ANNUAL REPORT AND ACCOUNTS 2023/24 2023/24 Financial year ended Financial year ended 30 September 2024 30 September 2024
1
## Our patron
Her Majesty Queen Elizabeth II (Deceased 8 September 2022)
## President
Leonora, Countess of Lichfield
## Vice Presidents
Des Benjamin Ruth Maxwell Shirley Palmer Alan Sanders The Mayor of Wandsworth (ex Officio)
## Administrative details
Royal Hospital for Neuro-disability Registered charity number – 205907 Companies House registration – RC00481
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
Our advisors
## Auditor
Crowe U.K. LLP 55 Ludgate Hill London EC4M 7JW
Investment Manager
Cazenove Capital Management 1 London Wall Place London EC2Y 5AU
## Banker
National Westminster Bank plc 153 Putney High Street Putney London SW15 1RX
## Insurance Broker
Marsh Ltd Merlin House Brunel Road Theale RG7 4BY
## Solicitors
Capsticks 1 St George’s Road London SW19 4DR
Fieldfisher Riverbank House 2 Swan London EC4R 3TT
## Investment Custodian
Schroder & Co Bank AG Central 2 8021 Zurich Switzerland
Bevan Brittan LLP Kings Orchard 1 Queen Street Bristol BS2 0HQ
## Our Trustees and Executives
## Board of Trustees
## Jane McCormick - Chairman
Previously a senior partner at KPMG and a member of the global management team for KPMG International. Chairs and serves on the boards of a number of commercial and not for profit organisations.
## 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 and general management in the pharmaceutical and medical devices industries.
## Andy Bailey – (from 19 October 2023)
Chief Marketing Officer primarily from the technology and services sectors, now non-executive director, advisor and interim board member of Roffey Park Institute and strategy advisor to Tollejo and BeMyEyes.
## Deborah Sanders – Deputy Chair
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.
## Mark Cooke
Currently the Chief Risk Officer for Schroders Personal Wealth, following on from a Technology start up in the Risk space. He was previous to that the Group Head of Operational Risk, Group General manager at HSBC and Chair of ORX; not for profit Industry Risk Consortium.
## 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.
## Chris Streather
Regional Medical Director and CCIO NHSE London, previously Chief Medical Officer Royal Free London NHS Foundation Trust, Trustee Royal Free Charity.
## Shoaib Ali Shah (retired 25 July 2024)
Extensive knowledge in Racial Equality, Equal Opportunity and Diversity; a champion with 25 years of work experience both at local and national level.
## Christopher Foster
Served as a bishop for twenty years and over seven years as member of the House of Lords with 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 a nonexec director of NHS Somerset, chairing finance and people committees.
## Julie Harding – Deputy Chair (retired 19 October 2023)
A 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.
## Executive Directors
## Deborah Hill
Works as a Finance Director at Unilever PLC with international finance and risk management expertise.
## Tessa Lindfield – (from 19 October 2023)
A Director of Public Health with senior NHS and Local Government experience of strategy, commissioning and delivery of health and care services. Previously a Speech and Language Therapist specialising in Neuro-disability and assistive technology.
## Salah Mirza (from 19 October 2023)
Salah is Director of Finance and Resources at Kings College Hospital Charity and is a Board Director at EMD UK where he chairs the Finance & Audit Committee.
Paul Allen Chief Executive
Jane Beaven Director of Fundraising, Marketing, Communications and Facilities
Frances Low Director of Governance
Steven Luttrell Medical Director
Lesley Mill Director of Service Delivery
Nanda Ratnavel Director of Finance
Della Warren Director of Nursing
**3**
## Our Trustees and Executives
## Our Board committees
Audit and Risk Committee Mark Cooke – Chair Julie Harding (retired 19 October 2023) Jane McCormick Salah Mirza (from 19 October 2023)
## Board Medical Committee
Dominic Fairclough Deborah Sanders Chris Streather - Chair
The Executive and senior clinical staff are also members
## Chairman’s Committee
Mark Cooke Chris Foster Hugh Rees- Treasurer Jane McCormick - Chairman Deborah Sanders Chris Streather
## Ethics Committee
Paul Allen – Chief Executive Geoff Coyne – Hospital Chaplain Dominic Fairclough Christopher Foster - Chair Dr Andrew Hanrahan – RHN consultant nominated by the Chief Exec Jane McCormick Laurence Oates (Co-optee) Deborah Sanders Shoaib Ali Shah (retired 25 July 2024)
Other members of Executive are also members and staff, GPs and others also attend
## Finance Committee
Andy Bailey Adam Barber (Co-optee) Rebekah Fajemirokun (Co-optee) Deborah Hill Hugh Rees – Treasurer and Chairman Christopher Streather
Nominations and Remuneration Committee
Mark Cooke Chris Foster Jane McCormick - Chairman Hugh Rees Deborah Sanders Chris Streather
Patient Safety and Quality Committee Andy Bailey Julie Harding Trudi Kemp Deborah Sanders – Chair Shoaib Ali Shah (retired 25 July 2024) Chris Streather Tessa Lindfield (from 19 October 2023)
4
## Contents
|CHAIRMAN’S OPENING STATEMENT|6|
|---|---|
|CHIEF EXECUTIVE’S INTRODUCTION|7|
|TRUSTEES’ REPORT:|8|
|FUNDRAISING|9|
|ACTIVITY AT THE RHN IN 2023/24|10|
|RESEARCH AND INNOVATION|11|
|LEISURE AND FAMILY SERVICES|12-13|
|MANAGING OUR RISKS|14-17|
|FINANCIAL REVIEW|18-20|
|GOING CONCERN|21|
|STRUCTURE, GOVERNANCE AND MANAGEMENT|22|
|LOOKING FORWARD|23|
|TRUSTEES’ RESPONSIBILITIES|24|
|INDEPENDENT AUDITOR’S REPORT|26-27|
|STATEMENT OF FINANCIAL ACTIVITIES (SOFA)|28|
|BALANCE SHEET|29|
|CASH FLOW STATEMENT|30|
|NOTES TO THE ACCOUNTS|32-47|
5
## Chairman’s opening statement
It has been another busy year at the RHN with a number of challenges and causes for celebration. During the year our three new trustees, Tessa Lindfield, Andrew Bailey and Salah Mirza brought new skills and perspectives to our board but we were sorry to lose Shoaib Ali Shah who was such a familiar presence at the hospital, latterly as a trustee but for many years visiting his son who was a patient. We thank Ali for his incredible contribution in both of these ways and look forward to welcoming him back in due course as a Fellow. During the year the board has worked closely with the talented executive team considering our longer term strategy, further developing our risk assurance framework and providing constructive challenge on difficult decisions in an embodiment of good governance. With the continued impact of inflation, especially on wages, there have been some financial challenges. It is great that we are able to increase the amount we
With the continued impact of inflation, especially on wages, there have been some financial challenges. It is great that we are able to increase the amount we pay to our dedicated staff and my thanks go to the executive team for the fact that through a strong focus on cost control we have been able to do this whilst meeting our budget and without affecting the quality of the care provided to our patients and residents.
A large contribution to our financial stability is our very low level of staff vacancies and low staff turnover. When I speak to staff it is clear that what makes a difference is our focus on patient care, our ethos as a charity and the fact that we are a learning and
teaching organisation. During the year we received an award from NHS England (NHSE) for our supervision and preceptorship framework for new registered nurses and nursing associates, and we had 2 advanced care practitioners and 15 nurse associates in training. As the centre of excellence on complex neuro-disability we continue to conduct a number of research projects and offer training and insight to other organisations. Our principal clinical psychologist, Axel Rose was awarded a PhD for her work on the assessment of mood after severe acquired brain injury. We are proud to be the first independent healthcare provider in the UK to achieve the international designation of Pathway to Excellence with the American Nurse Credentialing Center.
Our prudent management of resources and the generosity of donors has allowed us to continue with our programme of ward refurbishments. It is, of course, critical to the sustainability of the service we provide that we are able to continuously repair and upgrade our facilities to provide modern standards of care. We are grateful to donors who have contributed to these capital projects and also to those that help support the therapies and other services we provide to our patients and residents that have such a positive impact on the quality of their lives.
Jane McCormick Chairman January 2025
6
## Chief Executive’s introduction
As we reflect on the past year at the RHN, I would like to take this opportunity to share some key progress and achievements.
The RHN has been awarded the Race Equality Matters Bronze Trailblazer Status. Bronze is the first stage in the Trailblazer series spotlighting organisations that are implementing impactful solutions to drive race equality. There is also an extensive Equality, Diversity and Inclusion (EDI) programme across the RHN with many celebrations and events marked throughout the year. This is reflective of our diverse workforce and patient groups. A Race Equality Network (REN) has been launched with much success and this continues to be an area of focus and engagement for all. We also celebrate many professional events, such as Allied Health Professional Day and International Nurses Day, along with an annual RHN Festival for all of the RHN community.
A major achievement is the American Nurses Credentialing Center (ANCC) awarding the highly esteemed Pathway to Excellence designation to the RHN, the first independent hospital in the UK to achieve this prestigious recognition.
The designation recognises healthcare organisations that foster a positive and empowering work environment, provide outstanding care and is testament to the hard work of our entire workforce. As a national centre of excellence for neurodisability, the RHN is an environment where staff feel supported and empowered and to have this internationally recognised is extremely rewarding for everyone.
Financially, we have had another year of achieving budget at the hospital level, which is particularly satisfying as we continue to be challenged by downward pressure on fees and upward pressure on salaries. However, raising voluntary income through fundraising continues to be challenging and we did not achieve our target for a second year.
In addition, there has been much progress on our strategy, with 2024 being the second year of our current 5-year strategy. The RHN’s top priority will always be providing the best possible care for our patients and residents and as such, Patient Experience is at the heart of this strategy. It sets out the RHN priorities to ensure the best experience for patients, residents, their families and advocates. Patients and residents were also actively involved in creating a strategy on their own care. I am also pleased to report that service level forums and an RHN wide forum have replaced the Patient Representative Committee. These are already enabling many more patients and relatives to engage in discussions and for their voices be heard widely.
During the year, the executive and board commenced a significant piece of work on the long-term strategy for the RHN, looking at a 10year time horizon. The board and executive held a workshop in January 2024 and a number of focus groups have been meeting since then, working on various aspects of the long-term strategy. Work on this will continue throughout 2025.
Looking forward, we are excited about the opportunities ahead and recognise there are many challenges to come given the pressures in the wider healthcare sector. However, we look forward with positivity and I would like to thank our staff and volunteers for another year of excellent work, whether in a direct clinical role or support function.
The year has also seen some key achievements in improvements to our infrastructure. The expansion of the ventilated bed capacity has been completed, with 32 ventilated beds now on site across Leonora and Jack Emerson (JEC) wards. A major refurbishment of Hunter Ward is well underway and will finish in January 2025. As we continue to modernise in order to deliver high quality care the refurbishment of Glyn Ward, approved by the Board in October 2024, will swiftly follow. We have also been working with students from the KLC Design School, on a pro bono basis, with teams producing a number of different designs for staff changing facilities in the main building basement. The winning design has been chosen and we intend to implement this as part of our priority to make the RHN a better place to work and to encourage more staff to cycle to work and be more active. It is also a key priority as the majority of our staff change into uniforms for infection prevention control (IPC) reasons whilst on site.
**----- Start of picture text -----**
Paul Allen
Chief Executive
January 2025
**----- End of picture text -----**
**7**
## Report of the trustees for the year ended 30 September 2024
## The Trustees are pleased to present their annual report, together with the financial statements of the charity for the year ended 30 September 2024.
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
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.
## 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.
The Charity carries out its objects and activities through:
## Our charity
Founded by Andrew Reed in 1854, the Royal Hospital for Neuro-disability (RHN) is 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.
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.
- contracts with NHS England to provide rehabilitation to adults following catastrophic brain injuries;
- contracts with Integrated Care Boards and others to provide care to adults who, following brain injury, require continuing specialist and complex care; and
- fundraising in order to enhance the care and wellbeing of patients and residents, by improving facilities available to them, developing and providing therapies such as occupational art and music therapies, offering recreational and social events, and providing pastoral care to all – whatever their faith or background.
**8**
## Fundraising
2 years into the RHN’s 5-year strategy – “The Path to Excellence”, Fundraising’s contribution in support of the RHN’s vision and mission, continues to be crucial, as voluntary income supports the overarching ambition to be a national centre of excellence for complex neuro-disability.
The funds raised come from a variety of sources and they complement the RHN’s care package.
In 2023/24, fundraising generated £2.5m (82% of target), making it possible for the services listed below to be provided. These services added value to the care given to every patient and resident.
Funded services:
- Music Therapy
- Occupational Art Therapy
- Leisure and Families Service
- Physiotherapy equipment and hoists
- On site multi faith chaplaincy services
- Specialist adapted wheelchair services
- Hardship fund to help struggling families
- Nurse escorts and transport for patient trips
In addition to the above, fundraising’s engagement with individuals, businesses and Trusts achieved the following:
- Raised over £400k towards the Hunter Ward refurbishment capital project
- Obtained a £200k legacy donation
- Raised £40k of in memory donations from patient families and friends
- Funded the development of a new sensory theatre for patients
- Raised sufficient funds in support of specialised sporting equipment
With our charitable status, the RHN is well placed to secure additional funds that can contribute to the vital work of providing specialist care and rehabilitation for patients and residents.
The RHN is registered with the Fundraising Regulator and fully complies with their Code of Practice. No external professional fundraising bodies or commercial participators carry out activities on behalf of the RHN. The Events team do purchase places in external fundraising events, such as the London Marathon which are appropriately regulated.
No person on behalf of the charity, or the RHN itself was subject to an undertaking to be bound to any voluntary scheme for regulating fundraising or any voluntary standard of fundraising in respect of activities on behalf of the charity.
No complaints have been received by the RHN or a person on behalf of the charity.
The fundraising department complies with all codes of best practice as set out by the Fundraising Regulator and Charity Commission to ensure all necessary steps are followed to protect vulnerable people and other members of the public from behaviour in connection with such activities. The RHN is committed to transparent and ethical conduct in all matters relating to fundraising.
There has been no failure to comply with any schemes and the RHN does not monitor activities carried out by any person on behalf of the charity for the purpose of fundraising as this is not necessary.
**9**
## Activity at the RHN in 2023/24
**----- Start of picture text -----**
Statistics 2024 2023
Admission to the hospital 194 195
Bed Capacity
Brain Injury Service (excl. DToC) 42 42
Delayed Transfer of care (DToC) 6 6
Continuing Care 187 185
Aggregate bed capacity 235 233
Annual Bed Occupancies
Brain Injury Service (excl. DTOC) 38 40
Delayed Transfer of Care 5 4
Continuing Care 177 179
Average bed occupancy 220 223
Patients treated within the BIS 133 173
Percentage occupancy rate BIS inc. DTOC 90% 92%
Percentage occupancy rate BIS excl. DTOC 90% 95%
Percentage occupancy rate CC 95% 97%
**----- End of picture text -----**
The RHN is a registered Charity contracting with the NHS to provide the best possible rehabilitation and care for people living with a neuro-disability. In October 2022 we launched our 5-year strategy “A Path to Excellence” and our plans demonstrate our clear commitment to our patients and residents and our partnership with NHSE and integrated care boards (ICBs). Quality and Value for our Commissioners is an important part of our strategy, alongside our commitment to delivering exceptional care to our patients and residents.
We combine expert clinical care specialist therapies and innovative technologies to enable the best possible quality of life for people with neuro-disability. Our service pathways include:
- Ventilation and complex respiratory service
- Brain Injury service (Level 1 commissioned services)
- Neuro-behavioural service
- Specialist Nursing Home including a unit specifically designed to meet the needs of younger adults transitioning from longer term paediatric to adult care
- Augmentative and Alternative Communication service (Outreach service)
In 2023/24 the RHN accepted 194 admissions, which is comparable with admissions accepted in the previous year.
## Brain Injury Services
Of the 48 beds in the Brain Injury Service, 42 beds were used as part of the NHSE contract for the provision of specialist rehabilitation level 1/2a, with an additional 6 contingency beds to accommodate delayed transfers of care, pressure alleviation from NHS bed blocking and spot purchase packages for both NHS and private patients with rehabilitation needs.
its resources to maintain its ability to admit patients with considerably high complex needs, which is recorded on admission and discharge. The RHN continues to be a leader in the industry with its ability to accept patients who are severely impaired.
In 2023/2024, the RHN facilitated 176 discharges from across all our services. This data is inclusive of discharges to home and other services; and excludes deaths.
The average length of stay in the Brain Injury Service was 15.2 weeks, a reduction in length of stay from the previous year which was 17.5 weeks. The data for length of stay and percentage occupancy does not include delayed transfers of care.
The RHN is committed to continuously improving responsiveness to referrals and aims to process referrals within 14 days of receipt. Furthermore, the RHN dedicates
10
## Research and innovation
In 2022 we developed our research strategy with the following priorities:
- Understanding more. We are committed to understanding more about neuro-disability
- Discovering more. We are committed to discovering new interventions, support and methods of care
- Sharing more. We will share our understanding, knowledge and expertise within the RHN to ensure that our practice is up to date and with others for the benefit of the wider population of people with neuro-disabilities
developments in infection prevention and control, health digital technology and clinical development in Disorders of Consciousness.
We organised 5 lectures open to all and available on the RHN YouTube channel.
2 of our staff have successfully completed a Master’s degree and 1 staff member completed her PhD looking at the assessment of mood in people with severe brain injury at Glasgow University.
Our focus is on areas where there is potential benefit for our patients and residents and we are recognised for our expertise in:
- Disorders of consciousness
- Tracheostomy and long-term ventilator support
- Service and technology innovation
- Oral health and dental care
We are also undertaking research and innovation in other areas of relevance to our services.
## Publications during 2023/24 are listed below.
Articles:
As part of sharing our knowledge and expertise, we organised 26 courses, 11 of which were online and 8 delivered at another organisation.
This year we also hosted 3 conferences to bring together experts to share good practice and discuss the latest
Parsons L, Doshi M, Rice C. “Lip and tongue biting in patients with a brain injury: a practical guide”. Practical Neurology. 2024 Jul 23.
Rose AE, Cullen B, Crawford S, Evans JJ.” Working towards consensus on the assessment of mood after severe acquired brain injury: Focus groups with UK-based professionals”. Clinical Rehabilitation. 2024 Oct 9.
Rose AE, Cullen B, Crawford S, Evans JJ. “Assessment of mood after severe acquired brain injury: Interviews with UK clinical psychologists and medical professionals ». Clinical Rehabilitation. 2024 Sep 10.
Thorpe A. “Leaving on a Jet Plane reflections on working with a patient with complex acquired brain injury secondary to attempted suicide”. Brain Injury. 2024 Jul 24:1-5.
Bradley L, Wheelwright S. “The impact of delays in transfer to specialist rehabilitation on outcomes in patients with acquired brain injury”. Clinical Rehabilitation. 2024 Sep 25.
Clark T, Lewko A, Calestani M. “The circular paradox of including people with severe brain injuries and reduced decisional capacity in research: A feasibility study exploring randomized research, consent-based recruitment biases, and the resultant health inequities”. Physiotherapy Theory Practice. 2024 Oct.
11
## LaFS Leisure and family services
LaFS continues to evolve as a therapeutic leisure service, focussing on delivering tailored group activities and one on one sessions that prioritise the needs, preferences, and wellbeing of our residents. With a primary emphasis within our Specialist Nursing Home, we are committed to creating meaningful leisure experiences that enhance quality of life and support therapeutic goals across a variety of interests.
LaFS has now merged with other fundraised services across the organisation to operate under the same direct reporting line, incorporating LaFS, bereavement support, chaplaincy service and the art room team.
Our ward-based activity coordinators and ward administrators in the specialist nursing home and specialist services work closely to deliver various activity sessions for residents across the week. This collaboration ensures that sessions are adapted to the unique needs of each ward, with coordinators and administrators supporting one another to make this possible. Their teamwork has significantly strengthened communication and planning, allowing us to better meet residents’ interests and enhance their day-to-day wellbeing.
The visits from our pet therapy dogs have continued to be very well received across all wards, consistently bringing joy, comfort, and therapeutic benefits to residents throughout the organisation.
In partnership with LaFS, CoDA has continued to deliver 6 sessions per week across various wards at the RHN, consistently reaching full capacity and receiving enthusiastic feedback from patients, residents, family members, and staff. While CoDA lottery funding concluded in October 2024, we are actively collaborating with the fundraising team to ensure this valuable service can continue into next year and subsequent years thereafter.
The Chaplain’s commitment to providing spiritual and pastoral care extends both on and off the wards, encompassing individual Holy Communion for those unable to attend services, personalised readings and prayers, one on one spiritual counsel, and appropriate end of life support. When suitable, the Chaplain visits patients during their acute hospital stays.
The live concerts on Wednesdays have continued to run weekly, alongside our Saturday live concerts. With both concerts now firmly established, additional volunteers support resident and patient attendance, making these performances a highlight of the week for many.
In the last year, our family accommodation facilitated 655 nights (2023: 395) of overnight stays. The family accommodation is managed by the LaFS team, who coordinate bookings for the on-site 3 bedroomed flat. As more patients and residents come from out of the area, this affordable on-site option makes it easier for family and friends to visit more frequently, despite the travel distances involved.
Over the past year, our hairdresser has continued to visit 1 day a week, facilitating 331 appointments for patients and residents. The impact of having this service is invaluable, greatly enhancing the wellbeing and confidence of our patients and residents.
Lastly, LaFS and the Social Work Team continue to run a biweekly benefit advice clinic, staffed by our local job centre. This service provides patients, residents, and their family members with invaluable advice and insights into their entitlements, along with dedicated assistance in navigating communications with the DWP. Additionally, the Brain Injury Group has reintroduced a monthly on-site legal advice clinic, further enhancing the support available to our community.
Given the success of the first in house Christmas tree decorating sessions, this will now be an annual event. In November 2023 we hosted 4 workshops where residents and patients created new decorations for the trees, and with the help of a team of volunteers, the trees were beautifully set up in the first week of December.
Church services continue to be well supported, with over 80 patients and residents attending the traditional Sunday morning service in the Assembly Room, often joined by family members. The dedicated team of volunteers escorting patients and residents has proven to be effective in facilitating attendance. Our afternoon ward-based services, tailored for specific wards unable to attend the morning session, continue to thrive, including a Chatsworth overflow service, Haberdashers, JEC and Leonora wards.
In the Chatsworth Day Room, the Thursday informal service and quiz attract participants from various wards, while the Holy Communion service on Fridays in the Chapel sees a growing number of residents accompanied by family members. Additionally, the parish priest of St. Thomas A Becket, our local Catholic church, conducts a monthly mass on-site, and the visiting imam holds one to one sessions with Muslim residents.
12
## LaFS Leisure and family services (continued)
We are thrilled to continue working with our wonderful volunteer team, whose dedication and commitment to supporting our patients and residents remains invaluable.
## Volunteers
Number of new volunteers recruited between 1 October 2023 and 30 September 2024 was 83 (2023: 116) Number of volunteers active in the year to 30 September 2024 was 161 (2023: 206) Number of active volunteers at 30 September 2024 was 99 (2023: 169)
**13**
## Managing our risks
In order to minimise or eliminate risks to the charity during the 2023/24 financial year, potential risks were (and continue to be) identified and regularly reviewed by both the Executive team and Trustees. An online risk management system has streamlined and made more efficient the recording, assessing and reporting of risks.
In 2023/24 the RHN identified its principal risks as: Use of named patient medication as general stock, fluctuating occupancy levels and pressure on RHN income.
With regard to patient medication, there has been minimal risk to patients as staff check medicines before administration. Internal processes have been tightened and the nursing clinical education team have reinforced the understanding of differences between named patient supplies and general ward stock amongst nursing staff.
In relation to fluctuating occupancy levels, work to speed up the admissions process and reduce delays in filling beds has been completed and staff are focused on ongoing communication with commissioners and other referrers to generate additional referrals and admissions.
With the pressure on RHN income, there is regular dialogue with commissioners to fully explain inflationary uplifts requested and the quality of service provided by the hospital.
## 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 between 14 and 16 June 2023 which focused on the Safe and Well Led Key Lines of Enquiry, our rating in these two domains went down to Requires Improvement. We remain rated as Good in the other three domains. Our overall rating has however gone down to Requires Improvement.
The RHN has robust controls in place to ensure that it implements high standards of quality and safety, including quality of care and has been focussing on areas identified in the CQC quality report, including medicines management, National Patient Safety Alerts and oversight of their associated risks, infection prevention and control relating to equipment management and obtaining laboratory specimens. We have made good progress in all of these areas and completed all of the associated actions. Monitoring of progress has continued through the Clinical Quality Review Group (CQRG), through NHSE. Our Quality Account for 2023/2024 captures positive feedback from NHSE and South West London Integrated Care Board (SWLICB).
The controls we have in place are numerous and include robust clinical leadership at board level and across the hospital, a named board level trustee for quality and safety, a Patient Safety and Quality Committee, a named executive director for quality and safety, a dedicated team to drive quality and safety and robust management of the Datix incident recording and management system. We have successfully implemented the new Patient Safety Incident Response Framework (PSIRF) across the whole organisation and were the first independent healthcare provider outside of the early implementers to implement it in July 2023 ahead of the national deadline. We continue to review clinical risks and trends by the Clinical Risk and Incident Committee, review patient deaths by the Mortality Review Committee and have excellent safeguarding leadership, structures and processes with robust analysis of decision making, which has been affirmed by achieving the prestigious “Leaders in Safeguarding” discretionary gold award. We have maintained membership of the Safeguarding Adult National Network (SANN) and have consistently achieved high levels of mandatory training compliance (exceeding 90%). Our
Director of Nursing and Head of Safeguarding are recipients of NHS Safeguarding Medals, awarded by SANN for our excellence in safeguarding practice.
We have focused on the attainment of skills and competencies through a competency framework to underpin nursing and Health Care Assistants’ practice. We have also expanded our Clinical Skills Team to support practice on the wards, incorporating a robust student supervision and preceptorship framework for new Registered Nurses and Nursing Associates, for which we received a National Award from NHSE. Our commitment to developing our clinical staff continues and we have successfully appointed our first trainee Advanced Care Practitioners into our workforce. Our rolling programme of training and developing Nursing Associates continues with at least 15 students in training each year. Links with the South West London Integrated Care System, including membership of the SWL Quality Council, have also been maintained.
We have an ambitious Patient and Resident Experience Strategy, which underpins the RHN Strategy 2022 to 2027, “The Path to Excellence”. We also encourage feedback and involvement from patients, residents and their families through multiple formats including the Annual Patient Survey and through participation in service level forums which we have successfully introduced and through our comprehensive complaints and compliments process. Our clinical and medical risk registers are updated monthly by named clinical directors responsible for each of the risks on the registers and clinical risks are incorporated in the organisational risk register (ORR) if they meet the threshold. The Executive Management Team (EMT) also reviews the risk registers monthly. The Patient Safety and Quality Committee (a board Committee) has oversight of clinical risks.
We have successfully achieved international designation of 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. Led by our Director of Nursing and Pathway Director, through the senior nurse leadership and clinical skills teams across the RHN, we successfully achieved this designation in August 2024, the first independent healthcare provider to achieve this in the UK.
14
## Managing our risks (continued)
## Recruitment and Retention of Staff
During this financial year we have intentionally reduced the recruitment of international nurses from overseas. In the last financial year there were 32 international nurses recruited and this financial year there have been 16.
As well as this, we have recruited 13 Nurses (including 4 internal promotions) and 119 Healthcare Assistants. Continuous recruitment, assessment days and collaboration with the clinical recruiting managers have resulted in vacancy numbers reducing.
## Staff engagement, Wellbeing and Inclusion
## Staff Engagement and Wellness Roadshow
Our annual staff engagement and wellness roadshow took place on day one of the RHN Festival in June. This popular event attracted over 350 staff during the day and 140 at night. Staff participated in various wellness activities, including health and wellbeing checks, massages, yoga, hula hooping, and a healthy juice and smoothie bar. A walkthrough roadshow in the Assembly Room allowed staff to learn about staff networks, sustainability initiatives, freedom to speak up, the employee assistance programme, mental health first aid and more.
## Mental Health and Wellbeing
In 2023, over 45 staff members from various departments and wards across the hospital qualified as Mental Health First Aiders (MHFA). This achievement is a critical component of our People Strategy and reflects our commitment to wellbeing as part of becoming an accredited Pathway to Excellence organisation. Our goal is to equip staff with the skills and resources needed to address mental health concerns and provide essential support to colleagues. We regularly receive positive feedback from our MHFA network about the impact this support has on staff. Notably, our Mental Health First Aiders offer 24/7 coverage, with trained staff available even during night shifts.
## Women’s Network
The recently launched Women’s Network focuses on meaningful discussions around women’s health, career growth, caring responsibilities, domestic violence, and other relevant topics. The network meets regularly and plans to participate in upcoming staff wellbeing and winter wellbeing events.
## Wellbeing Council
Our Wellbeing Council, as part of our Pathway to Excellence accreditation, meets monthly and includes a multi professional team dedicated to developing wellbeing initiatives. One of our proudest achievements this year was the new recognition programme, “Celebrating Excellence: Recognising How People Demonstrate Our Values,” which launched in January 2024 and runs quarterly. To date, we’ve received over 190 nominations, and winners of each quarter have been celebrated at afternoon tea events with CEO Paul Allen.
## Learning and Organisational Development
Since the launch of the Insight Discovery profiling tool in May 2023, we have created profiles for 95 RHN staff members, including the executive team and all nursing and workforce leads. The tool has been recognised as valuable for fostering team relationships and is now recognised as a possible option for addressing employee relations issues.
To enhance management competency across departments, we provide in house courses covering coaching skills, managing performance, time and task management, and supervision skills. These courses maintain an attendance rate of over 90% and are usually fully booked, with absences primarily due to clinical incidents or illness. This approach has reduced our dependence on external training, resulting in lower external training costs.
## Inclusion and Staff Networks
## PRIDE@RHN
In June, PRIDE@RHN participated in the 2024 London Pride Parade as part of PRIDE month. The parade was a vibrant celebration with over 60 staff members in attendance. We also hosted a Pride themed cabaret event and movie screenings for patients, residents and staff, all of which received very positive feedback.
## Race Equality Staff Network (REN)
The network celebrated East and South East Asian Heritage Month in September and Black History Month in October. These celebrations featured cultural food, music and guest speakers, attracting an average of 280 staff members per event. The network meets monthly and has collaborated with Reed’s Café in the hospital to recognise and celebrate a broader range of religious festivals. Additionally, the network supported the RHN’s accreditation as a Bronze Trailblazer (Race Equality Matters).
15
## Managing our risks (continued)
## Pathway to Excellence
We successfully submitted evidence for Practice 6: Leadership and Management in line with the Pathway to Excellence accreditation. This outlined our strategy for developing direct care nurses and their involvement in shaping the learning and organisational development offerings at the RHN.
## Compliance
For the past 28 months, the RHN has consistently surpassed the 90% compliance target for mandatory and statutory training, marking a strong recovery from COVID-19. We have also adjusted our refresher intervals to align with the Core Standards Training Framework, reducing the frequency for certain courses.
## Learning Management System (LMS)
In September, we acquired the Perform module to streamline our annual performance review process. This system will provide more detailed reporting and a secure digital record, significantly reducing the manual workload associated with our current paper based process. User testing is underway, with a launch planned for January 2025.
## 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 ended 30 September 2024 with year-end reserves considered sufficient to continue operations for between three and four months in the unlikely event that all funding ceased. Our budget for the financial year ending 30 September 2025 anticipates a surplus in income and expenditure and continued satisfactory reserve levels. Further to the budget for the forthcoming financial year, the five-year financial projection to the year ending 30 September 2029 presented to trustees sees improving surpluses and adequate cash balances as the RHN continues to alter its mix of services and invest in its infrastructure to improve services to patients and residents.
The RHN’s primary sources of funding are NHSE, NHS Integrated Care Boards and Local Authorities. Notwithstanding additional funding promised to the NHS by the new government, 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 so 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 NHSE will be broken up with responsibility passed to Integrated Care Boards in the next twelve months.
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 2023/24 essential work on Leonora ward, water and electrical infrastructure; lift repairs and the commencement of the refurbishment of Hunter ward have been carried out. On the technology front, considerable improvements have been made including work to upgrade and move servers to a secure location on the Putney site.
The RHN has sufficient reserves for the foreseeable future, and has a five-year financial projection 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. The RHN is in the process of changing its investment manager so the committee met with the incumbent on one occasion to review the management of the RHN’s investment portfolio.
**16**
'Riiiiiii*
',111111111
1111111
TTr Iiii•
PATHWAY
DESIGNATED
pitalfor
AMERICAN NURSES
CREDENTIALING CENTER
++444144
,,/****i**
*4*1,
5•*44*,
*****4
*4•*4,**,
17
## Financial review
The RHN reported an overall net surplus in funds for the year of £4.8 million (2023: £1.7 million surplus) comprising the following:
**----- Start of picture text -----**
2024 2023
Hospital £m £m
Hospital Activity Income 53.27 49.88
Hospital Activity Expenditure (51.86) (49.33)
Surplus from Hospital Activities 1.41 0.55
Voluntary and Other Activities
Donations and Other Fundraising 2.57 2.47
Other Income 0.73 0.48
Income from Voluntary and Other Activities 3.30 2.95
Fundraising Expenditure (0.86) (0.96)
Voluntary and Other Expenditure (1.13) (1.14)
Expenditure of Voluntary and Other Activities (1.99) (2.10)
Surplus from Voluntary and Other Activities 1.31 0.85
Hospital and Charitable activities 2.72 1.40
Net Income on Pension Scheme 0.00 0.00
Net Gains on Investments and Fixed Assets 2.04 0.30
Net Surplus 4.76 1.70
**----- End of picture text -----**
The RHN receives the majority of its income for patient care from NHS England (for Brain Injury Services); and from Integrated Care Boards and some Local Authorities (for Continuing Care). The Charity has also seen an increase in donations and legacies of 5% (2023: 16% decrease)
Income from donations, legacies and fundraising events is £2.6 million (2023: £2.5 million) analysed as follows.
Donations, legacies and fundraising received for charitable expenditure during the year ended 30 September 2024
**----- Start of picture text -----**
30 September 2024 30 September 2023
£'000 £'000 £'000 £'000
Unrestricted 1,542 1,525
Restricted
(1) Additional therapies and services 210 185
(2) Purchase of specialist equipment 325 191
(3) Research and education 96 47
(4) Specific redevelopment and refurbishment of hospital buildings 447 523
(5) COVID crisis response - 1
1,078 947
2,620 2,472
**----- End of picture text -----**
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 our charity.
18
## Financial review (continued)
## Expenditure on charitable activities
The continuation of successful recruitment campaigns overseas has seen the arrival of more nurses and healthcare assistants, mainly from the Philippines and the RHN has been successful in employing graduate nurses who obtained practical experience whilst at the hospital.
The RHN continues to demonstrate its commitment to its staff through paying competitively, ensuring nobody is paid below the London Living Wage; and in addition to providing staff development opportunities commenced a nursing associate programme that saw its first graduates in the autumn of 2023.
A values-based recruitment process commenced during 2022/23 and ward staff have been trained so that this can be comprehensively rolled out in 2023/24.
In terms of clinical and service development, the hospital increased ventilated bed capacity by 4 in the year and is on track to reprofile specialist nursing home beds as behavioural beds during 2023/24. The refurbishment of Wellesley ward was completed on time and to budget so improving the environment of the behavioural service.
|Investments|30|September 2024|30 September 2023|
|---|---|---|---|
|||£ million|£ million|
**----- Start of picture text -----**
Net gains during the year 2.04 0.30
**----- End of picture text -----**
The RHN invests surplus funds, beyond working capital requirements, in a portfolio managed by Cazenove Capital Management, the charity division of Schroder & Co Ltd. 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, the target return was CPI + 3.5%. Investment income during the year was £0.73 million (2023: £0.48 million). The finance committee sets targets for the investment manager to meet and monitors performance, however, the overall performance of the portfolio reflects the general economic climate.
|Staff pension scheme|30|September 2024|30 September 2023|
|---|---|---|---|
|||£ million|£ million|
**----- Start of picture text -----**
Net actuarial gains on the defined benefit scheme 0.00 0.00
**----- End of picture text -----**
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 2024, the defined benefit pension scheme was in surplus but as it is not recoverable, was restricted to zero in the disclosures (30 September 2023: zero). The surplus of £3.8 million (2023: £2.0m 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.
**19**
## Financial review (continued)
## 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:
- Adverse movements in cash flow
- A shortfall in income net of fees payable
- A shortfall in voluntary income
- Falls in the realisable value of investments
- A contingency against business interruption
After carrying out a review of the risk areas stated above, the RHN Board of Trustees has determined a range of £13 million to £16 million (2023: range of £12 million to £14 million) of free reserves as being a minimum operating level for three months.
At 30 September 2024, the reserves were as follows:
- Free reserves of £17.3 million (2023 - £15.5 million) after accounting for the defined benefit pension scheme as per FRS102 are greater than the minimum operating level required for three months.
- Designated funds of £32.0 million (2023: £29.4 million) representing the net book value of the RHN’s fixed assets of £24.4 million (2023: £22.4 million) together with £0.8 million (2023: £0.7 million) for planned maintenance and £6.8 million (2023: £6.3 million) for future capital expenditure on the hospital buildings and equipment.
- Combined restricted reserves of £1.72 million (2023: £1.46 million) include £0.95 million (2023: £0.78 million) in cash required to fund specific projects.
- Endowment funds are £0.87 million (2023: £0.78 million)
The sum of the above gave total reserves of £51.9million (2023: £47.2million).
Further details of these reserves are disclosed within the statement of financial activities and balance sheet on pages 28 and 29; and in note 17.
**20**
## 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 30 September 2024, the RHN reported free reserves of £17.3 million (2023: £15.5 million), net current assets of £7.4 million (2023: £6.7 million) and a net cash inflow of £0.2 million (2023: £2.0 million net cash outflow) for the year. The change in cash flow between the two years was due to capital outlay exceeding earnings before interest, tax, depreciation and amortisation; and movement in working capital in 2022/23.
As at 30 September 2024, the defined benefit pension scheme was in surplus but as it is not recoverable, was restricted to zero in the disclosures (30 September 2023: 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.
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 (general, capital and maintenance funds) of around £25 million (2023: £23 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.
With regard to the year ending 30 September 2025, 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.
The RHN’s budget for 2024/25 and financial projection for 2025/26 were incorporated in its five year financial projection 2025/29 presented to the Board in July 2024 in support of and building on the organisational strategy for 2023/27. Prudent uplifts for patient income and an increase in the provision of ventilated and rehabilitation services are included.
In order to explore the sustainability of the RHN, a financial stress test exercise has been conducted with the above assumptions altered to model more adverse conditions in 2024/25 and 2025/26. 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 £3.6 million and £3 million respectively from investments to the current bank account in 2024/25 and 2025/26.
The mitigating actions that would be taken would be to pause further major refurbishments after Hunter ward, reduce staffing where occupancy had fallen and transfer £1.7 million from investments to the current bank account in 2024/25.
It is anticipated that the mitigating actions would result in reserves being sufficient for three to four months of operations during the two years in question.
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 fiveyear financial projection have reasonably secured the future of the RHN to sufficiently meet the requirements of a going concern.
The hospital holds investments valued at £20.2 million (2023: £18.1 million) inclusive of cash available of £0.8 million (2023: £0.7 million). Unrealised gains amounted to £2.0 million in 2023/24 (2023: £0.3 million).
Like other healthcare providers the RHN faces inflationary pressures, the hospital continues to monitor developments
**21**
## Structure, governance and management
The RHN’s governing constitution is a Royal Charter and byelaws. 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. The new Charter provides for a single Board of Governors who are the trustees of the charity. The requirement for the Board to delegate the day-to-day management of the RHN to a Chief Executive continues.
The Board is a non-executive body that has four meetings each year. It sets the strategic direction of the RHN and in 2022 agreed the current 5-year strategic plan. 2023/24 was the second year of the plan. The Board appoints committees with responsibility for scrutinising the executive’s delivery of the RHN’s functions, such as patient safety and quality and finance. In 2023/24 the Board adopted the Board Assurance Framework which is now being considered at each Board meeting.
The Board follows the Charity Commission’s Guidance on governance. It carries out an annual review of its governance processes, including review of the committee terms of reference. Board members and senior executives are required to complete an online declaration of interests and review this at least annually and to declare any gifts and hospitality received. All staff, volunteers and Board members are required to have DBS checks every three years. Board members, the Chief Executive and the Director of Finance sign annual declarations of fitness to hold office. This is being extended to all the executive directors for the year 2024/25.
## The Board of Governors (Trustees)
In 2023/24 the constitution required that the Board must be made up of a minimum of 8 and a maximum of 15 members, who hold office for 4 years. They may not hold office for longer than 2 consecutive terms of 4 years unless the Board decides there are exceptional circumstances. Members of the Board are appointed and retire by rotation. 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.
reviewed. The component 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 Chair 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.
3 new trustees were appointed in 2023/34 and a recruitment campaign was started for 2024/25.
## 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. A new Operational Management Committee was formed in 2024. It comprises senior managers and has delegated to it some operational matters thus freeing the executive team to concentrate on strategic matters.
## 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
**22**
## Looking forward
The RHN is now in the third year of its 2022 to 2027 strategy ‘The Path to Excellence’. We are on track to change our mix of activities with an expansion of ventilated, behavioural and young adults’ services by 2027.
Objectives for the RHN fall under the headings of patient experience, people, clinical and service development, marketing, fundraising, estates, information and technology, finance and governance.
Aims for 2024/25 include widened participation in the patients’ and relatives’ survey, development of personalised information packs for patients and residents, further reductions in turnover and sickness levels, implementation of a new Specialist Nursing Home service model, digital monitoring of effectiveness/value metrics in all services, implementation of year 1 of the marketing strategy, achievement of the target of £3.1m of fundraised income, the refurbishment of Hunter ward, commencement of the refurbishment of Glyn ward, upgrade of the telephone system, achievement of the budgeted hospital surplus, ending the year with a cash balance of at least £2m, achievement of the Disability Confident Accreditation, maintained preparedness for the next CQC inspection and making significant progress on devising RHN strategy beyond 2027.
improvements, commencing the refurbishing of Hunter ward, launching a sustainability project, carrying out major upgrades to computer servers, beating the hospital budget, signing off the 2022 triennial valuation of the defined benefit pension scheme, implementing a new board assurance framework and putting in place a CQC action plan and preparing for the next inspection.
2023/24 saw continued improvement in the net value of the RHN’s defined benefit pension scheme and the value of investments the RHN holds.
With regard to the pension scheme, the RHN intends to work with the trustee, Dalriada on Guaranteed Minimum Pension (GMP) Equalisation and improving governance and cyber security.
The year saw the RHN run a competitive tendering process for investment management services for the charity. The outcome was that Mercer will take over from Cazenove as the provider to the RHN, the necessary due diligence is being carried out before the transfer is completed.
Once Mercer is in place, it is anticipated that the RHN’s investment policy will be updated in 2024/25.
In 2023/24, successes included the launch of a new patient representative forum, the forging of new links with South West London ICB’s patient experience lead, implementation of the first stage of a pay and reward review, achievement of the Pathway to Excellence accreditation, reviewing best interests decisions of people in persistent disorders of consciousness receiving clinically assisted nutrition and hydration, increased ventilated capacity to 32 beds, review of our marketing strategy, the completion of major infrastructure
**23**
## 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:
- select suitable accounting policies and then apply them consistently;
- observe the methods and principles in the Charities SORP;
- make judgments and estimates that are reasonable and prudent;
- state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the financial statements; and
- prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charity will continue in business.
The trustees are responsible for 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.
Jane McCormick Chairman Royal Hospital for Neuro-disability
22 January 2025
**24**
Charlotte Pit
S?muei Seqyar
AÉGISFERED
Abigayle Daniels
REGISTERED
## Independent Auditor’s Report to the trustees of the Royal Hospital for Neuro-disability
## Opinion
We have audited the financial statements of Royal Hospital for Neuro-Disability for the year ended 30 September 2024 which comprise the Statement of Financial activities (SOFA) including income and expenditure account, the Balance sheet, the Cash Flow Statement and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).
In our opinion the financial statements:
- give a true and fair view of the state of the charity’s affairs as at 30 September 2024 and of its incoming resources and application of resources, including its income and expenditure for the year then ended;
- have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and
- have been prepared in accordance with the requirements of the Charities Act 2011.
## Basis for opinion
We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the charity in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.
## Conclusions relating to going concern
In auditing the financial statements, we have concluded that the trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate.
Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the charity’s ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue.
Our responsibilities and the responsibilities of the trustees with respect to going concern are described in the relevant sections of this report.
## Other information
The trustees are responsible for the other information contained within the annual report. The other information comprises the information included in the annual report, other than the financial statements and our auditor’s report thereon. Our opinion on the financial statements does not cover the other information and 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 this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.
We have nothing to report in this regard.
## Matters on which we are required to report by exception
We have nothing to report in respect of the following matters in relation to which the Charities (Accounts and Reports) Regulations 2008 require us to report to you if, in our opinion:
- the information given in the financial statements is inconsistent in any material respect with the trustees’ report; or
- sufficient accounting records have not been kept; or
- the financial statements are not in agreement with the accounting records and returns; or
- we have not received all the information and explanations we require for our audit
## Responsibilities of trustees
As explained more fully in the trustees’ responsibilities statement set out on page 24, the trustees are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.
In preparing the financial statements, the trustees are responsible for assessing the charity’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the trustees either intend to liquidate the charity or to cease operations, or have no realistic alternative but to do so.
## Auditor’s responsibilities for the audit of the financial statements
We have been appointed as auditor under section 144 of the Charities Act 2011 and report in accordance with the Act and relevant regulations made or having effect thereunder.
Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.
26
## Independent Auditor’s Report to the trustees of the Royal Hospital for Neuro-disability (continued)
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:
Extent to which the audit was considered capable of detecting irregularities, including fraud
Irregularities, including fraud, are instances of noncompliance with laws and regulations. We identified and assessed the risks of material misstatement of the financial statements from irregularities, whether due to fraud or error, and discussed these between our audit team members. We then designed and performed audit procedures responsive to those risks, including obtaining audit evidence sufficient and appropriate to provide a basis for our opinion.
We obtained an understanding of the legal and regulatory frameworks within which the charity operates, focusing on those laws and regulations that have a direct effect on the determination of material amounts and disclosures in the financial statements. The laws and regulations we considered in this context were the Charities Act 2011 together with the Charities SORP (FRS102) 2019. We assessed the required compliance with these laws and regulations as part of our audit procedures on the related financial statement items.
In addition, we considered provisions of other laws and regulations that do not have a direct effect on the financial statements but compliance with which might be fundamental to the charity’s ability to operate or to avoid a material penalty. We also considered the opportunities and incentives that may exist within the charity for fraud. The laws and regulations we considered in this context for the UK operations were CQC regulations for service providers and managers, taxation legislation, employment legislation and General Data Protection Regulation (GDPR).
Auditing standards limit the required audit procedures to identify non-compliance with these laws and regulations to enquiry of the Trustees and other management and inspection of regulatory and legal correspondence, if any.
procedures required by auditing standards would identify it. In addition, as with any audit, there remained a higher risk of non-detection of irregularities, as these may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal controls. We are not responsible for preventing non-compliance and cannot be expected to detect non-compliance with all laws and regulations.
A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.
## Use of our report
This report is made solely to the charity’s trustees, as a body, in accordance with Part 4 of the Charities (Accounts and Reports) Regulations 2008. 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.
## Crowe U.K. LLP
Statutory Auditor
## London
## Date 6 February 2025
Crowe U.K. 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.
We identified the greatest risk of material impact on the financial statements from irregularities, including fraud, to be within the timing of recognition of income and the override of controls by management. Our audit procedures to respond to these risks included enquiries of management and the Audit & Risk Committee about their own identification and assessment of the risks of irregularities, sample testing on the posting of journals, reviewing accounting estimates for biases, reviewing regulatory correspondence with the Charity Commission and reading regulatory reports and minutes of meetings of those charged with governance.
Owing to the inherent limitations of an audit, there is an unavoidable risk that we may not have detected some material misstatements in the financial statements, even though we have properly planned and performed our audit in accordance with auditing standards. For example, the further removed non-compliance with laws and regulations (irregularities) is from the events and transactions reflected in the financial statements, the less likely the inherently limited
27
## Statement of Financial activities (SOFA) including income and expenditure account
for the year ended 30 September 2024
**----- Start of picture text -----**
£’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000
Income and endowments from:
Donations and legacies 2.1 1,374 1,022 - 2,396 1,353 924 - 2,277
Other trading activities
- Fundraising events 168 7 - 175 172 23 - 195
Investments
- Dividends and Interest 2.2 716 14 - 730 466 14 - 480
2,258 1,043 - 3,301 1,991 961 - 2,952
Charitable activities 3 53,219 49 - 53,268 49,875 - - 49,875
Total Income and endowments 55,477 1,092 - 56,569 51,866 961 - 52,827
Expenditure on:
Raising funds 4.1 1,180 - 3 1,183 1,148 - 3 1,151
Charitable activities 4.2 52,220 450 - 52,670 49,827 445 - 50,272
Total expenditure 53,400 450 3 53,853 50,975 445 3 51,423
Net surplus before gains and losses 2,077 642 (3) 2,716 891 516 (3) 1,404
Net gains /(losses) on Investments 1,874 75 95 2,044 279 9 10 298
Net income 3,951 717 92 4,760 1,170 525 7 1,702
Transfers between funds 17 461 (461) - - 731 (731) - -
4,412 256 92 4,760 1,901 (206) 7 1,702
Other recognised gains
Net actuarial gains on defined benefit 6.5 - - - - - - - -
pension scheme
Net movement in funds for the year 4,412 256 92 4,760 1,901 (206) 7 1,702
Reconciliation of funds
Funds at 1 October 44,928 1,459 780 47,167 43,027 1,665 773 45,465
Total funds at 30 September 49,340 1,715 872 51,927 44,928 1,459 780 47,167
Notes Unrestricted funds Restricted funds Endowment funds Total 2024 Unrestricted funds Restricted funds Endowment funds Total 2023
**----- 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 32 to 47 form a part of these accounts.
28
## Balance sheet
## as at 30 September 2024
**----- Start of picture text -----**
Total Total
2024 2023
Notes £’000 £’000
Fixed assets
Tangible assets 8 24,358 22,372
Investments 9 20,202 18,093
44,560 40,465
Current assets
Stocks 10 224 254
Debtors 11 6,105 6,063
Cash at bank and In hand 5,025 4,799
11,354 11,116
Creditors - Amounts falling due within one year 12 (3,987) (4,414)
Net Current assets 7,367 6,702
Net assets - Excluding pension 51,927 47,167
Defined benefit pension scheme asset 6.5 - -
Total Net assets 17 51,927 47,167
The funds of the charity
Capital funds
Endowment funds 17 & 18 872 780
Restricted funds
Income funds 17 & 18 951 784
Other Restricted funds 17 & 18 764 675
Total Restricted funds 1,715 1,459
Unrestricted funds
Designated funds
Fixed assets 17 & 18 24,358 22,372
Planned capital expenditure 17 & 18 6,848 6,339
Anticipated maintenance 17 & 18 787 737
Total Designated funds 31,993 29,448
Free reserves
General funds 17 & 18 17,347 15,480
Total Unrestricted funds 49,340 44,928
Total charity funds 51,927 47,167
**----- End of picture text -----**
Approved and authorised for issue by the Board of Management on 22 January 2025 and signed on its behalf by:
Jane McCormick Chairman
Hugh Rees Treasurer
29
## Cash Flow Statement
## for the year ended 30 September 2024
**----- Start of picture text -----**
Total Total
2024 2023
£'000 £'000
Cash flows from Operating activities
Net cash provided by operating activities 3,823 2,462
Cash flows from Investing activities
Dividends, interest and rents from investments 730 480
Purchase of property, plant and equipment (4,263) (5,037)
Proceeds from sale of investments 5,745 4,273
Purchase of investments (5,809) (4,186)
Net Cash (used in) investing activities (3,597) (4,470)
Change in cash and cash equivalents in the reporting period 226 (2,008)
Cash and cash equivalents at the beginning of the reporting period 4,799 6,807
Cash and cash equivalents at the end of the reporting period 5,025 4,799
Reconciliation of cash flows from operating activities 2024 2023
£’000 £'000
Net income for the reporting period 4,760 1,702
(as per the statement of financial activities)
Adjustments for:
Depreciation charges 2,276 2,119
(Gains) on investments (2,044) (298)
Dividends, interest and rents from Investments (730) (480)
Decrease in stocks 30 22
(Increase) in debtors (42) (737)
(Decrease)/Increase in creditors (427) 134
Net cash provided by operating activities 3,823 2,462
Analysis of cash and cash equivalents 2024 2023
£'000 £'000
Cash in hand 5,025 4,799
Total cash and cash equivalents 5,025 4,799
**----- End of picture text -----**
30
rhnuk
West Hill, Putney, London, United Kingdom
VH
•4
•4¥¥
o*a
1.853 likes
#AHPsday
View all 115 comments
## Notes to the accounts
## for the year ended 30 September 2024
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.
- 1.2 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 2024, the RHN reported free reserves of £17.3 million (2023: £15.5 million), net current assets of £7.4 million (2023: £6.7 million), and a net cash inflow of £0.2 million (2023: net cash outflow of £2.0 million) for the year.
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.
- 1.3 The Statement of Financial Activities (SOFA) and Balance Sheet are the financial statements of the RHN. The subsidiary has been dormant in the financial year 2023-24.
- 1.4 Income and expenditure are accounted for on an accruals basis and expenditure includes Value Added Tax where this is not recoverable.
- 1.5 Grants Receivable are included in the SOFA in accordance with the terms of the grant agreement and the SORP criteria of entitlement, probability of receipt and reliability of measurement.
- 1.6 Donations of equipment and supplies are included within the appropriate expenditure at cost or estimated value to the donor and within gifts and donations.
- 1.7 Legacy income is recognised at the earlier of the charity being notified of an impending distribution or the legacy being received. Where legacies have been notified to the charity, or the charity is aware of the granting of probate, and the criteria for income recognition have not been met, then the legacy is a treated as a contingent asset and disclosed if material.
- 1.8 Patient services comprise the costs of nursing, treatment, therapy, domestic and catering services and the costs of maintenance of buildings and equipment, heating, depreciation and other support services attributable to patient care.
- 1.9 Research expenditure comprises staff costs and direct costs of medical research projects instigated by the RHN and their associated support costs.
- 1.10 Grants are charged to the SOFA in the period in which beneficiaries are notified and so a constructive obligation is entered into by the RHN.
- 1.11 Support costs, comprising facility charges, governance, management and administrative costs, are allocated to activities based on employee headcount.
- 1.12 The RHN operates a pension scheme which includes a defined benefit section and a defined contribution section. The assets of the scheme are held by the scheme trustees separately from the assets of the RHN. Further information on the pension scheme can be found in notes 6.4 and 6.5.
32
## Notes to the accounts
## for the year ended 30 September 2024
- 1 Accounting Policies (continued)
- 1.13 Rentals payable under operating leases are charged to the Statement of Financial Activities on a straight line basis over the lease term.
- 1.14 Depreciation is charged on all fixed assets except freehold land, on a straight line basis, at rates calculated to write off the assets over their estimated useful lives as follows:
**----- Start of picture text -----**
Buildings 2% - 20%
Plant and Machinery 7% - 25%
Furniture and Equipment 7% - 50%
**----- End of picture text -----**
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.
- 1.15 Stocks are valued at the lower of cost and net realisable value.
- 1.16 Fees receivable and other debtors are recognised at the settlement amount due. Prepayments are valued at the amount prepaid net of any trade discounts due.
- 1.17 Creditors and provisions are recognised where the RHN has a present obligation resulting from a past event that will probably result in the transfer of funds to a third party and the amount due to settle the obligation can be measured or estimated reliably. The RHN recognises Creditors and provisions at their settlement amount after allowing for any trade discounts due.
- 1.18 Unrestricted funds are funds which are available for use at the discretion of the Board in furtherance of the general objectives of the RHN and which have not been designated for any other purpose. Restricted funds are funds which are to be used in accordance with specific restrictions imposed by donors or which have been raised by the charity for particular purposes. The cost of raising and administering such funds are charged against the specific fund. The aim and use of each restricted fund is set out in note 17 to the accounts.
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.
Designated funds comprise unrestricted funds that have been set aside by the Board for particular purposes. The use of the designated funds is set out in note 17.
- 1.19 Taxation - The Charity is exempt from taxation in respect of income or capital gains received within categories covered by part 11, chapter 3 of the Corporation Tax Act 2010 or Section 256 of the Taxation of Chargeable Gains Act 1992, to the extent that such income or gains are applied exclusively to charitable purposes.
- 1.20 Estimates and judgements are continually evaluated and are based on historical evidence and other factors, including expectations of future events that are believed to be reasonable under the circumstances.
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.
33
## Notes to the accounts
## for the year ended 30 September 2024
- 1 Accounting Policies (continued)
- 1.21 The charity has financial assets and financial liabilities that qualify as basic financial instruments. These are recognised at transaction value and subsequently measured at either their settlement value or market value. The charity has taken reduced disclosure exemptions for sections 11 and 12 of FRS 102.
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 £10.4 million (2023: £10.2 million). Financial liabilities held at amortised cost comprise trade creditors and other creditors totalling £3.8 million (2023: £4.2 million). Investments at £20.2 million (2023: £18.1 million) held as part of an investment portfolio, are held at fair value with gains and losses being recognised within income and expenditure.
**----- Start of picture text -----**
2 Donations, Legacies and Investment Income Unrestricted Restricted Total Total
funds funds 2024 2023
£'000 £'000 £'000 £'000
2.1 Donations and Legacies
Gifts & donations 275 998 1,273 1,391
Legacies 1,099 24 1,123 886
1,374 1,022 2,396 2,277
**----- End of picture text -----**
As at 30 September 2024, the RHN has no bequeathed legacies in the financial statements (2023: £0).
|2.2 Investment Income||
|---|---|
|Listed investments|338
7
345
199|
|Interest on deposits|378
7
385
281|
||716
14
730
480|
|3 Income from Charitable Activities|Note|Unrestricted
funds
Restricted
funds
Total
2024
Total
2023
£’000
£’000
£’000
£’000|
|---|---|---|
|Patient services|3.1|
51,641
20
51,661
48,553|
|Staff accommodation||563
-
563
500|
|Wheelchair & technology services||120
-
120
138|
|Other income from charitable activities||895
-
895
684|
|Grants receivable|3.2|
-
29
29
-|
|||53,219
49
53,268
49,875|
||||
|3.1 Patient Services|||
|National Health Service||48,075
-
48,075
45,747|
|Local Authority||1,320
-
1,320
960|
|Non-NHS patients||115
-
115
29|
|One to One Nursing||2,029
-
2,029
1,675|
|Other sources||102
20
122
142|
|||51,641
20
51,661
48,553|
|3.2 Grants Receivable|||
|Funding research projects||-
29
29
-|
|||-
29
29
-|
34
## Notes to the accounts
## for the year ended 30 September 2024
## 4 Total Expenditure
**----- Start of picture text -----**
Direct costs Support Total Total
costs 2024 2023
£'000 £'000 £'000 £'000
4.1 Expenditure on raising funds
Voluntary expenditure (fundraising staff and administration) 934 109 1,043 996
Fundraising events 44 5 49 68
Investment management 91 - 91 87
1,069 114 1,183 1,151
4.2 Expenditure on charitable activities
Patient Services 42,552 8,688 51,240 48,897
Staff accommodation 82 17 99 92
Wheelchair & technology services 474 97 571 492
Other charitable activities 631 129 760 678
Research - - - 113
43,739 8,931 52,670 50,272
Total expenditure 44,808 9,045 53,853 51,423
**----- 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.
## 5 Support costs
|5 Support costs||
|---|---|
||Expenditure
on raising
funds
Expenditure
on charitable
activities
Total
2024
Total
2023
£'000
£'000
£'000
£'000|
|Administration and management|38
2,955
2,993
2,649|
|Building expenses|35
2,753
2,788
2,608|
|Finance|9
689
698
616|
|Human resources|14
1,119
1,133
1,249|
|Information technology|15
1,198
1,213
1,087|
|Governance|1
90
91
49|
|Statutory audit|1
59
60
57|
|Internal Audit, Counter Fraud and Pension Audit|1
68
69
69|
||114
8,931
9,045
8,384|
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.
35
## Notes to the accounts
## for the year ended 30 September 2024
6 Employee Information
**----- Start of picture text -----**
6.1 Staff costs during the year were as follows: Total Total
2024 2023
£'000 £'000
Salaries and wages 35,379 34,085
Social security costs 3,043 2,672
Other pension costs and life assurance premiums 2,022 1,772
40,444 38,529
**----- End of picture text -----**
Included within the wages and salaries figure above is the cost of employing agency staff £4,622,548 (2023 £6,879,037).
During the year, a total of £60,341 (2023: £76,007) has been recognised for termination payments, of which £0 remained payable at the year end (2023: £0).
## 6.2 Employees whose emoluments not including employers NI and pension costs exceeded £60,000 were as follows:
**----- Start of picture text -----**
||||
|---|---|---|
|Total|Total|
|2024|2023|
|£60,000 to £69,999|33|29|
|£70,000 to £79,999|14|11|
|£80,000 to £89,999|3|1|
|£90,000 to £99,999|-|1|
|£100,000 to £109,999|1|2|
|£110,000 to £119,999|1|-|
|£120,000 to £129,999|2|4|
|£130,000 to £139,999|3|-|
|£140,000 to £149,999|3|3|
|£150,000 to £159,999|1|1|
|£160,000 to £169,999|-|-|
|£220,000 to £229,999|1|1|
**----- End of picture text -----**
59 employees (2023 - 50) 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 £347,864 (2023 - £278,540).
Remuneration of key management personnel including employers NI and pensions payable during the year amounted to £1,264,050 for 6.6 FTE staff (2023 - £1,215,612 for 6.6 FTE staff). This group comprises the Executive team.
**----- Start of picture text -----**
||||
|---|---|---|
|6.3 The average number of staff employed (excluding agency staff) was as follows:|Total|Total|
|2024|2023|
|Patient services|812|733|
|Research|5|5|
|Other charitable activities|43|39|
|Generating funds|11|10|
|Governance|2|2|
|873|789|
**----- End of picture text -----**
**36**
## Notes to the accounts
## for the year ended 30 September 2024
## 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:
- A defined contribution section which, since 1 October 2006, includes all active members of the scheme. An eligible jobholder will be automatically enrolled as a member of the scheme on his automatic enrolment date. The contribution by the employer depends on whether a member is in the first or second tier. If a member has been automatically enrolled or has opted to join the scheme on the first tier contribution basis, the percentage required will be the minimum required under section 20(1)(b) (taking into account the transitional periods under section 29) of the Pension Act 2008. If a member is already in a scheme prior to 1 January 2014 or if the member has opted to be a member on the second tier contribution basis, the percentage will be determined by the member’s age as per the table below. A member can elect to move from the first tier to the second tier contribution basis on becoming a member or on providing one month’s written notice, with the exception of a member who does not work under a contract of employment.
- A defined benefit section, which was closed to new members on 1 November 2001 and closed to future accrual on 30 September 2006, when members were invited to join the defined contribution section.
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: 2024 2023
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
2024
Total
2023
£'000
£'000|
|---|---|
|Defned Contribution|1,757
1,538|
Pension contributions outstanding at the end of the year under the defined contribution scheme are as follows:
||Total
2023
Total
2022
£'000
£'000|
|---|---|
|Pension contributions outstanding at year end|272
235|
A stakeholder scheme is also available to employees of the charity, but no employer contributions are made to this scheme.
37
## Notes to the accounts for the year ended 30 September 2024
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
2024 2023 2022
Inflation 3.10% 3.70% 4.30%
Salary escalation n/a n/a n/a
Pension increases, subject to LPI 2.95% 3.50% 3.95%
Statutory revaluation in deferment 2.30% 2.90% 3.50%
Discount rate (pre and post retirement) 4.95% 5.40% 5.25%
Life expectancy for 65 year old male 87 87 87
Life expectancy for 65 year old female 89 89 90
Life expectancy for 45 year old male 68 68 69
Life expectancy for 45 year old female 71 71 71
**----- 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:
|to the long time period covered, may not necessarily be borne out in practice. The fair
asset are as follows:|value of the assets for each category of|
|---|---|
||Total
2024
Total
2023
Total
2022
£'000
£'000
£'000|
|Equities|5,338
7,532
7,857|
|Corporate bonds|5,739
6,511
6,953|
|Liability matching credit|22,755
24,382
31,778|
|Diversifed growth fund|3,403
5,298
5,215|
|Alternatives|2,669
3,766
4,103|
|Liability driven investment, Government Bonds and Cash|26,424
15,957
13,211|
|Insured annuities|400
383
417|
|Total fair value of assets|66,728
63,829
69,534|
|Present value of scheme liabilities|62,959
61,792
60,961|
||3,769
2,037
8,573|
|Restriction to the amount that can be recognised|(3,769)
(2,037)
(8,573)|
|Net pension asset|-
-
-|
The actual return on Assets is 4.95% per annum which is set to equal the discount rate (2023 - 5.4%).
|Assets in the scheme as a percentage of total scheme assets|Total
2024
Total
2023|
|---|---|
|Equities|8.0%
11.8%|
|Corporate bonds|8.6%
10.2%|
|Liability matching credit|34.1%
38.2%|
|Diversifed growth fund|5.1%
8.3%|
|Alternatives|4.0%
5.9%|
|Liability driven investment, Government Bonds and Cash|39.6%
25.0%|
|Insured annuities|0.6%
0.6%|
|Amounts included in the statement of fnancial activities:|Total
2024
Total
2023
£'000
£'000|
|Interest income (excluding interest income on assets that are not recoverable)|3,244
3,121|
|Interest cost|(3,244)
(3,121)|
|Interest on the net defned beneft liability|-
-|
38
## Notes to the accounts
## for the year ended 30 September 2024
6 Employee Information (continued)
## 6.5 Staff Pension and Life Assurance Scheme (continued)
**----- Start of picture text -----**
Assets Total Total
2024 2023
£'000 £'000
Assets in scheme at beginning of year 63,829 69,534
Movement in year:
Interest income 3,244 3,121
Benefits paid (3,517) (3,050)
Actuarial gains/(losses) on assets 3,172 (5,776)
Assets in scheme at end of year 66,728 63,829
Liabilities Total Total
2024 2023
£'000 £'000
Liabilities in scheme at beginning of year 61,792 60,961
Movement in year:
Administration costs 29 -
Interest cost 3,244 3,121
Benefits paid (3,517) (3,050)
Actuarial (gains) on liabilities 1,411 760
Liabilities in scheme at end of year 62,959 61,792
**----- End of picture text -----**
|History of experience gains and losses|Total
2024
Total
2023
Total
2022
Total
2021
Total
2020
£’000
£’000
£’000
£’000
£’000|
|---|---|
|Defned beneft obligation|(62,959)
(61,792)
(60,961)
(93,769)
(99,674)|
|Scheme assets|66,728
63,829
69,534
102,491
104,564|
|Surplus|3,769
2,037
8,573
8,722
4,890|
**39**
## Notes to the accounts
## for the year ended 30 September 2024
## 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, three members of the Board of management received £2,032 (2023 - four members, £1,861) for reimbursement of expenses. These expenses related to travel and accommodation costs for attending Board Meetings. Trustees’ Indemnity Insurance of £6,720 was paid for the year 2024 (2023 - £6,160).
## 7.2 Other Related Party Transactions
Other than the expenses listed, there have been no other related party transactions (2023 - £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
2024
£’000
£’000
£’000
£’000
£’000|
|||
|Opening balance|259
28,399
2,658
6,402
37,718|
|Additions|1,075
1,139
1,244
805
4,263|
|Transfers|(249)
85
160
4
-|
|Disposals|-
(557)
(112)
(593)
(1,262)|
||1,085
29,066
3,950
6,618
40,719|
|Depreciation||
|Opening balance|-
10,599
931
3,816
10,599|
|Disposals|-
(555)
(112)
(582)
(555)|
|Charge for the year|-
1,341
246
677
2,264|
||-
11,385
1,065
3,911
16,361|
|||
|Net book value 2024|1,085
17,681
2,885
2,707
24,358|
|Net book value 2023|259
17,800
1,727
2,586
22,372|
All fixed assets are held for charitable use.
40
## Notes to the accounts
## for the year ended 30 September 2024
**----- Start of picture text -----**
9 Investments Total Total
2024 2023
£'000 £'000
Market value at beginning of year 18,093 17,883
Purchases at cost 5,736 3,775
Proceeds from disposals (5,745) (4,273)
Net gains on investments 2,045 297
Increase in short term deposits 73 411
Market value at end of year 20,202 18,093
Historical cost at end of year 16,051 15,378
Analysed by type Total Total
2024 2023
£'000 £'000
Investments
Listed direct 14,210 12,385
Unlisted direct 118 118
Listed unit trusts 5,120 4,909
Term Deposits 754 681
20,202 18,093
Geographical analysis Total Total
2024 2023
£'000 £'000
United Kingdom Investments 8,466 8,441
Overseas Investments 11,736 9,652
20,202 18,093
**----- End of picture text -----**
Individual investments which have a market value of 5% or greater of the overall portfolio are:
Vanguard FTSE UK All Share Index
iShares PLC - S&P 500 Index
Schroder Global Sustainable Growth
HSBC FTSE All World Index Fund
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 £91,029 (2023 - £87,447).
|10 Stocks|Total
2024
Total
2023
£'000
£'000|
|---|---|
|Medical consumables|224
254|
||224
254|
41
## Notes to the accounts
## for the year ended 30 September 2024
|Notes to the accounts
for the year ended 30 September 2024||
|---|---|
|11 Debtors|Total
2024
Total
2023
£'000
£'000|
|Fees receivable|4,571
4,549|
|Other debtors|117
128|
|Prepayments|716
694|
|Accrued income|701
692|
||6,105
6,063|
**----- Start of picture text -----**
12 Creditors - Amounts falling due within one year Total Total
2024 2023
£'000 £'000
Trade creditors 435 1,144
Other creditors 662 376
Taxation and social security 795 754
Accruals 1,938 1,945
Deferred income (note 12.1) 157 195
Provisions and contingencies (note 12.2) - -
3,987 4,414
12.1 Analysis of Deferred income Total Total
2024 2023
£'000 £'000
Opening balance 195 195
Changes during the year:
Amounts released to the statement of financial activities (195) (195)
New income deferrals 157 195
Closing balance as at 30 September 157 195
**----- 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
**----- Start of picture text -----**
Legal Settlement Total Legal Total
Provision 2024 Settlement 2023
Provision
£'000 £'000 £'000 £'000
Opening balance - - 248 248
Changes during the year:
Additions - - - -
Charges against the provision - (118) (118)
Unused amounts reversed - (130) (130)
Closing balance as at 30 September - - - -
**----- End of picture text -----**
42
## Notes to the accounts
## for the year ended 30 September 2024
## 13 Funds held as agent
The charity holds funds as an agent on behalf of its patients and residents. During the year £89,831 (2023: £81,634) was received and £101,312 (2023: £90,689) was paid out of this account. At the year end the balance held in this account was £156,483 (2023: £167,964).
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 (2023: £160) was received and £0 (2023: £140,758) was paid out of this account. At the year end the balance held in this account was £250,212 (2023: £250,212).
**----- Start of picture text -----**
14 Operating Leases Total Total
2024 2023
Rentals charged in the year: £’000 £’000
Land and Buildings 8 7
Plant and Machinery 40 38
Equipment 48 147
96 192
Total Total Total Total Total Total
2024 2024 2024 2023 2023 2023
Land and Plant and Furniture and Land and Plant and Furniture and
Buildings Machinery Equipment Buildings Machinery Equipment
£'000 £'000 £'000 £'000 £'000 £'000
Payments due on operating lease
obligations
Within one year 8 29 48 6 38 48
Within two and five years - 49 - - 73 48
8 78 48 6 111 96
**----- End of picture text -----**
|15 Capital Commitments|Total
2024
Total
2023
£’000
£’000|
|---|---|
|Contracted for but not provided
Ward refurbishment|2,406
-|
|Other works|375
22|
||2,781
22|
## 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 2024.
43
## Notes to the accounts
## for the year ended 30 September 2024
17 Statement of funds
**----- Start of picture text -----**
As at 30 September 2024 Fund Fund
balance Transfers balance
brought Incoming Resources Investment between carried
forward resources expended gains funds forward
£'000 £'000 £'000 £'000 £'000 £'000
Unrestricted funds
General funds 15,480 55,477 (53,400) 1,874 (2,084) 17,347
Fixed asset fund 22,372 - - - 1,986 24,358
Planned capital expenditure 6,339 - - - 509 6,848
Planned maintenance 737 - - - 50 787
Total unrestricted funds 44,928 55,477 (53,400) 1,874 461 49,340
Restricted funds
John Howard Convalescent Home 675 14 - 75 - 764
Hunter Ward Refurb - 405 - - - 405
Wheelchair Loan Store 56 - (6) - - 50
Chapel Running Costs 2 36 (2) - - 36
Patient Gardens 15 - (3) - 18 30
Research - National Lottery Heritage Fund - 29 - - - 29
Chatsworth Ward 3 26 (3) - - 26
SW Hardship Fund 42 7 (24) - 1 26
PHD Research 113 - (89) - - 24
Physio/Gym Equipment 22 - (1) - - 21
Other 531 575 (322) - (480) 304
Total restricted funds 1,459 1,092 (450) 75 (461) 1,715
Endowment funds
Lopes Chaplains Stipend fund 8 - - - - 8
Other endowments 772 - (3) 95 - 864
Total endowment funds 780 - (3) 95 - 872
Totals 47,167 56,569 (53,853) 2,044 - 51,927
**----- End of picture text -----**
44
## Notes to the accounts
## for the year ended 30 September 2024
17 Statement of funds (continued)
**----- Start of picture text -----**
As at 30 September 2023 Fund Fund
balance Transfers balance
brought Incoming Resources Investment between carried
forward resources expended gains funds forward
£'000 £'000 £'000 £'000 £'000 £'000
Unrestricted funds
General funds 13,597 51,866 (50,975) 279 713 15,480
Pension reserve - - - - - -
Fixed asset fund 19,453 - - - 2,919 22,372
Planned capital expenditure 8,835 - - - (2,496) 6,339
Planned maintenance 1,142 - - - (405) 737
Total unrestricted funds 43,027 51,866 (50,975) 279 731 44,928
Restricted funds
John Howard Convalescent Home 653 13 - 9 - 675
Large Ambulance 2 63 65 - - - 128
Music Therapy Omega 188 - (75) - - 113
Wheelchair Loan Store 53 9 (6) - - 56
Leonora Ward Ventilator Project 20 35 - - - 55
Sensory Equip & Ward Activity 45 2 (3) - - 44
SW Hardship Fund 36 3 (16) 19 42
Assembly Room Windows 32 - (4) - - 28
Physio/Gym Equipment 25 - (3) - - 22
Dental Equipment 29 - (3) - (5) 21
Other 521 834 (335) - (745) 275
Total restricted funds 1,665 961 (445) 9 (731) 1,459
Endowment funds
Lopes Chaplains Stipend fund 8 - - - - 8
Other endowments 765 - (3) 10 - 772
Total endowment funds 773 - (3) 10 - 780
Totals 45,465 52,827 (51,423) 298 - 47,167
**----- End of picture text -----**
45
## Notes to the accounts
## for the year ended 30 September 2024
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.
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:
- Fixed assets funds represent the net book value invested in fixed assets . During the year the RHN transferred £1,986,000 (2023 £2,919,000 to its designated funds) to its designated funds from general fund.
- Identified planned capital expenditure is for works to be utilised within the next five years. During the year the RHN transferred £509,000 (2023 £2,496,000 out of designated funds) into designated funds from general fund.
- During the year the RHN transferred £50,000 (2023 £405,000) back into designated funds from general fund in anticipation of maintenance expenditure in the coming year.
Restricted These are funds available only for the purpose under which they were received, unless permitted by the donor. Further described below:
**----- Start of picture text -----**
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
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
Wheelchair Loan Store Wheelchairs for Bio-Medical department
Dental Equipment Funding for dental equipment
Sensory Equip & Ward Activity Funding for sensory equipment and ward
activities
Large Ambulance 2 For maintenance of ambulances
SW Hardship Fund For patients and relatives in financial need
Leonora Ward Ventilator Project Funding for Ventilator Project
Physio/Gym Equipment Funding for Physio/Gym equipment
Hunter Ward Refurb Refurbishment of Hunter ward
Chapel Running Costs Running costs of Chapel
Patient Gardens Funding for Patient gardens and gardening
Research - National Lottery Heritage Fund Funding of the RHN heritage archives
Chatsworth Ward For Chatsworth ward needs
PHD Research Funding of Music Therapy research
**----- End of picture text -----**
Other restricted funds is made up of 44 funds (2023 49 funds) none of whose balances are over £22,000 (2023 £20,000) 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.
46
## Notes to the accounts for the year ended 30 September 2024
## 17 Statement of funds (continued)
A summary of definition and descriptions (continued)
Endowment 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.
Included under endowment funds are the following:
|s are the following:||
|---|---|
||2024
2023
£'000 £'000|
|Permanent endowment:||
|Lopes Chaplains Stipend fund|8
8|
|Other Endowment funds|864
772|
||872
780|
## 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 funds which reflect the appropriation of pension reserves within unrestricted funds
**----- Start of picture text -----**
18 Analysis of fund balances Unrestricted Designated Restricted Endowment Total
funds funds funds funds 2024
£'000 £'000 £'000 £'000 £'000
Tangible fixed assets - 24,358 - - 24,358
Fixed asset investments 10,931 7,635 764 872 20,202
Net current assets 6,416 - 951 - 7,367
Total funds at 30 September 2024 17,347 31,993 1,715 872 51,927
Unrestricted Designated Restricted Endowment Total
funds funds funds funds 2023
£'000 £'000 £'000 £'000 £'000
Tangible fixed assets - 22,372 - - 22,372
Fixed asset investments 9,562 7,076 675 780 18,093
Net current assets 5,918 - 784 - 6,702
Total funds at 30 September 2023 15,480 29,448 1,459 780 47,167
**----- End of picture text -----**
47
## 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
48