followed, subject to any (a) there is no relevant audit material departures disclosed information of which the and explained in the financial charitable company’s auditors statements; and are unaware; and 

Company law requires the Trustees to prepare financial statements for each financial year. Under that law the Trustees have prepared the financial statements in accordance with United Kingdom Accounting Standards, comprising FRS 102 “The Financial Reporting Standard applicable in the UK and Republic of Ireland”, and applicable law (United Kingdom Generally Accepted Accounting Practice). 

• prepare the financial (b) the Trustees have taken statements on the going all the steps that they ought concern basis unless it is to have taken as a trustee to inappropriate to presume that make themselves aware of any the charitable company will relevant audit information and continue in business. to establish that the charitable company's auditors are aware of that information. 

The Trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the charitable company’s transactions and disclose with reasonable accuracy at any time the financial position of the charitable company and the group and enable them to ensure that the financial statements comply with the Companies Act 2006. 

The Trustees' Report on pages 2 to 35 was approved by the Trustees and signed on their behalf by 

Under company law the Trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of the affairs of the charitable company and the group and of the incoming resources and application of resources, including the income and expenditure, of the charitable group for that period. In preparing these financial statements, the Trustees are required to: 


Sir Andrew Cash, Chairman, St John of Jerusalem Eye Hospital Group Charity no. 1139527 Company no. 7355619 

They are also responsible for safeguarding the assets of the charitable company and the group and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. 

23 June 2022 

• select suitable accounting policies and then apply them consistently; 

The Trustees are responsible for the maintenance and integrity of the charitable 

- observe the methods and 


## Fundraising Statement 

formally contracted them to fundraise on our behalf. 

We do not use professional fundraisers or commercial participators in any of our activities and we are registered with the Fundraising Regulator. 

SJEHG as a charity with income over £1m is required to make a statement 

Our small team of in-house activities and we are registered fundraising staff are fully with the Fundraising Regulator. trained on fundraising regulations and have been No complaints were received made aware of relevant policy by SJEHG in relation to its procedures. We ensure that fundraising during the relevant we protect vulnerable persons period and, after due enquiry, from unreasonable intrusion we are not aware of any into their privacy, persistent breaches of the regulations approaches or undue pressure of the Fundraising Regulator to give by using a personal committed by SJEHG. approach to fundraising. 

regarding its fundraising activities in accordance with the Charities Act 2016. 

Fundraising activities are carried out on behalf of SJEHG by our own in-house fundraising staff and by volunteer fundraisers. We do not consider volunteer fundraisers to be acting as legal representatives for the charity as we have not 

32 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## Stakeholder Engagement 

For the 2021 financial year we are required to report on how the Board of Trustees has complied with its duty under section 172 of the UK Companies Act 2006. Section 172 requires the Trustees to have regard to the long-term consequences of its decisionmaking, to the interests of key stakeholders and to the importance of maintaining high standards of conduct. 

In our statement of Strategic Vision on page 26 we have set out the values and strategic aims which inform the Board's decision making, reflecting the Board's commitment to the long-term sustainability of the Group and to the maintenance of high standards not only in the provision of ophthalmic care and in research, but also in governance and in the way we care for our staff. Below we report on how the Trustees engage with four key groups of stakeholders. These are: 

## 1. Staff 

## 2. Patients 

3. The Patients’ Communities 4. Donors including major donors and Priories. 

The following sections outline a well-established strategy that ensures decisions made by the Board of Trustees are always well informed by our stakeholders. Communications and feedback from our stakeholders are featured in Board meetings and form a fundamental basis 

for the Trustees’ decisions. Furthermore, Trustees ensure that management operates the Hospital in a responsible manner that reflects the values of The Order of St. John. 

## Hospital Staff 

Within the Hospital Group there are several staff committees that form the main platforms for decision making. Each of these committees has at least one Senior Management Team (SMT) representative who is in direct communication with the concerned Trustees. The Board of Trustees has 13 different specialised committees that meet regularly where SMT members are in attendance. All relevant decisions are brought to these meetings and Trustees with the staff representatives making decisions as appropriate. The Board also meets three times annually, present at Board meetings are SMT members representing the various categories of staff. Staff surveys are conducted annually to explore staff levels of satisfaction as well as engagement in the decisionmaking process at the Hospital. These findings are presented at the various Board Committees for further analysis and conclusions. A good example of the Trustees’ full engagement with staff was the development of the Strategic Plan 20202022. Several workshops were held at the Hospital operational level to conduct a SWOT analysis and proposed strategic 

aims and objectives for the next three years. These strategic aims were presented to the Board of Trustees who, with the SMT, conducted extensive debate and agreed a set of five strategic objectives that will shape the Hospital activities for the next three years (see page 26). 

## Patients 

As part of our commitment to JCI accreditation, inspectors look to see that patients are engaged with on a regular basis and their suggestions for service improvements are taken on board. Patients’ views are fully appraised through a biannual survey that is conducted across the Group by our quality-ofcare teams. Patients are asked to comment on the service that they receive as well as make recommendations for improvements and their perceived needs for additional services as appropriate. The results of these surveys are discussed at the Board of Trustees’ meetings and discussions concerning patients' expressed needs are taken by the Trustees and the SMT. We are committed toward achieving equity in our services and in 2021 consulted with local disability and women’s rights organisations to best understand how we can meet their needs. 

## Patients’ Communities 

The Chairman and local Trustees of the Board meet with representatives from the 

Palestinian Ministry of Health at the ministerial level and with the Head of UNRWA in Gaza to discuss needs of their patients and strategies that the Hospital might be able to employ to respond to such needs. The SMT is in constant dialogue and communication with representatives from the Israeli Patients’ Fund to discuss services provided by the Hospital to their patients. 

These decisions are brought to the various Trustees committees for discussion. The Board of Trustees are fully aware of the considerations and decisions made at the Jerusalem community level. In this regard, we are part of the East Jerusalem Hospitals Network that meets regularly to discuss ways of enhancing the quality of care provided to patients in East Jerusalem. 

## Trustees 

Trustees’ have an involvement in the decision making and high-level monitoring of fundraising, project development, and marketing. They are all well informed through quarterly meetings focused on development in the aforementioned areas. The Board usually give input to any donorrequired pre-award surveys or due diligence processes that examine the capabilities, performance, and policies of the Hospital Group. 

## Priories 

As a foundation member of The Order of St John and benefactor from most Priories we have a distinct obligation to receive input and work in 

collaboration with the wider receive feedback on our work. St John family. We cater our The organisation is considered reporting and engagement to a sub-committee of the Board each Priory's preferences, For (Guild Liaison Committee) example, St John Scotland has and its membership includes, sponsored both staff and the in addition to members of Mobile Outreach Programme, the Guild, Board Trustees prior to which we provided and Senior management a detailed report on current team members.  The Guild and future operations and the Chairperson participates in budget. The Priory in the USA committee meetings which sponsors staff through their allows us to share information Nurse Initiative and receive across Trustees, staff and video messages from each staff volunteers, which feeds into our member they support in thanks decision-making. Finally our alongside a more detailed report. wider public donors are regularly Various staff members also engaged with via our bi-annual sit on the working groups of Jerusalem Scene, our Annual the Johanniter International, a Report and our social media collaborative organisation aimed channels. Any donor is welcome to enable European-based St and encouraged to contact our John organisations to develop Fundraising Team to discuss our best practice approaches to work. healthcare, fundraising and marketing together. Members of Covid-19 these teams meet quarterly. 

The Board of Trustees were fully involved and in agreement Other Major Donors with plans submitted by management in response to and Stakeholders the Covid-19 global pandemic. We value the feedback from These involved staff and our stakeholders on what they patient safety protocols that consider is the most effective were discussed and approved use of funds and why, and we by the clinical Trustees. Other report back demonstrating financial and efficiency plans the impact of this investment. were also discussed and Our Trusts and Foundations approved by the Board of programme has a reporting Trustees. Other stakeholders schedule for every grant given, involvement included our dependent on each stakeholders’ liaison with the Israeli and specific requirements. Our Palestinian Ministries of Development Team in Jerusalem Health in the form of Covid-19 is in regular contact with our infection prevention protocols institutional donors and have that were updated regularly. a stringent reporting policy for Vaccinations of all Jerusalem each project managed. staff were achieved through our partnership with the Israeli The fundraising Guild, made Ministry of Health in January up of supporters who work 2021. voluntarily to fundraise for the Hospital, a vital channel through which we communicate and 

34 

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St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



and, accordingly, we do not express an audit opinion or, except to the extent otherwise explicitly stated in this report, any form of assurance thereon. 

Independent Auditors' Report to the Members of St. John of Jerusalem Eye Hospital Group 

In connection with our audit of the financial statements, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the audit, or otherwise appears to be materially misstated. If we identify an apparent material inconsistency or material misstatement, we are required to perform procedures to conclude whether there is a material misstatement of the financial statements or a material misstatement of the other information. 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 based on these responsibilities. 

Report on the audit of the financial statements 

## _**Independence**_ 

## Opinion 

We remained independent of the group and parent charitable company in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, which includes the FRC’s Ethical Standard and we have fulfilled our other ethical responsibilities in accordance with these requirements. 

In our opinion, St. John of Jerusalem Eye Hospital Group’s group financial statements and parent charitable company financial statements (the “financial statements”): 

• give a true and fair view of the state of the group’s and of the parent charitable company’s affairs as at 31 December 2021 and of the group’s incoming resources and application of resources, including its income and expenditure, and of the group’s cash flows, for the year then ended; 

## Conclusions Relating To Going Concern 

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 group’s and the parent charitable company’s ability to continue as a going concern for a period of at least twelve months from the date on which the financial statements are authorised for issue. 

• have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice (United Kingdom Accounting Standards, comprising FRS 102 “The Financial Reporting Standard applicable in the UK and Republic of Ireland”, and applicable law); and 

Based on our work undertaken in the course of the audit, the Companies Act 2006 requires us also to report certain opinions and matters as described below. 

## _**Strategic Report and Trustees’ Report**_ 

- have been prepared in accordance with the requirements of the Companies Act 2006. 

In our opinion, based on the work undertaken in the course of the audit In auditing the financial statements, we the information given in the Trustees’ have concluded that the trustees’ use of Annual Report, including the Strategic the going concern basis of accounting Report, for the financial year for which in the preparation of the financial the financial statements are prepared is statements is appropriate. consistent with the financial statements; and the Strategic Report and the However, because not all future events Trustees’ Report have been prepared or conditions can be predicted, this in accordance with applicable legal conclusion is not a guarantee as to the requirements. 

We have audited the financial statements, included within the Annual Report (the “Annual Report”), which comprise: the group and charity balance sheets as at 31 December 2021; the consolidated statement of financial activities, the group income and expenditure account, and the consolidated cash flow statement for the year then ended; and the notes to the financial statements, which include a description of the significant accounting policies. 

However, because not all future events or conditions can be predicted, this conclusion is not a guarantee as to the group’s and parent charitable company’s ability to continue as a going concern. 

In addition, in light of the knowledge and understanding of the group and parent charitable company and their environment obtained in the course of the audit, we are required to report if we have identified any material misstatements in the Strategic Report and the Trustees’ Report. We have nothing to report in this respect. 

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

## Basis For Opinion 

We conducted our audit in accordance with International Standards on Auditing (UK) (“ISAs (UK)”) and applicable law. Our responsibilities under ISAs (UK) are further described in the Auditors’ responsibilities for the audit of the financial statements section of our report. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. 

## Reporting On Other Information 

Responsibilities for the Financial Statements and the Audit _**Responsibilities of the trustees for the financial statements**_ 

The other information comprises all of the information in the Annual Report other than the financial statements and our auditors’ report thereon. The trustees are responsible for the other information. Our opinion on the financial statements does not cover the other information 

As explained more fully in the Statement of Trustees’ Responsibilities, 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 in accordance with the applicable framework and for being satisfied that they give a true and fair view. The trustees are also responsible for such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. 

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

_**Auditors’ 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 auditors’ 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. 

Based on our understanding of the group and parent charitable company and the environment in which they operate, we identified that the principal risks of non-compliance with laws and regulations related to the Companies Act 2006 and the Charities Act 2011 and relevant regulations made or having an effect thereunder, including The Charities (Accounts and Reports) Regulations 2008, and we considered the extent to which non-compliance might have a material effect on the financial statements. We also considered the direct impact of these laws and regulations on the financial statements. We evaluated the incentives and opportunities for fraudulent manipulation of the financial statements (including the risk of override of controls) by the trustees and those responsible for, or involved in, the preparation of the underlying accounting records and financial statements and determined that the principal risks were related to the posting of inappropriate journal entries to conceal misappropriation of assets. Audit procedures performed by the engagement team included: 

• Testing journals entries where we identified particular fraud risk criteria. • Obtaining independent confirmations of material investment valuations and cash balances at the year  end. 

• Testing estimates and judgements made in the preparation of the financial statements for indicators of bias. 

- Reviewing meeting minutes, and significant contracts and agreements. 

- Holding discussions with the trustees and management to identify significant or unusual transactions and known or suspected instances of fraud or noncompliance with laws and regulations. • Assessing financial statement disclosures, and agreeing these to supporting evidence, for compliance with applicable laws and regulations. 

There are inherent limitations in the audit procedures described above. We are less likely to become aware of instances of non-compliance with laws and regulations that are not closely related to events and transactions reflected in financial statements. Also, the risk of not detecting a material misstatement due to fraud is higher than the risk of not detecting one resulting from error, as fraud may involve deliberate concealment by, for example, forgery or intentional 

misrepresentations or through collusion. A further description of our responsibilities for the audit of the financial statements is located on the FRC’s website at: www.frc.org.uk/ auditorsresponsibilities. This description forms part of our auditors’ report. 

## _**Use of this report**_ 

This report, including the opinions, has been prepared for and only for the charity’s members as a body in accordance with Chapter 3 of Part 16 of the Companies Act 2006 and for no other purpose. We do not, in giving these opinions, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing. 

## Other required reporting 

## Companies Act 2006 Exception Reporting 

Under the Companies Act 2006 we are required to report to you if, in our opinion: 

• we have not obtained all the information and explanations we require for our audit; or 

• adequate accounting records have not been kept by the parent charitable company or returns adequate for our audit have not been received from branches not visited by us; or 

• certain disclosures of trustees’ remuneration specified by law are not made; or 

• the parent charitable company financial statements are not in agreement with the accounting records and returns. 

We have no exceptions to report arising from this responsibility. 


Andrew Lowe (Senior Statutory Auditor) For and on behalf of PricewaterhouseCoopers LLP Chartered Accountants and Statutory Auditors London 

## 23 June 2022 

36 

37 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



St John of Jerusalem Eye Hospital Group Financial Statements 

St John of Jerusalem Eye Hospital Group Financial Statements 

as at 31 December 2021 

## Consolidated Statement of Financial Activities 

## Balance Sheets 

for the year ended 31 December 2021 

|||**Unrestricted**|**Restricted**|**Endowment**|**Total**|**Total**|
|---|---|---|---|---|---|---|
|||**Funds**|**Funds**|**Funds**|**Funds**|**Funds**|
|||**2021**|**2021**|**2021**|**2021**|**2020**|
||**Notes**|**£000**|**£000**|**£000**|**£000**|**£000**|
|**Income and Endowments**|||||||
|Income from donations and legacies|3|2,660|5,207|-|7,867|6,146|
|Income from charitable activities|4|5,337|-|-|5,337|4,378|
|Income from investments|8e|45|95|-|140|180|
|Other income||-|-|-|-|4|
|**Total Income and Endowments**||**8,042**|**5,302**|**-**|**13,344**|**10,708**|
|**Resources Expended**|||||||
|Expenditure on generating funds||(533)|-|-|(533)|(586)|
|Expenditure on charitable activities||(5,438)|(4,721)|-|(10,159)|(9,723)|
|Other expenditure||(196)|-|-|(196)|(178)|
|**Total Resources Expended**|5|**(6,167)**|**(4,721)**|**-**|**(10,888)**|**(10,487)**|
|Net gains / (losses) on investments|8|315|-|583|898|(215)|
|**Net Income**||**2,190**|**581**|**583**|**3,354**|**6**|
|Transfers between funds|12,13|574|(574)|-|-|-|
|Exchange gains on overseas activities||272|-|-|272|235|
|**Net Movement in Funds**||**3,036**|**7**|**583**|**3,626**|**241**|
|Fund balances brought forward at 1 January||11,490|465|7,047|19,002|18,761|
|**Fund balances carried forward at 31 December**|15|**14,526**|**472**|**7,630**|**22,628**|**19,002**|



All gains and losses recognised in the year are included in the statement of financial activities. All of the above results are derived from continuing activities. 

**Group Income and Expenditure Account for the year ended 31 December 2021** 

|**Group Income and Expenditure Account for the year ended**<br>**31 December 2021**||
|---|---|
||**2021**<br>**2020**<br>**£000**<br>**£000**|
|Income<br>Expenditure|13,344<br>10,708<br>(10,888)<br>(10,476)|
|**Net Income**|**2,456**<br>**232**|



The income and expenditure account excludes the unrealised investment and exchange gains and losses shown in the Statement of Financial Activities. The accounting policies and the notes on pages 40 to 53 form part of these financial statements. 

|||**Group**|**Group**|**Charity**|**Charity**|
|---|---|---|---|---|---|
|||**2021**|**2020**|**2021**|**2020**|
||**Notes**|**£000**|**£000**|**£000**|**£000**|
|**Fixed Assets**||||||
|Tangible assets|7|5,598|5,640|2|7|
|Investments|8|13,861|12,661|11,289|10,434|
|Total Fixed Assets||19,459|18,301|11,291|10,441|
|**Current Assets**||||||
|Stocks|9|758|469|-|-|
|Debtors|10|2,588|2,281|112|132|
|Cash at bank and in hand||9,423|6,338|5,457|3,923|
|Total Current Assets||12,769|9,088|5,569|4,055|
|Creditors: Amounts falling due within||||||
|one year|11|(3,114)|(2,471)|(75)|(95)|
|**Net Current Assets**||9,655|6,617|5,494|3,960|
|**Total Assets Less Current Liabilities**||29,114|24,918|16,785|14,401|
|Creditors: Amounts falling due after||||||
|more than one year|11|(6,486)|(5,916)|-|-|
|**Net Assets**||**22,628**|**19,002**|**16,785**|**14,401**|
|**The Funds of the Group and Charity**||||||
|**Restricted income funds**|13|472|465|354|364|
|**Endowment funds**|14|7,630|7,047|7,630|7,047|
|**Unrestricted income funds**|12|||||
|Designated funds||5,598|5,640|2|7|
|Revaluation funds||629|375|629|375|
|Other general funds||8,299|5,475|8,170|6,608|
|**Unrestricted income funds**||14,526|11,490|8,801|6,990|
|**Total Group and Charity Funds**|15|**22,628**|**19,002**|**16,785**|**14,401**|



The Charity's net income was £2,384,000 (2020, £1,415,000).  The accounting policies and the notes on pages 40 to 53 form part of these financial statements. The financial statements on pages 38 to 53 were approved by the Trustees and signed on their behalf by: 


**Sir Andrew Cash Chairman, Board of Trustees** 23 June 2022 


**Chris Hoult Treasurer and Company Secretary** 

Company number: 7355619 

38 

39 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## St John of Jerusalem Eye Hospital Group Financial Statements 

## Consolidated Cash Flow Statement 

for the year ended 31 December 2021 

|||**2021**|**2020**|
|---|---|---|---|
||**Notes**|**£000**|**£000**|
|**Net cash inflow from operating activities**|16|3,919|2,404|
|**Cash flows from investing activities**||||
|Investment income|8e|140|180|
|Purchase of tangible fixed assets|7|(750)|(462)|
|Proceeds from disposal of tangible fixed assets||44|22|
|Purchase of fixed asset investments|8a|(474)|(460)|
|Proceeds from sale of fixed asset investments|8a|172|246|
|**Net cash outflow from investing activities**||(868)|(474)|
|||||
|**Foreign**<br>**exchange differences**||34|(5)|
|||||
|**Change in cash and cash equivalents in the financialyear**||3,085|1,925|
|Cash at bank and in hand at 1 January||**6,338**|**4,413**|
|Increase in cash in the year||3,085|1,925|
|**Cash at bank and in hand at 31 December**||**9,423**|**6,338**|



The accounting policies and the notes on pages 40 to 53 form part of these financial statements. 

## Notes to the Financial Statements 

for the year ended 31 December 2021 

## **1 Principal accounting policies** 

the Group, adjustments are made on consolidation to apply the Group’s accounting policies when preparing the consolidated financial statements. Transactions and balances between the Charity and its subsidiary undertakings have been eliminated from the consolidated financial statements.  Balances between the companies are disclosed in the notes of the Charity's balance sheet.  A separate statement of financial activities, and income and expenditure account, for the Charity is not presented because the Charity has taken advantage of the exemption afforded by section 408 of the Companies Act 2006 and Charities SORP FRS 102. 

## **Basis of preparation** 

## **a** 

The Group constitutes a public benefit group as defined by FRS102. The financial statements have been prepared on the going concern basis, under the historical cost convention, except for investments which are stated at market value, with items recognised at cost or transaction value unless otherwise stated in the relevant note(s) to these financial statements. The financial statements have been prepared in accordance with the Statement of Recommended Practice: Accounting and Reporting by Charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) and the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS 102) and the Companies Act 2006. 

The Group's objects are the relief of sickness and the prevention and protection of health, in particular expert eye care in Jerusalem and the Occupied Palestinian Territories and the clinical, teaching and research activities connected therewith. 

## Going Concern 

These financial statements consolidate, on a line by line basis, the results and financial position of St John of Jerusalem Eye Hospital Group (the “Charity”) together with its wholly owned and controlled charitable subsidiary undertakings, St John of Jerusalem Eye Hospital, St John Eye Hospital in Jerusalem (RA), and St John Ophthalmic Association Limited (together the “Group”). Where a subsidiary has different accounting policies to 

## **BACKGROUND** 

In assessing the going concern position of the Charity and the Group, the Board of Trustees have considered the Group’s projected activities, financial budgets, cash flows and liquidity for a period to December 2023, which is a period of at least 12 months from the date of approval of the financial statements. 

Based on the Group’s cash flow projections, the Board of Trustees have adopted the going concern basis of accounting in preparing these financial statements. 

## **IMPACT OF COVID-19** 

The first case of Covid-19 was confirmed in Israel on 22nd February 2020 and the first case was confirmed in the occupied Palestinian territories on 6th March 2020. The Palestinian Authority (PA) declared a state of emergency and imposed a lockdown on all Palestinians, including severe movement restrictions. Beginning the 11th March 2020, Israel began lockdown measures, including enforcing social distancing and other rules to limit the spread of infection. 

The country was hit with a second Covid-19 wave in September 2020 and, as a result, the Israeli Authorities imposed a lockdown on the 18th September 2020 for 4 weeks. As for the PA, no lockdown was imposed, except for specific areas with a high incidence of Covid-19. The authorities kept all of these measures and restrictions under regular review. 

On 18th December 2020, The Palestinian Authority announced a new set of strict nationwide measures aimed at slowing down the rapid spread of the Covid-19 pandemic across Palestine. This was followed by similar measures by the Israeli authorities. 

The lockdown continued until 31st January 2021 after which both authorities started easing the restrictions on movements and allowed some businesses to reopen gradually. By May 2021, most of the restrictions were cancelled by the local authorities. From the beginning of August 2021, the country witnessed an increase in infected cases to reach a daily average of 3,500 cases. In early December 2021, the first confirmed cases of the Omicron variant were detected in Israel. For the first time since the skies were closed at the start of the coronavirus pandemic in March 2020, Israel’s borders were reopened to foreigners beginning 1st March 2022. 

The emergence of Covid-19 and reactions to it have had, and continue to have, a profound effect on domestic and global economies, organisations and society at large. As a result of all the restrictions imposed by the authorities in 2020, the Group experienced a reduction in clinical activities which resulted in a significant decline in patient related income. However, the Group was back to normal working levels and patients’ activities since the beginning of 2021. However, the PA has been facing major financial difficulties that have resulted in the inability of their ministry of health to make sufficient, regular and timely payments to the Group during 2020 and 2021. The Group has not experienced a severe decline in voluntary income receipts and income has been within the normal average rates. 

## **TRUSTEES’ ACTIONS** 

To seek to minimise the financial impact of the pandemic, the Group carried out the following actions during 2020 & 2021: 

- Over 40 staff members took one month of unpaid leave during April 2020 

- All staff took one month of unpaid leave (between May and August 2020) 

- A reduction in variable operational costs of circa 70% was targeted 

- Additional reduction in payroll costs due to postponement of recruitment (2020 & 2021) 

- Reduction in non-critical operational spending and deferral of capital expenditure (2020 & 2021) 

- Deferral of promotions and study/professional leave (2020 & 2021) 

- An emergency appeal was launched in 2020 

- All Priories of The Order of St John were requested and lobbied to increase their financial support. 

As for additional and new sources of finance, the hospital received US$150k from the Israeli Government as a grant for returning employees to work. Additionally, the hospital received US$75k from the Jerusalem Fund. Moreover, the Priories of St John have reassured the Trustees of their commitment to continue supporting the Group. 

## **BUSINESS PLAN** 

In order to assess, the use of the going concern assumption, Management and the Trustee Board have produced a detailed, yet adaptable, business plan that considers projected activity, the related financial budgets, cash flows and liquidity of the Group covering the period to December 2023. 

## **KEY ASSUMPTIONS** 

The business and financial plans incorporate the following key assumptions: 

- National and local Government decisions, rules and advice, along with travel and border restrictions and social distancing, will be relaxed sufficiently to permit the hospitals to provide a full range of 

- services so as to serve patients in the most efficient and safe manner 

- There are no further impositions of closures or lockdowns, or the impact of any matter noted above, that would affect the Group’s operations 

- Demand for services from patients return to a normal level 

- The capacity and supply of patient services by the Group is not impacted by Covid-related matters 

- Payment by the PA (directly, or indirectly via its own funding sources) of sufficient payments to the Group for patient services provided 

- The achievement of a reduction in cash outflows through the restructuring of the organisation and measures planned to reduce costs during periods when activities may be limited 

- The Group is able to obtain on-going voluntary and fundraising unrestricted income, in particular from the St John Priories, albeit at levels reduced from prior periods. 

## **SENSITIVITY ANALYSIS** 

Management and the Trustee Board have considered the impact on projected activities, budgets, and cash flows of several challenging, yet reasonably plausible, downside scenarios such that the key assumptions are not met, or able to be met, in whole or in part. These include, for example, restrictions in supply of, or demand for, patient services; and reductions in income through voluntary income and fundraising targets not being achieved, beyond those considered in the current plans. 

The Board of Trustees has also sought to identify certain mitigating actions that could be implemented in order to provide additional liquidity or reduce cash outflows so as to ensure that the Group can maintain sufficient liquidity over the period to December 2023.  The success of such measures, whilst being identified and achievable based on current advice, may not necessarily provide liquidity to the degree required or within the required timescales. As such, the Board of Trustees fully acknowledge that there is a level of uncertainty, which is likely to persist for some time, given the key assumptions and the financial modelling referred to above. 

## **CONCLUSIONS** 

Having assessed the combination of all these various options, the Board of Trustees has a reasonable current expectation that the Charity and the Group has adequate resources to continue in operational existence for the foreseeable future, being a period of at least 12 months from the date of approval of the financial statements. For these reasons, the Board of Trustees has adopted the going concern basis of accounting in the preparation of these financial statements. Accordingly, these financial statements do not include any adjustments to the carrying amount or classification of assets and liabilities that would result if the Charity and the Group were unable to continue as a going concern. 

40 St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

41 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## St John of Jerusalem Eye Hospital Group Financial Statements 

## Notes to the Financial Statements 

for the year ended 31 December 2021 

## **Principal accounting policies (continued)** 

## **j    Pension and other end of service costs** 

## **b   Foreign currencies** 

The Charity's functional and presentational currency is pounds sterling. Transactions in foreign currencies are recorded at the exchange rate ruling at the date of the transaction. Monetary assets and liabilities at the year end are translated at the rate ruling at the balance sheet date. Results of overseas operations are translated at the average rate for the period and their assets and liabilities at the balance sheet rate. All exchange differences are dealt with in the Statement of Financial Activities. Exchange differences on the translation of the assets and liabilities of overseas operations are included as Other recognised gains/(losses). All other exchange differences are included as incoming resources or resources expended as appropriate. The exchange rate of the Pounds Sterling to the Israeli Shekel at 2021 year-end was 4.2031 (2020, 4.3919), while the average rate for 2021 was 4.4458 (2020, 4.4131). 

The amount charged in the Statement of Financial Activities in respect of pension costs is the contributions payable in the year on an accruals basis in respect of defined contribution and money purchase pension arrangements. Other end of service benefits are accrued as earned on an undiscounted basis. 

## **k   Rentals** 

The costs in respect of rentals are charged to the Statement of Financial Activities on a straight line basis over the contract period. The rental cost for the office in London occupied rent free has been computed based on an estimate of arm's length value. No charge is imputed in respect of the Hospital premises in Jerusalem, which the Group occupied rent free until 2015, after which it has paid a nominal rent. 

## **I      Taxation** 

## **c    Income recognition** 

Donations and other income are recognised in the financial statements on a receivable basis.  Grants are recognised when the entitlement to the grant is confirmed.  Legacies are recognised when the entitlement arises, being the earlier of the Group being notified of the impending distribution or the legacy being received. Donations in kind are recorded as income when the resources are received and recorded at fair value. Income from charitable activities is accounted for when earned (i.e. the service is provided to patients).  Subsidies and exemptions in respect of medical services provided without charge are shown as a deduction from gross income. 

The Charity and each group entity is entitled to certain tax exemptions on income and gains from investments, and surpluses on any activities carried on in furtherance of their primary charitable objectives. 

## **m   Tangible assets and depreciation** 

Cost of tangible assets includes the original purchase price of the asset and the costs attributable to bringing the asset to its working condition for its intended use. 

Donated fixed assets are brought into account at an estimate of their market value at the time of acquisition and, thereafter, depreciated on the bases set out below. The costs of minor additions to fixed assets under £500 are expensed in the year in which they are incurred. Impairment reviews are carried out if there is an indication that the recoverable amount of an asset is below its net book value. 

## **d   Medical volunteers** 

The value of services rendered by medical volunteers is not recognised in these financial statements. However, where doctors, nurses or other members of staff are employed by the Group but paid by third parties, the estimated market value of their services is recorded within both income (donations) and expenditure (salaries). 

Depreciation on fixed assets is provided at rates estimated to write off the cost, less estimated residual value, of each asset over its expected useful life on a straight line basis, as follows: 

## **e   Resources expended and basis of allocation of costs** 

Resources expended are accounted for on an accruals basis and have been classified under headings that aggregate all costs related to the category. Where costs cannot be directly attributed to particular headings they have been allocated to activities on a basis consistent with use of resources. The irrecoverable value added tax is included with the item of expense to which it relates. 

|<br>on a straight line basis, as follows:||
|---|---|
|Buildings<br>Building improvements|- 2.5% per annum<br>- 10% per annum|
|Medical equipment|- 15% per annum|
|Motor vehicles<br>Other equipment<br>Fixtures and fttings<br>Computer equipment<br>UK ofce fxed assets|- 20% per annum<br>- 20% per annum<br>- 6% per annum<br>- 33% per annum<br>- 25% per annum|



## **f    Costs of generating funds** 

These include the salaries and direct expenditure costs of the staff who primarily promote fundraising. 

The carrying values and estimated useful lives of assets are regularly reviewed for impairment and, where deemed appropriate, are written down. 

## **g   Expenditure on charitable activities** 

These represent the costs of providing the medical and training services of the hospital and its clinics including both direct expenditure and the associated support costs. 

On disposal of an item of tangible assets, the difference between the disposal proceeds and its carrying amount is recognised in profit or loss within ‘Other hospital income’ in note 4. 

## **h   Governance costs** 

## **n   Investments** 

These comprise costs attributable to the overall management of the Group's affairs and compliance with constitutional and statutory requirements. 

Listed investments are stated at market value. Realised gains and losses on investments are calculated as the difference between the sales proceeds and their market value at the start of the period, or subsequent cost. Unrealised gains and losses represent the difference between market values at the beginning and at the end of the period. Income from fixed assets investments is recorded on an accruals basis. Market value for unlisted investments is calculated by the fund managers using underlying financial information. 

## **i    Cash flow statement exemption** 

The Charity has taken advantage of the exemption in FRS 102 from preparing a statement of cash flows, on the basis that it is a qualifying entity and the Group statement of cash flows included in these financial statements includes the cash flows of the Charity. 

may mean that actual results ultimately differ from those estimates, and these differences may be material.The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the change takes place if the revision affects only that period, or in the period of the revision and future periods if the revision affects both current and future periods. 

## **o   Liquid resources** 

Liquid resources are cash, time deposits, and certificates of deposit, in addition to cash at bank and in hand held in current accounts with UK, Israeli and Palestinian Banks. 

## **p   Stocks** 

Valuation of stocks is determined using the "first in-first out" method and stocks are stated at the lower of cost and net realisable value. 

Exchange rates are fundamental to the uncertainties. Mainly the impact of subsequent adverse movements between the exchange rates of the reporting and the operative currencies which would potentially affect, to some extent, the operating capability notwithstanding the enhanced but unrealisable balance sheet value of non UK assets. 

## **q   Funds** 

Unrestricted funds are funds which are generally available for the Group to carry out its charitable objectives; these include designated funds, which are amounts that have been set aside to finance fixed assets. 

The Group provides against receivables (mainly the Palestinian Authority Debt) by making judgements based on experience regarding the level of provision required to account for potentially uncollectible receivables. 

General reserves are unrestricted funds available to be used at the discretion of the Board of Trustees for the furtherance of the charitable objectives of the Group and which have not been designated for any other purpose. 

## **2    Legal status** 

The Charity was incorporated in England as a company limited by guarantee in August 2010 under registration number 7355619. It is registered as a charity under number 1139527. The registered office is at 4 Charterhouse Mews, London EC1M 6BB. It has no share capital and the liability of each member in the event of winding up is limited to £10. 

Restricted funds are funds which are subject to specific conditions imposed by the donors. 

Endowment funds are capital funds where the capital cannot be spent in the normal course of activities, although the income is added to restricted or unrestricted funds depending on the terms of the original endowment. 

## **3  Income from donations and legacies** 

||**Unrestricted**<br>**Restricted**<br>**2021 Total**<br>**Unrestricted**<br>**Restricted**<br>**2020 Total**<br>**£000**<br>**£000**<br>**£000**<br>**£000**<br>**£000**<br>**£000**|
|---|---|
|||
||2,268<br>5,207<br>7,475<br>2,299<br>3,446<br>5,745<br>243<br>-<br>243<br>199<br>20<br>219<br>149<br>-<br>149<br>182<br>-<br>182<br>Donations<br>Legacies<br>Donations in kind|
||**2,660**<br>**5,207**<br>**7,867**<br>**2,680**<br>**3,466**<br>**6,146**|



Transfers between funds represent tangible assets purchased with restricted donations and used for hospital operations. 

## **r    Estimates and assumptions** 

The preparation of financial statements in conformity with generally accepted accounting principles requires the use of estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of income and expenditure during the reporting period. Although these amounts are based on trustees' best estimates of the amount, events or actions 

Donations in kind include the estimated market value of  medical services donated by visiting doctors to the Jerusalem Hospital £nil (2020: £nil), and the value of donated tangible assets and medical supplies £92,000 (2020: £125,000). Income from related parties is set out in note 19. 

## **4 Income from charitable activities** 

||**2021**<br>**2020**<br>**£000**<br>**£000**|
|---|---|
||Outpatient income<br>2,458<br>1,977<br>Surgical income<br>3,647<br>3,380<br>Less: Patient Relief<br>(1,215)<br>(1,388)|
||Netpatient related income<br>**4,890**<br>**3,969**|
||Other hospital income<br>132<br>64<br>Rental income,board and lodging<br>315<br>345|
||Total other income<br>**447**<br>**409**|
||Total income from charitable activities<br>**5,337**<br>**4,378**|



Patient Relief principally represents subsidies and exemptions to cover the value of medical services rendered when payment is waived by the Group where funding is not available from the relevant authorities and where the patients are unable to pay any balance owing. All of the above income comprises unrestricted funds. 

## **5 Total resources expended** 

|||Support costs included above<br>**-**<br>**-**<br>**1,290**<br>**1,253**<br>**53**<br>**12**<br>**1,343**<br>**1,265**<br>Total resources expended in 2020 of £10,476,000 comprise £6,998,000 for unrestricted funds and £3,478,000 for restricted funds .<br>**For the year ended 31 December 2021**<br>**(Continued)**<br>**Costs of**<br>**Costs of**<br>**Generating**<br>**Generating**<br>**Charitable**<br>**Funds**<br>**Funds**<br>**Actvities**<br>**2021**<br>**2020**<br>**2021**<br>**£000**<br>**£000**<br>**£000**<br>Personnel costs (note 6)<br>294<br>315<br>5,956<br>Recruitment costs<br>7<br>2<br>-<br>Medical costs<br>-<br>-<br>2,172<br>Establishment costs<br>85<br>82<br>579<br>Depreciation (note 7)<br>4<br>6<br>1,026<br>Office expenses<br>22<br>26<br>181<br>Travel and subsistence<br>2<br>4<br>52<br>Marketing and publicity<br>66<br>115<br>-<br>Auditors' remuneration<br>13<br>7<br>-<br>Other professional fees<br>39<br>25<br>23<br>Legal fees<br>1<br>4<br>19<br>Finance costs<br>-<br>-<br>151<br>**533**<br>**586**<br>**10,159**<br>~~Support costs included above~~<br>~~**-**~~<br>~~**-**~~<br>~~**1,290**~~<br>**For the year ended 31 December 2021**<br>**(Continued)**<br>**Charitable**<br>**Governance**<br>**Governance**<br>**Actvities**<br>**Costs**<br>**Costs**<br>**Total**<br>**Total**<br>**2020**<br>**2021**<br>**2020**<br>**2021**<br>**2020**<br>**£000**<br>**£000**<br>**£000**<br>**£000**<br>**£000**<br>5,577<br>28<br>29<br>6,278<br>**5,921**<br>-<br>46<br>-<br>53<br>**2**<br>1,988<br>-<br>-<br>2,172<br>**1,988**<br>574<br>19<br>17<br>683<br>**673**<br>1,149<br>-<br>-<br>1,030<br>**1,155**<br>173<br>2<br>3<br>205<br>**202**<br>49<br>-<br>-<br>54<br>**53**<br>-<br>-<br>-<br>66<br>**115**<br>-<br>73<br>103<br>86<br>**110**<br>20<br>6<br>-<br>68<br>**45**<br>21<br>22<br>26<br>42<br>**51**<br>172<br>-<br>-<br>151<br>**172**<br>**9,723**<br>**196**<br>**178**<br>**10,888**<br>**10,487**<br>~~**1,253**~~<br>~~**53**~~<br>~~**12**~~<br>~~**1,343**~~<br>~~**1,265**~~|
|---|---|---|
||||
|||Support costs included above<br>**-**<br>**-**<br>~~Support costs included above~~<br>~~**-**~~<br>~~**-**~~<br>~~**1,290**~~|



42 St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

43 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



St John of Jerusalem Eye Hospital Group Financial Statements 

St John of Jerusalem Eye Hospital Group Financial Statements 

## Notes to the Financial Statements 

for the year ended 31 December 2021 


**----- Start of picture text -----**<br>
2021 2020<br>Support costs comprise: £000 £000<br>Personnel costs 502 449<br>Recruitment costs 46 -<br>Establishment costs 303 299<br>Depreciation 103 116<br>Office expenses 183 175<br>Travel and subsistence 52 49<br>Other professional fees 23 20<br>Finance costs 131 157<br>1,343 1,265<br>2021 2020<br>Auditors' remuneration (excluding VAT):  £ £<br>External audit 52,348 78,718<br>Other services provided by external auditors  11,506 8,359<br>Sub-total 63,854 87,077<br>Internal audit  9,048 7,313<br>72,902 94,390<br>**----- End of picture text -----**<br>


## **6 Employee information** 

## **a Number of employees** 

The average monthly number of employees, including part time staff calculated on a full-time equivalent basis, analysed by function during the year was: 

||**2021**|**2020**|
|---|---|---|
||**Number**|**Number**|
|Medical and nursing|177|168|
|Support services|40|47|
|Fundraising|11|10|
|Administration|36|32|
||**264**|**257**|
||||



## **b Staff costs** 

|**Staff costs**|||
|---|---|---|
||**2021**|**2020**|
||**£000**|**£000**|
|Wages and salaries|5,609|5,248|
|Social security costs|424|402|
|Other pension costs|252|276|
|Other related costs - net|(7)|(5)|
||**6,278**|**5,921**|



## **c Emoluments of employees** 

The number of employees whose emoluments (salaries and benefits in kind) fell within the  following bands were: 

||**2021**|**2020**|
|---|---|---|
||Number|Number|
|£140,001 - £150,000|1|-|
|£130,001 - £140,000|-|1|
|£110,001 - £120,000|1|2|
|£90,001 - £100,000|1|-|
|£80,001 - £90,000|1|1|
|£70,001 - £80,000|1|-|
|£60,001 - £70,000|5|5|



## Notes to the Financial Statements 

for the year ended 31 December 2021 

## **d Remuneration received by key management personnel** 

The total remuneration received by the 11 (2020, 10) senior management personnel in managing the operations of the Group amounted to £773,000 (2020, £719,000). 

## **e Pension costs** 

Pension costs comprise the contributions payable to authorised Israeli money purchase pension schemes in respect of non UK employees and a UK defined contribution retirement benefit scheme in respect of UK based employees. End of service accrued retirement benefits for non UK employees included in wages and salaries costs are included in the Balance Sheet in Creditors: Amounts falling due within and after more than one year (note 11). 

## **7 Tangible assets** 

|**Tangible assets**||||||
|---|---|---|---|---|---|
|**a**<br>**Group**||||||
||**Buildings &**|**Medical**|**Motor**|**Other**||
||**Improvements**|**Equipment**|**Vehicles**|**Assets**|**Total**|
|**Cost**|**£000**|**£000**|**£000**|**£000**|**£000**|
|1 January 2021|7,558|9,664|291|3,137|20,650|
|Additions|70|512|49|119|750|
|Exchange differences|344|464|11|145|964|
|Disposals|-|-|(86)|-|(86)|
|31 December 2021|**7,972**|**10,640**|**265**|**3,401**|**22,278**|
|**Accumulated Depreciation**||||||
|1 January 2021|4,453|7,738|221|2,598|15,010|
|Charge for the year|309|553|39|129|1,030|
|Exchange differences|218|380|8|120|726|
|Disposals|-|-|(86)|-|(86)|
|31 December 2021|**4,980**|**8,671**|**182**|**2,847**|**16,680**|
|**Net Book Value**||||||
|31 December 2021|**2,992**|**1,969**|**83**|**554**|**5,598**|
|31 December 2020|**3,105**|**1,926**|**70**|**539**|**5,640**|



Other Assets comprise fixtures and fittings, computer and office equipment. 

## **b Charity** 

||**Other**||
|---|---|---|
||**Assets**|**Total**|
|**Cost**|**£000**|**£000**|
|1 January2021|68|68|
|31 December 2021|**68**|**68**|
|**Accumulated Depreciation**|||
|1 January 2021|61|61|
|Charge for theyear|5|5|
|31 December 2021|**66**|**66**|
|**Net Book Value**|||
|31 December 2021|**2**|**2**|
|31 December 2020|**7**|**7**|



The above amounts include End of Service Benefits allowance. 

During the year, provident benefits and pension contributions on behalf of these staff amounted to £19,000 (2020, £17,000). 

4945 

44 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



St John of Jerusalem Eye Hospital Group Financial Statements 

## St John of Jerusalem Eye Hospital Group Financial Statements 

## Notes to the Financial Statements 

for the year ended 31 December 2021 

## Notes to the Financial Statements 

for the year ended 31 December 2021 

## **8 Investments** 

|**a **|**Analysis of movements (Group)**<br>**Bank**<br>**Listed**<br>**Deposits**<br>**Investments**<br>**Total**<br>**£000**<br>**£000**<br>**£000**|
|---|---|
||Market value at 1 January 2021<br>1,871<br>10,790<br>12,661<br>Additions<br>233<br>241<br>474<br>Withdrawals<br>-<br>(172)<br>(172)<br>Unrealised Gains<br>-<br>898<br>898|
||Market value at 31 December 2021<br>**2,104**<br>**11,757**<br>**13,861**|
|||
||Historical cost at 31 December 2021<br>**2,104**<br>**9,783**<br>**11,887**|



In 2020, unrealised losses of £215,000 comprise £59,000 for unrestricted funds and £156,000 for endowment funds. 

||**Listed**|
|---|---|
|**b **|**Analysis of movements (Charity)**<br>**Investments**<br>**Total**|
||**£000**<br>**£000**|
||Market value at 1 January 2021<br>10,434<br>10,434<br>Additions<br>140<br>140<br>Withdrawals<br>(172)<br>(172)<br>Unrealised Gains<br>887<br>887|
||Market value at 31 December 2021<br>**11,289**<br>**11,289**|
|||
||Historical cost at 31 December 2021<br>**9,313**<br>**9,313**|



## **c Listed investments:** 

Analysis by category of underlying holding and location 

|**2021 Group**<br>**2021 Charity**<br>**2020 Group**<br>**£000**<br>**£000**<br>**£000**|**2020 Charity**<br>**£000**|
|---|---|
|Equity investments<br>- UK<br>1,329<br>1,329<br>1,863<br>- Overseas<br>5,464<br>5,464<br>4,299<br>Fixed interest securities<br>- UK<br>620<br>620<br>674<br>Property Unit Trusts<br>- UK<br>1,217<br>1,217<br>1,311<br>Alternative Investments<br>- UK<br>608<br>608<br>319<br>Sterling & Cash Instruments<br>- UK<br>2,051<br>2,051<br>1,968<br>Others<br>- Overseas<br>468<br>-<br>356|1,863<br>4,299<br>674<br>1,311<br>319<br>1,968<br>-|
|Market value of listed investments<br>**11,757**<br>**11,289**<br>**10,790**|**10,434**|



At 31 December 2021, the following pooled funds represented each more than 4% of the total investment portfolio: 

|**Group & Charity**|**2021 %**|**2020  %**|
|---|---|---|
|Fidelity Global Dividend Fund|11.5|13.0|
|Vanguard S&P 500 UCITS ETF|8.3|7.0|
|Savills Charities Property Fund|7.9|7.8|
|Trojan Income Fund|5.0|8.8|
|Mayfair Property Income Trust for Charities|4.9|4.7|
|Schroder Income Fund|4.8|5.1|
|Majedie UK Equity Fund|4.5|4.8|
|HSBC FTSE All World Index Fund|3.9|5.6|



## **d Bank deposits** 

Bank deposits classified as investments represent deposit funds managed by investment managers. 

- **e Income from investments** 


**----- Start of picture text -----**<br>
2021 2020<br>£000 £000<br>Unrestricted funds 45 58<br>Restricted funds 95 122<br>140 180<br>**----- End of picture text -----**<br>


**ff Investment in subsidiariesInvestment in subsidiaries** 

The Charity is the controlling member of St. John of Jerusalem Eye Hospital (SJEH), a UK registered charitable company limited by guarantee (Company No.3867950 and Charity No. 1080185) and having no share capital. The liability of each member in the event of winding up is limited to £10. SJEH provides ophthalmic services through a branch in the occupied Palestinian territories. 

The Charity is also the controlling member of St. John Eye Hospital in Jerusalem (RA) (SJEHJ), an Israeli registered charitable society (No. 580040368), limited by guarantee and having no share capital. SJEHJ provides ophthalmic services from the Jerusalem Hospital and the Mobile Outreach Programme. SJEH owns two £1 shares being all the issued shares in The St. John of Jerusalem Eye Hospital (Palestine) Limited (Company No.6365210), a UK registered company, which has not traded since incorporation. 

The Charity owns one £1 share being all the issued shares in SJEH Trading Limited (Company No.12375269) a UK registered company, which has not traded since incorporation. 

The Charity is the controlling member of St John Ophthalmic Association Limited, a UK private company limited by guarantee (Company No.12631428) and having no share capital. The liability of each member in the event of winding up is limited to £1. 

The Charity is the controlling member of St John of Jerusalem Hong Kong Foundation Limited, a Hong Kong registered company (No.3045181), which has not traded since incorporation. 

Summary financial information for the subsidiary entities: 

|Summary financial information for the subsidiary entities:<br> <br>traded since incorporation.|||||
|---|---|---|---|---|
||**St. John Eye**|**St. John of**||**St John**|
||**Hospital in**|**Jerusalem**||**Ophthalmic**|
||**Jerusalem (RA)**|**Eye Hospital**|**Association Limited**||
||**2021**|**2021**||**2021**|
||**£'000**|**£'000**||**£'000**|
|Total income and endowments|7,620|4,110||9|
|Total resources expended|(7,718)|(2,746)||(1)|
|Net(outgoing)incomingresources before other recognised(losses) gains|**(98)**|**1,364**||**8**|
|Other recognised gains|11|227||-|
|Net movements in funds|**(87)**|**1,591**||**8**|
|Total assets|11,404|6,541||8|
|Total liabilities|(9,006)|(2,128)||-|
|Total funds|**2,398**|**4,413**||**8**|
|Restricted income funds|115|3||8|
|Designated funds|2,841|2,755||-|
|Othergeneral funds|(558)|1,655||-|
|Total funds|**2,398**|**4,413**||**8**|



## **9 Stocks** 

Stocks comprise hospital medical stores and supplies all owned by subsidiaries. 

## **10 Debtors** 

## **a Amounts falling due within one year** 

|||**Group**|**Group**|**Charity**|**Charity**|
|---|---|---|---|---|---|
|||**2021**|**2020**|**2021**|**2020**|
||Note|**£000**|**£000**|**£000**|**£000**|
|Trade debtors||3,977|2,845|-|-|
|Allowance for bad debts|10 b|(1,801)|(1,189)|-|-|
|Net  trade debtors||2,176|1,656|-|-|
|Donations receivable||116|488|91|83|
|Prepayments and accrued income||296|137|21|49|
|Total debtors||**2,588**|**2,281**|**112**|**132**|



46 

47 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



St John of Jerusalem Eye Hospital Group Financial Statements 

St John of Jerusalem Eye Hospital Group Financial Statements 

## Notes to the Financial Statements 

for the year ended 31 December 2021 

## **b** Movement in allowance for bad debts 

||**Group**|**Group**|
|---|---|---|
||**2021**|**2020**|
||**£000**|**£000**|
|1 January|1,189|420|
|Additions|1,003|1,054|
|Write off *|(403)|(290)|
|Exchange differences|12|5|
|31 December|**1,801**|**1,189**|



* The majority of the write off relates to an agreement with UNRWA whereby the actual contractual payments are lower than the normal invoiced value of services provided to those patients. The allowance also includes a provision against the receivables from the Palestinian Authority. 

**11 Creditors a Amounts falling due within one year** 

|**a**|**Creditors**<br>**Amounts falling due within one year**|
|---|---|
||**Group**<br>**Group**<br>**Charity**<br>**Charity**|
||**2021**<br>**2020**<br>**2021**<br>**2020**|
||~~Note~~<br>~~**£000**~~<br>~~**£000**~~<br>~~**£000**~~<br>~~**£000**~~|
||Trade creditors<br>598<br>318<br>10<br>32<br>Retirement benefits                                                       11 c<br>1,703<br>1,404<br>-<br>-<br>Taxation and social security<br>70<br>80<br>4<br>4<br>Accruals<br>643<br>569<br>61<br>59|
||Deferred income                                                            11 b<br>51<br>44<br>-<br>-|
||~~Holidaa accrual~~<br>~~49~~<br>56<br>~~-~~<br>-|
||~~y py  ~~<br>|
||~~**3,114**~~<br>~~**2,471**~~<br>~~**75**~~<br>~~**95**~~|
|||
|**b **|**Deferred income**|
||**Group**<br>**Group**<br>**2021**<br>**2020**<br>~~**£000**~~<br>~~**£000**~~<br>1 January<br>44<br>35<br>Deferred income recognised<br>250<br>251<br>Deferred income released<br>(246)<br>(244)<br>~~Exchange differences~~<br>~~3~~<br>~~2~~|
||~~31  December~~<br>~~**51**~~<br>~~**44**~~|
|||
|||
||Deferred Income represents income received in advance from renting out some of the hospital's properties in Jerusalem.|



## Notes to the Financial Statements 

for the year ended 31 December 2021 

## **12 Unrestricted Income Funds** 

|**Group**<br>General reserves<br>Designated funds: Tangible fixed assets<br>Revaluation reserve<br>Total unrestricted funds<br>**Charity**<br>General reserves<br>Designated funds: Tangible fixed assets<br>Revaluation reserve<br>Total unrestricted funds<br>**Group**<br>General reserves<br>Designated funds: Tangible fixed assets<br>Revaluation reserve<br>Total unrestricted funds<br>**Charity**<br>General reserves<br>Designated funds: Tangible fixed assets<br>Revaluation reserve<br>Total unrestricted funds|**1 January**<br>**Incoming**<br>**Resources**<br>**Transfers**<br>**Gains**<br>**31 December**<br>**2021**<br>**Resources**<br>**Expended**<br>**& Losses**<br>**2021**<br>**£000**<br>**£000**<br>**£000**<br>**£000**<br>**£000**<br>**£000**|
|---|---|
||5,475<br>7,952<br>(5,223)<br>-<br>95<br>8,299<br>5,640<br>90<br>(944)<br>574<br>238<br>5,598<br>375<br>-<br>-<br>-<br>254<br>629|
||**11,490**<br>**8,042**<br>**(6,167)**<br>**574**<br>**587**<br>**14,526**|
||6,608<br>2,144<br>(593)<br>-<br>11<br>8,170<br>7<br>-<br>(5)<br>-<br>-<br>2<br>375<br>-<br>-<br>-<br>254<br>629|
||**6,990**<br>**2,144**<br>**(598)**<br>**-**<br>**265**<br>**8,801**|
||**1 January**<br>**Incoming**<br>**Resources**<br>**Transfers**<br>**Gains**<br>**31 December**<br>**2020**<br>**Resources**<br>**Expended**<br>**& Losses**<br>**2020**<br>**£000**<br>**£000**<br>**£000**<br>**£000**<br>**£000**<br>**£000**|
||4,373<br>6,975<br>(5,901)<br>-<br>28<br>5,475<br>6,121<br>145<br>(1,097)<br>242<br>229<br>5,640<br>467<br>-<br>-<br>-<br>(92)<br>375|
||**10,961**<br>**7,120**<br>**(6,998)**<br>**242**<br>**165**<br>**11,490**|
||4,916<br>2,138<br>(464)<br>-<br>18<br>6,608<br>13<br>-<br>(6)<br>-<br>-<br>7<br>467<br>-<br>-<br>-<br>(92)<br>375|
||**5,396**<br>**2,138**<br>**(470)**<br>**-**<br>**(74)**<br>**6,990**|



Transfers represent amounts released from restricted funds for the purchase of tangible fixed assets. 

## **c Amounts falling due after more than one year** 

||**Group**|**Group**|**Charity**|**Charity**|
|---|---|---|---|---|
||~~**2021**~~|~~**2020**~~|~~**2021**~~|~~**2020**~~|
|Retirement benefits|**£000**|**£000**|**£000**|**£000**|
|~~1 January~~|~~5,916~~|~~5,479~~|~~-~~|~~-~~|
|Additions|550|564|-|-|
|Exchange differences|354|210|-|-|
|~~Transferred to amounts falling due within one year~~|~~(116)~~|~~(68)~~|~~-~~|~~-~~|
|~~Payments~~|~~(218)~~|~~(269)~~|~~-~~|~~-~~|
|~~31 December~~|~~**6,486**~~|~~**5,916**~~|~~**-**~~|~~**-**~~|
||||||



Accrued retirement benefits mainly represents amounts payable under Israeli law when staff leave the Group's employment. Such amounts are accrued when earned, based on current monthly salaries and periods of service. The balance also includes provident schemes in respect of certain Jerusalem employees and other retirement benefit amounts payable in line with Palestinian law. 

48 

49 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



St John of Jerusalem Eye Hospital Group Financial Statements 

St John of Jerusalem Eye Hospital Group Financial Statements 

## Notes to the Financial Statements 

for the year ended 31 December 2 ~~021~~ 

## Notes to the Financial Statements 

for the year ended 31 December 2021 

**13 Restricted Income Funds** 

|**tricted Income Funds**||||||
|---|---|---|---|---|---|
|||||**Purchase**||
||**1 January**|**Incoming**|**Charitable**|**of Tangible**|**31 December**|
||**2021**|**Resources**|**Activities**|**Fixed Assets**|**2021**|
||**£000**|**£000**|**£000**|**£000**|**£000**|
|**Charity**||||||
|Staff sponsorship|-|649|(649)|-|-|
|Outreach|-|98|(98)|-|-|
|West Bank and Gaza Facilities|-|31|(31)|-|-|
|Other capital projects|216|238|-|(256)|198|
|Patient relief|1|35|(34)|-|2|
|Income received from endowments|-|95|(95)|-|-|
|Other projects|70|9|-|-|79|
|Others value less in each case than £25,000|77|-|(2)|-|75|
|**Total Charity**|**364**|**1,155**|**(909)**|**(256)**|**354**|
|Capital projects|-|395|-|(318)|77|
|Other projects|47|3,745|(3,792)|-|-|
|Others value less in each case than £25,000|54|7|(20)|-|41|
|**Total Group**|**465**|**5,302**|**(4,721)**|**(574)**|**472**|
|||||**Purchase**||
||**1 January**|**Incoming**|**Charitable**|**of Tangible**|**31 December**|
||**2020**|**Resources**|**Activities**|**Fixed Assets**|**2020**|
||**£000**|**£000**|**£000**|**£000**|**£000**|
|**Charity**||||||
|Staff sponsorship|-|797|(797)|-|-|
|Outreach|-|82|(82)|-|-|
|West Bank and Gaza Facilities|-|-|-|-|-|
|Other capital projects|262|26|-|(72)|216|
|Patient relief|1|3|(3)|-|1|
|Income received from endowments|-|122|(122)|-|-|
|Other projects|50|20|-|-|70|
|Others value less in each case than £25,000|74|27|(24)|-|77|
|**Total Charity**|**387**|**1,077**|**(1,028)**|**(72)**|**364**|
|Capital projects|-|170|-|(170)|-|
|Other projects|183|2,293|(2,429)|-|47|
|Others value less in each case than £25,000|27|48|(21)|-|54|
|**Total Group**|**597**|**3,588**|**(3,478)**|**(242)**|**465**|



## **Charity** 

- Staff sponsorship represents funds received to cover or contribute to staff costs of 42 hospital staff. 

- Outreach funds cover the running costs of three outreach units. 

- West Bank and Gaza facilities fund contribute to cover the operating costs of Gaza, Hebron and Anabta Clinic. 

- Capital projects funds represent funds received from various UK Trusts and Middle East donors to establish refractive suite and purchase medical equipment for the Group. 

- Patient relief funds contribute towards the treatment costs of needy patients. 

- Other projects include joint teaching programmes with other medical institutions, and funds that cover the School of Nursing costs and Muristan. 

## **Group** 

- Capital projects funds represent funds received from various donors to establish refractive suite and purchase medical 

- • Other projects include  donations received to expand the level of operations within the Gaza hospital through the introduction of a Diabetic Retinopathy screening and epidemiological research components. Also, it includes funds received to establish a genetic research unit and a lab at the main hospital in Jerusalem as well as funds received to sustain services at the Muristan clinic in the Old City of Jerusalem. 

## **14 Endowment Funds** 

**Group and Charity** 

|**Endowment Funds**<br>**Group and Charity**||||
|---|---|---|---|
||**1 January**|**Investment**|**31  December**|
||**2021**|**Gains**|**2021**|
||**£000**|**£000**|**£000**|
|American Society of St John: Walsh Bequest|508|42|550|
|Bed Endowment|4,130|342|4,472|
|Frost Charitable Trust|556|45|601|
|Frost Nursing School|525|44|569|
|Mr. Owen Smith Endowment|112|9|121|
|The John Swire Foundation Endowment|1,216|101|1,317|
||**7,047**|**583**|**7,630**|
||**1 January**|**Investment**|**31 December**|
||**2020**|**Losses**|**2020**|
||**£000**|**£000**|**£000**|
|American Society of St John: Walsh Bequest|519|(11)|508|
|Bed Endowment|4,222|(92)|4,130|
|Frost Charitable Trust|568|(12)|556|
|Frost Nursing School|537|(12)|525|
|Mr. Owen Smith Endowment|114|(2)|112|
|The John Swire Foundation Endowment|1,243|(27)|1,216|
||**7,203**|**(156)**|**7,047**|



## These funds represent: 

The American Society of St John: Walsh Bequest: The Bequest was made in 2000 in honour of the Rev. Canon Edward West and Don Wesley Lundquist, for the endowment of 2 beds in the Children's Ward at the Hospital's facilities, maintained for the care of needy children. 

- 

The Bed Endowment Fund: Donations to endow 37 beds between 1981-1995, with the use of income restricted to general patient care in the Hospital. 

- 

The Frost Endowment Funds: These amounts were donated in 1989 by The Frost Charitable Trust (Mrs Sally Frost) to endow 4 beds at the Hospital and the Nurses Training School. 

- 

The Endowment  of Mr Owen Smith was received in 2008 to fund professional medical training. 

- 

- The John Swire Foundation Endowment was received in 2013 to fund general operating costs. 

- 

• Investment income on endowment funds is applied in providing the on-going services covered by the endowment and is accounted for as unrestricted investment income in the Statement of Financial Activities. 

|**15 **|**Total  Group and Charity Funds**|**Total  Group and Charity Funds**|**Unrestricted**|**Unrestricted**|**Restricted**|**Restricted**|**Endowment**|**Endowment**|**Total**|**Total**|
|---|---|---|---|---|---|---|---|---|---|---|
||||**Funds**|**Funds**|**Funds**|**Funds**|**Funds**|**Funds**|**Funds**|**Funds**|
||**a**|**Analysis by type of asset and liability (Group)**|**2021**|**2020**|**2021**|**2020**|**2021**|**2020**|**2021**|**2020**|
||||**£000**|**£000**|**£000**|**£000**|**£000**|**£000**|**£000**|**£000**|
|||Tangible assets|5,598|5,640|-|-|-|-|5,598|5,640|
|||Investments|6,231|5,614|-|-|7,630|7,047|13,861|12,661|
|||Net current assets|9,183|6,152|472|465|-|-|9,655|6,617|
|||Creditors: Amounts falling due|||||||||
|||after more than one year|(6,486)|(5,916)|-|-|-|-|(6,486)|(5,916)|
||||**14,526**|**11,490**|**472**|**465**|**7,630**|**7,047**|**22,628**|**19,002**|
||**b**|**Analysis by type of asset and liability (Charity)**|||||||||
|||Tangible assets|2|7|-|-|-|-|2|7|
|||Investments|3,659|3,387|-|-|7,630|7,047|11,289|10,434|
|||Net current assets|5,140|3,596|354|364|-|-|5,494|3,960|
||||**8,801**|**6,990**|**354**|**364**|**7,630**|**7,047**|**16,785**|**14,401**|



50 

51 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



St John of Jerusalem Eye Hospital Group Financial Statements 

St John of Jerusalem Eye Hospital Group Financial Statements 

for the year ended 31 December 2021 

## Notes to the Financial Statements 

## Notes to the Financial Statements 

for the year ended 31 December 2021 

## **16 Reconciliation of net operating income to net cash inflow from operating activities** 

||**2021**|**2020**|
|---|---|---|
||**£000**|**£000**|
|Net incoming resources|2,456|232|
|Investment income|(140)|(180)|
|Gain on disposal of tangible fixed assets|(44)|(5)|
|Depreciation|1,030|1,155|
|Increase in stocks|(289)|(45)|
|(Increase) / Decrease  in debtors|(307)|597|
|Increase in creditors|1,213|650|
|**Net cash inflow from operating activities**|**3,919**|**2,404**|



## **17 Financial instruments** 

|**ncial instruments**|||||
|---|---|---|---|---|
||**Group**|**Group**|**Charity**|**Charity**|
||**2021**|**2020**|**2021**|**2020**|
||**£000**|**£000**|**£000**|**£000**|
|**Financial assets at fair value through statement of financial activities**|||||
|Investments|**13,861**|**12,661**|**11,289**|**10,434**|
|**Financial assets that are debt instruments measured at amortised cost**|||||
|Stocks|758|469|-|-|
|Debtors|2,588|2,281|112|132|
|Cash at bank and in hand|9,423|6,338|5,457|3,923|
||**12,769**|**9,088**|**5,569**|**4,055**|
|**Financial liabilities that are debt instruments measured at amortised cost**|||||
|Trade creditors|598|318|10|32|
|Taxation and social security|70|80|4|4|
|Accruals|643|569|61|59|
|Deferred income|51|44|-|-|
|Holiday pay accrual|49|56|-|-|
|Retirement benefits|8,189|7,320|-|-|
||**9,600**|**8,387**|**75**|**95**|



## **18 Trustees' remuneration** 

The trustees receive no remuneration. 

Reimbursement of trustees' expenses for travel, accommodation and flights for no trustees (2020, 3) during the year amounted to nil (2020, £8,005). A dinner was held for 10 trustees to welcome the incoming 5 trustees during the year at an amount of £1,643 (2020, nil). Donations made by trustees amounted to £12,739 (2020, £48,039). 

Charity Trustee Indemnity insurance is provided at a cost of £9,530 (2020, £7,754) to cover the charity, trustees and officers against potential claims and losses. 

## **19 Related parties transactions** 

The Charity is a wholly owned subsidiary of The Most Venerable Order of the Hospital of St John of Jerusalem (Charity No. 235979, Principal Office: St John House, 3 Charterhouse Mews, London, EC1M 6BB). 

The Jerusalem Hospital premises occupied by the Group are owned by The Order of St John and were previously occupied rent free on a full repairing basis. During 2015, the Group signed an agreement with The Order of St John to lease the Hospital in Jerusalem and similarly the Muristan property at peppercorn rent. In the opinion of the trustees, it would be impracticable to place a value on these facilities. 

The Group also occupies, on a rent free basis, offices in London owned by The Order of St John.  The value of this facility has been estimated at £57,000 per annum based on the rents payable by the external tenants at the complex.  This amount is included in the financial statements as a donation in kind. 

During the year, the Chairman of the Charity, Sir Andrew Cash, was also a trustee of The Most Venerable Order of the Hospital of St John of Jerusalem. 

Donations include amounts received from Priories and Establishments of The Order of St John, which are considered to be related party transactions: 

|related party transactions:||||
|---|---|---|---|
|||**2021**|**2020**|
|**Priory**||**£000**|**£000**|
|USA||1,773|1,404|
|England and the Islands||212|231|
|Scotland||122|99|
|New Zealand||204|106|
|Australia||116|204|
|Canada||34|69|
|||**2,461**|**2,113**|
|||**2021**|**2020**|
|**Other Members of  St. John Family**||**£000**|**£000**|
|Johanniter Orde in Sweden||25|27|
|Johanniter Orde in Nederland||-|9|
|The Commandery of Ards in Northern Ireland||19|-|
|The Swiss Commandery of the|Order of Saint John|-|98|
|St John Ambulance HongKong||-|7|
|||**44**|**141**|
|||**2021**|**2020**|
|Donations bythe Prioryof the United States:||**£000**|**£000**|
|Hospital - General Support<br>Hospital Restricted Gifts|**Notes to the Financial Statements**<br>~~**For the year ended 31 December 2021**~~|1,251<br>522<br>**1,773**|1,342<br>62<br>**1,404**|



During the year, the Charity reimbursed the Priory of England and the Islands and The Order of St John £3,172 (2020, £2,925) in respect of certain expenses incurred. 

Outstanding donations from the Priories and Establishments of The Order of St John at 31 December 2021 amounted to £42,000 (2020: £109,427). 

## **20 Contractual & designated obligations** 

In 2020, the Group  signed an agreement with Johanniter International to administrate a grant funded by The German Federal Ministry for Economic Cooperation and Development (BMZ). It is a 3 year project that aims to prevent avoidable blindness and visual impairment in the West Bank, Gaza and East Jerusalem. 

The total value of the grant is 1,524,623 Euros, out of which 987,000 Euros were received in 2021 and 1,027,000 Euros were utilised during the year. 

52 St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

53 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 



## St John of Jerusalem Eye Hospital Group 

Professional Advisers & Administrative Information 

London & Registered Office Bankers in the occupied 4 Charterhouse Mews Palestinian territories London EC1M 6BB Bank of Palestine PLC Hebron Road Jerusalem Hospital P.O. Box 765 2 Mujir Eddin Street Bethlehem Sheikh Jarrah P.O. Box 19960 Investment Managers Jerusalem 91198 Schroders (C.I.) Limited PO Box 334, Regency Court Bankers in the UK Glategny Esplanade National Westminster Bank Plc St Peter Port 134 Aldersgate Street Guernsey GY1 3UF London EC1A 4JB 

St John of Jerusalem Eye Hospital Group (a UK Company Limited by guarantee, Company number 7355619, Charity number 1139527) has three charitable subsidiary undertakings; St John of Jerusalem Eye Hospital (a UK Company Limited by guarantee, Company number 3867950; Charity number 1080185), St John Eye Hospital in Jerusalem (RA) (an Israeli charitable society, registration number 580040368) and St John Ophthalmic Association Limited, a UK company Limited by guarantee, Company No.12631428) 

Independent Auditors Barclays Bank PLC PricewaterhouseCoopers LLP 1 Churchill Place 1 Embankment Place London E14 5HP London WC2N 6RH 


**----- Start of picture text -----**<br>
L-R: Sir Andrew Cash, Chairman, Charlie O'Doherty, Head of Fundraising, Professor Mark Compton, Lord Prior of The Order of St John, Dr Denise Magauran,<br>Member of the Guild and Former Medical Director at SJEHG, Dr Ahmad Ma'ali. CEO at the Gift of Sight Fair 2021.<br>**----- End of picture text -----**<br>


## St John Priory Funding 2021 

## £ $ 

£116k Australia, £34k Canada, £212k England and the Islands, £204k New Zealand, £122k Scotland, £1.77m USA 

$160k Australia, $47k Canada, $293k England and the Islands, $282k New Zealand, $168k Scotland, $2.44m USA 

## Thank You 

## **Our vital work is reliant on voluntary income from charitable donations** 

we thank them for their continued support. We are grateful to the Guild, the St John Ophthalmic Association, the Friends of St John Society, the Alliance of the Orders of St John, St John Associations and the St John Fellowship for their on-going and crucial support. 

Without our donors, we could not continue saving sight and changing lives. The patients and staff at SJEHG greatly appreciate the support of everyone who has given or helped in some way in 2021. The St John Priories from around the world have, delivered much-valued assistance to SJEHG and 

German Federal Ministry for Economic Cooperation and Development (BMZ) 

## Further Major Donors 2021: 

Altajir Trust 

Greendale Foundation 

Ancaster Trust 

Haramead Trust 

Ann Jane Green Trust 

International Medical Corps (IMC) John Swire 1989 Charitable Trust Juzoor For Health & Social Development Lord Hanson Foundation 

Anthony & Elizabeth Mellows Charitable Trust 

Arab Fund for Economic and Social Development The Australian NGO Cooperation Programme (ANCP) Bernadette Charitable Trust British Humane Association Bryan Guinness Charitable Trust CBM International 

Lorimer Trust 

Lions Club International Foundation 

The Knights Templar 

M Cannon-Brookes Charitable Trust Maurice and Hilda Laing Charitable Trust Palestinian Children Relief Fund Qatar Fund for Development Rest Harrow Trust Rhododendron Trust RTW Charitable Foundation 

Cadogan Charity Calpe Trust 

Carmen Butler-Charteris Charitable Trust Caroline Agnes Joan Hervey Trust Christian Broadcasting Network (CBN) Clothworkers' Foundation Colles Trust 

The Spectacle Makers' Charity Taawon (Welfare Association) The Representative Office of Norway to the Palestinian Authority 

Count Zoltan Rosco Maria Von Rosenthal Charitable Trust 

D G Albright Charitable Trust Dr Michael Dan 

Thriplow Charitable Trust UNOCHA-Country-based Pooled Funds (CBPF) USAID 

Dr Mortimer and Theresa Sackler Foundation 

Drapers' Company 

Edwina Mountbatten & Leonora Children's Foundation Erica Leonard Trust 

Valentine Charitable Trust Westcroft Trust 

Fulmer Charitable Trust 

And to all our anonymous donors 

Fred Hollows Foundation (FHF) 

54 

55 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 

St John Eye Hospital Group Trustees’ Annual Report and Financial Statements 2021 




If you would like to support St John of Jerusalem Eye Hospital Group or would like more information, please contact us: 

4 Charterhouse Mews, London EC1M 6BB, United Kingdom +44 (0)20 7253 2582 info@stjohneyehospital.org 

2 Mujir Eddin Street Sheikh Jarrah P.O.Box 19960 Jerusalem 91198 

www.stjohneyehospital.org 

@stjohneyehospital 


@StJohnEyeHosp @StJohnEyeHospital