2024-03-31-accounts

BRAIN TUMOUR SUPPORT FINANCIAL STATEMENTS 31 MARCH 2024

Company Registration Number 09718307 Charity Number 1163856

FINANCIAL STATEMENTS YEAR ENDED 31 MARCH 2024

BRAIN TUMOUR SUPPORT

Contents	Pages
Reference & Administrative Information	1
Trustees’ Annual Report	2 to 31
Independent Examiner’s Report	32
Statement of Financial Activities	33
Balance Sheet	34
Notes to the Financial Statements	35 to 44

BRAIN TUMOUR SUPPORT

REFERENCE & ADMINISTRATIVE INFORMATION

YEAR ENDED 31 MARCH 2024

Registered charity name Brain Tumour Support Charity registration number 1163856 Company registration number 09718307

Registered and principal office The Clock Tower Old Weston Road Flax Bourton Bristol BS48 1UR

The Trustees

The Trustees (who are directors for the purpose of company law) who served during the year and since the year end were as follows:

Mr A Chater (resigned 1 October 2023) Mr K Wilson Ms E Brereton Ms S Lawless Mr S Bodley Mr JP Stuart Mrs Alison Woodhead (appointed 26 April 2024) Mr Sam Derricourt (appointed 26 April 2024) Mr Stephen Mayers (appointed 26 April 2024)

Independent Examiner

Joshua Kingston BSc ACA

Burton Sweet Limited, Chartered Accountants The Clock Tower 5 Farleigh Court Old Weston Road Flax Bourton Bristol BS48 1UR

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BRAIN TUMOUR SUPPORT

TRUSTEES’ REPORT

YEAR ENDED 31 MARCH 2024

INTRODUCTION

The Trustees are pleased to present their annual report together with the financial statements of the charity for the year ending 31 March 2024.

Brain Tumour Support is a registered charity, number 1163856.

Vision

Our vision is that no-one feels alone when facing the effects of a brain tumour diagnosis.

Objects and activities

The Objects of the charity are:

• The relief of illness of persons suffering from brain tumours by the provision of support, advice and information for such persons and to offer support, advice and information to their carers and families; and

• The promotion of research into the effects and causes of brain tumours and the public dissemination of the useful results thereof.

Strategic Goals

• UNDERSTAND the support needs within the brain tumour community

• RAISE AWARENESS of how Brain Tumour Support supports those affected by a brain tumour

• PROVIDE SUPPORT to patients and families affected by any type of brain tumour

Values

• Be INCLUSIVE – Together we are stronger, all embracing and available to anyone.

• Be SUPPORTIVE – Together we are caring and always ready to come alongside to encourage and empower.

• Be COMPASSIONATE – Together we are gentle and warm-hearted with a listening ear, yet incredibly resilient.

• Be PROFESSIONAL – Together we are consistently reviewing and re-evaluating our services, so that they are personalised, proficient and rich with experience.

• Be INNOVATIVE – Together we strive to bring new ideas to the way we approach all areas of our work and engage with our community.

Mission

To support patients, carers, friends and families by providing individualised and specialist information, guidance and emotional support, for as long as it is needed.

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TRUSTEES’ REPORT

YEAR ENDED 31 MARCH 2024

SUPPORT MATTERS - Together WE are stronger

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STRATEGIC REPORT

Turning challenges into success through learned experience and continuous improvement

The Trustees have referred to the Charity Commission’s general guidance on public benefit when reviewing the aims and objectives of the charity and in planning future activities. All activities therefore reflect the Trustees’ desire to follow the purposes of the charity and to meet the requirements of general public benefit.

The Trustees are pleased that the achievements and performance of Brain Tumour Support, as set out below, demonstrate continued progress against strategic priorities. Our work in the last financial year, where our goal was to continue the reshape and the rebuild, has been successful in so many ways. The trajectory towards thrivability however has been increasingly challenged amidst the current economic landscape. Whilst we can still see a stronger, financially sustainable future for Brain Tumour Support within our reach, we can also see areas which need to be courageously addressed before the desired growth and stability can start to unfold to its fullest extent. The Office for National Statistics revealed that the UK entered into a technical recession in December 2023 and following the cost of living crisis, which plagued us in the previous year, we remain determined to ride the storm in order to attain a position capable of sustained growth. There is no doubt that we are frustrated at the overall results this year, feeling that we are at the cusp of what we know we can achieve.

This report sets out to explain why our financial resilience has been weakened, how our repeat performance in our final fundraising figures is astoundingly remarkable in the current climate and how we have achieved a huge shift in successful outcomes in our support service development and delivery.

Clearly, there will be ongoing challenges which have resulted from the recession and the cost of living crisis as well as the overall uncertainty of the economic climate. However, our careful planning in the year ahead underpins the financial health of Brain Tumour Support using our knowledge in the lessons learned and insights gained. The celebration of the 20[th] Anniversary of the charity continued into this financial year marking the outstanding support created and delivered across the UK for two decades. The longevity of this achievement is paramount and embodies all of the work we do. It gives us a renewed determination to successfully complete and strengthen our work project priorities, which we highlighted as a prerequisite to cementing our commitment to investment in the foundations of the charity for sustainability and future growth. Significant developments have been made in this area including the research, development and installation of a new website and CRM and the launch of an Early Intervention Pilot support programme with our flagship hospital, Southmead, Bristol. In addition to these projects, investment in other areas of operations, fundraising and our support delivery over the two years has been a part of the investment in infrastructure and all of these projects have been delivered successfully during this financial year.

We have had a clear plan for the past 24 months; a clear view for the future and we firmly believe that there is so much opportunity ahead of us.

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30 Month Strategy (April 2022 – October 2024)

We have continued to work towards our three strategic aims which encompass the three key areas to help us to achieve our vision:-

• UNDERSTAND the support needs within the brain tumour community

• RAISE AWARENESS of how Brain Tumour Support supports those affected by a brain tumour

• PROVIDE SUPPORT to patients and families affected by any type of brain tumour

Underpinning these three strategic aims are our six goals and these drive our work forward and help to guide the planning in all areas of the charity to ensure that we are operationally making progress and enhancing our work priorities.

• Operational Excellence

We continue to make significant developments in all operational areas within the charity. Compliance remains a key feature which runs through all charity operations. During this past financial year, our framework for our support service governance has been developed into systems and flow charts. This includes support information being categorised and stored for easier retrieval by the support team and has helped to improve workflow and communication between the other teams. The Data Officer has carried out extensive work updating the database and we now have the ability to define and report on the service Key Performance Indicators. Health and safety remains a priority, with annual GDPR and safeguarding training.

The risk review register continues to be fully operational at a Senior Team and Board level and provides an overview for how we manage risk. Succession planning continues apace and three new trustees are onboarding as part of this exercise. The ongoing succession planning is key to how we make decisions about our charity structure going forward into 2025 with pivotal roles being backfilled in this next financial year.

• Our People

Our staff team continue to be the catalyst that engenders the positive change to service and operational excellence and therefore how we grow and develop them is paramount to the charity’s success. Wellbeing remains high on the agenda and is a key priority for Brain Tumour Support, as we understand that working with those impacted by a brain tumour is a role which demands resilience and a deep core understanding of people. Regularly checking in with staff is part of the charity’s ongoing performance management governance and wellbeing work. It enables senior management to support staff in their mental and physical health, ensuring that individuals feel a sense of inclusion and job satisfaction, continuing to offer flexible working where possible. Staff are regularly informed about future plans for the charity in line with the strategy and they are integral to the forward succession planning. Quarter four of this past financial year has been difficult for our team as we have all been part of navigating the path of uncertainty around funding for the financial year ahead and the decision making around the reduction in resources.

The benchmarking exercise will continue to remain fundamental to the future growth of the organisation and, whilst it is still on hold, it will be crucial to any structural development in the next five years. The online HR system has a personalised help line, which continues to inform decision making within a safe environment, and manage training and development for staff.

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• Our Reach

The charity’s 20[th] Anniversary year has spanned the last two financial years, and the role allocated to this has been successful in maximizing the fundraising around the anniversary, reconnecting with past supporters and engaging with new ones. The role has now been been consolidated into philanthropy and the on-going needs of the fundraising team.

The brain tumour community has continued to work together collaboratively and the charity’s reach into this space has been a really positive one. Our on-going collaborative work with the Tessa Jowell Brain Cancer Mission has been a significant inroad towards the joint work we are continuing to do with the Tessa Jowell Academy. Attendance at the Tessa Jowell five-year anniversary summit in May 2023 contributed to this continuing work and was an opportunity to further identify where the gaps in patient care and support lie. Brain Tumour Support contributed to the care boxes which were distributed to all the Tessa Jowell accredited paediatric Centres of Excellence in June 2024 and the continued reach to these hospitals is invaluable. Presenting at the annual BNOS (British Neuro Oncology Society) conference in July 2023, on breaking bad news to children, created other networking moments with members of the MDT (Multi Disciplinary Team). Whilst we were hoping to embark on nationwide campaigns to raise awareness of our work in this past financial year, it was decided that this would need to be put on hold until we have more resources and consolidated our marketing plan.

Our work with Novocure on the challenges in the patient pathway for glioblastoma patients across the UK using the Delphi Panel methodology has involved working with other charities and our patient database.

• Our Service Excellence

Our goal for service excellence is paramount to everything we accomplish in our delivery of support and it is two-fold. Firstly, to find out what support is needed from those we support to help to continue to shape our services appropriately. Secondly, to develop the skills and competence of the service staff - an essential part of any client-centered service. We ensure that our staff are of a high standard, and to this end, we have devised a competency and skills framework. As well as identifying what makes an ’excellent‘ Support Professional, it also formally encapsulates the training Support Professionals have had to date, and is now allowing us to identify further knowledge and skills which are essential as the service grows.

During this financial year, we have made individual supervision with an external supervisor and three monthly group supervision sessions mandatory, as well as monthly team reflective practice.

Our safeguarding policies and procedures are reviewed regularly and the role of our Support Co-ordinator this year has been to further develop the referral process and to ensure that the procedures align with our pioneering Early Intervention Pilot work which started at the beginning of the financial year. The success of this Pilot and associated work flows has lead to a greater focus on efficiency and given us a firm foundation upon which to continue this work and to fully integrate this support partnership into the clinical pathway. All of this foundational work is the basis for enabling us to apply for professional accreditation for our services in the future.

In the previous financial year, we developed the client-focused support model blueprint with its two ‘at a glance’ infographics, which continues to be well received. This financial year we have continued this service transformation to allow the best possible experience for those we support and also for our staff delivering the support. Our competency framework has been devised to focus on improving the underlying and often invisible operations that ensure that the service functions efficiently, as well as developing the skills, competencies and wellbeing of the team.

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• Our Impact

Evidence garnered in the previous financial year from client surveys, through our Support Professionals and the clinical teams has clearly indicated that families wished they had known about the support available to them sooner following their diagnosis. As we are constantly striving to ensure that our services represent and cater to the needs of the families we support, we recognised that we had to bring together the strength of our support development and delivery and our progress in the formation of a comprehensive data capture and evaluation framework.

The outcome of this has culminated in an unrivalled support offering for families this year as we have launched the Early Intervention Pilot project work in tandem with this framework. We were aware that if we were going to launch this important pilot project, it was imperative that our planned investment in this project had to include making our impact more visible.

We now have raw data to demonstrate the significant and positive impact of our work and we are able to take learnings to further develop our services and steer us for the future. We have updated our CRM system and data storage processes and developed procedures to enable us to capture quantitative data, enabling us to report on KPIs in a timely manner. To capture qualitative data, we have trained the Support Professionals to identify case studies and relevant client quotes, and have conversations with clients that elicit useful evidence of need, and the benefits and impact of the support they have received.

• Our Financial Stability

Succession planning for key roles across the organisation has continued apace this financial year and a succession planning and exit strategy proposal paper was submitted to the trustees at the July 2023 Board meeting for consideration and forward planning. In setting the budget in line with the charity’s strategy, decisions were made to invest in the foundations of the charity for sustainability and future growth. Whilst this financial year has been challenging, the new data capture framework, which is now fully operational, is allowing us to demonstrate the impact our work is having within the brain tumour community.

The significant investment in our systems is the foundation for a solid approach to apply for further multi-year funding. As an organisation there still remains a strong sense of strategic vision for the longer term, and we continue to consider trends, work efficiencies and priorities. We have tightened our fundraising strategy to focus on greater diversity in our income streams to consolidate future financial stability. The Board continues to be aware and to consider the potential impact of environmental factors which may affect operations and performance in the future.

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Why We Are Needed

Brain tumours can affect anyone regardless of age, sex, lifestyle or general health. With approximately 45 people every day in the UK receiving a diagnosis, and incidences of brain tumours increasing, support is needed more than ever.

Imagine being diagnosed with a brain tumour – the shock, the devastation and the horror. Then imagine being told that you will lose your driving licence, that you won’t be able to work, that treatment options are so poor for high grade tumours that a palliative pathway is your only option.

Then imagine losing your word finding abilities, your speech, your mobility, your sight or hearing, your relationships and your life as you knew it. A brain tumour diagnosis is never just one shock to deal with. It is a series of compounding knocks to your life.

There is still little awareness of the complex and life-changing impact that any grade of brain tumour can have, and poor understanding of the often longterm support needed for those affected, including their family and friends.

Through 20 plus years as a charity, the continuing developments in science and treatment and care have still not been able to soften the fear and shock of receiving this diagnosis.

Brain Tumour Support was founded to ensure that no one faces this journey alone.

This will always be our challenge. We therefore commit to a continued focus on our campaigning priorities as follows:-

1. Earlier awareness of and access to the support services which are available.

2. Equity across the clinical and support pathway for all brain tumour types and grades.

3. Recognition of equal need for support beyond the patient – non-medical support services for all those whose lives are impacted by a diagnosis are an essential part of the pathway and wrap-around care.

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ACHIEVEMENTS AND PERFORMANCE

THE DIFFERENCE WE MAKE through our support service

2023-24 was the first full year of the support model being launched across the service and during this year, there have been a number of significant developments. Most notable, amongst these, has been the formation of the new competency framework , and its implemention in tandem with the support model.

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1. Core knowledge and understanding of operating contexts – the background information that will help employees understand brain tumours, the clinical interventions they may experience, the impact of a brain tumour on their and other’s lives around them, and the interventions that may support their well-being.

2. Core values, attitudes and people skills – ethical principles for employees that pertain to attitudes, behaviours and decision-making; principally person-centred.

3. People and relating skills – the ability to develop rapport and build relationships with clients, volunteers, staff and external stakeholders.

4. Professional and governance skills – functional competencies - that relate specifically to the Support Professional role.

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1. Organisational and administration skills – functional competencies - that relate specifically to the Support Professional role.

2. Optional skills and competencies – additional qualities that are relevant and beneficial to a range of work environments but aren't directly required for employment in this role.

3. Operational, technical and leadership skills – organisational competencies - the skills that trustees, leaders, managers require in order to ensure competence/operational delivery.

This framework is fundamental to streamlining our delivery and striding towards excellence.

Our support model

Whilst our NHS provides excellent clinical care, they are unable to give the emotional and practical support that patients need to be able to face their brain tumour diagnosis, often leaving them scared and alone. There are so many unanswered questions as well as a significant reduction in choice and control for patients, and this is where our dedicated Support Professionals and Counsellors come to the fore.

Clients are able to self-refer to access our services, or be referred by a clinician, at any stage of their clinical pathway and are allocated a named Support Professional at the outset. We have received feedback from many people to say just how important this is to them. During their medical journey a patient can come into contact with a lot of health professionals, so to know that they can call their own Support Professional who is a consistent, friendly point of contact makes a world of difference.

The foundational work around the new person-centered support model was completed in the last financial year, identifying all the necessary key components which were required to produce a support model blue print. As a support lead organisation, we focus greatly on the most important factor for everything – our patients and families – and we strive for the highest standards. As a result of the feedback they have given us, we have continued to ensure that our services support them in the best way possible and is responsive to the needs of our community. This means tailoring our services to meet each person’s need at whatever stage they are in their brain tumour journey.

Based on what they told us, we have defined groups of need, categories that have helped us to design services and track performance of services against these needs.

Client needs are for:

1. expert advice, guidance and emotional support

2. deeper psychological support

3. support through connection and sharing with others

4. specialist information

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The model gives those impacted by a brain tumour, external professionals and Brain Tumour Support staff, a clear idea about what we offer, and a structure to the delivery of our services. It has also enabled us to define key KPIs and reporting for the service as a whole and to streamline the data gathering accordingly.

This unique model of support is bespokely delivered through:-

• One-to-one support – Serving needs 1, 3 and 4

The bulk of our work is one-to-one support and demand continues to rise, with an increase outside summer months. Support is delivered by telephone, email, text and video call. Here we have made several important improvements.

Having implemented a time and motion study to ascertain the optimal caseload per Support Professional, we are now able to monitor caseload numbers carefully to ensure that Support Professionals maintain health and wellbeing, and clients receive the attention they deserve. We also defined clients by their level of need i.e. high, medium and low. Once we have sufficient data this will be analysed to ascertain patterns (tumour type, time needed for support, type of support etc.) to inform our service improvements. In future, we aim to match this data against population and geographical demographics, health outcomes and incidence and prevalence data. We are also trialling new methods of measuring impact including collecting client reported outcomes data.

One-to-one support includes our welfare benefits service which offers expert advice and information. This service has been highly effective in gaining due benefits and financial support for clients, and an additional improvement is being able to attend tribunals with them when needed.

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• Face-to-face and online support groups – Serving needs 1, 3 and 4

We reinstated face-to-face support groups, keeping within Brain Tumour Support’s financial and staff capacity, to ensure wellbeing and effective safeguarding. We ran two groups per quarter, in, or within an hour from, neuro-oncology units in each of the five areas covered by our Support Professionals. However, the flexibility of the delivery model has enabled us to respond to unexpected opportunities in each geography. Owing to an excellent partnership work in Wales these ran once a month, and in the Midlands, an extra Brain Tumour Support group was cofacilitated with Clinical Nurse Specialists. All locations were chosen for accessibility, parking and public transport.

The online support groups, so popular during Covid-19 and excellent for reaching those who are time poor, disabled, live rurally or simply find in person groups difficult, continue to run and attendance remains consistent. Responding to feedback, we trialled new sessions such as:

• End of life

• Wellbeing

• Coffee and drop-in

• Fatigue and sleep

• Bereavement

• Anxiety

• Power of Attorney and funeral planning

We also continued the regular groups for:

• low grade tumours

• high grade tumours

• family and friends of high grade patients

• specific regions - Wales, Bristol and environs, Midlands, Dorset/ Hampshire and Cornwall/Devon

• young people

Operationally, to ensure good governance, safety and safeguarding, and to implement further improvements, we updated and implemented new events risk assessments and codes of conduct, new safeguarding and GDPR policy and procedures, new paper and digital feedback processes, buddying, booking and attendance procedures and checks, and specific KPIs.

• Counselling – Serving need 2

We employed a new specialist counsellor, thereby doubling our counselling provision, and increased the sessions from six to ten in cases where six is not quite enough for the particular psychological needs. This is a unique offer in today’s general counselling provision by third sector and statutory bodies. Clients can also come back into the service later, and always free of charge, if they need to, even after finishing their allotted sessions.

We have implemented an efficient waiting list system to manage increasing number of referrals, and trained and given guidance to the support team in identifying who is appropriate for counselling. We have also updated the counselling terms and conditions to include a ‘counselling contract’, which sets out our expectation of commitment from clients. This is effective in reducing the number of short-notice cancellations and non-attendance (for which we still pay and is therefore a loss to Brain Tumour Support and another client).

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• – Digital support Serving need 3

The Brain Tumour Support Forum and the Family and Friends Group on Facebook, as well as the charity presence through Instagram and Twitter pages, are important aspects of our online service. The Forum is particularly popular and the membership continues to grow. These monitored, peerto-peer services are open 24 hours a day, thus enabling people to find guidance, comfort and connection with others when offices are closed or unreachable. We now have a designated Social Media Support Professional, who updates the groups with new information as well as monitors them for unsafe practice, abuse and safeguarding issues, and is skilled at providing online support.

• Volunteering – Serving need 3

We remain proud of our Queen’s Award for Voluntary Services (now known as the King’s Award) and our award-winning volunteers remain an integral and essential part of the Brain Tumour Support family. We recognise that people who have received support from the charity often want to give something back, or are seeking activities which are meaningful in their lives. Our dedicated Volunteer Co-ordinator continues to ensure that best practice guidelines and the safety and wellbeing of all our volunteers is paramount. Having now developed and implemented these robust guidelines, the hours required for this role have reduced over the past financial year, whilst still ensuring that our regular and active volunteers follow the full training and induction programme and receive suitable support.

Brain Tumour Support relies heavily on those who kindly volunteer in all areas across the charity, and, equally, volunteers have a real sense of purpose and achievement through the work they do.

Support volunteer Wendy Hayeck talked about her role at the

Shropshire support group:

"I was delighted to get involved. It’s only two hours of my time every six weeks and it gets me out of the house. In 2020 I was diagnosed with an aggressive brain tumour. I had an awake craniotomy, radiotherapy and chemotherapy. I am now recovered from all the treatment, but still have regular MRI scans. Unfortunately, I developed epilepsy as a result of my tumour, and my memory is shocking!

"My volunteer role has many aspects, from meet and greet, helping people

to settle in and introducing them to others who are, or have been, treated for brain tumours, along with their lovely families who are also affected by the diagnosis. I help serve refreshments and talk to people who want to share their experiences - or chat about other things like pets, hobbies, work. I found out that one of the group lived down the road from me, so we’ve agreed to meet for a dog walk. It’s a really sociable group and I love being involved and helping in any way I can.”

Our Support Professional for Shropshire, Emily Hackworthy, explained what a difference volunteers like Wendy make:

“They are a huge asset to all Support Professionals. At groups they allow us to have that one-on-one time with people. If someone wants to discuss private matters, I can take time out with them, knowing everyone else will be in safe hands with wonderful volunteers like Wendy. I also see first hand, the peer-to-peer support that our volunteers can give. Often they have personal knowledge and understanding of going through a brain tumour journey themselves and that can be invaluable. Support volunteers make such a big difference to every person attending. The meetings really cannot run as smoothly without them.”

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• Website and leaflets providing information – Serving need 4

This service has undergone major improvements. We launched a new website in October 2023, with a fresh new, contemporary look and a significant increase in easily accessible resources for people affected by a brain tumour. The Support Professionals were specifically engaged to contribute, thereby sharing first-hand knowledge of client needs. To this end, a member of the support team has been designated as a website administrator, thus enabling quick information to flow between clients, Support Professionals and the site. A usability study was also conducted with clients, ensuring the site is fit for purpose.

The website also includes a direct link to the support line to facilitate access and entry into the support service, regular information on the support groups and an online booking system.

Brain Tumour Support also produces paper leaflets, which are included in information packs in hospitals. These have been digitised for the website, thereby ensuring the website is a one-stop shop for people affected by a brain tumour, including clinical professionals and external stakeholders.

of ACTIVITY & IMPACT:

19% increase in number of referrals

44% increase in counselling sessions

71 calls per month on average to our

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RESPONDING TO FAMILIES and what they need

Feedback from individuals and families has told us that accessing our support from an early point in the diagnosis has a significant impact for them. So, how has Brain Tumour Support responded to this?

Pioneering Early Intervention Pilot – North Bristol NHS Trust

Evidence has consistently shown us that support needs tend to be greater around the time of the diagnosis of a brain tumour and the requirement for emotional support and practical advice at this time can also place huge demands on front line clinical staff. Recognising the benefits of offering early support, a pilot project was proposed, whereby Brain Tumour Support would form part of the patient pathway at Southmead Hospital, Bristol, and patients would be referred to us at the point of diagnosis. This would allow early access to our support services and relieve pressure on the clinical team.

The Early Intervention Pilot ran from April to October 2023 and support was delivered by two dedicated Support Professionals. Patients were automatically referred to Brain Tumour Support (opt out was possible) at the point of their diagnosis. They were subsequently contacted by their allocated Support Professional, their support needs were assessed and they were able to access the required support services. Support was also open to family members, carers and friends.

The people referred

Over the course of the pilot, there were 115 direct referrals from the Southmead clinical team to Brain Tumour Support.

The Early Intervention Pilot delivered a 161% increase in referrals from the Southmead area compared to the previous six months.

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Evaluation of the Southmead Pilot

A survey was sent to all of those referred to Brain Tumour Support as part of the Southmead pilot, to assess the value of early access to support.

When asked what in particular was valued about the support delivered, there was a clear sense of the importance of knowing that emotional support and advice was there and easily accessible when needed, and the fact that it would continue to be available helped to make people feel less alone.

The caring nature of the support and the feeling that the Brain Tumour Support team really understand the impact of a diagnosis was also perceived as reassuring. Additionally there was acknowledgement of the value of shared experience through meeting other patients and families in the support groups, whether face-to-face or online.

In some instances, the patients themselves declined the early support, but instead it was taken up by a family member. Awareness that support was available for loved ones too, at any time, proved to be important.

Early access to our additional specialised services also proved beneficial. A brain tumour diagnosis presents financial pressures for patients and their families and often necessitates a reliance upon the welfare and benefits system, so the opportunity for referral to specialist welfare and benefit support is immensely valuable in alleviating financial pressures and associated emotional stresses from the outset. This applied also to the benefit felt from our specialist counselling services as seeing a counsellor helps to meet additional emotional needs of those impacted by a brain tumour diagnosis.

Over two thirds of individuals said that through this direct referral to Brain Tumour Support they had been able to get all the support they needed. Those whose needs could not be met by services offered by Brain Tumour Support sought support from other organisations such as hospices for “relaxation and therapy sessions” and “palliative care” (primarily services not currently offered by Brain Tumour Support), and also from friends and colleagues.

94% of the survey respondents did not know about Brain Tumour Support prior to being referred by the Southmead clinical team, thereby demonstrating the value of the automatic referral.

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Furthermore clinicians at Southmead Hospital reported a 50% decrease in the number of calls requesting emotional support during the pilot study, freeing up a significant proportion of their own clinical resource.

This pilot project demonstrated clearly that early referral to the support services offered by Brain Tumour Support not only proved beneficial to the patients and families, but also relieved pressure on the clinical team in the provision of emotional support.

In agreement with the clinical team at Southmead we are continuing our early intervention work, making the automatic referral to Brain Tumour Support a permanent part of the clinical pathway for newly diagnosed patients.

“I have worked with the Brain Tumour Support Team for over 15 years and have seen first hand the positive impact the charity has on patients and families going through some of the hardest times of their lives.

“Brain Tumour Support’s guiding principle is that no-one – patient or relative – should feel alone when dealing with the Mr Neil Barua effects of a brain tumour.

As a brain tumour surgeon it is a huge privilege to look after patients with this diagnosis, but I am very aware that patients may not confide all of their fears and concerns in me – this is where the charity’s role becomes so invaluable as Brain Tumour Support’s team is there to answer any questions, however big or small.

“Together the Neuro Oncology team at North Bristol NHS Trust and the charity developed a pilot which aimed to give patients access to Brain Tumour Support’s services at the earliest opportunity. By referring patients at the time of their first clinic appointment to the charity we hoped that patients and families would get the support they need from the very start of their journey.

“With the tireless hard work of Brain Tumour Support and North Bristol NHS Trust’s brain tumour nurse specialist team, the project was a huge success. Patients contacted the charity for emotional support, family guidance, counselling and financial advice. This project helped not only our patients – with 87% telling us that they felt less alone – but also the clinical team with a 50% reduction in calls to the nursing team for emotional support. The results were really astounding and confirm what I have known for many years – that the contribution that Brain Tumour Support can make to patients can never be underestimated.”

Testimonial from Mr Neil Barua – Consultant Neuro Surgeon, North Bristol NHS Trust

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- BUILDING SUPPORT TOGETHER Partnerships, awareness and collaboration

Brain Tumour Support has continued to work hard this year to effectively collaborate with other organisations.

We have also developed and strengthened our relationships with clinical teams nationally.

Our team of Support Professionals is planned so that they work closely with, and offer support to, the neuro-centres in their region. We feed back to these clinical teams so patients and their families can be reassured that there is continued learning and deeper understanding of their needs. We also receive feedback that helps us to continually improve our own service and keep it up to date.

We see collaborative working as essential to bringing about change and to unite together as one voice to improve the lives of people affected by a brain tumour. Partnerships include other brain tumour charities and patient organisations, such as Macmillan England and Wales/Cymru, the Brain Cancer Network Alliance and International Brain Tumour Alliance, as well as attending the All Party Parliamentary Group for Brain Tumours (APPGBT), working with government and senior officials, local MPs and other decision makers on campaigning priorities.

We also have representation on the Joint Strategy Board for the Tessa Jowell Brain Cancer Mission, and have an important part to play within the Tessa Jowell Centres of Excellence programme, feeding into better progress towards the common goals of the brain tumour community. The Centres of Excellence designation has been a fundamental movement towards the Mission’s vision to ensure that a certain level of expertise is held across all areas of neuro oncology and that each designated centre provides a comprehensive level of service and research activities. Brain Tumour Support has a significant role in working with hospitals to help to support this. As part of the continuing Centre of Excellence designation process, we were delighted to once again contribute to the care boxes distributed to the newly accredited peadiatric hospitals. This enabled us to include the clear messaging around how Brain Tumour Support can make a difference to these patients and families, outlining the services which can be delivered by the Brain Tumour Support team.

Our joint work with the teams at the neuro centres across the UK is increasing and further collaboration with others is planned for the future.

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OUR STRUCTURE, GOVERNANCE AND MANAGEMENT

Brain Tumour Support is a charitable company limited by guarantee registered at Companies House as a company and with the Charity Commission. The company was established under a Memorandum of Association which outlined the objects of the charitable company. It is governed by its Articles of Association.

Public benefit

The Trustees confirm that they have complied with the duty in the Charities Act 2011 to have due regard to public benefit guidance published by the Charity Commission. The annual report contains a fuller description of the public benefit that the charity provides within the main body of the report.

The Board of Trustees

Brain Tumour Support has directors and members. The directors of the charity are also Trustees of the charity for the purposes of the Charities Act.

The Board of Trustees makes up the governing body and oversees the governance of the charity, whilst the day-to-day management is led by Tina Mitchell Skinner, the appointed Chief Executive Officer, supported by the appointed Deputy CEO.

The Chief Executive Officer, together with the charity's Senior Leadership Team, submit proposals and recommendations to the Board on a quarterly basis for approval of strategy and to review and officially sign off on-going implementation plans for each area of activity carried out by the charity. In between, all Trustees are sent comprehensive monthly reports, produced by each function, to update them on monthly activities including additional financial management reports with commentary by the Finance Manager.

The Trustees are all experienced business people in their individual fields and provide a sound authority on direction and governance. They willingly give up their time free of charge and none of them, without exception, receive any Trustee remuneration or expense reimbursement.

The Board ensures that Brain Tumour Support operates effectively and efficiently through an understanding of charity income and expenditure. They take on a genuine responsibility of deciding how the charity's assets are best used to benefit all those people affected by the diagnosis of a brain tumour.

Andrew Chater, Chair of Brain Tumour Support, offered his resignation during the last financial year, and Trustee Emma Brereton was voted in as the new Chair. Following Andrew’s departure, three new trustees Ali Woodhead, Steve Mayers and Sam Derricourt have joined the Board to bridge any skills gap and to provide an additional skill set as the planned growth of the charity is expected to accelerate over the next five to ten years.

Together with her professional background, which brings much-needed marketing expertise to the Board, Ali Woodhead’s own family experience of accessing support from Brain Tumour Support adds to the significant lived experience of brain tumours across the charity team.

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Ali sadly lost her mum Sylvia in April 2023 after a devastating terminal brain tumour diagnosis. Amongst the challenges of being a carer to a brain tumour patient, Ali was also a daughter losing her mum and a mother trying to support her teenage daughters through the changes they were seeing in their grandmother.

Sylvia, Ali and the girls had support throughout Sylvia’s illness and, following her death, the family received bereavement support. Ali says having Brain Tumour Support to lean on has been and continues to be a huge comfort during a difficult time.

“We couldn’t have been better supported. We were given our own counsellor, and a Support Professional who checked in with us weekly, invited us to support sessions, and help was just there if we wanted it. We didn’t need everything but we were definitely more cushioned by the fact that support was there. It just felt like we were being looked after, which made a massive difference, because at that stage it’s a very lonely existence.”

Ali wants Sylvia’s legacy to help raise awareness of the impact of a brain tumour diagnosis and of the help that Brain Tumour Support can provide.

“It is so important that Brain Tumour Support exists, because you don’t realise what you need until you need it, and it was absolutely what we needed at the time. If others can get the help and support that we had, and are able to feel less scared, vulnerable and alone, then we will have done the best we possibly can to make a difference.”

Recruitment and appointment of Trustees

In accordance with the Articles of Association, Trustees are not required to retire by rotation each year. Any member entitled to vote at the general meeting may propose one person for appointment or re-appointment as a Trustee. The number of elected Trustees shall not be less than three and subject to a maximum of 12. The elected Trustees may co-opt a maximum of up to one half of their number as Trustees.

Trustee training and induction

New Trustees undergo a comprehensive induction to brief them on their legal obligations under charity law, the content of the Memorandum and Articles of Association, the structure and governance of the charity as well as all policies and procedures, their obligations under the Trustees Code of Conduct, strategic and operational plans and budgets together with recent financial performance. Trustees are also provided by the Finance Manager with relevant information from the Charity Commission on a regular basis.

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Chief Executive

The Chief Executive is responsible for setting the strategic direction for the charity with the Trustees, leading its implementation, and holds operational and financial authority within the set parameters.

Succession of the Chief Executive

Succession planning is paramount to good governance in any organisation and Brain Tumour Support is no exception.

For Tina Mitchell Skinner, as charity Founder, handing over the CEO role after two decades of commitment was always going to be a particular challenge. The primary desire being to ensure that the charity’s work would continue to thrive under new leadership – seeking a balance of continuity, stability and embracing of new opportunity.

Discussions therefore started early and it was felt that advertising for the new role was not applicable to Brain Tumour Support in the same way that it applied to ‘larger’ charities. Thus a proposal was agreed by the Board back in February 2019 to introduce a Deputy CEO role for future succession planning and direct appointment of a new CEO. With a fundraising speciality and an overall business background, Emma McKeown was appointed to the Deputy CEO position in June 2019, to allow a seamless move within the team and give both Tina and Emma the opportunity to oversee fundraising and operations. This new structure was designed to give a strong and solid leadership to work with the wider team to start to successfully grow income, fully crystallize the support blue print model and to build up charity reserves.. This decision proved to be successful following the turbulent years of Covid-19 and the recovery which slowly but favourably transpired.

The succession planning proposal was submitted to the Trustees at the Board meeting on 28th July 2023, outlining the succession plan based on Emma taking on the new role of CEO. Therefore, the process which started back in June 2019 took a step forward with a more focused approach and continued execution of the strategy. It allowed for a timely exit for Tina, building on the work which they had already started to do together. It gave the opportunity to continue to build support together, to make decisions about the organisational structure and ultimately to make joint decisions about the future strategy.

The staff’s involvement in this succession planning work was very important to the stability of the whole team, and the support which was needed from them in this journey has been integral for our future.

Emma’s aforementioned professional background has provided an excellent foundation and this, together with her personal experience, with brain tumours affecting her own family, and her proven track record of persistence, resilience and overriding integrity has ensured confidence in a secure future and smooth transition, which officially took place on 1 August 2024.

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TRUSTEES’ REPORT

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Fundraising policy

Fundraising policy for Brain Tumour Support is regulated by the Fundraising Regulator. The charity primarily fundraises from community fundraising events and trusts and grants. The charity recognises the need to conduct its fundraising within the context of recognised standards set out in the Chartered Institute of Fundraising’s Code of Fundraising Practice, the Data Protection Act 1998/ UKGDPR2021 and the CAP Code (Committee of Advertising Practice). We do not employ external professional fundraisers or companies.

Risk management

The Trustees have a risk management strategy, which comprises:

• An annual review of the risks the charity may face

• The establishment of systems and procedures to mitigate those risks identified in the annual review of risks

• The implementation of procedures designed to minimise the risks

The risk register is regularly reviewed by the Chief Executive and Deputy Chief Executive and the Senior Leadership team are responsible for their areas of risk in their functions. Following the monthly Senior Team meetings, the procedure would be for the Board to be alerted if there was an area of concern to be addressed.

Equality, Diversity, Equity and Inclusion (EDEI)

Brain Tumour Support has made significant inroads into the formalising and implementing of EDEI improvements. An EDEI steering group was established and strengths, weaknesses and key deficits across the organisation were identified. The group made recommendations for improvements based on these findings.

An EDEI Lead was appointed and underwent EDEI training, and in turn delivered awareness training to the entire organisation, both an EDEI policy and strategy were written and approved by the Trustees, and year one of the operational plan started in spring 2024. The strategy focuses on five key areas: disability and mental health, gender and sexuality, race and cultural difference/awareness, neurodiversity, and age (all ages). We also analysed our staff and volunteers and recognise that we have a diverse team with representation from all five key focus areas.

Operational improvements include: training for Support Professionals to deliver services to the deaf/hard of hearing (text service, transcript on ZOOM, BT relay service), venues are chosen for accessibility, including car parking, and attendees are asked about special needs in advance of booking rooms to ensure attendees can be accommodated. We understand and make provision for memory or speech loss, personality change and high anxiety, and the website is designed for accessibility. Following feedback, online group timings have been adjusted to suit specific group needs e.g. some groups changed to lunchtime to accommodate people at work and we trialled a run of the men’s group between 5 and 6 pm.

Reasonable adjustments have been made for staff with both physical and mental health issues and we operate flexible work arrangements to support those with caring responsibilities (for children and adults) and attendance of medical appointments.

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OUR FINANCIAL REVIEW

Brain Tumour Support receives very little government or statutory funding and we rely in the main on voluntary donations and fundraising. Our published statutory accounts for 2023/24 include the financial position of the charity as at 31 March 2024.

The previous financial year 2022/23 was one of reshape and rebuild across all functions with a trajectory of thriveability, and especially fundraising where we have increased our team in line with our strategic aim of financial stability. Decisions were made with the Board of Trustees to invest in the foundations of the charity for sustainability and future growth. The expenditure of this investment was predominantly to be supported by budgeted income targets, but with an agreed deficit to completion, based on some spend from reserves over a two-year period. However, varying internal and external factors have compounded the effect of this planned deficit, resulting in an overstretching pull on cash reserves.

Fundraising and donations

We have always had tremendously loyal and supportive fundraisers and donors, and this has been particularly evident in 2023-2024. As a charity we celebrated our 20[th] Anniversary with a number of key events including the Emerald Ball held at the beautiful DeVere Tortworth Court. Hosted by our ambassadors Joel Dommett and Hannah Cooper, it brought together 270 people for an evening of reflection, celebration and fun. We were delighted to raise over £28,000 to fund our pioneering Early Intervention Pilot with the neuro-oncology team at Southmead Hospital, Bristol. It was amazing to see the impact of collective giving.

There has continued to be an increase in the number of people taking on runs, challenges and community fundraising initiatives on our behalf, including Jane Powell’s fashion show in collaboration with John Lewis which raised over £4,200. February saw the return of Move29 with four-year old Nell Lucas completing 29 star jumps a day for the 29 days of February and raising over £400.

A key focus for this year has been delivering gold standard supporter care to ensure fundraising opportunities are maximised across all income streams. We have been delighted to see high levels

of retention in our regular gifts because of us sharing the impact of financial support. In October 2023 we implemented a new fundraising CRM system which has had a significant impact on the relationship management of our donors. Alongside this we launched our first online raffle and were delighted to raise over £2,000 towards our core services.

A significant challenge this year was matching the £125,000 raised by our ambassador, Joel Dommett, from his Who Wants to be a Millionaire win in the last financial year. An increase in Trust and Foundations income by 52% made a big impact on narrowing that gap and we were delighted to be awarded a £30,000 unrestricted award from Garfield Weston Trust in December.

As the financial year progressed it became increasingly difficult to raise the income needed to meet budgeted expenditure due to the cost of living crisis and the impact that this was having on the volume and monetary amount of voluntary donations. In March 2024, in response to this funding gap, we launched the Save our Support emergency appeal, aiming to create financial recovery and sustainability through raising £200,000 allowing us to rebuild our cash reserves.

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We have been humbled and are so very grateful for those that have engaged with and financially supported our SOS Appeal. Through the month of March we raised just over £20,000 towards ensuring our support services are sustained, and many new supporters came on board whose invaluable fundraising continues.

Kimberley got involved to raise funds and awareness after her own life, as a busy mum and teacher, changed drastically in June 2023. After a week off work with a debilitating migraine she suffered a seizure at home. Two days later, after an MRI scan, Kimberley was told 'You have a brain tumour.'

She recalls, “The five words that changed our lives for the foreseeable future. In this moment, I felt like my world had shattered.”

Kimberley had a craniotomy the next week which removed 95% of the tumour, however to combat regrowth of the grade 3 astrocytoma she also needed radiotherapy and chemotherapy.

Kimberley’s treatment is going well but she knows that the future is uncertain. She has lost a lot of her independence, she cannot drive or work at present. She says her illness has at times taken away her main purposes in life – as a wife, daughter, granddaughter, mum, friend and teacher. Life has changed for her husband too, now being her carer, as well as working full time.

However, with support from her medical team and the help of Brain Tumour Support, Kimberley remains positive and is “slowly getting back to being me.”

As well as having one-to-one contact with a Brain Tumour Support Professional, Kimberley has met others going through similar experiences - both online in the Brain Tumour Support Forum on Facebook, and face to face at local group meetings.

To support our work, Kimberley decided to take on an abseil challenge with her lifelong friend Raj. Ahead of the event in July 2024, their fundraising had already passed £5,000.

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Andy Downes, was a Crew Manager for Thornbury Firefighters, serving for 14 years without a day’s sick leave. Then in 2020 he failed a hearing test as part of a routine medical check, and further tests revealed a brain tumour, requiring emergency surgery. It was a terrifying time for the whole family, made even worse by it happening during Covid-19 lockdown.

The tumour turned out to be a grade 4 glioblastoma and so Andy then faced gruelling cycles of daily chemotherapy and radiotherapy, plus immunotherapy.

He went from running a successful building business and serving the community as a firefighter, to being unable to drive due to his condition, losing independence and struggling with everyday activities. Ultimately, in November 2022, he was forced to take medical retirement from his role with the fire service.

Being Thornbury locals, the Downes family had grown up knowing about Brain Tumour Support, with its office based in the town, but they never imagined ever needing the charity’s services. However, in the time since Andy's diagnosis they have really felt the difference that the specialist support services make. They have been able to benefit from free counselling sessions, as well as some of the support groups. Andy has attended the men’s support group online and daughter Izzy has been to the Bristol face-to-face support group.

Especially beneficial, with Andy being self-employed, was working with Brain Tumour Support’s dedicated Welfare Benefits Support Professional, who could give financial advice that made a huge difference to the family during a really difficult time.

Andy and his family, took part in the Great Bristol Run 2024 to fundraise for Brain Tumour Support, and the level of support and respect for the family was clear when they received over £1,000 in donations within just 24 hours of launching their Just Giving page. With all of them taking on either the 10k or half marathon route around the city, it was an incredible family achievement and their fundraiser finished by raising over £3,800.

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Corporate support

Corporate fundraising continued to show encouraging growth. We were delighted with the ongoing support from Bath based legal firm RWK Goodman who increased their sponsorship of the salary costs of the Welfare Benefits Support Professional to £11,250.

Following the Emerald Ball, DeVere Tortworth Court chose Brain Tumour Support to be their Charity of the Year. They have undertaken a range of fundraising activities including sponsored cycle rides, firework evenings and raffles. Collectively they have raised over £13,000 to provide vital support to people affected by a brain tumour diagnosis.

Every corporate partnership plays a crucial part in funding our services, and their support often comes out of personal experience of brain tumours, making their involvement all the more meaningful.

IMPACT ACROSS THE YEAR -

The need for support in a cost of living crisis

A recurring issue faced after a brain tumour diagnosis is the devastating effect it can have on finances. Some people have to give up their careers completely, many face long periods of time off work and others are unable to return to a previous role. These added financial pressures, in tandem with the cost of living crisis, and complexities of the benefits system, place an unbearable burden on many people. RWK Goodman’s sponsorship of our dedicated Welfare Benefits Support Professional, has therefore been invaluable.

Number of individuals or families helped:

102

Amount of benefits gained with help from our Welfare Benefits Service:

£283,263

Type of benefit and % of queries involving primarily this benefit: Personal Independence Payment - 38% Universal Credit - 8% Employment and Support Allowance - 11% Attendance Allowance - 7% Carers Allowance - 4% Blue Badge - 5% Other (incl. Maternity Allowance & Statutory Sick Pay ) - 5% General Benefit Advice – all benefits - 22%

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Other funding sources

Over the last financial year, once again we report that a substantial portion of our income was derived from grant funding via grant making trusts.

As always we are very grateful to the many charitable trusts and foundations who help to fund our work but we want to highlight two charitable trusts this year who have made a particularly notable impact on our support services.

In December 2023 we were delighted to receive our first grant from Garfield Weston Foundation, an unrestricted grant which came at a crucial time for us as the cost of living crisis impacted our fundraising income.

Special thanks also to the Eveson Trust who have been incredible supporters of our work over many years, specifically helping our support services in Worcestershire, Herefordshire and West Midlands.

We were also delighted that a grant from The National Lottery Community Fund enabled us to do more community work in Wales and reach people who may otherwise struggle to access support. In areas where isolation can be a particular problem, and for someone like Martyn, it can make a crucial difference to health and wellbeing.

Martyn has been living with the impact of a brain tumour since 2016 when his life changed overnight and his diagnosis took a devastating physical and emotional toll on him and his family.

Happily married with three young children and busy with his business, he was diagnosed with a brain tumour after a seizure, and had further seizures after two brain surgeries. He was then diagnosed with epilepsy.

Martyn struggled with anxiety and depression having lost his driving licence and the business. His relationship suffered, resulting in a divorce and separation from his children.

After referral to Brain Tumour Support by his neuropsychologist, Martyn was assigned to his local Support Professional, Gavin, who offers Martyn regular one-to-one support. Together they talk about his wellbeing and strategies for coping. This has been particularly important recently as Martyn’s tumour has started to grow again and he may now face radiotherapy.

As for many people diagnosed with a brain tumour, the impact of the condition and the challenges faced are complex and life changing, but often not visible.

This year also brought the opportunity to work with high profile and major donors emanating from the work surrounding the charity’s 20[th] Anniversary, as well as funding sources such as Gift Aid and Facebook fundraisers.

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Summary

In summary, gross income for the year ending March 2023/24 has decreased by 2.04% from £505,791 to £495,470.

At 31 March 2024, the charity had unrestricted funds of £8,076 and restricted funds of £2,885.

With the favourable rate of interest on the Bounce Back Loan, the Board took the decision in the previous financial year to repay by instalments in order to continue to mitigate any risk and to remain cautious. In light of the climate in which we are still operating, we re-negotiated the loan payment term to extend the loan period a further four years (was 72 months and is now 120 months). We then entered into a six-month capital and interest payment holiday from 27 March 2024.

Whilst the Trustees were concerned about the levels of income against current expenditure, they conducted a thorough review of whether the charity was an on-going concern looking ahead both in the short term (i.e. next 12 months) and the longer term. Having scrutinised the budgeted forecast prepared for the coming 12 months, the trustees were able to make an informed decision based on the position of multi-year funds pending, a strong pipeline of trust and grants and a realistic programme of proven activities planned in all other areas of income generation. This aligned with the extensive work that was carried out on expenditure review, which included some staff reductions and cost saving measures, reassured the Trustees that the Charity was in a solid position to continue operating over the next 12 months at the very least.

Investment in support

In line with our vision, the charity's income is dedicated to being spent on the support services which we offer, free of charge, to any families affected by any type of brain tumour.

With the approved planned expenditure in reserves during this financial year in order to continue to build upon our foundational work, our investment in support included headline projects, such as the new website, the new CRM and the launch of the Early Intervention Pilot. All of these fundamental project plans proceeded at pace and were delivered successfully on time, with experienced personnel recruited to post as needed.

Our passionate and dedicated support team continue to deliver support in accordance with the new support model. A large demand on our service is supporting the mental health amongst those diagnosed or those caring for someone with a brain tumour.

Whilst we haven’t been able to renew the temporary contracts in support during this financial year, we have considered additional options to enable us to continue to offer support to those that need us, whilst finely balancing the morale and welfare of our staff throughout this period, in line with our values. This has been manifested through harnassing the newly available and relevant support data, implementing our new competency framework and re-working the way in which we categorise the support needs of each client.

The agreed spend for our focus on retrieving good, clean data and monitoring impact outcomes has meant that, through the use of this impactful data, we have been able to widen our trust funding asks and it is allowing us to focus on those areas offering the best opportunity for a return to meet income targets.

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Our Community Fund monies have allowed us to re-introduce our support presence in Wales. This has resulted in our Volunteer Co-ordinator hours being reduced in order to increase our support hours in Wales. This has worked well and has enabled us to deploy some additional hours to support other areas. Although the volunteer hours have reduced, we are still able to review and monitor our volunteer activity. We will continue to carefully oversee volunteer activity, including training and governance, and recruit new volunteers to help our Support Professionals where appropriate.

We may not be in the position of strength which we had hoped for, however we are confident that with the decisions taken to reduce cost and to re-focus fundraising efforts, we have most certainly achieved a robust support delivery function, and will reach a point of financial stability and set the solid foundation for growth.

Strategy day and future plans

Our financial year has been both rewarding and challenging in equal measure. Together the Board and Senior Leadership Team, in preparation for this financial year, made important decisions to invest in our support model and grow our income to reach a point of financial stability. We committed to diversifying our income streams to reduce the reliance on particular income lines and refocus fundraising resource to the areas offering us the best potential for return and income.

The annual meeting, where the Board join the Senior Leadership Team for a strategy day to discuss the key organisational priorities for the financial year ahead, was spent differently this year. The focus of the meeting on 6 March 2024 was for the CEO and Deputy CEO (rather than the whole Senior Leadership Team) to discuss with the Board a financial plan to rebuild reserves and to ensure that our fundraising priorities were clear and bold. The meeting resulted in an overall review and progress report of all the achievements which were realised throughout the year deriving from the monies raised at the Emerald Ball and the agreed planned deficit. We then discussed the areas in which further cost cutting needed to be focused, and the consideration of giving notice to end fixed term contracts which were due.

Our priority for the financial year ahead is to ensure that the Senior Leadership Team and the Board of Trustees work towards expenditure plans being maintained at minimal levels and that the activity within the fundraising team is focused on those areas offering the best opportunity for return to meet income targets.

Our aim is also to closely monitor income, expenditure and cash flow on a weekly basis whilst working on clear, operational plans to ensure focus remains in the right areas across all functions of the charity. We will strive to maintain clear focus on increasing income and re-building reserves by growing income lines, especially income streams which yield the best results for nonrestricted income, and introducing new initiatives to expand our audience.

We plan to continue to carry out the excellent support delivery programme and to build on the data collection and impact work. We will also be focusing on our communications and social media strategy, and within this, formulating a marketing strategy for the charity. As we move forwards in all areas of the organisation, we will fully integrate the new Trustees and maintain our work on our project plans to continue the foundational work before embarking on the charity’s strategy up to the year 2030.

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Balance sheet

The surplus realised this year has increased our accumulated funds and cash reserves at year end.

Investment policy

The cash balance at 31 March 2024 was £57,094 compared to £223,853 at 31 March 2023. It is always the charity’s aim to retain a prudent amount in reserves. Following a process of due diligence in previous years, the charity opened additional bank accounts to ensure all cash deposits are covered by the £85,000 Financial Services Compensation Scheme. The charity now has cash investments, deposited with NatWest Bank, The Co-operative Bank and the CAF Investment Portfolio which ensure we protect the principal sums invested whilst optimising the balance between flexibility and rate of return.

Remaining vigilant to improve the return on our cash resources and to not exceed our bank account indemnity is part of our risk management.

Reserves policy

The reserves policy of the charity is to maintain free reserves (defined as unrestricted funds less funds that can only be realised by disposing of tangible fixed assets) equal to three months operational costs which, at the date of signing these financial statements, equates to £151,000. To achieve this we will continue to closely monitor expense and income levels.

The charity ended the financial year with free reserves of £8,076, meaning that our reserves are below the level required by the policy. The charity has a robust fundraising strategy in place focussing on diversifying and increasing income from all streams, in an effort to work towards financial recovery of free cash reserves. The charity has held a 3 months’ free cash reserves policy for some time, and this is being reviewed for the financial year ahead to account for the funding approach, our average percentage of restricted funds held for direct support delivery staffing which accounts for a large proportion of our monthly expenditure and replenishing desired levels of free cash reserves in line with this.

The charity has a robust fundraising strategy in place focussing on diversifying and increasing income from all streams, in an effort to work towards financial recovery of free cash reserves. The charity has held a 3 months free cash reserves policy for some time, and this is being reviewed for the financial year ahead to account for the funding approach, our average percentage of restricted funds held for direct support delivery staffing which accounts for a large proportion of our monthly expenditure, and replenishing desired levels of free cash reserves in line with this.

Statement of Trustees' responsibilities

The Trustees (who are also directors of Brain Tumour Support for the purposes of company law) are responsible for preparing the Trustees' Report (incorporating the strategic report and directors' 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 Accepted Accounting Practice).

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Company law 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 charitable company and of the income and expenditure, of the charitable company for that period. In preparing these financial statements, the Trustees are required to:

• select suitable accounting policies and then apply them consistently

• observe the methods and principles in the Charities SORP

• make judgments and 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

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

Small company provisions

This report has been prepared in accordance with the special provisions for small companies under part 15 of the Companies Act 2006.

Registered office: The Clock Tower Old Weston Road Flax Bourton Bristol BS48 1UR

Approved by the Trustees on ……………………… 11 November 2024

Signed by order of the Trustees

Mrs E Brereton

Chair of Trustees

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INDEPENDENT EXAMINER’S REPORT

YEAR ENDED 31 MARCH 2024

Independent examiner’s report to the Trustees of Brain Tumour Support (‘the Company’)

I report to the charity trustees on my examination of the accounts of the Company for the year ended 31 March 2024.

Responsibilities and basis of report

As the charity’s Trustees of the Company (and also its directors for the purposes of company law) you are responsible for the preparation of the accounts in accordance with the requirements of the Companies Act 2006 (‘the 2006 Act’).

Having satisfied myself that the accounts of the Company are not required to be audited under Part 16 of the 2006 Act and are eligible for independent examination, I report in respect of my examination of your charity’s accounts as carried out under section 145 of the Charities Act 2011 (‘the 2011 Act’). In carrying out my examination I have followed the Directions given by the Charity Commission under section 145(5) (b) of the 2011 Act.

Independent examiner’s statement

Since the Company’s gross income exceeded £250,000 your examiner must be a member of a body listed in section 145 of the 2011 Act. I confirm that I am qualified to undertake the examination because I am a member of the Institute of Chartered Accountants in England and Wales, which is one of the listed bodies.

I have completed my examination. I confirm that no matters have come to my attention in connection with the examination giving me cause to believe:

1. accounting records were not kept in respect of the Company as required by section 386 of the 2006 Act; or

2. the accounts do not accord with those records; or

3. the accounts do not comply with the accounting requirements of section 396 of the 2006 Act other than any requirement that the accounts give a ‘true and fair view which is not a matter considered as part of an independent examination; or

4. the accounts have not been prepared in accordance with the methods and principles of the Statement of Recommended Practice for accounting and reporting by charities applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102).

I have no concerns and have come across no other matters in connection with the examination to which attention should be drawn in this report in order to enable a proper understanding of the accounts to be reached.

Joshua N Kingston BSc., ACA Burton Sweet Limited, Chartered Accountants The Clock Tower 5 Farleigh Court Old Weston Road Flax Bourton Bristol BS48 1UR

Date: 11 November 2024

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BRAIN TUMOUR SUPPORT

STATEMENT OF FINANCIAL ACTIVITIES (INCLUDING INCOME AND EXPENDITURE ACCOUNT)

YEAR ENDED 31 MARCH 2024

		Unrestricted	**Restricted **	Total funds	Total funds
		Funds	Funds	2024	2023
	Notes	£	£	£	£
Income from:
Donations and grants	2	350,225	139,464	489,689	499,684
Other trading activities	3	2,402	-	2,402	3,565
Investments		3,379	-	3,379	2,541
Total income		356,006	139,464	495,470	505,790
Expenditure on:
Raising funds	4	194,319	-	194,319	174,122
Charitable activities	5	296,922	155,958	452,880	417,675
Total expenditure		491,241	155,958	647,199	591,797
Net income/(expenditure) and
net movement in funds	7	(135,235)	(16,494)	(151,729)	(86,007)
Reconciliation of funds:
Total funds brought forward	15	143,311	19,379	162,690	248,697
Total funds carried forward	15	8,076	2,885	10,961	162,690

The comparative funds are detailed in note 9.

The company has no recognised gains or losses other than the results for the year as set out above.

All of the activities of the company are classed as continuing.

The notes on pages 35 to 44 form part of these financial statements

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BRAIN TUMOUR SUPPORT

BALANCE SHEET

BALANCE SHEET
AT 31 MARCH 2024	Company registration number: 09718307
Notes Fixed assets Tangible assets 10 Current assets Debtors 11 Cash at bank 12 Net current assets Total assets less current liabilities 13 Total net assets Funds Unrestricted Funds General funds 16 Designated funds 16 Restricted Funds 16 Creditors: Amounts falling due within one year Creditors: Amounts falling due after more than one year	2024 2023 £ £ £ £ 540 974 2,232 6,108 57,094 223,853 59,326 229,961 (27,979) (45,913) 31,347 184,048 31,887 185,022 (20,926) (22,332) 10,961 162,690 8,076 121,715 - 21,596 2,885 19,379 10,961 162,690
		184,048 185,022 (22,332)
		162,690
		121,715 21,596 19,379
		162,690

For the year ending 31 March 2024 the company was entitled to exemption from audit under section 477 of the Companies Act 2006 relating to small companies.

Directors' responsibilities

The members have not required the company to obtain an audit of its accounts for the year in question in accordance with section 476,

The directors acknowledge their responsibilities for complying with the requirements of the Act with respect to accounting records and the preparation of accounts.

The members have not required the company to obtain an audit of its accounts for the year in question in accordance with section 144(2) of the Charities Act 2011.

The financial statements have been prepared in accordance with the special provisions relating to companies subject to the small companies regime within part 15 of the Companies Act 2006.

The financial statements were authorised for issue, approved by the members of the committee on 11 November 2024

...................................

Mrs E Brereton Chair of Trustees

The notes on pages 35 to 44 form part of these financial statements

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BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

1 Accounting Policies

a) Basis of preparation

The financial statements have been prepared in accordance with the historical cost convention (except where otherwise stated in the accounting policy note) and 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) issued in October 2019, and the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS 102), and the Companies Act 2006.

The charity is a public benefit entity as defined under FRS102.

The financial statements have been prepared on a going concern basis. The trustees consider that there are no material uncertainties affecting the ability of the charity to continue as a going concern.

b) Income

All income is included in the Statement of Financial Activities when the company is legally entitled to the income and the amount can be quantified with reasonable accuracy.

Grants, including grants for the purchase of fixed assets, are recognised in the income and expenditure account as they become receivable.

Gifts in kind are valued at estimated open market value at the date of the gift, in the case of assets for retention or consumption, or at the value to the organisation in the case of donated services or facilities.

c) Expenditure

Expenditure is accounted for on an accruals basis and has been classified under headings that aggregate all costs related to that activity. Central costs are equivalent to the SORP's definition of support costs and are where costs cannot be directly attributed to activities they have been allocated to activities on a basis consistent with the use of the resource.

Governance costs include the costs of governance arrangements which relate to the general running of the charity. These costs are associated with constitutional and statutory requirements and include costs associated with the strategic management of the charity’s activities. These are included within central costs.

d) Fund accounting

Unrestricted funds contain accumulated surplus and deficits on general funds and can be used in accordance with the charity's objects at the discretion of the Trustees.

Restricted funds represent monies received for specific purposes. All income and expenditure relating to the restricted funds' movements is included in the income and expenditure account. Further details of restricted funds are shown in note 15.

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BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

1 Accounting Policies (continued)

e) Fixed assets

Fixed assets are held at cost less accumulated depreciation. Assets costing less than £500 are not capitalised.

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

Equipment 33% straight line Fixtures & fittings 15% straight line

f) Trade debtors

Trade debtors are recognised initially at the transaction price. They are subsequently measured at amortised cost using the effective interest method, less provision for impairment. A provision for the impairment of trade debtors is established when there is objective evidence that the charity will not be able to collect all amounts due according to the original terms of the receivables.

g) Cash and cash equivalents

Cash and cash equivalents comprise cash on hand and call deposits, and other short-term highly liquid investments that are readily convertible to a known amount of cash and are subject to an insignificant risk of change in value.

h) Trade creditors

Trade creditors are obligations to pay for goods or services that have been acquired in the ordinary course of business from suppliers. Accounts payable are classified as current liabilities if the company does not have an unconditional right, at the end of the reporting period, to defer settlement of the creditor for at least twelve months after the reporting date. If there is an unconditional right to defer settlement for at least twelve months after the reporting date, they are presented as non-current liabilities.

i) Pensions

The charity has arranged a defined contribution scheme for its staff. Pension costs charged in the SOFA represent the contributions payable by the charity in the period.

j) Government Grants

Government grants are recognised in the period in which relevant expenses were incurred and deemed to be receivable.

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BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

2 Donations and grants

Charitable trust donations Fundraising and individual donations The above includes £9,850 of government grants. Prior year comparative Macmillan funding Charitable trust donations Fundraising and individual donations The above includes £8,000 of government grants.	Unrestricted Restricted Total Funds Funds 2024 £ £ £ 90,913 125,699 216,612 259,312 13,765 273,077
	350,225 139,464 489,689
	Unrestricted Restricted Total Funds Funds 2023 £ £ £ - 2,463 2,463 59,450 70,711 130,161 353,663 13,397 367,060
	413,113 86,571 499,684

3 Income from: Other trading activities

Merchandise and other sales Prior year comparative Merchandise and other sales	Unrestricted Restricted Total Funds Funds 2024 £ £ £ 2,402 - 2,402
	2,402 - 2,402
	Unrestricted Restricted Total Funds Funds 2023 £ £ £ 3,565 - 3,565
	3,565 - 3,565

37

BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

4 Expenditure on: Raising Funds

4 Expenditure on: Raising Funds
Fundraising Prior year comparative Fundraising 5 Expenditure on: Charitable activities Providing support Raising awareness Prior year comparative Providing support Raising awareness	Activities Central undertaken costs Total directly (note 6) 2024 £ £ £ 184,550 9,769 194,319
	184,550 9,769 194,319
	Activities Central undertaken costs Total directly (note 6) 2023 £ £ £ 165,026 9,096 174,122
	165,026 9,096 174,122
	Activities Central undertaken costs Total directly (note 6) 2024 £ £ £ 404,513 21,413 425,926 25,599 1,355 26,954
	430,112 22,768 452,880
	Activities Central undertaken costs Total directly (note 6) 2023 £ £ £ 364,696 20,103 384,799 31,158 1,718 32,876
	395,854 21,821 417,675

38

BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

6 Central costs

Operating costs Governance costs Accountancy fees Prior year comparative Operating costs Governance costs Accountancy fees 7 Net income for the year This is stated after charging: Independent examiner's remuneration - Independent Examination - Accounts preparation Depreciation	Charitable Raising Total activities funds 2024 £ £ £ 21,014 9,017 30,031 1,754 752 2,506	Charitable Raising Total activities funds 2024 £ £ £ 21,014 9,017 30,031 1,754 752 2,506
	22,768 9,769 32,537
	Charitable Raising Total activities funds 2023 £ £ £ 20,337 8,478 28,815 1,484 618 2,102
	21,821	9,096 30,917
		2024 2023 £ £ 1,056 895 1,320 1,037 434 329

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BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

8 Staff costs and emoluments Total staff costs were as follows : Wages and salaries Social security costs Pension contributions	2024 2023 £ £ 472,577 418,389 35,712 32,503 9,211 8,424
	517,500 459,316

Particulars of employees:

The average number of employees during the year, calculated on the basis of average headcount, was 24 (2023: 23).

The average number of employees during the year, calculated on the basis of full time equivalents, was 16.9 (2023: 15.6).

No employee received remuneration of more than £60,000 during the year (2023 - nil)

Employment benefits received by seven (2023: seven) key management personnel in the period were £193,415 (2023: £179,870).

9 Prior-year comparative Statement of Financial Activities

Donations Charitable activities Other trading activities Investments Total income Expenditure on: Raising funds Charitable activities Total expenditure Reconciliation of funds: Total funds brought forward Total funds carried forward Net income/(expenditure) and net movement in funds	Unrestricted Restricted Total funds Funds Funds 2023 £ £ £ 413,113 86,571 499,684 - - - 3,565 - 3,565 2,541 - 2,541
	419,219 86,571 505,790
	174,122 - 174,122 286,295 131,380 417,675
	460,417 131,380 591,797
	(41,198) (44,809) (86,007) 184,509 64,188 248,697
	143,311 19,379 162,690

40

BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

10 Tangible fixed assets Cost At 1 April 2023 and at 31 March 2024 Depreciation At 1 April 2023 and at 31 March 2024 Charge for the year At 31 March 2024 Net book value At 31 March 2024 At 31 March 2023 11 Debtors Trade debtors Prepayments Other debtors 12 Creditors: amounts falling due within one year Trade creditors Accruals and deferred income Taxation and social security Other creditors Bank Loan	Fixtures & Equipment fittings Total £ £ £ 8,634 1,390 10,024 7,660 1,390 9,050 434 - 434	Fixtures & Equipment fittings Total £ £ £ 8,634 1,390 10,024 7,660 1,390 9,050 434 - 434
	8,094	1,390 9,484
	540	- 540
	974	- 974
		2024 2023 £ £ - 2,337 2,232 3,321 - 450
		2,232 6,108
		2024 2023 £ £ 4,899 253 11,074 12,379 7,630 8,007 2,013 15,274 2,363 10,000
		27,979 45,913

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BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

13 Creditors: amounts falling due after more than one year

	2024	2023
	£	£
Bank Loan	20,926	22,332

The bank loans due within one year and after more than one year represent a 'Bounce Back' loan, taken out in 2020, at an interest rate of 2.5% per annum. The loan is unsecured and was repayable in instalments over 10 years.

In March 2024, in response to the client's request, the bank agreed to a six-month repayment holiday until August 2024 and to extend the loan term to 120 months from the original term of 72 months.

14 Operating lease commitments

At 31 March 2024 the company had total minimum commitments under non-cancellable operating leases for premises as follows:

Payments due: Within 1 year Between 2 to 5 years 15 Movement in funds Year ended 31 March 2024 Restricted funds Regional support groups Support for neuro team Counselling Unrestricted funds General fund Designated funds Support salaries IT for new employees Fundraising salaries Staff training day Small projects Total Unrestricted funds Total funds	2024 2023 £ £ 6,075 2,850 30,250 - As at Transfers As at 1-Apr-23 Income Expenditure in/(out) 31-Mar-24 £ £ £ £ £ 18,693 136,214 (152,568) - 2,339 82 - - - 82 604 3,250 (3,390) - 464	2024 2023 £ £ 6,075 2,850 30,250 -
	19,379 139,464 (155,958) - 2,885
	121,715 356,006 (469,847) 202 8,076 17,158 - (17,158) - - 495 - - (495) - 3,585 - (4,236) 651 - 358 - - (358) - - - - - -
	21,596 - (21,394) (202) -
	143,311 356,006 (491,241) - 8,076
	162,690 495,470 (647,199) - 10,961

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BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

15 Movement in funds(continued) Year ended 31 March 2023 Restricted funds Co-ordinators Regional support groups Support for neuro team Counselling IT Unrestricted funds General fund Designated funds Support salaries Website development IT for new employees Fundraising salaries Staff training day Small projects Total funds	As at Transfers As at 1-Apr-22 Income Expenditure in/(out) 31-Mar-23 £ £ £ £ £ - 2,463 (2,463) - - 63,453 78,758 (117,539) (5,979) 18,693 163 - (81) - 82 572 2,000 (7,947) 5,979 604 - 3,350 (3,350) - -
	64,188 86,571 (131,380) - 19,379
	184,509 419,219 (362,373) (119,640) 121,715 - - (37,491) 54,649 17,158 - - (15,000) 15,000 - - - (2,505) 3,000 495 - - (37,694) 41,279 3,585 - - (1,442) 1,800 358 - - (3,912) 3,912 -
	- - (98,044) 119,640 21,596
	184,509 419,219 (460,417) - 143,311
	248,697 505,790 (591,797) - 162,690

The 'Co-ordinators' restricted fund is where Macmillan Cancer Support have restricted their grant to be used specifically to create and support Co-ordinator posts in the charity.

The 'Regional support groups' restricted fund is where donors have restricted their donation to be used specifically to support the running costs of one of the charity's many different regional support groups. The disclosure of these different restricted funds has been combined due to their similarity, however the individual restrictions of each donation are monitored and maintained. During the year, a transfer of £5,979 was made from this fund to the Counselling Fund, to transfer funds received for counselling in a specific geographical area which had been used for counselling rather than the regional support groups.

The 'Support for neuro team' restricted fund is where donors have restricted their donations to be used in supporting hospital CNS neuro teams who treat brain tumour patients.

The 'Counselling' restricted fund is the provision of counselling services to the charity's service users.

The IT restricted fund represents funding received to purchase equipment.

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BRAIN TUMOUR SUPPORT

NOTES TO THE FINANCIAL STATEMENTS

YEAR ENDED 31 MARCH 2024

16 Analysis of net assets between funds

As at 31 March 2024 Restricted funds Unrestricted funds Designated funds General funds As at 31 March 2023 Restricted funds Unrestricted funds Designated funds General funds	Other Fixed Cash at net assets/ assets bank (liabilities) Total £ £ £ £ - 2,885 - 2,885 - - - - 540 54,209 (46,673) 8,076
	540 57,094 (46,673) 10,961
	Other Fixed Cash at net assets/ assets bank (liabilities) Total £ £ £ £ - 19,379 - 19,379 - 21,596 21,596 974 182,878 (62,137) 121,715
	974 223,853 (62,137) 162,690

17 Related party transactions

Trustee remuneration in the year was £nil (2023: £nil). No Trustee was reimbursed for any expenses during the year or the prior year. Total Trustee donations to the charity in the year were £1,083 (2023: £1.143). Trustees waived expenses of £664 (2023: £602) during the year.

There were no other related party transactions in either the current year or the prior year.

44