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2023-03-31-accounts

ANNUAL REPORT 2022/23

REPORT OF THE TRUSTEES AND FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2023 FOR THE DAVID NOTT FOUNDATION

Registered charity number: 1162537

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CONTENTS

WELCOME FROM THE CHAIR OF THE BOARD OF TRUSTEES

AS A CHARITY PREPARING MEDICAL PROFESSIONALS TO HELP THEIR LOCAL COMMUNITIES IN A TIME OF WAR, WE WERE PROUD TO DELIVER OUR UNIQUE TRAINING IN SO MANY COUNTRIES DURING THE YEAR IN REVIEW. IN PARTICULAR, WE WERE RELIEVED TO BE ABLE TO RESPOND IN SUCH AN URGENT AND AGILE MANNER TO THE CONFLICT IN UKRAINE.

Overall, we trained 477 surgeons during the year and introduced a new conflict anaesthesia course, something long requested by those we serve, which runs parallel to the surgical course. 52 anaesthetists have taken the course so far and the figure continues to grow.

Alongside responding to war in Ukraine we continued to our colleagues elsewhere as well. We delivered world-class surgical training for surgeons from Syria, Palestine and Somaliland and undertook training missions to Palestine, and to Djibouti where we taught a cohort of Yemeni doctors.

Being able to respond to humanitarian emergencies where we have the resources, connections and expertise to do so, whilst also supporting our core programmes, is an integral element of the DNF strategy.

As part of our commitment to localisation in the humanitarian sector, we aim to give local doctors the skills to develop the expertise required to deliver

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TRAINING IN
POLTAVA, UKRAINE
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our world-class training, we also held a Train the Trainers (TTT) course in November 2022, attended by 29 surgeons and anaesthetists from South Sudan, Ethiopia, Somaliland, Palestine, Syria, the UK and Oman. On this course, they were given the knowhow to teach the Hostile Environment Surgical Training (HEST) course that many had experienced in their home states, thereby continuing that virtuous circle of knowledge and empowerment.

The year closed on a very sad note for everyone connected to the Foundation as our beloved Patron, Baroness Betty Boothroyd, passed away in February. She is sorely missed and the Foundation will be honouring her legacy for decades to come with a programme of scholarships bearing her name.

Responsive. Open-hearted. In it for the long haul. It inspires all we do. Thank you for helping us make it happen.

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ANSWERING THE CALL: UKRAINE RESPONSE

THE FOUNDATION IS PROUD TO HAVE PROVIDED CONSISTENT SURGICAL TRAINING OF THE HIGHEST QUALITY FOR THE BENEFIT OF THE PEOPLE OF UKRAINE THIS YEAR. COURSES WERE HELD FOR DOCTORS FROM ACROSS UKRAINE: IN KHARKIV, DNIPRO, ZAPORIZHZHIA, LVIV, ODESA, POLTAVA, ZHYTOMYR, AND MYKOLAIV.

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DAVID NOTT TEACHING SURGEONS
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“THE SKIN IS ALIVE BECAUSE OF YOU”

During Russian shelling, a woman suffered catastrophic leg injuries. Working to repair her wound during a mission in Ukraine, David used the surgery as an opportunity to train local doctors.

He showed them how to perform a skin graft to treat the injury, and that wrapping the graft in fluffy gauze can help with healing. This technique differs to standard wound treatment, which often involves the application of antiseptic spirits and bandages.

When Dr Ivan Parkhomenko looked at his patient’s wound in recovery, he was overwhelmed with joy to see that it was healing. During a phone call, he shared with David, “the skin is alive! It’s all because of you.

I’ve started a little revolution in my hospital. I’ve started to do what you do – using the fluffy gauze for skin grafts. The patient’s granulation (tissue that is an important component of wound healing) is awesome. We haven’t needed to use any antibiotics.

It was one of the best moments of my life doing this operation. I can only say thank you for your knowledge.”

ACTIVITIES

A CENTRAL OBJECTIVE OF THE DAVID NOTT FOUNDATION IS THE ABILITY TO RESPOND TO UNFORESEEN CRISES IN A TIMELY AND THOUGHTFUL MANNER WHILST ALSO MAINTAINING OUR COMMITMENT TO LONG-STANDING STRATEGIC AREAS OF FOCUS.

demonstrated our responsiveness by pioneering a new course, HEST-Anaesthesia. Anaesthetic training has long been requested by participants in HEST training and a programme, which runs parallel to the HEST surgical course, has been developed and pioneered in Ukraine.

We seek constantly to localise our impact and one of the ways we do this is with Train the Trainers activity.

We have clearly demonstrated this in the year in review with a fulsome response to the invasion of Ukraine whilst also serving colleagues in focus regions Palestine and Yemen, among others.

We help develop future teachers from former HEST participants, empowering them to take forward the principles of safe, skilled surgery.

Our principal product is the Hostile Environment Surgical Training course which equips surgeons with the knowledge and decision-making strategies to treat the war-wounded patient. We

Recognising the importance of research in our field, we also offer scholarships, including the David Nott Foundation Scholarship for Global Health and Conflict.

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ANAESTHESIA TRAINING IN ZHYTOMYR, UKRAINE
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PART OF THE STRATEGY OF THE FOUNDATION IS TO TARGET SUPPORT TO A SELECT NUMBER OF COUNTRIES AND REGIONS, TO STRENGTHEN AND DEEPEN THE TEACHING WE PROVIDE THROUGH REPEAT MISSIONS AND CONTACTS AND HAVE A WIDER HEALTH SYSTEM STRENGTHENING EFFECT.

However, we always retain flexibility to be able to respond to emergencies in areas outside our strategic plan, where there is a need for conflict surgery training and, following a needs assessment, we judge that we can help. The war by Russia against Ukraine constituted just such an emergency.

Within 10 days of the invasion, David ran a 12hour training session on Zoom with surgeons inside Ukraine, assisted by Henry Marsh, an eminent neurosurgeon who has spent decades training and helping Ukrainian surgeons.

To provide support and a ready reference following the online session, we created a library of short videos covering a number of trauma injuries the doctors may encounter and possible ways to treat them.

Foundation Co-Founders, Trustees and staff were appalled to wake to the news on 24 February that Russia had invaded Ukraine. We immediately started planning our response and how best to help the doctors, many of whom would be faced with catastrophic trauma injuries they had never encountered before.

Those videos were translated into Ukrainian so that the content was easily accessible.

DR IGOR BELKIN

DR IGOR BELKIN, A SURGEON FROM ZAPORIZHZHIA, WATCHED OUR TRANSLATED WAR SURGERY VIDEOS IN A BID TO BETTER TREAT DEVASTATING WOUNDS INFLICTED BY THE WAR. HE THEN ATTENDED OUR COURSE IN ZAPORIZHZHIA.

He shared: “I was very pleased to attend this course and meet David personally. I got very concise, practical information and was able to learn how to provide assistance in areas of medicine I don’t specialise in. Now, I can do thoracotomies. This is a far better method for both surgeons and anaesthetists to approach trauma injuries. I also learned how to use external fixations to secure bones and now perform fasciotomies on patients needing urgent pressure release in the limbs.”

DR IGOR BELKIN, UKRAINE

~~“NOW, I CAN DO THORACOTOMIES. THIS IS A FAR BETTER METHOD FOR BOTH SURGEONS AND ANAESTHETISTS TO APPROACH TRAUMA INJURIES.”~~

DR IGOR BELKIN

FINANCES

THE FOUNDATION IS IMMEASURABLY GRATEFUL TO OUR COMMITTED DONOR BASE. THANKS TO THE GENEROSITY OF OUR SUPPORTERS, THIS FINANCIAL YEAR WE HAVE BEEN ABLE TO RUN A RECORD 13 HEST COURSES AND A TRAIN THE TRAINERS COURSE IN LONDON, SUPPORTED BY THE HIGHEST QUALITY TEACHING MATERIALS AND AIDS.

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TRAINING YEMENI SURGEONS,
DJIBOUTI
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Our expertise has also been sought out by a number of humanitarian organisations and the World Health Organisation (WHO), the specialised United Nations (UN) agency responsible for global health.

By selecting operational partners that help us meet our costs, we are able to leverage our donors’ money and deliver more impact worldwide whilst keeping administrative costs modest. Post-pandemic, the cost to train a doctor abroad has risen with the increased costs of travel, insurance and the variety and quantity of innovative training materials the Foundation utilises to make training as realistic and engaging as possible.

Operating in a warzone like Ukraine incurs particularly high costs for insurance and travel, given the elevated risk and length of time it takes to enter and exit the country by road.

PEOPLE

THE DAVID NOTT FOUNDATION COMMUNITY WERE DEEPLY SADDENED BY THE LOSS OF OUR PATRON, BARONESS BETTY BOOTHROYD, IN FEBRUARY.

WITHOUT OUR DEDICATED TRAINING FACULTY, WE WOULD BE UNABLE TO DELIVER THE TEACHING.

Our Faculty expanded with the Train the Trainers course held in November 2022 and three of those trained were able to join missions swiftly afterwards in Moldova and Djibouti, training surgeons from Yemen. The development and nurturing of the Faculty is a priority for the coming year, as we show our appreciation for all they do and further professionalise our management of training materials and teams.

Betty was a strong supporter of the work of the Foundation and took a close interest in the various programmes and mission we undertook. In time, we may consider a new Patron but for the present, Betty is irreplaceable.

The Foundation’s office in Hammersmith, west London, continues to provide a base for our small team where a culture of collaborative working is supported by a requirement for staff to be present in the office for 3 days a week. Given the strategic use of partner organisations, we are able to keep administrative and operational costs low for the sector.

There were no changes to the Trustee board during the period under review, with the Board able to provide continuity at a time of expansion.

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OBJECTIVES AND ACTIVITIES

OUR VISION

EMPOWERING DOCTORS IN PALESTINE

A WORLD WHERE SAFE, SKILLED SURGICAL CARE IS AVAILABLE TO ALL.

AMONG THE PARTICIPANTS IN OUR TRAIN THE TRAINERS COURSE IN NOVEMBER 2022 WAS DR MARIAM AWEIDAH, A GENERAL SURGEON FROM RAMALLAH, WHO WE UPSKILLED TO BECOME ONE OF OUR SURGICAL TRAINERS AND COUNTRY LEADS.

OUR MISSION

WE TRAIN MEDICAL PROFESSIONALS TO PROVIDE SAFE, SKILLED SURGICAL CARE IN COUNTRIES IMPACTED BY CONFLICT AND CATASTROPHE.

We have held a special relationship with Dr Aweidah since her attendance of our first HEST course in Ramallah in July 2017. She remains one of just a handful female surgeons delivering surgical care to patients in Palestine.

OUR PURPOSE

OUR PURPOSE IS THE ADVANCEMENT OF HEALTH AND THE SAVING OF LIVES BY DELIVERING TRAINING FOR SURGEONS AND MEDICAL PROFESSIONALS, EITHER ALONE OR IN PARTNERSHIP WITH OTHER ORGANISATIONS.

We do this to enable them to address the needs of patients in conflict, disaster zones and other austere environments.

~~“I WAS CAPTURED BY IT (THE COURSE AND THE FOUNDATION). THE SPIRIT OF THE DAVID NOTT FOUNDATION IS FAMILY. WE ARE VERY HAPPY AND THANKFUL TO THE DAVID NOTT FOUNDATION (FOR TRAINING DOCTORS IN PALESTINE). TO COME AND SEE WHAT WE ARE DOING, TO UNDERSTAND OUR SITUATION, AND SEE IT IN OUR EYES.”~~

We are a humanitarian organisation dedicated to helping those injured in the many intractable conflicts raging across our world. The best way we can help is by leveraging the unparalleled experience of our Co-Founder, Professor David Nott.

Based on David’s thirty years of experience as a humanitarian surgeon, the Foundation has designed a surgical training programme which equips doctors with the knowledge they need to manage a vast array of injuries faced in conflict. Decisionmaking strategies are at the heart of the training, as doctors have difficult decisions to make in mass casualty settings, often with minimal resources and limited recourse to clinical investigations.

DR MARIAM AWEIDAH

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TRAINING IN RAMALLAH, PALESTINE
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THE NEED FOR WHAT WE DO

EXCELLENCE

Conflict is widespread, growing in scale and intensity and increasing waged against civilians. The UN proclaimed in January 2023 that we are seeing the highest number of violent conflicts since the Second World War and a connected, pervasive, sense of insecurity that drives humanitarian need. Confronted with the horror of the conflict landscape, one can feel powerless but David Nott Foundation-trained doctors provide a degree of reassurance to those experiencing injury and discomfort. In the midst of displacement and fear, access to safe, skilled surgical care is a source of hope for communities.

We arm local doctors living and working in conflict and catastrophe with world-class surgical training. We do this by recruiting highly experienced Faculty trainers to deliver our certified Hostile Environment Surgical Training course, using cutting-edge teaching equipment and simulators that are specially designed for us.

RESILIENCE

Thanks to the commitment and resilience of our Faculty of trainers, we empower skilled, resilient doctors in conflict and catastrophe to face any trauma injury and strengthen their own health systems.

OUR VALUES

Our values form our backbone. They inform our decision-making, guide our strategic direction and influence how we hold ourselves.

OUR LEGACY

Because we share knowledge, not things, our legacy remains long after our small team has departed and has the potential to last generations. As part of our commitment to make our training truly sustainable, we are also training in-country teams to be able to deliver courses to the highest standards, leading to a smaller UK-based footprint each time we visit a particular region.

COMPASSION

When we bear witness to the devastating impact of conflict and catastrophe, we are moved to act. We offer surgical education, community and friendship to every medical professional we train, and we speak up about what we see.

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10 2022/23 ACHIEVEMENT AND PERFORMANCE

A substantial response to the devastating conflict in Ukraine: 327 surgeons and anaesthetists trained in trauma surgery.

13 HEST courses in 12 months in Ukraine, Palestine, Moldova, Malaysia and Djibouti, for Yemeni surgeons.

Expanded our teaching Faculty with 29 doctors attending our second UK Train the Trainers course from Syria, Palestine, Somaliland, Oman, South Sudan, Ethiopia, Germany and the UK.

Continued to engage and inspire the next generation of humanitarian surgeons through the Friends of the David Nott Foundation student societies, of which we now have 25 across Europe.

Reaccreditation of our flagship HEST by Royal College of Surgeons (England).

Investment in teaching equipment including obstetric simulator models and 3-D printed organs to support teaching.

Maintained valued existing and developed new operational partners, including the World Health Organisation (WHO).

All time total Doctors trained 1,364

46 STAE & hest courses in Palestine Ukraine lebanon UK syria Moldova libya iraq Türkiye yemen cameroon Somaliland Argentina Djibouti kenya chile

PUBLIC BENEFIT

TRUSTEES CONTINUE TO HAVE REGARD TO THE GUIDANCE ISSUED BY THE CHARITY COMMISSION ON PUBLIC BENEFIT. THE FOUNDATION PROVIDES MEDICAL EDUCATION, TRAINING AND EXPERTISE. IT DOES SO WITH THE FOLLOWING PRINCIPAL PRODUCTS:

HOSTILE ENVIRONMENT SURGICAL TRAINING (HEST)

The average cost to train a surgeon on a HEST course has increased from the 2021-22 period. This is largely due to increased cost of air travel and the core training items that are essential to the running of the course, including prosthetic hearts, kidneys, bowel sections, veins and arteries. The insurance costs for training in Ukraine, essential to protect our people and resources, were also very high because it is an area of active conflict.

The HEST course is unique to the Foundation. A five-day course which covers all surgical specialisms, it equips doctors with the surgical skills and decisionmaking abilities to be able to address a variety of injuries they may face in conflict and disaster zones. Since the Foundation began operations in 2015, some 1,364 been taught life-saving surgical skills that have in many circumstances literally made the difference between life and death.

HOSTILE ENVIRONMENT SURGICAL TRAINING (HEST) – ANAESTHESIA

Following a needs assessment with a partner organisation, the HEST course is delivered with communities where it is needed most, sometimes to conflict frontlines like Ukraine.

Going beyond the surgeon to a ‘whole of the operating theatre’ approach, we developed a course that runs parallel to HEST which addresses the challenges faced by anaesthetists in conflict. Demand for the course was consistent and it was delivered for the first time in November 2022 where Dr Rachael Craven and Dr Elma Wong trained 22 doctors in Poltava and Zhytomyr, Ukraine.

We are hugely appreciative of the partners with whom we work. Their local knowledge and operational capability comprising logistics, risk analysis, security and transport means we are able keep our operations team to a minimum and reduce our expenditure. Our partners are also able, through their networks, to help identify the doctors who would benefit most from the teaching making sure we train those who will make the greatest impact.

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DR ELMA WONG TEACHING
IN POLTAVA, UKRAINE
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Cadaveric teaching is not practical or locally acceptable in many settings, so to make HEST as realistic as possible, the Foundation has designed and commissioned a number of prosthetic organs and vessels in addition to our life-size, whole-body simulator model, Heston. The practical sessions support the lectures, videos and discussions and create a highly interactive and engaging programme. Negotiations are advanced to commission a second Heston teaching model, with certain new procedures and features.

This would enable us to deliver courses concurrently.

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The team taught the anaesthetists how to give drugs and blood to patients through their bones, in cases where vessels are so severely damaged, they cannot be accessed.

To continue treating patients despite potential electricity cuts or low oxygen supplies, the group also learned how to use portable anaesthesia machines.

Elma shared: “The biggest gift you can give to a healthcare worker in a conflict zone is selfsufficiency – the dignity to be able to do everything themselves. It’s important to empower people to look after their own patients. A job well done is ultimately making yourself redundant.”

It was delivered again with different Faculty in February 2023 in Zaporizhzhia and Lviv and demand is high for the new course.

PERSISTING CRISES IN YEMEN

Yemeni surgeons commonly face injuries inflicted by war, such as gunshot wounds or landmine injuries requiring amputations. Car accidents are also common on uneven roads, leading to severe crush wounds or internal bleeding that demand urgent damage control.

Our teaching Faculty, including Dr Shabnam Parkar who completed our Train the Trainers course in 2022, upskilled 15 Yemeni doctors in Djibouti, giving them the skills needed to better treat the injuries they see daily.

One participant shared: “Working in any war zone, I know I can use my new skills,” while another said they were more confident and that they could “face any emergency case” because of their training.

Dr Parkar said: “It was lovely to see them presenting cases on their phones and sharing ideas of how they approach surgery.

The course created a platform for Yemeni doctors to connect and support each other, no matter the region they lived and worked in.”

TEACHING MATERIALS AND AIDS

Critical to the success of surgical teaching is the ability to observe, touch and feel the anatomy of a patient. With practical and ethical restrictions ruling out the use of cadavers on HEST courses, the Foundation has pioneered the creation of a number of teaching models to enhance the taught experience.

The Foundation’s bespoke human simulator model, Heston, allows the Faculty to demonstrate the anatomy of a patient in intricate detail. Heston is anatomically identical to a human body and made from materials that replicate the look and feel of human flesh, bone, skin and organs. Heston was built with the generous support of the Open Society Foundations and made to the precise specification of Professor David Nott.

The Foundation is always seeking new and innovative ways to make training more engaging and more accessible, especially in emergencies. New teaching modules are developed where a need is identified and we enhance the experience of that teaching with the best in surgical simulation and technology.

TRAINING FOCUS: MOLDOVA

Moldova’s proximity to Ukraine has meant it has faced a range of challenges in the past year, following Russia’s invasion of its neighbour. The state of 2.7 million opened its borders to Ukrainians forced to flee and it hosts the highest number of Ukrainian refugees per capita compared to other EU and EU-neighbouring countries.

The training was developed at the request of the World Health Organisation (WHO) and connected to our Ukraine response. WHO representative Dr Vitalii Stetsyk commented that “The Foundation’s course will strengthen surgical competencies. Building networks and sharing knowledge is vital. They save lives.”

CEO and Co-Founder Elly Nott stated: “It is our sincere hope that our Moldovan colleagues will not need to use the war surgical skills we have shared with them, but if so, well-trained doctors will be equipped to build healthcare resilience and save more lives. Preparation is power.”

TRAINING FOCUS: PALESTINE

In collaboration with Juzoor for Health and Social Development and the Palestine Medical Council, we trained 34 surgeons in Ramallah, Palestine, in July 2022. The surgeons came from several Palestinian cities and towns, such as Ramallah, Jenin, Hebron and Jericho.

Despite logistical challenges, our Faculty delivered a course that met the urgent needs of Palestinian doctors.

We first delivered our HEST course in Ramallah in March 2017 and, as part of our commitment to sustainability, also trained a dozen Palestinian surgeons on our UK course. Providing healthcare in Palestine is complicated by the realities of displacement and occupation. Since 2002, the construction of a separation wall cutting into Palestinian territory has severely inhibited freedom of movement across the West Bank. The wall is a barrier to Palestinians accessing healthcare. The movement of ambulances, healthcare workers and resources are impeded by military checkpoints and arbitrary closures.

During our latest mission in Ramallah, our CEO Elly Nott visited the Augusta Victoria and Al-Makassed Hospitals in East Jerusalem and heard about the challenges they face in providing care. Travel from the West Bank and Gaza to these hospitals requires a permit. Applications – and therefore treatment – is often delayed or denied.

CEO and Co-Founder, Elly Nott, said: “The goal of our training is the same wherever we go. To empower local surgeons and share our knowledge with them, in the hope that it will save more lives. We see this course as the start of an ongoing journey with Juzoor and Palestine – training which we hope will strengthen doctors’ surgical education.”

TRAIN THE TRAINERS

In July 2021, we held the first Train the Trainers course with the aim of increasing the number of Faculty to enable us to deliver more courses. The next TTT course was held in November 2022 and as part of our commitment to making our training truly sustainable, half the participants attending were drawn from the countries where we have active programmes. In the future, a greater proportion of Faculty will be from the particular state, with all the benefits in terms of language, communication and post-course embedding of the teaching that implies.

DR KOMA AKIM, SOUTH SUDAN

We upskilled Dr Akim to join our training Faculty in London in November 2022: “I remember a patient who sustained a pelvic injury as a result of a gunshot wound. When he came to our hospital, because of my training, I was able to save his life with pelvic packing. The skills enable me to pass on the knowledge and cascade it to others in South Sudan, so that more and more lives are saved.”

GRANTS

The Foundation awards grants to Faculty members and other training bodies to deliver training or conduct research that aligns with the Foundation’s aims and values. Grants may be given to individuals, private organisations and other charities and a policy covers the different parameters for making these awards.

During this reporting period, we awarded a David Nott Foundation Scholarship for Global Health and Conflict to a candidate studying for a PhD at King’s College London. Their research focuses on the evacuation of patients in conflict, and we are also commissioning a module on hospital management in conflict, to provide the optimal working environment and best outcomes for patients.

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FUTURE PLANS

GOALS FOR 2023/24

Statement of intent: There will be a shift in 2023-24 to a more holistic, programmatic focus that reflects more fully the variety of supportive activities and training the Foundation runs to further surgical education in areas affected by conflict. This includes HEST but also other scholarships, specialist training and education.

We want to further support our community by:

Strengthening our commitment to localisation by running Train the Trainers courses in northwest Syria and Ukraine.

Support healthcare professionals with scholarships to specialist courses that improve their skills in selected areas.

Run an inaugural in-person conference for the Friends of the David Nott Foundation student societies and Trainees of the David Nott Foundation Society.

Hold a Study Day for Faculty where we thank our invaluable training team and invite their suggestions for how we can do better.

Develop our training offer for surgical nurses, as we have for anaesthetists.

A cadaveric course in the UK for Faculty and surgeons wishing to undertake humanitarian work with other organisations. Scholarships reserved for Ukrainian surgeons.

Focus on a small number of target countries with the goal of having a health system-wide impact, whilst retaining the capacity to respond to crises.

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TRAINING IN KYIV,
UKRAINE
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FINANCIAL REVIEW

FINANCIAL POSITION

FUNDRAISING POLICY

THIS WAS THE SEVENTH FULL YEAR OF OPERATIONS FOR THE FOUNDATION.

We were delighted that our income in 2022/23 is 26% higher than the previous financial year. With the return to training abroad, investment in equipment and rising costs, we predict we will be running at a deficit for the financial year ending March 2024.

As the first year since the Covid pandemic we were able to plan a full year of operations and deliver in-person training at pace, necessitating increased orders for equipment and all other associated costs.

Our principal objective in fundraising for the year was to consolidate our existing donor base, whilst exploring the potential for longer-term engagement with corporate donors and grant-giving bodies.

We are therefore incredibly grateful to our supporters for their generosity throughout the pandemic which enabled us to hit the ground running as soon as conditions allowed. Thanks to our loyal supporter base, we were able to focus solely on our impact: delivering high quality training in areas that needed it most and plan the year ahead with confidence.

We elect to manage our own fundraising and do not solicit for donations through professional fundraisers, telemarketing, or other commercial participants. We take our responsibility to protect vulnerable people seriously, ensuring strict donation policy procedures and practices are in place, as is a safeguarding policy.

The Foundation raised £1,392k income in the period to 31 March 2023, increased from £999k the previous year. We delivered public engagement events with the BEARR Trust and a reception for supporters at the Reform Club. David and Faculty trainers gave presentations and talks online and in person, and David’s book War Doctor continued to stimulate interest in the work of the Foundation.

Furthermore, we comply with data protection laws and GDPR, and have a proactive complaint handling procedure that is published on our website. We are also bound by and will comply with the Fundraising Regulator’s Code of Fundraising Practice.

RESERVES

The ongoing substantial support of the Syncona Foundation is something we are immeasurably grateful for. Such generous, multi-year commitments enable us to plan for the future with confidence and focus institutional efforts on delivering our mission.

Total reserves of DNF at the 31 March 2023 were £1,989,243. This is calculated as the total funds of the charity less restricted funds and less fixed assets held for charity use. The reserve has accrued in the year in review due to:

AS OF MARCH 31ST 2023, THE VALUE OF THE FOUNDATION’S INVESTMENT WAS AS FOLLOWS:

The huge generosity of our donors, this has been our best year on record since 2015 demonstrating the compelling nature of our mission and activities to our donors

COIF charities investment fund accumulation units £769k

Our successful strategic use of operational partners to share costs enabling us to keep administrative and operational costs low. An example of this is our delivery of two HEST missions with the World Health Organisations in Moldova, where 95% of the costs were met.

EXPENDITURE

~~2022/23~~ 1,612k ~~2021/22~~ 654k

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The reserve allows the DNF to look forward with certainty and develop long-term programme strategy underpinned by sustainable strategic partnerships and a forward plan of training missions. Alongside greater resilience, it also gives us more flexibility to respond quickly to fast developing events as we did in Ukraine. There are plans to build on these developments and continue to increase the intensity of programmatic activity in the years ahead. To support this we will expand our teaching team and invest new equipment and teaching aids as needed.

INVESTMENT POLICY AND OBJECTIVES

The reserve is managed responsibly by the Trustees. The Foundation has developed a formal investment policy to seek to protect cash assets against inflation and grow capital in real terms.

The Foundation’s investment objective is to achieve an average annual total return of inflation of CPI plus 4% over a rolling five-year period. Investments are managed by a third party on a discretionary basis reporting to the Board at regular intervals.

The Foundation’s investments are well diversified, cost effective, and offer at least monthly liquidity. The portfolio performance for the year was -0.1% which underachieved our objective. In light of this the Foundation will be reviewing its investment strategy with a view to achieving the objectives over the full five-year period.

The Foundation’s ethical policy is applied to these investments regarding companies involved in the manufacture of controversial weapons, strategic military weapons, non-military firearms, tobacco, pornography, and online gambling. The Foundation also prefers investment partners who integrate Environmental, Social and Governance factors into the investment process and engage in active ownership to improve company performance and change behaviour.

OPERATING RESERVE POLICY

Operating reserve refers to ringfenced cash set aside by the Board of Trustees as a form of working capital to guarantee the stability of the programmes, employment, and ongoing operations of the organisation. As is best practice, this provides an internal source of funds for

unforeseen situations such as a sudden increase in expenses, one-time unbudgeted expenses, unanticipated loss in funding, or uninsured losses.

Operating Reserves are not intended to replace a permanent loss of funds or eliminate an ongoing budget gap and, if the funds are used, it is the intention of the Foundation to replenish the reserve within a reasonably short period of time.

The Operating Reserve in 2022/23 was set for four months of average budgeted operating costs, a relatively conservative provision for an organisation of this kind. The calculation of average monthly operating costs includes all recurring, predictable expenses such as programme related expenses, salaries and occupancy, but excludes depreciation, in-kind, and other non-cash expenses. Four months of budgeted operating costs equates to £270,696.

The amount of the Operating Reserve Fund will be calculated each year after approval of the annual budget, reported to the Board of Trustees, and included in the regular financial reports.

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RAMALLAH, PALESTINE
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GOVERNANCE AND MANAGEMENT

GOVERNING DOCUMENT

ORGANISATION

The charity is controlled by its governing document (the Constitution dated 9 June 2015) and is registered as a charitable incorporated organisation. The Constitution was amended on 2 July 2021 to protect the role of our CoFounders, David and Elly Nott, in determining the strategic direction of the charity despite not being Trustees or management themselves.

The Board of Trustees, which must have at least three members, administers the charity. The board normally meets at least quarterly but also informally on a very regular basis.

VOLUNTEERS

We are immensely grateful to volunteers who undertake challenge events and fundraising activities to support our work. Our Friends of the David Nott Foundation student societies and Trainees of the David Nott Foundation group are a vibrant community who conduct activities such as bake sales, quizzes and online workshops. We estimate an cumulative total of their efforts being 30 hours for the financial year. Bis Culley has for eight years volunteered her time to commission beautiful DNF Christmas cards, promote their sale, and post to supporters. We are immeasurably grateful for her efforts.

RECRUITMENT AND APPOINTMENT OF NEW TRUSTEES

Appointments to the Foundation are made following an appraisal of current needs, in terms of expertise, by the Board in conjunction with the Co-Founders.

REMUNERATION POLICY

All trustees give of their time freely and in a voluntary capacity and no trustee received remuneration in the year. Details of trustees’ expenses and related party transactions are disclosed in notes 15 and 25 respectively to the accounts. Compensation levels for all Foundation employees all is reviewed annually and normally increased in accordance with average earnings. The trustees also endeavour to benchmark roles against pay levels in other similar organisations.

RISK MANAGEMENT

The trustees have a risk management strategy which comprises:

An annual review of the principal risks and uncertainties that the charity faces.

The establishment of policies, systems, and procedures to mitigate those risks identified in the annual review.

TRUSTEE INDUCTION AND TRAINING

New trustees undergo an orientation period to brief them on their legal obligations under charity law, the Charity Commission guidance on public benefit, and inform them of the content of the Constitution, the committee and decisionmaking processes, the business plan and recent financial performance of the charity. During the induction period they meet key employees and other trustees. Trustees are encouraged to attend appropriate external training events where these will facilitate the undertaking of their role.

The implementation of procedures designed to minimise or manage any potential impact on the charity should those risks materialise.

This work has identified that overseas work and travel to conflict and disaster areas is an area of major risk. Key mitigants to these risks are security assessments, security procedures, security training and insurance.

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LEGAL AND ADMINISTRATIVE DETAILS

REGISTERED CHARITY NAME

CHIEF EXECUTIVE

The David Nott Foundation

Mrs Eleanor Nott

CHARITY REGISTRATION NUMBER

AUDITORS

Shipleys LLP Chartered Accountants & Statutory Auditor 10 Orange Street, Haymarket London WC2H 7DQ

1162537

PRINCIPAL OFFICE

1 Lyric Square Hammersmith London W6 0NB

BANKERS

The Co-operative Bank Business Direct PO Box 250 Skelmersdale WN8 6WT

TRUSTEES

Mr G J Hodgkin Ms C Hughes Mr R R Hoare Mr S J Armitage Ms K E L Kingstone

INVESTMENT MANAGERS

CCLA Investment Management Limited Senator House 85 Queen Victoria Street London EC4V 4ET

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TRAINING IN DJIBOUTI
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TRUSTEES’ RESPONSIBILITIES STATEMENT

THE TRUSTEES ARE RESPONSIBLE

FOR PREPARING THE TRUSTEES’ ANNUAL REPORT AND THE FINANCIAL STATEMENTS IN ACCORDANCE WITH APPLICABLE LAW AND UNITED KINGDOM ACCOUNTING STANDARDS INCLUDING FINANCIAL REPORTING STANDARD 102: THE FINANCIAL REPORTING STANDARD APPLICABLE IN THE UK AND REPUBLIC OF IRELAND (UNITED KINGDOM GENERALLY ACCEPTED ACCOUNTING PRACTICE).

The law applicable to charities in England and Wales requires the trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charity and the income and expenditure of the charity for that period.

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

select suitable accounting policies and then apply them consistently;

observe the methods and principles in the Charities SORP;

make judgments and accounting estimates that are reasonable and prudent;

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

prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charity will continue in business.

The trustees are responsible for maintaining proper accounting records which disclose with reasonable accuracy at any time the financial position of the charity and enable them to ensure that the financial statements comply with the Charities Act 2011, the Charity (Accounts and Reports) Regulations 2008 and the provisions of the trust deed/constitution. They are also responsible for safeguarding the assets of the charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

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

The trustees’ annual report was approved on 11 December 2023 and signed on behalf of the trustees by:

MS C HUGHES

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TRUSTEE
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INDEPENDENT AUDITOR’S REPORT TO THE TRUSTEES

YEAR ENDED 31 MARCH 2023

OPINION

BASIS FOR OPINION

We have audited the financial statements of The David Nott Foundation (‘the charity’) for the year ended 31 March 2023 which comprise the Statement of Financial Activities, the Balance Sheet, the Statement of Cash Flows and the related notes, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including The Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (United Kingdom Generally Accepted Accounting Practice).

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the charity in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

In our opinion the financial statements:

give a true and fair view of the state of the charity’s affairs as at 31 March 2023 and of its incoming resources and application of resources for the year then ended;

CONCLUSIONS RELATING TO GOING CONCERN

In auditing the financial statements, we have concluded that the trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate.

have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and

have been prepared in accordance with the Charities Act 2011.

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 David Nott Foundation’s ability to continue as a going concern for a period of at least 12 months from when the financial statements are authorised for issue.

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

OTHER INFORMATION

The other information comprises the information included in the annual report, other than the financial statements and our auditor’s report thereon. The trustees are responsible for the other information. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon.

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 such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in 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 in this regard.

MATTERS ON WHICH WE ARE

REQUIRED TO REPORT BY EXCEPTION

We have nothing to report in respect of the following matters in relation to which the Charities (Accounts and Reports) Regulations 2008 require us to report to you if, in our opinion:

the information given in the trustees’ report is inconsistent in any material respect with the financial statements; or

sufficient accounting records have not been kept; or

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

we have not received all the information and explanations we require for our audit.

OTHER MATTERS

The charity did not require an audit in the prior year and therefore the corresponding figures have not been audited.

RESPONSIBILITIES OF TRUSTEES

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

In preparing the financial statements, the trustees are responsible for assessing the charity’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 charity or to cease operations, or have no realistic alternative but to do so.

AUDITOR’S RESPONSIBILITIES FOR THE AUDIT OF THE FINANCIAL STATEMENTS

We have been appointed as auditor under section 144 of the Charities Act 2011 and report in accordance with the Act and relevant regulations made or having effect thereunder.

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

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

We obtained an understanding of the charity’s activities, controls and laws and regulations and assessed the susceptibility of the charity’s financial statements to material misstatement from irregularities, including fraud.

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We determined that the laws and regulations that are most significant to the charity are the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102), the Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (Charities SORP (FRS 102)), the Charities Act 2011 and the charity’s governing document.

Conclude on the appropriateness of the trustees’ use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the charitable company’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclosures in the financial statements or, if such disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the charitable company to cease to continue as a going concern.

Based on this understanding we designed our the date of our auditor’s report. However, future audit procedures to detecting irregularities, events or conditions may cause the charitable including fraud. Testing undertaken included company to cease to continue as a going concern. making enquiries on the management and those charged with governance; journal entry Evaluate the overall presentation, structure and testing; review of bank letters, investments content of the financial statements, including the reports, trustee board minutes and the disclosures, and whether the financial statements governing document; review of transactions represent the underlying transactions and events for any undisclosed related party transactions; in a manner that achieves fair presentation. reviewing financial statement disclosures and testing to supporting documentation to We communicate with those charged with assess compliance with applicable laws and governance regarding, among other matters, the regulations. These procedures were designed to planned scope and timing of the audit and significant provide reasonable assurance that the financial audit findings, including any significant deficiencies statements were free from fraud or error.

We communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit.

As part of an audit in accordance with ISAs (UK), we exercise professional judgment and maintain professional scepticism throughout the audit. We also:

USE OF OUR REPORT

This report is made solely to the charity’s trustees, as a body, in accordance with section 144 of the Charities Act 2011 and regulations made under section 154 of that Act. Our audit work has been undertaken so that we might state to the charity’s trustees those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charity and the charity’s trustees as a body, for our audit work, for this report, or for the opinions we have formed.

Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control.

Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the internal control.

TIM HARDY

13 December 2023

For and on behalf of Shipleys LLP Chartered Accountants & Statutory Auditor 10 Orange Street Haymarket London WC2H 7DQ

Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the trustees.

STATEMENT OF FINANCIAL ACTIVITIES

FOR THE YEAR ENDED 31 MARCH 2023

2023 2022
Unrestricted Restricted
funds funds Total funds Total funds
Notes £ £ £ £
Income and endowments
Donations and legacies 5 1,112,538 131,098 1,243,636 998,822
Income from charitable activities 6 136,755 - 136,755 -
Investment income 7 11,340 - 11,340 172
Total income 1,260,633 131,098 1,391,731 998,994
Expenditure on:
Raising funds 8 (64,933) - (64,933) (52,988)
Charitable activities 9 (1,407,209) (140,096) (1,547,305) (600,892)
Total expenditure (1,472,142) (140,096) (1,612,238) (653,880)
Net (expenditure)/income before
net (losses)/gains on investments (211,509) (8,998) (220,507) 345,114
Net (losses)/gains on investments 13 (6,925) - (6,925) 81,026
Net (expenditure )/income and
net movement in funds (218,434) (8,998) (227,432) 426,140
Reconciliation of funds
Total funds brought forward 2,371,863 90,875 2,462,738 2,036,598
Total funds carried forward 2,153,429 81,877 2,235,306 2,462,738

The notes on pages 26 to 47 form part of these financial statements

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BALANCE SHEET

FOR THE YEAR ENDED 31 MARCH 2023

2023 2022
Notes £ £ £ £
Fixed assets
Tangible fxed assets 17 229,251 192,368
Investments 18 769,478 776,403
998,729 968,771
Current assets
Debtors 19 138,069 83,126
Cash at bank and in hand 1,192,287 1,477,640
1,330,356 1,560,766
Creditors: amounts falling
due within one year 20 (93,779) (66,799)
Net current assets 1,236,577 1,493,967
Total assets less current liabilities 2,235,306 2,462,738
Net assets 2,235,306 2,462,738
Funds of the charity
Unrestricted funds 23 2,153,429 2,371,863
Restricted funds 24 81,877 90,875
Total charity funds 2,235,306 2,462,738

These financial statements were approved by the board of trustees on 11 December 2023 and are signed on behalf of the board by:

STATEMENT OF CASH FLOWS

FOR THE YEAR ENDED 31 MARCH 2023

2023 2022
Notes £ £
Cash fows from operating activities
Net income (227,432) 426,140
Adjustments for:
Depreciation of tangible fxed assets 61,633 53,966
Loss on disposal of fxed assets 7,865 -
Net gains on investments 6,925 (81,026)
Dividends and interest from investments (11,340) (172)
Changes in:
Trade and other debtors (54,943) (72,445)
Trade and other creditors 26,980 47,554
Cash generated from operations (190,312) 374,017
Net cash from operating activities (190,312) 374,017
Cash fows from investing activities
Dividends and interest from investments 11,340 172
Purchase of tangible assets (106,381) (53,838)
Net cash used in investing activities (95,041) (53,666)
Net increase in cash and cash equivalents 28 (285,353) 320,351
Cash and cash equivalents at beginning of year 1,477,640 1,157,289
Cash and cash equivalents at end of year 1,192,287 1,477,640

MS C HUGHES

TRUSTEE

The notes on pages 26 to 47 form part of these financial statements

The notes on pages 26 to 47 form part of these financial statements

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

1. General information

The David Nott Foundation meets the definition of a public benefit entity under FRS 102.

The charity is a Charitable Incorporation Organisation, registered in England and Wales. The address of the principal office is 1 Lyric Square, Hammersmith, London, W6 ONB. The objectives of the charity are set out on page 8.

The functional currency of the charity is considered to be pounds sterling because that is the currency of the primary economic environment in which the charity operates. The financial statements are also presented in pounds sterling.

The amounts in the financial statements are prepared to the nearest £, unless otherwise stated.

2. Statement of compliance

These financial statements have been prepared in compliance with FRS 102, ‘The Financial Reporting Standard applicable in the UK and the Republic of Ireland’, the Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (Charities SORP (FRS 102)) and the Charities Act 2011.

GOING CONCERN

The financial statements of the charity have been prepared on the going concern basis.

The charity’s overseas programme has expanded with seven HEST missions and three other courses successfully undertaken in the year including a ‘Train the Trainers’, further demonstrating our commitment to localisation. We are building relationships with partners including Action for Humanity, MedGlobal, MSF, UOSSM and the World Health Organisation, to part / fully fund our work or facilitate operational matters whilst overseas. The core team and DNF faculty have been expanded during the period to provide sufficient capacity. We have also built focus on outreach activities to strengthen and deepen our networks for the purpose of serving communities in need worldwide. The charity has sufficient funding and reserves in place to resource all anticipated programmes in the foreseeable future.

The financial statements have been prepared to give a ‘true and fair’ view and have departed from the Charities (Accounts and Reports) Regulations 2008 only to the extent required to provide a ‘true and fair view’. This departure has involved following 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) issued on 16 July 2014 rather than the Accounting and Reporting by Charities: Statement of Recommended Practice effective from 1 April 2005 which has since been withdrawn.

There are no material uncertainties about the charity’s ability to continue as a going concern.

3. Accounting policies

BASIS OF PREPARATION

FUND ACCOUNTING

The financial statements have been prepared on the historical cost basis, as modified by the revaluation of certain financial assets and liabilities measured at fair value through income or expenditure.

Unrestricted funds are available for use at the discretion of the trustees to further any of the charity’s purposes.

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

EXPENDITURE

Restricted funds are funds that can only be used for particular restricted purposes within the objects of the charity. They are subjected to restrictions on their expenditure declared by the donor or through the terms of an appeal.

Liabilities are recognised as expenditure as soon as there is a legal or constructive obligation committing the charity to that expenditure, it is probable that a transfer of economic benefits will be required in settlement and the amount of the obligation can be measured reliably. Expenditure is recognised on an accruals basis and is classified under headings of the statement of financial activities to which it relates:

INCOME

All income is included in the statement of financial activities when entitlement has passed to the charity; it is probable that the economic benefits associated with the transaction will flow to the charity and the amount can be reliably measured.

Expenditure on raising funds includes the costs of all fundraising activities, events and non-charitable trading activities.

Income from donations or grants is recognised when there is evidence of entitlement to the gift, receipt is probable and its amount can be measured reliably.

Expenditure on charitable activities includes all costs incurred by a charity in undertaking activities that further its charitable aims for the benefit of its beneficiaries, including those support costs and costs relating to the governance of the charity apportioned to charitable activities.

Donated professional services and donated facilities are recognised as income when the charity has control over the item, any conditions associated with the donated item have been met, the receipt of economic benefit from the use by the charity of the item is probable and that economic benefit can be measured reliably. On receipt, donated professional services and donated facilities are recognised on the basis of the value of the gift to the charity which is the amount the charity would have been willing to pay to obtain services or facilities of equivalent economic benefit on the open market; a corresponding amount is then recognised in expenditure in the period of receipt. In accordance with the Charities SORP (FRS 102), the contribution of volunteers is not recognised in the accounts.

All costs are allocated to expenditure categories reflecting the use of the resource. Direct costs attributable to a single activity are allocated directly to that activity.

Support costs are those functions that assist the work of the charity but do not directly undertake charitable activities. Support costs include staff, premises, finance and governance costs. These costs have been allocated between expenditure on raising funds and expenditure on charitable activities on the basis of an estimate of the proportion of time spent by staff on those activities.

Income from charitable activities relates to course fees and is recognised when the course takes place.

Governance costs comprise all costs involving the public accountability of the charity and its compliance with regulation and good practice.

Interest on funds held on deposits is included when receivable and the amount can be reliably measured by the charity. This is normally upon notification of the interest paid or payable by the bank.

Irrecoverable VAT is charged as a cost against the activity for which the expenditure was incurred.

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

INVESTMENTS

Grants payable are payments made to third parties in the furtherance of the charitable objects of the charity. In the case of an unconditional grant offer this is accrued once the recipient has been notified of the grant award. The notification gives the recipient a reasonable expectation that they will receive the grant. Grants awarded that are subject to the recipient fulfilling performance conditions are only accrued when the recipient has been notified of the grant and any remaining unfulfilled condition attaching to the grant is outside of the control of the charity. Provisions for grants are made when the intention to make a grant has been communicated to the recipient but there is uncertainty as to the timing of the grant or the amount of grant payable.

Investments are a form of basic financial instrument and are initially recognised at their transaction value and subsequently measured at their fair value as at the balance sheet date using the closing quoted market price.

All gains and losses are taken to the statement of financial activities as they arise. Realised gains and losses on investments are calculated as the difference between sales proceeds and their opening carrying value or their purchase value if acquired subsequent to the first day of the financial year. Unrealised gains and losses are calculated as the difference between the fair value at the year-end and their carrying value. Realised and unrealised investment gains and losses are combined in the Statement of Financial Activities.

TANGIBLE ASSETS

Tangible assets are initially recorded at cost, and subsequently stated at cost less any accumulated depreciation and impairment losses.

FINANCIAL INSTRUMENTS

The charity only has financial assets and financial liabilities of a kind that qualify as basic financial instruments. Basic financial instruments are initially recognised at transaction value and subsequently measured at their settlement value unless otherwise stated in the accounting policies.

DEPRECIATION

Depreciation is calculated so as to write off the cost of an asset, less its residual value, over the useful economic life of that asset as follows:

DEBTORS

Teaching equipment – 25% reducing balance Computer equipment – 25% reducing balance Office equipment – 25% reducing balance

Trade and other debtors are recognised at the settlement amount due after any trade discounts offered. Prepayments are valued at the amount prepaid net of any trade discounts due.

CASH AT BANK AND IN HAND

Cash at bank and cash in hand includes cash and short term highly liquid investments with a short maturity of three months or less from the date of acquisition or opening of the deposit or similar account.

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

CREDITORS AND PROVISION

DEFINED CONTRIBUTION PLANS

Contributions to defined contribution plans are recognised as an expense in the period in which the related service is provided. Differences between contributions payable in the year and the contributions actually paid are shown either in accruals or prepayments on the balance sheet.

Creditors and provision are recognised where the charity has a present obligation resulting in the transfer of funds to a third party and the amount due to settle the obligation can be measured or estimated reliably. Creditors and provisions are normally recognised at their settlement amount after allowing for any trade discounts due.

JUDGEMENTS AND ESTIMATES

OPERATING LEASE COMMITMENTS

There are no judgements or key sources of estimation uncertainty that would have a significant effect on the carrying amounts of assets and liabilities recognised in the financial statements.

Rentals paid under operating leases are charged to the Statement of Financial Activities on a straight line basis over the term of the lease.

4. Taxation

The charity is exempt from tax on income and gains to the extent that these are applied to its charitable objectives.

5. Donations and legacies

Unrestricted Restricted Total Funds
Funds Funds 2023
£ £ £
Donations 1,112,538 131,098 1,243,636
Unrestricted Restricted Total Funds
Funds Funds 2022
£ £ £
Donations 983,460 15,362 998,822

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

6. Income from charitable activities

Unrestricted Total Funds Unrestricted Total Funds
Funds 2023 Funds 2022
£ £ £ £
Course fees 136,755 136,755 - -
7. Investment income
Unrestricted Total Funds Unrestricted Total Funds
Funds 2023 Funds 2022
£ £ £ £
Deposit account interest 11,340 11,340 172 172
8. Costs of raising donations and legacies
Unrestricted Total Funds Unrestricted Total Funds
Funds 2023 Funds 2022
£ £ £ £
Cost of raising funds 45,683 45,683 41,194 41,194
Support costs 19,250 19,250 11,794 11,794
64,933 64,933 52,988 52,988

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

9. Expenditure on charitable activities

Unrestricted Restricted Total Funds
Funds Funds 2023
£ £ £
Hostile Environment Surgical Training (HEST) 1,127,869 140,096 1,267,965
Other training projects 279,340 - 279,340
1,407,209 140,096 1,547,305
Restricted Total Funds
Unrestricted Funds Funds 2022
£ £ £
Hostile Environment Surgical Training (HEST) 331,190 53,918 385,108
Surgical Training for Austere Environments (STAE) 71,097 10,367 81,464
Other training projects 118,958 15,362 134,320
521,245 79,647 600,892

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

Analysis of expenditure on charitable activities

Grant funding Support Total funds
of activities Direct costs costs 2023
£ £ £ £
Hostile Environment Surgical Training (HEST) - 1,145,400 122,565 1,267,965
Other training projects 15,620 199,288 64,432 279,340
15,620 1,344,688 186,997 1,547,305
Grant funding Support Total Funds
of activities Direct costs costs 2022
£ £ £ £
Hostile Environment Surgical Training (HEST) - 344,034 41,074 385,108
Surgical Training for Austere Environments (STAE) 28,896 39,351 13,217 81,464
Other training projects - 100,769 33,551 134,320
28,896 484,154 87,842 600,892

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

10. Analysis of support costs

10. Analysis of support costs
Other
Fundraising HEST STAE projects Total 2023
£ £ £ £ £
Premises costs 6,941 44,194 - 23,232 74,367
IT costs 663 4,223 - 2,220 7,106
Insurance 1,475 9,393 - 4,938 15,806
Depreciation 423 2,696 - 1,418 4,537
Bank charges 141 899 - 472 1,512
Governance costs 9,607 61,160 - 32,152 102,919
19,250 122,565 - 64,432 206,247

Support costs are allocated to the activities of the charity based on the estimated time spent on those activities by the charity’s employees.

Other
Fundraising HEST STAE projects Total 2022
£ £ £ £ £
Premises costs 3,954 13,772 4,431 11,249 33,406
IT costs 560 1,949 627 1,592 4,728
Insurance 1,552 5,405 1,739 4,415 13,111
Depreciation 167 583 188 476 1,414
Bank charges 39 135 44 111 329
Governance costs 5,522 19,230 6,188 15,708 46,648
11,794 41,074 13,217 33,551 99,636

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

11. Governance

11. Governance
Unrestricted Total Funds Unrestricted Total Funds
Funds 2023 Funds 2022
£ £ £ £
Accountancy 6,250 6,250 6,164 6,164
Audit 8,340 8,340 - -
Independent examination - - 3,300 3,300
Staf costs 67,267 67,267 34,022 34,022
Legal and professional fees 21,062 21,062 3,162 3,162
102,919 102,919 46,648 46,648
12. Analysis of grants
2023 2022
£ £
Scholarships 15,620 28,896
Total grants 15,620 28,896

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

13. Net (losses)/gains on investments

Unrestricted Total Funds Unrestricted Total Funds
Funds 2023 Funds 2022
£ £ £ £
Gains/(losses) on listed investments (6,925) (6,925) 81,026 81,026

14. Net income

Net income is stated after charging/(crediting):

Net income is stated after charging/(crediting):
2023 2022
£ £
Auditor’s fee:
– audit fee 8,340 -
– independent examination - 3,300
– accountancy 3,736 3,584
– corporation tax 1,170 1,140
– payroll 1,344 1,440
Depreciation of tangible fxed assets 61,633 53,966
Operating lease expense – land and building 63,245 22,801

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

15. Staff costs

The total staff costs and employee benefits for the reporting period are analysed as follows:

2023 2022
£ £
Wages and salaries 229,129 133,090
Social security costs 16,916 10,175
Employer contributions to pension plans 4,835 2,759
Other employee benefts - -
250,880 146,024

Pension costs are allocated to activities on the basis of time spent by each employee and are wholly allocated to unrestricted funds.

The average head count of employees during the year was 5 (2022: 3). The average number of full-time equivalent employees during the year is analysed as follows:

2023 2022
No. No.
Charitable activities 4.3 2.3
Fundraising 0.5 0.3
4.8 2.6

No employee received employee benefits of more than £60,000 during the year (2022: none). Pension contributions of £nil (2022: £nil) were paid on behalf of higher paid employees during the year. The number of higher paid employees accruing benefits under defined contribution pension schemes were nil (2022: nil).

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

16. Trustee remuneration and expenses

The trustees have not received any remuneration during the year (2022: £nil). No out of pocket expenses were reimbursed to trustees during the year (2022: £nil). No charity trustee received payment for professional or other services supplied to the charity (2022: £nil).

17. Tangible fixed assets

17. Tangible fxed assets
Teaching Computer Ofce
equipment equipment equipment Total
£ £ £ £
Cost
At 1 April 2022 464,526 14,658 1,810 480,994
Additions 93,401 12,566 414 106,381
Disposals (8,809) - - (8,809)
At 31 March 2023 549,118 27,224 2,224 578,566
Depreciation
At 1 April 2022 280,898 7,323 405 288,626
Charge for the year 57,096 4,100 437 61,633
Depreciation on disposals (944) - - (944)
At 31 March 2023 337,050 11,423 842 349,315
Carrying amount
At 31 March 2023 212,068 15,801 1,382 229,251
At 31 March 2022 183,628 7,335 1,405 192,368

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

18. Investments

2023 2022

18. Investments 2023 2022
£ £
Fair value
At 1 April 2022 776,403 695,377
Net (loss) / gain on revaluation (6,925) 81,026
At 31 March 2023 769,478 776,403
Historical cost 570,000 570,000
Analysis of investments at 31 March 2023:
UK listed investments 769,478 776,403

All investments are carried at their fair value. Holdings in investment funds, unit trusts and open-ended investment companies are at the bid price. Asset sales and purchases are recognised at the date of trade at cost (that is their transaction value).

The following investments were material in the context of the investment portfolio:

COIF Charities Investment Fund – £769,478 (2022: £776,403).

The main form of financial risk faced by the charity is the volatility in investment markets due to wider economic conditions and variability of investment returns. This risk is mitigated by obtaining advice from a financial expert on the charity’s investment portfolio.

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

19. Debtors

2023

2022

19. Debtors 2023 2022
£ £
Trade debtors 14,881 11,277
Prepayments and accrued income 113,388 65,657
Other debtors 9,800 6,192
138,069 83,126

20. Creditors: amounts falling due within one year

2023 2022
£ £
Trade creditors 66,387 21,052
Accruals and deferred income 12,302 40,540
Social security and other taxes 9,729 4,486
Other creditors 5,361 721
93,779 66,799

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

21. Deferred income

21. Deferred income
2023 2022
£ £
Balance at 1 April 2022 – 10,280
Amount released to income – (10,280)
Amount deferred in the year – –
Balance at 31 March 2023 – –

Deferred income comprises income received in advance in respect of training courses and fundraising events.

22. Pensions and other post retirement benefits

DEFINED CONTRIBUTION PLANS

The amount recognised in income or expenditure as an expense in relation to defined contribution plans was £4,835 (2022: £2,759).

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

23. Unrestricted funds

Gains and At 31 March
At 1 April 2022 Income Expenditure losses 2023
£ £ £ £ £
General funds 2,165,460 1,260,633 (1,472,142) - 1,953,951
Unrealised gain
on investment 206,403 – – (6,925) 199,478
2,371,863 1,260,633 (1,472,142) (6,925) 2,153,429
At 1 April 2021 Income Expenditure Gains and losses At 31 March 2022
£ £ £ £ £
General funds 1,756,061 983,632 (574,233) - 2,165,460
Unrealised gain
on investment 125,377 – – 81,026 206,403
1,881,438 983,632 (574,233) 81,026 2,371,863

The unrealised gain on investment is the difference between the historical cost of the investment and the fair value recognised in these financial statements.

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43

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

24. Restricted funds

At 1 April 2022 Income Expenditure Gains and losses At 31 March 2023
£ £ £ £ £
Simulator 86,753 – (21,688) – 65,065
Digital project 4,122 – – – 4,122
Ukraine – 116,408 (116,408) – –
Obstetrics training – 2,000 (2,000) – –
UK HEST – 5,000 – – 5,000
Syria-Turkey
Earthquake – 7,690 – – 7,690
90,875 131,098 (140,096) – 81,877
At 1 April 2021 Income Expenditure Gains and losses At 31 March 2022
£ £ £ £ £
Simulator 115,671 – (28,918) – 86,753
Digital project 4,122 – – – 4,122
Surgeons in Syria 25,000 – (25,000) – –
Manikins 10,367 – (10,367) – –
Ukraine – 15,362 (15,362) – –
155,160 15,362 (79,647) – 90,875

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

Restricted funds can only be used for particular restricted purposes within the objects of the charity as specified by the donor or when funds are raised for particular restricted purposes:

Simulator – Open Society Institute grant for teaching materials for war surgery training.

Digital project – Vodafone Foundation grant to support the costs used for the development and ongoing support of the charity’s learning platform for sharing videos and information related to the work of the charity.

Ukraine – Funds donated by a number of organisations and individuals to support work by the Foundation to train Ukrainian surgeons.

Obstetrics training – Funds donated to support Obstetrics training in war and disaster zones.

UK HEST – Funds donated to support a UK based HEST programme. This is planned for Q3 23/24.

Syria-Turkey Earthquake – Funds donated by a number of organisations and individuals to support work by the Foundation to train Syrian and Turkish surgeons in the recent earthquake zone.

Surgeons in Syria – CHK Foundation grant to support surgeons who are working in Syria to attend the specialist training course in the UK, or to attend a locally delivered HEST course.

Manikins – Festival Medical Services grant for the purchase of single use manikins.

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

25. Analysis of net assets between funds

Unrestricted Funds Restricted Funds Restricted Funds Total Funds 2023
£ £ £
Tangible fxed assets 164,186 65,065 229,251
Investments 769,478 - 769,478
Current assets 1,313,544 16,812 1,330,356
Creditors less than 1 year (93,779) - (93,779)
Net assets 2,153,429 81,877 2,225,306
Unrestricted Funds Restricted Funds Total Funds 2022
£ £ £
Tangible fxed assets 105,615 86,753 192,368
Investments 776,403 - 776,403
Current assets 1,556,644 4,122 1,560,766
Creditors less than 1 year (66,799) - (66,799)
Net assets 2,371,863 90,875 2,462,738

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

26. Related Party Transactions

The key management personnel of the charity comprise the trustees, the chief executive, the operations director, the head of communications & engagement and the head of supporter & donor relations. The total employee benefits of the key management personnel of the charity was £123,217 (2022: £96,257).

There were no other related party transactions for the years ended 31 March 2023 or 31 March 2022.

27. Commitments under operating leases

At 31 March 2023, the charity had total minimum lease payments under non-cancellable operating leases as set out below:

Land and buildings

2023 2022
Operating leases which expire £ £
Within 1 year 11,760 –

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NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

28. Analysis of changes in net debt

At 1 April 2022 Cash fows At 31 March 2023
£ £ £
Net cash
Cash at bank and in hand 1,477,640 (285,353) 1,192,287
At 1 April 2021 Cash fows At 31 March 2022
£ £ £
Net cash
Cash at bank and in hand 1,157,289 320,351 1,477,640

NOTES TO THE FINANCIAL STATEMENTS

FOR THE YEAR ENDED 31 MARCH 2023

29. Comparatives for the Statement of Financial Activities

Unrestricted Restricted
Funds Funds Total Funds 2022
£ £ £
Income and endowments
Donations and legacies 983,460 15,362 998,822
Investment income 172 – 172
Total income 983,632 15,362 998,994
Expenditure on:
Raising funds (52,988) – (52,988)
Charitable activities (521,245) (79,647) (600,892)
Total expenditure (574,233) (79,647) (653,880)
Net income / (expenditure) before net gains on investments 409,399 (64,285) 345,114
Net gains on investments 81,026 – 81,026
Net income / (expenditure) and net movement in funds 490,425 (64,285) 426,140
Reconciliation of funds
Total funds brought forward 1,881,438 155,160 2,036,598
Total funds carried forward 2,371,863 90,875 2,462,738

FOUNDATION