2021-03-31-accounts

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The Royal National Orthopaedic Hospital Charity

2020 | 21

Charitable Incorporated Organisation Charity Number: 1166129

Page	3	Reference and administration details
Page	4	Welcome from the Chair
Page	5	Introduction from the Chief Executive
Page	6	Our partner
Page	7	What we do
Page	20	Future plans
Page	22	Financial review
Page	24	Governance
Page	27	Statement of trustees' responsibilities
Page	28	Independent auditor's report to the board of trustees
Page	32	Statement of fnancial activities
Page	33	Balance sheet
Page	34	Cash fow statement
Page	35	Notes to the fnancial statements

Reference and Administrative Details

Registered Address:

Royal National Orthopaedic Hospital NHS Trust Brockley Hill Stanmore Middlesex HA7 4LP Tel: 020 8909 5362

Trustees:

Dorothy Dalton, Appointed Chair July 2020 Richard Linskell, Interim Chair from April 2020 - July 2020 Sarah Bedingfield Shutt, Appointed September 2020 Anju Jaggi, Appointed July 2020 Matthew Lee, Appointed September 2020 Hitesh Thakrar, Appointed July 2020

Robert Hurd

Advisors:

Fund Managers

CCLA Investment Management Limited (For COIF Charity Funds) Senator House 85 Queen Victoria Street London EC4V 4ET

Cazenove Capital (From December 2021) 1 London Wall Place London EC2Y 5AU

Bankers

Barclays Bank PLC 8 The Broadway Crouch End London N8 9SX

Independent Auditor Moore Kingston Smith LLP Devonshire House 60 Goswell Road London EC1M 7AD

Elizabeth Klein

John Magnier

Key management personnel:

Rosie Stolarski, Chief Executive

Anita Darashah-Borman, Head of Fundraising (From June 2021)

Carol Corney-Brotherston, Head of Finance (From July 2021)

Dorothy Dalton Chair

Welcome from the Chair

It has been a delight to join and chair the Royal National Orthopaedic Hospital (RNOH) Charity Board in its mission to support pioneering, world class orthopaedic treatment and research. In what has been one of the most challenging years in the NHS’ 100-year history, this first year as Chair has shown me first-hand the agility and resilience of the wonderful NHS staff and that of our CEO, Rosie Stolarski and her team at the RNOH Charity. I want to thank all of the staff at the RNOH NHS Trust, at both the Stanmore and Bolsover Street London sites. Your hard work, resilience and compassion is the lifeblood of the hospital.

It is with great pleasure that I welcome Anju Jaggi, Hitesh Thakrar, Sarah Bedingfield Shutt and Matt Lee as trustees to the Charity. Their combined breadth of experience and expertise across the medical, finance and marketing industries strengthens the leadership of the Charity as we look to grow our support for the RNOH. I am confident that the diversity of expertise and huge ability of my fellow trustees puts the RNOH Charity in the strongest possible position to not only navigate the complex legacy of a pandemic on the NHS, but to ensure that the RNOH Charity continues to support the development of the RNOH as the UK's leading specialist orthopaedic hospital, pioneering leading orthopaedic care and world-leading research.

This year, the Charity’s work has positively impacted the lives of people from across the UK. This strong legacy is thanks to the leadership and foresight of our former trustees.

I also want to thank our CEO, Rosie and her growing team at the Charity. Your dedication and hard work over the past year has seen the RNOH supported through unimaginable circumstances and provided with exceptional support. This included the Covid-19 Emergency Appeal that raised £235,597 providing crucial support to staff and the funding of a new cardiology ultrasound scanner that enables remote patient cardiac monitoring and greatly reduces Covid-19 associated infection risks. The trustees and myself are further encouraged by numerous fundraising activities, a testament to the over 400 former and current patients that united to support the Charity.

This continued support and the tireless fundraising of former patients underpins the importance of the Charity’s mission in supporting the RNOH where NHS funding has its limits.

We are delighted that the new, state-of-the-art SPECT-CT scanner, funded by the RNOH Charity, greatly strengthens the toolkit of our RNOH teams in the fight against cancer. The scanner provides doctors with instant and more accurate images for diagnosis, to help them plan complex treatments. Strengthening the suite of equipment and diagnostics tools is a crucial pillar of the Charity’s strategy. In the future, we look to fund new imaging equipment that uses lower radiation and provides radiologists and surgeons with superior musculoskeletal imaging; greatly benefitting all patients – especially children.

It is a huge privilege to work with such a strong charity team and enjoy the support of trustees whose expertise will only amplify the aims of the Charity. Over the coming year I look forward to working closely with Rosie, her team and my fellow trustees as we realise the Charity’s ambitious future plans.

Rosie Stolarski Chief Executive

Introduction from the Chief Executive

This year has been a year like no other. The pandemic has had a profound impact on everybody, causing changes to our lives that would have been unthinkable over a year ago. I have been particularly inspired by the dedication and resilience of the RNOH staff in the face of numerous pandemic-wrought challenges. In March 2020, to help relieve Covid-19 pressure on the NHS, the RNOH became an orthopaedic trauma centre for the first time since 1982 and broadened its remit to accept patients from North and Central London hospitals.

We in turn have been overwhelmed by the incredible support received from the local community, businesses and individuals. The generosity and kindness shown were unsurpassable and crucial to our Covid-19 response. It has been the RNOH Charity’s privilege to support the work of the hospital over the past year in many different ways.

Despite a challenging year, our income increased to £1,177,000 up from £773,000 in the previous year. We were able to award over £1,445,000 in grants. This includes fully funding the hospital’s first state-ofthe-art SPECT-CT scanner and continuing to fund the wonderful Volunteer Service whose volunteers played an integral role during the height of the pandemic. The Charity’s significant contribution to the development of Horatio’s Garden has made a substantial difference to hospital patients with spinal cord injuries and staff in the Spinal Cord Injury Centre. We are also pleased to have purchased a large number of items using our Covid-19 Emergency Appeal funds, including clothing and care packs for patients, the purchase of a cardiology ultra-sound machine and the funding of a health and wellbeing lead, who has developed an extensive wellbeing programme to support RNOH staff during and beyond Covid-19.

skills will only strengthen the Charity’s significant impact going forward. The support and continued commitment of all our trustees has been incomparable over the past year, I would also like to extend my thanks to them.

The Charity team readily adapted to remote working and I would like to thank all our team members for their hard work and resilience. I am delighted to welcome Carol Corney-Brotherston, our new Head of Finance and Anita Darashah-Borman, our new Head of Fundraising who have recently joined the Charity and will join me as part of the Charity’s senior leadership team.

As the hospital sets out its exciting, ambitious plans for the future, the RNOH Charity looks forward to continuing its partnership with the RNOH, working together to see the RNOH become a world-leading orthopaedic hospital with the best patient care and staff experience in the NHS.

I am thrilled and delighted to be working alongside a new trustee board, including our new Chair, Dorothy Dalton. She brings extensive experience of governance and charity leadership, and I am delighted she will be leading a new dynamic group of trustees, whose broad

Our Partner

The vision for the Royal National Orthopaedic Hospital NHS Trust (RNOH) is to continuously strengthen its status as the UK’s leading specialist orthopaedic hospital, enhancing its international profile for outstanding patient care, research and education.

The RNOH Charity is independent of the RNOH. Its mission is to strengthen and support the people, research and infrastructure that make the RNOH one of the world’s best orthopaedic hospitals.

The Charity’s support and collaboration with the hospital at both the Stanmore and Bolsover Street sites, enable the RNOH’s world-class teams of clinicians and researchers to access equipment, deliver rehabilitation and pursue ground-breaking research that is changing the face of how we treat complex orthopaedic conditions.

The new building and patient facilities provide a wonderful environment for patient care and would not have been possible without the leadership shown by the RNOH Charity and the generous support of all of its donors. On behalf of the RNOH’s patients and staff, thank you so much for making it happen… The Stanmore Building is the first step in putting in place our vision for a modern Stanmore site to match the RNOH’s standing as an internatinal centre of excellence in specialist orthopaedics.

Dominic Dodd Chair of the RNOH NHS Trust

9,742 inpatients

124,173 outpatients

2020 | 21 Attendance:

106,038 outpatient attendances at the Stanmore site

17,752 outpatient attendances at the Bolsover site

383

at home or in another setting

During 2020 | 21 the RNOH provided specialist orthopaedic care to 9,742 inpatients at the Stanmore site.

Altogether, there were 124,173 outpatient attendances: 106,038 outpatient attendances at the Stanmore site, 17,752 outpatients attendances at the Bolsover street site and 383 at home or in another setting. This has been achieved through the provision of high-quality acute medical and surgical services for patients who attend our Trust from as far as Scotland, Northern Ireland and Wales.

What we do

Strategic objectives

The RNOH Charity supports the RNOH NHS Trust by raising and awarding funds to the RNOH. The Charity has set itself ambitious objectives and targets in order to fulfil its vision. They are as follows:

Enhancing the patient exerience

Our aim is to ensure that every patient has the best possible experience at the RNOH and receives outstanding care. We will work together with the hospital to identify any areas that require improvement and also undertake our own research to identify any gaps. We will endeavour to ensure that the patient journey is of the highest quality.

Improving the staff experience

We will work with the RNOH to improve staff morale, staff retention and patient satisfaction. We will work closely with the hospital to identify any root cause issues and develop a robust programme to create collaborative team working.

Creating a world-class facility

Following the success of our significant contribution to the Stanmore Building, we aim to be a key funder of equipment and RNOH developments on site in order to provide the best environment for patients and staff.

Investing in medical research

The RNOH has always been a centre of excellence for orthopaedic research and education in the UK. It has a long tradition of translational research, implant development and teaching in collaboration with University College London and other partners. We aim to provide the best facilities for musculoskeletal specialists and researchers to help strengthen the RNOH’s world-leading position.

A year in numbers

Income

Expenditure

Total grants awarded of £1,445,000 by objective:

£361,000 Donations received (major donors, ward and general donations, collections, gift aid, etc.)

£348,000 Grants received (inclusive of NHS Charities Together)

£294,000 Legacies received

£16,000 Buttercup Day

£148,000 Investment income

£10,000 Other income

£257,000 Enhancing the patient experience

£114,000 Improving the staff experience

£271,000

Investing in medical research

£690,000

Creating a world-class facility

£113,000

Activities undertaken directly (funds spent directly by wards and departments)

Income and grants awarded over the past 5 years

Income from donations, Grants awarded legacies & fundraising

Grant giving

During 2020 | 21, we awarded a total of £1,445,000 to the RNOH, including: 49 grants totalling £1,332,000, and £113,000 towards activities undertaken directly by wards and departments.

We continued to rapidly adapt our grant giving in response to the Covid-19 pandemic, providing much-needed support to the RNOH staff and patients. This year has highlighted the importance of staff experience, wellbeing and the vital role that wellbeing provision plays in the hospital’s daily life.

It has been an exceptional year and the next few pages aim to give you insight into the 2020 | 21 funding we provided, which has benefitted patients, their families and staff.

Covid-19

A cardiology ultrasound machine

The Covid-19 outbreak put unprecedented pressure on the RNOH’s clinical staff. For this reason, the RNOH Charity created a Covid-19 Emergency Appeal, to support staff and patients during the pandemic. The purpose of the appeal was to help in any way possible - from providing meals, to purchasing essential equipment items, to supporting mental health in a time of crisis.

Our charitable spend here was all-encompassing and included medical equipment, comfortable furniture to allow staff to rest, iPads for patients to keep in touch with family, food and refreshments, hand cream for all staff, items of clothing and welcome packs for patients.

Grants awarded by the Charity from the Emergency Appeal totalled £108,661. A selection of these grants is outlined here and on page 10.

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Grant amount Date awarded
£35,000 July 2020
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The Charity helped to protect the RNOH as a Covidfree hospital (aka a green site) by funding a cardiology ultrasound machine. This extraordinary new technology enables remote patient cardiac monitoring, reducing the need for patient transfer from green to non-green sites. It also provides improved governance practices, where the RNOH is able to retain patients’ echo results on site for future reference.

Patients no longer need to visit their local GP or cardiology centre prior to surgery, thereby avoiding the associated Covid-19 risks. This also reduces the need for self-isolation prior to entering a green site, meaning care can begin earlier. This has accelerated the entire patient pathway, providing an improved patient experience and ensuring that the RNOH remains a world-class facility for treatment.

Wellbeing lead

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Grant amount Date awarded
£27,500 Aug 2020
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The RNOH Charity is proud to have funded a new dedicated wellbeing post at the RNOH. The hospital’s first staff Wellbeing Lead started in January 2021.

As well as expanding the practical and psychological support on offer for all RNOH staff, the Wellbeing Lead role also held weekly interactive webinars, supporting staff to develop personal wellbeing practices, gave crisis guidance and coordinated a number of peer support groups for returning staff and frontline workers.

They also delivered mental health training, mental health signposting for individuals and designed and implemented an interim ‘long-Covid’ pathway (whilst staff wait to access long-Covid clinics, etc). Finally, a collaboration with the RNOH IT team has generated a digital wellbeing platform on MS Teams. The platform enables every staff member to have a personalised wellbeing/mental health plan and gives them access to important wellbeing information. The new role has had a significant impact, with overwhelmingly positive feedback and high participation levels from staff across the RNOH.

Listening events for staff

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Grant amount Date awarded
£22,500 Aug 2020
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The Charity funded listening events to equip the RNOH with a better understanding of the experience of Black, Asian and minority ethnic staff. Research highlights how the BAME community face conscious and unconscious discrimination, both at work and in their daily lives and how they have been disproportionately affected by the Covid-19 crisis.

The RNOH employs one of the most diverse workforces in the UK, employing 48% BAME, 2% other and 50% white people.

The listening events facilitate a safe place for people to share their experiences whilst working at the Trust. They facilitate experience sharing, but also have a focus on achieving positive outcomes and solutions. Part of this solution will take the form of a Diversity Inclusion Charter, the foundations of which are co-designed in the listening events. This Diversity Inclusion Charter is a crucial step in establishing a culture of listening, inclusivity and equality. It will provide a platform for staff to feel a sense of belonging, to feel more comfortable to share experiences, ultimately improving the wellbeing and experience of every RNOH employee.

Creating a worldclass facility

The RNOH’s first state-of-the-art SPECT-CT scanner

Enhancing the patient experience

The volunteer service and volunteer buggy service

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Grant amount Date awarded
£667,984 Oct 2020
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Grant amount Date awarded
£113,788 Nov 2020
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During the year, the Trust received the first patient to benefit from the state-of-the-art SPECT-CT scanner. Particularly effective in the fight against cancer, the machine combines the best aspects of two different types of scanning - Single Photon Emission Computed Tomography (SPECT) and computerised tomography (CT) scanning.

SPECT-CT scans have become an essential tool for effectively diagnosing and treating bone and soft tissue cancers and inflammatory infections such as septic arthritis and osteomyelitis. There is currently however, a shortage of SPECT-CT scanners across London. This saw the RNOH outsourcing patients in need of a SPECT-CT scan to University College Hospital.

The RNOH’s volunteer service, which has been fully funded by the RNOH Charity since its inception in January 2015, provides invaluable support for RNOH patients and staff. The volunteers perform several roles from supporting pre and post operative patient care, to feeding patients with limited mobility. This past year the volunteers also played a crucial role supporting the staff vaccination programme.

During the Covid-19 pandemic, the volunteering team distributed over 320 food boxes and care packages to staff throughout the hospital. They ran a message delivery service for families to contact loved ones and supported patients by being a 'relative for an hour' while there was a no-visitor policy.

Having a scanner at the RNOH reduces stress and waiting times for patients. It also means that the scan images are immediately available for assessment by RNOH clinicians, avoiding wait times of up to one month for images. As well as being significantly more convenient for patients, the instantly available images provide doctors with more accurate images for diagnosis, helping them plan complex treatments.

The volunteer service also runs the RNOH’s patient buggy service. Launched in 2016, the Charity-funded buggy service has quickly become indispensable. The dedicated team of 15 volunteer drivers have transported over 94,000 patients and their visitors. The buggy trips give huge relief for our patients with limited mobility.

"The buggy service and volunteer drivers have been a lifeline. For the first time in 4 weeks, I was able to leave the ward and make my own way to an appointment." RNOH patient 2021 "Having the volunteers help has improved staff stress levels and wellbeing immeasurably...On a practical note, the fact that we are able to capture so much patient data has also meant we are saving time having to look up data etc..."

RNOH staff member

Horatio’s Garden

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Grant amount Date awarded
£85,000 May 2020
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The majority of people with spinal cord injuries spend upwards of two months in hospital with little or no access to the outside world. Horatio’s garden provides a restorative, safe outdoor space for patients with spinal injuries to use whilst at the RNOH.

The garden, designed by eight-time Chelsea gold medal winner Tom Stuart-Smith, has been built just beyond the ward doors of the London Spinal Cord Injury Centre for patients and their loved ones to enjoy as they adjust to living with life-changing injuries, giving them the space to establish vital support networks and enjoy respite in a safe, specially equipped outdoor environment. It also provides a haven for RNOH staff who can enjoy the garden to boost their own mental wellbeing.

The RNOH Charity worked in partnership with national charity, Horatio’s Garden, to support those affected by spinal injury to create the RNOH Spinal Injury Garden.

Occupational therapy equipment

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Grant amount Date awarded
£5,000 Apr 2020
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Every year, the RNOH Charity is delighted to support the Occupational Health Department by funding aid equipment for daily living. These small pieces of equipment make a big difference to RNOH patients upon their discharge. The aids assist patients to safely maintain independence in their own homes, reducing the need for care and additional support in the community.

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“The ongoing, generous support of the RNOH
Charity has funded crucial equipment for
patients who are returning to their own homes.
This equipment means patients can live fuller,
more independent lives when they transition
back home and ensures that this transition back
home is smoother and safer”.
RNOH Occupational Therapist
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Garden image courtesy of Lucy Shergold
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Improving the staff experience

As well as providing hands-on support to hospital staff through the Volunteer Service, the RNOH Charity funds a number of different programmes designed to recognise and reward hospital staff for the exceptional work that they undertake. The annual Staff Achievement Awards is one such initiative. The Charity awarded funding towards gift vouchers for each member of staff during the Christmas period. Other similar schemes the Charity supports include travel scholarships, staff training/conference support and discounted gym membership.

Grant for acknowledging staff

Welcome packs for international nurses

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Grant amount Date awarded
£30,000 Nov 2020
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Grant amount Date awarded
£4,211 May 2020
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All RNOH staff were offered a £15 gift voucher during the Christmas period as an acknowledgment and recognition of all their hard work which was so warmly received after such a difficult year.

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“Thank you very much for this thoughtful gift
from the [RNOH] Charity. This is wonderful
- in my years of working in the NHS; to have
received a ‘thank you’ like this, I feel very
honoured”.
RNOH Service Manager
for Cancer Division and Joint
Reconstruction Unit
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The UK healthcare sector faces huge staffing shortages. The RNOH is similarly affected by these vacancies, particularly within the nursing workforce.

The hospital’s three-year Nursing Recruitment and Retention Strategy strongly depends on recruiting international nurses to reduce our vacancies. A first round of 30 nurses, recruited from abroad, has shown significant success. Experience from across various NHS Trusts has highlighted the important role that supporting and welcoming international nurses plays in their satisfaction and ultimate retention rates.

The RNOH Charity committed to supporting these nurses, providing them with essential amenities during their first month. The Charity-funded welcome support package sees all international nurses provided with essential items such as bedding, kitchen utensils, a welcome food bundle and hospital restaurant vouchers.

Investing in medical research

The delivery of research and innovation is a key component of the RNOH’s vision to be “a world leading orthopaedic hospital with the best patient care and staff experience in the NHS”.

The RNOH Charity supports ground-breaking research projects, including research into musculoskeletal as well as neuro-musculoskeletal conditions, rehabilitation, peripheral nerve injury repair, sarcoma detection and surgical treatments. Due to the Covid-19 pandemic, a number of research projects have been paused until 2022. However, the Charity was pleased to fund the following:

Therapies research and development

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Grant amount Date awarded
£21,612 May 2019
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A post-doctoral nurse to deliver research training and support to nurses

The appointment of an Associate Professor of Nursing, in partnership with London South Bank University strengthens the RNOH’s research strategy. Nurses embedded in clinical practice are in an excellent position to identify the research questions that matter to the patient or service user. Currently only 0.1% of nurses have a clinical academic profile, an important precursor to research activity.

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Grant amount Date awarded
£7,371 May 2020
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Nurse research reader post

The second year of funding for the post which is part of the broader strategy to support and foster a culture of research amongst the nursing work force. The post operates under the supervision of the Associate Professor of Nursing.
The post-doctoral nurse delivers research training and support to RNOH nurses, fostering a research culture amongst the nursing workforce, strengthening the world-class research taking place at the RNOH. The RNOH Charity is delighted that the Associate Professor of Nursing was also recently awarded one of only 70 NHS awards for her work at the Trust.

Collaborative Care in Orthopaedic Rehabilitation (CCOPER) Project

Grant amount Date awarded £92,463 Oct 2020

The CCOPER project aims to research how to best provide mental health support for RNOH patients who present with physical ailments. Despite its prevalence, mental health is poorly understood and frequently goes unrecognised in physical health settings.

One approach to improving outcomes for patients who are being treated for musculoskeletal problems and who also have mental health disorders is the Collaborative Care Model (CCM). This model identifies and addresses mental health disorders. The CCM is an innovative way of treating depression and anxiety, involving a clinician, a case manager and a mental health specialist working with a patient.

The CCM has been used successfully in patients with major depression and cancer; with major depression and diabetes; in primary care; and in the cost-effective treatment of cardiac conditions. To date, however, there is no evidence of this model being used for patients with mental health disorders co-morbid with musculoskeletal disorders.

The aim of the CCOPER study is to establish the feasibility for a randomised control trial to test the hypothesis that: the use of the CCM in an orthopaedic setting improves clinical, service and patient-related outcomes.

Stanmore Children’s Orthopaedic Outcome Project (SCOOP)

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Grant amount Date awarded
£148,483 Oct 2020
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SCOOP is working to improve the short and longerterm health of children and young adults (CYA) that are treated for orthopaedic problems at the RNOH and nationwide. Even after successful surgery or treatment, these CYA are more likely to develop long-term health problems, often due to post-treatment inactivity as they overcome the various challenges of adjusting to life post-surgery.

Restrictions in daily activity increase the risk of obesity, long-term diabetes, high blood pressure and heart disease. For example, most children do not reach recommended walking activity levels post-treatment. The associated low levels of physical activity on health lead to increased health care costs for the NHS and hospitals such as the RNOH.

SCOOP is remedying the current lack of comprehensive information about the challenges that follow successful orthopaedic treatment by developing a large dataset of outcomes for children and young adults undergoing orthopaedic treatment at the RNOH. Using body-worn activity monitors, other technology and questionnaires, the experience and clinical responses of our younger patients are mapped. The technology delivers high quality data about activity out of the hospital, enabling remote patient monitoring in home and community environments. The resulting information is crucially supporting the development of recommendations and strategies that will improve the experience of young children and adults at the RNOH and beyond.

Better information about outcomes would improve surgical practice, demonstrate the impact of orthopaedic surgery, support patients making decisions about treatment and identify patients in need of a targeted intervention to improve their outcomes.

Virtual reality treatment for neuropathic pain

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Grant amount Date awarded
£50,000 Aug 2019
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Virtual Reality Robotics support patients who suffer from neuropathic pain, phantom limb pain and chronic regional pain syndrome. Nearly 50-80% of amputees are affected by Phantom Limb Phenomenon. This has significant traumatic psychological impact on the recovery of the patient and their treatment. Nearly 60% of people who have experienced injury or trauma to the lower limbs experience neuropathic pain or chronic regional pain syndrome.

The RNOH Bionic Limb Trial - A 2020 | 21 clinical trial, using low-cost 3D printed bionic limbs for the treatment of neuropathic pain saw a 60% pain reduction overall, with 3 of 10 participants pain free. The RNOH Charity is excited to follow and support the long-term impact from the trial and the potential to save millions of pounds for the NHS by using this drug-free approach to neuropathic pain.

Fundraising

We continue to benefit greatly from the efforts of our supporters, donors and volunteers, whose generosity has such a significant impact and for which we are extremely grateful.

The Charity’s fundraising income for 2020 | 21 totalled £1,019,000 and fundraising expenditure amounted to £221,000. Key income sources during 2020 | 21 were: individual and major donors; grant-making trusts; general donations and legacies.

Trusts and Foundations (including NHS Charities Together) Major donors

Legacy donations

General donations, ward donations, collections, gift aid, etc.

Buttercup Day

Covid-19 Emergency Appeal

In March 2020, to help relieve pressure that the NHS was facing from the pandemic, the RNOH became an orthopaedic trauma centre for the first time since 1982.

The Charity immediately launched a dedicated Covid-19 Appeal to help the RNOH’s frontline staff in any way possible – from providing meals , to purchasing essential equipment, to supporting mental health during the crisis.

Thanks to generous donations a total of £235,597 was raised, including grants from NHS Charities Together and gifts-in-kind.

We were overwhelmed by the response to our appeal for gifts-in-kind. Our diverse supporter base, including individuals and local and national businesses, gave generously. Gifts ranged from clothing and food items, to toiletries and appliances, all of which made a significant difference to the RNOH staff.

Major gifts

The RNOH Charity received a £170,000 in gifts from major donors. These gifts contributed to projects including the SPECT-CT scanner and Horatio’s Garden.

Grant-making trusts

We received a total of £348,000 from grant-making trusts, including £195,000 from NHS Charities Together, to support our Covid-19 response. These grants contributed towards the creation of a sensory room for adolescent patients in the hospital’s Children and Young People’s Ward, and part-funded the purchase of the hospital’s new SPECT-CT scanner.

The Buttercup Collection

Buttercups have long been an emblem of hope and optimism at the RNOH. Due to the pandemic, the RNOH Charity was not able to run its usual Buttercup Day. Instead, in October 2020, our Patron, HRH Princess Eugenie of York helped launch a limited collection of beautiful, hand-crafted porcelain buttercups to support staff and patients at the RNOH, which treated her for scoliosis when she was a child.

Designed by artist Clare Twomey, each porcelain flower in The Buttercup Collection is unique. Handmade in workshops with members of Clare’s studio, alongside staff and patients from the RNOH, these ceramic buttercups are an exquisite symbol of both fragility and freedom.

Priced at £45 the buttercups can be purchased at www.thebuttercupcollection.co.uk . The Buttercup Collection and associated activities raised £16,000.

Legacies

Since the establishment of the RNOH, gifts left in people’s wills have been a vital part of funding. This year we gratefully received £294,000 through legacies.

Fundraisers

The Charity is supported by a dedicated group of supporters, many of whom are former patients themselves. These are just two examples of our incredible fundraisers who supported us this year.

Nine-year-old Isla set up her own challenge during the national lockdown and shaved her head to raise money for the RNOH Charity. Isla chose to support the RNOH Charity after her mum, Faye, was involved in a road traffic accident in 2006. Faye was referred to the RNOH for extensive work on her right arm after severing her radial nerve and suffering a brachial plexus injury. She has been a patient at the RNOH ever since. Isla raised over £600 for the RNOH Charity.

Chloe Oram spent several months at the RNOH being treated for a spinal cord injury.

After being discharged, Chloe took part in the Goodwood Motor Circuit wheeling 5k in her wheelchair to raise £2,834 towards the RNOH's spinal cord injury centre.

Future plans

Following the Trust’s announcement of its visionary plans, now more than ever our fundraising ambitions are vitally important. We aim to raise £5 million from fundraising income in 3 years and £10 million in 5-7 years to strengthen and support the ambitious plans of the RNOH and build on the foundations laid out during 2020 | 21.

We will focus on developing the Charity’s infrastructure and aim to develop sustainable income over the coming years in order to deliver our key strategic objectives.

Patient wellbeing and transforming the patient experience

The redevelopment of Ensuring the RNOH Funding the RNOH Estate has the start-of-the-art transformational equipment needed to clincal research continue providing worldclass treatment

Furthermore, our funding priorities include:

Independent Living Unit

The Independent Living Unit will play an integral role in the rehabilitation of patients who have suffered a lifechanging injury such as spinal cord damage.

The unit will enable the medical staff to replicate all potential ‘home situations’ within the relative safety of the hospital grounds. Patients will be able to practice and train in self-care and domestic tasks, such as washing, dressing, eating, drinking, and housekeeping.

Patients’ loved ones will also be able to stay in the Independent Living Unit while they receive treatment. This, and the respite the unit will provide from the noise and busyness of the ward environment, will be extremely important for the morale of patients, many of whom will have been staying in the hospital’s spinal cord injury centre for several months.

Estimated project cost - £1.1 million

This significantly improves the quality of life people are able to have and their ability to live independently after they are discharged and return home. In many cases it also affords patients’ family members the opportunity to prepare for their new role as the patient’s carer.

EOS scanner

EOS is a medical imaging system that provides very low radiation dose scans with simultaneous frontal and lateral X-ray enhanced images. EOS can scan a patient’s whole body, in both standing and seated positions, giving doctors real functional information about the positions in which patients live and perform most of their daily activities.

Many of the RNOH’s young patients require frequent imaging to monitor the progression of complex musculoskeletal conditions. For example, in the treatment of scoliosis, multiple standard X-rays are needed. This increases a child’s life-long radiation exposure. EOS can effectively replace standard X-rays in these cases and can thereby significantly reduce any risks associated with radiation exposure over the child’s lifetime.

The scanner would also be used for patients requiring hip replacement and reconstruction, as it is the only device that allows clinicians to fully understand the relationship between spine, pelvis and hip in both sitting and standing positions.

EOS scans are extremely quick: the speed of the scan, coupled with the fact that patients can stand up in the scanner, minimises the claustrophobia many people experience when lying in a CT or MRI scanner.

With our supporters’ help, the RNOH Charity hopes to have an EOS scanner installed at the RNOH by the end of 2022.

Estimated project cost - £800,000 (Scanner and installation costs)

Staff welfare

Over the past 9 months, the Wellbeing Lead has laid the foundations for a culture that prioritises and comprehensively supports the wellbeing of all RNOH staff. Looking to the future, the Charity will continue to support the Wellbeing Programme as it looks to utilise opportunities afforded by the digital wellbeing platform. The programme will not only prioritise individual support on site, but marks the beginning of a digital opportunity, one that can support staff working both on and off site.

Estimated project cost - £100,000

Financial review

Overview

Expenditure

The Charity has delivered a sound performance during a challenging economic, political and social climate. Net assets at 31 March 2021 are £4.2m (FY2019 | 20 £3.9m), a £0.3m increase.

This is largely due to unrealised investments gains of £0.7m (2019 | 20 losses of £0.1m), which partially offset net expenditure for the year of £0.4m.

The net expenditure for the year is the result of the Charity actively promoting grant giving to utilise restricted funds.

Income

Total income in 2020 | 21, including fundraising and investment income, was £1.2m (2019 | 20 £0.8m). The increase from the prior year was driven by more significant legacy income and grants from NHS Charities Together, in response to the Covid-19 pandemic.

Continuing to generate sustainable fundraising income and supporter acquisition is vitally important to realise the Charity’s future ambitions.

Expenditure during 2020 | 21 amounted to £1.6m (2019 | 20 £0.4m), £1.2m higher than the previous year. This was driven by an increase in the annual grant programme of £1.1m, with grants and direct ward/ department expenditure totalling £1.4m (2019 | 20 £0.3m).

The cost of raising funds remains relatively consistent year on year at 0.2m.

Investment performance

The Charity hold an investment portfolio valued at £4.8 million at 31 March 2021 with CCLA Investment Management Limited who follow strict guidelines in accordance with the Charity’s moral and ethical policy.

During the year the investment portfolio generated dividends of £0.15m, an average gross income yield of 3.2%.

The net revaluation gain on investments was £0.72m (2019 | 20 loss of £0.13m).

5 year investment performance

Composite benchmark used by CCLA Investment Management Limited.

Investment Policy

The Charity Board of Trustees understands the trade-off between risk and return in its consideration regarding investments and favours a low risk approach. The Board has delegated investment decisions to the Finance and Audit Committee; the Committee is completely accountable to the Board and must report on a quarterly basis. The Board agrees that short-term capital preservation should be the priority for the funds set aside for the redevelopment and investment of funds needs to be cautious and proactively managed. The Board has agreed that its Investment Policy should:

Achieve above-inflation returns allowing for low risk tolerance
Receive a higher rate of return on cash deposits than the current 1% p.a
Reinvest income ensuring 15%-20% of funds can be realised within 3-6 months
Preclude direct or indirect investment in companies that trade in alcohol, tobacco or on-line gambling

The Charity appointed a professional investment management firm, CCLA Investment Management Limited, to manage the assets on a discretionary basis, in line with this investment policy. CCLA provides the following information on a regular basis:

Valuation of investments
Transaction reports
Performance analysis
Commentary

The Finance and Audit Committee has responsibility for recommending strategy and monitoring the investment assets. The Committee will review the information provided by the investment company at each quarterly meeting. The investment company will be required to present in person to the committee on a six/twelve monthly basis. Investment performance will be measured against agreed performance benchmarks. The level of capital volatility will be monitored to ensure the risk profile remains appropriate for the Charity.

Investment review

Following a rigorous review and tender process during July 2021, the management of the portfolio has been designated to Cazenove Capital to be invested in the Cazenove Charity Responsible Multi-Asset Fund.

This is an actively-managed investment fund which incorporates Environmental, Social and Governance views as part of their investment process. The Fund has a responsible investment policy and aims to have a positive impact across environmental, social, and governance factors whilst meeting short and long-term criteria on liquidity, risk and return.

As part of this review the long term investment objectives and risk/return targets were considered. Looking ahead, a priority will include amending our investment policy to incorporate this and also to formally document the factors which are already being considered in relation to ESG.

Reserves

As part of effective financial management, we hold reserves to ensure we can manage:

Financial impact of risk. There are a range of risks we face, including the risk of an unforeseen drop in income as well as a reduction in the value of our investments.

Working capital. A significant proportion of our reserves are represented by investments and therefore we need to ensure we retain sufficient working capital to be able to meet approved grants given to the RNOH as well as guarantee that operations can continue over the short term and commitments can be met.

The Trustee Board believes it is prudent to hold a level of free reserves to enable the Charity to take advantage of opportunities as they present themselves and to have sufficient working capital to support the fundraising, administration and governance operations of the Charity. This will allow the Charity to respond in a considered way to an adverse change in circumstances, giving sufficient time to enable emerging circumstances to be assessed and appropriate plans developed and implemented, without requiring a crisis response.

Having carefully considered the best interests of the Charity and its beneficiaries the Trustee Board believes it appropriate to aim to hold at least £350k unrestricted reserves. This is made up of c. £150k to meet the annual operating expense of the Charity, £50k to meet the requirement of recurring grants and c. £150k is the Trustee Board’s best estimate of the amount which should be held for both known non-recurring grants as well as potential future (but as yet unknown) opportunities.

Any free reserves held by the Charity over and above this amount which are not expected to be used in the short term will be made available by the Trustee Board for grants to benefit the patients of the RNOH.

If free reserves fall below this level the Trustee Board will consider whether this is due to short term circumstances or a longer-term reason and will review its expenditure and fundraising plans accordingly.

The Board formerly reviews the reserves policy annually and the reserve level quarterly to ensure that the arrangements continue to be appropriate.

As at 31 March 2021 the Charity held unrestricted reserves of £549k. Whilst this exceeds the minimum level noted above, the Trustee Board continues to monitor potential funding commitments and fundraising income projections accordingly.

Going concern

The Trustees have reviewed the financial position of the Charity, including its forecast cash flows, liquidity position and existing and potential funding commitments for the forthcoming year. Budget and forecast projections are considered on a fund by fund basis to ensure that adequate unrestricted funds remain.

The Charity will only commit to charitable activities and any other major projects as long as it is confident that it is able to meet its obligations. The Trustees believe that there are adequate resources to continue in operation for the foreseeable future, for a period of at least 12 months from the approval of the financial statements, and that it is appropriate to continue to adopt the going concern basis of accounting when preparing its annual report and financial statements.

Governance

Constitution

The Trustees derive their authority, powers and scope from its Constitution duly created when the Charity became a Charitable Incorporated Organisation (CIO) that is fully independent from NHS legislation (registered charity number 1166129). The objects of the CIO are for the public benefit to advance any charitable purpose or purposes relating to: the general or specific purposes of the Royal National Orthopaedic Hospital NHS Trust or its successor from time to time; or any other part of the national health service associated with the Royal National Orthopaedic Hospital.

The Trustees

The Charity currently has nine Trustees to oversee the governance arrangements. The Board normally meets quarterly with two additional away days per year for strategy and planning. There is a Finance and Audit Committee and a Grants Committee which normally meet quarterly. The Charity is managed on a day to day basis by the Chief Executive. To facilitate operations, the Trustees have delegated day to day activities for operational matters including fundraising, finance and operations to the Chief Executive.

Appointment, induction and training of Trustees

Trustees are recruited via an external recruitment agency. New Trustees undergo a period of induction organised by the Charity and include training on charity finances and grant giving. As well as the induction, Trustees are briefed on their duties and legal obligation under charity law, the Charity’s governing document, any related Charity Commission guidance, the Charity’s latest activity, future plans and recent financial performance. New Trustees will also meet key employees, Executive Directors of the RNOH and key clinicians.

Related parties and co-operation with other organisations

None of the Charity Trustees received remuneration or other benefit from their work with the Charity. Any related party transactions are disclosed on an annual basis as well as any conflicts of interests.

Further details of related party transactions are detailed in note 14.1 of the financial statements.

Equality, diversity and inclusion

grading and pay structure.

RNOH Charity wholeheartedly supports the principles of equality, diversity and inclusion in employment. We aim to create, value and encourage diversity and we recognise that talent and potential are distributed across the population. Not only are there moral and social reasons for promoting equality of opportunity, it is in the best interest of this Charity to recruit and develop the best people for our jobs from as wide and diverse a pool of talent as possible.

A comprehensive policy is in place which demonstrates our commitment to challenge and eliminate discrimination and to promote equality and diversity amongst our workforce and Trustees.

Pay policy

Having a consistent and robust, gender-neutral method for assessing and comparing the value of different jobs is vital to achieving equal pay. Our remuneration policy aims to provide a fair basis for the Charity to operate its

The Finance and Audit Committee routinely review the remuneration policy, the remuneration ratio and provide scrutiny to remuneration decisions.

Salaries are benchmarked prior to appointment against relevant sectors or the wider not-for-profit sector and then every three years thereafter.

The Charity also reviews salaries on an annual basis, in light of relevant market indices, to establish whether an annual incremental increase is appropriate.

Risk management

The risk register is designed to identify the key risks and existing controls and allocates a current score based on the impact and likelihood of each risk causing a loss to the Charity.

The key risks identified are summarised in the table below:

Risk	Risk summary	Mitigation
	• Inability to meet existing
	commitments from appropriate fund.	• Regular review of reserves policy and reserves
Liquidity risk	• Lack of liquidity to respond to emerging needs or to cover variance in budgeted costs.	level. • Detailed cash fow projections by fund type. • Regular review of restricted funds and spend
	• Being a forced seller of investment	allocation by fund.
	assets in times of volatility.
	• Funds applied outside of donor-
Restriction compliance	imposed restriction. • Impact on relationship with donors and Charity reputation.	• Transaction capture and fnancial reporting at a fund level. • Maintenance of restricted fund purposes record.
	• Regulatory implications.
Fundraising income volatility	• Loss of key income source. • Competition for funds.	• Identify major dependencies and consider diversifcation plans.
Operational risk of Covid-19	• The impact of Covid-19 on the Charity’s operations and ability to fundraise. • Impact on grant delivery within the RNOH as priorities reassessed.	• Successful transition to remote working and ongoing review to safeguard the Charity’s workforce and benefciaries. • Post grant award monitoring procedures.
	• Small Charity team resulting in	• Growing the charity team and training to ensure
Key	over-reliance on key management	appropriate cover for key processes/roles.
person	personnel.	• Build on existing relationships with senior
risk	• Loss of a key contact within the	management team, senior clinicians and research
	RNOH Trust.	teams.

Fundraising governance

The charitable sector has been under particular scrutiny over its approach to raising funds and communicating with potential supporters. We are aware of the need to protect vulnerable persons in any fundraising we undertake and are continually taking steps to ensure our fundraising approach takes this into account. We continually review our methods of fundraising and communications to ensure that our approaches are appropriate, that we provide our supporters with the very best donor care and that we are compliant with both best practice and legislation.

Public benefit

The Charity confirms that the Trustees have complied with their duty to have due regard to the guidance on public benefit requirement published by the Charity Commission under the Charities Act 2011 in exercising its powers or duties.

The fundraising work of the Charity builds upon the grant giving, providing the RNOH NHS Trust with additional resources and support enabling a higher standard of patient care to members of the public attending the hospital.

We are a member of the Fundraising Regulator and fully comply with all relevant laws including the Data Protection Act 1998, the General Data Protection Regulation, and the Privacy and Communications Regulations 2003. We also screen against the Fundraising Preference Service.

We always strive for best practice in our fundraising and take complaints very seriously. Between 1 April 2020 and 31 March 2021, we received no complaints about fundraising activity undertaken by the Charity.

Statement of Trustees' Responsibilities

The Trustees are responsible for preparing the Trustees’ Annual Report and the financial statements in accordance with applicable law and regulations. Charity law requires the Trustees to prepare financial statements for each financial year.

Under that law they are required to prepare the financial statements in accordance with UK Accounting Standards and applicable law (UK Generally Accepted Accounting Practice), including FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland. Under charity law the Trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of affairs of the Charity and of the excess of expenditure over income for that year.

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

select suitable accounting policies and then apply them consistently;
make judgements 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; and,
prepare the financial statements on the going concern basis unless it is inappropriate to presume that the Charity will continue its activities.

The Trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the Charity’s transactions and disclose with reasonable accuracy at any time the financial position of the Charity and enable them to ensure that the financial statements comply with the Charities Act 2011. They have general responsibility for taking such steps as are reasonably open to them to safeguard the assets of the Charity and to prevent and detect fraud and other irregularities. The Trustees are responsible for the maintenance and integrity of the corporate and financial information included on the Charity’s website. Legislation in the UK governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.

In addition, the Trustees confirm that they are satisfied that the content of the annual review in pages 1 to 21 of this document meet the requirements of the Trustees’ Annual Report under charity law. They also confirm that the financial statements have been prepared in accordance with the accounting policies set out in the notes to the accounts and comply with the Charity’s governing document, the Charities Act 2011 and Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with FRS 102, The Financial Reporting Standard applicable in the UK and Republic of Ireland published on 16 July 2014.

Each of the persons who is a Trustee at the date of approval of this report confirms that:

so far as the Trustee is aware, there is no relevant audit information of which the Charity’s auditors are
unaware; and,
the Trustee has taken all the steps he/ she ought to have taken as a Trustee to make himself/herself aware of
any relevant audit information and to establish that the Charity’s auditors are aware of that information.

This report was approved and authorised for issue by the Board of Trustees on 30/11/2021 and signed on its behalf by:

Dorothy Dalton Chair

Date: 30/11/2021

Independent Auditor's report to the Trustees of the Royal National Orthopaedic Hospital Charity

Opinion

We have audited the financial statements of Royal National Orthopaedic Hospital Charity for the year ended 31 March 2021 which comprise the Statement of Financial Activities, the Balance Sheet, the Statement of Cash Flows and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including FRS 102 ‘The Financial Reporting Standard Applicable in the UK and Republic of Ireland’ (United Kingdom Generally Accepted Accounting Practice).

In our opinion the financial statements:

give a true and fair view of the state of the charity’s affairs as at 31 March 2021, and of its incoming resources and application of resources, for the year then ended;
have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and
have been prepared in accordance with the requirements of the Charities Act 2011.

Basis for opinion

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

Conclusions relating to going concern

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

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

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

Other information

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

Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.

We have nothing to report in this regard.

Matters on which we are required to report by exception

We have nothing to report in respect of the following matters where the Charities Act 2011 requires us to report to you if, in our opinion:

the information given in the Trustees’ Annual Report is inconsistent in any material respect with the financial statements; or
the charity has not kept adequate accounting records; or
the financial statements are not in agreement with the accounting records and returns; or
we have not received all the information and explanations we required for our audit.

Responsibilities of trustees

As explained more fully in the trustees’ responsibilities statement set out on page 27, the trustees are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the trustees determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

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

Auditor’s responsibilities for the audit of the financial statements

We have been appointed as auditor under section 144 of the Charities Act 2011 and report in accordance with regulations made under section 154 of that Act.

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

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

Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control.
Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purposes of expressing an opinion on the effectiveness of the charity’s internal control.
Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the trustees.

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

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

Explanation as to what extent the audit was considered capable of detecting irregularities, including fraud

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

The objectives of our audit in respect of fraud, are; to identify and assess the risks of material misstatement of the financial statements due to fraud; to obtain sufficient appropriate audit evidence regarding the assessed risks of material misstatement due to fraud, through designing and implementing appropriate responses to those assessed risks; and to respond appropriately to instances of fraud or suspected fraud identified during the audit. However, the primary responsibility for the prevention and detection of fraud rests with both management and those charged with governance of the charity.

Our approach was as follows:

We obtained an understanding of the legal and regulatory requirements applicable to the charity and considered that the most significant are the Charities Act 2011, the Charity SORP, and UK financial reporting standards as issued by the Financial Reporting Council.
We obtained an understanding of how the charity complies with these requirements by discussions with management and those charged with governance.
We assessed the risk of material misstatement of the financial statements, including the risk of material misstatement due to fraud and how it might occur, by holding discussions with management and those charged with governance.
We inquired of management and those charged with governance as to any known instances of non-compliance or suspected non-compliance with laws and regulations.
Based on this understanding, we designed specific appropriate audit procedures to identify instances of noncompliance with laws and regulations. This included making enquiries of management and those charged with governance and obtaining additional corroborative evidence as required.

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

Use of our report

This report is made solely to the charity's trustees, as a body, in accordance with Chapter 3 of Part 8 of the Charities Act 2011. Our audit work has been undertaken so that we might state to the charity’s trustees those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to any party other than the charity and charity's trustees as a body, for our audit work, for this report, or for the opinion we have formed.

Luke Holt (Senior Statutory Auditor) for and on behalf of Moore Kingston Smith LLP, Statutory Auditor

Devonshire House 60 Goswell Road London EC1M 7AD

Date: 03/12/2021

Statement of Financial Activities for the year ended 31 March 2021

		Unrestricted	Restricted	2021	Unrestricted	Restricted	2020
		funds	funds	Total	funds	funds	Total
	Notes	£’000	£’000	£’000	£’000	£’000	£’000
Income
Donations and legacies	2.1	376	627	1,003	24	547	571
Fundraising events		16	-	16	22	1	23
Investment income	3.1	19	129	148	22	133	155
Other activities	3.2	-	10	10	-	24	24
Total income		411	766	1,177	68	705	773
Expenditure
Cost of raising funds	4.1	-	221	221	-	201	201
Expenditure on charitable activities	5.1	259	1,162	1,421	227	(36)	191
Total expenditure		259	1,383	1,642	227	165	392
Net gains / (losses) on investments	8.1	72	651	723	6	(136)	(130)
Net income/(expenditure)		224	34	258	(153)	404	251
Transfer between funds	11.1	74	(74)	-	-	-	-
Net movement in funds		298	(40)	258	(153)	404	251
Reconciliation of Funds
Funds brought forward at 01 April		251	3,682	3,933	404	3,278	3,682
Funds carried forward at 31 March		549	3,642	4,191	251	3,682	3,933

During the year, no operations have been either discontinued or acquired by RNOH Charity.

The notes on pages 35 to 47 form part of these accounts.

Balance Sheet as at 31 March 2021

		Unrestricted	Restricted	2021	2020
		funds	funds	Total	Total
	Notes	£’000	£’000	£’000	£’000
Fixed assets
Investments	8.1	985	3,842	4,827	4,500
Debtors non-current	9.1	-	18	18	55
Total fxed assets		985	3,860	4,845	4,555
Current assets
Debtors - current	9.1	23	166	189	123
Cash at bank and in hand		6	40	46	62
Total current assets		29	206	235	185
Creditors: amounts falling	10.1	(373)	(424)	(797)	(807)
due within one year
Net current liabilities		(344)	(218)	(562)	(622)
Total assets less current liabilities		641	3,642	4,283	3,933
Creditors: amounts falling due after more than one year	10.2	(92)	-	(92)	-
Net assets		549	3,642	4,191	3,933
Reserves
Unrestricted funds	11.1	549	-	549	251
Restricted funds	11.1	-	3,642	3,642	3,682
Total funds		549	3,642	4,191	3,933
The notes on pages 35 to 47 form part of these accounts.

Approved and authorised by the Trustees and are signed on their behalf by:

Dorothy Dalton Chair Date: 30/11/2021

Matthew Lee Trustee Date: 30/11/2021

Cash Flow Statement for the year ended 31 March 2021

Cash Flow Statement for the year ended 31 March 2021
Cash fows from operating activities: Net cash used in operating activities Cash fows from investing activities: Income from investments Receipts from sale of investment assets Payments to acquire investment assets Net cash provided by investing activities Change in cash and cash equivalents in the reporting year Cash and cash equivalents at the beginning of the reporting year Cash and cash equivalents at the end of the reporting year Reconciliation of net cash used in operating activities Net income for the period Adjustments for: Losses/(gains) on revaluation of investment assets Investment income Decrease in debtors Increase / (decrease) in creditors Cash (outfow) from operating activities Analysis of cash and cash equivalents and net debts Cash at bank and in hand Opening balance Cash-fows Closing balance	2021 2020 Total Total £’000 £’000 (460) (374) 148 155 445 421 (149) (269)
	444 307
	(16) (67) 62 129
	46 62
	258 251 (723) 130 (148) (155) 71 76 82 (676)
	(460) (374)
	62 129 (16) (67)
	46 62

Accounting policies

1.1 Basis of preparation

These financial statements have been prepared under the historic cost convention, with the exception of investments which are included at market value.

The financial statements have been prepared in accordance with 'Charities SORP (FRS 102) - Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) second edition (effective 1 January 2019)', the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102), including Update Bulletin 2 and relevant charity law.

RNOH Charity is a charitable incorporated organisation registered in Engand & Wales. The Charity constitutes a public benefit entity as defined by FRS 102.

The financial statements are prepared in sterling, which is the functional currency of the Charity, and monetary amounts are rounded to the nearest thousand pounds.

The significant accounting policies applied in the preparation of these financial statements are set out below. These policies have been consistently applied to all years presented unless otherwise stated.

1.2 Going concern basis

The Trustees have considered the Charity’s forecasts and projections and have concluded that there is a reasonable expectation that the Charity has adequate resources to continue in operation for the foreseeable future.

Whilst the Charity’s investment portfolio is susceptible to movements in investment values, it still has sufficient liquidity through existing cash facilities to meet its grant commitment obligations. The Charity therefore continues to adopt the going concern basis in preparing the financial statements.

The Trustees have assessed whether the use of the going concern basis is appropriate and have considered possible events or conditions that might cast significant doubt on the ability of the Charity to continue as a going concern. The Trustees have made this assessment for a period of at least one year from the date of approval of the financial statements.

1.3 Income

a) Recognition

All income is included in full in the Statement of Financial Activities as soon as the following three factors can be met:
i) Entitlement – arises when a particular resource is receivable or control over the right to economic benefit has passed to the Charity.
ii) Probable – it is more likely than not that the economic benefits associated with the transaction will flow to the Charity;
iii) Measurement – when the monetary value of the incoming resources can be measured with sufficient reliability.

b) Donated services and facilities

In 2020 | 21 gifts were received to provide support to NHS staff and patients. The Charity also receives

IT support and the use of office facilities from the RNOH free of charge. In both cases the amount at

which gifts in kind are brought into account is a reasonable estimate of their market value and the amount which the Charity would be prepared to pay for the service.

1.4 Expenditure

All expenditure is accounted for on an accruals basis. All expenditure is recognised once there is a legal or constructive obligation to make a payment to a third party.

Where possible, all costs are directly attributed to an expenditure category.

a) Cost of raising funds

The costs of raising funds are the costs associated with generating income for RNOH Charity.

b) Expenditure on charitable activities

This includes grants payable and other directly associated support costs. Grants payable are primarily

payments to RNOH, in furtherance of the Charity’s objectives. Grants are accounted

for on an accruals basis where the conditions for their payment have been met or where a third party has a reasonable expectation that they will receive the grant and where the liability can be reasonably quantified.

c) Support costs

Support costs, which include governance costs, that relate to more than one expenditure category are apportioned based on representing activities.

d) Irrecoverable VAT

Irrecoverable VAT is charged against the expenditure category for which it was incurred.

1.5 Fund structure

Restricted funds are those for which a legal restriction exists over its use and related income is restricted to the purpose of the fund.

Unrestricted funds and their related income are available for use at the discretion of the Trustees for general charitable purposes.

The major funds held within these categories are disclosed in note 11.1.

1.6 Pension contributions

The cost of employer contributions to the NHS Pension Scheme and the Defined Contribution Scheme, is charged to the Statement of Financial Activities.

Certain past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of benefits payable under these provisions can be found on the NHS Pensions website (www.nhsbsa.nhs. uk/nhs-pensions). The Scheme is an unfunded, defined benefit scheme, preparing its own statements, that covers NHS employers, general practices and other bodies allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying Scheme assets and liabilities. Therefore, the Scheme is accounted for as if it were a defined contributions scheme: the cost to an NHS body of participating in the Scheme is taken as equal to the contributions payable to the Scheme.

Applicable rates for employee contributions for the NHS Pension Scheme ranged from 7.1% to 13.5% for 2020 | 21 and 2019 | 20. Employer contributions were 14.38% for both 2020 | 21 and 2019 | 20.

Employees employed after 2018 can choose to belong to a Defined Contribution Work Place Pension Scheme. Applicable rates for both employee and employer contributions were 5% (2019 | 20 5% and 5% respectively).

1.7 Investments

Investments are stated at market value as the balance sheet date and asset purchases and sales are recognised at the date of trade. Unrealised and realised gains and losses on investment assets are recorded in the Statement of Financial Activities as they arise.

1.8 Financial instruments

The Charity only has financial assets and financial liabilities of a kind that qualify as basic financial instruments. Basic financial instruments are initially recognised at transaction value and subsequently measured at their settlement value.

1.9 Cash and cash equivalents

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

1.10 Taxation

As a registered charity, income and gains are exempt from Corporation Tax to the extent that they are applied to the charitable objects of the charity.

1.11 Critical accounting estimates and areas of judgement

In preparing financial statements it is necessary to make certain judgements and assumptions that affect the amount recognised in the financial statements.

Accounting estimates and judgements are continually evaluated and are based on historical experience and other factors, including expectations of future events that are believed to be reasonable under the circumstances.

The key judgements and estimates are:

a) Allocation of income, expense and gain/loss to unrestricted and restricted funds
In preparing the financial statements judgements and estimates have been made in relation to the extent of allocation to the funds.
b) Grant creditors settled over multi-year time period
Some grant commitments will settled over multiple financial years and so the short term and long term
grant creditor balances represent the best estimate of the expected cash outflows at the balance sheet date.
c) Donated services and facilities
Judgements and estimates have been made in relation to the market value of donated services and facilities.

facilities.
2.1 Income from donations and legacies
	Unrestricted	Restricted	Total Funds	Total Funds
	funds	funds	2021	2020
	£’000	£’000	£’000	£’000
Donations and grants	73	412	485	548
Legacies	289	5	294	23
Gifts in kind	14	15	29	-
NHS Charities Together Grants	-	195	195	-
	376	627	1,003	571

Legacy income in 2020 | 21 included 2 substantial legacies, there were none of a similar value in 2019 | 20.

Gifts in kind include £15k in relation to the Covid-19 Emergency Appeal and £14k of donated services and facilities from the RNOH.

See note 1.3b for further information.

NHS Charities Together Grant funding relates to the Covid-19 Emergency Appeal Grant Scheme for enhancing the wellbeing of NHS staff, volunteers and patients as part of the Charity's Covid-19 response.

3.1 Investment income

3.1Investment income
	Unrestricted	RestrictedTotal Funds		Total Funds
	funds	funds	2021	2020
	£’000	£’000	£’000	£’000
CCLA interest	-	-	-	3
CCLA dividend	19	129	148	151
Barclays interest	-	-	-	1
	19	129	148	155

3.2 Other activities

3.2Other activities
	Unrestricted	Restricted	Total Funds	Total Funds
	funds	funds	2021	2020
	£’000	£’000	£’000	£’000
Course fees	-	10	10	24

4.1 Cost of raising funds

4.1 Cost of raising funds
	Unrestricted	RestrictedTotal Funds		Unrestricted	Restricted	Total Funds
	funds	funds	2021	funds	funds	2020
	£’000	£’000	£’000	£’000	£’000	£’000
Staff costs	-	133	133	-	131	131
Other direct costs	-	61	61	-	70	70
Apportionment of overheads	-	27	27	-	-	-
	-	221	221	-	201	201

5.1 Expenditure on charitable activities

	Unrestricted	Restricted	Total Funds	Unrestricted	Restricted	Total Funds
	funds	funds	2021	funds	funds	2020
	£’000	£’000	£’000	£’000	£’000	£’000
Grant funded activity	300	1,032	1,332	133	29	162
Activities undertaken directly	-	113	113	55	165	220
Total grant programme	300	1,145	1,445	188	194	382
Grants undrawn, written back or returned	(105)	(98)	(203)	(60)	(395)	(455)
Total grant programme	195	1,047	1,242	128	(201)	(73)
after reversal of prior years' grants
Staff costs	29	50	79	82	98	180
Other direct costs	24	21	45	-	-	-
Apportionment of overheads	11	44	55	17	67	84
Net grant expenditure	259	1,162	1,421	227	(36)	191

Grant funded activity includes £557k of grants awarded in year, where the Trustees have committed to expenditure and costs are expected to fall due largely within the next financial year (see note 10.3).

In addition, £775k of grants were paid in year to fund the SPECT-CT scanner, Horatio's garden and children's sensory equipment.

Grants undrawn, written back or returned reflect underspend across various projects. Although RNOH Charity maintains regular contact with grantholders, there are occasions where planned expenditure is not achievable and the related grant commitment is reversed.

5.2 Total grant programme summary

5.2 Total grant programme summary
	Unrestricted	Restricted	Total Funds
	funds	funds	2021
	£’000	£’000	£’000
Improving the staff experience
Wellbeing lead	-	28	28
Listening Events	-	23	23
Staff acknowledgement	30	-	30
Other grants	17	16	33
Activities undertaken directly	-	21	21
Total	47	88	135
Enhancing the patient experience
Volunteer Service	114	-	114
Horatio's Garden	-	85	85
Cardiology ultrasound machine	-	35	35
Other grants	13	10	23
Activities undertaken directly	-	2	2
Total	127	132	259
Investing in medical research
Stanmore Children's Orthopaedic Outcome Project (SCOOP)	91	57	148
CCOPER Project 2020	35	58	93
Other grants	-	30	30
Activities undertaken directly	-	53	53
Total	126	198	324
Creating a world-class facility
SPECT-CT scanner	-	668	668
Children's sensory equipment	-	22	22
Activities undertaken directly	-	37	37
Total	-	727	727
Total grant programme	300	1,145	1,445

6.1 Cost allocation

During 2020 | 21 the Charity updated the support cost allocation methodology and so this is not directly comparable to that of 2019 | 20.

Where possible, costs have been directly allocated to one of the above categories.

The remainder, relating to general office costs and governance costs, have been allocated based on represented activities.

Apportioned overheads include governance costs of £21.6k (2019 | 20 £35.9k) which includes external audit fees of £8.7k (2019 | 20 £8.0k).

7.1 Analysis of staff costs

7.1Analysis of staff costs
Salaries and wages Redundancy costs Social security costs Pension costs Total Average number of full time equivalents Average head count	2021 2020 Total Total £’000 £’000 175 199 - 63 14 22 23 27
	212 311
	4 4 6 6

7.2 Pension contributions for higher paid employees

The following pension contributions were made for employees within the annual emolument ranges indicated:

			Value of	Number of
			contributions	staff receiving
			£’000	contributions
80,001	to	90,000	12	1

7.3 Higher paid employees

The following number of employees received emoluments falling within the ranges indicated:

	2021	2020
80,001 to 90,000	1	1
100,001 to 110,000	0	1

Key management personnel received aggregate employee benefits of £105k (2019 | 20 £222k).

8.1 Fixed asset investments

8.1 Fixed asset investments
		Common
	Common	Investment	Property	2021	2020
deposit fund		fund	fund	£'000	£'000
	£’000	£’000	£’000	Total	Total
Market Value at 1 April	441	3,550	509	4,500	4,782
Net gain/(loss) on revaluation during the year	-	734	(11)	723	(130)
Additions	149	-	-	149	269
Disposals	(545)	-	-	(545)	(421)
Market Value at 31 March	45	4,284	498	4,827	4,500
The historical cost of the investment as at 31 March 2021 was £4,037k (2020			£4,037k).
The net gain on revaluation comprised unrealised gains only.

9.1 Debtors

9.1Debtors
Non-current Other debtors Current Other debtors Cash in transit Prepayments Accrued income	2021 2020 £’000 £’000 Total Total
	18 55
	28 37 100 - 7 - 54 86
	189 123

Cash in transit relates to a transfer from the CCLA Common Deposit Fund made on 31st March 2021.

10.1 Creditors: amounts falling due within one year

General Creditors Accruals Grant Commitments (see note 10.3) 10.2 Creditors: amounts falling due after more than one year Grant Commitments (see note 10.3)	2021 2020 £’000 £’000 Total Total 38 4 19 61 740 742
	797 807
	2021 2020 £’000 £’000 Total Total
	92 -

Consideration has been taken of the time effect of money on these future commitments, however given the value is immaterial no adjustment is necessary.

10.3 Grant commitments

10.3 Grant commitments
Grant Commitments as at 1 April Commitments awarded in year Commitments expended in year Grants undrawn, written back or returned Grant Commitments as at 31 March	2021 2020 £’000 £’000 Total Total 742 937 557 162 (264) (219) (203) (138)
	832 742

Grant commitments comprise a number of grant awards to RNOH where the Trustees have committed to expenditure and costs are expected to fall in future years.

11.1 Analysis of Charity funds

Restricted funds General Redevelopment Appeal The Portelli Children's Fund The London Irish Ward Fund Venables Fund Foot & Ankle Research & Education Fund Pharmacy Department Spinal Surgery - Education & Research Covid-19 Support Fund London Spinal Cord Injury Centre Independent Living Unit Funds £50k-£100k - Research (4) - Wards/departments (3) - Fundraising (3) - Other (1) Others, up to £50k - Research (11) - Wards/departments (27) - Fundraising (19) - Other (1) Total restricted funds General funds Total funds	1 April Gains/ 31 March 2020 Income Expenditure (losses) Transfers 2021 £’000 £’000 £’000 £’000 £’000 £’000 577 55 (102) 214 205 949 381 4 (17) (1) (367) - 342 - - - - 342 191 9 (25) 41 - 216 129 6 (8) 28 - 155 106 23 (8) 25 - 146 100 5 (6) 21 - 120 1 236 (119) - - 118 110 9 (37) 19 - 101 104 (5) (17) 24 - 106 181 98 (57) 43 - 265 208 27 (21) 46 - 260 208 8 (20) 36 - 232 57 1 (3) - - 55 180 7 (73) 36 - 150 156 17 (38) 33 22 190 633 264 (832) 83 66 214 18 2 - 3 - 23
	3,682 766 (1,383) 651 (74) 3,642
	251 411 (259) 72 74 549
	3,933 1,177 (1,642) 723 - 4,191

Transfers between funds represent income or grant expenditure which has been reclassified to ensure donations are used in accordance with donors wishes.

11.2 Details of material restricted funds

Name of fund Nature and pupose of fund General Redevelopment Appeal For the redevelopment of the hospital. The Portelli Children's Fund For the new Children’s Activity Centre. The London Irish Ward Fund For the London Irish Ward (from the London Irish Ward Appeal).

Venables Fund

To assist RNOH staff who are experiencing financial difficulty.

Foot & Ankle Research & Education Fund To improve the service of the Foot and Ankle Unit. Pharmacy Department For pharmacy education and training, workforce development and patient benefit.

Spinal Surgery - Education & Research For the furtherance of spinal surgery education and research at the RNOH. Covid-19 Support Fund Funding for Covid-19 projects to help staff, patients and

Funding for Covid-19 projects to help staff, patients and volunteers.

London Spinal Cord Injury Centre To support staff and patients, including maintenance and upkeep of reintegration vehicles and staff training.

Independent Living Unit For the new independent living unit

11.3 Analysis of Charity funds - prior year

Restricted funds General Redevelopment Appeal The Portelli Children's Fund The London Irish Ward Fund Venables Fund Foot & Ankle Research & Education Fund Pharmacy Department Spinal Surgery Education & Research SPECT-CT scanner London Spinal Cord Injury Centre Independent Living Unit Funds £50k-£100k (13) Others up to £50k (87) Total restricted funds General funds Total funds	1 April Gains/ 31 March 2019 Income Expenditure (losses) Transfers 2020 £’000 £’000 £’000 £’000 £’000 £’000 (1,237) 89 385 (257) 1,597 577 528 7 (48) 45 (151) 381 628 101 (18) - (369) 342 203 10 (22) - - 191 141 8 (20) - - 129 95 24 (12) (1) - 106 103 6 (9) - - 100 - 263 (13) (23) - 227 176 8 (87) 5 8 110 115 10 (22) 1 - 104 829 74 (12) - 1 892 1,697 105 (287) 94 (1,086) 523
	3,278 705 (165) (136) - 3,682 404 68 (227) 6 - 251
	3,682 773 (392) (130) - 3,933

12.1 Analysis of net assets between funds - 2021

12.1Analysis of net assets between funds - 2021
			2021
	Unrestricted	Restricted	Total
	Funds	Funds	Funds
	£’000	£’000	£’000
Total fxed assets	985	3,860	4,845
Current assets	29	206	235
Current liabilities	(373)	(424)	(797)
Creditors: amounts falling due after more than 1 year	(92)	-	(92)
	549	3,642	4,191

12.2 Analysis of net assets between funds - 2020

12.2Analysis of net assets between funds - 2020
			2020
	Unrestricted	Restricted	Total
	Funds	Funds	Funds
	£’000	£’000	£’000
Total fxed assets	291	4,264	4,555
Current assets	12	173	185
Current liabilities	(52)	(755)	(807)
Creditors: amounts falling due after more than 1 year	-	-	-
	251	3,682	3,933

13.1 Trustee remuneration

None of the Trustees received remuneration for their services to the Charity (2019 | 20 £nil) and no Trustees were reimbursed for expenses incurred during 2020 | 21 (2019 | 20 £nil).

Indemnity cover is provided for Trustees by the Charity.

14.1 Related party transactions

The total amount of related party donations made, without conditions, was £49 (2019 | 20 £nil).

During the year, RNOH Charity made grants totalling £1.332m to RNOH (2019 | 20 £162k).

One Trustee is employed by the RNOH and was awarded a grant during 2020 | 21 of £92,464 (2019 | 20 nil). The standard procedure for grant applications was followed and the Trustee was not involved in the approval process. As at 31st March 2021 the grant balance was £92,464.

The Charity also benefits free of charge from the use of offices and IT services, these have been accounted for as a gift in kind (see note 2.1).

RNOH staff and finance system were utilised to manage the finance operations of the Charity at a cost of £55.1k (2019 | 20 £73k which included backdated VAT of £18k).

There are no other related party transactions which require disclosure in the year (2019 | 20 - nil).

2020 | 21

Charitable Incorporated Organisation Charity Number: 1166129

The Royal National Orthopaedic Hospital Charity

Contents

Reference and Administrative Details

Registered Address:

Trustees:

Robert Hurd

Advisors:

Elizabeth Klein

Key management personnel:

Dorothy Dalton Chair

Welcome from the Chair

Introduction from the Chief Executive

Our Partner

2020 | 21 Attendance:

What we do

Strategic objectives

Enhancing the patient exerience

Improving the staff experience

Creating a world-class facility

Investing in medical research

A year in numbers

Income

Expenditure

£271,000

£690,000

£113,000

Grant giving

Covid-19

A cardiology ultrasound machine

Wellbeing lead

Listening events for staff

Creating a worldclass facility

The RNOH’s first state-of-the-art SPECT-CT scanner

Enhancing the patient experience

The volunteer service and volunteer buggy service

Horatio’s Garden

Occupational therapy equipment

Improving the staff experience

Grant for acknowledging staff

Welcome packs for international nurses

Investing in medical research

Therapies research and development

Nurse research reader post

Collaborative Care in Orthopaedic Rehabilitation (CCOPER) Project

Stanmore Children’s Orthopaedic Outcome Project (SCOOP)

Virtual reality treatment for neuropathic pain

Fundraising

Covid-19 Emergency Appeal

Major gifts

Grant-making trusts

The Buttercup Collection

Legacies

Fundraisers

Future plans

Independent Living Unit

Estimated project cost - £1.1 million

EOS scanner

Staff welfare

Financial review

Overview

Expenditure

Income

Investment performance

5 year investment performance

Investment Policy

Investment review

Reserves

Going concern

Governance

Constitution

The Trustees

Appointment, induction and training of Trustees

Related parties and co-operation with other organisations

Equality, diversity and inclusion

Pay policy

Risk management

Fundraising governance

Public benefit

Statement of Trustees' Responsibilities