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The Royal College of Surgeons of England Annual Report and Accounts 2023–2024

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ANNUAL REPORT AND ACCOUNTS 2023–24

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President’s foreword Chief Executive’s statement

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President’s foreword 2
Chief Executive’s statement 4
TRUSTEES’ REPORT 5
Our objects and aims 5
What we have achieved this year 6
Leading our profession 6
Improving practice 8
Supporting and engaging with our members 16
Embracing diversity 19
Transforming our College 20
Promoting public and professional engagement 21
Our new home of surgery 25
FINANCIAL REVIEW 26
Funding partnerships 33
Structure, governance and management 35
Statement of trustees’ responsibilities 39
Independent Auditor’s Report to the Members of the Royal College of
Surgeons of England 40
FINANCIAL STATEMENTS 43
Consolidated statement of financial activities 43
Consolidated balance sheet 44
Consolidated cash flow statement 45
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REFERENCE AND ADMINISTRATIVE DETAILS 75
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ANNUAL REPORT AND ACCOUNTS 2023–24

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President’s foreword

I am very pleased to present the annual report for 2023– 24, as I embark on my second year as President.

The past year has been another challenging one for the National Health Service (NHS). Indeed, the incoming Secretary of State for Health and Social Care, soon after �� England is ‘broken’. The picture in the devolved nations is, if anything, more challenging, although it has at least been encouraging to see the re-convening of the Northern Ireland Assembly. I was pleased to contribute to the review of the current state of the NHS in England by Lord Darzi and look forward to seeing how this will inform the proposed ten-year plan.

�� pressure, as borne out by our census report, ‘Advancing the Surgical Workforce’, published at the beginning of 2024. I am very grateful to the more than 6,000 consultants, dental surgeons, surgeons in training, specialty and associate specialist surgeons, locally employed doctors and extended surgical team members who responded. It is concerning that 61% of respondents cited burnout and stress related to excessive workloads as the main challenge in surgery. We must address this to ensure that ��ment and retention, all of which ultimately lead to better patient care.

Access to theatres is a major challenge that clearly has an impact on our ability to address large surgical waiting lists and ensure adequate training opportunities. Similar issues are evident in dental care. Our drive to support the establishment of surgical hubs has been successful and we continue to be part of the accreditation process with Getting it Right First Time and the Royal College of Anaesthetists. It was pleasing to see the recent Health �� separation of elective surgical activity in hubs from urgent and emergency care has realised the anticipated increase in throughput. However, challenges remain around job planning and especially ensuring that training is embedded in the activity carried out in surgical hubs.

Over the past year, we have worked closely with the Working Party on Sexual Misconduct in Surgery. Their report, ‘Breaking the Silence’, published in September 2023 demonstrated the shocking scale of inappropriate behaviour happening in our profession. We signed the NHS England Sexual Safety Charter and were pleased that following our encouragement to employers to sign, this was made mandatory for trusts across England. In July, we published our Code of Conduct, which applies �� clear that sexual misconduct is a blight on our profession

We have been very clear that sexual misconduct is a blight on our profession and that no matter how technically competent or senior they may be, there is no place in our College for surgeons who abuse the trust placed in them

ANNUAL REPORT AND ACCOUNTS 2023–24

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President Tim Mitchell and Professor
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President Tim Mitchell with Professor Vishy
Mahadevan and Bulletin specialty editor Deepak
Batura at the Bulletin ’s 40 [th] anniversary event.
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and that no matter how technically competent or senior they may be, there is no place in our College for surgeons who abuse the trust placed in them.

We have maintained an active quality improvement and research programme during the year. Notably, we marked the tenth anniversary of the College’s incredible Surgical Trials Initiative in December and our work continues to support 9 groundbreaking surgical trials centres, 9 chairs of surgical trials and more than 25 surgical specialty leads. Following the highly successful launch of the National Cancer Audit Collaborating Centre in autumn 2023, we were set to publish annual State of the Nation reports. �� inform the continual improvement of cancer care.

To prepare for the future of surgery, we continue to help surgeons learn from the past. The Library and Archives team has embarked upon a major project to digitise our priority collections and some of our historical texts. This will help to make them more accessible to members and researchers around the world.

�� do to support the wide range of College activities, only some of which can be described here. I particularly wish to thank our Chief Executive, Andrew Reed, who has announced that he will be retiring at the end of 2024. �� his exceptional leadership in supporting myself, previous Presidents, the Board of Trustees and Council, especially during the COVID-19 pandemic, and in overseeing the refurbishment of our headquarters in Lincoln’s Inn Fields.

Looking forward to the coming year, we will continue to lobby the NHS, Westminster government and devolved administrations to support surgical and dental services in addressing long waiting lists. We will also work with other stakeholders to maintain the focus on improving the working lives of surgeons at all career stages, in response to the issues raised in our census report. It is clear that surgical training has struggled to recover following the pandemic, with logbook numbers still lagging behind 2019 levels. It is, therefore, critical that all possible steps are taken to maximise training opportunities and ensure that we nurture the surgeons of the future.

Tim Mitchell President

ANNUAL REPORT AND ACCOUNTS 2023–24

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Our

Chief Executive’s statement

vision is to

create a culture of collaboration, innovation and agility, enabling us to leverage digital technology to its full potential for �� membership and their patients

2023–24 marked another year of progress for the College in being inclusive, engaging and supportive of our membership.

from improving elective waits to better working arrangements for surgeons. Our workforce census, published in January 2024 and supported by the surgical specialist associations and other colleges, highlighted in particular the need for more training opportunities

�� Council’s decision by an overwhelming majority to open up the election of the President and Vice-Presidents �� recommendations of the Kennedy Review. We will be seeking approval at our 2024 Annual General Meeting before we submit the required changes to our ordinances to the Privy Council, but we very much hope the changes will be in place in time for the election of the next President in 2026.

for resident surgeons and more operating time for senior doctors.

�� sexual misconduct that is sadly still all too common within the profession following the publication of the Working Party on Sexual Misconduct in Surgery report in September 2023. As well as convening interested groups to agree on action, the College has produced its own Code of Conduct and lobbied the NHS hard for the adoption of a zero-tolerance stance.

Financially, the College posted an operating surplus of £1.2m, representing another successful year for our professional and commercial activities. The Bjorn Saven Centre, our bespoke learning centre, continues to be extremely busy and we look forward to the opening of the Extended Reality Laboratory in the coming months. Across our learning activities as a whole, we delivered training to almost 10,000 course participants, and a further 11,000 users undertook digital learning modules, demonstrating our continued ‘digital’ learning reach postpandemic. Our wonderful building is proving extremely popular as a conference venue for external clients as well as the College itself, where we were delighted to celebrate the success of more than 1,400 diplomates during the course of the year. The new Hunterian �� more than 90,000 visitors.

Our membership numbers continued to increase in 2023–24 maintaining our position as the college of choice for most surgeons in the UK. We have continued to use our voice to lobby policymakers on a wide range of issues,

A major theme for us is the development of our digital services and we have made important progress in designing a new Customer Relations Management system that will transform the way we work and interact with members, course participants and exam candidates. We have also begun the work to redesign our website, which will improve the user experience even further.

This is my last foreword as Chief Executive as I plan to retire at the end of 2024. May I take the opportunity to thank the Presidents, trustees and Council members I have had the pleasure of working alongside over a wonderful nine years and, more especially, as ever, our �� have been a delight to work with. It has been a great privilege and I will miss them all.

Andrew Reed Chief Executive

ANNUAL REPORT AND ACCOUNTS 2023–24

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Trustees’ Report

The trustees of the Royal College of Surgeons of England (RCS England) are pleased to present their report for the year ended 30 June 2024.

Our objects and aims

RCS England was established for the study and promotion of the art and science of surgery. Our vision is to see excellent surgical care for everyone.

Our mission

Our mission is to enable our members, in all their diversity, to deliver excellence in everything they do.

We will do this by:

leading our profession : being the pre-eminent voice of surgery, championing excellent surgical care by engaging the profession, policy makers, patients and the public;

improving practice : continually improving the practice, standards and safety of surgical care, and developing the workforce across the UK;

engaging our members : inspiring, supporting, educating and representing the professional interests of a growing, diverse membership;

embracing diversity : championing the diversity of our profession, treating everyone with respect and compassion, and demonstrating our commitment to fairness, gender equality and anti-racism;

transforming our College : building a sustainable, diverse, digital, forward-looking organisation that plays its part in the world and is accountable for everything it does.

OUR CORE VALUES

Our values are:

Collaboration : we embrace our collective responsibility, working as one college

Respect : we value every person we come into contact with as an individual, we respect their aspirations and commitments in life, and seek to understand and meet their physical and wellbeing needs

Excellence : we aspire to excellence and success, we share learning from our experiences, apply feedback to practice and commit to continual improvement

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�� development of surgeons and the delivery of surgical �� surgeons. We provide strong leadership and support for surgeons in all matters relating to their surgical practice throughout their careers. Our activities and �� our strategic aims and demonstrate our commitment to maintain the highest standards of surgical practice and patient care.

�� to the guidance issued by the Charity Commission on ��

Our work is based on a number of the charitable �� advancement of education, the advancement of health or the saving of lives, and the advancement of the arts, culture, heritage or science. We engage directly with the public through the Hunterian Museum, the media, our publications and our journals (the Annals , the Bulletin and the FDJ ).

ANNUAL REPORT AND ACCOUNTS 2023–24

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What we have achieved this year

Leading our profession

�� to address the large elective backlog that has built up following the pandemic, as well as concerns about the culture and unacceptable behaviours in the surgical community, and industrial action.

The College played a leading role in working with NHS �� waiting times, while representing the profession and surgical patients in speaking out strongly about the slow pace of progress. Solutions we proposed included additional NHS funding, capital investment, public health initiatives, including to reduce the incidence of dental disease, and the further roll out of the surgical hub model where we continue to work with Getting it Right First Time to accredit hubs.

In January 2024, we published the landmark intercollegiate UK Surgical Workforce Census Report, receiving widespread national news coverage. This set out the key challenges facing consultants, surgeons in training, Specialist, Specialty and Associate Specialist (SAS) surgeons, locally employed doctors in surgery (LEDs) and members of the extended surgical team. Some 56% of respondents cited access to theatres as a major challenge, alongside workload pressures on teams, which are leading to burnout, stress and lack of training time. This report has provided comprehensive �� surgical community.

The Working Party on Sexual Misconduct in Surgery's Breaking the Silence report, published in September 2023; the intercollegiate UK Surgical Workforce Census Report, published in January 2024; and the RCS England Code of Conduct, published in July 2024.

Greta McLachlan speaking during the WinS conference at the College.

ANNUAL REPORT AND ACCOUNTS 2023–24

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In September 2023 a pivotal report was released by the Working Party on Sexual Misconduct in Surgery. ‘Breaking the Silence’, alongside a paper in the British Journal of Surgery , highlighted the shocking reality of sexual harassment, sexual assault and rape in surgical departments across the UK. As a College, we are determined to eradicate these unacceptable behaviours. We supported the Working Party to enact its recommendations and we established our own programme of work to pursue their proposals. We were an early signatory of the NHS England Sexual Safety in Healthcare Charter and we successfully lobbied other NHS organisations to sign up. �� made the Charter mandatory for all NHS organisations. Work also began on our new Code of Conduct, published in July 2024, which makes clear that no matter how technically competent or senior a surgeon is, if they abuse their position as a surgeon, they will have no place in our College.

The College continues to work on �� the highest levels of government. During the year, we continued to meet with UK government and devolved ministers and advisors, senior NHS �� Chief Executive and the Chief Dental �� leaders in NHS England Workforce, Training and Education, as well as leading parliamentarians and assembly members in Northern Ireland and Wales. We continue to advocate through the media and we maintained our position as the leading voice on surgical issues in the English, Welsh and Northern Ireland press.

We will continue to hold UK and devolved political and NHS leaders to account and we will also support them where policies and decisions advance patient and professional priorities. We publicly backed the UK government’s proposed anti-smoking and vaping legislation with our President appearing at a Public Bill Committee. This Bill failed to pass with the calling of a general election but we look forward to seeing this legislation resume in 2024–25 alongside other initiatives that advance surgical care for everyone.

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As a
College, we are
determined to eradicate
these unacceptable
behaviours. We supported
the Working Party to enact
its recommendations and
we established our own
WinS conference held at the College. programme of work to
pursue their
7 proposals
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ANNUAL REPORT AND ACCOUNTS 2023–24

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Improving practice

We have delivered multiple programmes of activity supporting surgeons to improve practice.

Setting standards and providing advice

on good surgical practice

Throughout 2023–24 we maintained a diverse portfolio of good practice guidance with more than 20 separate resources providing detailed advice on key legal, moral, ethical and practical aspects of working in surgery. Following the much-needed attention given to this important subject during the year, we are developing new good practice guidance on surgical wellbeing. We are also at an advanced stage of updating our core standards and guidance document ‘Good Surgical Practice’ for agreement by our Council.

Reviewing surgical practice to support patient safety

We undertook important work to assure and improve the quality and safety of patient care, completing 21 individual, service and clinical record reviews for hospitals across the UK.

Driving quality improvement

�� care for patients with acute gallstone disease and hand trauma continued to make impressive progress. Having concluded and evaluated CholeQuIC3, we launched our fourth cycle of this collaborative, CholeQuIC4, which began in September 2023 and will complete in November 2024.

We were also delighted to build on our very successful HandsFirst quality improvement collaborative, improving care for patients experiencing hand trauma, by launching HandsFirst2, working with 12 hospitals across the UK. Participant sites are achieving hugely impressive improvements to patient care and the wider �� progress with what we anticipate will be an even more successful second cycle of the project.

In addition to HandsFirst and CholeQuIC, in January 2024, we were very happy to commence a groundbreaking new improvement collaborative, �� are working with 13 hospitals across the UK and Ireland to put in place new systems and processes to support surgeons after adverse events occur. Led by Professor Kevin Turner and supported by a multiple professional team of psychologists, quality improvement specialists and an Innovation and Improvement Fellow kindly

Our newly commenced collaborative, SUPPORT, and the planned timeline for the launch and planned progress.

supported by the MPS Foundation, participant sites are working hard to improve surgical health and wellbeing.

Accrediting and assuring excellence

Our accreditation and quality assurance team has had an extremely successful year, continuing to provide what we believe to be the biggest surgical education accreditation scheme in the world, with more than 84 surgical education centres accredited globally. We also accredited 25 surgical education courses last year and awarded CPD for 306 surgical education events. Our senior clinical fellowship scheme continues to thrive with more than 120 senior clinical fellowships currently approved across the UK and worldwide.

Facilitating research

We continue to sustain a thriving programme of research fellowships and wider awards, thanks to the continuing support of our extremely generous and long-standing funding partners, alongside the College’s endowed research funds. During 2023–24, we awarded 16 one-year surgical research fellowships and 1 honorary research fellowship. We also supported research fellowships with the National Joint Registry and Orthopaedic Research UK, a Fulbright Award and a robotics research fellowship in partnership with NHS England. Other awards included nine pumppriming grants, three Harry Morton Fellowships, nine intercalated and nine elective grant awards.

ANNUAL REPORT AND ACCOUNTS 2023–24

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Our activity in 2023-24

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16
one-year We
surgical research awarded
fellowships
CPD for
2
surgical education
events
Funded
1
robotics fellowship in
partnership with the
We
NHS
launched
SUPPORT, our
new collaborative,
We working with 13
launched hospitals across
HandsFirst2, the UK
working with 12
hospitals across
the UK
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----- Start of picture text -----
We launched
CholeQuiC4 in
September 2023
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September 2023
Over 84
s urgical education
c entres accredited
globally
25
surgical education
centres accredited
in the UK
9
9 elective grant
awards
intercalated
awards
150k
9
awarded to
pump-priming
six applicants
grants
researching robotic-
assisted surgery
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Surgical trials

2023 marked the tenth anniversary of the College’s incredible surgical trials initiative, which we celebrated �� publication in the British Journal of Surgery describing the impact of the scheme. We continue to support 9 groundbreaking surgical trials centres, 9 chairs of surgical trials and more than 25 surgical specialty leads. Each working hard to drive excellence in surgical trials across the UK.

Clinical ��

The Clinical �� closely with the surgical specialty associations to conduct large-scale studies into the quality

of surgical care. Following the highly successful launch of the National Cancer Audit Collaborating Centre (NATCAN) in 2022, our national centre of excellence for improvement of NHS cancer services looks at treatments and outcomes across the country and delivers national cancer audits in bowel, prostate, lung, oesophagogastric, kidney, ovarian, pancreatic, primary and metastatic breast cancer, as well as non-Hodgkin lymphoma. Commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England, NATCAN brings national cancer audits together into �� practice and promote clinical excellence. Alongside our wider work with the National Vascular Registry and the CRANE Cleft Lip and Palate Registry, these studies publish annual ‘State of the Nation’ reports that are used by NHS services, healthcare regulators and policymakers to improve the quality of care for patients, with exciting future work planned for 2024–25.

Leading the future of surgery

Our robotics and digital programme and our Innovation Hub continued to be at the forefront of our cuttingedge Future of Surgery work. Our robotics work hosted multiple national events looking at research, training, data and public and patient awareness work alongside a series of interesting and informative webinars and other meetings. Most notably, we were delighted to receive more than 25 applications for pump-priming grants for new research into robotic-assisted surgery and be able

ANNUAL REPORT AND ACCOUNTS 2023–24

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to award £150k funding to six successful applicants. Our Future of Surgery Innovation Hub continued to provide support to members keen to navigate the complex pathway from innovative idea to new product and service improving healthcare. More than 150 members participated in a diverse and dynamic programme of in-person and virtual activities, including the ‘Festival of Innovation’ at our annual Future of Surgery Show, with new exciting activities planned for 2024–25.

and 1-2-1 virtual sessions. As well as increasing �� members a more substantial discount.

Our extended reality laboratory (RCS XR Lab) has been approved by trustees, a tender process completed and supplier contracts signed. The build is in progress, learning content in development and it is on track to be launched in autumn 2024. We are developing a suite of content for immersive and extended reality (XR) learning environments to support our technology-enhanced learning vision and lead the way in surgical education.
We have allocated £125k of funding for piloting innovation in surgical education. This funding will support pilots and proof of concepts that develop our evidence base and approach towards technology in surgical education. We are extremely grateful for the continued support of our funders without whom this critical development work would not be able to happen.

Learning

�� supporting our members and meeting the current and future needs of the surgical workforce. We focus on leading and driving forward surgical education, delivering high-quality learning for our members and the wider profession, and bringing people together to learn and connect through educational courses, events, communities and networks.

�� COVID-19 pandemic in September 2023. Our diverse speakers and facilitators led expert plenary and breakout sessions focusing on The Future of Surgical

Highlights of 2023–24:

Education. This hybrid event saw delegates attend in-person and online with a total attendance �� covering 52 countries.

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We delivered training
to 9,688 participants
on 677 courses,
working with 155
centres •
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We delivered training to 9,688 participants on 677 courses, working with 155 centres. We have seen particular growth in our international course delivery and a record-breaking year for Advanced Trauma Life Support® Provider, exceeding 4,000 �� average quality score across all courses this year is 93.4%.
�� day for our community of regional course coordinators, who arrange and deliver our
500+ yearly franchised courses.

• Our National Emerging Leaders programme continues to support and equip women and nonbinary people with tools, practical support, networks �� College and wider surgical and dental professions. This year we supported 25 people across the two years of the programme and received more than 130 applications to be part of the 2024 cohort.

Our 4,200+ volunteer faculty members are the essential backbone without whom our courses would not be possible and we have introduced a range of initiatives to better recognise and support our faculty, including personalised mechanisms for feedback �� more than 1,200 times in the past year.
105 change-makers in a variety of
leadership roles across UK regions have participated in our Parents in Surgery workshops this year. We have created dedicated web pages for parents in

We have provided 526 people with PGCert modules through our digital learning

�� to develop to meet our members’ needs; this year, alongside providing 526 people with PGCert modules, we delivered 10 virtual classrooms for Professional Behaviours in Aesthetic Surgery. We launched a series of modules on leadership skills and human factors and will continue to release these over the coming year. Across our paid-for, open access and �� users undertook digital learning modules.

surgery and continue to integrate across �� advocate for parents in surgery and drive forward change.

We have improved accessibility, relevance and impact for faculty and participants through a wide range of initiatives including targeted faculty development days to ensure faculty diversity is representative of our participant groups.
�� scheme for participants to improve equity and accessibility and increased our available funding. We awarded 30 bursaries over the past year, three times the number in previous years.
Our Training the Trainers course was redesigned as a blended learning modular course, with a mix of online learning, in-person practical sessions

ANNUAL REPORT AND ACCOUNTS 2022–23

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Global engagement

Global governance and representation

Eighteen members of the College were appointed to advisor roles in 14 countries during the year. Country advisors represent the College and act as key points of contact for members in the country they represent and for those in the UK who wish to engage with that country. They use their local knowledge to advise the College, develop country engagement plans and implement regional priorities at country level, identifying opportunities for collaboration and membership development.

International Surgical Training Programme

Forty-eight international medical graduates were matched and placed in International Surgical Training Programme (ISTP) training posts during the year. Of these placements, 73% were made in trauma and orthopaedics, general surgery and neurosurgery. Some 68% of the placements were made in three regions: East of England, Yorkshire and The Humber, and London. In relation to the College’s General Medical Council (GMC) sponsorship scheme, 51 overseas surgeons have been sponsored by the College to the GMC medical register during the year. Almost 50% of these doctors were in the trauma and orthopaedics and general surgery specialties.

Professor Vivien Lees and Miss Rachel Hargest represented the College at the annual meetings of the Association of Surgeons of India and the Society for Health Simulation India (SIMULCON) in December 2023. Professor Lees and Miss Hargest were �� also delivered career advice workshops and guidance on the College’s ISTP.

care in resource-limited settings. Almost 400 delegates attended the conference.

Stefan Galeski Global Surgery Fellowship

This new fellowship scheme was launched in June 2024 and is supported by the Anna and Stefan Galeski Trust. The launch was attended by several members of the Galeski family, including Anna and Stefan Galeski’s children, grandchildren and great-grandchildren. The fellowship provides UK surgical trainees with an opportunity to travel overseas to undertake teaching, training and research activities that help to build local surgical capacity and improve access. Fellowships are awarded for up to 12 months and include being matched with a UK or overseas partner institution within the College’s partnership network. The maximum award provided to each fellow is £5k. The scheme’s 2024–25 fellowship partners are:

Operation International UK
Refugee Crisis Foundation
Somali Health Exchange
West African College of Surgeons

Global Surgical Frontiers conference

Global Surgical Frontiers, the College’s annual global health conference returned in June 2024 after a sixyear hiatus. The two-day conference included an online Global Oral Health Day and brought together the wider surgical and dental community, policymakers, nongovernmental organisations, development agencies, trainees, students and academics to understand the challenges and share evidence-based solutions �� surgical, dental, obstetric, anaesthesia and trauma

Humanitarian Surgery Initiative

Emergency medical teams are groups of health professionals, including doctors, nurses, paramedics, support workers and logisticians, who provide care for �� is a classroom-based simulation training exercise that uses a specially designed tabletop ‘playboard’ and ‘playing cards’ to recreate the layout of an emergency �� trauma casualty cases, and major incident scenarios.

ANNUAL REPORT AND ACCOUNTS 2023–24

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Created and developed by Colonel (Retd) David Vassallo and drawing on many years of experience of �� and disaster zones, HOSPEX Tabletop is based on UK Defence Medical Services operational protocols and World Health Organisation (WHO) doctrine.

In June 2024, the College collaborated with Colonel (Retd) Vassallo to pilot HOSPEX Tabletop in Ethiopia with the Ministry of Health of Ethiopia and the Ethiopia Emergency Medical Team. The pilot included an instructor workshop, �� delivering HOSPEX Tabletop simulations to improve local capacity and preparedness. The training was hosted by the Ethiopian Public Health Institute. Representatives of WHO Geneva, the Ethiopian Red Cross Society, UNICEF Ethiopia and the UK Foreign and Commonwealth ��

UK–Yemen Surgical & Trauma Care Mentoring Scheme

The College has been successful in obtaining a small grant from the Tropical Health Education Trust to pilot a remote international mentoring scheme between the UK and Yemen, partnering with the Yemeni Society of Surgeons. The scheme will run for 18 months and will recruit and match 16 early-career Yemeni surgeons and surgical residents with UK mentors (surgeons/trainees ST6–7). As part of the award, the scheme will be part of a doctoral research study conducted by Oxford Brookes University to examine mentoring relationships within the

context of international health partnerships.

Yemen remains one of the largest humanitarian crises �� people need humanitarian support and 4.5 million people have been displaced since 2015, of whom 76% are women and children. The national socioeconomic and healthcare systems in Yemen remain on the edge of �� shocks have left families vulnerable to communicable diseases outbreaks. Healthcare is either unavailable or inaccessible to large parts of the population.

The Global Surgery Policy Unit

During the period, the Global Surgery Policy Unit (GSPU), a collaboration between RCS England and the London School of Economics and Political Science, participated in a number of projects and research. In November 2023, GSPU launched a project in Somaliland with our partners to provide training �� paediatric surgical care for burns and pyloric stenosis. We participated in key research including WHOcommissioned research on indicators for implementing the Emergency, Critical, and Operative (ECO) Care resolution.

The GSPU continues to be well-represented in key global health meetings. Notably, our co-directors, Dr Friebel and Miss Hargest, moderated sessions at WHO’s Global Alliance for Care of the Injured meeting in Geneva in June 2024, and the Unit led a policy dialogue at an African Health Observatory and WHO convened meeting in Addis Ababa on the topical subject of Task Shifting and Task Sharing.

Assessment

We are a leading national and international centre for �� continued to ensure that our approach to assessment delivery is modern, accessible and inclusive.

We have continued to embrace the return to full face-toface activity in many areas while retaining a number of recent developments that have resulted in the greater use of technology in our examinations. This has meant �� enhanced assessment options and accessibility for candidates in the assessment of knowledge, while �� activity in assessing skills and behaviours.

We have delivered a considerable programme of surgical examinations activity in the past year with the MRCS, accommodating larger numbers of candidates

ANNUAL REPORT AND ACCOUNTS 2023–24

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Workforce and training

The Workforce and Training Committee oversaw the �� in 12 years. The census was project managed within the Standards and Workforce team and supported by teams across the College, as well as the other surgical Royal Colleges in the UK and all the surgical specialty �� a Workforce Report which set out key recommendations around improving productivity, ensuring sustainability of �� action plan was developed and is in the process of being delivered. Planning for the next census in 2025 is underway.

in each Part B centre – UK and overseas – than ever �� candidate demand following the continued success of test centre activity for the knowledge-based Part A. We continue to work to ensure that our international presence can expand to further widen the examination’s important role of raising standards of practice and care, while being delivered in the most sustainable way possible.

Regarding our dental activity, we have developed capacity to accommodate considerable demand for our Licence in Dental Surgery (LDS) licensing examination, �� profession. We have continued to run a high-quality general membership examination with the Membership of the Faculty of Dental Surgery (MFDS), laying the foundations for overseas delivery of this in the coming year. With our specialty membership examinations, we have approached the development of assessments for all the new curricula on an entirely intercollegiate basis, working with colleagues in the Royal College of Physicians and Surgeons of Glasgow (RCPSG), Royal College of Surgeons of Edinburgh (RCSEd) and Royal College of Surgeons in Ireland (RCSI). This is a continued part of a broader process of remodelling �� our organisational aims, and those of the broader ��

Through the work of a strengthened Intercollegiate �� made towards developing a scope of practice document for physician associates (PAs) in surgical teams following a statement from the Council, and to respond to related consultations. Work to develop the role, career framework, status and governance of surgical care practitioners, in collaboration with Association of Surgical Care Practitioners, also progressed.

�� Scheme with increased application numbers allowing the scheme to cover its costs, a planned rebrand and closer working with the Joint Committee on Cosmetic Procedures and the Department of Health and Social Care in England.

The Joint Committee on Surgical Training (JCST), which is hosted by RCS England on behalf of the four surgical Royal Colleges of the UK and Ireland, enrolled

Across all of our assessment activity, we continue to work to ensure that all candidates can perform to their full potential. Following the publication of our �� examinations last year, we have committed to a number of key areas of future work to address the attainment gap in practice. Our candidate-centred approach looks to ensure that information and service before, during and after examinations with us are as accessible and supportive as possible, ensuring that our assessment activity continues to ��

ANNUAL REPORT AND ACCOUNTS 2023–24

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847 specialty trainees, recommended 553 trainees for �� (CESR) and supported 13 CESR appeals on behalf of the GMC.

Although surgical training showed some signs of recovery, logbook data still indicated that progress remained slower, and numbers were yet to achieve pre-pandemic levels. The data also showed that the number of non-standard Annual Review of Competency Progression outcomes increased during the past 12 months, with larger numbers of trainees being awarded outcome.

The JCST continued to monitor implementation of the 2021 curricula and the Multiple Consultant Report (MCR). MCR usage and Capabilities in Practice implementation data were analysed to inform JCST’s reporting to the GMC. The data demonstrated that the MCR was being used and completed at the right stages in training, and that the curriculum is embedding successfully. Several improvements were made to the Intercollegiate Surgical Curriculum Programme (ISCP) website during this period to better support users and the system.

Following a consultation with stakeholders and subsequent discussions with the GMC, it was agreed �� for purpose and met GMC requirements. The JCST will continue to monitor core surgical training and apply changes to the curriculum as and when necessary, in line with changes to surgical practice.

The most recent JCST Trainer Survey report was published on the JCST website here.

The standard for the Portfolio pathway (previously known as CESR) changed on 30 November 2023. �� specialties is now published on the GMC website here.

Supporting dental surgery

Throughout the year, the Faculty of Dental Surgery �� aims as follows:

To set the highest possible standards in oral healthcare by driving research, collating expertise, reviewing the evidence and understanding the needs of patients.
�� knowledge of our members at all career stages.
�� better and more equitable oral healthcare.
To continue to grow our Faculty by embracing diversity, fostering belonging, nurturing future (clinical/research) leaders and inspiring the professionals of the future.
To transform our Faculty, sharing the values and aligning our strengths with the College.

Improving children's oral health

Throughout 2023–24, most of our initiatives have sought �� her second year of her term as FDS Dean, Dr Charlotte Eckhardt has continued her advocacy to improve children’s oral health, calling for a national supervised toothbrushing programme, extension of free breakfast clubs to every primary school and extending the current Soft Drinks Industry Levy (SDIL) to include all sweetened juice and milk-based products. In April 2024, Dr Eckhardt participated in a parliamentary roundtable, where she discussed funding for early years nutrition and called for the extension of the SDIL.

Dr Eckhardt has been interviewed by BBC Radio 5 Live and BBC Radio 4’s File on Four, and quoted in several news outlets including The Guardian, Daily Mail, Daily Telegraph and British Dental Journal. She has advocated for children’s oral health, addressing the increasing rates of tooth extraction among children and ��

Addressing workforce issues

Dr Eckhardt regularly meets with Jason Wong, Chief �� the British Dental Association and has raised issues regarding the Dental Contract.

In December 2023, Dr Eckhardt attended a dentistry roundtable hosted by former Parliamentary Under Secretary of State in the Department of Health and Social Care, Andrea Leadsom.

FDS responded to the Department of Health and Social Care’s consultation on provisional registration for �� proposal, which would give the General Dental Council (GDC) powers to provisionally register dentists who �� without passing the necessary examinations. Our concerns about the proposal in its current form were addressed in an exclusive article in The Sun.

Educational excellence

We continue to be a leading provider of dental education both nationally and internationally.

With the introduction of new specialty training curricula in October 2024, we have a unique opportunity to redesign the specialty examinations. We have secured agreement from all four medical royal colleges to implement a single standard assessment with a common purpose, provided on an intercollegiate arrangement in the UK and Ireland that will allow us to provide better governance, oversight and structure to the assessments.

ANNUAL REPORT AND ACCOUNTS 2023–24

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The intention is for these examinations to be open access, with the MFDS being a mandatory requirement. This will enable individuals who have not pursued a national training route, as well as those with international training, to participate in the examination process as part of the specialist list assessment.

These changes have been welcomed by the GDC and the UK Committee of Postgraduate Dental Deans and Directors.

�� event included a Global Oral Health day. This covered global, national and specialty perspectives suitable for anyone involved or interested in improving equitable access to dental care and strengthening to improve population health outcomes.

Further work is underway with representatives from around the globe attending and discussing how FDS can assist in education, training, career advancement and progression of dentists in their regions, as well as oral health promotion within communities with the highest levels of need. We are also working with the FDS Board to update, improve and promote FDS educational resources and assessment tools �� and create new partnerships with reputable institutions around the world.

Our online e-Den dentistry programme in collaboration �� This continues to grow: more than 3,000 new registrations in the past academic year brings the total number of registrations to 64,000.

The Faculty is also prioritising emerging technologies with �� in dentistry. We have recently introduced a regular feature to our journal, the FDJ, in which we invite experts to contribute to this important topic. We are also working �� AI and digital innovation in dentistry and oral health, with a particular focus on revolutionising approaches to care.

ANNUAL REPORT AND ACCOUNTS 2023–24

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Supporting and engaging with our members

Throughout the year, we have worked hard to support our members in the UK and globally, whatever their career stage. We continue to engage with our 335 College representatives, surgical tutors and regional and devolved nation directors who carry out vital roles on behalf of the profession. Almost 450 consultant job descriptions were reviewed by College representatives to ensure all new appointments deliver a safe and �� your views through almost 40 regional and devolved nation board meetings and at our annual Regional Representatives Conference. This year’s event hosted at our Manchester hub in November 2023 was attended by 105 delegates online and in person. We look forward to celebrating all those who perform important College roles at this year’s conference later in 2024.

We have sponsored and engaged with more than 40 surgical societies and national organisations, providing almost £11k in funding to support educational and training opportunities at all career stages from young people (aged 16+) through to senior trainees.

�� in December for 400 aspiring surgeons, and two virtual interview workshops in early February 2024 for Foundation doctors to help them prepare for core surgical training interviews in the spring. The workshops were supported by 40 mock-interview panellists. Although the events were targeted at UK Foundation doctors, we received a lot of interest from overseas doctors, highlighting their desire to interact with the College.

In April, we welcomed 28 CT2 trainees from schools of �� of the annual Are You Cut Out For It? surgical skills competition. We look forward to meeting trainees across the nation at the 2024–25 regional heats.

We have made excellent progress with some key membership-focused diversity, equity and inclusion (DEI) projects, including the launch of a Mentorship �� platform will launch in the autumn, and the College’s Women in Surgery (WinS) and SAS networks will pilot ��

For the second year, we collaborated with widening participation teams at three Yorkshire medical schools by running Cutting Edge Careers workshops to inspire the next generation of surgeons. Schools from as far as Bristol and Newcastle sent almost 100 Year 12 students to participate in the day at the University of Leeds.

Our Grassroots in Surgery scheme is nearing the end of its second year, with £35k of seed funding given to seven grassroots groups to support a variety of projects. The scheme entered its third year in spring 2024, and of the 27 applications submitted, eight projects were successful in receiving seed funding and support.

�� been busy this year meeting with members, surgical teams, and trust leadership teams around the UK, holding Presidential Visits to hospitals in Derby, Grantham, Bournemouth, Newcastle and Northumbria, and London. We look forward to visiting Cambridge at the end of the year.

�� to meet the needs of our diverse audiences. We were delighted to host our third in-person Future Surgery Show in November 2023 in partnership with CloserStill Media. The show attracted almost 1,800 unique attendees, demonstrating its continued relevance and appeal.

We have maintained an extensive programme of webinars and conferences for fellows, members and other stakeholders, supporting our commitment to continuous professional development. More than 4,000 attendees have participated in 14 conferences and

ANNUAL REPORT AND ACCOUNTS 2023–24

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We welcomed 1,400 diplomates and

4,000 guests throughout the

year

18 webinars, covering a diverse range of topics, from global surgery, sustainability and leadership to exam preparation, wellbeing and AI in surgery.

We have also continued to host networking events to help individuals forge connections and build valuable relationships. Highlights were our PRiSM event for the �� Ramadan, which was a resounding success. This cultural event was well received, and we look forward to incorporating more such events into our future programmes.

Beyond these initiatives, we conducted 18 diplomates ceremonies for new fellows and members, welcoming over 1,400 diplomates and more than 4,000 guests throughout the year. These ceremonies are an essential part of our calendar, and we are delighted to celebrate the achievements of our members and strengthen our professional network.

We have also hosted and supported a number of events at the RCS England Outreach Hub in Manchester, which allowed us to interact with various groups from across the North and Midlands and reinforced the College’s presence outside London.

�� of WinS Chair, which allowed eligible WinS network members to choose who represents them on Council as an invited member. We were pleased to see eight fantastic candidates passionate about women in surgery stand for this important leadership role. Felicity Meyer was elected as the next WinS Chair, took up the position in September 2024 when the current WinS Chair, Tamzin Cuming, stepped down following a successful three-year term.

ANNUAL REPORT AND ACCOUNTS 2023–24

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Across digital channels including our website, emails and social media, the College has seen a year of continued growth. As expected, our most popular website content relates to exams and courses. Total page views increased year on year to an estimated 8,494,161 in 2023–24 from 7,856,045 in 2022–23. �� in organic search results pages for priority keywords including ‘royal college of surgeons’, ‘diversity surgery’ and ‘MRCS’.

Members are engaging with our newsletters and email content at well above industry rates, with more than one million unique email opens across the year. Our average open rate for member newsletters and updates sat at just over 56%, outperforming last year’s average rate of 54% and comparing favourably with the sector average of around 40%. Engagement on our social media channels has continued to rise with users commenting, liking or sharing our content more than 161,000 times across the year.

The College’s journal portfolio, consistently listed as one �� wide and diverse surgical audience.

Annals , our scholarly research journal, transitioned to being fully Open Access in January, in line with

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publishing industry trends and the increasing demand for freely accessible research content. Consequently, usage has increased by 50% with all content being immediately available in the public domain upon publication, driving article page views and citations. The traditional Open Access Article Processing Charge connected with this publishing model is fully waived �� journal publishes eight online issues annually, which in 2024 included special focus editions on human factors, genomics, sustainability and innovation.

The Bulletin , our membership magazine, continues to go from strength to strength, publishing a variety of themed issues on topics such as open vs minimally invasive surgery, global surgery and health tourism. It has exercised its impact as the voice of the surgical community by driving the conversation on sexual misconduct, surgical culture and diversity, as well as the healthcare workforce. Publishing eight issues annually (six in print and two digital-only), we post nearly 100,000 Bulletin copies per year to our UK members, and the journal averages 33,000 monthly online page views, an increase of 20% year on year.

The FDJ has undergone a successful and extensive redesign. The new look and feel of the journal has been very well received by our readers and membership. �� usage, averaging 5,100 monthly online page views, while publishing four issues a year comprising a total of 12,000 print copies.

ANNUAL REPORT AND ACCOUNTS 2023–24

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Embracing diversity

Since the start of our diversity, equity and inclusion (DEI) journey, the College has ensured that our members and the profession are at the heart of everything we do. The past year has seen the College go from strength to strength in its quest to embrace diversity and create a more inclusive and welcoming environment. Not only have we seen considerable advancements in key initiatives, such as the DEI Research Fellowships and the Mentorship programme. The College has led from the front to tackle sexual misconduct in surgery.

�� Research Fellowship in DEI in surgery awards. In March 2024, we received the completed reports from �� attainment in surgical higher speciality education, and the second reported on the barriers to leadership for minoritised surgeons in general surgery. Both areas of research aim to improve the culture of surgery and improve conditions for underrepresented groups in surgery.

Following the launch of our Mentorship Toolkit in April 2023, and the development of an e-learning package focused on the ‘Mentoring Fundamentals’, the project has now been given the green light to develop the �� SAS Forum will be invited to pilot a mentor scheme, and we will work with both groups to ensure they meet their required needs before rolling it out further.

We embraced our commitment to building strong networks and communities and were excited to host �� The event was a celebration for our Muslim fellows, �� fast during Ramadan. We were delighted to have the Egyptian Ambassador and the Deputy Commissioner of Bangladesh in attendance, alongside 73 other guests.

Meanwhile, the Pride in Surgery Forum hosted a networking reception with a talk from Dr Ronx Ikharia, the award-winning emergency medicine doctor, author, TV presenter and activist, during June 2024 Pride Month.

In October 2023, we released a special Black History Month episode of The Theatre podcast, featuring Samantha Tross who shared her experiences, journey into surgery, and insights on the importance of social responsibility.

This year saw the start of a new journey, one that seeks �� practicing what we preach. This has led us to receiving ��status, which is supporting us to improve how we recruit, retain and develop people living with a disability. We are proud to report that in ��

lived experience across the College, we have launched our neurodiversity and reasonable adjustments guidance.

So that we can continue to embrace DEI in what we do and what we stand for, we have developed an Equality Impact Assessment framework. Our aim is to foster more inclusive and collaborative decision-making across the College, while ensuring that all voices are heard and valued. This has led to a collaboration with inclusive employers to develop a bespoke webinar �� coming in autumn 2024.

�� Ambassador and the Deputy Commissioner of Bangladesh in attendance.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

In line with our work on Parents in Surgery, we have �� partner. We have also created emergency kits available to anyone who may need a change of clothing due to such circumstances.

�� strong 88% response rate.

Although this is a great achievement there is always more that can be done to ensure we are living our values. This led to the development �� plan to improve belonging in the College. In response to this, focus groups on values and belonging have been created and rolled out, with insights being used to inform and improve the College experience.

We are deeply committed to fostering a culture of diversity, inclusion and belonging within the College and profession. We believe that by embracing the unique backgrounds, experiences and perspectives of our �� create a more innovative and supportive environment �� society we serve.

partner Our initiatives are designed to ensure that every individual, regardless of their background, or any other aspect of their identity, feels valued and empowered to contribute fully. We are dedicated to breaking down barriers and promoting equity in all areas of our work, from recruitment and training to professional development and leadership opportunities. By prioritising diversity, inclusion and belonging, the College aims to lead the way in building a more inclusive future for surgery.

Transforming our College

Our ambitious digital transformation journey is a major and complex undertaking, one that will transform how we do business, ensure that we deliver excellent customer experiences and become a more agile and data-intelligent organisation.

The cornerstone project of our digital transformation is the new Customer Relationship Management (CRM) system. It is progressing well, marked by

�� initial development showcases. As we move forward, we are also advancing early plans for a new website �� our commitment to technological innovation across the College.

In addition, we have taken the strategic decision to put people at the heart of our digital transformation and are well underway with the development and implementation of our Digital Skills programme. The programme includes ‘Essential Digital Skills’ – for �� disposal to modernise their ways of working and �� We have also developed, launched and completed cohort one of a unique Digital Accelerator programme, which will nurture a critical community in the College to accelerate change from within. The programme comprises a variety of modules such as AI prompting and digital service design.

We hope that our digital transformation will drive the College forward and ensure we remain at the forefront ��

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Digital Accelerator Programme
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ANNUAL REPORT AND ACCOUNTS 2023–24

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Promoting public and professional engagement

Library and archives

�� our library and archives, with a focus on promoting and raising awareness of the extensive facilities, resources �� and researchers, both nationally and globally. Our highlights and activities during the year have included:

initiated the digitisation of priority collections, making them accessible and searchable;
partnered with LSE to digitise historical texts alongside modern transcripts, enriching the accessibility and understanding of these valuable documents;
extended our global reach through partnerships, notably with Ukraine, enhancing our international collaboration and impact;
increased school activity sessions, incorporating contemporary and historical materials, with overwhelmingly positive feedback;

made available with 10,645 biographies, 835 images of surgeons and 3 blog posts celebrating the Paris 1924 Olympic fellows.

�� working with contemporary written sources from the library alongside historical archive material. Visits have covered anatomy, grave-robbing and punishment, with feedback from attendees and event organisers overwhelmingly positive.

The archives service established a system for regular conservation, which has enabled us to include these collections within our digitisation project. This includes the Council Minutes, the ‘Diary of a Resurrectionist’ the only surviving diary of a grave-robber, the ‘Petition for the Admission of Women to the College’ and the ‘London Lock Asylum Patient Histories’, which give a very rare insight into the lives of working-class 18[th ] century women.

hosted displays of rare books and archival materials at several events, engaging diverse audiences and showcasing our rich collections.

These activities have contributed to more frequent and regular use of library and archives facilities, services and resources by members, fellows and researchers throughout the year. In total, 728 visitors utilised the Members’ Library and Research Room during �� year. We also responded to 691 remote enquiries, demonstrating our commitment to accessibility and support.

The library Instagram account has grown �� 2023. In total, 335 short articles were generated with images directly relating to the Heritage collections. We have �� usage of our digitised Tracts collection, with a 230% rise to 393,401 users. Members were provided with access to more than 2,000 e-journals and approximately 1,200 e-books. They conducted over 115,000 searches and downloaded 85,700 journal articles and book chapters.

FDS fellows were incorporated into Plarr’s Lives of the Fellows from June 2023, with entries added for all fellows with recorded deaths from 1990 to 2022, including 59 full obituaries. A list of the elected, �� 1947–1989 from the Council Minutes were

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ANNUAL REPORT AND ACCOUNTS 2023–24

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�� collections to explore the role of women in developing surgical ethics.

As a result of a successful Conserve Our Collections campaign we completed conservation of rare books from the 16[th] to 18[th] centuries, ensuring their durability for future research and engagement.

In February 2024, the Library’s Evidence Support Team delivered a training session to the Ukrainian Medical Student's Association, receiving 100% positive �� in supporting global audiences. Throughout the year, the team undertook 20 personalised training sessions for members and secured a contract for income-generating searches to inform clinical guidelines.

TESTIMONIALS

“Thank you for your detailed and prompt response. If I may say so, I am a member of the RCPSG and RCSEd. But the library resources of RCS England are unparalleled.”

Member response to answered enquiry, March 2024.

“What made the visit really special was hearing the stories that surrounded the books and their content, and hearing additional information relating to them, their writers, and their extracts…. Also the fact that we were allowed to touch and handle the books ourselves!”

Jessica Moon, Learning Team Leader, Queen Mary University of “I have loved London. the experience of being an HLCE grantee and found the �� welcoming.” �� Henry Lumley Grant Awardee.

Patient history from the London Lock Asylum, 1795, MS0022/6/10

Petition to allow women to study at RCS England (1906). The signatories are led by Elizabeth Garrett Anderson.

��

Museum collections and services

�� more than 90,000 visitors. It was shortlisted for the Museums and Heritage Awards permanent exhibition of the year, and was awarded silver in the European Design Awards. Shop stock was enhanced with new Hunterian and RCS England branded goods.

A new Hunterian Museum app, funded by Bloomberg Connects, was launched in November 2023 with the option to translate all text and audio into more than 30 languages, it also includes a 30-minute British Sign Language (BSL) tour. Inperson BSL and weekly curator tours, and a new Hunterian Drawing Club were established. Marketing of the museum was mostly through digital channels and press and media.

The Hunterian Museum website had many new features added with new online school

ANNUAL REPORT AND ACCOUNTS 2023–24

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The Hunterian Museum is now showing the Transforming Lives ��

resources, for self-led school visits – studying history of medicine, biology, English literature and BTEC healthcare subjects – going live in June 2024. Social media channels, Facebook, X and Instagram saw month-on-month increases in followers – some posts receiving more than 150,000 views.

Press and media coverage included international coverage and features on BBC and ITV evening news of visits by two RCS England fellows and their patients (both included in the Hunterian Museum Transforming ��

More than 50 museum volunteers (40% retired fellows and members) were recruited and trained with short building tours and object handling sessions introduced in the summer.

The museums’ public talks and events programme was relaunched in autumn 2023 and included talks by fellows Ms Liz O’Riordan and Mr Michael Crumplin. The Hunterian Provocation programme was soft launched with underrepresented histories explored in the International VariAbilities conference held at the College in collaboration with Winchester University and an evening symposium in collaboration with Medics4Rare �� Progressiva) First Do No Harm: Perspectives on FOP.

Conservation on key museum collections continued, on-site collections storage was maximised with new

roller racking and options for the long-term storage �� consideration.

RCS England museums were awarded Arts Council England Provisional Accreditation for the seventh year with Full Accreditation submission due in October 2024. Museum services for curatorial enquiries, research support and image provision and licensing continued.

The Anatomy and Pathology Museum (APM) facilitated revision sessions for MRCS Part B candidates in addition to visits from medical professional and healthcare student groups and individuals. The APM virtual learning environment became established online as an exclusive fellows and members learning resource.

The Art Fund and the Arts Council England V&A Acquisitions Fund awarded grants of £15k for the purchase of artist Annie Cattrell’s sculpture Sense, now on display in the atrium. A painting, showing a mid-18[th] century amputation scene, stolen from the College in 1983, was returned via the French police in August 2023.

The year saw the retiral of six Hunterian trustees: Professor Malcolm Macleod, Lord Robert Salisbury, Professor Lewis Spitz, Professor Susan Standring, Ms Sarah Staniforth and Dame Janet Vitmayer. Following public advertisement, new Hunterian trustees – Dr Yewande Okuleye, Ms Hannah Lake and Ms Kate Heyman – were appointed, and Lord Edward Garnier.

ANNUAL REPORT AND ACCOUNTS 2023–24

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Fundraising

�� funds every year from our donors and supporters and we are grateful for the generosity and loyalty of our long-time supporters, particularly in surgical research and learning. These funds support a comprehensive range of projects and activities undertaken in pursuit of our charitable objectives. This is despite the impact on fundraising and philanthropy experienced across the charitable sector following the pandemic. Fundraising from trusts, foundations and corporate sponsors is also increasingly competitive, especially when seeking engagement and ��

Exciting and far-reaching projects such as Stop The �� trusts approached by the fundraising team, including the Adint Charitable Trust and the Grace Trust who have toured the Bjorn Saven Centre and forged fruitful working relationships with the learning team.

All legacy gifts this year have been unrestricted, which indicates our supporters' �� judgement

With the Hunterian Museum attracting higher than �� following redesign and reopening, the fundraising team had the opportunity to trial new ways of attracting donations from visitors. While the College is determined that the museum should be free and fully accessible, all donations are voluntary and encouraged. Successful trials of working with Complete Works, a visitor experience consultancy, have proven that visitors are keen to donate to a museum as outstanding as the Hunterian and we will be continuing this model for the foreseeable future.

Once more this year we have been privileged to receive generous legacy donations, as supporters have left generous donations of shares, cash and property in their wills. All legacy gifts this year have been unrestricted, �� judgement and their strong emotional connection with our mission.

We extend our gratitude to all our donors and supporters. �� those members of Council who have championed our �� have given generous personal donations.

ANNUAL REPORT AND ACCOUNTS 2023–24

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Our new home of surgery

We continue to enjoy the spaces in our new building. We opened our fellows and members’ lounge in March 2024, which has been appreciated by those visiting and networking in London.

Our visitors use the College for networking or ceremonial events and enjoy our state-of-the-art examination and learning spaces. The conference venue and our other hospitality spaces continue to attract delegates and have been extremely popular with outside organisations. The success of these activities with a warm welcome is supporting our visitor �� and the College.

�� further developed the facilities for hybrid working and ��

The newly opened fellows and members' lounge

ANNUAL REPORT AND ACCOUNTS 2023–24

��

Financial review

�� areas except grants, donations and legacies.

We have posted a net income position this year of £10.1m (2023: £2.5m net expenditure) primarily due to a gain on ��

�� provision from 2023.

�� endowed expenditure ahead of income has seen net expenditure in these areas increase to £1.2m (2023: £0.1m), although investment gains of £5.1m have resulted in a £3.9m increase in reserves.

Total reserves have increased to £145m (2023: £135m). A net unrealised gain on revaluation of £2.3m on investment property has contributed to an improved investment performance returning net unrealised unrestricted investment gains of £5.1m, resulting in unrestricted funds increasing 7% to £96.7m (2023: £90.5m). Endowed funds have increased by 9% to £42.0m and restricted funds by 9% to £6.4m (2023: £5.9m).

Income

Income has risen by 5% to £35.1m (2023: £33.5m), with unrestricted income rising 4% to £29.1m (2023: £27.9m)

Change in underlying income

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3050030,500
3000030,000 211 (735)
1,789
2950029,500
(62) 29,061
2900029,000
2850028,500
2800028,000 27,858
2750027,500
2700027,000
2023 Charitable Trading Grants, donations Investment 2024
activities activities and legacies income
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Charitable activity income has risen by 7% to £26.6m (2023: £24.9m). Membership subscriptions remain the largest single revenue stream up 5% to £9.9m (2023: £9.4m) closely followed by exams, which demonstrated continuing strong performance with revenues up 15% to £9.8m (2023: £8.5m). Courses have recovered the majority of the decline seen in 2023 with revenue up 18% to £3.6m (2023: £3.1m).

Income from grants donations and legacies has declined by 5% to £5.7m (2023: £6.0m) with the continuing increase �� revenue streams are more volatile but together this year have declined 39% to £1.0m (2023: £1.6m).

��

ANNUAL REPORT AND ACCOUNTS 2023–24

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Expenditure

Expenditure has fallen 2.5% or £0.89m to £35.2m with unrestricted expenditure down 7.5% or £2.3m on 2023 levels to £28.0m. This includes a £3.1m release of the FRS 102 pension provision from 2023 and, excluding this, total expenditure is up 6% and unrestricted expenditure is up 2.8% on 2023.

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Change in underlying income
3300033,000
1,869 (8) (2,996)
3200032,000
3100031,000
30,235
3000030,000
(1,134)
2900029,000
27,966
2800028,000
2700027,000
2023 Charitable Raising FRS102 Other 2024
activities funds provision expenditure
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Unrestricted charitable activity expenditure is up 7.6%; 0.4% higher than the increase in income from charitable �� reposition ourselves in a post-pandemic world. Our course and exam portfolios continue to evolve as we seek to ��

We have reported higher costs across most expenditure areas including professional and public engagement, �� outlined in the Trustees’ Report is supported by our restricted and endowed funds. Total expenditure against these funds has grown 24% to £7.3m (2023: £5.9m).

Net assets

�� notes 9 and 11 to the accounts.

The College’s landmark building is depreciating currently at an annual rate of approximately £2.4m. All components �� completion of the capital works.

Cash holdings have decreased by £0.35m to £7.9m, debtors are £1.3m higher at £10.2m, current liabilities are £0.55m higher at £16.4m, and the current ratio has increased to 1.10 from 1.08 in 2023.

Hunter Trading Limited

�� Limited (note 15�� of trading and it has been a highly successful one for our new conference and events venue, The View, as well as for our other iconic and unique venue spaces. Our catering and events partner, Searcys, has successfully promoted our �� normal levels of activity post-COVID.

ANNUAL REPORT AND ACCOUNTS 2023–24

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Financial outlook

Our new Hunterian Museum opened in May 2023 to great acclaim and attracted considerable global interest. The opening represented the successful conclusion of the redevelopment programme of our estate. Since its opening, the museum has welcomed a steady stream of visitors through its doors, helping to create a thriving public space on the �� enormous disruption to our day-to-day business operations with unprecedented constraints placed upon business activity both within the UK and globally. Since this time, we have been successfully building back up our revenues and activities, taking advantage of the opportunities this recovery period has presented to redesign and reshape our �� further COVID-19-related changes expected in future.

�� and investment in change, developing our understanding of demand trends in current and new markets so that we �� continue to expand and develop our revenues streams, extending our global reach, investing in and promoting the �� improve our venue packages so that we maintain and grow demand for our excellent event spaces. While we continue �� progressing with our transformation strategy in the digital space. This is a complex endeavour that requires substantial investment of our time and our funds to secure success. Delivering our transformation strategy is pivotal to securing �� deliver better services and to broaden our reach, fostering greater engagement, accessibility and inclusivity. It will also ��

Since the year-end, interest rates have started to decline and this is expected to continue over the next 12 months, �� welcome changes, it remains vital that we continue forward with our transformation plan to deliver a new business �� time.

�� valuation has resulted in a surplus and the release of the provision we were holding. We remain alert to the possibility under the scheme’s Monitoring and Actions Framework that short-term corrective actions such as higher contributions or accelerated valuations could be taken in the event that the scheme’s funded status is impacted adversely by market ��

Reserves policy

Our reserves comprise unrestricted funds, restricted and endowed funds. The restricted and endowed funds result �� not available for general purposes. We aim to carry out the activities and projects supported by these funds on a �� 30 June 2024 (notes 17 and 18). The unrestricted funds represent the accumulated surpluses generated from general �� funds, designated funds and general funds.

Fixed assets fund

�� at 30 June 2024 (2023: £68.2m). The fund includes £1.6m of assets in the course of construction in respect of the digital transformation programme to redesign our systems landscape. The fund also includes the £8.5m of historical ��

ANNUAL REPORT AND ACCOUNTS 2023–24

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Designated funds

�� support the next phase of digital transformation and new systems investment. £975k has been expended on digital transformation in the year to 30 June 2024.

General funds

In accordance with Charity Commission guidance, the trustees set a target range for the level of free reserves, or �� determine that a prudent target range for the College’s free reserves is between 75% and 100% (i.e., between nine and twelve months) of gross annual unrestricted operational expenditure, excluding movements in the pension reserve. This equates to a target range of £23.3m to £31.1m for 2023–24. This range is set taking into account:

��
the risk of an unexpected need for funds;
the need to provide working capital for the College’s current operational and future development activities;
the need to meet its annual obligations under the long-term loan arrangement in place since 2020;
�� pension schemes and future increases in employer contributions to eliminate these shortfalls.

General funds stand at £24.74m at 30 June 2024. This is an increase of 13% or £2.89m on the previous year (2023: £21.85m). This represents 80% (2023: 72%) of the unrestricted annual operating expenditure, excluding movements on the pension reserve, within the target range. Free reserves have increased by the net income of £1.10m, a net unrealised investment gain of £2.86m arising on the unrestricted investment portfolio, and a £1.55m reduction in �� represented by our unrestricted investment portfolio, which is providing 93% cover (2023: 96%) at a value of £23.0m as of 30 June 2024 (2023: £21.9m).

�� debt obligations and ensures that it maintains an appropriate level of free reserves to enable the College to withstand future unexpected events as well as deliver on its priorities.

Fundraising

The College aims to raise funds in accordance with best practice and in an open, legal and fair manner, and has �� are undertaken in a considered and balanced manner. We are registered with the Fundraising Regulator and undertake our fundraising activities with reference to the Code of Fundraising Practice. Each year, we review our data protection processes to ensure full compliance with the General Data Processing Regulation (2018). We do not engage commercial partners or volunteers to raise funds on our behalf. If complaints and concerns are raised, these are taken seriously and responded to promptly and handled in accordance with the College’s complaints procedures, which are available on the website. We did not receive any complaints in respect of our fundraising activity in 2023–24 (2023: nil).

Investment policy

We invest for the long term and we invest to generate the best overall returns from our unrestricted and endowed �� return strategy for all of our invested funds and a more global and broader asset allocation strategy to ensure that we continue to achieve the best returns going forward in what is a changing investment landscape.

�� have continued to take action during the year to pivot the portfolios towards our long-term asset investment strategy, ��

ANNUAL REPORT AND ACCOUNTS 2023–24

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Our statement on ethical investing was issued in 2021. This sets out our clear commitment to sustainable and responsible investing and strengthens our commitment to divesting from fossil fuels. We seek to divest from all exposure to fossil fuels by 2030 and will build up our investments in green energy renewables and infrastructure in support of the green economy. This statement is fully endorsed by our Council members.

We have adopted an environmental, social and governance (ESG)-integrated investment model to deliver on our ethical investment commitments. Our investment approach excludes direct investment in fossil fuels, tobacco, alcohol, controversial and conventional weapons, and we aim to minimise our levels of indirect exposure to these sectors through regular ethical screening and careful selection of fund managers with strong ESG credentials. We consider �� the funds to support our professional and operational objectives. We keep the details of our ESG investment approach under periodic review and a detailed evaluation will be conducted in 2025.

��

Investment portfolio performance

�� including investment management, and advises and reports on a regular basis to the Board of Trustees on the performance of the investment portfolios and the appointed fund managers.

Both portfolios are managed on a total return basis and are structured to enable the College to continue to receive an annual cash distribution of around £2m to support its ongoing operations and restricted activities. Greater focus is therefore placed on overall investment performance rather than on earning investment income. The investment portfolio delivered an overall unrealised gain of £7.9m (2023: £1.3m). Portfolio income rose to £0.76m this year (2023: £0.67m). A cash distribution of £2.4m was made during the year, comprising £1.5m against the restricted and endowed portfolio to replenish operating cash balances for endowed fund expenditure, and £0.89m against the ��

Total return accounting

The College adopted total return accounting for its permanently endowed funds in 2014–15. A base date of 24 June 1992 was approved for determining the permanent capital value of the endowed funds, based upon the market value of the permanent endowments at that date and the original value of any subsequent additions. The value of these ��

We seek to preserve the value of the endowments in real terms over the medium to long term. A target spending rate of between 3.5% and 4.5% of the value of the endowments is considered achievable without diminishing the value of the portfolio in real terms and represents our best estimate of the long-term real rate of return on the endowments. This target range is kept under review to ensure that it remains appropriate.

A total of £1.5m was applied in the year to fund restricted expenditure, and together with investment management fees of £0.30m, the total applied from the endowed funds was £1.8m. This represents an application of 4.5% in the year, which is at the top of the target rate range. The cumulative total applied since the adoption of total return accounting is in line with the cumulative maximum target level for this same period and we will continue to need a strong investment performance over the long term if spending plans are to continue at current rates.

Key management personnel

�� responsibility for making recommendations to the Board regarding overall remuneration policy, including approving salaries and conditions of service at director level and above. The Committee receives recommendations from the

ANNUAL REPORT AND ACCOUNTS 2023–24

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Head of Human Resources based on a detailed market review benchmarked to similar organisations carried out biannually, as well as through the annual performance appraisal process. Based on this advice, the Committee �� senior post holders.

Risk management

The Board of Trustees maintains ultimate responsibility for the College's risk management and control. The Board sets the risk appetite and oversees comprehensive risk management processes, with the Audit and Risk Committee �� auditors.

The risk management framework involves multiple layers of oversight and implementation, from Council's handling of professional and public policy matters to the Chief Executive and executive team's operational management. �� monitoring processes. The College maintains departmental, project and corporate risk registers as part of its robust ��

In 2024, the College maintained a robust approach to risk management, with particular focus on addressing �� educational courses. The College has actively engaged with other medical royal colleges, NHS England and the Department of Health and Social Care to advocate for the protection of Supporting Professional Activities in consultant contracts, recognising their crucial role in maintaining clinical excellence and education standards.

The College has made substantial progress in its digital transformation journey, implementing comprehensive improvements across its technology infrastructure. These digital initiatives are designed to enhance member experience, strengthen cyber security and ensure the College maintains its competitive edge while providing value to its professional community. The implementation of a new CRM system will enable more personalised support for current and prospective members. This includes the Digital Home Project, which incorporates a brand refresh and aims to deliver personalised services tailored to every stage of surgical and dental careers.

Financial sustainability remained a key priority, with careful attention paid to operating surpluses and long-term �� optimisation of commercial property management.

A clear and focused strategy

�� everyone, and we aim to achieve this by enabling our diverse members to deliver excellence in everything they do. Throughout implementation we will focus on the risks that may impact our ability to deliver our strategic aims including continued pressures on the NHS and regulatory changes. Our strong governance and engagement framework will also help to ensure we are able to respond to and manage any risks to our strategic objectives.

Going concern

�� rates, reducing, and expectations for future UK growth being revised upwards. The decisive 2024 UK election result has also removed some political uncertainty. It is against this backdrop that a robust review has been undertaken of the ��

The College prepares its annual budget for the forthcoming year in late spring. This involves a prudent assessment �� next year will be one of consolidation and progress as the College continues its work to reshape the organisation, develop and broaden its revenue base, including new commercial revenue, and to build and strengthen its

ANNUAL REPORT AND ACCOUNTS 2023–24

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The College has updated its long-term revenue and cash projections for its latest results, annual plan, and other expected changes in its operating position over the next 18 to 24 months. The projections are stress-tested and set the minimum long-term operating surplus target that the College must achieve to meet its interest and repayment �� over the next 18 to 24 months.

The trustees consider that the College’s primary revenue streams remain broadly robust and demand-positive over the medium term, and that any reduction in revenues in this period as a result of a downturn in demand will be short ��

�� risks. The trustees consider that it is reasonable to expect that the College has adequate resources to continue in operational existence for the foreseeable future and therefore support the going concern basis in preparing the annual accounts.

Corporate trustee responsibilities

The College is a corporate trustee of the Colledge Family Memorial Fellowship Trust. This trust holds investments and assets in its own name and its activities are entirely separate from those of the College.

Colledge Family Memorial Fellowship Trust

The College is one of three trustees of the Colledge Family Memorial Fellowship Trust, which was set up to award travelling fellowships to surgeons. The other trustees of this fund are Mr T George and Professor A Narula. We provide a number of services to the Trust, namely, the preparation of annual accounts, the submission of these and the annual return to the Charity Commission, and liaison with the investment fund managers, Cazenove Capital Management, to �� audited by Crowe U.K. LLP.

The value of the Colledge Family Memorial Fellowship Trust endowed fund at 30 June 2024 is £2.8m (2023: £2.6m) and its restricted fund is £68k (£2023: £73k).

Other trustee responsibilities

The Sir Ratanji Dalal Research Scholarship Fund

Our President is one of two trustees of the Sir Ratanji Dalal Research Scholarship Fund, the other being the President of the Royal College of Physicians. We provide administrative and accounting services to the Fund and its trustees, �� are audited by Crowe U.K. LLP.

The value of the Sir Ratanji Dalal Research Scholarship endowed Fund was £0.77m at 30 June 2024 (2023: £0.72m) and its restricted fund was £121k (2023: £170k).

ANNUAL REPORT AND ACCOUNTS 2023–24

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Funding partnerships

As a registered charity (212808), we rely upon charitable support to underpin our work in advancing surgical standards through education, research and training.

We are grateful to our many supporters, whose donations and encouragement are crucial as the demands on our limited resources become ever greater. We would like, in particular, to acknowledge the following charitable trusts, foundations, companies and individuals.

Foundations, charitable trusts, associations and individuals

Foundations, charitable trusts, associations and individuals
Association of Breast Surgery		Hon Societyof Knights of the Round Table Benevolent Fund
Association of Coloproctologyof Great Britain and Ireland		Huggard Charitable Trust
Blond McIndoe Research Foundation		Linder Foundation
Bowel Cancer UK		LollipopFoundation
Bowel Research UK		Marx FamilyTrust
Breast Cancer UK		Masonic Charitable Foundation
British Association of Urological Surgeons		Miss Leela Kapila OBE FRCS
British Gynaecological Cancer Society		Mr Bjorn Saven
British Obesity& Metabolic SurgerySociety		Mr Leon J Grant
Brock Webb Trust		National Joint Registry
Bryan Guinness Charitable Trust		Occtopus
Circulation Foundation		Orthopaedic Research UK
Edwin George Robinson Charitable Trust		PF Charitable Trust
ENT UK		Professor Miles H IrvingKB FRCS
Frances and Augustus Newman Foundation		Rosetrees Charitable Trust
Freemasons Fund for Surgical Research		Shears Foundation
G D Herbert Charitable Trust		Sir John Fisher Foundation
G M Morrison Charitable Trust		Societyfor Cardiothoracic Surgeryin Great Britain and Ireland
George Drexler Foundation		St Jude's Charitable Trust
Gilbert and Eileen Edgar Foundation		Swann-Morton Foundation
Globe Lodge No. 23		Vascular Surgical Societyof Great Britain and Ireland
Gunnar Nilsson Cancer Treatment Trust Fund		Worshipful Companyof Needlemakers
Health Education England		Wyndham Charitable Trust
HenryLumleyCharitable Trust

Corporate Support
Abbott Medical		Medtronic
B Braun Medical Ltd		MoInlycke Health Care
BloombergConnects		Pensionlite Ltd
��		Rocialle Healthcare
CMR Surgical Ltd		Siemens Healthineers
Eido Healthcare Limited		Stryker Corporation
Ethicon UK		THD(UK)Ltd
Immerse Education		Thomas Tunnock Ltd
Karl Storz Endoscopy (UK)Ltd		TruCorpLtd

ANNUAL REPORT AND ACCOUNTS 2023–24

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Endowed and Restricted Funds

Endowed and Restricted Funds
Alban Barros D’Sa ScholarshipFund		HenryLumleyCharitable Trust
Arthritis Research Trust Fund		Margaret Witt ScholarshipFund
Blond McIndoe Fund		Philipand Lydia Cutner Fund
Doctor Shapurjui H Modi Memorial ENT Fund		Preiskel FamilyFund
Fellows FellowshipFund		Sorab(Soli)Jamshed Lam Research Fund
Harold Bridges Bequest		Vandervell Research Fund

Legacies

Legacies
The late Ms J Anderton forgeneral charitablepurposes		The late Mr M W E Morgan forgeneral charitablepurposes
The late Ms L Bartlett for the Margaret Witt Fund		The late Mrs B Mountford-Quinn forgeneral charitable purposes
The late Ms D C Bartleyforgeneral charitablepurposes		The late Mr A R Mowlem forgeneral charitablepurposes
The late Mr D P Goodwin forgeneral charitablepurposes		The late Mr A G Neville forgeneral charitablepurposes
The late Mr R W Heslopforgeneral charitablepurposes		The late Mr N J Norris forgeneral charitablepurposes
The late Ms W L W Maclean forgeneral charitablepurposes		The late Miss S J White forgeneral charitablepurposes
The late Mr F T Middleton forgeneral charitablepurposes

ANNUAL REPORT AND ACCOUNTS 2023–24

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Structure, governance and management

Charter

The Royal College of Surgeons of England was established by Royal Charter in 1800 to promote and encourage the study and practice of the art and science of surgery. Its earlier history lies in the records of the City Companies of �� ordinances. The most recent of these charters was granted in April 2015, and prior to that in March 1992. The College is a charity, with the registered number 212808.

Constituent parts

For administrative purposes, the College comprises the Commonalty of Surgeons and the Faculty of Dental Surgery.

Trustees

�� Dean of the FDS, three elected trustees (elected by and from Council), and four lay trustees appointed by the Board.

��
President		Mr T Mitchell(from 13 July2023)
		Professor Sir N Mortensen(to 13 July2023)
Vice-Presidents		Professor F Myint
		Mr T Goodacre(to 13 July2023)
		Mr T Mitchell(to 13 July2023)
		Professor V Lees(from 13 July2023)
		Professor P Friend(from 13 July2023)
Dean of the Facultyof Dental Surgery		Dr C Eckhardt

Elected Trustees		Lay Trustees
Mr L Wijesinghe(to 6 June 2024)		��
Mr W Allum		Mr S Davis
Professor F Bhatti		Mr R Greig
Professor A Carr(from 6 June 2024)		Miss J Kirby (from 27 July2023)

Members of Council

Council consists of 24 elected surgical fellows, 10 appointed surgical specialty association members, and 2 dental surgery fellows elected by the Board of the FDS. Surgical Council members are elected by ballot by fellows and members of the College. Specialty association members are appointed by a transparent and democratic procedure that has been determined by their appointing surgical specialty association and approved by the Council. In addition, ��

ANNUAL REPORT AND ACCOUNTS 2023–24

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Elected surgical and dental fellows

Elected surgical and dental fellows
Mr A Ahmed		Professor F Smith
Mr W Allum		Ms S Vig
Professor F Bhatti		Mr L Wijesinghe
Professor P Brennan		Miss N Yassin
Dr C Eckhardt		Ms G Bowbrick(from 13 July2023)
Miss N Fearnhead		Professor A Carr(from 13 July2023)
Professor P Friend		Ms D Kufeji(from 13 July2023)
Ms L Hamilton		Miss B Lovett(from 13 July2023)
Miss R Hargest		Mr R Moorthy (from 13 July2023)
Miss S Howells		Professor P Sagar(from 13 July2023)
Mr O Karim		Mr T Goodacre(to 13 July2023)
Professor C Lavy		Mr R Kerr(to 13 July2023)
Professor V Lees		Professor N Mortensen(to 13 July2023)
Professor I Loftus		Mr A Nanu(to 13 July2023)
Mr T Mitchell		Miss V Pegna(to 13 July2023)
Mr S Singh		Professor T Rockall(to 13 July2023)

Surgical specialty association members

Surgical specialty association members
Mr N Moorjani		Mr S Dover(to 13 July2023)
Professor R Sayers		Mr J Glass(to 13 July2023)
Mr S Singh		Mr T Goodacre(to 13 July2023)
Mr K Allison(from 13 July2023)		Mr N Phillips(to 13 July2023)
Mr J Epstein(from 13 July2023)		Professor P Sagar(to 13 July2023)
Mr W Hellier(from 13 July2023)		Professor J Skinner(to 13 July2023)
Professor I Kamaly-Asl(from 13 July2023)		Mr P Spraggs(to 13 July2023)
Mr F Monsell(from 13 July2023)
Professor N Soomro(from 13 July2023)
Mr B Visavadia(from 13 July2023)

ANNUAL REPORT AND ACCOUNTS 2023–24

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Governance

The Board of Trustees has responsibility for the overall direction of the College, but delegates all substantive matters relating to professional and public policy to the Council and allows the Council to further delegate its powers. All trustees and Council members are given an induction course and ongoing training on their responsibilities and other matters as required.

The trustees are aware of the Charity Governance Code published in 2017, which sets out the principles and recommended practice for good governance within the sector. The trustees are committed to maintaining high standards of ��ments. The College’s compliance with the Code will be reviewed on an annual basis.

The committees of the Board of Trustees are:

Committee		Chair
Audit and Risk Committee		��
Finance and Investment Committee		Miss J Kirby (from 27 July2023)
People and Culture Committee		Mr R Greig
Health and Safety		Mr A Reed

The committees of the Council are:

Committee		Council Member
Learning and assessment
Overall responsibility		Professor F Myint
Learning		Miss R Hargest(from 13 July2023)
		Mr R Kerr(to 13 July2023)
Dental and Surgical Examinations		Professor F Smith(from 16 June 2023)
		Mr M Garrett(to 16 June 2023)
Library, Museums and Archives		Professor F Myint
QualityAssurance		Professor F Bhatti(from 13 July2023)
		Mr A Nanu(to 13 July2023)
Research and Quality
Overall responsibility		Professor V Lees(from 13 July2023)
		Mr T Goodacre(to 13 July2023)
Research Fellowships and Lectureships		Professor I Loftus(from 13 July2023)
		Professor P Friend(to 13 July2023)
Global Committee
Overall responsibility		Professor V Lees(from 13 July2023)
		Mr T Goodacre(to 13 July2023)
Global Policyand Advocacy		Mr L Wijesinghe(from 13 July2023)
		Mr T Goodacre(to 13 July2023)
Global SurgeryProgrammes		Professor C Lavy
Membership Engagement
Overall responsibility		Professor P Friend(from 13 July2023)
		Mr T Mitchell(to 13 July2023)
Future of Surgery		Professor P Sagar(from 13 July2023)
		Professor J Skinner(to 13 July2023)

ANNUAL REPORT AND ACCOUNTS 2023–24

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The FDS reports to Council and forms part of the business of the Board of Trustees. The Faculty has its own committee structure and has a Dean to chair the Board of the Faculty. The results of the FDS are included in the ��

The Board delegates to the Chief Executive responsibility for the day-to-day management of the College and the �� portfolio of directorates.

Subscribing fellows and members elect the Council and the Board of the FDS.

Management

Principal managers employed during 2023-24
Chief Executive		Mr A Reed
DeputyChief Executive, Executive Director(Planningand Operations)		Mrs J Weller
Executive Director(Resources)		Ms J Porritt(to 1 September 2023)
Executive Director(Professional Services)		Mr S Hills
��		Ms L Davies
Executive Director(Finance)		Mr S Fox(from 16 September 2024)
Director of Finance		Ms C Hibbs(to 13 September 2024)
Director of Dental and Surgical Exams		Mr A Landau
Director of Learning		Ms L Goldring
Director of Libraryand Archives		Mr R Williams(to 29 November 2023)
Director of Libraryand Archives		Ms S Pink(from 3 June 2024)
Director of Membership		Ms N Rowe
Director of Museums		Ms D Kemp
Director of Research and QualityImprovement		Mr R Tomlinson
Director of Strategy, Trainingand Workforce		Ms K Smith
Registrar of the Facultyof Dental Surgery		Ms H Johnstone

ANNUAL REPORT AND ACCOUNTS 2023–24

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Statement of trustees’ responsibilities

�� applicable law and regulations.

�� Kingdom Generally Accepted Accounting Practice (United Kingdom Accounting Standards) and applicable law.

��

select suitable accounting policies and then apply them consistently;
observe the methods and principles in the Charities Statement of Recommended Practice;
make judgements and estimates that are reasonable and prudent;
state whether applicable accounting standards have been followed, subject to any material departures disclosed ��
�� and the group will continue to operate.

�� for safeguarding the assets of the Charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

Auditor

Crowe U.K. LLP has indicated its willingness to be reappointed as the company’s auditor for the coming year.

Signed on behalf of the members of the Board of Trustees on 14 November 2024.

T Mitchell President of Council Chair of the Board of Trustees

V Lees Vice-President of Council Member of the Board of Trustees

ANNUAL REPORT AND ACCOUNTS 2023–24

��

Independent Auditor’s Report to the Members of the Royal College of Surgeons of England

Opinion

�� 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).

��

�� group’s income and expenditure, for the year then ended;
have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and
have been prepared in accordance with the requirements of the Charities Act 2011.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) [ISAs (UK)] and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the ��

We are independent of the group in accordance with the ethical requirements that are relevant to our audit of the �� our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have ��

Conclusions relating to going concern

��

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

Other information

The trustees are responsible for the other information contained within the annual report. The other information �� 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 �� misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to �� work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.

ANNUAL REPORT AND ACCOUNTS 2023–24

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We have nothing to report in this regard.

Matters on which we are required to report by exception

We have nothing to report in respect of the following matters in relation to which the Charities (Accounts and Reports) Regulations 2008 requires us to report to you if, in our opinion:

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

Responsibilities of trustees

As explained more fully in the trustees’ responsibilities statement set out on page 42, the trustees are responsible �� from material misstatement, whether due to fraud or error.

�� ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the trustees either intend to liquidate the charity or to cease operations, or have no realistic alternative but to do so.

��

We have been appointed as auditor under section 151 of the Charities Act 2011, and report in accordance with the ��

�� 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 ��

Details of the extent to which the audit was considered capable of detecting irregularities, including fraud and noncompliance with laws and regulations are set out below.

�� Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

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

�� discussed these between our audit team members. We then designed and performed audit procedures responsive to ��

We obtained an understanding of the legal and regulatory frameworks within which the Charity and group operates, �� Act 2011 together with the Charities Statement of Recommended Practice (FRS 102). We assessed the required ��

ANNUAL REPORT AND ACCOUNTS 2023–24

��

�� statements but compliance with which might be fundamental to the Charity’s and the group’s ability to operate or to avoid a material penalty. We also considered the opportunities and incentives that may exist within the Charity and the group for fraud. The laws and regulations we considered in this context for the UK operations were GDPR, taxation legislation and employment legislation.

Auditing standards limit the required audit procedures to identify non-compliance with these laws and regulations to enquiry of the trustees and other management and inspection of regulatory and legal correspondence, if any.

��

Owing to the inherent limitations of an audit there is an unavoidable risk that we may not have detected some �� in accordance with auditing standards. For example, the further removed non-compliance with laws and regulations �� limited procedures required by auditing standards would identify it. In addition, as with any audit, there remained a higher risk of non-detection of irregularities, as these may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal controls. We are not responsible for preventing non-compliance and cannot be expected to detect non-compliance with all laws and regulations.

Use of our report

This report is made solely to the Charity’s trustees, as a body, in accordance with Part 4 of the Charities (Accounts and Reports) Regulations 2008. Our audit work has been undertaken so that we might state to the Charity’s trustees those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Charity and the Charity’s trustees as a body, for our audit work, for this report, or for the opinions we have formed.

Crowe U.K. LLP

Statutory Auditor London Date:

Crowe U.K. LLP is eligible for appointment as auditor of the Charity by virtue of its eligibility for appointment as auditor of a company under section 1212 of the Companies Act 2006.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

Financial Statements

�� ended 30 June 2024

		Unrestricted	Restricted	Endowed	Totals	Totals
		Funds	Funds	Funds	2024	2023
	Notes	£000	£000	£000	£000	£000
Income from
Grants, donations and legacies	5a	241	5,423	-	5,664	5,940
Charitable activities	5b	26,528	43	-	26,571	24,924
Tradingactivities	5c	1,257	70	-	1,327	1,101
Investment Income	5d	1,035	27	510	1,572	1,580
Total Income		29,061	5,563	510	35,134	33,545

Expenditure On
Raisingfunds	6a	575	15	295	885	1,036
Charitable activities	6b	26,538	6,945	-	33,483	30,090
Other expenditure	6c	853	-	-	853	4,983
Total Expenditure		27,966	6,960	295	35,221	36,109

Net income/(expenditure) beforegains		1,095	(1,397)	215	(87)	(2,564)

Netgains/(losses)on investments	11	5,128	252	4,837	10,217	111

Net income/(expenditure)		6,223	(1,145)	5,052	10,130	(2,453)

Application of total return	20	-	1,672	(1,672)	-	-

Net movement in funds for theyear		6,223	527	3,380	10,130	(2,453)

Balances brought forward at 1 July	16-18	90,510	5,869	38,655	135,034	137,487

Balances carried forward at 30 June 2024	16-18	96,733	6,396	42,035	145,164	135,034

��pages 46 to 74.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

Consolidated balance sheet as at 30 June 2024

----- Start of picture text -----
2024 2023
GROUP RCS GROUP RCS
Notes £000s £000s £000s £000s
Fixed assets
�� 9 96,123 96,123 102,676 102,676
�� 9 2,006 2,006 1,284 1,284
Investments 11 85,363 85,363 72,906 72,906
�� 183,492 183,492 176,866 176,866
Current assets
Stock 48 24 41 41
Debtors 12 10,192 10,374 8,861 9,480
Cash and short-term deposits 7,874 7,716 8,221 8,221
Total current assets 18,114 18,114 17,123 17,742
Current liabilities
Creditors: amounts falling due within one year 13 (16,399) (16,399) (15,854) (16,473)
Total current liabilities (16,399) (16,399) (15,854) (16,473)
Net current assets/(liabilities) 1,715 1,715 1,269 1,269
Long-term liabilities
Creditors: amounts falling due after more than one year 13 (43) (43) - -
Long term loan (40,000) (40,000) (40,000) (40,000)
�� 20 - - (3,101) (3,101)
Total long-term liabilities (40,043) (40,043) (43,101) (43,101)
Net assets 145,164 145,164 135,034 135,034
Funds
Unrestricted funds:
Fixed asset funds 66,611 66,611 68,161 68,161
Other designated funds 154 154 642 642
Property revaluation reserve 5,233 5,233 2,959 2,959
Pension reserve - - (3,101) (3,101)
General funds 24,735 24,735 21,849 21,849
Total unrestricted funds 16 96,733 96,733 90,510 90,510
Restricted funds 17 6,396 6,396 5,869 5,869
Endowed funds 18 42,035 42,035 38,655 38,655
Total funds 145,164 145,164 135,034 135,034
----- End of picture text -----

The notes on pages 46 to 74��

Approved on behalf of the members of the Board of Trustees and authorised for issue on 14 November 2024.

Professor V Lees Vice-President of Council Member of the Board of Trustees

Mr T Mitchell President of Council Chair of the Board of Trustees

ANNUAL REPORT AND ACCOUNTS 2023–24

��

----- Start of picture text -----
Total funds
2024 2023
Notes £000 £000
Net cash provided by (used in) operating activities A (2,475) (4,293)
��
Dividends, interest and rents from investments 1,572 1,580
Purchase of property, plant and equipment (1,485) (2,010)
Proceeds from sale of investments 2,826 2,777
Purchase of investments (785) (674)
Net cash provided by / (used in) investing activities 2,128 1,673
Change in cash and cash equivalents in the reporting period (347) (2,620)
Cash and cash equivalents at the beginning of the reporting period B 8,221 10,841
Cash and cash equivalents at the end of the reporting period B 7,874 8,221
��
�� 10,130 (2,453)
activities)
Adjustments for:
Depreciation charges 2,956 2,608
(Gains)/losses on investments (10,217) (111)
Dividends, interest and rents from investments (1,572) (1,580)
�� 79 1,298
(Increase)/decrease in stocks (7) 26
(Increase)/decrease in debtors (1,331) (3,713)
Increase/(decrease) in creditors (2,513) (368)
Net cash provided by/(used in) operating activities (2,475) (4,293)
B. Analysis of cash and cash equivalents
Current and short term deposits 7,874 8,221
Total cash and cash equivalents 7,874 8,221
----- End of picture text -----

The notes on pages 46 to 74��

ANNUAL REPORT AND ACCOUNTS 2023–24

��

�� year ended 30 June 2024

1. Charity information

The Royal College of Surgeons of England was established by Royal Charter in 1800 and is a registered charity in England and Wales (Charity no. 212808).

2. Basis of preparation

�� Reporting by Charities (2019) preparing their accounts in accordance with the Financial Reporting Standard applicable ��

�� year ended 30 June 2024. Intergroup transactions are eliminated on consolidation. Hunter Trading Limited is a private limited company incorporated in England and Wales.

2.1 Going concern

�� original budget. The economic uncertainty both within the UK and globally appears to be easing slightly with �� decisive 2024 UK election result has also removed some political uncertainty. It is against this backdrop that a �� 30 June 2026.

The College prepares its annual budget for the forthcoming year in late spring. This involves a prudent assessment �� This next year will be a year of consolidation and progress as the College continues its work to reshape the organisation, develop and broaden its revenue base, including new commercial revenue, and to build and ��

The College has updated its long-term revenue and cash projections for its latest results, annual plan and other expected changes in its operating position over the next 18 to 24 months. The projections are stress-tested and set the minimum long-term operating surplus target that the College must achieve in order to meet its interest and �� operations over the next 18 to 24 months.

The trustees consider that the College’s primary revenue streams remain broadly robust and demand-positive over the medium term, and that, any reduction in revenues in this period as a result of a downturn in demand will be short term ��

ANNUAL REPORT AND ACCOUNTS 2023–24

��

3. Critical accounting judgements and key sources of estimation uncertainty

�� expectation and may cause a material adjustment to the carrying amounts of assets and liabilities within the next reporting period. Revisions to accounting estimates are recognised in the period in which the estimate is revised.

No judgements other than those involving estimations have been made by management in the process of applying the College’s accounting policies in the preparation of these statements. Sources of estimation uncertainty may vary from year to year and these are reassessed each year to ensure disclosure remains relevant.

��

��
��
determination of mixed-use property;
��

3.1. Component accounting

The construction of the redeveloped freehold property was completed on 30 April 2021 and the property was brought �� useful economic lives. This was based upon a detailed assessment of the construction contract provided by the capital programme’s cost management consultants and discussions with the consultants to agree the principles of allocation in respect of costs not directly linked to physical assets. Management revised the asset allocation only where required in order to ensure consistency of categorisation and alignment with standard asset accounting categorisations. Other assets within the class were grouped for depreciation purposes and allocated the depreciation measure of the nearest major component asset. Management considers that this approach provides a reasonable basis upon which to depreciate all of the assets within each class (see accounting policy ��).

�� the programme’s project management consultants. Components within each asset class were assigned depreciation �� and allocated to the largest component asset.

3.2. Useful economic lives

�� redevelopment of the freehold property have been based on useful economic lives determined by the capital programme’s specialist construction cost management consultants.

�� consultants.

�� warranty periods and average expected replacement cycles as determined by relevant management personnel.

3.3. Mixed-use property

The College intends to lease part of its freehold property to other organisations for the purposes of earning rental income. The freehold property is therefore a mixed-use property where part of the property is held for use in the ordinary course of business and part of the property is held as an investment property.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

The total cost of the freehold property has been apportioned between the net internal area and the gross internal �� The investment property is measured at cost at initial recognition and then measured subsequently at fair value in accordance with FRS 102.

�� valuation is based upon a set of assumptions and estimates, for example, yields, whereby a small change in these ��

��

�� actuarial risks associated with other participating entities and is unable to identify its share of the underlying assets and liabilities on a consistent and reasonable basis. Both schemes are currently in surplus (see note 20) so no liability is recognised in these accounts.

4. Principal accounting policies

4.1. Income

Income is recognised when the entitlement is established, there is probability of receipt and the amount can be reliably measured. Income received relating to future accounting periods is deferred and shown as a creditor on the balance sheet.

4.1.1�� course and examination takes place.
4.1.2 Membership subscription fees are accounted for on an accruals basis.
4.1.3 Grant income (revenue and capital) is accounted for on a receivables basis.
4.1.4��
4.1.5�� 4.1.6 Investment income is credited on a receivables basis.
4.1.7�� the contract or service is completed

4.2. Expenditure

All expenditure is accounted for on an accruals basis, and, with the exception of support costs, is attributed directly to each activity undertaken.

�� of our strategic priorities.

4.2.1 Employee costs include the net movement in year on the provision for annual leave accrued by employees in respect of services rendered as required by FRS 102.
4.2.2 Support costs are allocated to activities on a basis consistent with the use of these resources: building services costs are charged to departments and faculties based upon area occupied; portering and cleaning services, ��
4.2.3 Governance costs comprise those costs incurred in relation to the overall strategic management of the College, and the costs of compliance with statutory requirements and under FRS 102 are disclosed as part of support costs and allocated to other professional activities.
4.2.4 Overheads in relation to grant-funded projects are charged, where appropriate, on the basis of their activity.
4.2.5��
4.2.6 Fundraising costs comprise the costs incurred in encouraging others to make voluntary contributions to the College and its activities.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

4.3. Taxation

The College is a registered charity incorporated by Royal Charter and as such is exempt from taxation on its income and gains to the extent that they are applied for its charitable purposes.

�� trading operations are gifted each year to the College.

The College is partially exempt for the purposes of VAT and is only able to reclaim a percentage element of VAT charged on goods and services purchased.

��

Freehold land is stated at historic cost and is not depreciated as it is considered that its value is not impaired by the passage of time and therefore has an unlimited useful life.

Property development project which are not completed at the year-end are shown as ‘Assets in the course of construction’ and are not depreciated until they are brought into use on practical completion.

�� cost at initial recognition. All items of property, plant and equipment are measured after initial recognition using the �� accumulated impairment losses. Fixed assets are reviewed for impairment on an annual basis.

The freehold property redevelopment was completed on 30 April 2021. The total cost of redevelopment on practical �� determined by construction cost management specialists. The useful lives of each of the major component assets within each asset class have been adopted as the principal component depreciation measures. Other assets that were ��

The cost of the completed museum works has been allocated to three major tangible asset classes, plant and �� The useful life of the component assets in each asset class has been determined by external cost management specialists and these lives have been adopted as the component depreciation measures.

All assets are depreciated over their useful lives using the straight-line method and the annual depreciation charge is ��

The depreciation measures are set out as follows:

i. Freehold property assets are depreciated over component periods of 45, 60, 75 and 80 years.

ii. Plant and machinery assets are depreciated over component periods of 20, 25 and 40 years.

��

iv. Infrastructure equipment assets are depreciated over component periods of 5, 8, 10 and 15 years.

v. Furniture assets are depreciated over component periods of 5 and 10 years.

vi. Computer and other equipment is depreciated over 4 years.

��

�� functionality and therefore enhance the value of the asset to the business are also capitalised.

��

ANNUAL REPORT AND ACCOUNTS 2023–24

��

�� has been assigned to the computer software asset class and assigned an appropriate depreciation measure as determined by the external cost management specialists.

All assets are depreciated over their useful lives using the straight-line method and the annual depreciation charge is ��

Software assets are depreciated over component periods of 4 or 10 years.

4.5. Fixed asset investments

Fixed asset investments are stated at fair value at the balance sheet date. These investments include cash held by the investment managers intended for investment or held as part of the portfolio.

In accordance with Section 16 of FRS 102, investment property is property (land, building and part of a building) held by the College for long-term rental yields and for capital appreciation and is not used for operational purposes. Investment property is measured at cost at initial recognition and then is measured subsequently at fair value.

�� of the Royal Institution of Chartered Surveyors. Fair value represents the estimated amount for which an asset or liability should exchange on the valuation date between a willing buyer and a willing seller in an arm’s length transaction.

Changes in fair value representing the net unrealised gains and losses arising on revaluation are recognised in the Statement of Financial Activities together with the realised gains and losses arising from disposals in the year.

Where part of the freehold property is or is intended to be leased to another entity, then the property is deemed to be mixed-use property and the cost of the property must be separated between property, plant and equipment that is held �� entity. If the fair value of the investment property component cannot be measured reliably then the entire property is ��

Endowments are accounted for under the total return approach using a base date of 24 June 1992 to determine the permanent capital of each endowment.

4.6. Heritage assets

�� technological, geophysical or environmental qualities and are held and maintained principally for their contribution to knowledge and culture.

The College’s heritage assets comprise mainly the numerous specimens and artefacts collected by John Hunter in the 1700s and presented to the College in 1799, and leading to the establishment of the Hunterian Museum. The College is by law the proprietor of these specimens and the Hunterian trustees have a duty to ensure that the College maintains the specimens and does not dispose of them. The College also owns historic books related to surgery and medicine which were bequests in the 19[th] century and are preserved and maintained in the library and are not to be disposed.

No value has been attributed to these heritage assets in the balance sheet on the grounds that the trustees consider there is no reliable method of establishing historic cost information for these artefacts and that the costs of valuation �� period of the closure of the Hunterian Museum and no donated heritage assets have been received in this accounting period.

4.7. Stock

Stock comprises goods produced for re-sale, including course manuals purchased or printed, and is stated at the lower of cost and net realisable value.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

4.8. Cash and cash equivalents

Cash and cash equivalents include cash at bank and in hand, and cash held on readily realisable short-term deposits ��

4.9. Financial instruments

��

Financial assets measured at amortised cost include cash, trade debtors, other debtors and accrued income. Financial assets measured at fair value include investments. Financial liabilities measured at amortised cost include trade creditors, other creditors and accruals.

��

The College contributes to four pension schemes on behalf of its employees: the USS, a multi-employer externally ��

�� scheme, whereby the participating entities are not under common control and the schemes represent industry-wide schemes. Where the employer has entered into an agreement with a multi-employer scheme that determines how the �� income and expenditure account.

The assets of the USS and SAUL multi-employer schemes are held in separate trustee-administered funds. Given the mutual nature of these schemes, the scheme’s assets are not attributed to individual institutions and a scheme-wide contribution rate is set. The College is therefore exposed to actuarial risks associated with other entities’ employees and is unable to identify the College’s share of the underlying assets and liabilities of the schemes on a consistent and �� account represents the contributions payable to the schemes in respect of the accounting period.

�� technical provisions.

�� and expenditure account represents the contributions payable to the scheme in respect of the accounting period. The �� income and expenditure account represent the contributions payable for the accounting period.

4.11. Other provisions for liabilities

Provisions are recognised when the College has a present obligation (legal or constructive) as a result of a past event, it is probable that the College will be required to settle the obligation and a reliable estimate can be made of the amount of the obligation. The amount recognised is the best estimate of the consideration required to settle this obligation at the end of the reporting period.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

4.12. Operating leases

�� the lease term.

4.13. Funds

Unrestricted funds are available for use at the discretion of the trustees in furtherance of the College’s general charitable objectives.

�� in the future.

�� implementation of the College’s operational strategy and that their disposal could adversely impact on the College’s ability to deliver its aims.

�� accordance with the terms of the donation, legacy or grant.

Endowed funds represent donations or legacies given to the College, the terms of which stipulate that the original capital cannot be spent. The funds are invested to generate an income and capital growth, which can then be expended in accordance with the purposes stated by the donor.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

5. Income

	Unrestricted	Restricted	Endowment
	Funds	Funds	Funds	2024	2023
Income from:	£000	£000	£000	£000	£000
5a. Grants, donations and legacies
Donations	53	294	-	347	675
Grants	7	4,704	-	4,711	4,380
Legacies	181	425	-	606	885
Total	241	5,423	-	5,664	5,940

5b. Charitable activities
Courses	3,619	27	-	3,646	3,092
Examinations	9,800	-	-	9,800	8,523
Subscriptions	9,837	16	-	9,853	9,391
Qualityand standards income	1,095	-	-	1,095	1,157
Other charitable income	2,177	-	-	2,177	2,761
Total	26,528	43	-	26,571	24,924

5c. Trading activities
Income from charitable trading	319	70	-	389	445
Income from taxable trading	938	-	-	938	656
Total	1,257	70	-	1,327	1,101

5d. Investment income
Investmentpropertyincome	757	-	-	757	894
Investmentportfolio income	223	27	510	760	674
Interest received	55	-	-	55	12
Total	1,035	27	510	1,572	1,580

Income Total	29,061	5,563	510	35,134	33,545

�� criteria of entitlement, probability of receipt and measurement at the balance sheet date amount to £195k (2023: £231k).

ANNUAL REPORT AND ACCOUNTS 2023–24

��

6. Expenditure

	Unrestricted	Restricted	Endowed
	Funds	Funds	Funds	2024	2023
Expenditure on:	£000	£000	£000	£000	£000
6a. Raising funds
Fundraisingcosts	437	-	-	437	651
Investment management fees	138	15	295	448	385
Total	575	15	295	885	1,036

6b. Charitable activities
Qualityand standards	1,670	2,825	-	4,495	3,498
Career andprofessional development	7,105	611	-	7,716	7,055
��	2,871	159	-	3,030	3,022
Trainingand assessingsurgeons	9,495	69	-	9,564	8,312
Promoting public andprofessional engagement	2,961	402	-	3,363	3,232
Research	-	2,819	-	2,819	2,554
Facultyof Dental Surgery	2,436	60	-	2,496	2,417
Total	26,538	6,945	-	33,483	30,090

6c. Other expenditure
38-43 Lincoln's Inn Fields depreciation	2,399	-	-	2,399	2,373
Hunterian Museum depreciation	307	-	-	307	24
��	67	-	-	67	1,298
Interestpayable	888	-	-	888	888
Other expenditure	293	-	-	293	505
FRS 102pension costs	(3,101)	-	-	(3,101)	(105)
Total	853	-	-	853	4,983

Expenditure Total	27,966	6,960	295	35,221	36,109

Allocated support costs

�� governance costs. These costs are allocated to activities on a basis consistent with the use of these resources. The allocation method and cost of each support service is summarised below.

		2024	2023
Support Services	Allocation Basis	£000	£000
BuildingServices	Space occupied	1,552	1,445
Facilities Services, incl.porteringand cleaning	��	1,565	1,181
Human Resources	��	389	322
Finance Services	��	1,735	1,650
IT Services	��	2,862	2,943
Governance costs		1,320	1,319
Total Support Costs		9,423	8,860

ANNUAL REPORT AND ACCOUNTS 2023–24

��

			Allocared
	Direct	Grants	support
Support Costs Allocation	costs	made	costs	2024	2023
Expenditure on:	£000	£000	£000	£000	£000
Raising funds
Fundraisingcosts	131	-	306	437	651
Investment management fees	448	-	-	448	385
Total	579	-	306	885	1,036

Charitable activities
Qualityand standards	3,403	-	1,092	4,495	3,498
Career andprofessional development	5,495	-	2,221	7,716	7,055
��	1,274	-	1,756	3,030	3,022
Trainingand assessingsurgeons	8,045	-	1,519	9,564	8,312
Promoting public andprofessional engagement	1,847	-	1,516	3,363	3,232
Research	585	2,023	211	2,819	2,554
Facultyof Dental Surgery	1,694	-	802	2,496	2,417
Total	22,343	2,023	9,117	33,483	30,090

Other expenditure
Other expenditure	3,954	-	-	3,954	5,088
FRS 102 Pension costs	(3,101)	-	-	(3,101)	(105)
Other expenditure	853	-	-	853	4,983

Expenditure Total	23,775	2,023	9,423	35,221	36,109

Governance costs include fees payable to the College’s auditors in respect of audit and non-audit services.

	2024	2023
Auditors’ remuneration	£000	£000
Included ingovernance costs are:
Audit fees – The Royal College of Surgeons of England	84	62
Audit fees – Hunter TradingLtd	4	4
Fees for non-audit fees	19	7
Total	107	73

ANNUAL REPORT AND ACCOUNTS 2023–24

��

7. Research grants

	2024	2023
	£000	£000
Researchgrants expenditure
Research fellowships	2,018	1,640
Travellingfellowships & otherprojects	5	7
Surgical Trial Units	264	365
Administration	532	542
Total Expenditure	2,819	2,554

Research fellowships
Liabilities at the start of theyear	(1,830)	(1,786)
Paid in theyear	1,622	1,596
Liabilities at the end of theyear	2,226	1,830
Charge for theyear	2,018	1,640

Awards
Research awards	68	80
Travel awards	8	8
Total	76	88
Research awards include:
1year fellowships	17	27
2year fellowships	3	2
3year fellowships	1	1
Dental fellowships	12	10
Intercalated Bachelor of Science awards	9	21

Grants totalling £515k were awarded to individuals at institutions with which members of Council are connected (2023: £663k). These members of Council did not participate in the decisions to award the respective grants.

Surgical research fellowships awarded by the College are only eligible to surgical trainees who are members of the College (MRCS) and who have entered their period of specialty training (specialist registrars). The overriding objective of the surgical research projects is to improve care of surgical patients and the projects are based upon the principles �� awarded and other research projects undertaken are available in the annual research report published by the research department.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

8. Employee information

8. Employee information
	2024	2023
	£000	£000
Salaries and wages	10,894	10,003
National Insurance costs	1,173	1,117
Apprenticeshiplevy	39	-
Pension costs	1,730	1,639
FRS 102 Pension	(3,101)	(104)
Total	10,735	12,655

Redundancy and termination payments arising from restructuring activities during the year totalled £48k (2023: £10k).

No amounts were outstanding at year end (2023: Nil).

��

	2024	2023
��	35	22
Dental & Surgical Examinations	35	30
Fundraising	3	5
��	5	8
Facultyof Dental Surgery	10	10
��	5	4
Joint Committee on Surgical Training	25	25
Learning	27	25
Libraryand Museum	27	26
Membershipand Engagement	42	34
Transform	5	4
QualityImprovement	11	12
Research	6	5
Support Services	41	36
Total	277	246

��
At 30 June the number of employees whose emoluments exceeded £60k was:
£60,000 - £70,000	17	20
£70,001 - £80,000	4	7
£80,001 - £90,000	4	-
£90,001 - £100,000	1	2
£100,001 - £110,000	2	1
£110,001 - £120,000	1	2
£120,001 – £130,000	1	1
£150,001 - £160,000	1	1

RCS England key management personnel are set out on page 38�� received in the year by the College’s key management personnel amounted to £1.57m (2023: £1.74m).

No trustees received any remuneration for services as members of the Board of Trustees in the current and preceding years.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

9. Fixed assets (Group and Charity)

----- Start of picture text -----
Fixture Plant Infra- Computer Assets in
Freehold Freehold and and structure and Other course of
Land Property Fittings Furniture Machinery Equipment Equipment construction 2024
Tangible Fixed
Assets £000 £000 £000 £000 £000 £000 £000 £000 £000
Cost at 1 July 2023 1,945 71,870 17,774 1,382 12,620 1,819 783 252 108,445
Additions during the - - - - - 0 - 510 510
year
Transfers - - 62 - 0 0 195 (241) 16
Transfers to - - - - - - -
investment property (4,281) (4,281)
�� - - - - - - -
during the year (12) (12)
At 30 June 2024 1,945 67,589 17,836 1,382 12,620 1,819 978 509 104,678
Depreciation at 1 July 2023 0 (2,052) (1,151) (519) (1,075) (355) (617) 0 (5,769)
Charge for the year 0 (952) (767) (240) (512) (186) (129) - (2,786)
At 30 June 2024 0 (3,004) (1,918) (759) (1,587) (541) (746) 0 (8,555)
Net Book Value 2023 1,945 69,818 16,623 863 11,545 1,464 166 252 102,676
Net Book Value 2024 1,945 64,585 15,918 623 11,033 1,278 232 509 96,123
----- End of picture text -----

Intangible Fixed Assets	Computer Software £000	Assets in course of construction £000	2024 £000
Cost at 1 July 2023	3,046	936	3,982
Additions duringtheyear	-	975	975
Transfers	240	(256)	(16)
��	-	(67)	(67)
At 30 June 2024	3,046	936	3,982

Depreciation at 1 July 2023	(2,698)	-	(2,698)
Charge for theyear	(170)	-	(170)
At 30 June 2024	(2,868)	-	(2,868)

Net Book Value 2023	348	936	1,284

Net Book Value 2024	418	1,588	2,006

Completion of construction works in respect of the College’s freehold property located at 38–43 Lincoln’s Inn Fields �� straight-line basis over a range of component periods and with a maximum period of 80 years for certain freehold property components. The building assets are depreciating currently at an annual rate of approximately £2.4m. All components except freehold property will have been fully depreciated after 25 years.

Investment in the College’s digital transformation agenda, including the build of a new CRM system and enterprise platform, is held under intangible assets in the course of construction (£1.59m).

ANNUAL REPORT AND ACCOUNTS 2023–24

��

The College has adopted the cost model as the method of subsequent measurement for the freehold property at 38– �� investment property and after its initial recognition at cost is to be measured at fair value. The cost of the investment property at £4.2m was determined on an apportionment basis from the total cost of the redeveloped freehold property �� determined at £4.3m on the same basis as previously.

A valuation of the freehold property as at 30 June 2024 was carried out by Gerald Eve, the College’s real estate management agency, with an inspection taking place on 19 June 2024. The property is valued at £82.4m, a decrease �� the property or its immediate locality between the inspection date and the valuation date of 30 June 2024.

��

�� building. No value was attached to the reversionary interest in the lease because management considers a valuation to be problematic given the length of the lease and unlikely to be of material value. The residual freehold land at 38–43 Lincoln’s Inn Fields is stated at the historic cost of £1.95m.

10. Heritage assets

Heritage assets can be acquired by gift, bequest, exchange or purchase on the open market.

The College’s heritage assets comprise the designated collections held by the College library, museum and archives. The museum and library closed in June 2017 ahead of the redevelopment of the estate and the collections are now stored in appropriate secure facilities and with partner organisations across a number of locations for the period of the redevelopment.

Most archive and library material can be accessed via a research service based at the London Metropolitan Archives and research access to the museum collections is available on request. All enquiry and online services continue to be available and are detailed on the College website. Preservation and conservation costs continue to be incurred. No heritage assets were capitalised during the year as none exceeded the capitalisation threshold of £1k.

The Hunterian Museum represents a world-class surgical heritage resource that seeks to tell the story of surgeons and surgery over the past three centuries. The main collection is the Hunterian Collection, which comprises approximately 3,700 anatomical specimens and artefacts. These were collected by John Hunter in the 1700s and presented to the College in 1799.

The College Museum Collection holds approximately 3,500 objects associated with surgical and dental research and training since 1800, including anatomy and pathology specimens which are more than 100 years old. The Historical Surgical Instruments Collection comprises approximately 9,000 surgical instruments.

�� this collection.

The library collections became a designated collection under the Designation Scheme of Arts Council England in 2013. They comprise an estimated 115,000 books and pamphlets dating from the 15[th] century onwards as well as an important collection of rare journals dating from the 17[th] century onwards.

The 20[th] century collections focus on surgery, dentistry, anatomy, physiology and pathology, whereas the subjects in �� [th] century College museum curators responsible for the Hunterian Museum. Further information on all of these collections is available on the College website at rcseng.ac.uk.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

11. Investments

11. Investments
	Portfolio	Property				Total 2024	Total 2023
	£000			£000		£000	£000
Investments
Quoted securities at market value	63,534			-		63,534	57,657
Deposits with Investment Managers	4,829			-		4,829	4,829
Investmentproperties at fair value	-	17,000				17,000	10,420
Fair value at 30 June 2024	68,363	17,000				85,363	72,906

Movements in theyear:
Fair value at 1 July	62,486	10,420				72,906	74,898
Additions	760			25		785	674
Disposals	(2,826)			-		(2,826)	(2,777)
��	-		4,281			4,281	-
Netgain/(loss)duringtheyear	7,943		2,274			10,217	111
Fair value at 30 June 2024	68,363	17,000				85,363	72,906

Cost at 30 June 2024	60,763		4,537			65,300	64,864

Portfolio UK investments	2,145			-		2,145	4,829
Portfolio overseas investments	66,218			-		66,218	57,657
	68,363			-		68,363	62,486
	Cost	Fair Value 2023		Additions 2024		Fair Value 2024	SOFA Gain/(Loss)
Investment Properties	£000	£000			£000	£000	£000
49-50a Lincoln's Inn Fields	336	2,630			25	2,450	(205)
38-43 Lincoln's Inn Fields (Leased Floor 2)	4,201	7,790			0	7,250	(540)
38-43 Lincoln's Inn Fields (Leased Floor 3)	0	0			4,281	7,300	3,019
Investment Property	4,537	10,420			4,306	17,000	2,274

�� available for operational use, is held as an investment property. The investment property had a cost of £4.2m �� investment property as part of the valuation of the whole building carried out by Gerald Eve in June 2024 resulting in a revised cumulative net unrealised gain of £3.6m and a decrease of £540k on 2023 (2023: £3.6m).

�� an original cost of £4.3m on transfer. A valuation of £7.3m exclusive of VAT has been attributed to the investment property as part of the valuation of the whole building carried out by Gerald Eve in June 2024 resulting in a net unrealised gain of £3.0m.

�� investment property.

A valuation of the College’s investment property at 49–50a Lincoln’s Inn Fields at 30 June 2024 was also carried out by Gerald Eve in June 2024. This resulted in a reduction of the carrying value of these assets decreasing by �� main tenant break date in February 2025.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

�� locality between the inspection date and the valuation date of 30 June 2024. The valuations are undertaken by an �� out these valuations have the appropriate knowledge, skills and experience to undertake the valuation competently.

12. Debtors

	2024	2024	2023	2023
	Group	RCS	Group	RCS
	£000	£000	£000	£000
Trade debtors	4,456	3,726	2,772	2,772
Membershipdebtor	1,577	1,577	1,638	1,638
Accrued income	2,917	2,079	3,365	3,365
Prepayments	662	662	677	677
Other debtors includingtaxation	580	580	409	409
Amounts due fromgroupundertakings	-	1,750	-	619
Total	10,192	10,374	8,861	9,480

13. Creditors

	2024	2024	2023	2023
	Group	RCS	Group	RCS
	£000	£000	£000	£000
13a. Amounts falling due within oneyear
Accruals	3,788	3,788	4,252	4,252
Membershipincome in advance	3,621	3,621	3,456	3,456
Deferred income	4,562	4,562	4,729	4,729
Researchgrantspayable	2,226	2,226	1,830	1,830
Trade creditors	1,425	1,425	1,014	1,014
Other creditors	469	469	291	291
Taxation and social security	308	308	282	282
Amounts owed togroupundertakings	-	-	-	619
Total	16,399	16,399	15,854	16,473

13b. Amounts falling due after more than oneyear
Other creditors and accruals	43	43	-	-
Long-term loan	40,000	40,000	40,000	40,000
��	-	-	3,101	3,101
Total	40,043	40,043	43,101	43,101

13c. Analysis of deferred income
Brought forward at 1 July	4,729	4,729	3,971	3,971
Deferred duringtheyear	4,562	4,562	4,729	4,729
Released as income duringtheyear	(4,729)	(4,729)	(3,971)	(3,971)
Carried forward at 30 June 2024	4,562	4,562	4,729	4,729

Deferred Income comprises examination fees, course fees and accreditation fees.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

Long-term loan

�� Insurance Corporation Group Ltd, a UK-based insurance company. The issue provided £40m of unsecured funding at an annual coupon rate of 2.22% with a maturity date of 30 years (due 3 November 2050) and weighted average life of 20.05 years. This funding was settled on 3 November 2020. The funds have been used to fund the redevelopment ��

Interest is payable semi-annually on 3 May and 3 November each year and commenced on 3 May 2021. The principal sum will be repayable semi-annually on the 3 May and 3 November each year commencing 3 May 2026 until 3 May �� tested on an annual basis. The covenant requires that the ratio of net debt of the Group to the net assets of the Group at 30 June shall not exceed 50%.

14. Financial instruments

	2024	2023
	£000	£000
Financial assets measured at amortised cost	17,402	16,396
Financial assets measured at fair value	68,363	62,486
Financial liabilities measured at amortised cost	(47,248)	(46,863)

15. Hunter Trading Limited

2024 £000 2023 £000 �� Income 938 656 Expenditure 115 37 �� 823 619 �� (823) (619) Result for theyear - -	2024 £000 2023 £000 Balance sheet Bank 158 - Stock 24 - Debtors 1,568 619 Total current assets 1,750 619 Creditors: due within oneyear (1,750) (619) Net Assets - -

The College holds the entire issued £1 share capital of Hunter Trading Limited.

Conference events are outsourced to Searcys, a long-established, independent and highly respected catering ��

ANNUAL REPORT AND ACCOUNTS 2023–24

��

16. Unrestricted funds

		Net Surplus/	Investment	SOFA	Fixed Asset
	2023	��	Gains/Losses	Allocation	Allocation	2024
	£000	£000	£000	£000	£000	£000
Fixed assets reserve net of LT loan	68,161	-	-	(3,035)	1,485	66,611
Other designated funds	642	-	-	-	(488)	154
Propertyrevaluation reserve	2,959	-	2,274	-	-	5,233
Pension reserve	(3,101)	-	-	3,101	-	-
General funds	21,849	1,095	2,854	(66)	(997)	24,735
Total	90,510	1,095	5,128	-	-	96,733

Unrestricted reserves have increased overall by 7% or just over £6m in the year. This is represented by a net income position of £1.1m for the year and a net unrealised gains of £5.1m on unrestricted investments.

The investment loss comprises a net unrealised gain of £2.85m in respect of the unrestricted investments portfolio and a net unrealised gain of £2.27m in respect of investment properties. The investment property loss comprises a �� in respect of 49–50a Lincoln’s Inn Fields. A property revaluation reserve is set up to hold investment gains or losses arising in respect of the investment properties.

��

General funds are broadly represented by our unrestricted investment portfolio, which is providing 93% cover (2023: 96%) at a value of £23.0m as at 30 June 2024 (2023: £21.9m).

The trustees designated £1.5m in 2021 (Other designated funds) to support the next major phase of the digital �� assets reserve leaving a closing fund balance of £154k.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

17. Restricted funds

----- Start of picture text -----
2023 Income Expenditure Gains/(Losses) 2024
£000 £000 £000 £000 £000
Trust Funds 1,978 468 (374) 252 2,324
Other restricted funds 3,891 5,095 (4,914) - 4,072
Total Restricted Funds 5,869 5,563 (5,288) 252 6,396
RCS has 22 trust funds and their position is set out below:
Research Trust Funds:
Sir Alan Parks Research Fund 186 2 (2) 23 209
Saven Research & Development Programme 377 5 (96) 52 338
Surgical Research Fund 185 12 (77) 26 146
Mr Sorab J Lam Legacy 137 2 (59) 17 97
Ethicon Travelling Fellowship 189 2 (7) 23 207
Modi Fund 140 2 (2) 17 157
Blond McIndoe (Joint Fund with Education) 97 1 (40) 12 70
The Arthritis Research Trust 82 426 (10) 10 508
Roberta Swan Legacy 8 1 (8) 9 10
Preiskel Fund 73 3 (4) 7 79
RCSE Fellows Fellowship Fund 78 6 - 1 85
Miss Carol Rummey Legacy 54 1 (1) 7 61
Gunnar Nilsson Cancer Treatment Trust Fund 16 1 (1) 8 24
Curry Legacy Damage/Pain 17 - - 2 19
H Speight Discretionary Trust 17 - - 2 19
Phyllis A George Legacy 8 - - - 8
Cutner Legacy 7 - - - 7
Rex & Jean Lawrie O/S Fund 5 - - - 5
Ethicon Research Fund 1 - - - 1
Shrimpton Fund 1 - - - 1
��
E&T Haddock Legacy 99 1 (65) 12 47
Faculty of Dental Surgery Funds:
J W Mclean Fund 201 3 (2) 24 226
Total Trust Funds 1,978 468 (374) 252 2,324
Grants and donations are summarised as follows:
Other restricted funds:
National Cancer Audit Collaborating Centre 1,159 2,917 (2,197) - 1,879
Transform Fundraising 403 - - - 403
National Lung Cancer Audit 350 74 (131) - 293
eDEN (elearning for dentistry) 271 12 (1) - 282
Expert Advisory Network 148 28 (21) - 155
FDS-NAC 136 16 (17) - 135
Other Balances less than £100,000 1,424 2,048 (2,547) - 925
Total Other Funds 3,891 5,095 (4,914) - 4,072
Total Restricted Funds 5,869 5,563 (5,288) 252 6,396
----- End of picture text -----

ANNUAL REPORT AND ACCOUNTS 2023–24

��

18. Endowed funds

	Unapplied Total Return	Permanent Capital	Total Endowment
	£000	£000	£000
Endowed Funds at 1 July 2023	23,704	14,951	38,655

Investment income	510	-	510
Investmentgains	4,837	-	4,837
Total income andgains	5,347	-	5,347

Application of total return	(1,672)	-	(1,672)
Investment management fees	(295)	-	(295)
Total application and fees	(1,967)	-	(1,967)

Net movement inyear	3,380	-	3,380

Total Endowed Funds at 30 June 2024	27,084	14,951	42,035

ANNUAL REPORT AND ACCOUNTS 2023–24

��

RCS England has 22 endowed funds and the 2022–23 position is set out below by fund.

	Unapplied			Applied		Unapplied
	Total			Total		Total
	Return	Investment	Investment	Return	Investment	Return	Permanent
	2023	Income	Gains	2024	Fees	2024	Capital	2024 Total
Fund Name	£000	£000	£000	£000	£000	£000	£000	£000
RCSE Research Fund	5,110	118	1,116	(414)	(68)	5,862	3,784	9,646
RCSE Education Fund	4,289	88	837	(383)	(51)	4,780	2,262	7,042
RCSE Cancer Research Fund	3,239	66	631	(231)	(39)	3,666	1,756	5,422
Presidents Finch Fund	1,369	45	427	(24)	(26)	1,791	2,108	3,899
Dental Science Research Fund	1,533	34	322	(215)	(20)	1,654	1,016	2,670
Rank Chair Physics in Surgery	1,415	31	299	(129)	(18)	1,598	955	2,553
RCSE LibraryFund	1,306	28	262	(97)	(16)	1,483	833	2,316
RCSE Biochemical Research Fund	763	15	144	(34)	(9)	879	374	1,253
Witt Fund	646	11	101	(7)	(6)	745	182	927
Macrae-Webb Johnson Fund	425	11	104	(50)	(6)	484	425	909
Moser Trust(FDS)	559	9	90	(3)	(5)	650	173	823
HS Morton
Travelling	440	8	78	(27)	(5)	494	200	694
Fellowship
Groves Bequest for Museum	419	7	71	(22)	(5)	470	161	631
George Qvist for Hunterian	349	7	68	(22)	(4)	398	209	607
John Kinross Fund	433	7	66	(2)	(4)	500	104	604
RCSE Prize Fund	379	6	54	(2)	(3)	434	61	495
Sims
Commonwealth	258	5	44	(1)	(3)	303	106	409
TravellingFell.
Commemoration Fund(FDS)	212	4	34	(1)	(2)	247	66	313
RCSE Scholarship Fund	182	3	28	(1)	(2)	210	51	261
Rishworth Fund for Annals	145	3	24	(1)	(1)	170	50	220
Darlow Fellowship Fund	123	2	23	(2)	(1)	145	67	212
RCSE Museum Fund	110	2	14	(4)	(1)	121	8	129
Total Endowed Funds	23,704	510	4,837	(1,672)	(295)	27,084	14,951	42,035

8 of the 22 funds have closing balances greater than £1m, amounting to £34.8m of the £42.0m of funds at 30 June 2024. A brief description of their purposes is provided below.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

Fund name		Purpose of fund
RCSE Research Fund		To promote, carry on and fund study and research into surgery and related subjects and to publish useful results of such study and research
		To educate surgeons, medical practitioners and the general public in the art, science
RCSE Education Fund		and practice of surgery and related subjects and to further instruction and training in
		surgery
RCSE Cancer Research Fund		To promote, carry on and fund study and research into cancer and its preventative treatment and care and to publish useful results of such study and research
Presidents Finch Fund		Income to be applied for charitable purposes which will be of service for the welfare and advancement of the Science and Art of Surgery
Dental Science Research Fund		For the promotion of research into improving dental treatment and dental health
Rank Chair Physics in Surgery		To support research work
RCSE Library Fund		To promote, carry on, maintain and fund the establishment of libraries of the RCS for the furtherance of study and research into surgery and related objects
RCSE Biochemical Research Fund		To further biochemical research by such means as the Trustees shall from time to time ��

The remaining 14 funds with balances of less than £1m, and amounting to £7.2m, are summarised under the following categories:

	Faculty of Dental		Travelling Fellowship
Research Funds	Surgery Funds	Museum Funds	(F/S) Funds	Other Funds
Darlow Fellowship Fund	Commemoration Fund	Macrae-Webb Johnson Fund	HS Morton Travelling F/S	Rishworth Fund for Annals
RCSE Prize Fund	Moser Trust	Groves Bequest for Museum	Sims Commonwealth Travel F/S	John Kinross Fund
RCSE ScholarshipFund		George Qvist for Hunterian
Witt Fund		RCSE Museum Fund

19. Analysis of net assets between funds

	Unrestricted Funds	Restricted Funds	Endowed Funds	Total 2024
As at 30 June 2024	£000	£000	£000	£000
��	96,123	-	-	96,123
��	2,000	6	-	2,006
Investments	39,996	2,328	43,039	85,363
Current assets	12,466	5,630	18	18,114
Current liabilities	(13,809)	(1,568)	(1,022)	(16,399)
Liabilities after 1year	(40,043)	-	-	(40,043)
Total Funds	96,733	6,396	42,035	145,164
As at 30 June 2023	Unrestricted Funds £000	Restricted Funds £000	Endowed Funds £000	Total 2023 £000
��	102,676	-	-	102,676
��	1,280	4	-	1,284
Investments	31,364	2,061	39,481	72,906
Current assets	11,980	5,064	79	17,123
Current liabilities	(13,689)	(1,260)	(905)	(15,854)
Liabilities after 1year	(43,101)	-	-	(43,101)
Total Funds	90,510	5,869	38,655	135,034

ANNUAL REPORT AND ACCOUNTS 2023–24

��

20. Pension liabilities and charges

	2024	2023
	£000	£000
��	-	3,101

Liability greater than 1year	-	3,101
Summary ofpension scheme charges to Statement of Financial activities:
USS	(2,316)	744
SAUL	797	659
Standard Life	108	90
NHS	40	42
Total	(1,371)	1,535
Charges in respect of the USS scheme to Statement of Financial activities:
Employer contributions	785	849
��	-	(244)
Change in contributions frompast expectations	(2,956)	20
Totalpension contribution cost	(2,171)	625
Interestpayable	(145)	119
Totalpension charge	(2,316)	744
Scheme employee members	Nos.	Nos.
USS	80	78
SAUL	116	103
Standard Life	40	32
NHS	10	4
Total employees in apension scheme	246	217

�� carry out a formal actuarial valuation every three years as required by the Pensions Act 2004. The latest available ��

According to the latest valuations, both the USS and SAUL schemes are in technical surplus and there is no liability for the College to recognise.

��

Under the 2023 valuation, the scheme contribution rates were set at 31.4% of salaries (employer 21.6%, employee 9.8%) to 31 December 2023 and 20.6% of salaries (employer 14.5%, employee 6.1%) from 1 January 2024 with no ��

�� 2023 with its assets valued at £3,092m. As SAUL was in surplus on its Technical Provisions basis at that date, no ��

The 31 March 2024 update showed a further increase in the funding level to 109%. As a result, the trustees decided to reduce the contribution rate to 19% from 1 September 2024 (previously 21%).

ANNUAL REPORT AND ACCOUNTS 2023–24

��

Supplementary scheme disclosures

Since the College cannot identify its share of the assets and liabilities of the USS and SAUL schemes, the following �� whole.

USS

�� appropriate assets to cover their technical provisions.

	2024	2023
Scheme summary position at 31 March	2023 Valuation	2020 Valuation
	£bn	£bn
Scheme assets	73.1	66.5
Scheme liabilities	65.7	80.6
��	7.4	(14.1)
FRS 102 Fundinglevel	111%	83%

SAUL

�� colleges and institutions with links to higher education.

The SAUL Final Salary Section closed at 31 March 2016 and from 1 April 2016 all members now build up pension

��

The College is not expected to be liable to SAUL for any other current participating employer’s obligations under the rules of SAUL, but in the event of an insolvency event of any participating employer within SAUL, an amount of any pension shortfall (which cannot otherwise be recovered) in respect of that employer, may be spread across the ��

�� to be paid and for the commitments which arise from Members’ accrued pension rights to be met. The Technical Provisions include appropriate margins to allow for the possibility of events turning out worse than expected. However, the funding method and assumptions do not completely remove the risk that the Technical Provisions could be ��

��
	2024	2023
Scheme summary position at 31 March	2024 Update	2023 Valuation
	£m	£m
Scheme assets	3,058	3,092
Scheme liabilities	2,815	2,958
��	243	134
FRS 102 Fundinglevel	109%	105%

Other pension schemes

�� of 16.64% (16.18% to March 2024) into the NHS Pension Scheme. No contributions in respect of these schemes were outstanding at the balance sheet date.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

21. Transactions with trustees

No trustees receive any fees or honoraria for their services. Trustees may incur expenses in the carrying out of their duties; for example, travel, subsistence and accommodation costs. These expenses may be reimbursed to the trustees or paid directly by the College to third parties on their behalf. Expenses totalling £48k were incurred in respect of 11 trustees during the 2023–24 year (2023: £43k in respect of eight trustees).

�� duties:

provision of rental accommodation amounting to £61k (2023: £79k);
provision of broadband amounting to £6k (2023: £6k);
��

��

There were no donations received from trustees during the current period (2023: £1k).

There were no related party transactions in the period.

22. Capital commitments

�� and design contracts delivering the IT transformation programme (2023: £0.9m).

23. Operating leases

23. Operating leases
	2024	2023
	��	��
	£000	£000
Payments due:
Within oneyear	13	13
Between one and twoyears	9	13
��	-	9
Total	22	35

These represent the future minimum payments that the College is committed to make under operating leases.

ANNUAL REPORT AND ACCOUNTS 2023–24

��

24. Restricted funds 2023 for comparison

----- Start of picture text -----
2022 Income Expenditure Gains/(Losses) Transfers 2023
£000 £000 £000 £000 £000 £000
Trust Funds 2,207 319 (591) 43 - 1,978
Other restricted funds 2,541 4,911 (3,561) - - 3,891
Total Restricted Funds 4,748 5,230 (4,152) 43 - 5,869
RCS has 26 trust funds and their position is set out below:
Research Trust Funds:
Sir Alan Parks Research Fund 182 2 (1) 3 - 186
Saven Research & Development Programme 241 253 (122) 5 - 377
Surgical Research Fund 237 12 (68) 4 - 185
Mr Sorab J Lam Legacy 215 3 (85) 4 - 137
Ethicon Travelling Fellowship 191 3 (9) 4 - 189
Moondance Foundation 151 2 (156) 3 - -
Modi Fund 137 1 (1) 3 - 140
Blond McIndoe (Joint Fund with Education) 95 1 (1) 2 - 97
The Arthritis Research Trust 78 1 - 3 - 82
Roberta Swan Legacy 75 1 (69) 1 - 8
Preiskel Fund 72 3 (4) 2 - 73
RCSE Fellows Fellowship Fund 53 25 - - - 78
Miss Carol Rummey Legacy 53 1 (1) 1 - 54
Gunnar Nilsson Cancer Treatment Trust Fund 53 8 (47) 2 - 16
Dunhill Medical Trust 24 - (24) - - -
Curry Legacy Damage/Pain 17 - - - - 17
H Speight Discretionary Trust 17 - - - - 17
Phyllis A George Legacy 8 - - - - 8
Cutner Legacy 7 - - - - 7
Rex & Jean Lawrie O/S Fund 5 - - - - 5
Ethicon Research Fund 1 - - - - 1
Shrimpton Fund 1 - - - - 1
��
E&T Haddock Legacy 97 1 (1) 2 - 99
Faculty of Dental Surgery Funds:
J W Mclean Fund 197 2 (2) 4 - 201
Total Trust Funds 2,207 319 (591) 43 - 1,978
Other restricted funds:
National Cancer Audit Collaborating Centre - 1,399 (240) - - 1,159
Transform Fundraising 554 55 (206) - - 403
National Lung Cancer Audit 118 294 (62) - - 350
eDEN (elearning for dentistry) 249 20 2 - - 271
National Vascular Registry 229 316 (289) - - 256
Robotics 250 - - - - 250
Expert Advisory Network 102 55 (9) - - 148
National Prostate Cancer Audit 96 298 (251) - - 143
FDS-NAC 148 10 (22) - - 136
Breast Cancer Project 150 74 (89) - - 135
NIHR Clinical Research - 120 (3) - - 117
Other Balances less than £100,000 645 2,270 (2,392) - - 523
Total Other Funds 2,541 4,911 (3,561) - - 3,891
Total Restricted Funds 4,748 5,230 (4,152) 43 - 5,869
----- End of picture text -----

ANNUAL REPORT AND ACCOUNTS 2023–24

��

25. Endowed funds 2023 for comparison

	Unapplied Total Return	Permanent Capital	Total Endowment
	£000	£000	£000
Endowed Funds at 1 July 2022	24,223	14,951	39,174

Investment income	457	-	457
Legacyincome	-		-
Investmentgains/(losses)	746	-	746
Total income andgains	1,203	-	1,203

Application of total return	(1,488)	-	(1,488)
Investment management fees	(234)	-	(234)
Total application and fees	(1,722)	-	(1,722)

Net movement inyear	(519)	-	(519)

Total Endowed Funds at 30 June 2023	23,704	14,951	38,655

ANNUAL REPORT AND ACCOUNTS 2023–24

��

RCS England has 22 endowed funds and the 2022–23 position is set out below by fund.

	Unapplied				Applied			Unapplied
	Total			Investment	Total		Transfer	Total
	Return	Legacy	Investment	Gains/	Return	Investment	of	Return	Permanent	2023
	2022	income	Income	(Losses)	2023	Fees	Funds	2023	Capital	Total
Fund Name	£000	£000	£000	£000	£000	£000	£000	£000	£000	£000
RCSE Research Fund	5,244	-	106	172	(358)	(54)	-	5,110	3,784	8,894
RCSE Education Fund	4,505	-	79	130	(384)	(41)	-	4,289	2,262	6,551
RCSE Cancer Research Fund	3,327	-	59	96	(213)	(30)	-	3,239	1,756	4,995
Presidents Finch Fund	1,357	-	40	65	(73)	(20)	-	1,369	2,108	3,477
Dental Science Research Fund	1,571	-	31	50	(103)	(16)	-	1,533	1,016	2,549
Rank Chair
Physics in	1,462	-	29	47	(108)	(15)	-	1,415	955	2,370
Surgery
RCSE Library Fund	1,350	-	25	41	(97)	(13)	-	1,306	833	2,139
RCSE
Biochemical	775	-	14	22	(41)	(7)	-	763	374	1,137
Research Fund
Macrae-Webb Johnson Fund	443	-	10	17	(40)	(5)	-	425	425	850
Witt Fund	630	-	9	15	(3)	(5)	-	646	182	828
Moser Trust (FDS)	544	-	8	13	(2)	(4)	-	559	173	732
HS Morton
Travelling	432	-	7	12	(7)	(4)	-	440	200	640
Fellowship
Groves Bequest for Museum	426	-	7	11	(22)	(3)	-	419	161	580
George Qvist for Hunterian	356	-	7	11	(22)	(3)	-	349	209	558
John Kinross Fund	422	-	6	10	(2)	(3)	-	433	104	537
RCSE Prize Fund	371	-	5	8	(2)	(3)	-	379	61	440
Sims
Commonwealth Travel	250	-	4	7	(1)	(2)	-	258	106	364
Fellowship
Commemoration Fund(FDS)	207	-	3	5	(1)	(2)	-	212	66	278
RCSE
Scholarship	177	-	3	4	(1)	(1)	-	182	51	233
Fund
Rishworth Fund for Annals	141	-	2	4	(1)	(1)	-	145	50	195
Darlow FellowshipFund	121	-	2	4	(3)	(1)	-	123	67	190
RCSE Museum Fund	112	-	1	2	(4)	(1)	-	110	8	118
Total Endowed Funds	24,223	-	457	746	(1,488)	(234)	-	23,704	14,951	38,655

ANNUAL REPORT AND ACCOUNTS 2023–24

��

�� comparison

		Unrestricted	Restricted	Endowed
		Funds	Funds	Funds	Totals	2022
	Notes	£000	£000	£000	£000	£000
Income from
Grants, donations and legacies	5a	976	4,964	-	5,940	5,314
Charitable activities	5b	24,739	185	-	24,924	21,715
Tradingactivities	5c	1,046	55	-	1,101	363
Investment Income	5d	1,097	26	457	1,580	692
Other income	5e	-	-	-	-	-
Total Income		27,858	5,230	457	33,545	28,084

Expenditure On
Raisingfunds	6a	583	219	234	1,036	1,021
Charitable activities	6b	24,669	5,421	-	30,090	26,867
Other expenditure	6c	4,983	-	-	4,983	6,558
Total Expenditure		30,235	5,640	234	36,109	34,446

Net income/(expenditure) before investment gains/(losses)		(2,377)	(410)	223	(2,564)	(6,362)

Netgains/(losses)on investments	11	(678)	43	746	111	(1,242)

Net income/(expenditure)		(3,055)	(367)	969	(2,453)	(7,604)

Application of total return	18	-	1,488	(1,488)	-	-

Net movement in funds for theyear		(3,055)	1,121	(519)	(2,453)	(7,604)

Balances brought forward at 1 July	19	93,565	4,748	39,174	137,487	145,091

Balances carried forward at 30 June 2023	19	90,510	5,869	38,655	135,034	137,487

ANNUAL REPORT AND ACCOUNTS 2023–24

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Reference and administrative details

Principal advisors

Bankers

�� 37 Fleet Street, London EC4P 4DQ Barclays Bank PLC 1 Churchill Place, London E14 5HP External auditor Crowe U.K. LLP 55 Ludgate Hill, London EC4M 7JW Internal auditor Mazars LLP Tower Bridge House, St Katharine’s Way, London E1W 1DD Solicitors BDB Pitmans LLP One Bartholomew Close, London EC1A 7BL �� 66 Lincoln’s Inn Fields, London, WC2A 3LH Veale Wasbrough Vizards LLP Narrow Quay House, Narrow Quay, Bristol BS1 4QA Investment managers J.P. Morgan Private Bank 60 Victoria Embankment, London EC4Y 0JP Property development advisors Lendlease Consulting Ltd Level 9, 5 Merchant Square, London W2 1BQ Real estate advisors Gerald Eve LLP 72 Welbeck Street, London, W1G 0AY

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ANNUAL REPORT AND ACCOUNTS 2023–24

Produced by the Royal College of Surgeons of England Published 25 November 2024

2024-06-30-accounts

The Royal College of Surgeons of England Annual Report and Accounts 2023–2024

Contents

President’s foreword Chief Executive’s statement

President’s foreword

Our

Chief Executive’s statement

Trustees’ Report

Our objects and aims

Our mission

OUR CORE VALUES

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What we have achieved this year

Leading our profession

Improving practice

Setting standards and providing advice

on good surgical practice

Reviewing surgical practice to support patient safety

Driving quality improvement

Accrediting and assuring excellence

Facilitating research

Our activity in 2023-24

Surgical trials

Clinical ������������

Leading the future of surgery

Learning

Global engagement

Global governance and representation

International Surgical Training Programme

Stefan Galeski Global Surgery Fellowship

Global Surgical Frontiers conference

Humanitarian Surgery Initiative

UK–Yemen Surgical & Trauma Care Mentoring Scheme

context of international health partnerships.

The Global Surgery Policy Unit

Assessment

Workforce and training

Supporting dental surgery

Improving children's oral health

Addressing workforce issues

Educational excellence

Supporting and engaging with our members

Embracing diversity

Transforming our College

Promoting public and professional engagement

Library and archives

TESTIMONIALS

Patient history from the London Lock Asylum, 1795, MS0022/6/10

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Museum collections and services

Fundraising

Our new home of surgery

Financial review

Income

Change in underlying income

Expenditure

Net assets

Hunter Trading Limited

Financial outlook

Reserves policy

Fixed assets fund

Designated funds

General funds

Fundraising

Investment policy

Investment portfolio performance

Total return accounting

Key management personnel

Risk management

A clear and focused strategy

Going concern

Corporate trustee responsibilities

Colledge Family Memorial Fellowship Trust

Other trustee responsibilities

The Sir Ratanji Dalal Research Scholarship Fund

Funding partnerships

Foundations, charitable trusts, associations and individuals

Endowed and Restricted Funds

Legacies

Structure, governance and management

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Clinical ��

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