2021-03-31-accounts

ANNUAL REPORT & ACCOUNTS 2021

Company registered in England and Wales No 256353, Charity No 206002, Charity Scotland No SC038828

2 Combat Stress

PTSD hasn’t stopped and neither have we. We’ve been supporting veterans throughout the COVID-19 pandemic, rapidly moving to deliver our specialist treatment for complex mental health issues online and by phone.

We quickly adapted and refined our fundraising activity – this included launching a variety of new virtual events open to supporters across the UK. Pictured on the front cover are participants in our ‘Ride to Victory’ cycling event which took place on 15 August 2020 and our ‘Race to Remember’ ultra-marathon event on 8 November 2020.

CONTENTS

CONTENTS
Our year in review	1–4
Combat Stress at a glance this year	1
Introduction from our Chairman and Interim CEO	4
Trustees’ report	5–21
Vision, mission, values and aims	5
Future plans	21
Strategic report	22–28
Financial review	23
Principal risks and uncertainties	25
Remuneration and fundraising	26
Public beneft, policies and governance	27
Statement of trustees’ responsibilities	29
Independent auditor’s report to the trustees and members	30
Consolidated statement of fnancial activities	33
Consolidated and Charity balance sheets	34
Consolidated and Charity statement of cash fows	35
Notes forming part of the fnancial statements	36
Legal and administrative information	57
A special thank you	59

1 Combat Stress

COMBAT STRESS AT A GLANCE THIS YEAR 14,000

Almost 14,000 veterans* benefited from our help.

3 614 , 1,334 veterans accessed our veterans directly veterans called newly developed online received support from our Helpline. self-help resources. our specialist staff. 2,000 17

is the number of different conflicts we’ve supported veterans from this year – this includes Northern Ireland, Afghanistan, Iraq, Bosnia and the Falklands.

family members have benefited from veterans directly receiving our specialist mental health support.

*This is an estimate as it is not currently possible to identify any overlap between veterans using our free open access online self-help resources and the other ways we support veterans.

Annual Report and Accounts 2021 2

----- Start of picture text -----
The youngest The oldest
veteran we veteran we
support is support is
21 88
21 years old 88 years old
is the average age a
33%
44
veteran seeks our help
were new callers
11,000+
calls were handled
by our Helpline 75%
during the year.
reliant on donations from supporters – we
need help to meet the needs of every former
serviceman and woman who turns to us for our
unique mental health treatment.
----- End of picture text -----

----- Start of picture text -----
50
40
42%
30
20
19%
10
10%
6%
0
1 2 3 4+
Number of conflicts each veteran has served in
Percentage of veterans
----- End of picture text -----

is the average time it takes from leaving the military for a veteran to seek our help for mental health problems.

All statistics relate to our latest financial year (1 April 2020 to 31 March 2021).

3 Combat Stress

Annual Report and Accounts 2021 4

INTRODUCTION

The last year has been like no other any of us has ever experienced but the Charity reacted and adapted quickly to the COVID-19 pandemic. We rapidly moved to deliver our specialist treatment online and by phone whilst also adjusting our fundraising efforts to encompass virtual events and challenges to help ensure the Charity continued to receive vital funds.

Almost 14,000 veterans benefited from our help: 8,877 veterans called our Helpline, 3,614 accessed our newly developed online self-help resources and 1,334 veterans directly received support from our specialist staff.

During the year, our expert clinicians evolved the treatment programmes for our updated service to provide specialist support to veterans with the most complex mental health needs that have arisen because of traumatic experiences whilst serving in the military. We officially launched this in November 2020. Through our Helpline and online self-help resources our reach is wider, allowing us to play an even bigger role in the veterans’ mental health sector.

Alongside our own clinical treatment and support services, we have continued to support veterans in collaboration with the NHS. We deliver parts of Op Courage – the NHS’ veterans’ mental health service in England. We also remain partfunded by the Scottish Government, through NHS Ayrshire & Arran, to deliver our community, outpatient

and intensive treatment in Scotland. In Northern Ireland we work closely with the NHS as part of the Regional Trauma Network.

Our National Veterans’ Voice initiative has significantly progressed this year, enabling the voice of the veteran to be heard in every area of the Charity, including service design and implementation.

In February 2021, our Director of Resources Jeff Harrison took up the position as Interim CEO following the departure of Sue Freeth. Under Sue’s leadership, Combat Stress was modernised and transformed. Working closely with Giles Peel, Chairman of our Board of Trustees, Jeff leads the Charity until a permanent successor is in place.

We are enormously grateful to our dedicated staff who have continued to work with enthusiasm and determination throughout the COVID-19 pandemic to help change the lives of those who need our help.

Through a combination of prudent financial management, continued significant support from The Royal British Legion, major organisational change, and a year of successful fundraising in the face of many challenges, the Charity is in a strong position to move forward and support veterans with the most complex mental health needs. By providing both in-person (when safe to do so) and online treatment, we will continue to help veterans tackle the past and take on the future.

Giles Peel Chairman of the Board of Trustees

Jeff Harrison Interim CEO

55 Combat Stres Combat Stre s s

VISION, MISSION, VALUES AND AIMS 2017–2022

OUR VISION

OUR VALUES

We want all former servicemen and women with complex mental health problems to live full and meaningful lives.

Together

We are united in purpose, collaborative in action.

Bold

We’ll do and say what we must to achieve our organisation’s vision.

OUR MISSION

To provide support and treatment to veterans with complex mental health problems to help them tackle the past and take on the future.

Focused

We’re clear about what we will and won’t do to deliver the best outcomes.

Personal

We respect diversity and appreciate everyone’s individual needs and talents.

OUR STRATEGIC AIMS AIM 1 AIM 2 AIM 3

Deliver sustainable, accessible services to meet the needs of veterans with complex mental health problems.

Develop a distinct brand positioning to improve engagement and sustain and grow our supporter and financial base.

Build a healthy, cohesive and effective organisation – a place where people want to work.

Annual Report and Accounts 2021 6

DEAN’S STORY

My issues were really hindering my day-to-day life but treatment from Combat Stress literally changed my life.”

Army veteran Dean.

7 Combat Stress

STRATEGIC AIM 1

Deliver sustainable, accessible services to meet the needs of veterans with complex mental health problems

The start of the COVID-19 pandemic coincided almost exactly with the start of our new financial year (1 April 2020). At this time we had planned to fully introduce our new modern, innovative and evidencebased service model focusing on veterans with the most complex mental health needs. However, the onset of the pandemic caused us to delay introducing some elements and accelerated others through digital means to continue providing our vital treatment and support to veterans. This included providing 1:1 assessments, support and therapy sessions by phone and online, the creation of a range of online self-help resources and access to an online peer support community. Adapting in this way meant we continued to provide our specialist services and other support throughout the pandemic.

Service delivery during the pandemic

We had already trialled online versions of some of our services. In 2017 we undertook research, funded by the Forces in Mind Trust, into delivering psychological treatment for PTSD using online video technology. This was successful, with very high acceptability and low drop-out rates, even with veterans who were significantly unwell. Our findings showed that in most cases, online therapy was as effective as delivering in person. Veterans spoke positively about having therapy in

this way. For some, it was preferable to coming to treatment centres.

So, when the Government lockdown was announced in March 2020, this insight meant we had the right knowledge in place to quickly and confidently support veterans. In our new service model we had always planned to provide more online treatment but the pandemic meant we introduced this much more quickly than originally planned.

We invested in IT equipment and additional staff training to ensure our services online were safe and high quality. Veteran insights during 2020 continued to show they engaged well with online treatment.

In March 2021 we extended our online offering with a pilot of our digital treatment and support platform, delivering intensive psychological rehabilitation programmes to veterans remotely through live group-based webinars and workshops as well as 1:1 assessments and treatments.

New service model launch

In November 2020 we were able to officially launch our new service model, providing personal, flexible and accessible treatment. The model is based on four key service principles:

• Veterans are at the heart of what we do

Combat Stress is veteran-centric and veteran-friendly. That is why veterans come to us for help. We have made huge progress in integrating the voices of veterans and their families through our National Veterans’ Voice to every aspect of our service. We aim to make coming into and leaving our services as easy as possible and are piloting a veteran Buddy:Buddy Service nationally to help veterans take that vital first step in asking for help. We have a highly valued Peer Support Service in which we employ

98%

of those veterans who were offered online therapy during COVID-19 restrictions took it up (as opposed to waiting for a return to in-person treatment).

Annual Report and Accounts 2021 8

veterans who, working with veteran volunteers, support those receiving our treatment and after this has ended.

• We are clear about what we offer

We are focused on veterans with complex mental health needs that are a consequence of military trauma. We have an interdisciplinary, recovery-focused approach to understanding a veteran’s needs. Tailored to individual requirements, our aim is to help veterans make sense of their difficulties; change what is going on for them in the present; and help them realise their hopes for the future.

• We only offer treatment that works i.e. is evidence based

We only offer veterans treatments based on what we know works and is supported by research of a high quality. We have an active research team and we regularly connect with the veteran mental health treatment system nationally and internationally to discuss treatment programmes and new ways of working. We also trial new services to gain veteran feedback and insight before launching more widely.

• We are committed to staff awareness and understanding of our services.

Our goal is to ensure that every member of staff has a fundamental understanding of what we do and who we can help. We have a goal to become a trauma-informed organisation – that every member of staff has trauma-related knowledge – as we know this will result in better outcomes for our veterans. We are very proud that all our staff have a passion for our cause We also aim to employ staff that are empathic and have expert understanding and knowledge about military and veteran culture and mental health.

How our new service works

The first step on a veteran’s journey is to call our free 24-hour Helpline. For those most in need of our specialist treatment, we assess and match veterans with the most appropriate treatment as quickly as possible. For others, our experienced team puts them in touch with alternative NHS or other third sector mental health services and/or military organisations that are better placed to meet their needs.

After assessment, we work with the veteran to plan their treatment to best suit their needs. There are four areas of treatment available and each treatment plan is unique

to the veteran and their own needs. A veteran’s treatment may comprise one or more of the following areas:

• Building resilience: this treatment is about giving veterans a range of approaches to cope better and improve the quality of their life.

• Managing the consequences of trauma: this is about offering help for some of the particular difficulties that come with complex mental health problems (for example low selfesteem, relationship problems, managing emotions).

• Trauma-focused treatment: this is offered when a veteran has enough skills to manage this form of treatment.

• Looking to the future: this helps veterans feel connected to the wider world and helps them find practical ways to build resilience.

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88%
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of staff have completed our trauma-informed training module this year

9 Combat Stress

Developed and launched online self-help resources

During the year we have developed accessible online help and advice for veterans on our website that is evidence-based and of high clinical quality. These free-to-use materials enable veterans to start to understand their difficulties even before contacting us for help and can continue to be used during treatment and afterwards.

In addition, as the resources are open to all, regardless of whether a veteran is accessing the rest of our services, it means they have the potential to reach the whole of the UK veteran community, providing vital mental health advice and support.

Veterans can watch our clinicians talk about mental health difficulties that might affect them and read information about what to do to help themselves. There is also help and advice for veterans’ families,

employers and other organisations who support veterans.

There are eleven modules in total available to use, ranging from Alcohol Misuse to PTSD, and all have been created by our expert clinicians. Since their official launch in November 2020 up to 31 March 2021, over 3,600 veterans have accessed the content, providing a valuable step in the initial engagement with our services prior to assessment and future treatment.

Helpline

Over 11,000 calls were handled by the Helpline during the year, with almost 5,000 of these from new contacts. This is a lower number of calls than the previous year – something we attribute to the pause in referrals we had to put in place in England and Wales between January and May 2020 and the COVID-19 lockdowns which dampened help-seeking. Contacts did however increase in the latter

half of the year to the level seen in the previous year.

Following a detailed review and analysis of our Helpline provision, in February 2021 we invested in two additional full-time call handlers to improve the service we provide.

We also set up and held three cross-sector meetings with other organisations that have helplines – attendees included the Office for Veterans’ Affairs, Cobseo, Veterans’ Gateway, The Royal British Legion, and SSAFA. There was broad agreement from these meetings that further collaboration would be helpful to make it easier for veterans to understand which helpline best meets their needs. We plan to explore this collaboration in more detail in the year ahead.

Examples of online self-help resource content

Anger

Depression

PTSD

Substance misuse

Alcohol misuse

Anxiety

Annual Report and Accounts 2021 10

“ These sessions have been a godsend during lockdown.”

“ The virtual meetings have been a life saver during isolation as a result of the coronavirus lockdown.”

Anonymised quotes from veterans who participated in our online Peer Support Service meetings

Peer Support Service

We have a unique Peer Support Service that is run by veterans for veterans, set up in 2017. It offers veterans the opportunity to talk and share experiences with others who have received our services, providing support during and after treatment. It’s the first UK-wide service of its kind for veterans with mental health problems. Veterans can attend small group meetings and meet individually with a regional peer support coordinator once a month. All peer support coordinators have undertaken mental health first aid training as well as training in risk indicators, helping us to identify when a veteran may benefit from more of our specialist support.

Our service redesign also included introducing a Head of Social Care and Engagement to lead the Peer Support Service. Veteran Dave Aitken, a qualified social worker with substantial experience overseeing the delivery of nonclinical and non-statutory services, took up this role. He is ideally placed to provide appropriate oversight of the Peer Support Service whilst still demanding high standards of professional excellence, and he works under

the Medical Director to provide additional structure and expertise.

As well as making these significant service provision changes, our Peer Support Service rapidly innovated when the pandemic began. Within six days of the first UK lockdown being announced, our Peer Support Service moved online and offered a daily national support group via video conferencing as well as the usual monthly regional support groups online. This provided veterans with a vital connection on a more flexible basis and it is something we hope to continue in the future alongside in-person meetings.

We also delivered our first external peer support training package to members of the Light Dragoons Regimental Association. Following the training, the Light Dragoons have established a very successful and well received peer support group to support their veteran community. This collaboration is hopefully the first of many external training sessions to be provided by our Peer Support Service.

Family Support pilot

A veteran’s family can be crucial to recovery; supporting them as they go through treatment. From our own research, we know that partners of veterans diagnosed with PTSD can be at risk of developing a mental health condition themselves. In February 2021 we launched a pilot Family Support Service in Scotland to help family members understand mental health symptoms, the treatment we provide, how to help their loved one and – crucially – how to access support for their own mental health needs or those of their children. Once the pilot completes in July 2021, we will review the data and hope to introduce the service more widely later in the year.

11 Combat Stress

Veterans with lived experience, working with the experts in mental health, make the Charity veteran-centric. This is a positive step forward for the future of Combat Stress, the wonderful staff within it, and the veterans and families that use the service. I am proud and honoured to be the Chair of the National Veterans’ Voice.”

Veteran Davina is Chair of our National Veterans’ Voice group

National Veterans’ Voice

The National Veterans’ Voice (NVV) acts as a co-production channel between Combat Stress and our veteran community. Every member of the NVV is a veteran who has used (or is currently using) our services. The NVV allows veterans to be involved by providing an informed yet impartial perspective on the direction and operation of the Charity. There are eleven veteran members of the NVV and during the year co-production with this group has really developed, becoming more interwoven into the Charity as a whole. The NVV has been involved in a large number of different areas including, for example, senior appointment recruitment and the content creation for the online self-help resources.

Video call meetings became the norm during the pandemic for members of our National Veterans’ Voice (screen shot taken at one of their regular meetings).

Annual Report and Accounts 2021 12

NHS collaboration

Our two-year (£1m pa) contract with NHS England continued to help ensure our core services are funded and that we can provide support in conjunction with the NHS veteran mental health services.

Following a successful tender as part of a consortium with two NHS Trusts for provision of the new High Intensity Service (HIS) in England, in November we began to provide a clinician advice line and specialist evaluation through our research team for the north of England HIS led by the Leeds and York Partnership NHS Foundation Trust.

We continued to provide peer support services and substance misuse nursing for the NHS Complex Treatment Service (CTS) across the north of England, also under contract to Leeds and York Partnership NHS Foundation Trust.

Before our year-end we received indication that the Scottish Government would continue our contract to provide specialist mental health services to veterans across Scotland until March 2022. We maintained ongoing discussions with Veterans First Point (the NHS veterans’ mental health service in Scotland) around working in ever closer collaboration.

In Northern Ireland, Combat Stress is working closely with the NHS as part of the Regional Trauma Network.

We have continued our military mental health training for NHS GPs, frequently providing our one-day training course during the year in collaboration with the MoD and other service charities. Since we began to offer this course in 2016, over 6,500 GPs have been trained.

We are also members of the NHS Confederation Mental Health Network.

Finally, through our partnership with King’s College London, we have been involved in studies looking at the impact of the pandemic on NHS healthcare workers. We have also been part of an NHS Trauma Working Group developing guidance and support for NHS healthcare workers.

Nation-specific support for the veterans’ mental health sector

We are part of a new mental health committee, led by the Northern Ireland Veteran’s Commissioner, to develop mental health services for veterans in Northern Ireland.

As part of our service redesign, we no longer have any services based in Wales but veterans can access our services from our England central hub. We continue to seek funding from the Welsh Government and Wales-based donors to develop our services to Welsh veterans with the aim of re-establishing services inside Wales.

In Scotland we are part of the Scottish Veterans Care Network. This network is working to produce a mental health action plan for veterans (to be published in late 2021).

In addition, to support the sector nationwide, we remain an active contributor to the Defence Health Select Committees, NHS England Armed Forces Clinical Reference Group and the Contact Armed Forces Group. Our Director of Research also chairs the Quality Network for Veterans’ Mental Health Services (QNVMHS), a subgroup of the Contact Group which through the Royal College of Psychiatrists’ Quality and Accreditation Service is conducting a quality evaluation of providers of veterans’ mental health services across the United Kingdom.

We also began a new training programme to help others support veteran mental health. A grant from the Armed Forces Covenant Fund Trust made it possible for us to develop and start delivering a two-year programme to help organisations that work with veterans understand and support veteran mental health issues.

Diversity and inclusion

To help address the diverse needs of those who seek our help, we met with Fighting with Pride, a charity that supports the health and wellbeing of LGBT+ veterans, service personnel and their families, to discuss how to improve access and approach to LGBT+ veterans. We have also begun capturing data on protected characteristics.

Our Helpline team routinely asks veterans about any online access issues (disability or technology related) so that, if needed, one of our Buddy:Buddy workers can reach out and provide the relevant support.

Our living archive project Combat Stress 100 shows the true stories of veterans as spoken by them. We continue to work with veterans who have been through our treatment, seeking more diverse voices to share their stories and show others that there is help available for them, no matter their background or characteristics.

13 Combat Stress

Research

Our research department was established in 2014 by Dr Walter Busuttil, the Charity’s then Director of Medical Services, and Professor Dominic Murphy. It was – and remains today – a collaboration with the King’s Centre for Military Health Research at King’s College London. This research group investigates veterans’ mental health needs, evaluates treatment outcomes and develops clinical services based on research findings.

After 13 years in post, Dr Busuttil stepped down as Director of Medical Services in August 2020 to take on the part-time, newly created role of Director of Research and Training at Combat Stress. This role enables him to be more involved in research – something which has always been a passion of his. The Charity is extremely grateful for his hard work and contribution over the years.

This year, our research team published over 20 academic papers in peer reviewed scientific journals. This included a paper looking at barriers for treatment in BAME Commonwealth veterans and, in collaboration with the Women’s Royal Army Corp Association (WRAC), the largest study to date in the UK exploring the needs of female veterans.

Highlights from research work undertaken during the year include:

• Complex PTSD treatment: following on from our study to confirm the validity of complex PTSD and the differences between veterans with PTSD and complex PTSD, we have researched development of new treatments to support these more vulnerable veterans who are less likely to respond to current NICE-approved gold standard treatment for PTSD.

Professor Dominic Murphy, Head of Research

• Moral injury treatment: using the knowledge from our research into moral injury, we began the development of a novel treatment to support veterans who have a moral injury. The next phase of this will be to pilot the treatment with veterans – we expect this to be undertaken in 2021–22.

• Exploring the treatment needs of veterans accessing the NHS High Intensity Service (HIS): working with two NHS partners (Leeds and York Partnership NHS Foundation Trust and Dorset Healthcare University NHS Foundation Trust), we have researched the profile of veterans accessing these services and identified the groups who may need additional support to engage in treatment.

• During the COVID-19 pandemic we have continued to be active internationally, participating in the Five Eyes Research Collaborative advising the veterans’ ministers of the

Dr Walter Busuttil MBChB MPhil MRCGP FRCPsych RAF (Retd), Director of Research and Training

UK, USA, Australia, Canada and New Zealand; as well as participating in international ground breaking groups such as the Emerging Treatments In Veterans’ Mental Health, which includes key thinkers from the UK, USA, The Netherlands, Israel, Canada, and Australia.

20 peer reviewed research papers published in the last year.

Annual Report and Accounts 2021 14

15 Combat Stress

STRATEGIC AIM 2

Develop a distinct brand positioning to improve engagement and sustain and grow our supporter and financial base

The impact of COVID-19 has been significant for fundraising, marketing and communications but we have been successful in the face of many challenges. Our target for the year was £7.5m but we achieved £9.2m – an illustration of the continued generous support of donors and fundraisers as well as the amazing commitment of our Fundraising and Marketing & Communications teams despite the limitations placed upon us all.

When the pandemic hit, we rapidly adapted and refined our activity. This included launching a variety of new virtual events open to supporters across the UK as well as keeping supporters regularly informed via social media, email and phone about how we were continuing to provide crucial treatment to veterans.

COVID-19 has presented us with challenges for brand and awareness but also great opportunities. During the pandemic many of our opportunities to engage in person were limited as events and meetings had to take place virtually. This accelerated our commitment to take a digital first approach, expanding our use of online content and communication.

At the start of the pandemic we quickly created content to support veterans and supporters with their mental health. This was shared via emails, social media and our website. This was then developed into a dedicated self-help section on our website for veterans. With

almost 100 videos, animations and graphics, it was devised with clinical colleagues to make self-help more effective. This broadened our reach and showcased the expertise – and services – of the Charity, cementing our uniqueness and specialism in the field of veterans’ mental health.

This digital work has also translated into our support for fundraising. We have increased use of social media to promote challenge events, creating engaging online content and accurately identifying new potential supporters based on their profiles. We also worked closely with the volunteer and community team to create digital graphics and content for use on Funraisin, an interactive platform with integrated event registration and fundraising, which has improved the user experience of our challenge events.

We have continued work on our living archive project, Combat Stress 100, which gathered veterans’ experiences in their own words to raise the public’s awareness of the impact of military trauma. In September 2020 we launched our Combat Stress 100 campaign, which culminated on Armistice Day. Using the veterans’ heart wrenching stories, we asked the nation to pause to think about today’s veterans and the mental health problems many can experience once they leave the armed forces. The campaign included the launch of our sixepisode podcast series, the launch of the living archive on our

For further information about the Combat Stress 100 project and to view the film, please visit combatstress.org.uk/combat-stress-100

website, a streaming of the film for the first time with the National Army Museum in partnership with the National Museum of The Royal Navy, and an Armistice fundraising appeal. In total this campaign raised £60,000. The year ahead will see us add to this archive and work with our clinical team to assess how the archive can be used in a clinical context.

We devised a new more compact format for the Combat Stress magazine – a four-page newspaper. This was launched in Autumn 2020 and provided supporters with an easily digestible overview of the Charity’s activities and support to veterans during the pandemic. The newspaper was very well received by supporters and exceeded its objectives, raising income, starting conversations and improving readers’ understanding of the mental health challenges faced by

Annual Report and Accounts 2021 16

Our newspaper which launched in Autumn 2020

veterans and how our treatment helps. Our Spring issue was also positively received, and the two issues have raised over £57,000 in additional donations combined. We plan to continue with this format for the foreseeable future.

Real stories are one of the best ways to raise awareness and inspire action and this has been an important focus for the year. We have proactively sought out stories from those who have used the services of the Charity – examples from the last year include a veteran who has benefited from our occupational therapy-led sensory modulation treatment and a veteran who used our virtual Peer Support Service when he found himself stranded in Asia at the start of the pandemic.

We have also introduced a new email marketing platform (dotdigital). This has positively transformed the way we communicate with our supporters to keep them informed and engaged. Through this more strategic approach to email communications, we have seen a significant increase in income from email marketing as

well as cost and time efficiencies for the Charity by using the platform.

The combined efforts of our Marketing and Communications and Fundraising teams have helped deliver a favourable return for supporters in terms of efficacy. For every £1 we spend on fundraising, we raise £5 – a good result for our sector. Our supporters should be encouraged that so much of what they give goes directly to support veterans. From each £1 spent, 81p supports veteran treatment.

To demonstrate the breadth of our fundraising approaches, below are some highlights from our various sources of income:

Trusts and Foundations

The support from trusts and foundations has continued to play a vital role in our treatment of veterans with complex mental health needs. In the past year we have received more than 250 donations of all sizes from these generous supporters.

This funding has proved particularly crucial in the past year as we have developed our services to be increasingly accessible and flexible, ensuring that veterans could access the treatment and support they need during the pandemic. Some key examples of this were a grant of £250,000 from the Armed Forces Covenant Fund Trust, Ministry of Defence and Cabinet Office through the COVID-19 Impact Programme; the ongoing support

of the Oak Foundation for our core services with a grant of £333,333; and a grant of £100,000 from the Corporation of Lloyd’s to support the delivery of our clinical services during the pandemic.

Examples of other support from veteran charities and funds included:

• Armed Forces Covenant Fund Trust has funded the delivery of Training for Veterans’ Wellbeing through the Strategic Pathways programme as well as our online self-help resources.

• ABF The Soldiers’ Charity has continued their generous support of our mental health services for Army veterans.

• Poppyscotland has helped us to deliver vital mental health services in the Scottish Highlands.

• RAF Benevolent Fund has supported us in providing treatment and support to RAF veterans across the UK.

• The Royal British Legion is supporting the delivery of services from our South of England Hub, ensuring veterans in the region could access treatment and support.

• Royal Navy and Royal

• Marines Charity has continued to help us to provide former servicemen and women from the Royal Navy and Royal Marines with the help they need.

17 Combat Stress

Through a combination of

Individual Giving

highlighting the impact that gifts in Wills achieve and making it easier for supporters to write their Wills for free with a solicitor, we also saw a significant increase in the number of enquiries from supporters about this way of giving. It’s a testament to the relationship we have developed with supporters that many who leave legacies will have been committed to our work over several decades, with the longest relationship being over 50 years.

Our supporters have provided very generous funding through cash gifts, regular giving, In Memory giving and our lottery. By building our digital, creative and content teams’ expertise and resources, we were able to rely less on external agencies and so significantly reduce costs while still producing impactful fundraising appeals inhouse, particularly online. Although we continued to send direct mail appeals to existing donors, we have used far more social media advertising. Online advertising has allowed us to be more targeted and to rapidly adapt activity to maximise efficiency.

Volunteer, Regional and Community Fundraising

Despite almost every event being cancelled during this year due to COVID-19 restrictions, we responded quickly to create new virtual events to engage supporters and raise funds. These included:

In addition, we have reviewed In Memory giving and will be moving it into our Legacy team to provide a very personal approach for supporters, providing one point of contact at what can be a difficult time. In Memory fundraising can take many forms; from tribute funds, collections in lieu of flowers at funerals through to general fundraising.

• VE Day – Celebrate at Home: a free downloadable pack full of ideas to help mark 75 years since VE Day (8 May 2020). Almost 3,000 packs were downloaded, and supporters engaged in a whole range of different ways.

Legacies

• Ride to Victory: a 75-mile cycle ride on 15 August 2020 to commemorate the 75th anniversary of Victory over Japan Day (VJ Day).

Legacy giving has remained strong throughout the year, with 89 bequests totalling over £2.5 million received, once again providing a vital source of funding.

For every £1 spent:

supports veteran treatment 81p is invested in fundraising 15p raises awareness 4p

The winning photo in our ‘VE Day: Celebrate at Home’ competition – just one of the ideas in our specially designed pack.

Supporters across the country created their own 75-mile route and raised over £44,000.

• Race to Remember: when the second lockdown was announced just three days before this inaugural ultramarathon event was due to take place, the team and fundraisers rallied round and ran the event virtually, raising almost £30,000.

• 1200 Squats by Christmas: engaging over 500 members of our online Facebook community, this simple but strenuous exercise challenge helped to raise £12,000.

We are also very grateful to all those fundraisers who came up with their innovative ideas to raise funds – this included a wheelchair marathon

Annual Report and Accounts 2021 18

Some of our amazing fundraisers taking on a whole host of different challenges during COVID-19.

in a kitchen, sewing and selling thousands of facemasks, and a group of soldiers box jumping the height of Mount Everest in under 24-hours!

The highlight of our year in this area was our March in March event. This is the fourth year we have run this event and it continues to go from strength to strength, helped hugely by the involvement of the Army Cadet Force this year. Overall the largest ever number of fundraisers signed up to take part – 1,003 – and as a result income from the event was increased to over £180,000.

Major Gifts

Our Major Gifts team has focused on nurturing and developing relationships. We are grateful that so many of our generous supporters and Benefactors, individuals giving over £5,000 per annum, have understood the challenges faced by veterans this year and continued or – in many cases – increased their support.

We are indebted to late Sir Michael Uren’s family for continuing their partnership through The Michael

Uren Foundation and to Ms Jacobs and Mrs Bramall for their ongoing support.

Events

Our events programme was severely disrupted as a result of the pandemic but in December 2020, we were able to hold our traditional Christmas Carol Service in a virtual format which broadened its reach significantly. Over 500 supporters enjoyed the amazing choir and service from the Royal Hospital Chelsea from the comfort of their homes. Readers at the service included TV Presenter Lorraine Kelly, Sergeant Major Glenn Haughton OBE, and Royal Chelsea Pensioner Dewi Treharne. The event raised over £13,000 in donations.

Corporate Partnerships

We are extremely fortunate that many of our corporate supporters, including BAE Systems, General Dynamics, Northrop Grumman and Thales UK, increased their financial support to help the Charity with the impact of COVID-19.

Employees of our corporate partners also participated in our virtual events, helping to raise vital funds through sponsorship. Ride to Victory was very popular with staff from Secure Cloud Plus, CDS Defence and Security and Aquila all taking on the challenge.

Finally, corporate partners were also involved in our record-breaking March in March fundraising challenge, with 132 individual corporate supporters taking part. In total there were 13 different company teams, including Pall Ex, Unum and Giftpoint who between them raised in excess of £13,000.

TV Presenter Lorraine Kelly was one of the readers at our virtual Christmas Carol Service.

19 Combat Stress

Annual Report and Accounts 2021 20

STRATEGIC AIM 3

Build a healthy, effective organisation – a place where people want to work

The wellbeing of our staff will always be of the upmost importance but was even more crucial during the COVID-19 pandemic. We implemented a series of new measures to help staff with their wellbeing, strengthening engagement between colleagues and within line management relationships to support our employees to adjust to new ways of working. We also created more opportunities for staff to keep us informed on their mental health, undertaking two surveys to understand levels of wellbeing and resilience. Results from these surveys helped us to focus our efforts on the mental and physical health needs of our staff during the pandemic.

As a direct result of the first wellbeing survey, we offered all staff the opportunity to attend a series of resilience workshops. We also set up a new wellbeing team that provided staff with helpful advice and self-care tips as well as running weekly events such as mindfulness sessions, guided art appreciation and yoga.

We also supported employees with a range of flexible working options during the various COVID-19 lockdowns, taking into account individual circumstances. Just a few staff were placed on furlough to protect them from financial hardship during the pandemic. To further help staff working from home, we conducted IT equipment and home office set-up audits to ascertain and meet specific needs.

The pandemic amplified the need for internal communications and during the year we have transformed our communication channels. We implemented a range of new initiatives to bring employees together and ensure they felt included, involved and updated on the Charity, even when working from home. Staff engagement with internal communications has steadily built up over time, with an average of 75% of staff now attending the monthly all-staff meetings, the highest attendance being 95%. Staff report that they have felt informed, supported and respected during the last year, helping to create a more inclusive, accepting organisation.

enable them to be better informed. The training covers our history, our services, an insight into those who seek our help as well as advice on working in a trauma-informed way. An online training zone was also created to bring together learning for all staff, a mixture of clinical and non-clinical courses as well as computer application training.

Our commitment to diversity and inclusion continues – we have begun to review our current diversity and inclusion programmes by working with an external organisation to aid us in developing evaluation tools to help us achieve our strategic aims.

Finally, Viewpoint, our employee forum, achieved full membership this year. It continues to be instrumental in working with the Executive team and the staff in embedding change management over the last 12 months, particularly in relation to flexible working during the pandemic.

We launched a new online training portal. This includes mandatory core training modules for all staff to undertake to help build understanding about the Charity, veterans, causes of mental health issues and our range of treatment to

Mandatory core training modules for all staff:

Module 3: Veteran centric

Module 2: Military knowledge

Module 1: Who we are

Module 4: Service redesign

Module 5: Module 6: Module 7: Trauma informed Veteran journey Research - led service

21 Combat Stress

FUTURE PLANS

Over the coming year we will finalise the next stage of implementing our service model redesign, continuing to evolve and develop our services to offer cutting-edge treatment. In addition, to continue meeting the needs of veterans and their families today, alongside in-person treatment (and residential when required to meet a veteran’s specific needs), we plan a significant increase in online treatment provision, including our unique intensive PTSD treatment, to provide accessible and effective therapy and support for those with complex mental health issues related to military trauma. We will also extend our online group clinical treatment programmes.

During the year we will consider our footprint across the UK to ensure we are located to give better access to the veterans who seek our help.

We will continue to collaborate and work closely with others in the charitable sector, especially those in the veteran and mental health sector.

Our research department, which works closely with the world leading King’s Centre for Military Health

Research at King’s College London, will lead evaluation of our treatment programmes as well as undertaking follow up studies to look at unique trauma experiences of female veterans and of UK BAME veterans.

Also, we will introduce a continuous quality improvement plan. Working with the internationally renowned not-for-profit Virginia Mason Institute, the plan will help ensure we continue to provide better outcomes for veterans.

Building on the success of our virtual events during the pandemic, we plan to continue a blend of virtual and in-person fundraising events.

In October we will launch our first Secret Postcard Auction, offering a new supporter audience the chance to buy a unique piece of art through an online auction. This event is an opportunity to highlight the important role art and creativity play in our specialist treatment and a myriad of celebrities and artists have already submitted artwork for the auction. Veterans who have benefited from art therapy whilst undergoing treatment will also be invited to take part.

Our virtual events will also,

COVID-19 restrictions permitting, run alongside in-person fundraising such as a dinner at The Tower of London in November, thanks to a generous offer from Lord Houghton, Constable of The Tower of London, who has chosen Combat Stress as one of his official charities. We are very much looking forward to being able to thank donors in person for their support and generosity during the pandemic.

Following a review of donor journeys, we will launch a new programme of activity to engage and excite those who show an interest in our work.

Finally, for our National Veterans’ Voice, we plan to continue to build on what has already been established to involve them in future strategy and services. Co-production training is planned for the Board so that this can be embedded into the culture of the organisation at all levels. We will also be extending our staff wellbeing plans and initiatives to give employees greater empowerment to engage with the Charity.

Annual Report and Accounts 2021 22

STRATEGIC REPORT

23 Combat Stress

FINANCIAL REVIEW

The lockdowns caused by

COVID-19 began just as our financial year was starting and have affected every part of our organisation, as it has our lives. In order to continue to provide our lifechanging services to veterans, we had to rapidly change the way that we delivered help. The work that we were doing on the total redesign of our service proved invaluable, as it was designed around greater amounts of distanced support, through telephone and online. Designed with greater accessibility of our services in mind, it was exactly what was needed at a time when we were not able to see veterans in person or on our sites. We accelerated the work that we were doing, and also developed and implemented a range of self-help tools for our website that are free to download and use.

Our Helpline services continued throughout. Peer support, therapy and psychiatric services were delivered by telephone or online. The generosity of our wonderful supporters continued throughout the year, enabling us to modify our services to meet the rapidly changing needs. With the help of these supporters, and government support and new grants, our income recovered from the low figure in the previous financial year.

Our expenditure was incurred in ways that were quite different to previous years. We spent less in some areas such as travel, building maintenance and utilities. We spent more on equipping our employees to work from home in a productive manner, investing in computer

hardware and desks and chairs for home use.

As part of a review to ensure that we were using all of our assets in the best interests of the Charity, we undertook a property review. We have already announced that Audley Court, our centre in Shropshire, will be sold, and replaced by more centrally based premises. As part of this announcement we have had to re-assess the value of our properties, and this has produced the need to write down their values. This impairment charge of £2.3m had to be charged in this year’s financial results.

We operate a defined benefit pension scheme, although it closed to new members and further service accruals in 2000. This has previously shown a surplus valuation, which has been reflected in the accounts. The triennial pension scheme valuation at 30 September 2020 showed a deficit, and even though the FRS102 valuation at 31 March 2021 again showed a surplus, it was felt to be imprudent to show this as an asset. The previously shown asset has been written back to zero.

The net effect of all of these factors is a reduction in funds of £0.1m (2020 reduction £4.8m). As the impairment and pension scheme charge are not cash related, reserves have remained in the level that has been set by trustees, and cash balances have returned to a level that is needed for ongoing service to veterans.

Our work would not be possible without the amazing help of individuals, companies, trusts and statutory bodies. We are immensely grateful for their continued help and support.

Going concern

The Trustees review financial plans and risks at each Board meeting as part of their normal review. They are satisfied that Combat Stress has sufficient resources to continue operating for the foreseeable future and accounts have been prepared in the knowledge that the Charity is a financially viable organisation.

The restructuring that we undertook prior to the onset of the pandemic helped us during the difficult economic year, as we had already reduced our costs to a level that matched our expected levels of income.

The hard work of our fundraising team, together with the continued support that we receive, enabled us to continue providing our services, and also to begin the process of rebuilding reserves and cash that were reduced in the previous financial year.

The level of reserves at 31 March 2021, in the form of cash (£2m) and investments (£7.5m), together with substantial contracts and pledges are such that the trustees remain satisfied that Combat Stress can continue operating for the foreseeable future. Accounts have been prepared in the expectation that Combat Stress remains a financially viable organisation and a going concern.

Annual Report and Accounts 2021 24

The Trustees will continue to review plans with the executive team to make any necessary changes to remain within the free reserves level over the life of the three-year plan, as per the reserves policy.

The financial statements are prepared on the going concern basis which assumes that Combat Stress will continue in operational existence for the foreseeable future. The Board of Trustees have considered the working capital and cash flow requirements and consider that the current and forecast cash resources are sufficient to cover the working capital requirements of the Charity for at least 12 months from the date of approval of the accounts. Having considered these matters, the Trustees do not consider there to be a material uncertainty and have accordingly prepared the financial statements on a going concern basis.

Income

Our total income for the year was £12.2m (2020: £10.2m). £1.4m of the increase in income was due to a rise in voluntary income. Legacies were £0.7m higher at £2.5m (2020 £1.8m).

Income from our strategic partners was up at £2.1m compared with £1.3m in 2020, due principally to timing differences. The relationships with these partners remain close and collaborative. We have received multiple year pledges relating to 2021 and beyond from these partners which will allow us to continue our work.

this year at £0.9m (2020: £0.1m), in particular due to specific grants related to supporting both veterans and staff during the coronvirus pandemic.

Income from charitable activities was £2.6m (2020: £1.8m). Contractual income from NHS Scotland was £1.4m (2020: £1.4m). In 2017–18, NHS England changed the way that it funds veteran mental health. Until that year we had received contract income of £3.4m each year. In 2018–19 we received £552k, as the residual part of this contract. In that year, NHS England redirected this veteran mental health funding to their new HIS and CTS services, which are principally run by NHS Trusts. As part of this new funding model we received £123k of contract work from Leeds and York Partnership NHS Foundation Trust (2020: £117k). NHS Dorset gave us £24k for HIS services in SW England (2020: £nil) and NHS England funded us with £1m (2020: £nil) for the provision of care to veterans with complex PTSD in England.

Investment income of £234k was slightly reduced from last year (2020: £241k).

Expenditure

Total expenditure for 2021 was £12.9m (2020: £14.6m) with 85% being spent on charitable activities (2020: 82%). This includes an impairment charge against property of £2.3m.

Expenditure on raising funds was reduced to £2.0m (2020:£2.6m) as many fundraising activities were curtailed due to the pandemic situation.

In 2021, our spending on charitable activities was £10.9m (2020: £12.0m). This reduction was a direct effect of the closure of treatment centres to face to face activities due to coronavirus.

Staff costs comprise 59.8% of our total costs (2020: 70.1%) as shown in Note 8. It remains a challenge to recruit and retain excellent employees in a competitive market, and we are seeking to address this through our HR strategy review.

Statutory income (income from government bodies) was higher

25 Combat Stress

PRINCIPAL RISKS AND UNCERTAINTIES

The Board of Trustees has overarching responsibility for managing risks faced by the Charity. Significant risks to which the Charity are exposed to are formally reported to the Audit and Risk Management Committee and the Board of Trustees at every meeting via the corporate risk register. All other committees review their sections of the risk register. In 2021 we reviewed and refreshed our risk register. The risks are categorised as: corporate governance (and includes compliance), financial, people, quality of care (includes safety, effectiveness and efficiency) and strategic (includes reputational risk). We also maintain registers for key projects and for each department.

The Trustees have given consideration to the major risks to which the Charity is exposed and satisfied themselves that systems or procedures are established in order to manage those risks.

As we are a veterans’ complex mental health charity, clinical and service-related incidents are reported to the Medical Director and Director of Operations. The most significant cases are reported to the Serious Incident Review Group, which is made up of senior managers and directors, as well as to the Clinical Governance Committee (or other applicable committee) and the Board of Trustees. If it is a reportable incident, then the appropriate regulatory bodies would be informed. All incidents undergo appropriate investigation.

Other significant areas of risk currently include:

1. The ongoing impact of the COVID-19 pandemic. Throughout the year we have monitored and reacted accordingly to UK Government advice to ensure the safety of our staff and veterans, as well as other stakeholders we would usually engage with on a face to face basis.

2. The continued UK economic instability impacts our ability to fundraise and secure sustainable income. We review our fundraising performance frequently at team and director meetings with updates and assurance provided to the appropriate committee meetings and Board each quarter.

3. The pandemic led to a demanding environment for staffing. In recruitment, especially in the clinical and operations fields, we had some staff leave to work back in the NHS, and we had to deal with some staff being seconded for an interim basis back to the NHS, to help with the crisis the hospitals faced last year. As a result, our vacancy rate has at times been quite high. We also addressed the challenges faced by our staff on both a work and personal basis, especially during the initial lockdown when schools were closed and some colleagues had other caring dependencies.

Combat Stress was supported by the Coronavirus Retention Scheme with grants across the year totalling £458k. 63 people were initially furloughed at the start of the pandemic and this had dropped to 15 people for our March 2021 claim.

Annual Report and Accounts 2021 26

REMUNERATION FUNDRAISING

Combat Stress is committed to ensuring a proper balance between paying employees fairly to attract and retain the best people for the job within the constraints of the financial management of the Charity’s funds. We employ people whose skills and competencies are in great demand throughout the healthcare and charity sectors. We use NHS pay scales as an important reference point for staff salaries.

The Remuneration and

Nominations Committee determines the salary and any benefits of the Chief Executive and executive directors. Their salaries are set with reference to the median for the charity sector.

We disclose all payments to Trustees and the number of staff with total remuneration of £60,001 and above in accordance with SORP.

Combat Stress operates a defined contribution pension scheme, to which all eligible employees are auto-enrolled. Any employee who does not qualify automatically may opt to join. The minimum employee contribution level was 5% of basic salary in 2020/21 and is in line with the auto-enrolment requirements. The employee contribution is matched by the organisation. Staff may opt to make higher contributions, which we match up to a maximum of 10%. At 31 March 2021 88% (March 2020: 89%) of our employees were enrolled in the pension scheme.

We only work with external agencies that meet our high standards to help deliver our work – including telemarketing agencies, creative agencies, print and fulfilment houses. We monitor closely all the organisations we use; having regular meetings, listening to live calls (if applicable), and carrying out checks. If we find cause for concern, we will investigate as a matter of urgency. We do not engage the services of professional fundraisers who take commission from donations to fundraise on our behalf.

We strive for the highest possible standards in our fundraising, are registered with the Fundraising Regulator and are committed to complying with its Fundraising Promise and the Code of Fundraising Practice. We are also a member of the Institute of Fundraising. We have complied with all the rules and regulations and to date not received any notification of a breach.

In 2020/2021, we received seven fundraising complaints (2019/20: 19) which were logged on our incident management system, Datix. All complaints are investigated thoroughly in a timely and sensitive manner and acted upon as necessary. Complaints typically concern matters such as the frequency of communications, or queries around why someone is receiving communications from the Charity.

We are especially careful and sensitive when engaging with vulnerable people, including

the elderly and those affected by mental health issues. Our procedures and practice reflect this. Each supporter is given a genuine choice to donate and we are always respectful of the wishes of our supporters.

27 Combat Stress

PUBLIC BENEFIT, POLICIES AND GOVERNANCE

Public benefit

Combat Stress is the UK’s only clinical provider specialising in veterans with complex mental health needs. The Board of Trustees have considered the Charity Commission’s general guidance on public benefit and have taken it into account when reviewing the Charity’s strategic aims and objectives and in planning future activities. The Board of Trustees are satisfied that the aims of the Charity are carried out wholly in pursuit of its charitable aims for the public benefit.

The public benefit of the Charity is in mitigating the effect of mental health issues of veterans across the UK. Our strategic aims and activities are designed to achieve this benefit.

Combat Stress is widely acknowledged as the specialist in the treatment of veterans suffering from service-related mental illness.

Our services are accessible to all veterans who need our help. We help UK veterans on their recovery journey so they are able to integrate more fully back into their communities.

Our research and education work means we contribute to a better understanding of mental illness across the UK, and particularly in the Armed Forces. By working in partnership with the NHS, other service charities, statutory agencies and the media, and offering health and social care service employers education and training in psychological first aid, we are now seeing a growing understanding of the needs of those with hidden injuries.

As a result of the above, the Trustees consider that Combat Stress clearly satisfies the public benefit test.

Investment policy and returns

Under the Memorandum and Articles of Association, Combat Stress has the power to make any investment that the Trustees see fit. The Finance Committee and Board of Trustees are responsible for setting our investment policy, which it reviews on an annual basis.

We recognise that the way we invest our funds can make a positive contribution to society. Combat Stress does not invest in the shares of individual companies, but instead in a pooled fund. This is the most effective way to produce a reasonable, sustainable return, and to reduce the risk of financial loss should stock markets fall, so best protects our financial position. This meets our obligation to make the best use of our assets in the interest of veterans. It means though that we are not able to make decisions ourselves on which companies to exclude from our portfolio. However, we work with an investment manager who takes ethical investment issues seriously, including demonstrating active engagement with companies on environmental, social and governance issues (ESG). Schroders have been considering ESG factors in their investment process for more than twenty years. Sustainability is a priority for Schroders and is one of their strategic capabilities. They recognise that environmental damage and social transformation are happening faster than ever,

with climate change, shifting demographics and technological developments reshaping our planet. They believe that those companies that can adapt and thrive will be more successful in attracting customers, employees and growing their business and will be better investments for their clients.

Schroders have achieved an A+ rating from the UN Principles for Responsible Investment in each of the last six years. They have been named as one of the world’s most influential companies with the ability to make a meaningful contribution to achieving the sustainable development goals. They are ranked in the top five of the AODP Global Climate Index for Asset Managers and are a special adviser to the Carbon Disclosure Project; a founding member of the institutional investor group on climate change; and a member of the UK Sustainable Investment and Finance Association and the European Sustainable Investment Forum.

Combat Stress holds its investments in the Cazenove Charity Multi-Asset Fund. The stated objective of the fund is inflation (UK CPI) +4.0% over the long-term. The fund holds a range of diversified investments to reduce risk. We review the performance of our investments on a quarterly basis. During 2020/21, the performance of markets resulted in unrealised gains of £983k (2020:losses of £594k).

At 31 March 2021, our investments were worth £7.5m (2020: £5.1m). Cash balances totalling £1.3m (2020: £0.1m) held by the investment manager at year end awaiting investment are included in these investment figures.

Annual Report and Accounts 2021 28

Reserves policy

Trustees review our reserves policy annually.

Combat Stress has a long-term commitment to veterans. The Trustees believe the level of free reserves (that is those funds not tied up in fixed assets, designated and restricted funds) should represent six to nine months’ budgeted unrestricted expenditure. This protects our services from the risk of disruption due to lack of funds, whilst at the same time ensuring we do not retain income for longer than necessary.

The general reserve, excluding pension scheme reserve, at 31 March 2021 stood at £7.4m, representing 7.4 months’ budgeted unrestricted expenditure (2020: £5.6m, or 6.6 months).

Restricted and designated funds are held for specific purposes, as detailed in Note 21.

The valuation for financial reporting purposes of the Ex-Services Mental Welfare Society 1974 Pension & Life Assurance Scheme at 31 March 2021 showed a surplus on the fund of £610k (2020: surplus of £430k), which has been capped at zero, as the last triennial actuarial valuation was for 30 September 2020 and the initial report showed a deficit. Under the previous recovery plan, the Charity made no payments during 2020/21 (2020: no payments). Following a consultation with active members, the scheme was closed to future accrual on 31 March 2013. Details of the scheme are disclosed in Note 17

of the accounts. The next triennial actuarial valuation will take place at 30 September 2023.

Governance

Combat Stress is a charitable company limited by guarantee. It was incorporated on 11 May 1931 and is governed by Memorandum and Articles of Association, which were revised on 14 November 1991 and then amended by resolution on 21 September 2006, 20 September 2007 and 17 July 2008.

The objects of the Charity are ‘to provide, establish and maintain recuperative homes, hospitals, sanatoria, schools of training, clubs, workshops and other centres for discharged officers, men and women members of the Navy, Army, Air Force and other allied services, with a view to aid their restoration to health of mind and body, and more particularly to assist those suffering from neurasthenia and mental diseases, and to train or employ them in industries and handicrafts either for a return to their homes and previous occupations or so as to enable them to take up a new life and occupations in the United Kingdom, and to assist and to provide for their dependants’.

The Board of Trustees is responsible for selecting and recommending suitable Trustees for election to office at the annual general meeting. A maximum of fifteen Trustees are elected, each of whom serve for an initial period of three years. One third of the trustees normally retire from office at each Annual General Meeting.

Retiring trustees are the longest serving Board members, excluding ex-officio members.

A retiring trustee is eligible for re-election and may serve a maximum of two consecutive terms of three years unless there is an extenuating reason for their retention approved at the General Meeting, or they are elected to the office of Chairman, Vice Chairman or Honorary Treasurer. The Board of Trustees is empowered to appoint a trustee to fill a casual vacancy until the next Annual General Meeting. The Trustees are the directors for the purposes of company law.

The Chairman, Interim CEO and executive directors induct new trustees through briefings. We also provide a copy of the Trustee handbook to all new Board members.

The Board of Trustees meets at least four times a year and has appointed committees with responsibility for finance, fundraising, marketing and communications, audit and risk management, clinical governance, and remuneration and nominations.

A further independent committee is responsible for stewardship of the closed defined benefit pension scheme.

The Board delegates management of day-to-day activities to the CEO and the executive directors.

The Trustees support the principles-based approach of the Charity Governance Code.

29 Combat Stress

STATEMENT OF TRUSTEES’ RESPONSIBILITIES

The Trustees (who are also directors of Combat Stress for the purposes of company law) are responsible for preparing the strategic report, the annual report and the financial statements in accordance with applicable law and regulations.

Company law requires the trustees to prepare financial statements for each financial year. Under that law the trustees have elected to prepare the financial statements in accordance with United Kingdom Generally Accepted Accounting Practice (United Kingdom Accounting Standards and applicable law). Under company law the trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of affairs of the charitable company and of the profit or loss of the charitable company for that period.

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

• select suitable accounting policies and then apply them consistently;

• make judgements and accounting estimates that are reasonable and prudent;

• ensure that applicable UK Accounting Standards have been followed, subject to any material departures disclosed and explained in the financial statements, and

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

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

Disclosure of information to auditors

In the case of each of the persons who are trustees of the charitable company at the date when this report was approved:

• so far as each of the trustees is aware, there is no relevant audit information (as defined in the Companies Act 2006) of which the charitable company’s auditors are unaware; and

• each of the trustees has taken all the steps that he/she ought to have taken as a trustee to make himself/herself aware of any relevant audit information

(as defined) and to establish that the charitable company’s auditors are aware of that information.

This confirmation is given and should be interpreted in accordance with the provisions of S418 of the Companies Act 2006.

The Board of Trustees approved this Trustees’ Annual report and Strategic report.

G R PEEL (Sep 23, 2021 16:52 GMT+1)

Giles Peel Chairman

Date: Sep 23, 2021

Annual Report and Accounts 2021 30

INDEPENDENT AUDITOR’S REPORT TO THE TRUSTEES AND MEMBERS OF COMBAT STRESS

Opinion on the financial statements

In our opinion, the financial statements:

• give a true and fair view of the state of the Group’s and of the Parent Charitable Company’s affairs as at 31 March 2021 and of the Group’s incoming resources and application of resources for the year then ended;

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

• have been prepared in accordance with the requirements of the Companies Act 2006, the Charities and Trustee Investment (Scotland) Act 2005 and regulations 6 and 8 of the Charities Accounts (Scotland) Regulations 2006, as amended in 2010.

We have audited the financial statements of Combat Stress (“the Parent Charitable Company”) and its subsidiary (“the Group”) for the year ended 31 March 2021 which comprise the consolidated statement of financial activities (incorporating an income and expenditure account), the consolidated and Charity balance sheets, the consolidated and Charity statement of cash flows, and notes forming part of the financial statements, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting

Standards, including Financial Reporting Standard 102, the Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Independence

We remain independent of the Group and the Parent Charitable Company in accordance with the ethical requirements relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements.

Conclusions related to going concern

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

Based on the work we have performed, we have not identified any material uncertainties relating to

events or conditions that, individually or collectively, may cast significant doubt on the Group and the Parent Charitable Company’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. The other information comprises the information included in the Annual report, other than the financial statements and our auditor’s report thereon. The other information comprises the information at pages 1 to 4 and the Trustees report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are

31 Combat Stress

required to report that fact.

We have nothing to report in this regard.

Other Companies Act 2006 reporting

In our opinion, based on the work undertaken in the course of the audit:

• the information given in the Trustees’ report, which includes the Directors’ report and the Strategic report prepared for the purposes of Company Law, for the financial year for which the financial statements are prepared is consistent with the financial statements; and

• the Strategic report and the Directors’ report, which are included in the Trustees’ report, have been prepared in accordance with applicable legal requirements.

In the light of the knowledge and understanding of the Group and the Parent Charitable Company and its environment obtained in the course of the audit, we have not identified material misstatement in the Strategic report or the Trustee’s report.

We have nothing to report in respect of the following matters in relation to which the Companies Act 2006 and the Charities and Trustee Investment (Scotland) Act 2005 requires us to report to you if, in our opinion;

• proper and adequate accounting records have not been kept by the Parent Charitable Company, or returns adequate for our audit have not been received from branches not visited by us; or

• the Parent Charitable Company financial statements are not in agreement with the accounting records and returns; or

• certain disclosures of directors’ remuneration specified by law are not made; or

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

Responsibilities of Trustees

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

In preparing the financial statements, the Trustees are responsible for assessing the Group’s and the Parent Charitable Company’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 Group or the Parent Charitable Company 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 44(1)(c) of the Charities and Trustee Investment (Scotland) Act 2005 and under the Companies Act 2006 and report in accordance with the acts 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.

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

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

Based on our understanding of the Group and Charity and the industry in which it operates, we identified that the principal laws and regulations that directly affect the financial statements to be relevant charities acts in the UK and Ireland. We assessed the extent of compliance with these laws and regulations as part of our procedures on the related financial statement items.

In addition, the Group and Charity are subject to many other laws and regulations where the consequences of non-compliance could have a material effect on amounts or disclosures in the financial statements, for instance through the imposition of fines or litigation. 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.

Annual Report and Accounts 2021 32

Audit procedures performed by the engagement team included:

• We determined that the most significant laws and regulations which are directly relevant to specific assertions in the financial statements are those related to the financial reporting framework including but not limited to United Kingdom Generally Accepted Accounting Practice and the Charities Act 2011, Statement of Recommended Practice for Accounting Reporting by Charities (SORP FRS 102)and tax legislation.

• We understood how the Charity is complying with those legal and regulatory frameworks that are significant to their activities by making enquiries to management and those responsible for legal and compliance procedures. We corroborated our enquiries through our review of minutes and correspondences with HMRC and the various regulators;

• Challenging assumptions made by management in their significant accounting estimates in particular in relation to impairment of tangible fixed assets, legacy income recognition and assumptions relating to the valuation of Defined Benefit Pension Scheme asset; and

• In addressing the risk of fraud through management override of controls; testing the appropriateness of journal entries and other adjustments; testing the application of cutoff and revenue recognition, particularly around grant income, donations and legacies, and evaluating the business

rationale of any significant transactions that are unusual or outside the normal course of business.

Our audit procedures were designed to respond to risks of material misstatement in the financial statements, recognising that the risk of not detecting a material misstatement due to fraud is higher than the risk of not detecting one resulting from error, as fraud may involve deliberate concealment by, for example, forgery, misrepresentations or through collusion. There are inherent limitations in the audit procedures performed and the further removed non-compliance with laws and regulations is from the events and transactions reflected in the financial statements, the less likely we are to become aware of it.

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

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

Use of our report

This report is made solely to the Charitable Company’s members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006, and to the Charitable Company’s trustees, as a body, in accordance with the Charities and Trustee Investment (Scotland) Act 2005. Our audit work has been undertaken so that we might state to the Charitable Company’s members and 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 Charitable Company,

the Charitable Company’s members as a body and the Charitable Company’s trustees as a body, for our audit work, for this report, or for the opinions we have formed.

Paula Willock (Senior Statutory Auditor) For and on behalf of BDO LLP, statutory auditor, Gatwick, UK

Date: 28 September 2021

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

33 Combat Stress

CONSOLIDATED STATEMENT OF FINANCIAL ACTIVITIES FOR THE YEAR ENDED 31 MARCH 2021

Incorporating an Income and Expenditure Account

Note Income from: Donations and legacies 3 Charitable activities 4 Trading activities Investments	Note Income from: Donations and legacies 3 Charitable activities 4 Trading activities Investments	Unrestricted Funds £’000 5,534 2,606 208 234	Restricted Funds £’000 3,602 31 5 -	Totals 2021 £’000 9,136 2,637 213 234	Totals 2020 £’000 7,784 1,818 361 241
Other		10	-	10	40
Total income		8,592	3,638	12,230	10,244
Expenditure on: Raising funds Charitable activities
		1,962	-	1,962	2,635
Clinical services Helpline Raising awareness and improving access		6,856 246 510	3,239 70 -	10,095 316 510	11,051 429 491
		7,612	3,309	10,921	11,971
Total expenditure	5	9,574	3,309	12,883	14,606
Net (expenditure)/ income before transfers and investment gains and losses Net gains/(losses) on investments Net income/(expenditure) Transfers between funds Other recognised (losses) / gains Actuarial (losses)/gains on defned beneft pension scheme	21 17	(982) 982	329 -	(653) 982	(4,362) (594)
		-	329	329	(4,956)
		350	(350)	-	-
		(440)	-	(440)	134
Net movement in funds		(90)	(21)	(111)	(4,822)
Reconciliation of funds: Fund balances brought forward at 1 April
		15,214	906	16,120	20,942
Fund balances carried forward at 31 March	21	15,124	885	16,009	16,120

The notes on pages 36 to 56 form part of these financial statements. All activities relate to continuing operations.

There are no gains and losses for either the current or prior years other than those recognised above. All items in the statement of financial activities would appear in the Income and Expenditure Account with the exception of the realised and unrealised gain/(loss) on investments. There is no difference between the net income before other recognised gains and losses and their historical cost equivalents. The Consolidated statement of financial activities funds analysis for 2020 is shown in Note 22.

Annual Report and Accounts 2021 34

CONSOLIDATED AND CHARITY BALANCE SHEETS AT 31 MARCH 2021

Notes Fixed assets Tangible assets 9 Investments 10 Total fixed assets Current assets Property for resale (donated in October 2019, sold August 2020) Stock Debtors 11 Cash at bank and in hand Total current assets Liabilities Creditors: amounts falling due within one year 12 Net current assets Net assets excluding pension asset Defned beneft pension scheme asset 17	Notes Fixed assets Tangible assets 9 Investments 10 Total fixed assets Current assets Property for resale (donated in October 2019, sold August 2020) Stock Debtors 11 Cash at bank and in hand Total current assets Liabilities Creditors: amounts falling due within one year 12 Net current assets Net assets excluding pension asset Defned beneft pension scheme asset 17	Group 2021 2020 £’000 £’000 5,642 8,470	Group 2021 2020 £’000 £’000 5,642 8,470	Charity 2021 2020 £’000 £’000 5,640 8,470	Charity 2021 2020 £’000 £’000 5,640 8,470
		7,468	5,070	7,468	5,070
		13,110	13,540	13,108	13,540
		- 60 1,478	966 74 2,208	- - 1,611	966 - 2,317
		2,003	179	1,925	121
		3,541 (642)	3,427 (1,277)	3,536 (635)	3,404 (1,254)
		2,899	2,150	2,901	2,150
		16,009	15,690	16,009	15,690
		-	430	-	430
Total net assets	19	16,009	16,120	16,009	16,120
The funds of the Charity: Unrestricted income funds General fund Defned beneft pension scheme reserve General fund, including pension scheme reserve Investment revaluation reserve Designated funds		7,403 -	5,616 430	7,403 -	5,616 430
		7,403	6,046	7,403	6,046
		1,081	98	1,081	98
		6,640	9,070	6,640	9,070
		15,124	15,214	15,124	15,214
Restricted income funds		885	906	885	906
Total Charity funds	21	16,009	16,120	16,009	16,120

The notes on pages 36 to 56 form part of these financial statements. During the year ended 31 March 2021, Combat Stress, the parent charity results showed a loss after gains, losses and transfers of £111k (2020: loss of £4,822k).

The financial statements were approved by the Board of Trustees and signed on its behalf by:

Giles Peel

Chairman G R PEEL (Sep 23, 2021 16:52 GMT+1)

Date: Sep 23, 2021

Mickey Morrissey Michael P Morrissey Honorary Treasurer Michael P Morrissey (Sep 23, 2021 13:25 GMT+1)

Sep 23, 2021

Date:

Company Limited by Guarantee Registered in England and Wales No 00256353 Charity Registration No England and Wales 206002, Charity Registration No Scotland SC038828

35 Combat Stress

CONSOLIDATED STATEMENT OF CASH FLOWS AND CHARITY STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 MARCH 2021

Cash fows from operating activities:	Group	Group	Charity	Charity
	2021 £’000	2020 £’000	2021 £’000	2020 £’000
Net cash provided by / (used in) operating activities	3,509	(4,463)	3,487	(4,434)
Cash fows from investing activities: Dividends, interest and rents from investments Proceeds from sale of property, plant and equipment Purchase of property, plant and equipment Proceeds from sale of investments Purchase of investments Net cash provided by (used in) investing activities Change in cash and cash equivalents in the reporting period Cash and cash equivalents at the beginning of the reporting period
	234 - (4)	241 4 (187)	234 - (2)	241 4 (187)
	- (200)	1,011 (420)	- (200)	1,011 (420)
	30	649	32	649
	3,539 (231)	(3,814) 3,583	3,519 (289)	(3,785) 3,496
Cash and cash equivalents at the end of the reporting period	3,308	(231)	3,230	(289)

Reconciliation of net (expenditure)/income to net cash flow from operating activities

Net (expenditure) for the reporting period (as per the statement of fnancial activities) Adjustments for: Depreciation charges Impairment charges (Gains) / losses on investments Actuarial losses / (gains) on defned beneft pension scheme Dividends, interest and rents from investments Loss / (proft) on the sale of fxed assets Decrease in current asset property for resale Decrease in stocks Decrease in debtors (Decrease) in creditors Pension scheme costs under FRS102 – Interest Movements	Group	Group	Charity	Charity
	2021 £’000 (111) 424 2,320 (983) 440 (234) 88 966 14 730 (135) (10)	2020 £’000 (4,822) 396 - 594 (134) (241) (4) 238 3 109 (595) (7)	2021 £’000 (111) 424 2,320 (983) 440 (234) 88 966 - 706 (119) (10)	2020 £’000 (4,822) 396 - 594 (134) (241) (4) 238 - 142 (596) (7)
Net cash provided by / (used in) operating activities	3,509	(4,463)	3,487	(4,434)

The analysis of cash and cash equivalents and the analysis of changes in net debt are shown in tables in Note 23.

Annual Report and Accounts 2021 36

NOTES FORMING PART OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2021

1. Accounting policies

a. Basis of preparation

The financial statements have been prepared under the historical cost convention, with the exception of investments, which are included at fair value (bid price). The financial statements have been prepared in accordance with the Statement of Recommended Practice (Charities SORP (FRS 102) second edition – October 2019), “Accounting and Reporting by Charities” applicable to charities in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102), Companies Act 2006, Charities Act Trustee Investment (Scotland) Act 2005 and regulations 6 and 8 of the Charities Accounts (Scotland) Regulations 2006, as amended in 2010, the Charities Act 2011 and UK Generally Accepted Accounting Practice effective 1 January 2019.

b. Going concern

The Trustees review financial plans and risks at each Board meeting as part of their normal review. At all meetings, they were satisfied that Combat Stress had sufficient resources to continue operating for the foreseeable future and accounts have been prepared in the knowledge that the Charity is a financially viable organisation.

The work that we undertook since 2019 to re-design our services, and to reduce expenditure to a level that matches our sustainable income proved to be effective. Since the implementation of the

plan our income has been sufficient to continue to fund our activities. We understand the changes in our funding streams, and have adapted our fundraising work to reflect this, but we need to be aware that the economic effects of the pandemic are not over. We will continue to monitor income and expenditure closely.

During 2020–2021 we were able to begin to rebuild our reserves and cash balances and the most recent forecasts and projections out to 31 March 2023 show an acceptable level of cash and reserves to fund our services to veterans. Those projections show that reserves and cash will be at similar levels to 31 March 2021, as shown in these accounts.

The Trustees will continue to review plans with the executive team at each committee meeting to make any necessary changes to remain within the free reserves level contained in the reserves policy.

As such, they remain satisfied that the Combat Stress can continue operating for the foreseeable future and accounts have been prepared in the expectation that Combat Stress remains a financially viable organisation.

The financial statements are prepared on the going concern basis which assumes that Combat Stress will continue in operational existence for the foreseeable future. The Board of Trustees have considered the working capital and cash flow requirements and consider that the current and forecast cash resources are sufficient to cover

the working capital requirements of the Charity for at least 12 months. Having considered these matters, the Trustees do not consider there to be a material uncertainty and have accordingly prepared the financial statements on a going concern basis.

c. Key judgements and estimates

Accounting estimates and judgements are continually evaluated and are based on historical experience and other factors, including expectations of future events that are believed to be reasonable under the circumstances. The estimates and assumptions that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities with the next financial year are as follows:

1. Defined benefit pension

assumptions – estimate

As disclosed in Note 17, the Group’s principal retirement benefit scheme is a defined contribution scheme. However there is a smaller residual defined benefit scheme. Year end recognition of the liabilities under this residual scheme requires a number of significant assumptions to be made, relating to key financial market indicators such as inflation and expectations on future asset returns and mortality rates.

Defined benefit pension – judgement

The pension asset disclosed in Note 17 has not been recognised in the balance sheet as there is no expectation of recovery of funds in the foreseeable future.

37 Combat Stress

Annual Report and Accounts 2021 37

1. Accounting policies (continued)

2. Legacy recognition – estimate

Legacies are included in the accounts based on their probate value, where there is reasonable certainty that Combat Stress is entitled to the funds (see Note 3). In the case residuary legacies, the final income received may change from this initial valuation.

3. Depreciation – estimates

Estimates are made in assessing the useful economic life of categories of assets to spread their cost over the accounting periods to which their use relates. See accounting policy 1i for further details.

4. Impairment – judgement

In March 2021 a review was carried out on the carrying values of the properties following the decision to market Audley Court for sale. An impairment adjustment of £2.3m was made to the property values of Audley Court and Hollybush House.

d. Basis of consolidation

The Charity has two wholly owned subsidiaries, Combat Stress Trading Limited and Ex-Services Mental Welfare Society, both of which are registered in England. Consolidated financial statements for the Group, being Combat Stress and Combat Stress Trading Limited have been prepared on a line by line basis in the statement of financial activities and balance sheet. The Ex-Services Mental Welfare Society is a shell company used to protect the previous name of Combat Stress. It has never traded and holds nil net assets.

e. Company status

Combat Stress is a company limited by guarantee. The directors of the company are the members of the Board of Trustees named on page 57 and 58.

In the event of Combat Stress being wound up, the liability in respect of the guarantee is limited to £1 per member.

f. Fund accounting

General funds are unrestricted funds which are available for use at the discretion of the Trustees in furtherance of the general objects of Combat Stress and which have not been designated for other purposes.

Designated funds comprise unrestricted funds that have been set aside by the Board of Trustees for particular purposes. The aim and use of each designated fund is set out in the notes to the financial statements.

Restricted funds are funds which are to be used in accordance with specific restrictions imposed by donors or which have been raised 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 the notes to the financial statements.

g. Income

All income is included in the statement of financial activities when Combat Stress is legally entitled to the income, and the amount can be quantified with reasonable accuracy. The following specific policies apply to categories of income:

• Donations

Donations of cash are recognised when received. Donations of property are recognised at valuation on title transfer and held as a current asset until sold.

• Legacies

Legacies are recognised as income when notification of entitlement has been received by Combat Stress, a grant of probate has been issued, the amount of the legacy can be estimated with reasonable certainty and the likelihood of

receiving the income is judged to be probable. No value is included where the legacy is subject to a life interest held by another party.

• Donated services and facilities

Auction prizes donated for resale are included as income when they are sold. Donated assets and services are included at the value to Combat Stress where this can be quantified. No amounts are included in the financial statements for services donated by volunteers.

• Grants received which are to be utilised over more than one year In accordance with the Charities Statement of Recommended Practice, Combat Stress recognises grant funding in the year of receipt if there are no performance related conditions, as a restricted grant. Therefore, the income is not deferred but the unspent monies are carried forward as a restricted fund balance to be expended in future years.

h. Expenditure

All expenditure is accounted for on an accruals basis and has been classified under headings that aggregate all costs related to the category. Where costs cannot be directly attributed to particular headings they have been allocated to activities on a basis consistent with use of the resources.

Expenditure is allocated as follows:

i. Expenditure on raising funds

Fundraising costs are those incurred in seeking voluntary contributions and do not include the costs of disseminating information in support of the charitable activities.

ii. Clinical services

This represents all direct

expenditure incurred in the running of clinical services to veterans, whether from our treatment hubs, out in the community or through online technology, including related payroll, office and other

Annual Report and Accounts 2021 38

costs. A proportion of central support costs is allocated on the basis set out in note 6.

iii. Helpline

This represents the direct cost of providing the 24-hour Helpline and a proportion of central support costs allocated on the basis set out in note 6.

iv. Raising awareness and improving access

This represents the direct costs of publicising and promoting our services directly to veterans, their families and medical health professionals. It includes a proportion of central support costs allocated on the basis set out in note 6.

v. ww vi.

g. w h.

i. Tangible fixed assets

Tangible fixed assets are stated at cost less depreciation and provision for impairment. Only items over £1,000 are capitalised. Repairs are written off as incurred. Depreciation is provided from the month following the date assets are brought into use, to write down cost to estimated residual value over the estimated useful life by equal annual instalments.

The useful life estimates for the different groups of tangible fixed assets are as follows:

Freehold property –	No write
land	down
Freehold property –	20–100
buildings	years
Furniture and	5 years
equipment Computer equipment	3 years
Computer software –	6 years
Patient Administration
System Plant Maintenance vehicles	10 years 3 years

j. Investments

Investments are stated at fair value (bid price). Unrealised gains and losses arising on the revaluation of investments are, together with the realised gains and losses arising on the sale of investments, shown in the consolidated statement of financial activities as net gains/ (losses) on investments.

k. Pension costs

Pension costs and the pension provision for the defined benefit scheme are calculated on the basis of actuarial advice and are charged to the statement of financial activities on a basis to spread the costs over the employees’ working lives. Pension costs for the defined contribution scheme are charged to the accounts on an accruals basis. The defined contributions are allocated to the activities in line with the cost allocations of the individual employees’ staff costs. A pensions reserve has been created within unrestricted funds. Details of the pension schemes are disclosed in note 17 to the accounts.

l. Leases

Rentals applicable to operating leases are charged to the statement of financial activities over the period term of the lease.

m. Employee benefits

Expenditure is recognised for all employee benefits resulting from their service to Combat Stress during the period. A liability has been included for the cost of annual leave to which employees are entitled at the reporting date that has yet to be paid.

n. Financial instruments

The Group and parent financial instruments comprise fixed asset investments measured at fair value

through profit or loss and other financial assets which comprise cash, Group debtors, and other debtors and financial liabilities which comprise trade creditors, and other creditors, measured at amortised cost.

o. Stock

Stock is valued at the lower of cost and net realisable value.

39 Combat Stress

2. Results of the parent charity

Total Charity income Total Charity expenditure Transfers between funds Charity net expenditure Gain / (loss) on investment assets Actuarial (loss) / gain on defned beneft scheme Charity net movement in funds Funds balance brought forward Funds balance carried forward	Unrestricted £’000 8,549 (9,531) 350	Restricted £’000 3,638 (3,309) (350)	Total 2021 £’000 12,187 (12,840) -	Total 2020 £’000 10,175 (14,537) -
	(632) 982 (440)	(21) - -	(653) 982 (440)	(4,362) (594) 134
	(90) 15,214	(21) 906	(111) 16,120	(4,822) 20,942
	15,124	885	16,009	16,120

The total income for the Charity excluding the subsidiary includes the gift aid donation from Combat Stress Trading Limited of £25,058 (2020: £41,111). This will result in no tax having to be paid on the net profits.

As permitted by section 408 of the Companies Act 2006 no separate statement of financial activities is presented in respect of the parent company.

3. Voluntary income

Group voluntary income

Group voluntary income
Donations Statutory grants Legacies	Unrestricted £’000 3,129 -	Restricted £’000 2,567 923	Total 2021 £’000 5,696 923	Total 2020 £’000 5,828 125
	2,405	112	2,517	1,831
	5,534	3,602	9,136	7,784

The voluntary income in 2020 was £7,784k of which £1,026k was restricted.

Charity voluntary income

Donations Statutory grants (see below) Legacies	Unrestricted £’000 3,154 -	Restricted £’000 2,567 923	Total 2021 £’000 5,721 923	Total 2020 £’000 5,870 125
	2,405	112	2,517	1,831
	5,559	3,602	9,161	7,826

The voluntary income in 2020 was £7,826k of which £1,026k was restricted.

The Charity’s voluntary income includes a donation from the subsidiary trading company of £25k (2020: £41k).

Certain legacies had been notified to Combat Stress as at 31 March 2021 but have not been included in the accounts as they do not meet the criteria to enable them to be measured or the entitlement is not yet certain. None are considered to be material but their combined value is estimated to be £431k (2020: £410k).

Annual Report and Accounts 2021 40

The details of government (statutory) grants received were as follows:

Purpose Armed Forces Covenant Fund Grant to fund digital services to continue to reach veterans during lockdown Armed Forces Covenant Fund Grant to fund training in mental health to be provided to other service charities HMRC Coronavirus Job Retention Scheme Grant to cover furlough payments during lockdown due to C-19 pandemic	Total 2021 £’000 250 215	Total 2020 £’000 - 125
	458	-
	923	125

None of the above grants have any unfulfilled conditions or contingencies.

4. Income from charitable activities (Group and Charity)

Clinical services Contract funding Performance related grant Other	Unrestricted	Restricted	Total	Total
	£’000 2,571 35 -	£’000 31 - -	2021 £’000 2,602 35 -	2020 £’000 1,574 243 1
	2,606	31	2,637	1,818

5. Total Group expenditure (Group and Charity except where stated)

Cost of generating funds Cost of generating voluntary income Cost of trading activity (Combat Stress Trading Limited only) Investment management fees Charitable activities Clinical services Clinical services – impairment charge Helpline Awareness raising and improving access Total	Activities undertaken directly £’000 1,643 50	Allocated support costs £’000 255 -	Total 2021 £’000 1,898 50	Total 2020 £’000 2,546 74
	14	-	14	15
	1,707	255	1,962	2,635
	6,425 2,320 304 394	1,350 - 12 116	7,775 2,320 316 510	11,051 - 429 491
	9,443	1,478	10,921	11,971
	11,150	1,733	12,883	14,606

41 Combat Stress

5. Total Group expenditure (continued)

5. Total Group expenditure (continued)
	2021	2020
Expenditure includes:	£’000	£’000
Audit fee – Charity	34	32
Audit fee – trading company	6	5
Audit fee – pension scheme	9	8
Operating leases	75	99
Depreciation	424	396
Impairment of tangible fxed assets	2,320	-

6. Support costs

2020/21 Allocations: Activities for generating funds Clinical services Helpline Awareness raising and improving access	Finance £’000 43 229 8 10	Management £’000 49 254 1 25	Governance £’000 38 197 1 19	Human Resources £’000 39 202 1 20	Maternity £’000 13 65 - 7	Information Technology £’000 73 403 1 35	2021 Total £’000 255 1,350 12 116
	290	329	255	262	85	512	1,733

2019/20 Allocations: Activities for generating funds Clinical services Helpline Awareness raising and improving access	Finance	Management	Governance	Human Resources	Maternity	Information Technology	2020 Total
	£’000 72 298 13 13	£’000 32 196 - 10	£’000 16 100 - 5	£’000 61 372 - 19	£’000 19 115 - 6	£’000 77 502 - 22	£’000 277 1,583 13 75
	396	238	121	452	140	601	1,948

Basis of allocation

The support costs expenditure is allocated on the following basis:

Finance: On the basis of the value of direct costs incurred by each activity.

Management: On the basis of full time equivalent numbers of employees directly employed in each activity. Governance: On the basis of full time equivalent numbers of employees directly employed in each activity. Human resources: On the basis of full time equivalent numbers of employees directly employed in each activity. Maternity: On the basis of full time equivalent numbers of employees directly employed in each activity.

Information technology: On the basis of the number of employees directly employed in each activity.

Annual Report and Accounts 2021 42

7. Trustee expenses

Out-of-pocket expenses were reimbursed or paid on behalf of trustees as follows.

Travel and sundry expenses	2021	2021	2020	2020	2020
	Number 2	£’000 -	Number 9	£’000 3

Travel and hotel expenses for two trustees were paid in April 2020 relating to meetings in the prior year. No member of the Board of Trustees received any remuneration or emoluments in respect of services during the year (2020: £Nil), nor had any beneficial interest in any contract with Combat Stress during the year.

8. Staff costs

Combat Stress Trading Limited and Ex-Services Mental Welfare Society, the subsidiary companies in the Group, do not have any employees and do not pay directors. Consequently, all of the information in this note relates to the Group and to the Charity.

Wages and salaries Social security costs Redundancy & termination payments Pension costs Other costs	2021 £'000 6,524 646 86 327 120	2020 £'000 8,654 868 150 442 122
	7,703	10,236

Emoluments for employees above £60,000

Between £60,001 – £70,000 Between £70,001 – £80,000 Between £80,001 – £90,000 Between £90,001 – £100,000 Between £110,001 – £120,000 Between £130,001 – £140,000 Between £140,001 – £150,000 Between £190,001 – £200,000	2021 Executive - 2 2 - - - - 1	2021 Clinical 4 1 - 1 - - - -	2021 Total 4 3 2 1 - - - 1	2020 Total 5 2 2 - 1 1 1 -
	5	6	11	12

The total remuneration costs of the CEO and Executive Directors in 2021 was £747k (2020: £739k).

As a charity providing complex clinical services, we employ senior clinicians, including psychiatrists and psychologists. In recent years, the highest paid Director has been the Medical Director, a Consultant Psychiatrist, who leads the research and design of the treatment programmes. It is essential that we have a leading expert in the field of veterans mental health for this post. However this year, due to changes in personnel during the year, the new Medical Director is only included for 8 months from August onwards. The highest paid member of staff was the outgoing CEO, Sue Freeth who ceased to hold this role at 31 January 2021, and the highest paid Director in the year was the Director of Operations.

Payments to the outgoing CEO also include compensation for loss of office and consultancy work after finishing in the role of CEO. Total payments include contractual payments of £166k and non contractual payments of £25k.

Benefits provided to all staff include matched contributions of up to 10% into the Group Personal Pension Scheme, childcare voucher scheme, cycle to work scheme and free car parking.

43 Combat Stress

8. Staff costs (continued)

Pension contributions for employees above £60,000

Defned contribution schemes	2021 Number £’000 9 50	2021 Number £’000 9 50	2020 Number £’000 12 75	2020 Number £’000 12 75

The number of employees including bank and casual staff, analysed by function was:

Clinical services Fundraising and communications Management and administration	2021	2021	2020	2020
	Number 120 34 38	FTE*	Number	FTE*
		103	205	165
		32	40	36
		35	31	25
	192	170	276	226

* FTE = Full Time Equivalent

Management and administration in the 2021 figures include an average headcount of five staff on maternity leave (2020: six staff).

9. Tangible fixed assets for use by the Group and the Charity (except where stated for Trading)

Asset cost At 1 April 2020 Additions Disposals At 31 March 2021 Accumulated depreciation At 1 April 2020 Charge for period Impairment charge Disposals At 31 March 2021 Net book values At 1 April 2020 At 31 March 2021	Trading Furniture & Equipment £’000 - 2 -	Freehold property £’000 12,237 - -	Furniture, Equipment & Motor Vehicles £’000 2,138 2 (125)	Plant £’000 84 - -	Total £’000 14,459 4 (125)
	2	12,237	2,015	84	14,338
	- - - -	4,309 193 2,283 -	1,633 223 8 (37)	47 8 29 -	5,989 424 2,320 (37)
	-	6,785	1,827	84	8,696
	-	7,928	505	37	8,470
	2	5,452	188	-	5,642

Annual Report and Accounts 2021 44

10. Investments

Fixed asset investments

Investments at start of the year Less cash held by investment manager Less unrealised gain held on cash products Market value at start of the year Additions at cost Disposals Net investment gain / (loss) Market value at end of year Cash and cash products held by investment manager – at cost Analysis of investments held at end of the year Cazenove Charity Multi Asset Fund Historical cost of listed investments at end of year Unrealised gains	Group and Charity	Group and Charity
	2021 £’000 5,070 (90) -	2020 £’000 8,295 (2,129) (1)
	4,980 200 -	6,165 420 (1,011)
	5,180 983	5,574 (594)
	6,163 1,305	4,980 90
	7,468	5,070
	6,163 5,082 1,081	4,980 4,882 98

The cash held by the investment manager is held for cash management purposes.

11. Debtors

Fees Accrued income Income tax recoverable Other debtors Intercompany debtor Prepayments	Group	Group	Charity	Charity
	2021 £’000 111 1,060 31 4 - 272	2020 £’000 193 1,820 21 6 - 168	2021 £’000 111 1,055 31 4 139 271	2020 £’000 155 1,820 21 6 147 168
	1,478	2,208	1,611	2,317

12. Creditors: amounts falling due within one year

Deferred income reconciliation:

Brought forward at 1 April Recognised/Refunded during the year Received in the year and deferred Carried forward at 31 March	Group 2021 £’000 67 (23) -	and Charity 2020 £’000 350 (350) 67
	44	67

Due to COVID-19 two ticketed fundraising events were postponed in 2020 with the hope of running them in the 2021 financial year. The ticket income has been partially refunded in 2021 and partially deferred as it will need to be refunded if the events are unable to take place now in 2022 financial year.

45 Combat Stress

12. Creditors: amounts falling due within one year (continued)

Bank loans and overdrafts Trade creditors Other taxes & national insurance Accruals & deferred income Accrued holiday pay VAT payable Accrued pension contributions Sundry creditors	Group	Group	Charity	Charity
	2021 £’000 - 109 181 114 140 3 48 47	2020 £’000 500 146 256 157 134 7 76 1	2021 £’000 - 114 181 105 140 - 48 47	2020 £’000 500 146 257 140 134 - 76 1
	642	1,277	635	1,254

For the deferred income reconciliation please see the bottom of the previous page.

13. Capital and financial commitments

Total commitments under non-cancellable leases – total payments due over lease term: In less than one year In two to fve years In later years	Group 2021 £'000 74 184 2	and Charity 2020 £'000 76 128 10
	260	214

14. Group and Charity contingent liabilities

In 2011/12 restricted funding of £3.5m was received from Help for Heroes for refurbishment and to extend the facilities at Tyrwhitt House as follows:

• the refurbishment and extension to the Welfare Block

• the extension to the Activities Centre

• the extension of Tyrwhitt House – the “Living Zone”

• the reorganisation of the ground floor of Tyrwhitt House including the construction of a new main entrance

• other associated work including professional fees and expenses for design and project management, infrastructure, external works, furnishings and equipment

If Combat Stress disposes of Tyrwhitt House or ceases to make use of it in accordance with its charitable objects then for a period of ten years from 31 March 2011 funding shall be repayable on reducing terms calculated as a proportion of the period yet to expire. The remaining value of the restricted fund at 31 March 2021 is nil (2020: £0.35m) as there is no future obligation attached to this historic grant.

15. Taxation

The company is a charity within the meaning of Para 1 Schedule 6 Finance Act 2010. Accordingly, the company is potentially exempt from taxation in respect of income or capital gains within categories covered by Chapter 3 of Part 11 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.

No tax charge arose in the year.

The subsidiary trading company makes qualifying donations of all taxable profit to the Charity and the dormant subsidiary has no transactions and therefore is not subject to tax. No corporation tax liability arises in the accounts.

Annual Report and Accounts 2021 46

16. Subsidiaries

Combat Stress owns the whole of the issued share capital of Ex-Services Mental Welfare Society (company registration number 11578139, domiciled in the United Kingdom with registered office at Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey, KT22 0BX). This company was registered at Companies House on 19 September 2018, has net assets of £1 and did not trade in the period to 31 March 2021.

The Charity also has one wholly owned trading subsidiary, Combat Stress Trading Limited, which is registered in England and Wales (Company registration number 07839816) and has its registered office at Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey, KT22 0BX. The company was incorporated on 9 November 2011 and started to trade on 1 April 2013.The following is a summary of the assets and liabilities at 31 March.

Net assets at 31 March Fixed assets Current assets Current liabilities Share capital	2021 £	2020 £
	2,391 149,079 (151,469)	- 170,429 (170,428)
	1	1

Combat Stress Trading Limited’s issued share capital comprises one £1 ordinary share, which is held by the Charity.

During the year the directors of the trading company, who were both executive directors of the Charity, were Sue Freeth (retired 31 January 2021) and Robert Marsh. The office of Company Secretary was held by Jeff Harrison.

The main source of income for the trading company was the sale of merchandise, such as Christmas cards, clothing and badges and promotional material bearing the Combat Stress logo. An additional income strand relates to Commercial Participator Agreements. An agreement is in place between Combat Stress and the trading subsidiary such that the profits are gifted annually to Combat Stress under deed of covenant.

Sale of merchandise and event income Commercial Participator Agreement income Total turnover Cost of sales Gross proft Administrative costs Proft for the year Qualifying distribution to Combat Stress Retained proft for the year	2021 £ 49,664 40,837	2020 £ 71,298 63,316
	90,501 (41,114)	134,614 (68,154)
	49,387 (24,329)	66,460 (25,349)
	25,058 (25,058)	41,111 (41,111)
	-	-

17. Pension costs

Payments made into pension schemes for the year were as follows:

Payments made into pension schemes for the year were as follows:
Defned beneft scheme Defned contribution scheme*	Group and Charity
	2021 £'000 - 337	2020 £'000 - 449
	337	449

*The defined contribution scheme is a Group Personal Pension Scheme provided by Royal London. Employee contributions into the scheme are matched by Combat Stress up to a maximum of 10% of basic salary.

47 Combat Stress

17. Pension costs (continued)

Ex-Services Mental Welfare Society 1974 Pension & Life Assurance Scheme

Combat Stress (the “Employer”) operates a defined benefit pension arrangement called the Ex-Services Mental Welfare Society 1974 Pension and Life Assurance Scheme (the “Scheme”). The scheme was closed to new entrants on 31 August 2000 and closed to future accrual on 31 March 2013. The Scheme provides benefits based on final salary and length of service on retirement, leaving service or death. The following disclosures exclude any allowance for defined contribution schemes operated by the Employer.

The Scheme is subject to the Statutory Funding Objective under the Pensions Act 2004. A valuation of the Scheme is carried out at least once every three years to determine whether the Statutory Funding Objective is met. As part of the process the Employer must agree with the trustees of the Scheme the contributions to be paid to meet the Statutory Funding Objective.

The most recent comprehensive actuarial valuation of the Scheme as at 30 September 2020 is currently in progress and will be reported upon in the financial statements for the year ended 31 March 2022. The initial results of that valuation were updated to 31 March 2021 allowing for cashflows in and out of the Scheme and changes to assumptions. The next valuation of the Scheme is due as at 30 September 2023.

In the event that the valuation reveals a deficit, the Employer may be required to increase contributions above those set out in the existing Schedule of Contributions. Conversely, if the valuation reveals a surplus, no deficit reduction contributions will be payable.

The Employer expects to pay no contributions to the Scheme in the year to 31 March 2022, in line with the current Schedule of Contributions dated 14 December 2018, although the contribution requirements are currently under review as part of the actuarial valuation as at 30 September 2020.

The Scheme is managed by a board of Trustees appointed in part by the Employer and part from elections by members of the Scheme. The Trustees have responsibility for obtaining valuations of the fund, administering benefit payments and investing the Scheme’s assets. The Trustees delegate some of these functions to their professional advisers where appropriate.

There were no Scheme amendments, curtailments or settlements during the period.

Actuarial assumptions

The principal assumptions used to calculate the Scheme’s liabilities include:

	2021	2020
Discount rate	2.15% p.a.	2.40% p.a.
Retail Prices Index (RPI) infation	3.30% p.a.	2.85% p.a.
Consumer Prices Index (CPI) infation	2.55% p.a.	1.95% p.a.
Pensionable salary increases	3.30% p.a.	2.85% p.a.
Increases to pension payment at 5% or RPI if less, subject to a minimum of 3% pa	3.70% p.a.	3.50% p.a.
	115% of the S3PMA table for males
Post-retirement mortality projections	and 105% of the S3PFA table for females with CMI 2019 projections, using a long-term improvement rate of 1.25% p.a. and initial addition	90% of the S2PA tables with CMI 2017 projections using a long-term improvement rate of 1.50% p.a.
	parameter of 0%
Tax free cash	Members are assumed to take 20% of their pension as tax free cash	Members are assumed to take 20% of their pension as tax free cash
Life expectancy at age 65 of male aged 45	22.2	24.8
Life expectancy at age 65 of male aged 65	20.9	23.1
Life expectancy at age 65 of female aged 45	25.4	26.8
Life expectancy at age 65 of female aged 65	23.9	25.0

Annual Report and Accounts 2021 48

The current asset split is as follows:

Asset category UK equities Overseas equities Bonds Property Other assets Cash Insured assets Total	2021 10% 16% 11% 7% 4% 3% 49%	2020 8% 13% 12% 6% 4% 2% 55%
	100%	100%

The Scheme has no investments in the Charity or the Group or in property occupied by the Charity or the Group.

Explanation of amounts in the financial statements

The amounts recognised in the balance sheet at 31 March are as follows:

he amounts recognised in the balance sheet at 31 March are as follows:
Fair value of Scheme assets Present value of Scheme obligations Surplus in scheme Effect of asset ceiling Net defned beneft asset at 31 March	2021 £'000 11,307 (10,697)	2020 £'000 11,591 (11,161)
	610 (610)	430 -
	-	430

The amounts recognised in the Statement of Financial Activities (SoFA) over the year are as follows:

Interest on liabilities Interest on assets Remeasurements over the year: Loss on scheme assets in excess of interest Experience (gains) on liabilities (Gains) from changes to demographic assumptions Losses/(gains) from changes to fnancial assumptions Losses from change in effect of asset ceiling Total remeasurements	2021 £'000 263 (273)	2020 £'000 295 (302)
	(10)	(7)
	2021 £'000 135 (97) (1,073) 865 610	2020 £'000 339 - - (473) -
	440	(134)

Remeasurements over the year:

49 Combat Stress

17. Pension costs (continued)

Change in value of the assets:

Fair value of assets at start of year Interest on assets Benefts paid Return on assets less interest Fair value of assets at end of year Actual return on assets Change in value of the defned beneft liabilities: Value of liabilities at start of year Interest on liabilities Benefts paid Experience (gain) on liabilities Changes to demographic assumptions Changes to fnancial assumptions Value of liabilities at end of year	2021 £'000 11,591 273 (422) (135)	2020 £'000 12,057 302 (429) (339)
	11,307	11,591
	138	(37)
	2021 £'000 11,161 263 (422) (97) (1,073) 865	2020 £'000 11,768 295 (429) - - (473)
	10,697	11,161

Change in value of the defined benefit liabilities:

There was an actuarial gain on the liabilities of £1,073,000, from the change in demographic assumptions following the results of the scheme-specific postcode mortality analysis undertaken as part of the 2020 actuarial valuation.

Reconciliation of effect of asset ceiling:

Effect of asset ceiling at start of year Actuarial losses Effect of asset ceiling at end of year	2021 £'000 - 610	2020 £'000 - -
	610	-

Sensitivity of the value placed on the liabilities:

Discount rate -0.50% Infation +0.50%	Approximate increase in deficit £'000 581 338

Projected Profit & Loss account for next year:

Interest on liabilities Interest on assets Interest on effect of asset ceiling Total charge to Profit & Loss	2022 £'000 225 (239) 14 -

The above estimate is based on the assumptions adopted at the Review Date and assumes the following:

• i. Cashflows to and from the pension scheme are broadly the same as for the current period.

ii. There are no events (other than those already notified to us) that would give rise to a settlement, curtailment or past service cost.

Annual Report and Accounts 2021 50

18. Related party transactions

Combat Stress Trading Limited

• During the year Combat Stress purchased merchandise from Combat Stress Trading Ltd for £6,218 (2020: £4,832), which it used for fundraising activities. Combat Stress also subsidised third party challenge event merchandise purchases from Combat Stress Trading Ltd for £638 (2020: £nil).

• All profits of Combat Stress Trading Limited are donated to its ultimate parent undertaking, Combat Stress. For the year ended 31 March 2021 this was £25,058 (31 March 2020: £41,111).

• There are no employees within Combat Stress Trading Limited. Work undertaken by the ultimate parent undertaking, Combat Stress, on behalf of Combat Stress Trading Limited has been charged as a management fee. For the year ended 31 March 2021 this was £15,416 (31 March 2020: £19,137).

• At 31 March 2021 Combat Stress Trading Limited owed Combat Stress £138,921 (2020: £146,872).

• All of these items have been eliminated on consolidation into these Group accounts.

19. Analysis of net assets between funds

Group

Fund balances at 31 March 2021 are represented by:

Tangible fxed assets Investments Current assets Current liabilities	Restricted funds £’000 - - 885 -	Designated funds £’000 5,640 1,000 - -	Investment revaluation reserve £’000 - 1,081 - -	General funds £’000 2 5,387 2,656 (642)	Total £’000 5,642 7,468 3,541 (642)
	885	6,640	1,081	7,403	16,009

Fund balances at 31 March 2020 are represented by:

Tangible fxed assets Investments Current assets Current liabilities Defned beneft pension scheme surplus	Restricted funds £’000 350 301 255 - -	Designated funds £’000 8,120 950 - - -	Investment revaluation reserve £’000 - 98 - - -	General funds £’000 - 3,721 3,172 (1,277) 430	Total £’000 8,470 5,070 3,427 (1,277) 430
	906	9,070	98	6,046	16,120

Analysis of net assets between funds is materially the same for the parent charity as the Group figures shown above.

51 Combat Stress

20. Disclosure of funding

In addition to those funders mentioned elsewhere in this report, funding is acknowledged under the terms and conditions of the following grants and donations:

Funder	Purpose	Funding
		Received £’000
ABF The Soldiers’ Charity	Services for Army veterans 2020/21	250
ABF The Soldiers’ Charity	Services for Army veterans 2021/22	250
Armed Forces Covenant Fund Trust	Training for Veterans Wellbeing through the	215
	Strategic Pathways programme
The Corporation of Lloyd’s	Core clinical services	100
The Corporation of Trinity House	Services for Royal Navy, Royal Marines and	25
	Merchant Navy veterans
Elizabeth, Lady Cowdray’s Charity Trust	Peer Support Service	2
Lloyd's Patriotic Fund	Sensory Modulation in Occupational Therapy	100
Ministry of Defence, Cabinet Offce and Armed	Digital mental health services	250
Forces Covenant Fund Trust
Mrs Maud Van Norden’s Charitable Foundation	Unrestricted	2
National Emergencies Trust/Mind	Coronavirus Appeal Programme	40
Oak Foundation	Core funding	333
Poppyscotland	Veteran services in the Scottish Highlands	25
RAF Benevolent Fund	Community services and residential treatment for	35
	ex-RAF personnel
The Rothley Trust	Unrestricted	4
The Royal British Legion	Treatment and support of veterans in England South	1,000

Annual Report and Accounts 2021 52

21. Statement of changes in reserves

• General (Free) Reserves: these are funds which are available for general use and are not designated or restricted to particular purposes.

• Investment Revaluation Reserve: this represents the excess of the market value of investments over their historical cost at the balance sheet date.

• Defined Benefits Pension Scheme asset: this represents the actuarial surplus calculated under the requirements of FRS 102. At 31 March 2021, the valuation of the pension scheme showed nil surplus/loss (2020: surplus of £430k).

• Transfers from restricted to unrestricted funds represent restrictions which have been discharged following the purchase of a capital asset.

Designated funds:

Total net transfers of £2,430k during the year from designated funds to general reserves (2020: £309k from designated funds to general reserves) as detailed below:

• Fixed Asset Fund: this represents the net book value of fixed assets, less amounts represented by restricted funds, and reflects the fact that the reserve value is tied up in property.

• Tyrwhitt House Project Fund: these are designated funds which have been set aside for expected capital work. Following the strategic review it was decided to release this fund back to general reserves in 2019/20.

• IT Development Fund: this enables Combat Stress to undertake planned development of its IT infrastructure and move to more online therapy.

• The Property Maintenance Fund: this is to ensure that sufficient funds are set aside for any unforeseen major property issues and to provide a sinking fund for regular, but costly maintenance.

• The Strategy Implementation Fund: this represents estimated one-off costs relating to implementation of our corporate strategy. These costs will be incurred in 2021/22.

53 Combat Stress

21. Statement of changes in reserves (continued)

Statement of changes in reserves 2020/21

General reserves Investment revaluation reserve Defined benefit pension scheme asset Designated funds Fixed asset fund IT development fund Property maintenance fund Strategy implementation fund Total unrestricted funds Restricted funds Clinical services Medical research Peterborough Veterans Veterans Hardship Fund Community services Peer Support Helpline Head Offce (raising awareness) Substance misuse case management service Property – Tyrwhitt House Total restricted funds Total funds	At 1 April 2020 £’000 5,616 98 430 8,120 200 150 600	Income £’000 8,592 - - - - - -	Expenditure £’000 (9,584) - 10 - - - -	Gains/ (Losses) £’000 - 982 (440) - - - -	Transfers £’000 2,779 1 - (2,480) 50 - -	At 31 March 2021 £’000 7,403 1,081 - 5,640 250 150 600
	15,214	8,592	(9,574)	542	350	15,124
	202 174 1 7 103 - - 7 62 350	2,782 63 - - 96 163 71 463 - -	(2,371) (44) - - (141) (163) (70) (458) (62) -	- - - - - - - - - -	- - - - - - - - - (350)	613 193 1 7 58 - 1 12 - -
	906	3,638	(3,309)	-	(350)	885
	16,120	12,230	(12,883)	542	-	16,009

Restricted funds:

• Clinical services: This funding allows us to provide ongoing clinical services to veterans.

• Medical research: Funding of £63k from the Forces in Mind Trust via the King’s Centre for Military Health Research was received to allow us to continue our research into which treatments provide the best outcomes for veterans.

• Peterborough Veterans: This is the balance of funding received from a supporters’ group to help local veterans.

• Veterans’ Hardship Fund: This fund is to help pay for veterans’ travel if they are unable to attend treatment due to financial hardship.

• Community services: These funds represent donations or grants which have been received for regional community services.

• Community Occupational Therapists: These funds were used specifically on OT work done by our geographically dispersed community teams.

Annual Report and Accounts 2021 54

Statement of changes in reserves 2019/20

General reserves Investment revaluation reserve Defined benefit pension scheme asset Designated funds Fixed asset fund Tyrwhitt House project IT development fund Property maintenance fund Strategy implementation fund Total unrestricted funds Restricted funds Clinical services Medical research Peterborough Veterans Veterans Hardship Fund Community services Community occupational therapists Peer Support Helpline Head Offce (raising awareness) Substance misuse case management service Property – Tyrwhitt House Total restricted funds Total funds	At 1 April 2019 £’000 8,598 845 289 7,979 500 200 300 400	Income £’000 9,199 - - - - - - -	Expenditure £’000 (13,005) - 7 - - - - -	Gains/ (Losses) £’000 - (594) 134 - - - - -	Transfers £’000 824 (153) - 141 (500) - (150) 200	At 31 March 2020 £’000 5,616 98 430 8,120 - 200 150 600
	19,111	9,199	(12,998)	(460)	362	15,214
	160 228 1 8 111 1 212 - 10 400 700	264 23 - - 673 - 40 45 - - -	(210) (77) - (1) (681) (1) (252) (45) (3) (338) -	- - - - - - - - - - -	(12) - - - - - - - - - (350)	202 174 1 7 103 - - - 7 62 350
	1,831	1,045	(1,608)	-	(362)	906
	20,942	10,244	(14,606)	(460)	-	16,120

• Peer Support: This fund was used to provide veterans with help and support on a non-clinical basis.

• Helpline: This represents grant funding for running the Helpline.

• The Head Office fund relates to a grant from the National Lottery Heritage Fund to establish an organisational archive, used for raising awareness of the work the Charity.

• Substance misuse case management service: This funding has been provided by the from The Royal British Legion to run a UK wide project providing a case management service for those veterans with substance misuse disorders who may also have underlying mental health issues.

• Property – Tyrwhitt House: this restricted fund is detailed in Note 14. The transfer of £350k to general reserves reflects the release of the final restriction for 2020/21.

55 Combat Stress

1. Consolidated statement of financial activities (incorporating an income and expenditure account) for the year ended 31 March 2020 – comparative figures

Note Income from: Donations and legacies 3 Charitable activities 4 Trading activities Investments Other Total income Expenditure on: Raising funds Charitable activities Clinical services Helpline Raising awareness and improving access Total expenditure 5 Net expenditure before transfers and investment gains and losses Net losses on investments Net expenditure Transfers between funds 21 Actuarial gains on defned beneft pension scheme 17 Net movement in funds Reconciliation of funds: Fund balances brought forward at 1 April Fund balances carried forward at 31 March 21	Unrestricted Funds £’000	Restricted Funds £’000	Totals 2020 £’000
	6,758 1,818 361 241 21	1,026 - - - 19	7,784 1,818 361 241 40
	9,199	1,045	10,244
	2,635	-	2,635
	9,491 384 488	1,560 45 3	11,051 429 491
	10,363	1,608	11,971
	12,998	1,608	14,606
	(3,799) (594)	(563) -	(4,362) (594)
	(4,393) 362 134	(563) (362) -	(4,956) - 134
	(3,897)	(925)	(4,822)
	19,111	1,831	20,942
	15,214	906	16,120

Annual Report and Accounts 2021 56

23. Supporting note to cash flow statement

Analysis of cash and cash equivalents

23. Supporting note to cash fow statement Analysis of cash and cash equivalents
Changes in net funds during the year: Cash at bank and in hand Notice deposits (less than 3 months) held by investment manager Overdraft	Group 2021 2020 £’000 £’000 2,003 179 1,305 90 - (500)		Charity 2021 2020 £’000 £’000 1,925 121 1,305 90 - (500)
	3,308	(231)	3,230	(289)

Analysis of changes in net debt

Analysis of changes in net debt
Cash Notice deposits (less than 3 months) held by investment manager Overdraft facility repayable on demand		Group			Charity
	At 1 April 2020 £’000 179 90 (500)	Cash fows £’000 1,824 1,215 500	At 31 March 2021 £’000 2,003 1,305 -	At 1 April 2020 £’000 121 90 (500)	Cash fows £’000 1,804 1,215 500	At 31 March 2021 £’000 1,925 1,305 -
	(231)	3,539	3,308	(289)	3,519	3,230

57 Combat Stress

LEGAL AND ADMINISTRATIVE INFORMATION

Combat Stress was founded on 12 May 1919, incorporated on 11 May 1931, registered with the Charity Commission on 22 September 1962, and registered with the Office of the Scottish Regulator on 19 October 2007.

We are also registered with the Care Quality Commission, the Care Inspectorate and the Regulation and Quality Improvement Authority.

Patron

HRH The Prince of Wales KG KT GCB OM AK QSO CC ADC

President

General Sir Peter Wall GCB CBE DL

Vice Presidents

Dennis Bailey MCSI

Air Vice-Marshal Nigel Baldwin CB CBE

Robert Bieber MBE MA

Major General Peter Currie CB CBE Commodore Toby Elliott OBE DL RN

Brigadier Charles S Grant OBE

Jenny M Green OBE MA

Sir Bernard Jenkin MP

Dr Lord Moonie Surgeon Captain Morgan O’Connell RN

Richard Nunneley MBE

Dr Chai Patel CBE FRCP

Sir Malcolm Rifkind KCMG QC

Derek Twigg MP

Dr Suzy Walton BSc MSc PhD CPsychol CSci Cdir FRSA FIoD

Major General Sir Evelyn Webb-Carter KCVO OBE DL

Professor Sir Simon C Wessely MA BM BCh MSc MD FRCP FRCPsych FMedSci FRS

Board of Trustees

Our governing document permits a maximum of 15 trustees, all of whom must be Members of the Charity. Under company law, the Trustees are also the directors of the Charity.

Chairman of the Board of Trustees

Giles Peel

Vice Chair

Sally Goldthorpe

Honorary Treasurer Major Mickey Morrissey FSCI

Dr Carole Allan MA MPhil PhD CSci CPsychol FBPsS Douglas Campbell

Mark A Izatt BSc

Calvin Man TD BSc (to 09.12.2020) Surgeon Rear Admiral Calum JG McArthur FRCGP

Dr Jane McCue DL MS FRCS

Mary Molesworth-St Aubyn DL (to 09.12.2020)

George Osborne BA MBA

Jan Sobieraj

Graham Williams BA FCA

General Sir Roger Wheeler GCB CBE

Air Marshal Sir Robert Wright KBE AFC FRAeS

Co-opted members

Rorie Evans (from 09.12.2020) Calvin Man TD BSc (from 09.12.2020)

Colonel Robert Ward MBE

Annual Report and Accounts 2021 58

Executive management

Interim Chief Executive Jeff Harrison BSc FCA (from 01.02.2021)

Chief Executive Sue Freeth BA MBA (to 31.01.2021)

Director of Resources, Company Secretary Jeff Harrison BSc FCA

Medical Director

Professor Catherine Kinane MB BCh BAO DObs DCh DFMH MRCGP MRCPsych MSc (from 17.08.2020)

Wing Commander Walter Busuttil MBChB MPhil MRCGP FRCPsych RAF (until 16.08.2020)

Director of Fundraising Robert Marsh VR BSc MSc

Director of Operations Dr Felix Davies BA PgDip MPhil DClinPsy AFBPsS CPsychol BCPA

Director of Marketing & Communications Alan Friggieri BSc MBPsS

Key committees as at 31.03.2021

*denotes Committee Chair

Audit & Risk Management Graham Williams BA FCA * Sally Goldthorpe

Clinical Governance Jan Sobieraj *

Dr Carole Allan MA MPhil PhD CSci CPsychol FBPsS

Surgeon Rear Admiral Calum JG McArthur FRCGP

Dr Jane McCue DL MS FRCS

Finance

Major Mickey Morrissey FSCI * George Osborne BA MBA Rorie Evans

Fundraising, Marketing & Communications

Mark A Izatt BSc * Douglas Campbell Calvin Man TD BSc Colonel Robert Ward MBE

Remuneration & Nominations

Sally Goldthorpe * Major Mickey Morrissey FSCI Giles Peel

Advisors

Auditors (External)

BDO LLP 2 City Place Beehive Ring Road Gatwick West Sussex RH6 0PA

Bankers

National Westminster Bank plc 1 Princes Street London EC2R 8BP

The Royal Bank of Scotland plc 36 St Andrew Square Edinburgh EH2 2YB

Investment Managers

Cazenove Capital Management 1 London Wall Place London EC2Y 5AU

Registered Office

Tyrwhitt House Oaklawn Road Leatherhead Surrey KT22 0BX

Company Registered in England & Wales No. 256353

Charity Registration No. 206002

Charity Registration Scotland No. SC038828

combatstress.org.uk

59 Combat Stress

A SPECIAL THANK YOU

Combat Stress is sincerely grateful for all donations, every single one of which makes a real difference to the veterans we help. Our supporters are fundamental to our success and we would like to acknowledge their generosity and encouragement. In particular, we would like to thank the following who have contributed £10,000 or more to our work this year:

The 29th May 1961 Charitable Trust

ABF The Soldiers’ Charity

The Alan and Sheila Diamond Charitable Trust

Armed Forces Covenant Fund Trust BAE Systems Plc

Mrs G M Bramall

The Castanea Trust

The Childwick Trust

The Corporation of Lloyd’s The Corporation of Trinity House

Edith Murphy Foundation

The Elizabeth Frankland Moore and Star Foundation

Forces in Mind Trust

General Dynamics UK Limited

The Grace Anderson Charitable Trust

Help for Health

Ms Frances Jacob The John Scott Trust Koin Limited The Linbury Trust

Lloyd’s Patriotic Fund

Miss S M G Ross Trust National Emergencies Trust Northrop Grumman

Oak Foundation PA Consulting Pall-Ex Group Poppyscotland Queen Mary’s Roehampton Trust RAF Benevolent Fund The Royal British Legion

The Royal Navy and Royal Marines Charity

The Anthony Scholefield Foundation

ShareGift Slaughter and May

The Steel Charitable Trust The Swire Charitable Trust Thales UK The Michael Uren Foundation

We also want to thank all those who chose to remain anonymous and all our supporters who make our work possible.

This year we have received 45 legacies with a value of £10k or more. Legacies in total raised over £2.5million. A gift in a Will is a thoughtful and generous way of supporting veterans and we are extremely grateful to each and every one of the supporters who chose to donate in this way.

Annual Report and Accounts 2021 60

SPIKE’S STORY

Art has helped me a great deal. Before coming to Combat Stress, I’d never painted a picture in my life but, with the encouragement of the specialist team at the Charity, I tried it out and found I could paint.

“As I continued with treatment for PTSD my painting improved and as my art improved, my PTSD became more manageable. Painting has given me something constructive to do and takes my mind away from the traumas I’ve suffered.”

Royal Navy veteran Spike served around the world, including in the Falklands.

CONTACT US

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