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2023-03-31-accounts

ANNUAL REPORT & ACCOUNTS 2023

Company Registered in England & Wales No. 00256353. Charity Registration No. 206002. Charity Registration Scotland No. SC038828 Company Registered in England & Wales No. 00256353. Charity Registration No. 206002. Charity Registration Scotland No. SC038828

2 Combat Stress

For veterans with PTSD, very often there’s no such thing as normal life. Going to the supermarket, a walk in the woods, a family BBQ, watching the news – all of these very ordinary activities can be hidden triggers, taking a veteran straight back to their traumatic experiences in the military.

Our campaign, ‘Life as we know it: Living with PTSD’ highlights the day-to-day reality for veterans living with post-traumatic stress disorder. The campaign was made possible thanks to the generosity of professional photographer Tom Skipp, who donated his time free of charge.

Five veterans, aged from 33-64, who served in conflicts including the Falklands, Bosnia, Northern Ireland and Afghanistan, bravely shared on camera their own personal everyday issues and the difference our specialist treatment has made in helping them to learn to cope with them and lead a more normal life.

To find out more, please visit: living-with-ptsd.combatstress.org.uk

CONTENTS

Our year in review 1–4
Combat Stress at a glance this year 1
Introduction from our Chairman and CEO 3
Trustees’ report 5–30
Vision, mission, values and aims 5
Future plans 30
Strategic report 31–40
Financial review 32
Principal risks and uncertainties 34
Remuneration and fundraising 35
Public beneft, policies and governance 36
Statement of trustees’ responsibilities 40
Independent auditor’s report to the trustees and members 41–43
Financial statements 44–70
Consolidated statement of fnancial activities 44
Consolidated and Charity balance sheets 45
Consolidated and Charity statement of cash fows 46
Notes forming part of the fnancial statements 47
Legal and administrative information 69
A special thank you 71

1 Combat Stress

COMBAT STRESS AT A GLANCE

WHO WE HELP

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NEARLY 12,500
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from our help[*]

veterans called our Helpline

7,929

3,190 veterans accessed our online self-help resources

veterans directly received 1,375 support from our specialist staff

*Our externally-supplied patient record system, Carenotes, experienced a cyber-attack during the year. Whilst the software provider has confirmed that there was no breach of confidential data as result of the cyber-attack, it wasn’t until February 2023 that a stable version returned. Our annual veteran treatment statistics have therefore been extrapolated from previous year’s data.

VETERAN PROFILE

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83 YEARS
25% 45
UNDER 40 YEARS 26 YEARS
OF VETERANS WE HELPED AVERAGE AGE AGE RANGE
DURING THE YEAR WERE A VETERAN OF VETERANS
UNDER THE AGE OF 40 SEEKS OUR HELP WE SUPPORT
VETERANS FROM WE SUPPORTED
VETERANS FROM
NORTHERN 13
IRELAND, YEARS
DIFFERENT
AFGHANISTAN THE AVERAGE TIME IT
14 CONFLICTS
TAKES FROM LEAVING THE
AND IRAQ MILITARY FOR A VETERAN INCLUDING NORTHERN
MAKE UP THE LARGEST NUMBER
TO SEEK OUR HELP FOR IRELAND, IRAQ, AFGHANISTAN,
OF THOSE WE HELP MENTAL HEALTH ISSUES BOSNIA AND THE FALKLANDS
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VETERANS FROM NORTHERN IRELAND, AFGHANISTAN AND IRAQ MAKE UP THE LARGEST NUMBER OF THOSE WE HELP

Annual Report and Accounts 2023 2

OUR 24-HOUR CONFIDENTIAL MENTAL HEALTH HELPLINE

OUR HELPLINE WAS CONTACTED 16,000

TIMES DURING THE YEAR

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ALMOST
50%
OF CALLS TO OUR HELPLINE
WERE FROM NEW CALLERS
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THE NEED FOR OUR SPECIALIST SERVICES

SERVING IN 16% MORE INCREASE IN NEW VETERAN CONFLICTS REFERRALS YEAR ON YEAR INCREASES COMPLEXITY OF THIS DEMONSTRATES THE MENTAL HEALTH ONGOING NEED FOR OUR HIGHLY SPECIALIST SERVICES ISSUES

IN NEW VETERAN REFERRALS YEAR ON YEAR THIS DEMONSTRATES THE ONGOING NEED FOR OUR HIGHLY SPECIALIST SERVICES

VETERAN TREATMENT – some examples of our support

PSYCHOLOGISTS CARRIED OUT appointments with veterans 4,598 OCCUPATIONAL THERAPISTS CARRIED OUT appointments with veterans 1,190

NURSES CARRIED OUT appointments with veterans 2,878

All statistics relate to our latest financial year (1 April 2022 to 31 March 2023).

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INTRODUCTION

Giles Peel BSc FCG Chairman of the Board of Trustees

Jeff Harrison BSc FCA CEO

For over 100 years, we have provided specialist mental health support to veterans – no one knows veterans’ mental health better than us. Whilst the conflicts have changed enormously over the years, demand for our services remains high and our commitment remains the same – to provide treatment and support to former servicemen and women to help them tackle the past and take on the future.

During the year we all experienced the cost-of-living crisis. As a charity we expected this to affect us in three main ways: the veterans we treat, our capacity to fundraise and our staff. For the veterans we treat, we know through our own anecdotal research, the cost-of-living crisis has caused significant additional pressure and exacerbated their mental health issues. We created a cost-of-living crisis working group and signposted veterans to other charities and organisations that could help.

We have been extremely fortunate that support for the charity has remained strong during this difficult time for many and our ability to fundraise has been largely unaffected.

Recognising that our staff were highly likely to be affected we introduced a number of measures to support them. This included a oneoff financial support payment to all permanent and fixed term contract staff to help ease the burden during these unprecedented times.

Another challenge was the cyberattack in August 2022 on Carenotes, our externally supplied electronic patient record system. The system plays a key role in our provision of safe and secure treatment to veterans. Whilst the software provider has confirmed that there was no breach of confidential data as result of the cyber-attack, it wasn’t until February 2023 that a stable version returned.

The Carenotes outage major incident was a huge disruption to our clinical teams. In February 2023 we had to begin the enormous task of migrating records taken over the previous six-month period using our back up system onto Carenotes to ensure complete veteran records were held on file.

Despite these challenges we have had many successes during the year. We have made progress on our footprint across the UK to ensure we are located to give better access to the veterans who seek our help. We have begun delivery of our updated intensive treatment service and we have continued exploring collaborations and creating partnerships to help ensure veterans get treatment from the right organisation at the right time.

We expected to use a small amount of our reserves on some non-recurring transitional costs in 2022/23 but thanks to the generosity of our supporters and partners, a higher than planned investment income and in-year

Annual Report and Accounts 2023 4

savings, we exceeded our income budget and spent less than we had anticipated.

As an organisation we are continually evolving and developing to meet the changing needs to veterans today and in the future. During the year, we set out our strategy for what we plan to achieve between 2022–25 to help ensure that in the future every veteran in the UK with complex mental health needs knows that lasting recovery starts at Combat Stress. You can read more about our progress against this strategy over the following pages.

In the past veterans were in-patients at our recuperative homes

Today our specialist treatment and support is available online and in-person

5 Combat Stress

OUR STRATEGIC PLAN 2022–2025

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

To deliver specialist treatment for veterans with complex mental health needs, whilst supporting their families and network, to help them tackle the past and take on their future.

OUR AMBITION

We want every veteran in the UK with complex mental health problems to know that lasting recovery starts at Combat Stress.

OUR VALUES TOGETHER PERSONAL BOLD FOCUSED

Annual Report and Accounts 2023 6

TO ACHIEVE OUR AMBITION, WE WILL FOCUS ON:

QUALITY

Deliver the most effective service for veterans with complex mental health needs.

SERVICE

Enhance our leading role in the veterans’ mental healthcare system.

IMPROVEMENT AND INNOVATION

Advance and share our knowledge for the benefit of the veteran community.

OUR PEOPLE

Make them feel valued and involved in making a difference to the lives of veterans and their families.

LASTING RECOVERY STARTS WITH COMBAT STRESS

7 Combat Stress

OUR STRATEGIC AIMS

AIM 1: QUALITY

We believe that veterans should have the best possible mental health treatment. We will deliver the most effective service for veterans with complex mental health needs, supporting their families and network too. We will deliver this directly and in partnership with others.

WHAT WE’RE GOING TO DO

WHAT WILL SUCCESS LOOK LIKE?

WHAT WE’VE DONE THIS YEAR

VICTOR

Our updated intensive treatment service is at the forefront of innovation. Delivered flexibly to suit the needs of veterans, it draws on the latest research to provide the best possible outcomes for long-term recovery. This highly specialised service is for those with PTSD and Complex PTSD requiring intensive intervention and has been devised to help enable meaningful recovery for veterans. VICTOR involves a preparatory, intensive and post-intensive treatment phases. At the core of VICTOR is three-week intensive treatment with evidenced-based psychological therapy for PTSD plus occupational therapy, art therapy, psychiatry and nursing interventions and peer and family support. Up to a year of support is available for veterans who are offered VICTOR.

During the financial year we completed three VICTOR programmes with a residential component at our England South hub in Surrey. Further programmes will take place during the next financial year. We have also developed a VICTOR model for

Annual Report and Accounts 2023 8

Veterans Tony and Trev who undertook cohort 2 of VICTOR

implementation in Scotland. This will be a blend of in-person and online engagement, in groups and on a 1:1 basis and we will begin to deliver the programme during 2023. We have also planned to run a female-only VICTOR cohort in autumn 2023.

Led by the Royal College of Psychiatrists, the network is made up of over 30 NHS and third sector services. The Royal College of Psychiatrists has a long history of driving high quality care by setting standards for what good practice should look like. Their accreditation process consists of evaluating the quality of clinical services and promoting quality improvement through highlighting areas of best practice and areas for change.

Initial outcomes from the first three cohorts are encouraging. Treatment completion was high and 90% of veterans reported clinically significant reductions in PTSD symptoms and 60% no longer met criteria for Complex PTSD. VICTOR was well received by veterans and is highly deliverable as a service. Findings from the initial programmes will inform future developments of VICTOR.

In December 2022 we were awarded with accreditation by the Royal College of Psychiatrists. The accreditation will last for three years but we are committed to continuing to achieve increasingly high standards, and further demonstrating our dedication to supporting veterans with complex mental health problems.

Quality Network for Veterans’ Mental Health Services

As one of the first adopters of this accreditation, we will be promoting its value to further improve quality in this sector and encourage others to strive to achieve the same level of recognition.

As part of the Quality Network for Veterans’ Mental Health Services peer review and accreditation scheme, we are contributing to the promotion of quality and safety of services nationwide.

The Veterans’ Places, Pathways and People (VPPP) Programme

The VPPP Programme, funded by The Armed Forces Covenant Fund Trust, is designed to develop better, more joined up, lasting support for veterans with mental health needs in their local communities. As one of the four strategic leads, we are collaborating with other specialist organisations to improve the lives of more veterans.

As the mental health strategic lead, we’ve shared our expertise in providing services to veterans with mental health issues by developing specialist training for organisations participating in the VPPP projects. Through the funding received, we’ve launched a learning and development online platform with a range of modules designed to help others to support veterans with complex mental health needs. Training includes safeguarding, suicide prevention and military awareness. Through this platform, we have been sharing our expertise, encouraging

THE AIMS OF THE VPPP ARE TO:

9 Combat Stress

collaboration and offering training to over one hundred VPPP projects, increasing mental health knowledge, practical skills, and joined-up working, for the benefit of veterans nationally.

Training has been delivered by Combat Stress to 83 organisations in 2022–23 as part of the VPPP programme.

We are currently engaged in service delivery collaborations with 67 organisations.

Continuous improvement plan

In 2021 we partnered with the internationally renowned not-forprofit Virginia Mason Institute (VMI). VMI works with healthcare organisations around the world, including working with the NHS for over 15 years. The Virginia Mason Medical Centre is consistently one of the top-rated hospitals in the USA. During the year, we have completed Phase 1 of our continuous improvement plan, which consisted of the following:

We then began Phase 2 which includes building continuous improvement concepts into strategy deployment and further coaching of staff on their improvement projects.

Research

We aim to conduct high quality robust research to further our knowledge and understand how best to support the veteran community. The research department is led by Professor Dominic Murphy, Head of Research, and Professor Walter Busuttil, Director of Research and Training. We are committed to publishing our research as part of our commitment to contribute to the advancement of the veteran mental health field. We work closely with King’s Centre for Military Health Research at King’s College London to ensure our research is of the highest standards.

In total we have published 35 academic reports and papers in peer reviewed scientific journals this financial year. The breadth of our research has been extensive, with a wide range of different study areas. Three highlights contributing to improving quality are:

After undertaking research to explore the concept of moral injury and recognising that standard treatment for those with PTSD does not have as good outcomes for those also with moral injury, this year we have completed the pilot of a new treatment, ‘Restore and Rebuild’, for this condition.

Moral injury has in the past been seen as part of PTSD but is now increasingly being recognised as developing as a separate entity which may or not be present with PTSD.

Now the treatment has been trialled, we are working on a further study to formally evaluate if the treatment is effective. This randomised

control trial will start in summer 2023 and will involve testing the treatment with a larger group of former armed forces personnel with moral injury related mental health conditions. Our research in this area is kindly funded by the Forces In Mind Trust and is being conducted in partnership with King’s College London.

Following this trial, the aim is that Restore and Rebuild will be available as part of our specialist treatment to veterans.

Unfortunately there is evidence that existing treatment for PTSD does not target the additional symptoms central to Complex PTSD (CPTSD). This year we have developed and trialled a treatment for those veterans with CPTSD and there is early evidence that the treatment is effective and accepted by

Professor Walter Busuttil, Consultant Psychiatrist and Director of Research & Training

Professor Dominic Murphy, Head of Research

Annual Report and Accounts 2023 10

EXAMPLES OF SENSORY MODULATION TECHNIQUES

Movement within nature has lots of sensory properties

The power of smell is useful for grounding

Touching a smooth calming object can work really quickly to help relax and ground

veterans. We will complete the trial in April 2023 and then undertake a formal review. Our research in this area is kindly funded by the Forces in Mind Trust and is being conducted in partnership with Edinburgh Napier University.

research into how sensory modulation can benefit veterans experiencing complex mental health issues. The research outcomes showed statistically significant changes on the anxiety, anger, trauma and emotional regulation measures following treatment. The qualitative themes showed participants felt sensory modulation was useful to them, they reported feeling calmer, more self-aware and could implement coping strategies in varying environments.

In addition to the research undertaken by our research department, thanks to funding from the Lloyds Patriotic Fund our occupational therapy team has completed sector-leading

Quality and clinical governance

During the year we prepared and managed our services to ensure we continue to meet the standards set by the clinical regulators in each nation. For example:

Measurement

We have increased the use of and accessibility of data in the organisation to improve the tracking and reporting of veteran

11 Combat Stress

outcome and experience data. This has improved our ability to have a more comprehensive understanding of the effectiveness of our services as well as enhancing the quality of our service to better support veterans in the future. For example, we have restructured the way we collect data, and developed a more efficient user interface for veterans, families and clinicians. This has allowed us to create a centralised repository of data for reporting purposes for veterans and clinicians working collaboratively towards their recovery and at a business level.

Measures (VROMs) to go alongside our Routine Clinical Outcome Measures (RCOMS) plus the information we collect about Veteran Experience (VEQ). The VROMS will support capturing information on veteran’s progress towards those self-defined goals most important to their lives and recovery. Collectively this new data collection and reporting interface has the potential to transform our understanding of how well our services are working and how we can improve what we offer to veterans.

We also have a regular review of quality metrics, demonstrating our focus and commitment to quality throughout the organisation.

We began with the implementation of Veteran Reported Outcome

Further development of our clinical model

Our model is multidisciplinary with clinicians from each discipline represented in the teams. They work together to develop the optimum treatment plan collaboratively with each veteran.

We have continued to develop our range of offer and our empirically evidenced psychological therapies now include Narrative Exposure Therapy (NET), Eye Movement Desensitisation and Reprocessing Therapy (EMDR) and Prolonged Exposure (PE) this year. Having a range of different therapies available means we can offer choice to the veteran and better tailor our treatment to their needs.

An example of Narrative Exposure Therapy

Annual Report and Accounts 2023 12

“

I’m a nurse at Combat Stress, helping to deliver our evidence-driven service. I wanted to get more involved in a holistic approach to mental health and recovery and that’s exactly what I am able to do in my role here. The best part of my job? The fact that we’re veterancentric, we listen and therefore we evolve.” Brian, Deputy Head of Operations – Residential, England South

13 Combat Stress

OUR STRATEGIC AIMS

AIM 2: SERVICE

For veterans with complex mental health issues we currently provide the most comprehensive multidisciplinary intensive mental health treatment service available in the UK. We want to enhance our leading role in the veterans’ mental healthcare sector to deliver the best possible treatment ensuring veterans get treatment from the right organisation at the right time.

WHAT WE’RE GOING TO DO

WHAT WILL SUCCESS LOOK LIKE?

hub locations. Where possible we will co-locate with partners, service charities and other third sector organisations to build and enhance relationships.

WHAT WE’VE DONE THIS YEAR

Collaborations and partnerships

We have expanded our collaborations and partnerships with the NHS and others working in the veterans’ mental health sector. We continue to look for further opportunities to streamline services for veterans and their families and overall improve the efficiency of the service they receive.

During the year we partnered, collaborated or explored opportunities with 65 other organisations – including NHS Trusts, other military sector charities, the MOD personnel recovery centre in Edinburgh,

Annual Report and Accounts 2023 14

REBECCA’S STORY

White, clinical lights in a supermarket, the sound of sirens, and even some TV shows take Rebecca back to the field hospital in Afghanistan.

Rebecca joined the Army Reserves when she was 30. During her 18 years of service she completed two tours in Afghanistan, where she worked as a ward master at the Camp Bastion Hospital. Upon her return, everyday activities became triggers for her mental health.

“I couldn’t watch the news for a long time… We were having terrorist attacks like the Manchester bombing and then there was an incident on the bridge in London. I remember watching that and I had to leave work – I just couldn’t cope.”

After undertaking our specialist treatment, Rebecca learnt techniques to improve her mental health. She says “I wanted to end my life but Combat Stress saved me.”

To hear more from Rebecca please visit living-with-ptsd.combatstress.org.uk

15 Combat Stress

Inspire and Brook House in Northern Ireland, and the Defence Medical Welfare Service (as part of VPPP in the Midlands), and Bridge for Heroes (as part of VPPP in the East of England).

We are founder members of Contact and remain a very active contributor to the group, sharing our expertise with other mental health service members of this important organisation. Several directors play a key role in the group – for example, our CEO was interim chair for several months during the year, and our Director of Operations is the chair of new member registration committee.

Combat Stress is also a full board member of Cobseo and our Medical Director sits on the Medical Advisory Committee of this organisation.

NHS collaboration

We continue to work closely with the NHS on the delivery of Op COURAGE service – a specialist NHS service for those armed forces veterans experiencing mental health issues. This allows us to forge stronger links with the NHS and means that we are part of a national collaborative delivering an invaluable service to veterans.

During the year we delivered a clinician advice line, peer and family support, and substance misuse services under contract to Leeds and York Partnership NHS Foundation Trust.

We also provided a clinician advice line and training under contract to the Dorset University HealthCare NHS Foundation Trust.

In addition we have been awarded two new Op COURAGE contracts in the north and southwest from 1 April 2023. In the north, this is with Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust and in the southwest, it is with Avon and Wiltshire Partnership NHS Trust. For both regions we will be providing peer and family support as well as substance misuse services. For these regions we are part of Op COURAGE partnerships, which include the lead contractor NHS Trusts mentioned above, and also other NHS Trusts and charities.

In Scotland we have received confirmation that the Scottish Government will continue our contract to provide specialist mental health services to veterans across Scotland until March 2023.

We have also been commissioned to lead the Scottish Government’s implementation team responsible for the design and development of the national Veterans Mental Health and Wellbeing service. The team, led by our Deputy Director of Operations, is responsible to Dr Charles Winstanley as the Ministerial appointee and is establishing a framework to ensure services nationally

are easily accessible, wellcoordinated and are readily available regardless of where a person lives.

A core focus is being placed on veterans at risk of marginalisation; so the needs of female veterans, LGBT+ veterans and individuals from black and minority ethnic groups are being prioritised. The programme is being developed over a period of two years and is working closely with Scottish Ministers, Health and Social Care Partnerships across the country, the MOD and a wide range of third sector partners.

In England, NHS England has confirmed our contract extension for 2023–24. This £1m contract will help ensure our core services are funded and that we can provide support in conjunction with the NHS veteran mental health services.

Streamlining the sector

As a project partner in the Armed Forces Covenant Fund Trust’s Veterans’ People, Places, Pathways for the West and East Midlands, we’re working with our project partners with the ultimate aim of streamlining the overall sector to create a quicker, safer, more effective and better experience of mental health services for veterans and their families. We have been working together to fully understand each other’s offerings and help veterans get the right support by guiding and cross-referring veterans to the right place for their needs.

Annual Report and Accounts 2023 16

justice partners in terms of providing direct support and increasing the knowledge and capacity of their staff in working with veterans; this includes the Scottish Prison Service, community justice teams and Police Scotland. We also work closely with addictions services to ensure that we appropriately align our support and secure a whole systems approach to care.

• Our Helpline

Our free 24-hour confidential mental health Helpline remains a source of great support for veterans, reservists, friends and families and professionals. During the year our Helpline was contacted almost 16,000 times.

Emotional support remains the main reason for calling, with advice and guidance on mental health and other issues the second reason for calling. We regularly signpost those who contact us to other sources of help (when we are not best placed to help).

In keeping with the development of a ‘no wrong door’ mental health care system, we have identified more organisations to whom we can safely signpost. By increasing our database of other organisations, our Helpline team is better equipped to direct those who contact us for help and advice as needed. In particular, we have been continually reviewing and ensuring that the social prescribing organisations on our database fulfil the needs of those reaching the end of our treatment and support (for example veterans breakfast clubs, physical activities, volunteering opportunities etc).

We were also quick to put in place a new referrals process

when Carenotes, our externally supplied electronic patient records system, went offline due to a cyber-attack. In record time we created a new inhouse online referral process so that referrals could continue uninterrupted.

personnel and their families on behalf of the MOD.

• Social media community

management

During the year we have seen a continued increase in messages via our social media channels (over 7,000 this year), an increase of approximately 12% on the previous year. Some of these messages are from veterans in significant distress and in need of support. We have extended our social media community management process, working more closely with clinical teams to ensure we can help and respond to those in need efficiently.

We have also collaboratively worked with VPPP and other partners to find support for those that Combat Stress is unable to help. We met with our counterparts at most of the large military organisations to better understand what each does to make cross referrals more appropriate.

We continued to provide a dedicated Helpline for serving

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“
I called the
charity’s Helpline
and there was a
friendly voice
at the end of the
phone, making me
feel like I wasn’t
on the scrap heap.
Someone cared –
finally someone
was giving a damn
about me.”
RAF veteran Liz
----- End of picture text -----

17 Combat Stress

Meeting the needs of the family

We know a veteran’s family can be hugely affected by their PTSD. Our research has shown that partners of veterans diagnosed with PTSD can be at risk of developing a mental health condition themselves and also indicated that children are impacted and their relationship with the parent with PTSD often suffers.

We also recognise how important it is to include loved ones in a veteran’s road to recovery. It can be a daunting time for everyone involved and it’s important a veteran’s family gets the support they need too. Research has shown that outcomes for the veteran’s recovery are better when their partner is involved. And by supporting the adults, they are better placed to support any children in the family.

Our support for families during the year included:

“ Combat Stress has given me my life and my family back. I wouldn’t be here if it wasn’t for them.”

Army veteran Herbie

Herbie’s wife and daughters

support they might need from other organisations. In our next financial year we will launch this service in England.

family or support network an assessment to help better assess the veteran. This conveys the important message that families are valuable to recovery. In addition to gaining a more rounded assessment to make better treatment recommendations, this acts as an opportunity to see if they have any needs so that we can signpost them for help as required.

Annual Report and Accounts 2023 18

BRIAN’S STORY

The smell of a barbeque takes Brian back to evacuating guardsmen off a burning ship in the Falklands.

Brian served for 42 years, undertaking tours all over the world including Northern Ireland, the Falklands, Belize, Angola and Iraq.

“There were so many sights and smells that other people would just ignore but I found very difficult. BBQs were particularly hard. And the noise of a nail gun on a building site can sometimes make me dive to the ground in a panic.”

“With life becoming increasingly difficult, Brian sought our help. Diagnosed with Complex PTSD, Brian says our specialist treatment ‘has without a doubt made my life so much better. My wife has said ‘I’ve got my husband back’.”

To hear more from Brian please visit living-with-ptsd.combatstress.org.uk

19 Combat Stress

Our footprint across the UK

Our specialist treatment and support is available online and in-person. By providing the vast majority of our services online, we can remove geographical and logistical barriers for receiving treatment. Where required, our online provision is complemented by in-person outpatient appointments and community services including peer support, and treatment on a residential basis.

Our staff are based across the UK. We have teams based in the following locations:

We currently have no in-person services based in Wales but veterans can access our online treatment 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.

Shortening the path into treatment

It can take many years for a veteran to ask for our help (the average time is 13 years from leaving the military before seeking our help) so once a referral is made, we would like to provide them with treatment as soon as possible.

Recognising the need to reduce time between referral and treatment, we held a continuous improvement ‘rapid improvement event’. A small team devoted 100% of their time over three days to analysing and improving the defined issue and a new way of working

was agreed. This included the development of a Wellbeing Group – a new intervention to provide access to treatment as soon as possible following assessment. The Wellbeing Group content covers a range of helpful information and guidance around different forms of mental and physical health issues to help veterans improve their coping strategies. We have trialled the group in Scotland and found it was successful in getting veterans into treatment more quickly.

We expected to implement the new process across the organisation this year but due to the significant disruption caused by the unexpected outage of our externally supplied electronic patient records system (from August 2022 to February 2023), implementation across the country will now take place in our next financial year.

Equality, Diversity and Inclusion (EDI) action plan for veterans

In preparation for the Quality Network for Veterans’ Mental Health Service peer review, we identified that EDI was an area for further attention. We undertook a survey which highlighted that Combat Stress supports predominantly white, male, heterosexual veterans that served in the Army.

Understanding this has allowed us to identify those who might find it difficult to reach out to us, and develop a plan to reach all of those who would benefit from the service. This plan is still being implemented. However following the data analysis, the first step was that each region nominated an EDI champion. This group will meet regularly, chaired by our Head of Engagement and Social Care, to create change and to implement the recommendations from the

Employers Network for Equality & Inclusion - a UK based nonfor-profit organisations that helps employers build and maintain diverse teams and inclusive cultures through membership, training, and consultancy services.

During the year we have continued to provide a female-only peer support group. Run by our female peer support co-ordinator, the group is held virtually and attended by female veterans from across the UK, providing an opportunity to gain support and understanding from other women similar to themselves.

We have also begun work to secure the ‘Pride in Veterans Standard’ through LGBT+ military charity Fighting With Pride.

Strengthening our team

During the course of the year, we have strengthened our clinical leadership with the appointment of more senior clinical roles. This is to meet the increased level of mental health complexity that we now work with and the quality of service that we strive to deliver. We’ve worked hard to refine and

improve our offering to staff to enhance recruitment and retention. This is reflected in the calibre of our new appointments and the improvements in vacancy rates.

Building on the appointments of an Associate Clinical Director in January 2022, this year we have introduced a Head of Maximising Clinical Effectiveness and Specialist External Training Lead. These two new roles have UK-wide responsibilities.

We have also recruited a consultant CBT therapist and consultant clinical psychologist (job share) along with a consultant psychiatrist to help us lead our service

Annual Report and Accounts 2023 20

“

I love supporting veterans with their mental health. I think they’re a client group who really deserve the best support that can be given.”

Kerry Crichton, Lead Nurse, Scotland East

delivery in Scotland. Notably, these appointments are of clinicians who have decades of experience in establishing, delivering and innovating in the field of ComplexPTSD and veterans’ mental health, and are national thought leaders in their areas of clinical expertise.

In addition, we have appointed a number of nurses into more senior roles in the organisation. This includes a lead nurse in our Edinburgh hub, a lead nurse for our substance misuse service and a lead nurse in community services.

These posts provide senior experience and support to the nursing team and are an investment in the development of those services delivered by our nurses.

We have also introduced two lead occupational therapy roles – one overseeing the England team and the other responsible for the Scotland team. This allows for some career progression within the occupational therapy team, retaining experienced staff, which benefits the treatment of veterans.

21 Combat Stress

OUR STRATEGIC AIMS

AIM 3: IMPROVEMENT AND INNOVATION

Advance and share our knowledge for the benefit of the veteran community. Veterans are at the heart of everything we do. We involve them in every area of the charity and share our knowledge with peers and partners.

WHAT WE’RE GOING TO DO

WHAT WILL SUCCESS LOOK LIKE?

WHAT WE’VE DONE THIS YEAR

Learning and development provision

During the year we successfully launched our new Combat Stress Learning initiative. This exciting initiative is delivering collaborative and interactive learning experiences for Combat Stress and organisations across our sector.

A wide range of training content has been created by our team of clinical, military and learning and development experts during the build phase of the platform. With the aim of improving the safety and quality of services for veterans with mental health difficulties, we have launched these bespoke learning resources to the 100+ projects nationally within the VPPP programme, and in a pilot project within The Royal British Legion.

Annual Report and Accounts 2023 22

COMBAT STRESS SYMPOSIUM – FEEDBACK FROM ATTENDEES

“

I thought it was absolutely brilliant.”

Sean Duggan, Chief Executive MH Network, NHS Confederation

“

I will send the link throughout our organisation to remind everyone how Combat Stress is moving forward now. Exciting times.”

Patricia Calley C2, Welfare Manager IPC4V South, Veterans Welfare Service, Veterans UK

Sharing our knowledge at conferences and events

Over the course of the year, we have presented at a large number of conferences and events including:

  1. Combat Stress symposium: Military Minds 2022 – innovations and collaborations for the care of veterans.

In May 2022 we held a virtual oneday symposium to share insights about the latest innovations and future trends in complex mental health treatment for veterans as well as demonstrating our commitment to collaboration.

Our high calibre speakers included:

Over 400 people registered to attend and we received extremely positive feedback from the event. We plan to hold another in 2024.

  1. Sensory Integration Education Annual Conference 2022: outcomes of sensory modulation research project

  2. Royal College of Psychiatrists Quality Network for Veterans’ Mental Health Services second annual conference: innovations within Combat Stress services for veterans with complex mental health difficulties.

  3. Veterans’ Mental Health conference: treating Complex PTSD.

  4. Office of Veteran Affairs Research Symposium. Presentation: exploring the needs of treatment seeking veterans and novel treatments for PTSD.

  5. Op COURAGE NHSE Veterans Workshop. Presentation: military mental health and treating moral injury.

  6. Veterans UK, Ministry of Defence. Presentation: Understanding the needs of treatment seeking veterans.

  7. British Psychological Society: Defence and Security Section Annual Conference. Presentation: understanding the needs of female veterans.

  8. NATO HFM329 Psychological Guidance for Military Leaders. Presentation: health and wellbeing of the UK military.

In addition we are an active member of the Five Eyes Research Collaborative advising the veterans’ ministers of the UK, USA, Australia, Canada and New Zealand; as well as participating in international research consortiums exploring the needs of treatment-seeking veterans, developing the tools to measure the impact of moral injury work, NATO research task groups and supporting the work conducted in Canada to improve the outcomes of veterans with chronic pain.

23 Combat Stress

We will start to use virtual reality in our treatment in a new research study during the year ahead.

to their gender. Our work has shown that these can have a lasting impact. As a nation we must understand and respond to these experiences, mental health problems and associated needs, so women veterans can access the support and treatment they need.

Research innovations

We’re extremely grateful to the Watson Trust for the funding to enable us to consider the use of virtual reality to help veterans overcome social anxiety, which can be central to PTSD. Using evidence-based treatment alongside virtual reality, veterans will be able to explore situations virtually with a therapist by their side (rather than experiencing exposure alone, which has been the traditional route). We plan to start the pilot phase for delivering this innovative treatment in June 2023.

Using a sample of 750 female veterans drawn from the WRAC Association, the research indicates that around 10% may experience PTSD symptoms, compared to about 7% of male veterans and 4.5% in the general population.

The research also shows that female veterans may experience higher rates of loneliness and has identified that adversity during service due to gender or sexuality may be linked with experiencing poor mental health as a veteran.

We have undertaken the largest study of female veterans in the UK in conjunction with the Women’s Royal Army Corp Association (WRAC) to explore their needs. We’re very grateful to the WRAC for their help.

Thanks to funding from the Office of Veterans’ Affairs we are now using the research findings to inform and shape mental health services and treatment provision for female veterans.

Female veterans report a range of experiences during military service that are unique due

Sensory modulation research

Our lead research occupational therapist helped establish a network of occupational therapists working within the military health provision sector to share knowledge and best practice. This has led to the Royal College of Occupational Therapists (RCOT) piloting a new community of practice initiative as well as a special interest group specifically for those working with veterans, and one of our occupational therapists is part of the group’s steering committee.

The RCOT has also signed up for the Armed Forces Covenant.

Fundraising highlights

We have continued to innovate, develop and expand our fundraising activity to enable our strategic development. The fundraising team has continued to perform very well against targets despite the considerable headwinds caused by the pandemic and the cost-of-living crisis. We would like to acknowledge our extremely loyal and generous supporters who consistently answer the call to fund our important work with veterans. We need at least £15m a year to fund our specialist services and we are 74% reliant on donations from supporters. Effective, efficient and inspirational fundraising activity is critical and this year our generous and loyal supporters helped us raise those vital funds. Highlights include:

Challenges & Community

We’re grateful to our amazing and innovative supporters who always manage to surprise us with their tough exploits and ingenious fundraising and it’s our pleasure to support and encourage them on their fundraising journeys. This included serving soldier Jonathan

Annual Report and Accounts 2023 24

Guests at our England South hub open day event in March 2023

Roberson who attempted to break a world record by climbing Pen Y Fan as many times as possible whilst carrying a rowing machine on his back (in order to row the height of the mountain at the summit).

We’ve started exploring online streaming, a new fundraising income channel that we are planning to expand on in the coming years.

Our volunteer network continues to grow, which enables us to have representatives at local and regional events across the UK that we’d otherwise be unable to attend helping us to raise further funds and also increase awareness.

March in March, our annual walking challenge event was bigger and better than ever this year. Building on the previous year’s experiences and with the introduction of new elements, over £160,000 was raised from this challenge event.

Corporate

We have engaged with new and existing corporate supporters through in-person and virtual webinars as well as Lunch and Learn opportunities that raise awareness of our work, how we

support veterans and how to engage and support our fundraising. Notable presentations included GCHQ, Serco, KBR, AMS and BAE Systems

We have developed our support of, and engagement with, companies’ Employee Resource Groups (ERG). ERG’s are becoming a vital tool for companies to support colleagues and ensure their environmental, social and governance / corporate social responsibility objectives are met.

Events

We have used our flagship events, such as our annual Supporter Dinner, to share our knowledge and spread awareness of how we treat and support veterans.

We also welcomed almost 100 supporters to our England South hub in March 2023 for an Open Day event. Attendees met some of the specialist team who provide our life-changing treatment, took a tour around our facilities, including our sensory room, and found out more from veterans who have benefitted from our services. We were also able to welcome a number of other supporters on private visits.

Our annual Extra Mile Awards event took place in February 2023 and was a chance to recognise incredible achievements and innovative fundraising from our supporters and veteran volunteers.

Trusts and Foundations

Through the continued development of our strong and established relationships with veteran charities and funds, we are able to deliver the most holistic, comprehensive package of help to veterans with complex mental health needs, covering a broad range of services relating to mental health, physical health, substance misuse, peer support and family support.

We’re extremely grateful for all the support we receive in this area, including the support from veteran charities and funds such as:

25 Combat Stress

Some of our amazing Extra Mile Award winners

organisations have ‘on-demand’ access to the Combat Stress Training Programme for Organisations, aimed at improving veteran wellbeing and mental health.

Major Gifts

This year we have reached out to major supporters and our Vice Presidents with knowledge and expertise in HR, fundraising, communications and digital development. We are extremely grateful to all those who have given up their time to provide advice and leadership to help us continue to learn and grow as an organisation.

We have continued to work closely with our Benefactors whose significant investment helps to achieve a greater impact on the veterans who need our support. We are particularly grateful to the Stannah family and company who, after many years of support, have this year geneorusly provided funds to urgently replace two lifts at our England South Hub.

Legacies

One in five veterans are funded through gifts in Wills. Our in-house Legacy team has continued to manage and maximise this form of giving to secure vital funds. This year we have worked closely with other fundraising teams to generate interest in legacy giving. Over half

of our legators this year have been supporters of the charity in some way for more than ten years.

In addition, many of our supporters have a military connection so this year we have recognised and acknowledged their unique understanding of our work in our communications. Our targeted legacy mailing, which utilised online and offline materials, paid for itself in donations and resulted in expected future gifts of around £2million.

We have also introduced a new memorial area in the garden at our England South hub. This provides a calm and peaceful area where families and friends can have a plaque to commemorate the life of a loved one in whose memory funds were raised to help veterans.

Individual Giving

To generate interest in the charity and expand our supporter base, we’ve trialled a lead generation / value exchange campaign on social media for the first time this year.

We have also continued our work to engage new supporters. Combining both online and offline communications, we aim to demonstrate how important our work with veterans is and why we need ongoing support from this group of individuals. During the year we have added over 2,600 new supporters through this communications channel and received donations directly from this.

Raising awareness

During Armistice, we launched our new hard-hitting photography campaign: Life as we know it: Living with PTSD to convey the impact of PTSD on the most normal aspects of everyday life. Coverage included The Scottish Sun, Scotland on Sunday, The Evening Standard, BFBS and

Annual Report and Accounts 2023 26

BBC Radio Solent. The campaign, which was also promoted by the British Army communications team, helped us to reach new audiences through targeted digital advertising as well as veteran audiences to encourage them to come forward for help. It also provoked conversations amongst our veteran community, for example one post on social media prompted over 500 comments from veterans, sparking messages of support amongst them.

Following the operationalisation of our new service model, we reviewed how Combat Stress presents itself as a brand. A lot had changed both within and outside the charity and we needed to ensure we’re always expressing ourselves clearly and distinctly and that we properly represent who we are and what we do.

We revisited the brand look and feel and made some improvements. This included subtly tweaking our logo to make it more accessible to those with visual impairment and introducing the use of camouflage to clarify and emphasise our military identity to those who don’t know us. The introduction of the camouflage will make the brand far more identifiable to veterans and the Armed Forces community as a whole, helping us to ensure that every veteran in the UK knows that lasting recovery can start at Combat Stress. We also introduced a new brand narrative to help convey our distinct positioning.

We have created multi-sensory engaging content that was used to raise both money and awareness to new audiences. This included three 60-second animations for new supporters and followers that explain what PTSD is, how it impacts veterans, and what Combat Stress does to help.

Veteran Tom has used art therapy to good effect and featured in our new art and creativity film, shown at our Secret Postcard Auction event

A new impactful film around art and creativity, featuring a veteran who has used art therapy to good effect, was created and shown at the Secret Postcard Auction event and profiled on our social media channels.

veteran stories wherever possible within appeal mailings, and profiling an Army veteran during Mental Health Awareness Week on our social media channels, which had an excellent engagement rate.

To improve our reach and grow the charity, we have achieved a 29% increase in engagement across our social media platforms, despite the challenges of new rules and algorithms constantly changing within the digital space.

During the year we also collected and shared 15 new veteran stories for use within communications and fundraising materials to help raise awareness and understanding about how we can help. Activity included supporting a veteran to speak in-person at the Supporter Dinner, having a veteran speak at the launch of the Armed Forces T20 cricket event, working with the Individual Giving team to include

FOR EVERY £1 SPENT:

VETERAN TREATMENT 76p FUNDRAISING 19p AWARENESS AND ACCESS 5p

27 Combat Stress

OUR STRATEGIC AIMS

AIM 4: OUR PEOPLE

Our people help us deliver the best service and treatment to veterans – from staff to volunteers to generous donors and enthusiastic fundraisers. We want them to feel valued and involved in making a difference to the lives of veterans and their families.

WHAT WE’RE GOING TO DO

WHAT DOES SUCCESS LOOK LIKE?

WHAT WE’VE DONE THIS YEAR

Learning and development

During the year we have established a new learning and development team and as a result launched a new learning platform. Since early 2023 our induction for new members of staff has been delivered via the platform, ensuring a dynamic and interactive experience. A new training needs analysis has been developed to ensure the continuous professional development of Combat Stress staff and enhance safe and effective service delivery.

Annual Report and Accounts 2023 28

We have also made progress on offering student nurse placements, with seven staff now trained as practice assessors and practice supervisors.

Equality, diversity and inclusion (EDI) plan for staff

We have developed our EDI action plan for staff and begun the early stages of implementation of some key areas of the plan. This includes developing our recruitment system to digitise the process and provide diversity monitoring, planning a diversity champion group, and providing recruitment training tips for management level staff members.

Our engagement strategy

A lot of work has gone into making sure our supporters feel part of the Combat Stress family and know how much we appreciate them. To build on the work on the new donor journey last year we have now introduced some new updated communications, so supporters know what is happening within the charity and some special thank yous for our longer term, and incredibly generous supporters. The impact of this work will become evident in due course as it aims for supporters to stay with us for longer, helping us

grow and maintain a larger donor base over time.

We have also continued work on improving the experience people have on our website. In particular, the move to a new donation platform, which offers a simpler, smoother experience to make it easier for potential donors to give.

By continuing to build on email automation and targeting, we have been able to send more relevant updates based on subscribers’ preferences and interests, to promote our services and fundraising efforts. People who receive our emails are now 12% more likely to open them than they were in the previous year.

Co-production

Veterans are at the heart of everything we do. And as part of our co-production with the veteran community, we have established an Open Forum event to gain insights and opinions from veterans on a number of initiatives being considered at Combat Stress.

Taking place quarterly, the forum seeks to hear opinions from veterans from a wider variety of backgrounds to help develop our services and support. The forum is an evolution of the NVV, a group of

volunteers who, since 2020, have been providing Combat Stress with an invaluable veteran perspective on a range of topics.

Our NVV continues to meet regularly but we have also started to introduce local NVV groups. We established a group in Scotland and involved them on the location of our Glasgow hub. Further local groups are planned for the year ahead.

Defence Employer Recognition Scheme

We have submitted an application to become a Gold Defence Employer. This is the highest award any organisation can achieve to demonstrate their commitment to the Armed Forces Community as a Forces-friendly employer. This also positions Combat Stress alongside many of the largest and supportive companies and organisations in the country.

29 Combat Stress

GARRY’S STORY

Simple tasks like the school run or going to the shops are impossible for Garry who is hypervigilant and sees general threats everywhere.

Garry joined up as soon as he could when he left school. He undertook two tours of Afghanistan but left the Army aged 23. Bonfire Night is a particular trigger for Garry’s mental health.

“The challenge I face is getting out of the house every day. But, since coming to Combat Stress I’ve made real progress, and it’s helped a lot knowing they are there and I’m not alone. At the time I didn’t know what was going on in my head but now I have support and understanding.”

To hear more from Garry please visit living-with-ptsd.combatstress.org.uk

Annual Report and Accounts 2023 30

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FUTURE PLANS
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Looking ahead, we will continue to implement our new strategy and below you will find some examples of planned activity against each of our strategic aims. However we expect there to be some challenges for the charity to face. We will have to commit resources to continuing restoring our veteran records after the Carenotes outage and this will have a significant impact on the number of veterans we are able to help.

We also continue to expect the costof-living-crisis to have an impact on our fundraising, staff and the veterans who seek our help. Whilst our ability to fundraise during the last financial year was unaffected, this may not be the case for the year ahead. We will continue to monitor how best to support staff during this difficult time and our cost-of-livingcrisis working group will remain in place to signpost veterans to other charities and organisations that could help.

EXAMPLES OF PLANNED ACTIVITY FOR THE YEAR AHEAD

Quality

Over the first year, enabled by our partnership with Virginia Mason Institute, staff have been continuing to learn and develop their knowledge and skills in continuous improvement so that, in the second year of this organisational strategy, we will begin embedding continuous improvement in Combat Stress’ culture, systems and processes. In the spirit of continuous improvement, there’s always more to learn but we are now

in a position to make real change. This will include every member of staff seeking out, supporting and implementing changes contributing to continuous improvement in their own areas to ensure we can continue to provide better outcomes for veterans while maintaining safety and excellence of outcomes and service.

We will further develop our service to make it a comprehensive offer to veterans with complex mental health needs. We will refine our intensive treatment service (VICTOR) as we learn from the service currently being offered and start to provide the service in Scotland. We will also run a female-only VICTOR cohort.

Service

We will continue to grow the number of formal collaborations and partnerships we have with other providers, including with the NHS and third sector partners in each region of the UK, striving towards the more joined-up system we envisage for veterans’ mental health by streamlining and enhancing the experience of seeking, accessing and receiving support and treatment.

We will also continue development of our intensive approach through the provision of psychological therapy for CPTSD as part of our multidisciplinary approach.

Innovation and Improvement

We aim to become nationally regarded as the thought-leader in veterans’ mental health, and extend our credentials wherever we can.

We’ll do this through more research, more external training, more conference presentations, more co-production and establishing VICTOR as the recognised high watermark for how to deliver intensive treatment to veterans’ with complex mental health problems.

Examples of our planned activity in this area include using research to assess the use of virtual reality to help veterans overcome social anxiety which can be central to PTSD. We will also be presenting VICTOR at the prestigious European Society for Traumatic Stress Studies conference in June 2023.

Our People

While continuing to make Combat Stress an even better place to work, volunteer and support, where people feel cared for and engaged in the aims of the charity. We will continue to invest in our people through excellent learning and development opportunities and an even stronger culture of equality, diversity and inclusion through our EDI action plan we have already been rolling out.

We know there are thousands of veterans struggling today who would benefit from our help. Many are in pain for years before they receive our life-changing treatment. Our strategic plan for 2022–2025 has been developed to help ensure that every veteran in the UK with complex mental health needs knows that the journey to lasting recovery starts with Combat Stress and help them tackle the past and take on the future.

31 Combaisiress STRATEGIC REPORT

Annual Report and Accounts 2023 32

FINANCIAL REVIEW

This year has been one of recovery from the Covid pandemic and lockdowns that impacted our face-toface work in the previous two years. We have moved back into an open environment and restarted in-person working and treatment programmes. We have filled more of our clinical vacancies and have been able to see more veterans. We have had space to rebuild our financial stability and execute more elements of our strategic plan.

Our Helpline services continued throughout the year. Peer support, therapy and psychiatric services were delivered by telephone, online and in person. 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 has remained strong at £13.9m (2022 £15.4m). The drop in income from the prior year is due to the drop in legacy income which is acknowledged to be unpredictable due to its nature, £1.9m in 2023 (2022: £3.5m).

Expenditure in total for the year increased to £14.2m (2022: 10.2m). This is due in part to a partial reversal of impairment of £0.9m in 2022 and an increase of £2.5m expenditure related to clinical services, where we have sought to fill vacancies in front line staff in order to see more veterans.

During the year we sold our Audley Court centre in Shropshire and are in the process of opening a new treatment centre near Birmingham, to allow us to be nearer to more veterans.

We operate a defined benefit pension scheme, although it closed to new members and further service accruals in 2000. The triennial pension scheme valuation at 30 September 2020 showed a deficit, and even though the FRS102 valuation at 31 March 2022 and again at 31 March 2023 showed a surplus, it is imprudent to show this as an asset and the current valuation surplus is capped at zero.

The net effect of all of these factors is a decrease in funds of £981k (2022 increase £5.4m). The decrease in funds has predominantly shown in reduced fixed asset designation offset by increased general funds.

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.

At 31 March 2023, the level of reserves is £2m (2022: £2m) in the form of cash and £12.7m (2022: £10.9m) in investments. This, together with substantial pledges and contracts, continues to be reviewed by the Trustees and the executive team to ensure the Charity remains 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.

33 Combat Stress

Income

Our total income for the year was £13.9m (2022: £15.4m). £1.6m of the reduction in income was due to a drop in legacy income. Excluding the legacy income, other income has seen a small increase of £11.9m in 2023 (2022 £11.8m). That said, Legacies continued to be a significant support to our work and accounted for £1.9m (2022 £3.5m).

Income from our strategic partners was £3.9m compared with £3.7m in 2022, due principally to the additional funding from The Royal British Legion. This forward planned gifting enables us to have better certainty of our income in the following year which is extremely helpful when it comes to planning and budgeting our expenditure. The relationships with all these partners remain close and collaborative. The grants and pledges relating to 2023 and beyond from these partners are so important to our future going concern projections and ensure that we have certainty to enable future planning for our continued work with veterans who will benefit from our support.

Statutory income (income from government bodies) was slightly higher this year at £0.4m (2022: £0.3m), predominantly from a variety of initiatives supported by the Armed Forces Covenant Fund Trust (see details in Note 3).

(2021: £1m) for the provision of care to veterans with complex PTSD in England. NHS Leeds & York Partnership Foundation Trust supported services in the North of England with contract income of £246k (2022: £199k). In addition we were delighted to also receive other contracts from various local NHS trusts.

Investment income of £409k was increased from last year (2022: £280k) as our investment funds increased following the sale of Audley Court.

Expenditure

Total expenditure for 2023 was £14.2m (2022: £10.2m) with 80% being spent on charitable activities (2022: 77%). This is broken down into expenditure on raising funds of £2.8m (2022:£2.3m) and spending on charitable activities of £11.4m (2022: £7.9m).

Staff costs comprise 75.3% of our total costs (2022: 79.6%) as shown in Note 8. Whilst it remains a challenge to recruit and retain excellent employees in a competitive market, we have sought to address this through our HR strategy review. We have made good progress during the year in bringing our vacancies down and we are continuing to recruit into long standing clinical vacancies as we move forwards into the new financial year.

Income from charitable activities was £2.8m (2022: £2.8m). Contractual income from NHS Scotland was £1.4m (2022: £1.4m). NHS England funded us with £1m

Annual Report and Accounts 2023 34

PRINCIPAL RISKS AND UNCERTAINTIES

The Board of Trustees has overarching responsibility for managing risks faced by the Charity. Significant risks to which the Charity is exposed to are formally reported to all Committees and the Board, though there is a greater in depth review of the latest corporate risk report and register at the Audit and Risk Management Committee.

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.

Significant areas of risk currently include:

  1. The demand from veterans for support and treatment has remained high this year. The ability to manage demand within our service capacity without significant waiting times developing has been a risk. Mitigating actions have included continued progress in recruiting to vacancies, and developing new treatment formats to speed up access.

  2. Due to the environment Combat Stress works in, there is a risk that a veteran known to us, at any stage of the journey, whether under our direct care or not, may come to harm. We mitigate this through a variety of means, from stringent policies aligned to our regulators and training, such as in the area of safeguarding, to having the best practice standards. More on how we measure veteran data can be found on page 10.

  3. The UK healthcare sector has experienced an unprecedented shortage of key medical professionals, from nurses to psychiatrists. Whilst there have been some delays in recruiting, we have taken innovative steps to attract new candidates, including offering sector/role specific recruitment webinars to provide an insight at working at Combat Stress as well as reviewing the whole package we offer to our staff. We have been reviewing every aspect – engagement, retention, training, motivation, promoting and rewarding – for our staff where possible.

  4. In order to deliver services to veterans and their support networks, we need to be financially sustainable and do so though our fundraising. However, we know that the ongoing economic crisis has been hard for so many and so we have been looking at new and innovative fundraising approaches and working on how to enhance the supporter journey.

  5. We take data security very seriously, especially as much of our service is now delivered online. This year, we made our cyber security even more secure and achieved Cyber Essentials accreditation for another year, reassuring veterans, their families and our supporters that we treat their information with the utmost respect, sensitivity and care, and reducing the risks of data breaches and malware. Whilst the loss of access to Carenotes was beyond our control,

we took this opportunity to review all major systems and make enquiries about their disaster recovery and business continuity plans. This work is underway now.

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 notifiable incident, then the appropriate regulatory bodies would be promptly advised. All incidents undergo the appropriate investigation and we always look to learn from any issues raised.

35 Combat Stress

REMUNERATION

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.

The Remuneration and Nominations Committee determines the salary and any benefits of the CEO 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. All Trustees are unremunerated.

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 2022/23 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 11%.

At 31 March 2023, 90% (March 2022: 91%) of our employees were enrolled in the pension scheme.

In the reporting period, Combat Stress initiated a full review of the benefits package for staff, which includes ensuring that staff can continue to have a hybrid working pattern, where appropriate.

FUNDRAISING

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 (for training and monitoring purposes), 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 did not receive any notification of a breach.

In 2022/2023, we received five fundraising complaints (seven in 2021/22) which were logged on our fundraising database. Complaints are then also logged on our incident management system, Datix, if they involve a veteran or serious reputational risk. All fundraising complaints are investigated thoroughly in a timely and sensitive manner and acted upon as necessary. Fundraising 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.

Annual Report and Accounts 2023 36

PUBLIC BENEFIT, POLICIES AND GOVERNANCE

Public benefit

Combat Stress is the UK’s only regulated 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 as demonstrated on pages 5–30 of this report (front section).

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.

Combat Stress held its investments in the Cazenove Charity MultiAsset Fund throughout 2022/23. 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 2022/23, the performance of markets resulted in unrealised losses of £628k (2022: gains of £243k).

At 31 March 2023, our investments were worth £12.7m (2022: £10.9m). Cash balances totalling £5.1m (2022: £3.0m) held by the investment manager at year end in fixed term deposit accounts are included in these investment figures.

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 twelve 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 at 31 March 2023 stood at £10.7m, representing 9.8 months’ budgeted unrestricted expenditure (2022: £9.4m, or 9.4 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 2022 showed a surplus on the fund of £2,964k (2022: surplus of £1,413k), 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 2022/23 (2022: 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.

37 Combat Stress

The Charity has a duty to secure the ongoing benefits of the pension scheme, for the benefit of its members. Given the current financial strength of the scheme, we are actively pursuing a move to transfer the assets and liabilities to a third party provider, to eliminate any long term liability for Combat Stress.

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, CEO and executive directors induct new trustees through briefings. We also provide a copy of the updated 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 of Trustees is responsible for appointing selected suppliers, including external auditors. In 2022/23 Combat Stress retained its

previous audit firm, Moore Kingston Smith, into a second year following a tender process in 2021/22 driven by good governance and the need to test the market.

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

The Trustees support the principlesbased approach of the Charity Governance Code.

Annual Report and Accounts 2023 38

Environmental, Social and Governance (ESG) Reporting

At the start of the year, Combat Stress set up an ESG Steering Group comprising key senior managers and led by an executive director.

This group meets bi-monthly to discuss and review progress in all areas of ESG. This is a long term review process before drafting a strategy as Combat Stress recognises ESG is a holistic approach for us to help create and sustain long term value in a rapidly changing world, and managing the opportunities and risks associated with these changes. Whilst we already undertake a variety of activities in the ESG arena, we are focusing on developing a track record. Examples of activity to date includes our work on equality, diversity and inclusion (see page 28), offering all staff a ‘cycle to work’ scheme’, securing the Pride in Veterans Standard,and continuing with participation in the UK Environment Agency’s Energy Savings Opportunity Scheme.

Key progress markers to report from this year are:

2) 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. 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 seven 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.

We have reviewed our investment portfolio with our investment managers and made the decision to move from the Charity Multi Asset Fund to the Responsible Multi Asset Fund. This move actually took place just after the year end in April 2023. This decision was made primarily with concern for disinvesting from areas which are additional challenges and a barrier to good mental well-being for some of our veterans.

39 Combat Stress

CRAIG’S STORY

In hot weather, the smell of oil refinery on the way to work can stir up emotions of being back in Iraq.

Craig joined the Army when he was 16 years old and served for 23 years, completing tours of Northern Ireland, Bosnia, Kosovo, Iraq and Afghanistan. When Craig returned to civvy life, his traumatic experiences kept him in a permanent state of high alert. He turned to alcohol, drinking heavily to avoid his triggers. After being diagnosed with PTSD, he’s learnt how to manage these.

“Thanks to Combat Stress, I know now that certain things can be triggers – I just have to be mindful of my environment.”

To hear more from Craig please visit living-with-ptsd.combatstress.org.uk

Annual Report and Accounts 2023 40

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:

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:

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.

Giles Peel (Aug 2, 2023 15:59 GMT+1)

Giles Peel BSc FCG Chairman

Date: Aug 2, 2023

41 Combat Stress

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

Opinion

We have audited the financial statements of Combat Stress (the ‘parent charitable company’) and its subsidiaries (the ‘group’) for the year ended 31 March 2023 which comprise the Group Statement of Financial Activities, the Group Summary Income and Expenditure Account, the Group and Parent Charitable Company Balance Sheets, the Group Cash Flow Statement and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

In our opinion the financial statements:

Basis for opinion

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

Conclusions relating to going concern

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

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the group’s and 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 other information comprises the information included in the annual report, other than the financial statements and our auditor’s report thereon. The trustees are responsible for the other information contained in the annual report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon.

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

We have nothing to report in this regard.

Opinions on other matters prescribed by the Companies Act 2006

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

Annual Report and Accounts 2023 42

Matters on which we are required to report by exception

In the light of the knowledge and understanding of the group and parent charitable company and their environment obtained in the course of the audit, we have not identified material misstatements in the strategic report or the trustees’ annual report.

We have nothing to report in respect of the following matters where the Companies Act 2006 or the Charities Accounts (Scotland) Regulations 2006 (as amended) require us to report to you if, in our opinion:

Responsibilities of trustees

As explained more fully in the trustees’ responsibilities statement set out on page 40, 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 determine is necessary to enable the preparation of financial

statements that are free from material misstatement, whether due to fraud or error.

In preparing the financial statements, the trustees are responsible for assessing the group and 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 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 to you in accordance with regulations made under those Acts.

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists.

Misstatements can arise from fraud or error and are considered material if, individually or in aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

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

financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control.

• Conclude on the appropriateness of the trustees’ use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the group and parent charitable company’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclosures in the financial statements or, if such disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the group or parent charitable company to cease to continue as a going concern.

43 Combat Stress

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

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

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

The objectives of our audit in respect of fraud, are: to identify and assess the risks of material misstatement of the financial statements due to fraud; to obtain sufficient appropriate audit evidence regarding the assessed risks of material misstatement due to fraud, through designing and implementing appropriate responses to those assessed risks;

and to respond appropriately to instances of fraud or suspected fraud identified during the audit. However, the primary responsibility for the prevention and detection of fraud rests with both management and those charged with governance of the charitable company.

Our approach was as follows:

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

Use of our report

This report is made solely to the 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 Section 44(1)(c) of 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 which we are required to state to them in an auditor’s report addressed to them and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to any party other than the charitable company and charitable company’s members as a body, and the charity’s trustees, as a body, for our audit work, for this report, or for the opinions we have formed.

Moore Kingston Smith llp Moore Kingston Smith llp (Aug 11, 2023 15:02 GMT+1)

Neil Finlayson (Senior Statutory Auditor) for and on behalf of Moore Kingston Smith LLP, Statutory Auditor

9 Appold St, London, EC2A 2AP

Date: Aug 11, 2023

Moore Kingston Smith LLP is eligible to act as auditor in terms of Section 1212 of the Companies Act 2006.

Annual Report and Accounts 2023 44

CONSOLIDATED STATEMENT OF FINANCIAL ACTIVITIES FOR THE YEAR ENDED 31 MARCH 2023

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
Restricted
Totals
Totals
Funds
Funds
2023
2022
£’000
£’000
£’000
£’000
4,909
5,336
10,245
11,896
2,795
38
2,833
2,834
344
-
344
348
409
-
409
280		 Unrestricted
Restricted
Totals
Totals
Funds
Funds
2023
2022
£’000
£’000
£’000
£’000
4,909
5,336
10,245
11,896
2,795
38
2,833
2,834
344
-
344
348
409
-
409
280		 Unrestricted
Restricted
Totals
Totals
Funds
Funds
2023
2022
£’000
£’000
£’000
£’000
4,909
5,336
10,245
11,896
2,795
38
2,833
2,834
344
-
344
348
409
-
409
280		 Unrestricted
Restricted
Totals
Totals
Funds
Funds
2023
2022
£’000
£’000
£’000
£’000
4,909
5,336
10,245
11,896
2,795
38
2,833
2,834
344
-
344
348
409
-
409
280
Other 21 - 21 11
Total income 8,478 5,374 13,852 15,369
Expenditure on:
Raising funds
Charitable activities
2,779 - 2,779 2,305
Clinical services
Helpline
Raising awareness and improving access		 5,450
4,902
10,352
6,966
301
137
438
419
645
-
645
503
6,396 5,039 11,435 7,888
Total expenditure 5 9,175 5,039 14,214 10,193
Net (expenditure)/income before transfers and
investment gains and losses
Net (losses)/gains on investments
Net (expenditure)/income
Transfers between funds
Other recognised gains
Actuarial gains on defned beneft
pension scheme		 17 (697)
(628)		 335
-		 (362)
(628)		 5,176
242
(1,325) 335 (990) 5,418
39 (39) - -
9 - 9 -
Net movement in funds (1,277) 296 (981) 5,418
Reconciliation of funds:
Fund balances brought forward at 1 April
18,394
3,033
21,427
16,009
Fund balances carried forward at 31 March 21 17,117 3,329 20,446 21,427

The notes on pages 47–70 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 2022 is shown in Note 22.

45 Combat Stress

CONSOLIDATED AND CHARITY BALANCE SHEETS AT 31 MARCH 2023

Notes
Fixed assets
Tangible assets
9
Investments
10
Total fxed assets
Current assets
Stock
Debtors
11
Cash at bank and in hand
Total current assets
Liabilities
Creditors: amounts falling due within one year
12
Net current assets		 Notes
Fixed assets
Tangible assets
9
Investments
10
Total fxed assets
Current assets
Stock
Debtors
11
Cash at bank and in hand
Total current assets
Liabilities
Creditors: amounts falling due within one year
12
Net current assets		 Group Group Charity Charity
2023
£’000
4,118
12,692		 2022
£’000
6,373
10,948		 2023
£’000
4,118
12,692		 2022
£’000
6,373
10,948
16,810
47
2,459
2,226		 17,321
53
2,686
2,109		 16,810
-
2,623
2,096		 17,321
-
2,823
2,015
4,732
(1,096)		 4,848
(742)		 4,719
(1,068)		 4,838
(732)
3,636 4,106 3,651 4,106
Total net assets 19 20,446 21,427 20,461 21,427
The funds of the Charity:
Unrestricted income funds
General fund
Investment revaluation reserve
Designated funds		 10,674
690
5,753		 9,426
1,320
7,648		 10,689
690
5,753		 9,426
1,320
7,648
17,117 18,394 17,132 18,394
Restricted income funds 3,329 3,033 3,329 3,033
Total Charity funds 21 20,446 21,427 20,461 21,427

The notes on pages 47–70 form part of these financial statements. During the year ended 31 March 2023, Combat Stress, the parent charity results showed a loss after gains, losses and transfers of £966k (2022: gain of £5,418k).

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

Giles Peel (Aug 2, 2023 15:59 GMT+1) George Osborne (Aug 4, 2023 09:14 GMT+1) Giles Peel BSc FCG George Osborne BA MBA Chairman Honorary Treasurer Date: Aug 2, 2023 Date: Aug 4, 2023

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

Annual Report and Accounts 2023 46

CONSOLIDATED STATEMENT OF CASH FLOWS AND CHARITY STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 MARCH 2023

Cash fows from operating activities: Group Group Charity Charity
2023
£’000		 2022
£’000		 2023
£’000		 2022
£’000
Net cash provided by operating activities (83) 3,068 (119) 3,052
Cash fows from investing activities:
Dividends, interest and rents from investments
Proceeds from the 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		 409
2,261
(98)
18
(305)		 280
-
(4)
15
(1,551)		 409
2,261
(98)
18
(305)		 280
(4)
15
(1,551)
2,285 (1,260) 2,285 (1,260)
2,202
5,116		 1,808
3,308		 2,166
5,022		 1,792
3,230
Cash and cash equivalents at the end of the reporting period 7,318 5,116 7,188 5,022

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

Net (expenditure) / income for the reporting period
(as per the statement of fnancial activities)
Adjustments for:
Depreciation charges
Recovery of impaired fxed asset value
Loss/(Gains) on investments
Actuarial (gain) on defned beneft pension scheme
Dividends, interest and rents from investments
Proft on the sale of fxed assets
Decrease in stocks
Decrease/ (increase) in debtors
Increase in creditors
Pension scheme costs under FRS102 – Interest Movements		 Group Group Charity Charity
2023
£’000
(981)
103
-
628
(9)
(409)
(11)
6
227
354
9		 2022
£’000
5,418
183
(910)
(242)
-
(280)
-
7
(1,208)
100
-		 2023
£’000
(966)
103
-
628
(9)
(409)
(11)
-
200
336
9		 2022
£’000
5,418
181
(910)
(242)
-
(280)
-
-
(1,212)
97
-
Net cash (used in)/ provided by operating activities (83) 3,068 (119) 3,052

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

47 Combat Stress

NOTES FORMING PART OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2023

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 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 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. These assumptions are prepared by the scheme actuary.

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.

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 of 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.

Annual Report and Accounts 2023 48

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. In March 2022 the Audley Court property was revalued upwards by £0.9m to bring its value in line with an updated market valuation in light of its sale which took place during this financial year. Hollybush House has not had its valuation changed since its March 2021 impairment.

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 pages 69–70.

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:

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.

• 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 notification 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.

• Donations Donations of cash are recognised

49 Combat Stress

1. Accounting policies (continued)

h. Expenditure

Expenditure is allocated as follows:

ii. Clinical services

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.

e. 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 equipment 5 years Computer equipment 3 years Computer software 6 years Plant 10 years Maintenance vehicles 3 years Assets in leased 3–7 premises – dependent years on lease period

f. 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.

g. 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 as a designated fund in relation to allocating an element of the sale proceeds from Audley Court to supporting the employer covenant with the Pension Fund Trustees for the defined benefit scheme. Details of the pension schemes are disclosed in note 17 to the accounts.

h. Leases

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

i. 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.

j. 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.

k. Stock

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

Annual Report and Accounts 2023 50

2. Results of the parent charity

Total charity income
Total charity expenditure
Transfers between funds
Charity net expenditure
Gain on investment assets
Actuarial gain on defned beneft scheme
Charity net movement in funds
Funds balance brought forward
Funds balance carried forward		 Unrestricted
£’000
8,437
(9,119)
39		 Restricted
£’000
5,374
(5,039)
(39)		 Total
2023
£’000
13,811
(14,158)
-		 Total
2022
£’000
15,315
(10,139)
-
(643)
(628)
9		 296
-
-		 (347)
(628)
9		 5,176
242
-
(1,262)
18,394		 296
3,033		 (966)
21,427		 5,418
16,009
17,132 3,329 20,461 21,427

The total income for the Charity excluding the subsidiary includes no gift aid donation from Combat Stress Trading Limited for 2023 as the subsidiary made a loss (2022: gift aid donation £8,523). There is no tax having to be paid on 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

Donations
Statutory grants
Legacies		 Unrestricted
£’000
2,997
34		 Restricted
£’000
4,881
415		 Total
2023
£’000
7,878
449		 Total
2022
£’000
8,039
328
1,878 40 1,918 3,529
4,909 5,336 10,245 11,896

The voluntary income in 2022 was £11,896k of which £4,908k was restricted.

Charity voluntary income

Charity voluntary income
Donations
Statutory grants (see below)
Legacies		 Unrestricted
£’000
2,997
34		 Restricted
£’000
4,881
415		 Total
2023
£’000
7,878
449		 Total
2023
£’000
8,047
328
1,878 40 1,918 3,529
4,909 5,336 10,245 11,904

The voluntary income in 2022 was £11,904k of which £4,908k was restricted.

The Charity’s voluntary income includes no donation from the subsidiary trading company for 2023 (2022: £9k).

Certain legacies had been notified to Combat Stress as at 31 March 2023 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. Six are individually worth potentially in excess of £50k each and the combined value of all these uncertain legacies is estimated to be £887k (2022: £337k). One of these legacies has subsequently delivered estate accounts in June, post year end, with £246k now confirmed as due to Combat Stress.

51 Combat Stress

3. Voluntary income (continued)

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

Purpose
Armed Forces Covenant Fund
Grant to fund training in mental health to be provided to
other service charities (suicide prevention training)
Armed Forces Covenant Fund
Refund of unused portion of prior years’ grant
Armed Forces Covenant Fund
VPPP Scottish Veterans’ Wellbeing Alliance
Armed Forces Covenant Fund
Offce for Veterans’ Affairs, Welsh Afghanistan Veterans’
Specialist Treatment
Armed Forces Covenant Fund
VPPP Strategic Lead for Clinical Quality in Mental Health
Armed Forces Covenant Fund
VPPP Regional Portfolio Partner Defence Medical
Welfare Service, Midlands – Helpline
Armed Forces Covenant Fund
VPPP Regional Portfolio Partner Bridge for Heroes –
Helpline (2023 and 2022 funding)
Armed Forces Covenant Fund
VPPP Regional Portfolio Partner Bridge for Heroes –
Helpline (2024 funding approved within 2023)
Armed Forces Covenant Fund
Veterans People, Places and Pathways, Northern Ireland
Armed Forces Covenant Fund
Reaching & Supporting Armed Forces Communities:
Family Support Services
HMRC
Coronavirus Job Retention Scheme Grant to
cover furlough payments during lockdown due to
C-19 pandemic
Offce for Veterans Affairs
Research grant on improving female veterans access
to services
Scottish Government
Thank you payment to workers in the care sector
Scottish Government
Veterans Mental Health and Wellbeing Action Plan
 Total
2023
£’000
17
-
-
34
100
29
30		 Total
2022
£’000
89
(3)
6
40
50
7
5
22
95
16
-
-
-
106		 -
-
-
45
61
28
-
449 328

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

Annual Report and Accounts 2023 52

4. Income from charitable activities (Group and Charity)

Clinical services
Contract funding
Performance related grant		 Unrestricted Restricted Total Total
£’000
2,699
96		 £’000
38
-		 2023
£’000
2,737
96		 2022
£’000
2,754
80
2,795 38 2,833 2,834

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

Activities
undertaken
directly
£’000
Cost of generating funds
Cost of generating voluntary income
2,399
Cost of trading activity (Combat Stress Trading Limited
only)
78
Investment management fees
22
2,499
Charitable activities
Clinical services
8,979
Clinical services – impairment (revaluation)
-
Helpline
419
Awareness raising and improving access
520
9,918
Total
12,417
Expenditure includes:
Audit fee – Charity
Audit fee – trading company
Audit fee – pension scheme (2023 £11k due but invoice received late and not
Operating leases
Depreciation
Revaluation of previously impaired tangible fxed assets		 Activities
undertaken
directly
£’000
2,399
78		 Allocated
support
costs
£’000
280
-		 Total
2023
£’000
2,679
78		 Total
2022
£’000
2,219
68
22 - 22 18
2,499 280 2,779 2,305
8,979
-
419
520		 1,373
-
19
125		 10,352
-
438
645		 7,876
(910)
419
503
9,918 1,517 11,435 7,888
12,417 1,797 14,214 10,193
accrued) 2023
£’000
27
5
-
253
103
-		 2022
£’000
23
5
10
117
183
(910)

53 Combat Stress

6. Support costs

6. Support costs
2022/23 Allocations:
Activities for
generating funds
Clinical services
Helpline
Awareness raising and
improving access
2021/22 Allocations:
Activities for
generating funds
Clinical services
Helpline
Awareness raising and
improving access		 Finance
£’000
61
231
11
13		 Management
£’000
38
192
2
19		 Governance
£’000
44
223
2
21		 Human
Resources
£’000
52
262
2
25		 Maternity
£’000
9
47
-
5		 Information
Technology
£’000
76
418
2
42		 2023
Total
£’000
280
1,373
19
125
316 251 290 341 61 538 1,797
Finance Management Governance Human
Resources		 Maternity Information
Technology		 2022
Total
£’000
60
177
12
12		 £’000
32
146
1
15		 £’000
37
167
1
17		 £’000
53
241
1
25		 £’000
6
28
-
3		 £’000
105
501
-
48		 £’000
293
1,260
15
120
261 194 222 320 37 654 1,688

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 2023 54

7. Trustee expenses

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

Travel and sundry expenses 2023 2023 2022 2022 2022
Number
4		 £’000
1		 Number
4		 £’000
1

No member of the Board of Trustees received any remuneration or emoluments in respect of services during the year (2022: £Nil), nor had any beneficial interest in any contract with Combat Stress during the year.

8. Staff costs

Ex-Services Mental Welfare Society, the dormant subsidiary company in the Group, does not have any employees and does not pay directors. Combat Stress Trading Limited has two staff on joint contracts of employment with the parent Charity.

Wages and salaries
Social security costs
Redundancy & termination payments
Pension costs
Other costs		 Group
2023
£'000
8,820
985
6
477
420		 Group
2022
£'000
6,559
684
89
357
426		 Charity
2023
£'000
8,791
983
6
475
420		 Charity
2022
£'000
6,546
683
89
357
426
10,708 8,115 10,675 8,101

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 £100,001 – £110,000
Between £120,001 – £130,000
Between £130,001 – £140,000		 2023
Non clinical
4
1
1
2
1
-
-		 2023
Clinical
5
3
1
-
1
-
1		 2023
Total
9
4
2
2
2
-
1		 2022
Total
4
3
2
1
1
1
-
9 11 20 12

The total remuneration costs of the CEO and executive directors (key management personnel) in 2023 was £644k (2022: £595k).

As a charity providing complex clinical services, we employ senior clinicians, including psychiatrists and psychologists. In 2023 the highest paid director was the Medical Director, a consultant psychiatrist, who leads the design of the treatment programmes. It is essential that we have a leading expert in the field of veterans mental health for this post.

Benefits provided to all staff include matched contributions of up to 11% into the Group Personal Pension Scheme, childcare voucher scheme, cycle to work scheme and free car parking.

55 Combat Stress

8. Staff costs (continued)

Pension contributions for employees above £60,000

Defned contribution schemes 2023
Number
£’000
18
112		 2023
Number
£’000
18
112		 2022
Number
£’000
12
68		 2022
Number
£’000
12
68

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

2023
2022
Number
FTE
Number
FTE
Clinical services
155
134
122
107
Fundraising and communications
43
39
37
34
Management and administration
25
24
24
21
223
197
183
162
* FTE = Full Time Equivalent
Management and administration in the 2023 fgures include an average headcount of three staff on maternity leave
(2022: three staff). During the course of the year, we have strengthened our clinical leadership with the appointment of more senior
clinical roles and we have focused strongly on recruitment to reduce our clinical vacancy rate.		 2023
2022
Number
FTE
Number
FTE
Clinical services
155
134
122
107
Fundraising and communications
43
39
37
34
Management and administration
25
24
24
21
223
197
183
162
* FTE = Full Time Equivalent
Management and administration in the 2023 fgures include an average headcount of three staff on maternity leave
(2022: three staff). During the course of the year, we have strengthened our clinical leadership with the appointment of more senior
clinical roles and we have focused strongly on recruitment to reduce our clinical vacancy rate.		 2023 2023 2023 2023 2022 2022 2022
Number
155
43
25		 FTE* Number
122
37
24		 FTE*
134 107
39 34
24 21
223 197 183 162

of more senior
9. Tangible fxed assets for use by the Group and the Charity
(except where stated for Trading)
Trading
Furniture &
Equipment
Freehold
Property
Furniture,
Equipment
& Motor
Vehicles
£’000
£’000
£’000
Asset cost
At 1 April 2022
2
13,147
1,977
Additions
-
-
59
Disposals
-
(4,771)
(155)
At 31 March 2023
2
8,376
1,881
Accumulated depreciation
At 1 April 2022
2
6,846
1,905
Charge for period
-
61
42
Disposals
-
(2,521)
(155)
At 31 March 2023
2
4,386
1,792
Net book values
At 1 April 2022
-
6,301
72
At 31 March 2023
-
3,990
89
Trading
Furniture &
Equipment
£’000
2
-
-		 Freehold
Property
£’000
13,147
-
(4,771)		 Furniture,
Equipment
& Motor
Vehicles
£’000
1,977
59
(155)		 Plant
£’000
84
39
(84)		 Total
£’000
15,210
98
(5,010)
2 8,376 1,881 39 10,298
2
-
-		 6,846
61
(2,521)		 1,905
42
(155)		 84
-
(84)		 8,837
103
(2,760)
2 4,386 1,792 - 6,180
- 6,301 72 - 6,373
- 3,990 89 39 4,118

Annual Report and Accounts 2023 56

10. Investments

Fixed asset investments

Fixed asset investments
Investments at start of the year
Less cash held by investment manager
Market value at start of the year
Additions at cost
Disposals
Net investment gain
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
2023
£’000
10,948
(3,007)		 2022
£’000
7,468
(1,305)
7,941
305
(18)		 6,163
1,551
(15)
8,228
(628)		 7,699
242
7,600
5,092		 7,941
3,007
12,692 10,948
7,600
6,910
690		 7,491
6,621
1,320

11. Debtors

Fees
Accrued income
Income tax recoverable
Other debtors
Intercompany debtor
Prepayments		 Group Group Charity Charity
2023
£’000
256
1,795
28
7
-
373		 2022
£’000
205
2,116
32
13
-
320		 2023
£’000
233
1,791
28
7
191
373		 2022
£’000
205
2,109
32
13
144
320
2,459 2,686 2,623 2,823

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 and Charity
2023
£’000
2022
£’000
37
44
(37)
(11)
38
4
38
37		 Group and Charity
2023
£’000
2022
£’000
37
44
(37)
(11)
38
4
38
37
38 37

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 was partially refunded in 2021 and 2022 and partially deferred as the events finally took place in April/May 2022 and therefore recognised in financial year 2023. Supporter Dinner ticket income and sponsorship received in 2023 was deferred at year end as the event takes place in May 2023.

57 Combat Stress

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

2. Creditors: amounts falling due within one year (continued) one year (continued)
Trade creditors
Other taxes & national insurance
Accruals & deferred income
Accrued holiday pay
VAT payable
Accrued pension contributions
Sundry creditors		 Group Charity
2023
£’000
390
283
156
186
2
78
1		 2022
£’000
213
200
137
129
3
59
1		 2023
£’000
370
283
150
186
-
78
1		 2022
£’000
213
200
130
129
-
59
1
1,096 742 1,068 732

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		 Land &
Buildings
2023
£’000
142
132		 Group and Charity
Other
2023
Land &
Buildings
2022
£'000
£'000
80
66
151
104		 Group and Charity
Other
2023
Land &
Buildings
2022
£'000
£'000
80
66
151
104		 Other 2022
£'000
65
151
274 231 170 216

14. Group and Charity contingent liabilities

In 2022/23 and 2021/22 the Group and the Charity had no contingent liabilities.

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, when this arises, 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 2023 58

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 year to 31 March 2023.

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
Loss carried forward
Net equity		 2023
£		 2022
£
-
184,308
(199,407)		 -
153,241
(153,240)
(15,099) 1
1
(15,100)		 1
-
(15,099) 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 all executive directors of the Charity, were Jeff Harrison and Robert Marsh. The office of Company Secretary was held by Alan Friggieri.

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
(Loss)/Proft for the year
Qualifying distribution to Combat Stress
Retained loss carried forward		 2023
£
54,702
27,704		 2022
£
53,376
43,080
82,406
(31,801)		 96,456
(26,787)
50,605
(65,705)		 69,669
(61,146)
(15,100)
-		 8,523
(8,523)
(15,100) -

17. Pension costs

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

Defned contribution scheme* Group and Charity Group and Charity
2023
£'000
477		 2022
£'000
357

*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 11% of basic salary.

59 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 and the next valuation of the Scheme is due as at 30 September 2023. In the event that the valuation reveals a larger deficit than expected, the Employer may be required to increase contributions above those set out in the existing Schedule of Contributions. In line with the Schedule of Contributions dated 27 February 2023, which is based on an updated funding position as at 1 September 2022, the Employer currently expects to pay no contributions over the year from 31 March 2023 to 31 March 2024.

The Scheme is managed by a board of Trustees appointed in part by the Employer and in 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:

2023 2022
Discount rate 4.80% p.a. 2.70% p.a.
Retail Prices Index (RPI) infation 3.15% p.a. 3.55% p.a.
Consumer Prices Index (CPI) infation 2.40% p.a. 2.80% p.a.
Increases to pension payment at 5% or RPI
if less, subject to a minimum of 3% pa
3.65% p.a.		 3.85% p.a.
115% of the S3PA table for males and 115% of the S3PA table for males and
Post-retirement mortality projections 105% of the S3PA table for females with
CMI 2019 projections, using a long-		 105% of the S3PA table for females
with CMI 2019 projections, using a long-
term improvement rate of 1.25% p.a term improvement rate of 1.25% p.a
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 22.4 22.3
Life expectancy at age 65 of male aged 65 21.0 21.0
Life expectancy at age 65 of female
aged 45		 25.5 25.5
Life expectancy at age 65 of female
aged 65		 24.1 24.0

Annual Report and Accounts 2023 60

The current asset split is as follows:

The current asset split is as follows:
Asset category
UK equities
Overseas equities
Bonds
Property
Other assets
Cash
Insured assets
Total		 2023
12%
17%
13%
9%
10%
2%
37%		 2022
12%
16%
11%
8%
7%
1%
45%
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:

Explanation of amounts in the fnancial statements
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		 2023
£'000
10,373
(7,409)		 2022
£'000
11,340
(9,927)
2,964
(2,964)		 1,413
(1,413)
- -

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

Administration costs
Interest on liabilities
Interest on assets
Interest on effect of asset ceiling
Total charge to proft and loss		 2023
£'000
10
261
(300)
38		 2022
£'000
-
226
(239)
13
9 -

Remeasurements over the year

Remeasurements over the year
Loss/(gain) on Scheme assets in excess of interest
Experience losses on liabilities
(Gains) from changes to fnancial assumptions
Losses from change in effect of asset ceiling
Total remeasurements		 2023
£'000
768
336
(2,626)
1,513		 2022
£'000
(222)
-
(568)
790
(9) -

61 Combat Stress

17. Pension costs (continued)

Change in value of the assets

Change in value of the assets
Fair value of assets at start of year
Interest on assets
Benefts paid
Administration costs
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 loss on liabilities
Changes to fnancial assumptions
Value of liabilities at end of year		 2023
£'000
11,340
300
(489)
(10)
(768)		 2022
£'000
11,307
239
(428)
-
222
10,373 11,340
(468) 461
2023
£'000
9,927
261
(489)
336
(2,626)		 2022
£'000
10,697
226
(428)
-
(568)
7,409 9,927

Reconciliation of effect of asset ceiling:

Effect of asset ceiling at start of year
Interest on effect of asset ceiling
Actuarial losses
Effect of asset ceiling at end of year		 2023
£'000
1,413
38
1,513		 2022
£'000
610
13
790
2,964 1,413

Sensitivity of the value placed on the liabilities:


Discount rate -0.50%
Infation +0.50%		 Approximate increase in defcit
£'000
304
168

Annual Report and Accounts 2023 62

18. Related party transactions

Combat Stress Trading Limited

19. Analysis of net assets between funds

Group

Fund balances at 31 March 2023 are represented by:

Tangible fxed assets
Investments
Current assets
Current liabilities		 Restricted
funds
£’000
-
2,000
1,329
-		 Designated
funds
£’000
4,118
1,635
-
-		 Investment
revaluation
reserve
£’000
-
690
-
-		 General
funds
£’000
-
8,367
3,403
(1,096)		 Total
£’000
4,118
12,692
4,732
(1,096)
3,329 5,753 690 10,674 20,446

Fund balances at 31 March 2022 are represented by:

Tangible fxed assets
Investments
Current assets
Current liabilities		 Restricted
funds
£’000
-
1,800
1,233
-		 Designated
funds
£’000
6,373
1,275
-
-		 Investment
revaluation
reserve
£’000
-
1,320
-
-		 General
funds
£’000
-
6,553
3,615
(742)		 Total
£’000
6,373
10,948
4,848
(742)
3,033 7,648 1,320 9,426 21,427

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

63 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 The delivery of mental health treatment to Army veterans 250
2023/24
Armed Forces Covenant Fund Grant to fund training in mental health to be provided to 17
other service charities (suicide prevention training)
Armed Forces Covenant Fund Offce for Veterans’ Affairs, Welsh Afghanistan Veterans’ 34
Specialist Treatment
Armed Forces Covenant Fund VPPP Strategic Lead for Clinical Quality in Mental Health 100
Armed Forces Covenant Fund VPPP Regional Portfolio Partner Defence Medical Welfare 29
Service, Midlands – Helpline
Armed Forces Covenant Fund VPPP Regional Portfolio Partner Bridge for Heroes – Helpline 30
(2023 funding)
Armed Forces Covenant Fund VPPP Regional Portfolio Partner Bridge for Heroes - Helpline 22
(2024 funding approved within 2023)
Armed Forces Covenant Fund Veterans People, Places and Pathways, Northern Ireland 95
Armed Forces Covenant Fund Reaching & Supporting Armed Forces Communities: 16
Family Support Services
Irish Ex-Service Trust, administered by Mental health services in Northern Ireland 75
The Royal British Legion
Lloyd’s Patriotic Fund Sensory Modulation in Occupational Therapy 100
Leopardstown Park Hospital Trust Northern Ireland 25
Oak Foundation Core funding 333
RAF Benevolent Fund Delivering treatment and support to former members of the RAF 90
Royal Navy and Royal Marines Charity Providing mental health services and support for veterans who 89
have served in the Royal Navy and Royal Marines
(inc £48k accrued for use in 2023/24)
Scottish Government Veterans Mental Health and Wellbeing Action Plan 106
The Royal British Legion Treatment and support of veterans in England South 1,500
The Royal British Legion Treatment and support of veterans in England Central 750
The Royal British Legion Treatment and support of veterans in England North 750
Trinity House Maritime Charity Support for Royal Navy, Royal Marine and Merchant Navy 16
benefciaries with complex mental health needs
Veterans’ Foundation Core costs for the England South hub 20
Veterans’ Foundation Added capacity for delivering full clinical assessments 18

Annual Report and Accounts 2023 64

21. Statement of changes in reserves

Designated funds

Total net transfers of £1,984k during the year from designated funds to general reserves (2022: £1,008k to designated funds from general reserves) as detailed below:

65 Combat Stress

21. Statement of changes in reserves (continued) Statement of changes in reserves 2022/23

General reserves
Investment revaluation reserve
Defned beneft pension
scheme
Designated funds
Fixed asset fund
IT development fund
Property maintenance fund
Defned beneft pension
reserve
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)
Total restricted funds
Total funds		 At 1 April
2022
£’000
9,426
1,320
-
6,373
350
190
-
735		 Income
£’000
8,478
-
-
-
-
-
-
-		 Expenditure
£’000
(9,166)
-
(9)
-
-
-
-
-		 Gains/
(Losses)
£’000
-
(628)
9
-
-
-
-
-		 Transfers
£’000
1,936
(2)
-
(2,255)
(160)
30
1,000
(510)		 At 31 March
2023
£’000
10,674
690
-
4,118
190
220
1,000
225
18,394 8,478 (9,175) (619) 39 17,117
2,589
332
1
7
58
25
9
12		 4,527
335
-
-
184
200
128
-		 (4,485)
(128)
(1)
-
(89)
(199)
(137)
-		 -
-
-
-
-
-
-
-		 (39)
-
-
-
-
-
-
-		 2,592
539
-
7
153
26
-
12
3,033 5,374 (5,039) - (39) 3,329
21,427 13,852 (14,214) (619) - 20,446

Restricted funds

Annual Report and Accounts 2023 66

Statement of changes in reserves 2021/22

General reserves
Investment revaluation reserve
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)
Total restricted funds
Total funds		 At 1 April
2021
£’000
7,403
1,081
5,640
250
150
600		 Income
£’000
10,461
-
-
-
-
-		 Expenditure
£’000
(7,433)
-
-
-
-
-		 Gains/
(Losses)
£’000
-
242
-
-
-
-		 Transfers
£’000
1,005
(3)
733
100
40
135		 At 31 March
2022
£’000
9,426
1,320
6,373
350
190
735
15,124 10,461 (7,433) 242 - 18,394
613
193
1
7
58
-
1
12		 4,130
288
-
-
148
182
87
73		 (2,154)
(149)
-
-
(148)
(157)
(79)
(73)		 -
-
-
-
-
-
-
-		 -
-
-
-
-
-
-
-		 2,589
332
1
7
58
25
9
12
885 4,908 (2,760) - - 3,033
16,009 15,369 (10,193) 242 - 21,427

67 Combat Stress

22. Consolidated statement of financial activities (incorporating an income and expenditure account) for the year ended 31 March 2022 – 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 gains on investments
Net income/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
2022
£’000
6,988
2,834
348
280
11		 4,908
-
-
-
-		 11,896
2,834
348
280
11
10,461 4,908 15,369
2,305 - 2,305
4,285
340
503		 2,681
79
-		 6,966
419
503
5,128 2,760 7,888
7,433 2,760 10,193
3,028
242		 2,148
-		 5,176
242
3,270 2,148 5,418
15,124 885 16,009
18,394 3,033 21,427

Annual Report and Accounts 2023 68

23. Supporting note to cash flow statement

Analysis of cash and cash equivalents

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		 Group
2023
2022
£’000
£’000
2,226
2,109
5,092
3,007		 Charity
2023
2022
£’000
£’000
2,096
2,015
5,092
3,007
7,318 5,116 7,188 5,022

Analysis of changes in net debt

Cash
Notice deposits (less than 3 months)
held by investment manager		 Group Charity
At 1 April
2022
£’000
2,109
3,007		 Cash
fows
£’000
117
2,085		 At 31 March
2023
£’000
2,226
5,092		 At 1 April
2022
£’000
2,015
3,007		 Cash
fows
£’000
81
2,085		 At 31 March
2023
£’000
2,096
5,092
5,116 2,202 7,318 5,022 2,166 7,188

69 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 PC ADC

Following His Majesty The King’s Accession, the Royal Household will over the coming months conduct a review of Royal Patronage. The review will cover the organisations of which Her Majesty Queen Elizabeth II was Patron and those organisations to which The King and The Queen Consort were connected through Patronage or Presidency as Prince of Wales and Duchess of Cornwall.

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 APN Currie CB CBE Commodore Toby Elliott OBE DL RN Brigadier Charles S Grant OBE Lieutenant General Sir Andrew Graham Bt CB CBE

Jenny M Green OBE MA Sir Bernard Jenkin MP Dr Lord Moonie

Surgeon Captain Morgan O’Connell RN

Major Mickey Morrissey FSCI Richard Nunneley MBE Dr Chai Patel CBE FRCP Sir Malcolm Rifkind KCMG QC Jan Sobieraj

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

General Sir Roger Wheeler GCB CBE Air Marshal Sir Robert Wright KBE AFC FRAeS

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. Six of our current trustees are veterans.

Chairman of the Board of Trustees Giles Peel BSc FCG

Vice Chair

Sally Goldthorpe BSc

Honorary Treasurer

Major Mickey Morrissey FSCI (until 13.10.2022) George Osborne BA MBA (from 13.10.2022)

Dr Carole Allan MA MPhil PhD CPsychol FBPsS Douglas Campbell BSc Rorie Evans CFA

Dr John Gaffney BSc MA MRCGP (from 13.10.2022)

Mark A Izatt BSc

Neeraj Kapur BEng ACGI FCA CF FCIBS (from 13.10.2022)

Dr Jane McCue DL MS FRCS Jan Sobieraj (until 13.10.2022) Graham Williams BA FCA

Co-opted Members

Dr Susan Elcock MBChB MRCPsych

Colonel Peter Fraser-Hopewell CMG MBE

Calvin Man TD BSc

Florence Maybury BA MA MBA Colonel Robert Ward MBE (until 13.10.2022)

Annual Report and Accounts 2023 70

Executive management

CEO Jeff Harrison BSc FCA

Company Secretary Alan Friggieri BSc

Director of Marketing, Communications and Information Alan Friggieri BSc

Medical Director Professor Catherine Kinane MB BCh BAO DObs DCh DFMH MRCGP FRCPsych MSc

Director of Fundraising Robert Marsh VR BSc MSc

Key committees as at 31.03.2023

denotes Committee Chair Audit and Risk Management* Graham Williams BA FCA * Sally Goldthorpe BSc Florence Maybury BA MA MBA

Clinical Governance

Dr Jane McCue DL MS FRCS * Dr Carole Allan MA MPhil PhD CPsychol FBPsS

Dr Susan Elcock MBChB MRCPsych Dr John Gaffney BSc MA MRCGP

Advisors

Auditors (External)

Moore Kingston Smith LLP 9 Appold Street London EC2A 2AP

Bankers

National Westminster Bank plc 1 Princes Street London EC2R 8BP

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

Finance

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

George Osborne BA MBA *

Rorie Evans CFA

Neeraj Kapur BEng ACGI FCA CF FCIBS

Fundraising, Marketing and Communications

Mark A Izatt BSc *

Douglas Campbell BSc

Colonel Peter Fraser-Hopewell CMG MBE Calvin Man TD BSc

Remuneration and Nominations Sally Goldthorpe BSc *

George Osborne BA MBA Giles Peel BSc FCG

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 and Wales No. 00256353

Charity Registration No. 206002

Charity Registration Scotland No. SC038828

combatstress.org.uk

71 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:

ABF The Soldiers’ Charity

The Grace Anderson Charitable Trust

Armed Forces Covenant Fund Trust BAE Systems PLC

Mrs G M Bramall

The Castanea Trust

Corps Security

The Alan and Sheila Diamond Charitable Trust

Economic and Social Research Council

Elizabeth, Lady Cowdray’s Charity Trust

Forces in Mind Trust

General Dynamics UK Ltd

Green Light Enterprise Limited (Shoes and Clothes Recycling)

Healing Military Minds

Irish Ex-Service Trust Ironbridge Gorge WWII Weekend

Ms Frances Jacob

Dr and Mrs J D Olav Kerr’s Charitable Trust (No 2)

Koin Limited

Leopardstown Park Hospital Trust Lila & Angelys Jewellery Lloyd’s Patriotic Fund

Market Aware Ltd Mountpark Properties Ltd Mr & Mrs J M B Trust The Edith Murphy Foundation Oak Foundation Platinum Pageant Queen Mary’s Roehampton Trust RAF Benevolent Fund

The Royal British Legion Royal Navy and Royal Marines Charity

The David Snowdon Trust

The Office of Veterans’ Affairs Stannah family companies Thales UK

Mr and Mrs ARW Tomkins

The Corporation of Trinity House

UK Armed Forces Cricket Association Union Congregational Church 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 33 legacies with a value of £10k or more. Legacies in total raised over £1.9million. 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.

L3 Harris Technologies UK

CONTACT US

Combat Stress Tyrwhitt House Oaklawn Road Leatherhead Surrey KT22 0BX

Head Office: 01372 587 000 contactus@combatstress.org.uk

24-hour Helpline for veterans and their families: 0800 138 1619

24-hour Helpline for serving personnel and their families: 0800 323 4444

To make a donation and help us provide our life-changing mental health treatment to veterans please:

combatstress.org.uk

Company registered in England and Wales No 00256353, Charity No 206002, Charity Scotland No SC038828

GOLD AWARD 2023

23JH009