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2022-09-30-accounts

2021/22

Financial year ended 30 September 2022

Our Trustees and Executives

Our patron

Her Majesty Queen Elizabeth II (Deceased 8 September 2022)

President

Leonora, Countess of Lichfield

Vice Presidents

Ruth Maxwell Shirley Palmer Alan Sanders The Mayor of Wandsworth (ex Officio)

Administrative details

Royal Hospital for Neuro-disability Registered charity number – 205907 Royal Hospital for Neuro-disability (Services) Limited Company registration number – 04570542 (Non Trading)

Principal address and registered office

Royal Hospital for Neuro-disability West Hill Putney London SW15 3SW

Board of Trustees

Des Benjamin – Chairman

Previously Group Chief Executive at SimplyHealth for 13 years; and President of the Institute of Customer Service.

Les Broude

Worked at Mars Snackfoods Europe, Barclays Bank, Premier Foods PLC; and became a Non-Executive Director and Audit Committee Chair at Buckinghamshire Healthcare NHS Trust where he remains an honorary lay member of the Charitable Funds Committee. He is a Non-Executive Director of South Central Ambulance Service NHS Foundation Trust.

Mark Cooke

Currently leading a Financial Services Risk Utility start up, in conjunction with the ORX Association. Formerly, Group General Manager and Group Head of Operational Risk at HSBC and non-executive Chairman of ORX Association until 2020.

Dominic Fairclough

A partner in the personal injury and clinical negligence team at Russell-Cooke solicitors, whose expertise includes advocacy in Coroners Courts advising on clinical negligence and personal injury claims.

Christopher Foster

Retired as Bishop of Portsmouth in 2021 after over seven years as a member of the House of Lords. He has a lifelong concern for the wellbeing, support and care of the most vulnerable people in our communities, and for those closest to them. He is an independent non-exec director of NHS Somerset.

Julie Harding – Deputy Chair

An HR professional working locally and internationally with HSBC before specialising in culture and change management at the Co-operative Bank and more recently, the House of Commons.

Deborah Hill

Works as a Finance Director at Unilever PLC with international finance and risk management expertise.

Jane McCormick (from 20 October 2022) – Chair designate

Previously a senior partner at KPMG and a member of the global management team for KPMG International. Chairs the Diocesan Board of Finance for the Diocese of Salisbury and sits on other boards.

Dr David Mitchell – Deputy Chair (until 26 January 2022) Medical Director and the Responsible Officer for the Hospital of St John and St Elizabeth, David was previously Medical Director at Imperial College Healthcare NHS Trust and Consultant in General and Chest Medicine at St Mary’s Hospital London.

Hugh Rees (Treasurer)

Previously a non-executive director at Enigma Healthcare based in Singapore and formerly the Chairman and CEO of Wilkinson Healthcare. Following an international career in finance and corporate strategy in the pharmaceutical industry.

Deborah Sanders – Deputy Chair (from 14 April 2022) Chief Executive at Barnet Hospital and executive director of the Royal Free London NHS Foundation Trust. A registered nurse with 10 years’ experience as a chief nurse and director of infection prevention and control.

Chris Streather (from 26 Jan 2022)

Regional Medical Director and CCIO NHSE London, previously Chief Medical Officer Royal Free London NHS Foundation Trust, Trustee Royal Free Charity

Shoaib Ali Shah

Extensive knowledge in Racial Equality, Equal Opportunity and Diversity; a champion with 25 years of work experience both at local and national level.

Dr Yen Foung Tai

A consultant neurologist and honorary Clinical Senior Lecturer with a clinical and research interest in the treatment of movement disorders and neurodegenerative diseases.

Executive Directors

Paul Allen Chief Executive

Ashraff Ali Interim Medical Director (From 1 August 2021 to 2 November 2021)

Jane Beaven

Director of Fundraising, Communications and Facilities

Frances Low

Director of Governance

Steven Luttrell

Anna Marks (Resigned 20 October 2022)

A senior partner at Deloitte working with publicly listed corporates, Vice Chair of the UK Firm and a member of the Deloitte Global Board. She is also a member of the Board of the CBI.

Medical Director (From 2 November 2021)

Lesley Mill

Director of Service Delivery

Nanda Ratnavel Director of Finance

Della Warren Director of Nursing

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Our Trustees and Executives

Our Board committees

Our advisors

Audit and Risk Committee Les Broude – Chairman Mark Cooke Julie Harding

Auditor BDO LLP 55 Baker Street London W1U 7EU

Board Medical Committee Dr David Mitchell – Chair to 26 January 2022 Dr Yen Foung Tai – Chair from Chair 27 January 2022 Dominic Fairclough Deborah Sanders Chris Streather

Banker

National Westminster Bank plc 153 Putney High Street Putney London SW15 1RX

Insurance Broker Marsh Ltd Merlin House Brunel Road Theale RG7 4BY

The Executive and senior clinical staff are also members Chairman’s Committee Des Benjamin – Chairman Julie Harding Jane McCormick (from 20 October 2022) David Mitchell – (to 26 January 2022) Hugh Rees- Treasurer Deborah Sanders (from 14 April 2022)

Investment Custodian

Schroder & Co Bank AG Central 2 8021 Zurich Switzerland

Ethics Committee

Christopher Foster - Chair Paul Allen – Chief Executive Des Benjamin Geoff Coyne – Hospital Chaplain Dominic Fairclough Dr Andrew Hanrahan – RHN consultant nominated by the Chief Executive Laurence Oates (Co-optee) Deborah Sanders Shoaib Ali Shah

Investment Manager Cazenove Capital Management 1 London Wall Place London EC2Y 5AU

Solicitors

Capsticks 1 St George’s Road London SW19 4DR

Other members of Executive are also members and staff, GPs and others also attend

Fieldfisher Riverbank House 2 Swan London EC4R 3TT

Finance Committee

Hugh Rees – Treasurer and Chairman Adam Barber (Co-optee, from 3 October 2022) Rebekah Farjemirokun (Co-optee, from 3 October 2022) Stephen Ford (Co-optee, to 15 July 2022) Deborah Hill Anna Marks (to 20 October 2022) Christopher Streather (from 20 October 2022)

Bevan Brittan LLP Kings Orchard 1 Queen Street Bristol BS2 0HQ

Nominations and Remuneration Committee

Des Benjamin – Chairman Julie Harding Jane McCormick (from 20 October 2022) David Mitchell (to 26 January 2022) Hugh Rees Deborah Sanders

Patient Safety and Quality Committee Deborah Sanders – Chair (from 27 January 2022) Julie Harding Trudi Kemp David Mitchell – Chairman (to 26 January 2022) Shoaib Ali Shah Yen Foung Tai

Our Trustees and Executives

CHAIRMAN’S WELCOME 6
CHIEF EXECUTIVE’S INTRODUCTION 8
TRUSTEES’ REPORT: 10
FUNDRAISING 11
ACTIVITY AT THE RHN IN 2021/22 12
RESEARCH AND INNOVATION 13
LEISURE AND FAMILY SERVICES 14
MANAGING OUR RISKS 16
FINANCIAL REVIEW 20
STRUCTURE, GOVERNANCE AND MANAGEMENT 24
LOOKING FORWARD 26
TRUSTEES’ RESPONSIBILITIES 27
INDEPENDENT AUDITOR’S REPORT 28
STATEMENT OF FINANCIAL ACTIVITIES (SOFA) 30
BALANCE SHEET 31
CASH FLOW STATEMENT 32
NOTES TO THE ACCOUNTS 34-49

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Chairman’s welcome (continued)

Chairman’s welcome

For most of the population of the United Kingdom and perhaps many people overseas too, 2022 will become a time stamped year in their memories, as the year in which, very sadly, we were all affected by the passing of Her Majesty, Queen Elizabeth II.

Her Majesty has been our Patron at the RHN since she ascended to the throne in 1953 and for that we would all like to express our unreserved gratitude and respect for the invaluable contribution she made to us.

We made sure to pass on the condolences of everyone involved with the RHN to His Majesty King Charles and wished him and all the Royal Family well.

So to the affairs of the RHN over the last twelve months and I would like to start this year’s annual report with some quite uplifting news of the very considerable achievements of the hospital in yet another COVID-19 recovery year.

The first thing to say, with great applause to our staff, is that we have not suffered a single patient or resident death from COVID-19 at the hospital since January 2021, two years now.

On our Jack Emerson ward, which is a high dependency ward where all patients have a ventilator to help them breathe, we have not had a single patient become infected with the virus throughout the entire pandemic.

For a year, we have been open for family visiting and we have been able to hold many events in our grounds and wonderful community rooms. All of this changes the atmosphere of the hospital for the better and has been achieved through the diligence of everyone in our community working together to protect our patients and residents.

Our clinical teams of Doctors, Nurses, Healthcare Assistants, Allied Health Professionals, Pharmacists, Adaptive Technology and Infection Control people have worked tirelessly in concert with our Porters, Facilities, Estates, Catering, Security and Grounds staff to make this happen safely and for that I am most thankful. A truly great achievement.

All of this supported as always by our HR, Finance, Secretariat, IT, Communications, Fundraising, Contracts and Learning and Development teams who give such fundamental support to the operating of the hospital, it simply wouldn’t happen without them all.

And as ever our team of Volunteers come in to make so much possible to enhance the lives of our patients and residents that otherwise would not take place, my thanks goes to all of them.

It means that many of our annual celebrations have been reinstated including Founders Day and Festival Week, recruitment drives, lectures and hospital tours, events which encourage many of our sponsors, funders, prospective employees and volunteers to come and experience our world and really get to appreciate the extraordinary work we do.

This year we have exceeded our charity fundraising target, which is an extraordinary achievement by our fundraising team given the difficulties of the last few years. The funding of vital patient and resident treatments and therapies; and important capital developments come out of these funds.

Our bed occupancy is very close to capacity which reflects the phenomenally hard work of our outreach teams in what is still a confused and stressed world of healthcare. This is a better position than we expected to be in at this stage of the pandemic recovery.

Despite inflation gripping the whole country, we have achieved a satisfactory financial result at the hospital operating level through diligent work on income negotiation, cost control and high levels of bed occupancy. While many have contributed to this success, I would like to pass my thanks to the finance team for the clarity with which they both presented the financial challenges and then played their part in tackling them.

Although financial markets are in some difficulty, our strong reserves mean that our investment programme has progressed further this year with the Board agreeing to the refurbishment of Wellesley Ward, a £3 million project that has

just commenced and will complete during 2023. We have also continued to add ventilator beds to Leonora ward and this has now given us one of the pre-eminent ventilator care facilities in the United Kingdom with 26 operational beds and capacity for more in the years ahead.

This year we have updated our Royal Charter, signed by Royal consent of Her Majesty the Queen on 19 July 2022. Our new documents of Constitution now reflect up to date corporate governance and best practice with a strong historical connection to the intent of our founder Andrew Reed and the universal values of the RHN that travel with us through time. It is difficult to appreciate just what a strong foundation this is for the RHN in the truest sense, unseen but relied upon by everyone, every day.

Our disciplines around patient and resident safeguarding continue to improve, even from last year’s high standard. The result of this is we are seeing fewer events that can adversely affect the wellbeing of those we care for and when we do see them, we are quick to resolve them and to learn from our experience.

At our October Board meeting this year our inspector from the Care Quality Commission reflected their view to the Board that the RHN’s progress in respect of safeguarding was noteworthy on a national basis and that they had been truly impressed at both how we had implemented improvements and the speed with which we had done it. Everyone involved in this assessment should be rightly proud.

Our continuous programme of improvements to the unseen parts of our infrastructure has been maintained and we have continued to upgrade many aspects of our computer technologies, as well as managing the ongoing programme of improvements to the infrastructure of the RHN’s land and buildings.

Together with our ward improvement programme, it means we are keeping pace with our goal of having first class infrastructure to support our first class services for patients. These two go hand in hand and neither is achievable without the other.

Our programme of education continues unabated with more events now happening in person rather than via video conferencing and our staffing recruitment initiatives have successfully recruited from an increasing diverse number of places, helping us greatly in the incredibly competitive environment for good quality staff.

I think it is worth mentioning that although this year has been a great deal steadier than the previous two years, I think it will take time for many staff who have been submerged in COVID-19 to recover their strength and energy as well as their full mental fortitude. I expect us all to fully recover more slowly over the next few years, we must afford people time and consideration in this regard.

So to the road ahead for the RHN in 2023.

What is clear is that the road ahead will be bumpy for a good while yet. External pressures of inflation, national debt, staffing shortages, political uncertainty and a legacy of COVID-19 fatigue will all adversely impact the RHN in the months and years ahead.

I take great comfort in our ability to meet these challenges from our rootedness in the purpose for which the hospital was formed, to look after the most vulnerable in society.

From the calibre and skill of our management teams and dedicated staff who, every year, display their willingness to learn and unfailing desire to care for our patients and residents to the best of their ability.

I would like to give my personal thanks to the RHN’s executive team whose courage, balance, resolve and integrity in all of their work, combined with leading by example and fostering such an inclusive approach to the whole community, really do bring such strength to the hospital.

My thanks go as they always do to my fellow trustees for their generous contribution in overseeing the RHN. As volunteers operating in a set of very difficult circumstances, to me, it says much about them as people.

And it is with great pleasure that I am also able to announce that we have successfully recruited my successor as Chair of the RHN, Mrs Jane McCormick will take over from me as Chair in April this year and I am sure Jane will bring great skill and heart to a new period of stewardship of this most important Institution.

So, this year after eight years, I sign myself off into the archives of those who have been fortunate enough to Chair the RHN with some words I have been repeating since very soon after I arrived here.

It has been the great privilege of my life to have served at the RHN and, working with this caring family of people who have such a clear and selfless purpose, the RHN has done more for me than I ever could have done for it. I am most grateful. My thanks and best wishes to everyone.

Take care,

Des Benjamin Chairman

25 January 2023

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Chief Executive’s
Introduction
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The financial year 2021/22 has been a successful year for the RHN. The hospital has emerged from the main part of the COVID pandemic in good shape and has returned to “business as usual” in many respects, not the least of which has been returning to unrestricted visiting of patients by their relatives and the resumption of face to face meetings, including activities for patients. Lifting of COVID restrictions meant that we were able hold the RHN festival week and founders’ day in June 2022 for the first time since 2019.

Occupancy within the hospital has improved significantly such that all available capacity is essentially full. The financial performance has improved in tandem: we have exceeded budget for the year at hospital and operating levels, delivering surpluses. Fundraising has had a particularly good year, exceeding budgeted income by some £600k.

I am very pleased to be able to report that we have been able to restart our programme of ward refurbishments, delayed by two years because of COVID. The £3m refurbishment of Wellesley ward commenced in October 2022. Subject to board approval, the refurbishment programme will be completed over the next few years

In November we published a new strategy for the RHN, titled The Path to Excellence. This document sets out a roadmap for the next 5 years with patient experience at its heart. The development of our people is also key and we have specific plans to develop our clinical strategy. Happily, the lifting of COVID restrictions has meant that development of the strategy has included open engagement sessions with all staff.

In November 2022 we saw a significant change to the arrangements for the management of the historic defined benefit pension scheme. The scheme trustees (a mixture of hospital appointed and member appointed), expertly chaired by Eric Stobart, stepped down and handed over trusteeship of the scheme to a sole corporate trustee, Dalriada Ltd. This change ensures that trusteeship of the scheme is sustainable on the long term basis.

to Des for the numerous achievements at the RHN under his leadership and the enormous support he has given me. He has been a pleasure to work with and he definitely hands over the RHN in a better place than when he started.

The governance of our hospital has been improved by the revision of our Royal Charter, which was approved by Her Majesty the Queen in July 2022 and adopted at the October 2022 board meeting. We were of course deeply saddened by the death of our Royal Patron, HM Queen Elizabeth II in September and await the appointment of a new Royal Patron by Buckingham Palace.

Looking ahead, although the RHN is in good shape and has an ambitious strategy, it is faced with many of the same pressures affecting other organisations. Inflation of both costs and wages is well documented and the RHN will have to manage the challenge of squeezed commissioning budgets, general cost increases and the impact of wage increases. On the last of these points, the RHN remains committed to paying the London Living Wage.

In conclusion, many thanks to all our staff for another year of hard work with great commitment and passion, all for the benefit of our patients and residents. Thanks also to our growing number of volunteers and to the continued support of our Board of Trustees.

Paul Allen CEO

25 January 2023

Fundraising events made a comeback in 2022.

There have been no changes to the executive team over the last year and I am very grateful for the excellent work carried out by this talented and experienced team. Our Chair, Des Benjamin, steps down in April 2023 after 8 years in post. Jane McCormick has been recruited to replace him and I look forward to working with Jane in the future. I would like to record special thanks

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Report of the trustees for the year ending 30 September 2022

The Trustees are pleased to present their annual report, together with the financial statements of the charity for the year ended 30 September 2022.

The financial statements comply with the Charities Act 2011 and the Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (effective 1 January 2019).

Our purpose

Our charity

The charity’s object is to give permanent relief to such persons as are hopelessly disqualified for the duties of life by disease, accident or deformity. The charity aims to enable people with profound or complex disabilities, resulting from damage to the brain or other areas of the nervous system, to enjoy an optimal quality of life through enhanced independence.

Founded by Andrew Reed in 1854, the Royal Hospital for Neuro-disability (RHN) is one of the oldest independent hospitals and charities in the UK; today we are a charity hospital and research centre.

Our charitable status enables us to raise funds for a variety of specialist services that complement the NHS funded care package received by our patients and residents. These services broadly cover our Brain Injury Service and Continuing Care Service, both aimed at improving the quality of life for our patients and residents living with severe neurological disabilities.

Public benefit

The Royal Hospital for Neuro-disability’s trustees have considered the Charity Commission’s published guidance on public benefits requirements under the Charities Act 2011.

As a medical charity with a holistic approach to treatment, we take great pride in delivering excellent work in the areas of assessment, rehabilitation and specialist care to some of the most disabled adults in the UK, as well as support to their families.

The Charity carries out its objects and activities through:

Fundraising

As a charity, the RHN raises vital funds for our patients and residents from a variety of generous supporters and organisations.

With the influence of Fundraising and the generosity of supporters, the RHN is better placed to provide additional therapies and recreational services that help to boost the quality of life for patients and residents at the hospital, as well as provide support for families.

With the lifting of all national restrictions brought on by the impact of the global COVID-19 pandemic, Fundraising was able to deliver on the following objectives:

Some of the additional services we are able to fund include

Leisure and Families Service (including disability sports)

As we emerge from the challenges caused by COVID-19, Fundraising is open to adopting alternative ways of raising funds which has led to our Events team taking a more tailored approach to some of its work and fully utilising the beautiful grounds of the hospital.

Computer therapy and specialist communication aids

One of the key contributors to delivering our objectives, is our supporter centric approach to fundraising, a service that serves and supports all fundraising disciplines and helps us to deliver an effective supporter engagement and stewardship programme in order to retain their support and increase their financial contributions.

Nurse escorts and transport for patient trips

As a charity we are still committed in delivering best practice in all our Fundraising activities; as such we remain registered with the Fundraising Regulator and continue to adhere to its code of practice for charitable fundraising in the UK.

Furthermore, with our compliance to the Data Protection Act of 2018 and our online privacy notice (www.rhn.org.uk/help/ privacy), we are able to lawfully support our need to gather, process and store personal data in a way that assures the public, our supporters and those in our care of our respectful, accountable, open and transparent approach to fundraising.

Onsite multi-faith chapel services

Specially adapted wheelchairs

Occupational art therapy

Music therapy

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Activity at the RHN in 2021/22

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Statistics 2022 2021
Admission to the hospital 168 203
Bed Capacity
Brain Injury Service (exc. DToC) 42 42
Delayed Transfer of care (DToC) 6 6
Continuing Care 188 187
Aggregate bed capacity 236 235
Annual Bed Occupancies
Brain Injury Service (exc. DTOC) 39 40
Delayed Transfer of Care 3 1
Continuing Care 174 164
Aggregate bed occupancy 216 205
Patients treated within the BIS 143 143
Percentage occupancy rate BIS inc. DTOC 88% 85%
Percentage occupancy rate BIS excl. DTOC 93% 95%
Percentage occupancy rate CC 93% 88%
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Continuing Care

The RHN had 168 admissions in 2022 (2021: 203). The hospital splits its services into two main categories; The Brain Injury Service and Continuing Care.

There were 26 discharges from Continuing Care (2021: 23). The data for discharges only includes home discharges and discharges to other services. It excludes deaths and discharges to acute hospitals.

The aggregate bed capacity for the RHN in 2022 was 236 (2021: 235) of which Brain Injury Service was 48 (2021: 48) and Continuing Care 188 (2021: 187). The aggregated bed occupancy for the RHN was 216 (2021: 205).

There were 134 unplanned temporary admissions made to acute services (2021: 77) and Continuing Care had a percentage occupancy rate of 93% (2021: 88%).

Brain Injury Services

Research and innovation

Research

Publications during this period

After the disruption of the COVID-19 pandemic, our research projects have started again with two new dental projects, two collaborative studies with the dietetics department, one COVID review and two projects on long term ventilation on top of the three existing PhD projects.

Yelden, K., James, L.M., Duport, S., Kempny, A., Farmer, S.F., Leff, A.P. and Playford, E.D., 2022. A simple intervention for disorders of consciousness - is there a light at the end of the tunnel? Frontiers in neurology, 13.

Our PhDs were invited to present their work at international events as follows:

da Conceição Teixeira, L., Blacker, D., Campos, C., Garrett, C., Duport, S. and Rocha, N.B., 2021. Repeated Clinical Assessment Using Sensory Modality Assessment and Rehabilitation Technique for Diagnosis in Prolonged Disorders of Consciousness. Frontiers in human neuroscience, p.729.

Gill - Thwaites, H.L., Elliott, K.E. and Morrissey, A.M., 2021. LOCCATE: A tool to identify the diagnostic spectrum profile of motor function and functional communication responses for the individual with a prolonged disorder of consciousness. Neuropsychological Rehabilitation, pp.1-21.

Gallagher, L., 2021. Dental nursing in a neuro-disability hospital. BDJ Team, 8(10), pp.26-27.

Education

We organised 23 courses and 9 open lectures. We have successfully migrated our courses online and when restrictions were lifted were able to organise face to face training again.

The open lectures are recorded and made available on the RHN Youtube channel thus made available to a broad range of people. Our recorded webinars have been viewed by around 2,000 people and is a great way to reach a wider audience. Our online courses are also very popular and attract a national and international audience.

The Brain Injury Unit has 6 beds available for use outside of the NHSE contract. They can accommodate any delayed transfers of care and spot purchase rehabilitation packages for both the NHS and private patients with rehabilitation requirements.

Excluding Delayed Transfers of Care, the average length of stay in the Brain Injury Service was 17.5 weeks (2021: 17.2 weeks) and percentage occupancy was 93% (2021: 95%).

In terms of responsiveness we continue to aim to process referrals within the 14 day target. The complexity of our patients is recorded on admission and our scores show that we continue to take patients who are more severely impaired when compared with many other units.

Heritage

We have completed the National Lottery Heritage Fund project by organising an online and onsite exhibition in the RHN gardens. The exhibition was complemented by open days and tours that were very popular. The feedback from the Fund was “It is impressive to see the contribution to disability history, high standards of archiving, promotion of heritage skills and the level of engagement with the archives, which can be a difficult process to do. It is also good to see the organisational impact and project legacy.”

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LaFS Leisure and family services (continued)

LaFS Leisure and family services

We are continuing to reimagine LaFS as a Therapeutic Leisure Service with a focus on offering ward based activity groups based on the needs and interests of residents. The groups and one to one sessions continue to be based within the Specialist Nursing Home wards and led by the LaFS coordinators and volunteers. Over the past year the number of volunteers within the organisation has continued to grow and we aim to expand the service in the coming months. During the repeat COVID-19 outbreak between December 2021 and February 2022 the LaFS team and volunteers, once again, helped with “Red Running” within the RHN. Red Runners helped with receiving, moving and delivering essential supplies and equipment during this period. Visiting remained open across all wards with stringent infection control compliance during this period. Since family visiting started after the initial COVID-19 outbreak in July 2020, LaFS and volunteers have supported family visiting, initially just doing lateral flow testing for visitors and then moving to registering all visitors, checking LFT results and issuing visitors with masks. Support for family visiting continued up until the end of January 2022 when the automated visitor checking in system was installed. There are several visiting check in points across the site and these have worked smoothly since installation.

During the repeat COVID-19 outbreak between December 2021 and February 2022 the LaFS team and volunteers, once again, helped with “Red Running” within the RHN. Red Runners helped with receiving, moving and delivering essential supplies and equipment during this period. Visiting remained open across all wards with stringent infection control compliance during this period.

Since family visiting started after the initial COVID-19 outbreak in July 2020, LaFS and volunteers have supported family visiting, initially just doing lateral flow testing for visitors and then moving to registering all visitors, checking LFT results and issuing visitors with masks. Support for family visiting continued up until the end of January 2022 when the automated visitor checking in system was installed. There are several visiting check in points across the site and these have worked smoothly since installation.

With help from the Fundraising department, the CoDA Dance Group had previously secured a three year lottery grant. We are now into the second year of the grant. Year 2 has allowed an increase from three to four sessions per week to be run. There are currently two sessions per week on our Continuing Care wards, one in Goodman house and one in the Brain Injury Unit. In addition to the CoDA Dance Group, staff, ward staff and volunteers facilitate all sessions

which are greatly enjoyed by residents and staff. Year 3 will see an increase to six sessions per week.

Church services continue to be adapted to how they run on a Sunday. Since March 2021, the Chaplain, LaFS staff and volunteers have been running eight separate ward based Sunday services. Since March 2022 when COVID restrictions were further relaxed, Sunday services were able to recommence in the Assembly room but with reduced maximum capacity. The Chaplain, LaFS staff and volunteers have been able to facilitate a service for up to fifty residents in the Assembly room every Sunday morning, separate services continue to be held on a Sunday afternoon in Chatsworth, Haberdashers, JEC, Devonshire and Drapers Wards.

The Thursday informal service and quiz is now held in the Chatsworth Day Room with a few residents from other wards joining in. The holy communion service on Fridays, for a small number of residents, continues to take place in the chapel. Wednesday afternoons see group Bible Study for a small number of residents.

The parish priest from St Thomas A Becket, Wandsworth has recommenced a monthly Mass on the premises on the first Wednesday of each month. This restarted in May 2022.

An Imam visits twice a week to conduct “one to ones” with Muslim residents and patients.

The Chaplain continues to offer spiritual and pastoral care both on and off the wards (including individual holy communion for those residents and patients not able to get to a service), one to one readings and prayers; and one to one spiritual counsel.

Saturday concerts resumed after August 2021 but with reduced capacity. Due to this, with support from Fundraising, we were successful with an application for a COVID funding grant from Wandsworth council. With the

Community outings have recommenced in a new way. To ensure an individual approach to the planning of outing activities and trips, they are now arranged and booked by Ward Administrators. LaFS continues to support the ward administrators with these bookings and have created a directory of wheelchair accessible venues that have been enjoyed and successfully visited by residents in the past; we will continue to expand the directory.

grant, we have been able to offer a Wednesday afternoon concert for patients and residents to attend. To help support the running of the concerts we have partnered with a volunteer programme for year 12 students from the local Ark Academy. As the Wednesday afternoon sessions have been so well received we aim to continue running them in 2023.

Massage and Beauty Therapy services continue to run. Four external massage therapists registered to work with the RHN visit on different days in the week and continue to accept new referrals via the LaFS team.

The hydrotherapy pool remains closed, significant repairs and refurbishment is required in order for it to reopen. We are currently putting together a proposal for the required work; as the work is likely to be significant, there is no clear timeline for when this will happen.

Hairdressing services resumed in March 2022. The hairdresser is available one day a week and has been running at full capacity. We will consider an additional day per week if demand increases.

After the refurbishment of the Assembly Room, the audio/ visual equipment was removed and quotes were obtained for new equipment with the Fundraising team securing a donor to fund the purchase and installation of the new equipment in June 2022. The curtains in the room were replaced by blinds in July 2022 and alternative light and sound filters within the doors were installed.

In conjunction with the Brain Injury Group we were able to reinstate our on site free Legal and Welfare Advice clinics. These clinics run every six weeks and are open to patients, residents and family members to discuss any legal query relating to brain injury. We hope to continue to run these clinics throughout 2023. In addition, with the social work department we have been liaising with the DWP and hope to set up a separate Benefits Advice Clinic as there has been a growing need for support in this area.

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Volunteers
Number of active volunteers as of 1 October 2021 39
Total number of volunteers active in the year to 30 September 2022 122 (2021: 51)
Total number of new volunteers recruited in the period 1 October 2021 – 30 September 2022 79 (2021: 21)
(4 withdrew before starting)
Total number of volunteers on 30 September 2022 87
(54 Regular, 33 ad hoc)
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Donated services received from volunteers are not included in our Statement of Financial Activities as the charity does not pay to obtain these services in the course of carrying out core activities. There is no economic benefit that requires the value of this gift to be recognised.

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Managing our risks

In order to minimise or eliminate risks to the charity during the 2020/21 financial year, potential risks are and continue to be identified and regularly reviewed by both the Executive team and Trustees.

In 2021/22 the RHN identified its principal risks as: patient safety and wellbeing, COVID, and financial risks. The principle safeguarding risk is now well controlled. The RHN’s response to the COVID pandemic has demonstrated the robustness of it infection control measures, but vigilance continues to be crucial. The RHN’s finances were impacted by events in particular the challenges of the pandemic, but have proved resilient, and robust plans are in place to ensure continued stability and growth. Board committees keep these risks under review, and the Audit and Risk Committee reviews all significant risks quarterly before consideration by the Board.

The Coronavirus and COVID-19

The hospital is now operating in line with the “Living with COVID-19” government plan. This means that COVID-19 cases are closely monitored and escalated in line with best clinical practise guidelines. A rolling programme for patient vaccinations is in place.

We continue to have a routine screening programme in place for patient facing staff and all staff are strongly encouraged to continue to be up to date with their vaccines. Our business continuity planning has enabled us to return to delivering the full range of services for our patients and residents and our occupancy levels have improved significantly over the last year. We are well prepared for any future iterations of COVID-19 and as such the risks around this are considered to be well mitigated.

Managing our risks (continued)

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Inadequate improvementRequires Good Outstanding
Good
Good
Good
Good
Good
Safe?
Effective?
Caring?
Responsive?
Well led?
Royal Hospital for Neuro-Disability
Are services
Royal Hospital for Neuro-Disability
Rated
‘good’ in all
areas for the
first time!
Last rated
27 October 2021
Overall
rating
Call us onWe would like to hear about your experience of the care you have received, whether good or bad.inspection report atThe Care Quality Commission is the independent regulator of health and social care in England. You can read our 03000 61 61 61 www.cqc.org.uk/location/1-117350917, e-mail enquiries@cqc.org.uk, or go to www.cqc.org.uk/share-your-experience-finder
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Quality of care

We are a regulated healthcare provider with The Care Quality Commission (CQC) and The Charity Commission. Following our unplanned CQC Quality Inspection in 2021, which focussed on the Safe and Well Led Key Lines of Enquiry, we have been rated Good in all domains with an overall rating of Good by the CQC.

The RHN has robust controls in place to ensure that it implements high standards of quality and safety, including quality of care. These include the following:

We have an ambitious Patient and Resident Experience Strategy, which underpins the RHN Strategy 2022 to 2027, A Path to Excellence. We also encourage feedback and involvement from patients, residents and their families through multiple formats including through the Annual Patient Survey and through participation in a number of forums and through our comprehensive complaints and compliments process. We have a Patient Representative Committee (chaired by a Trustee, which includes representatives from patients, residents and families from all wards) which is a forum to receive feedback on experiences hospital wide and to share information.

We are a regulated healthcare provider with The Care Quality Commission (CQC) and The Charity Commission. Following our unplanned CQC Quality Inspection in 2021, which focussed on the Safe and Well Led Key Lines of Enquiry, we have been rated Good in all domains with an overall rating of Good by the CQC.

Our clinical risk registers (Clinical and Medicines) are updated monthly by the named clinical directors responsible for each of the risks on the registers and clinical risks are incorporated into the organisational risk register (ORR) if they meet the threshold. The Executive Management Team (EMT) also reviews the risk registers monthly. A new risk management system is in the process of introduction to strengthen our management. The Patient Safety and Quality Committee (a board Committee) has oversight of clinical risks

As well as our overall quality rating of Good with our regulator, CQC, our Director of Nursing and Head of Safeguarding are recipients of NHS Safeguarding Medals, awarded by SANN for our excellence in safeguarding practice.

We are embarking on Pathway To Excellence™ with the American Nurse Credentialing Center (ANCC), which provides us with a framework for nursing excellence through the development of positive practice environments for all of our clinicians and where nursing can excel. We aim to achieve this accreditation by 2023/24, which is led through our Director of Nursing and the senior nurse leadership and clinical skills teams across the RHN.

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17

Managing our risks (continued)

Managing our risks (continued)

Recruitment and retention of staff

During the financial year, we continued seeing the benefits of the overseas nurse recruitment campaigns from 2019 and various online campaigns conducted remotely. Whilst the impact of COVID-19 could still be felt during the year, the lifting of restrictions allowed fifteen further overseas to join during 2021/22 which is a slight increase on the previous year. Another two overseas nurses arrived in December 2022.

We have also begun extending visas for those nurses that came in 2019 for a further 3 years, which is real evidence of return on investment. So far, twelve visas have been extended in this way.

As well as the above, during 2021/22, seven permanent RNs, six bank RNs, 40 permanent HCAs and 21 bank HCAs were recruited. The RHN is now far less dependent on agency nurses and HCAs than previously, greatly helped by the success of the Putney bank (the RHN’s internal agency).

It is anticipated that more overseas nurses will be recruited from the Philippines after a campaign in August 2022 resulted in fifty - six offers of employment.

Staff engagement

The RHN held a staff engagement roadshow led by the staff engagement lead during the year. The roadshow was for all staff and ran during the day as well as a night session to ensure night staff had the opportunity to attend. The roadshow’s aim was to increase employee understanding and awareness of the various ways the RHN seeks to engage and support its employees. There were the following stalls:

We also had the following activities available for staff:

We received very positive feedback about the roadshow and plan to have targeted and focused quarterly roadshows in the future.

In response to the feedback our staff surveys in the last two years, videos have now been planned for workshop delivery. They will be used across the RHN in training and discussion groups to help us consider how we address the issues presented. The videos were shot using actors portraying RHN staff members. The focus is on bullying, harassment and equal opportunities.

We are planning a CIC employee assistance awareness campaign to launch the CIC employee assistance programme mobile app and to provide workshops to people managers to support signposting and awareness to their staff of this valuable service. We will also be running workshops for staff to get an update on the many resources and support that are available via this service. The EAP service advised us that, since the roadshow, there had been an increase in usage across the services they provide. We held an additional wellness/health check day in July for staff who had not been successful in reserving a place at the roadshow. This was provided by Medigold (occupational health) for which we have a waiting list. This was a very popular initiative and staff have commented positively about it.

Learning and development

The Learning Management System (LMS) is being updated to make it easier to navigate and to provide at a glance reporting with clear dashboards for those with directly managed staff. We are also looking at the system hierarchies to ensure required learning is easier to manage and staff groups in clinical, corporate, allied health professional, estates and facilities areas can easily be identified along with departmental compliance levels.

Our annual performance reviews are to be moved online, either through an addition to our LMS system or as part of the new HR system being developed. There will be an automatic course reminder function for courses where completion is mandatory.

The RHN Academy (Learning and Development’s vocational learning centre) has partnered with Kingston University and the University of Roehampton to introduce a trainee nurse associate programme to the hospital. Supported by the Director of Nursing and Matron for Long Term Care, healthcare assistants are being provided with an opportunity which will see them embark on an apprenticeship that results in them becoming nurse associates.

The RHN Academy continues to receive applications for Adult Care Levels 2 and 3, and also functional skills in English and mathematics; and as part of the new initiative for developing skills in relation to the delivery of Safer People Handling, staff will be offered the opportunity to complete the Level 3 Award in Education and Training (AET).

Financial sustainability

In order to improve and provide the highest quality of care to patients and residents, the RHN recognises the need to maintain financial stability and to continue to attract donations, legacies and other fundraised income in order to invest in its facilities and equipment.

The RHN recorded a financial surplus for the financial year ending 30 September 2022 with year end reserves at satisfactory levels. Our budget for the financial year ending 30 September 2023 anticipates a return to pre COVID-19 occupancy levels with a surplus in income and expenditure and continued satisfactory reserve levels. Further to the budget for the forthcoming financial year, the five year financial plan to the year ending 30 September 2027 approved by trustees sees improving surpluses and cash balances as the RHN gradually alters its mix of existing services and continues to invest in its infrastructure to improve services to patients and residents.

The RHN’s primary sources of funding are NHS England, NHS Integrated Care Boards and Local Authorities. Though NHS bodies receive annual increases with which to pay the RHN for its services, these are not sufficient to meet all the RHN’s cost pressures. In order to mitigate such funding shortfalls, the RHN continues to work in partnership with commissioners to negotiate adequate contractual agreements whilst increasing efficiency. It is expected that the block contract for rehabilitation services with NHS England will be broken up with responsibility passed to either a lead or multiple Integrated Care Boards.

The drive to maintain financial sustainability includes investment in technology, equipment and the estate with which to provide the highest standards of care and generate income. During 2021/22 important work on water infrastructure, lifts, staff accommodation, HR and payroll systems; and detailed planning for the refurbishment of Wellesley ward in 2022/23 has been carried out.

The RHN has sufficient reserves for the foreseeable future, and has a five year financial plan supporting its corporate strategy. Further disclosures are available within the financial review and note 1.2 of our accounting policies.

The RHN’s Committee with oversight of finances is the Finance Committee. In the year the Committee has updated the RHN’s Investment Policy. It received a presentation from the investment managers of sustainable (ie socially responsible) investing, following which it held a joint meeting with the Ethics Committee so that they could jointly understand the issues and advise the Board on a way forward.

Pride at RHN (The LGBTQI+ Staff Network) continues to meet monthly and is working on various initiatives such as LGBTQI+ awareness training and LGBTQI+ history months. We have also received feedback about other networks that staff would like at the RHN and are planning focus groups to gauge support for further rollout throughout the hospital.

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21

Financial review

Financial review (continued)

Expenditure on charitable activities (i.e. hospital activities)

The RHN reported an overall net surplus in funds for the year of £0.18 million (2021: £0.96 million) comprising the following:

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2022 2021
Hospital £m £m
Patient Income 45.84 41.00
Patient Expenditure (45.32) (42.85)
Surplus/(Deficit) from Hospital Activities 0.52 (1.85)
Voluntary and Other Activities
Income
Donations and Other Fundraising 2.89 1.88
Other Income 0.42 0.29
Income from Voluntary and Other Activities 3.32 2.17
Expenditure
Fundraising Expenditure (0.89) (0.78)
Voluntary and Other Expenditure (1.02) (1.06)
Expenditure of Voluntary and Other Activities (1.91) (1.84)
Surplus from Voluntary and Other Activities 1.40 0.33
Hospital and Charitable activities 1.92 (1.53)
Net Income on Pension Scheme - -
Net Gains / (Losses) on Investments and Fixed Assets (1.74) 2.48
Net Surplus / (Deficit) 0.18 0.96
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The RHN receives the majority of its income for patient care from NHS England (for Brain Injury Services) and from Clinical Commissioning Groups and some Local Authorities (for Continuing Care). COVID 19 has compromised occupancy levels and adversely affected income for patient care. The Charity has also seen an increase in donations and legacies of 51% (2021: 1% decrease)

Income from donations, legacies and fundraising events is £3.2 million (2021: £1.9 million) analysed as follows.

Donations, legacies and fundraising received for charitable expenditure during the year ended 30 September 2022

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30 September 2022 30 September 2021
£'000 £'000 £'000 £'000
Unrestricted 2,233 1,261
Restricted
(1) Additional therapies and services 188 167
(2) Purchase of specialist equipment 357 132
(3) Research and education 253 67
(4) Specific redevelopment and refurbishment of hospital buildings 204 221
(5) COVID crisis response - 33
1,002 620
3,235 1,881
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The RHN’s fundraising activities are overseen by the Fundraising Regulator (FR) whose responsibilities include ensuring the charity records all complaints, completes an Annual Complaints Returns Report and displays the FR logo. These convey our commitment to complying with legislation as well as building trust with supporters of the charity.

The campaigns by the RHN to recruit nurses from overseas in recent years has resulted in more of them commencing employment during 2021/22. A recent recruitment drive in the Philippines in the autumn of 2022 will see more arrive in 2023. Allied to the successful operation of our own bank of nurses, reliance on agency staffing continues to be successfully managed.

The RHN continues to demonstrate its commitment to its staff through paying competitively, ensuring nobody is paid below the London Living Wage; and by providing staff development opportunities.

Investments 30 September 2022 30 September 2021
£ million £ million

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Net (losses)/gains during the year (1.74) 2.48
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The RHN invests funds surplus to working capital requirements in a portfolio managed by Cazenove Capital Management, Schroder & Co Ltd.’s charity division. They place investments based on asset allocation ranges previously agreed by the RHN’s Finance Committee, who review the Charity’s investments during the course of the financial year. Investment income during the year was £0.42 million (2021: £0.29 million). The overall performance reflects the general economic climate and is much in line with the performance of stock and other investment markets.

Staff pension scheme 30 September 2022 30 September 2021
£ million £ million

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- -
Net actuarial gains on the defined benefit scheme
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The results above pertain to the RHN’s defined benefit pension scheme which was closed to new members in 2001 and existing members in 2006.

As at 30 September 2022, the defined benefit pension scheme was in surplus but as it is not recoverable, was restricted to zero in the disclosures (30 September 2021: zero). The surplus of £8.6 million (2021: £8.7m surplus) in the scheme is not available as a refund to the RHN and is therefore deemed to be irrecoverable under FRS102.

The RHN continues to run a defined contribution scheme for its employees which was transferred to an Aviva Master Trust in October 2019.

Reserves

Reserves are held to help the charity operate effectively in accordance with the Charity Commission’s guidance. The Board has carried out a detailed review of the charity’s activities, identified the major risks the RHN is exposed to and produced a financial risk assessment.

Free reserves are intended to cover the following:

After carrying out a review of the risk areas stated above, the RHN Board of Trustees has determined a range of £12 million to £14 million (2021: range of £11 million to £13 million) of free reserves as being a minimum operating level for three months.

At 30 September 2022, the reserves were as follows:

The sum of the above gave total reserves of £45.4million (2021: £45.2million).

Further details of these reserves are disclosed within the statement of financial activities and balance sheet on pages 30 and 31; and in note 17.

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Going concern

The RHN is a public benefit entity, and its Board has set out a review of financial performance and the charity’s reserves position. At the 30 September 2022, the RHN reported free reserves of £13.6 million (2021: £14.6 million), net current assets of £8.1 million (2021: £6.0 million), and a net cash inflow of £2.0 million (2021: £1.3 million net cash outflow) for the year. The change in cash flow between the two years was largely because of improved patient and fundraised income as the hospital emerged from the COVID-19 pandemic which had adversely affected both streams.

As at 30 September 2022, the defined benefit pension scheme was in surplus but as it is not recoverable, was restricted to zero in the disclosures (30 September 2021: zero). The surplus in the scheme is not available as a refund to RHN and is therefore deemed to be irrecoverable under FRS102. The RHN’s strategy of funding any residual obligation in order to eliminate any future deficit remains.

With regard to the year ending 30 September 2023, the most significant areas that are likely to affect the charity’s net assets are levels of patient and fundraised income, operating revenue expenditure and capital investment. Occupancy levels will have returned to pre pandemic levels.

The hospital holds investments valued at £17.9 million (2021: £19.6 million) inclusive of cash available of £0.3 million (2021: £0.8 million). Though unrealised losses amounted to £1.7 million in 2021/22 (2021: £2.4 million gain), judicious management of funds aims to minimise adverse market fluctuations.

Like other healthcare providers the RHN faces inflationary pressures, the hospital continues to monitor developments and take appropriate action. The trustees will continue to monitor plans with the RHN executive team to ensure that the RHN retains sufficient reserves to continue operating. The charity has a strong balance sheet, with unrestricted liquid reserves of around £24 million and so the trustees are of the opinion that the charity will have sufficient resources to meet its liabilities as they fall due.

The trustees are satisfied that the RHN can continue operating for the foreseeable future and accounts have been prepared on the basis that the RHN is a going concern.

Neither the Trustees, nor any key persons within the charity, are aware of any further specific, nor general events which would change the charity’s status as a going concern.

In setting the budget for 2022/23, the trustees have deferred some costs but less so than the prior year. In the event of another wave of COVID-19, continued and further social distancing measures and rigorous hygiene procedures will be followed once again.

The RHN’s budget for 2022/23 and financial plan for 2023/24 were incorporated in its five year financial plan 2022/27 presented to the Board in October 2022 in support of the organisational strategy over the same period. Prudent uplifts for patient income and an increase in the provision of ventilated services are included.

In order to explore the sustainability of the RHN, a financial stress test exercise was conducted with the above assumptions altered to model more adverse conditions in 2022/23 and 2023/24. With these changed assumptions, a consequent adverse impact was seen on income and expenditure, cash balances and reserves in those two years.

In terms of cash, in order that the RHN retained desired cash balances at the end of the two financial years in question, without curtailing spend, it would be necessary to transfer from investments to the current bank account. It is anticipated that investments would be fully replenished towards the end of the five year financial plan.

Reserves would be sufficient throughout the course of the plan.

On its operational activities, the trustees believe that the current strategy for growth including some shift in the balance of services provided; and the associated rolling five year financial plan has reasonably secured the future of the RHN to sufficiently meet the requirements of a going concern.

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23

Structure, governance and management

From 20 October 2022, the Board of Management was abolished and replaced by the Board of Governors, with the same functions as the previous Board of Management. The existing members of the Board of Management became members of the Board of Governors and the arrangements above continue to apply to the executive and the new Board.

The RHN’s governing constitution is a Royal Charter and byelaws. Amendments to the Royal Charter and revised byelaws were approved by the Board of Management in January 2022 and by the AGM in April 2022. On 19 July 2022 Her Late Majesty the Queen allowed the amendments to the Charter and the Privy Council approved the revised Byelaws. The Board brought both these documents into force at its meeting on 20 October 2022, thus completing the project to update the RHN’s constitutional document which began in January 2019.

The arrangements under the version of the Charter current in 2021/2022 were as follows. Members of the Board of Management acted as trustees of the charity. They were elected by the Governors at their Annual General Meeting (AGM) to act on behalf of the charity in the management of its business, property and affairs.

The Board is a non-executive body that has four meetings each year and sets the strategic direction of the RHN.

The Board aims to follow the Governance Code for Larger Charities recommended by the Charity Commission. It carries out an annual review of its governance processes. Board members and senior executives are required to complete a declaration of interests and review this at least twice a year, and to declare any gifts and hospitality received. All staff, volunteers and Board members are required to have regular DBS checks every three years. Board members, the Chief Executive and the Director of Finance sign annual declarations of fitness to hold office.

Structure, governance and management (continued)

The Board of Trustees

Managing our risks

In 2021/22 the constitution required that the Board must be made up of a minimum of twelve members, who hold office for four years. They may not hold office for longer than two consecutive terms of four years unless the Board decides there are exceptional circumstances. Members of the Board are appointed and retire by rotation, usually at the Annual General Meeting. The Nominations and Remuneration Committee regularly reviews the skills requirements of the Board. A formal recruitment process has been adopted where particular skills are being sought, which includes open advertisement and interview to ensure the appropriate skills and experience are identified and to extend the Board’s ability to recruit a diverse Board. An induction programme and continuing trustee training is also in place.

In order to minimise or eliminate risks to the charity during the 2021/22 financial year, potential risks are and continue to be identified and regularly reviewed by both the Executive team and Trustees.

During the year Covid was removed from the top risks to the RHN. The RHN has robust infection control measures, and vigilance continues to be crucial. The principle safeguarding risk is now well controlled and the RHN’s safeguarding processes have been recognised as exemplary by stakeholders. The RHN’s finances were adversely impacted by the events of the past two years but have proved resilient. The RHN recovered well from the financial effects of the pandemic and the effects of Brexit were well managed. The effects of the Ukraine conflict and the general world economic situation are now posing a different risk, in particular to the ability of staff to live and work in London and the increased pressure on the RHN’s costs. However, robust plans are in place to ensure continued stability and growth, including a successful overseas recruitment campaign for nurses, reconsideration of our pay and reward structure for staff; and analysis of energy costs to premptively obtain as favourable contracts as possible for the future. Board committees keep these risks under review, and the Audit and Risk Committee reviews all significant risks quarterly before consideration by the Board.

From 20 October 2022 the revised byelaws set the number of Board members as a minimum of 8 and a maximum of 15.

Responsibilities of the Executive and Committees

The Board delegates certain functions to the Executive and Committees. The day to day running of the RHN is the responsibility of the Chief Executive. The Chief Executive carries out operations according to the strategy and the budget set by the Board and is assisted by the executive team which meets every week.

Remuneration

Trustees (Board members) are not remunerated but may claim reasonable expenses.

As an employer, the charity operates the ‘Putney Scale’, a harmonised pay method which helps the RHN remain competitive within the healthcare industry. This is available to all nursing and therapy staff and is in line with the NHS Agenda for Change classifications and is periodically reviewed. The components parts are basic pay and a market supplement reflecting the higher cost of inner London living.

The Board’s Nominations and Remuneration Committee (comprising Board Members) is responsible for deciding the remuneration of the key management personnel constituting the executive directors. Chaired by the Chairman of the Board, the committee considers directors’ salaries and benefits. The Chief Executive’s pay is determined by the committee and the Chief Executive provides advice to the Committee on the other directors’ remuneration. The remuneration of the Executive team is disclosed in full in notes to the accounts.

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25

Looking forward

The RHN’s launched its 2022 to 2027 strategy entitled ‘The Path to Excellence’ in November 2022.

Our objectives focus on the patient experience, our people, clinical and service development, fundraising, the estate, our facilities, IT, finance and governance and leadership. Our plan is for changes in our mix of activities over the next five years with expansion of our ventilated, behavioural and young adults’ services.

Fundraising saw a return to pre pandemic levels of income in 2021/22 and the target for 2022/23 is to achieve similar levels in order to reinvest in our services for patients and residents. Being able to run the full range of engagement and income generating activities with donors and sponsors makes this a realistic ambition.

2021/22 was a challenging year with falls in the asset values of the RHN’s defined benefit pension funds and the value of investments the RHN holds. In the case of the defined benefit scheme, the value of liabilities fell commensurately resulting in a net surplus close to the surplus in 2020/21. Work is ongoing with investment managers of both pension fund assets and the RHN’s investments to minimise the impacts of market volatility and to maximise returns.

In support of our plan to expand of our behavioural, ventilated, and young adults’ services, 2022/23 will see the RHN complete the refurbishment of Wellesley ward and further expand capacity on Leonora ward. Additionally, the rolling programme of upgrades and investment in buildings, equipment and information technology will continue.

In 2022/23 we expect to see occupancy back at pre pandemic levels and though COVID-19 had an impact on staff absence in 2021/22, this was much diminished from 2020/21. There were no deaths from the disease amongst patients, residents and staff during the year and visiting has returned to normal with suitable precautions being taken. COVID-19 hygiene measures remain however for all patient facing staff.

Trustees’ responsibilities

The Trustees are responsible for preparing the Trustees’ Annual Report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).

The law applicable to charities in England and Wales requires the trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charity; and of the incoming resources and application of resources of the charity for that period. In preparing these financial statements, the trustees are required to:

The trustees are responsible for keeping proper accounting records that disclose with reasonable accuracy at any time the financial position of the charity and enable them to ensure that the financial statements comply with the Charities Act 2011, the Charity (Accounts and Reports) Regulations 2008 and the provisions of the Royal Charter.

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

The trustees are responsible for the maintenance and integrity of the charity; and financial information included on the charity’s website.

Des Benjamin Chairman

Royal Hospital for Neuro-disability

25 January 2023

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to the trustees of the Royal Hospital for Neuro-disability (continued)

Independent Auditor’s Report to the trustees of the Royal Hospital for Neuro-disability

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 audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.

Opinion on the financial statements

In our opinion, the financial statements:

We have audited the financial statements of Royal Hospital for Neuro-Disability (“the Charity”) for the year ended 30 September 2022 which comprise the Statement of Financial Activities, the balance sheet, the cash flow statement and notes to the financial statements, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

We have nothing to report in this regard.

Matters on which we are required to report by exception

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

the information given in the Trustees’ Report for the financial year for which the financial statements are prepared is inconsistent in any material respect with the financial statements; or

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 believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Independence We remain independent of the Charity in accordance with the ethical requirements 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. Conclusions related 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.

Responsibilities of Trustees

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

We remain independent of the Charity in accordance with the ethical requirements 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.

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.

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.

Auditor’s responsibilities for the audit of the financial

statements

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

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

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

Other information

The Trustees are responsible for the other information. The other information comprises the information included in the Annual Report and Accounts, other than the financial statements and our auditor’s report thereon. The other information comprises: The Chairman’s Welcome, The Chief Executive’s Introduction and the Trustees’ Report.

Independent Auditor’s Report

incidents

considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

Extent to which the audit was capable of detecting irregularities, including fraud

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

Our audit procedures were designed to respond to risks of material misstatement in the financial statements, recognising that 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, misrepresentations or through collusion. There are inherent limitations in the audit procedures performed and the further removed non-compliance with laws and regulations is from the events and transactions reflected in the financial statements, the less likely we are to become aware of it.

A further description of our responsibilities for the audit of the financial statements is located at the Financial Reporting Council’s (“FRC’s”) website at:

https://www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

Audit procedures performed by the engagement team included the following:

Use of our report

This report is made solely to the Charity’s trustees, as a body, in accordance with 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 anyone other than the Charity and the Charity’s trustees as a body, for our audit work, for this report, or for the opinions we have formed.

Heather Wheelhouse (Senior Statutory Auditor)

BDO LLP, statutory auditor 55 Baker Street W1U 7EU

Date 30 January 2023

BDO LLP is eligible for appointment as auditor of the charity by virtue of its eligibility for appointment as auditor of a company under section 1212 of the Companies Act 2006.

BDO LLP is a limited liability partnership registered in England and Wales (with registered number OC305127).

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29

for the year ended 30 September 2022

Statement of Financial activities (SOFA) including income and expenditure account

for the year ended 30 September 2022

----- Start of picture text -----
£’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000
Income and endowments from:
Donations and legacies 2.1 2,092 625 - 2,717 1,181 613 - 1,794
Other trading activities
- Fundraising events 141 35 - 176 80 7 - 87
Investments
- Dividends and Interest 2.2 412 12 - 424 280 9 - 289
2,645 672 - 3,317 1,541 629 - 2,170
Charitable activities 3 45,842 - - 45,842 40,986 13 - 40,999
Total Income and endowments 48,487 672 - 49,159 42,527 642 - 43,169
Expenditure on:
Raising funds 4.1 1,043 - 4 1,047 1,010 - 4 1,014
Charitable activities 4.2 45,632 562 - 46,194 43,162 519 - 43,681
Total expenditure 46,675 562 4 47,241 44,172 519 4 44,695
Net surplus / (losses) before gains and losses 1,812 110 (4) 1,918 (1,645) 123 (4) (1,526)
Net (losses) / gains on Investments (1,589) (64) (83) (1,736) 2,279 92 112 2,483
Net income/(losses) 223 46 (87) 182 634 215 108 957
Transfers between funds 17 157 (157) - - 33 (33) - -
380 (111) (87) 182 667 182 108 957
Other recognised gains
Net actuarial gains on defined benefit 6.5 - - - - - - - -
pension scheme
Net movement in funds for the year 380 (111) (87) 182 667 182 108 957
Reconciliation of funds
Funds at 1 October 42,647 1,776 860 45,283 41,980 1,594 752 44,326
Total funds at 30 September 43,027 1,665 773 45,465 42,647 1,776 860 45,283
Notes Unrestricted funds Restricted funds Endowment funds Total 2022 Unrestricted funds Restricted funds Endowment funds Total 2021
----- End of picture text -----

The RHN made no other unrealised gains or losses which do not appear on the SOFA. All the above are derived from continuing activities.

The notes on pages 34 to 49 form a part of these accounts.

Balance sheet

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Total Total
2022 2021
Notes £’000 £’000
Fixed assets
Tangible assets 8 19,453 19,684
Investments 9 17,883 19,644
37,336 39,328
Current assets
Stocks 10 276 215
Debtors 11 5,326 5,512
Cash at bank and In hand 6,807 4,793
12,409 10,520
Creditors - Amounts falling due within one year 12 (4,280) (4,565)
Net Current assets 8,129 5,955
Net assets - Excluding pension 45,465 45,283
Defined benefit pension scheme asset 6.5 - -
Total Net assets 17 45,465 45,283
The funds of the charity
Capital funds
Endowment funds 17 & 18 773 860
Restricted funds
Income funds 18 1,012 1,070
Other Restricted funds 18 653 706
Total Restricted funds 1,665 1,776
Unrestricted funds
Designated funds
Fixed assets 17 19,453 19,684
Planned capital expenditure 17 8,835 6,305
Anticipated maintenance 17 1,142 2,050
Total Designated funds 29,430 28,039
Free reserves
General funds 13,597 14,608
Total Unrestricted funds 43,027 42,647
Total charity funds 45,465 45,283
----- End of picture text -----

Approved by the Board of Management on 23 January and signed on its behalf by:

Des Benjamin Hugh Rees Chairman Treasurer

The notes on pages 34 to 49 form a part of these accounts.

30

31

Cash Flow Statement

for the year ended 30 September 2022

----- Start of picture text -----
Total Total
2022 2021
Cash flows from Operating activities £'000 £'000
Net cash provided by (used in) operating activities 3,257 (626)
Cash flows from Investing activities
Dividends, interest and rents from investments 424 289
Purchase of property, plant and equipment (1,692) (1,069)
Proceeds from sale of investments 4,840 4,550
Purchase of investments (4,815) (4,457)
Net Cash (used in) investing activities (1,243) (687)
Change in cash and cash equivalents in the reporting period 2,014 (1,313)
Cash and cash equivalents at the beginning of the reporting period 4,793 6,106
Cash and cash equivalents at the end of the reporting period 6,807 4,793
Reconciliation of cash flows from operating activities 2022 2021
£'000 £'000
Net income for the reporting period 182 957
(as per the statement of financial activities)
Adjustments for:
Depreciation charges 1,923 1,812
Pension fund contributions and finance costs - -
Losses / (gains) on investments 1,736 (2,483)
Dividends, interest and rents from Investments (424) (289)
(Increase) in stocks (61) (97)
Decrease / (increase) in debtors 186 (86)
(Decrease) in creditors (285) (440)
Net cash (used in) / provided by operating activities 3,257 (626)
Analysis of cash and cash equivalents 2022 2021
£'000 £'000
Cash in hand 6,807 4,793
Total cash and cash equivalents 6,807 4,793
As of Acquisition New As of
1 Oct Cash / disposal of finance Other non 30 Sep
2021 inflows subsidiaries leases cash changes 2022
£'000 £'000 £'000 £'000 £'000 £'000
Cash 4,793 2,014 - - - 6,807
- - - - - -
Cash equivalents
- - - - - -
Overdraft facility repayable on demand
4,793 2,014 - - - 6,807
- - - - - -
Loans falling due within one year
- - - - - -
Loans falling due after more than one year
- - - - - -
Finance lease obligations
Total 4,793 2,014 - - - 6,807
----- End of picture text -----

----- Start of picture text -----
33
ANNUAL REPORT AND ACCOUNTS
2021/22
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32

Notes to the accounts

Notes to the accounts

for the year ended 30 September 2022

Royal Hospital for Neuro-disability (Charity No. 205907)

1 Accounting Policies

1.1 The Royal Hospital for Neuro-disability is an unincorporated charity registered in England & Wales with the Charity Commission. The address of the registered office is shown on page 2 and the nature of its operations is set out in the report of the Trustees.

The principal accounting policies which have been adopted in the preparation of the financial statements are set out below and have been prepared in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their financial statements in accordance with the Financial Reporting Standard applicable in the United Kingdom and Republic of Ireland (FRS 102) effective 1 January 2019, and the Charities Act 2011.

The financial statements have been prepared to give a “true and fair view” and have departed from the Charities (Accounts and Reports) Regulations 2008 only to the extent required to provide a “true and fair view”. This departure has involved following the Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS102) issued on 1 January 2019 rather than the Statement of Recommended Practice: Accounting and Reporting by Charities which was effective from 1 April 2005 but which has since been withdrawn.

Neither the Trustees, nor any key persons within the charity, were aware of any further specific, nor general events which would change the charity’s status as a going concern.

for the year ended 30 September 2022

1 Accounting Policies (continued)

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Buildings 2% - 20%
Plant and Machinery 7% - 25%
Furniture and Equipment 7% - 50%
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The depreciation charge begins from the first day of the month following either; the date of asset acquisition or the date that the asset comes into use.

Tangible fixed assets costing more than £2,500 are capitalised at cost and depreciated at the rates shown.

Impairment losses are included in the Statement of Financial Activities.

Fixed Asset Investments are included in the Balance Sheet at market value. Realised and unrealised gains and losses incurred during the year are included in the Statement of Financial Activities.

Assets in the course of construction, reflect fixed asset projects undertaken by the RHN which have not been completed as at the reporting date. Such assets when completed are transferred to the appropriate asset class and depreciated according to existing accounting policy. Any assets under construction which during review are considered to have declined in value are written off; to any extent identified to the Statement of Financial Activities.

Endowment funds comprise monies that must be held indefinitely as capital. Related income is credited to general funds and applied for general purposes unless under the terms of the endowment such income must be used for specific purposes in which case it is credited to restricted funds.

With regard to FRS102 Section 28 (Retirement benefits) and the RHN’s defined benefit pension scheme, the best estimates used are chosen from a range of possible actuarial assumptions. Further disclosures of the estimates governing these retirement benefits can be found within note 6.5 of this annual report.

34

35

Notes to the accounts (continued)

Notes to the accounts (continued)

for the year ended 30 September 2022

1 Accounting Policies (continued)

At the balance sheet date the charity held financial assets at amortised cost. Financial assets held at amortised cost comprise cash at bank, trade debtors and other debtors totalling £11.9 million (2021: £9.7 million). Financial liabilities held at amortised cost comprise trade creditors and other creditors totalling £3.8 million (2021: £3.3 million). Investments at £17.9 million (2021: £19.6 million) held as part of an investment portfolio, are held at fair value with gains and losses being recognised within income and expenditure.

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2 Donations, Legacies and Investment Income Unrestricted Restricted Total Total
funds funds 2022 2021
£’000 £’000 £’000 £’000
2.1 Donations and Legacies
Gifts & donations 415 625 1,040 1,256
Legacies 1,677 - 1,677 538
2,092 625 2,717 1,794
At 30 September 2022, the RHN has no bequeathed legacies in the financial statements (2021: £0).
2.2 Investment Income
Listed investments 214 6 220 142
Interest on deposits 198 6 204 147
412 12 424 289
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for the year ended 30 September 2022

----- Start of picture text -----
4 Total Expenditure Direct Support Total Total
costs costs 2022 2021
£’000 £’000 £’000 £’000
4.1 Expenditure on raising funds
Voluntary expenditure (fundraising staff and administration) 851 77 928 904
Fundraising events 25 2 27 19
Investment management 92 - 92 91
968 79 1,047 1,014
4.2 Expenditure on charitable activities
Patient Services 38,111 6,755 44,866 42,451
Staff accommodation 48 9 57 57
Wheelchair & technology services 411 73 484 455
Other charitable activities 567 100 667 595
Research 102 18 120 123
Other Finance Costs (see note 6.5) - - - -
39,239 6,955 46,194 43,681
Total expenditure 40,207 7,034 47,241 44,695
----- End of picture text -----

Expenditure on raising funds comprises staff and running costs of the fundraising department together with any other costs directly associated with raising funds for the group, including related publicity costs. This expenditure heading also includes other costs associated with generating funds such as investment management fees and expenditure directly related to trading income.

Patient services comprise the costs of nursing, treatment, therapy, domestic and catering services and the costs of buildings and equipment maintenance, heating, depreciation and other support services attributable to patient care.

3 Income from Charitable Activities
Note		 Unrestricted
funds
Restricted
funds
Total
2022
Total
2021

£’000
£’000
£’000
£’000
Patient services
3.1
44,707
-
44,707
40,150
Staff accommodation 426
-
426
360
Wheelchair & technology services 122
-
122
118
Other income from charitable activities 587
-
587
358
Grants receivable
3.2
-
-
-
13
45,842
-
45,842
40,999
3.1 Patient Services
National Health Service 41,858
-
41,858
37,701
Local Authority 756
-
756
867
Non-NHS patients 148
-
148
161
One to One Nursing 1,943
-
1,943
1,418
Other sources 2
-
2
3
44,707
-
44,707
40,150
3.2 Grants Receivable
Funding research projects -
-
-
13
-
-
-
13
5 Support costs Expenditure
on raising
funds
Expenditure
on charitable
activities
Total
2022
Total
2021
£’000
£’000
£’000
£’000
Administration and management 27
2,406
2,433
2,267
Building expenses 22
1,954
1,976
2,118
Finance 6
583
589
504
Human resources 9
778
787
631
Information technology 12
1,079
1,091
1,004
Governance 1
52
53
48
Statutory audit 1
56
57
44
Internal Audit, Counter Fraud and Pension Audit 1
47
48
68
79
6,955
7,034
6,684

Total expenditure includes the allocation of support costs to the various expenditure categories set out in the SOFA. These support costs relate to information technology, property and facilities management, human resources and finance, in addition to the support costs incurred by communications and other centralised departments that are not otherwise allocated directly. Support costs have been allocated to activities consistently based on employee headcount.

36

37

Notes to the accounts (continued)

Notes to the accounts (continued)

for the year ended 30 September 2022

for the year ended 30 September 2022

6 Employee Information

----- Start of picture text -----
6.1 Staff costs during the year were as follows: Total Total
2022 2021
£'000 £'000
Salaries and wages 31,738 29,728
Social security costs 2,540 2,434
Other pension costs and life assurance premiums 1,691 1,721
35,969 33,883
----- End of picture text -----

Included within the wages and salaries figure above is the cost of employing agency staff £6,710,453 (2021: £4,827,712).

During the year, a total of £0 (2021: £0) has been recognised for termination payments, of which £0 remained payable at the year end (2021: £0).

6 Employee Information (continued)

6.4 The charity operates a pension scheme for those members of staff who are eligible. The scheme has two sections:

6.2 Employees whose emoluments not including employers NI and pension costs exceeded £60,000 were as follows:

Total
2022
Total
2021
£60,000 to £69,999 17
11
£70,000 to £79,999 11
11
£80,000 to £89,999 3
1
£90,000 to £99,999 -
-
£100,000 to £109,999 1
3
£110,000 to £119,999 1
-
£120,000 to £129,999 3
2
£130,000 to £139,999 2
3
£140,000 to £149,999 2
2
£150,000 to £159,999 -
-
£160,000 to £169,999 -
-
£200,000 to £209,999 1
1
41
34

The increase in numbers by 7 is due to the inclusion of members of staff who had increases in pay related to bank work to cover staff vacancies as a result of increase in activities.

39 employees (2021 - 31) earning more than £60,000 were members of the defined contribution section of the scheme. Employers’ contributions payable during the year in respect of these employees amounted to £212,306 (2021 - £166,641).

Remuneration of Key Management Personnel including employers NI and pensions payable during the year amounted to £1,197,642 for 6.6 FTE staff (2021 - £1,140,016 for 6.5 FTE staff). This group comprises the Executive team.

6.3 The average number of staff employed (excluding agency staff) was as follows: Total
2022
Total
2021
Patient services 682
682
Research 6
5
Other charitable activities 36
38
Generating funds 8
8
Governance 2
2
734
735

The assets of the scheme are held by the scheme trustees separately from the assets of the charity.

The rates of contribution to the defined contribution scheme on the second tier basis are:

----- Start of picture text -----
Defined Defined
Contribution Contribution
Employer contributions: 2022 2021
age 18 to 35 4.0% 4.0%
age 36 to 50 7.0% 7.0%
age 51 to 65 10.0% 10.0%
Employee contributions 4.0% 4.0%
----- End of picture text -----

In addition the charity pays death in service insurance premiums in respect of members of the scheme in the second tier. Employers pension contributions payable to the defined contribution section of the scheme were as follows:

Total
2022
Total
2021
£'000
£'000
Defned Contribution 1,404
1,400
Pension contributions outstanding at the end of the year under the defned contribution scheme are as follows:
Total
2022
Total
2021
£'000
£'000
Pension contributions outstanding at year end 200
194

A stakeholder scheme is also available to employees of the charity, but no employer contributions are made to this scheme.

38

39

Notes to the accounts (continued)

Notes to the accounts (continued)

for the year ended 30 September 2022

for the year ended 30 September 2022

6 Employee Information (continued)

6 Employee Information (continued)

6.5 Staff Pension and Life Assurance Scheme

The assumptions used in calculating the liabilities were as follows:

----- Start of picture text -----
Total Total Total
2022 2021 2020
Inflation 4.3% 3.8% 3.1%
Salary escalation n/a n/a n/a
Pension increases, subject to LPI 4.0% 3.5% 3.0%
Statutory revaluation in deferment 3.5% 2.9% 2.4%
Discount rate (pre and post retirement) 5.3% 1.9% 1.5%
Life expectancy for 65 year old male 87 87 87
Life expectancy for 65 year old female 90 90 90
----- End of picture text -----

The assumptions used by the actuary are the best estimate chosen from a range of possible actuarial assumptions which, due to the long time period covered, may not necessarily be borne out in practice. The fair value of the assets for each category of asset are as follows:

the long time period covered, may not necessarily be borne out in practice. The fair value
are as follows:		 of the assets for each category of asset
Total
2022
Total
2021
Total
2020
£'000
£'000
£'000
Equities 7,857
12,401
13,489
Corporate bonds 6,953
11,172
11,293
Liability matching credit 31,778
38,946
22,481
Diversifed growth fund 5,215
8,609
9,202
Equity linked bond fund -
-
-
Alternatives 4,103
6,457
7,319
Liability driven investment, Government Bonds and Cash 13,211
24,291
40,153
Insured annuities 417
615
627
Total fair value of assets 69,534
102,491
104,564
Present value of scheme liabilities 60,961
93,769
99,674
8,573
8,722
4,890
Restriction to the amount that can be recognised (8,573)
(8,722)
(4,890)
Net pension asset -
-
-

The actual return on Assets is 5.3% per annum which is set to equal the discount rate (2021 - 1.9%).

6.5 Staff Pension and Life Assurance Scheme (continued)

----- Start of picture text -----
Assets Total Total
2022 2021
£'000 £'000
Assets in scheme at beginning of year 102,491 104,564
Movement in year:
Interest income 1,751 1,472
Employer contributions - -
Benefits paid (3,316) (3,047)
Actuarial (losses) on assets (31,392) (498)
Assets in scheme at end of year 69,534 102,491
Liabilities Total Total
2022 2021
£'000 £'000
Liabilities in scheme at beginning of year 93,769 99,674
Movement in year:
Interest cost 1,751 1,472
Benefits paid (3,316) (3,047)
Actuarial (gains) on liabilities (31,243) (4,330)
Liabilities in scheme at end of year 60,961 93,769
History of experience gains and losses Total Total Total Total Total
2022 2021 2020 2019 2018
£’000 £’000 £’000 £’000 £’000
Defined benefit obligation (60,961) (93,769) (99,674) (96,462) (85,535)
Scheme assets 69,534 102,491 104,564 106,219 92,558
Surplus 8,573 8,722 4,890 9,757 7,023
----- End of picture text -----

The movement during the year is as follows (unless otherwise specified, the figures calculated are based on the assumptions as at the beginning of the year):

the beginning of the year):
Assets in the scheme as a percentage of total scheme assets Total
2022
Total
2021
11.3%
12.1%
10.0%
10.9%
45.7%
38.0%
7.5%
8.4%
5.9%
6.3%
19.0%
23.7%
0.6%
0.6%
Total
2022
Total
2021
£'000
£'000
1,751
1,472
(1,751)
(1,472)
-
-
Surplus in the scheme at beginning of year
Movement in year:
Contributions
Net return on pension scheme
Actuarial gains
Surplus in the scheme at end of year		 Total
2022
Total
2021
£’000
£’000
Equities
Corporate bonds
Liability matching credit -
-
Diversifed growth fund -
-
Alternatives -
-
Liability driven investment, Government Bonds and Cash -
-
Insured annuities -
-
Amounts included in the statement of fnancial activities: -
-
Interest income (excluding interest income on assets that are not recoverable)
Interest cost
Interest on the net defned beneft liability

40

41

Notes to the accounts (continued)

Notes to the accounts (continued)

for the year ended 30 September 2022

7 Related Party Transactions

7.1 Trustees Remuneration and Expenses

Members of the Board of management are not entitled to and did not receive any remuneration during the year. Additionally, one member of the Board of management received £1,255 (2021: no member, £0) for reimbursement of expenses. These expenses related to travel and accommodation costs for attending Board Meetings. Trustees’ Indemnity Insurance of £5,600 was paid for the year 2022 (2021: £5,042).

7.2 Other Related Party Transactions

Other than the expenses listed, there have been no other related party transactions (2021: £0).

8 Tangible Fixed Assets

8 Tangible Fixed Assets
Cost Assets in the course
of construction
Land and
Buildings
Plant and
Machinery
Furniture and
Equipment
Total
2022
£’000
£’000
£’000
£’000
£’000
Opening balance 76
32,284
1,796
6,114
40,270
Additions 119
423
390
760
1,692
Transfers (30)
30
-
-
-
Disposals -
(11)
(185)
(196)
165
32,726
2,186
6,689
41,766
Depreciation
Opening balance -
15,600
769
4,217
20,586
Disposals -
(11)
-
(185)
(196)
Charge for the year -
1,208
141
574
1,923
Impairment -
-
-
-
-
-
16,797
910
4,606
22,313
Net book value 2022 165
15,929
1,276
2,083
19,453
Net book value 2021 76
16,684
1,027
1,897
19,684

for the year ended 30 September 2022

----- Start of picture text -----
9 Investments Total Total
2022 2021
£'000 £'000
Market value at beginning of year 19,644 17,254
Purchases at cost 5,384 3,760
Proceeds from disposals (4,840) (4,550)
Net (losses) / gains on investments (1,735) 2,482
(Decrease) / Increase in short term deposits (570) 698
Market value at end of year 17,883 19,644
Historical cost at end of year 15,093 14,506
Analysed by type Total Total
2022 2021
£'000 £'000
Investments
- Listed direct 13,697 14,897
- Unlisted direct 118 95
- Listed unit trusts 3,798 3,812
Term Deposits 270 840
17,883 19,644
Geographical analysis Total Total
2022 2021
£'000 £'000
United Kingdom Investments 7,963 7,961
Overseas Investments 9,920 11,683
17,883 19,644
----- End of picture text -----

Individual investments which have a market value of 5% or greater of the overall portfolio are:

iShares PLC - S&P 500 Index

HSBC FTSE All World Index Fund

All fixed assets are held for charitable use.

Short term deposits under the management of the charity’s professional investment managers are included in fixed asset Investments as they form part of the overall investment portfolio. The investment management fee for the year was £92,294 (2021: £90,975).

----- Start of picture text -----
Assets in the course of Land and Plant and Furniture and Total
construction Buildings Machinery Equipment 2021
Cost £’000 £’000 £’000 £’000 £’000
Opening balance 565 31,440 1,730 5,798 39,533
Additions 45 361 205 458 1,069
Transfers (534) 491 2 41 -
Disposals - (8) (141) (183) (332)
76 32,284 1,796 6,114 40,270
Depreciation
Opening balance - 14,439 783 3,884 19,106
Transfers - - - - -
-
Disposals (8) (141) (183) (332)
Charge for the year - 1,169 127 516 1,812
Impairment - - - - -
- 15,600 769 4,217 20,586
Net book value 2021 76 16,684 1,027 1,897 19,684
Net book value 2020 565 17,001 947 1,914 20,427
----- End of picture text -----

10 Stocks Total
2022
Total
2021
£'000
£'000
Dispensing stocks 276
215
Other consumables -
-
276
215

42

43

Notes to the accounts (continued)

Notes to the accounts (continued)

for the year ended 30 September 2022

for the year ended 30 September 2022

Notes to the accounts (continued)
for the year ended 30 September 2022
11 Debtors Total
2022
Total
2021
£'000
£'000
Fees receivable 4,352
4,391
Other debtors 155
91
Prepayments 604
462
Accrued income 215
568
5,326
5,512

----- Start of picture text -----
12 Creditors - Amounts falling due within one year Total Total
2022 2021
£'000 £'000
Trade creditors 732 430
Other creditors 378 365
Taxation and social security 687 650
Accruals 2,051 1,874
Deferred income (note 12.1) 184 897
Provisions and contingencies (note 12.2) 248 349
4,280 4,565
12.1 Analysis of Deferred income Total Total
2022 2021
Opening balance 897 1,054
Changes during the year:
Amounts released to the statement of financial activities (897) (1,054)
New income deferrals 184 897
Closing balance as at 30 September 184 897
----- End of picture text -----

Deferred income largely relates to the provision of patients’ services which will be recognised in the forthcoming year.

12.2 Analysis of Provisions and contingencies

Opening balance Legal Settlement
Provision
Total
2022
Legal Settlement
Provision
Total
2021
£'000
£'000
£'000
£'000
349
349
-
-
Changes during the year:
Additions -
-
349
349
Charges against the provision (101)
(101)
-
-
Unused amounts reversed -
-
-
-
Closing balance as at 30 September 2022 248
248
349
349

13 Funds held as agent

The charity holds funds as an agent on behalf of its patients and residents. During the year £64,938 (2021: £50,093) was received and £68,382 (2021: £38,322) was paid out of this account. At the year end the balance held in this account was £177,019 (2021: £180,463).

The charity holds funds as an agent on behalf of beneficiaries of deceased employees entitled to death in service lump sum payments, payable under the Life Assurance Scheme. During the year £0 (2021: £374,834) was received and £0 (2021: £326,375) was paid out of this account. At the year end the balance held in this account was £390,810 (2021: £390,810).

----- Start of picture text -----
14 Operating Leases Total Total
2022 2021
Rentals charged in the year: £’000 £’000
Land and Buildings 6 6
Plant and Machinery 34 32
Equipment 151 151
191 189
----- End of picture text -----

Payments due on operating lease obligations Total
2022
Total
2022
Land and
Buildings
Plant and
Machinery
£'000
£'000
Total
2022


Furniture and
Equipment

£'000		 Total
2021
Total
2021
Total
2021
Land and
Buildings
Plant and
Machinery
Furniture and
Equipment
£’000
£’000
£’000
Within one year 6
34
124		 6
32
146
Within two and fve years -
92
1		 -
113
74
Over fve years -
11
-		 -
13
-
6
137
125		 6
158
220
15 Capital Commitments Total
2022
Total
2021
£'000
£'000
Contracted for but not provided 296
108

16 Subsidiary and Connected Entities

The RHN owns the whole of the issued share capital of Royal Hospital for Neuro-disability Services Limited, a company registered in England with a paid up share capital of £1. The subsidiary has been dormant in the trading year to 30 September 2022 (Year end 2021 balance owed to parent £0).

It is expected that the charity will be liable to pay the remaining legal costs £7k (2021: £103k) and settlement £241k (2021: £246k) relating to an existing court case within the next 12 months, for which a provision has been made.

44

45

Notes to the accounts (continued)

Notes to the accounts (continued)

for the year ended 30 September 2022

for the year ended 30 September 2022

17 Statement of funds

17 Statement of funds (continued)

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As at 30 September 2022 Fund Pension Fund As at 30 September 2021 Fund Pension Fund
balance scheme Transfers balance balance scheme Transfers balance
brought Incoming Resources Investment actuarial between carried brought Incoming Resources Investment actuarial between carried
forward resources expended gains gains funds forward forward resources expended losses gains funds forward
£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
Unrestricted funds Unrestricted funds
General funds 14,608 48,487 (46,675) (1,589) - (1,234) 13,597 General funds 12,587 42,527 (44,172) 2,279 - 1,387 14,608
Pension reserve - - - - - - - Pension reserve - - - - - - -
Fixed asset fund 19,684 - - - - (231) 19,453 Fixed asset fund 20,427 - - - - (743) 19,684
Planned capital expenditure 6,305 - - - - 2,530 8,835 Planned capital expenditure 6,185 - - - - 120 6,305
Planned maintenance 2,050 - - - - (908) 1,142 Planned maintenance 2,781 - - - - (731) 2,050
Total unrestricted funds 42,647 48,487 (46,675) (1,589) - 157 43,027 Total unrestricted funds 41,980 42,527 (44,172) 2,279 - 33 42,647
Restricted funds Restricted funds
John Howard Convalescent Home 706 11 - (64) - - 653 John Howard Convalescent Home 610 4 - 92 - - 706
Research Department 104 9 (102) - - - 11 Research Department 184 24 (104) - - - 104
Assembly Room Windows 44 38 - - - (50) 32 Assembly Room Windows 42 2 - - - - 44
Music Therapy Omega 188 - - - - - 188 Music Therapy Omega 188 - - - - - 188
Circadian Rhythm 25 - (13) - - - 12 Circadian Rhythm 54 - (29) - - - 25
Patient Beds 6 74 (6) - - (9) 65 Patient Beds 9 - (3) - - - 6
IT Suite 1 - (1) - - - - IT Suite 10 15 (24) - - - 1
Pergola Garden Project 19 1 - - - - 20 Pergola Garden Project 19 - - - - - 19
Training - HEE Mouthcare 14 - (9) - - - 5 Training - HEE Mouthcare 23 - (9) - - - 14
Escorts 61 8 (10) - - - 59 Escorts 70 1 (10) - - - 61
Patients Amenities/Patients without 18 2 - - - - 20 Patients Amenities/Patients without 27 - (9) - - - 18
Relatives Relatives
Wheelchair Loan Store 55 1 (3) - - - 53 Wheelchair Loan Store 39 29 (13) - - - 55
Dental Equipment 29 - - - - 29 Dental Equipment 29 - - - - - 29
Treatment of Mood & Wellbeing 30 - (30) - - - - Treatment of Mood & Wellbeing 30 - - - - - 30
Wellesley Ward Refurbishment 92 21 - - - - 113 Wellesley Ward Refurbishment - 92 - - - - 92
Habs House Equipment 35 5 - - - (40) - Habs House Equipment 35 - - - - - 35
DoC Emergence 34 - (15) - - - 19 DoC Emergence 20 31 (17) - - - 34
Sensory Equip & Ward Activity 67 4 (13) - - (13) 45 Sensory Equip & Ward Activity 2 76 (11) - - - 67
Shower Chairs - 41 (2) - - - 39 Other 203 368 (290) - - (33) 248
Large Ambulance 2 8 55 - - - 63 Total restricted funds 1,594 642 (519) 92 - (33) 1,776
SW Hardship Fund 19 23 (6) - - - 36
Other 221 379 (352) - - (45) 203 Endowment funds
Total restricted funds 1,776 672 (562) (64) - (157) 1,665 Lopes Chaplains Stipend fund 8 - - - - - 8
Other endowments 744 - (4) 112 - - 852
Endowment funds Total endowment funds 752 - (4) 112 - - 860
Lopes Chaplains Stipend fund 8 - - - - - 8
Other endowments 852 - (4) (83) - - 765 Totals 44,326 43,169 (44,695) 2,483 - - 45,283
Total endowment funds 860 - (4) (83) - - 773
Totals 45,283 49,159 (47,241) (1,736) - - 45,465
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46

47

Notes to the accounts (continued)

Notes to the accounts (continued)

for the year ended 30 September 2022

17 Statement of funds (continued)

A summary of definition and descriptions

Name of fund

Description, nature and purpose of the fund

General These are the ‘available’ funds of the charity, after transfers to or from any other/designated funds and contributions to the pension reserve.

for the year ended 30 September 2022

17 Statement of funds (continued)

A summary of definition and descriptions (continued)

Restricted (continued)

Other restricted funds is made up of 37 funds (2021: 41 funds) none of whose balances are over £26,000 (2021: £26,000) and they are for a variety of specific purposes.

Restricted funds for the John Howard Convalescent Home relate to the proceeds received on the agreed sale of a convalescent home in prior years. The asset was originally provided to the charity as a restricted fund.

Designated Reviewed on a rolling year basis, these are amounts appropriated within the unrestricted category for the continued development and maintenance of the charity’s assets for:

Restricted These are funds available only for the purpose under which they were received, unless permitted by the donor. Further described below:

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Restricted Fund Description Purpose of the fund
John Howard Convalescent Home To provide support for necessitous members of
the middle class and persons generally who are
only able to make a small payment in return for
convalescence and care
Research Department Running costs of Research department
Assembly Room Windows Replacement of the Assembly room windows
Music Therapy Omega Funding of Music Therapy research project.
Re-assigned to PhD research with plans to use
funds over the coming years
Circadian Rhythm Funding of research into prolonged disorder of
consciousness
Patient Beds Replacement of hospital beds and parts
IT Suite Running costs of Compass department
Pergola Garden Project Funding for grounds renovation projects
Training - HEE Mouthcare Training in Dentistry provided by Mouthcare
Escorts Funding for nurse escorts for leisure
Patients Amenities/Patients without Relatives Funding for personal expenses of patients
Wheelchair Loan Store Wheelchairs for Bio-Medical department
Dental Equipment Funding for dental equipment
Treatment of Mood & Wellbeing Funding for Research PHD
Wellesley Ward Refurbishment Refurbishment of Wellesley ward
Habs House Equipment Funding for Haberdashers House equipment
DoC Emergence Funding for Research projects
Sensory Equip & Ward Activity Funding for sensory equipment and ward
activities
Shower Chairs Funding for shower chairs
Large Ambulance 2 For maintenance of ambulances
SW Hardship Fund For patients and relatives in financial need
----- End of picture text -----

The income generated from these funds are used specifically to contribute towards the cost of chaplaincy services available at the Royal Hospital for Neuro-disability; and bequests which are required to be held as permanent endowments of the charity. Income generated on the latter is available for the general purposes of the charity.

Endowment

Included under endowment funds are the following:

Included under endowment funds are the following:
Total
2022
Total
2021
£'000
£'000
Permanent endowment:
Lopes Chaplains Stipend fund 8
8
Other Endowment funds 765
852
773
860

Lopes Chaplains Stipend fund

This is a trust fund set up by the Rt. Hon. Sir Massey Lopes Bt to generate income to contribute towards the cost of chaplaincy services available at the Royal Hospital for Neuro-disability.

Other endowment funds

Other endowment funds represent several bequests which are required to be held as permanent endowments of the charity. The income generated by these funds is available for the general purposes of the Charity.

*Transfers are explained above with the exception of those in unrestricted fund which reflect the appropriation of pension reserves within unrestricted funds

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18 Analysis of fund balances Unrestricted Designated Restricted Endowment Total
funds funds funds funds 2022
£'000 £'000 £'000 £'000 £'000
Tangible fixed assets - 19,453 - - 19,453
Fixed asset investments 6,480 9,977 653 773 17,883
Net current assets 7,117 - 1,012 - 8,129
Total funds at 30 September 2022 13,597 29,430 1,665 773 45,465
Unrestricted Designated Restricted Endowment Total
funds funds funds funds 2021
£'000 £'000 £'000 £'000 £'000
Tangible fixed assets - 19,684 - - 19,684
Fixed asset investments 9,723 8,355 706 860 19,644
Net current assets 4,885 - 1,070 - 5,955
Total funds at 30 September 2021 14,608 28,039 1,776 860 45,283
----- End of picture text -----

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49

rri-h I, rtri'i IFld 11

Registration

Under the registration system of the Care Quality Commission and the regulations laid down by the Health and Social Care Act 2008, the Royal Hospital for Neuro-disability achieved its registration in 2010 and is therefore licensed to provide services under the regulations.

The Royal Hospital for Neuro-disability West Hill, Putney, London, SW15 3SW

telephone 020 8780 4500

email info@rhn.org.uk website www.rhn.org.uk

Registered charity number 205907